Tag Archives: fibre

ketogenic fibre

  • High fibre foods are often high in carbohydrates which can be problematic for people with diabetes or those trying to achieve ketosis.
  • People aiming for a low carbohydrate diet often avoid all carbohydrates, including fibre, however this may not be optimal for gut health or overall nutrition in the long term.
  • This article highlights nutrient dense, low carbohydrate sources of fibre that will have a minimal effect on blood glucose levels while helping to support gut health.

Dr Michael Ruscio

The human gut and the bacteria that inhabit it are still largely a mystery.  However the latest research indicates that it is important.

I recently heard an intriguing information-packed interview with Michael Ruscio on Episode 985 of Jimmy Moore’s Livin’ La Vida Low Carb Show where he said that:

  • Some people don’t do well with a very low carb approach in the long term;
  • Some studies indicate that a very high fat diet can lead to increased intestinal permeability (aka leaky gut) which can lead to insulin resistance;
  • In spite of the possible risk to optimal gut health, Dr Ruscio advises his patients to use a LCHF approach to manage blood glucose and weight, particularly for those who are insulin resistant;
  • His preferred approach is to start patients on a low carbohydrate autoimmune protocol and slowly increase carbohydrates to find their tolerance level for carbohydrates where they stop benefiting in terms of body weight or body fat; and
  • People on a low carb diet may benefit from a diet high in fibre / prebiotics / FODMAPs to promote microbial diversity and improve insulin sensitivity.

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While some people believe that it is beneficial to try to manipulate the firmicutes : bacteroides ratio[1]  [2] or some other feature of gut microbiome,[3] Dr Ruscio says that this is far from settled science.  What we do know is that a more diverse population of gut bacteria will reduce the probability that one strain of bacteria will take over our gut and become dominant (i.e. overgrowth).

Early exposure to a range of bacteria in a less sanitised environment helps to improve the ‘tone’ of our gut bacteria and reduces our chance of developing autoimmune issues.

While Dr Ruscio is cautious to highlight that we can’t just run a test and treat based on the results, he does a great job of teasing out what we can really know from the latest research on gut health in his AHS2014 talk.

total or net carbohydrates?

Prebiotics are, quite simply, indigestible food ingredients that stimulate the growth and maintenance of beneficial gut microbiota.[4]

While prebiotic fibre[5] appears to be beneficial for the gut microbiome, some people in the low carbohydrate scene will avoid fibre containing foods to eliminate the risk of these foods impacting on their blood glucose levels.[6] [7] [8]

In practice, however, this approach leaves people with a fibre intake well below the recommended minimum of 25g for women and 30g per day for men.[9]

In his article Sorry Low Carbers Your Microbiome is Just Not that Into You[10] Jeff Leach of the Human Food Project notes that (although he eats a high fat high fibre diet) people consuming a low carbohydrate diet aren’t necessarily slimmer.  He suggests that this may be due to the lack of fermentable fibre.

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The confusion around whether to count ‘total carbs’ or ‘net carbs’ is exacerbated by the fact that many people find that, despite claims of low net carbohydrates and high fibre, some manufactured ‘low carb’ products will often raise blood glucose levels.

At the same time, the food insulin index data suggests that there is no insulin response to fibre in foods.  As detailed in this article, the correlation between insulin response and net carbs is much better than with total carbohydrates.   This makes sense when we consider that fibre is not digested and absorbed by our intestinal tract but is instead metabolized by our gut bacteria.

The formula below for the calculation of insulin load is based on the observation that there is no insulin response to fibre and thus fibre should be negated from the calculation.  To minimise the insulin load of our diet we need to prioritise foods that are high in fibre, low in digestible carbohydrates, and moderate in protein.

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For most people this is largely a theoretical issue, but for people with type 1 diabetes who need to accurately calculate their insulin dose it becomes more important.  The most prudent approach used by experienced type 1’s is to take a ‘net carbs’ approach to real whole foods, while assuming half or maybe all of the fibre in manufactured food products will be digestible (or ideally avoiding manufactured foods completely).

If you are particularly concerned about your blood glucose levels the ideal approach is to do your own n=1 experiment to test and track your own blood glucose levels to see if they rise after a particular food.

David Perlmutter

Dr David Perlmutter is a fascinating character on the cutting edge of the latest in health and wellness.

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Perlmutter talks a lot about the benefits of prebiotics and probiotics for gut and brain health.  Prebiotics are fibres that are not digestible by our stomach but rather feed the bacteria in our gut.  Probiotics involve actually ingesting bacteria such as those found in yogurt, sauerkraut, Kombucha, Kefir, or other fermented foods.

Perlmutter notes that Americans typically get about five grams of fibre per day compared to the estimated one hundred and thirty grams of fibre that our Palaeolithic ancestors appear to have consumed.[11]

Dr Perlmutter spoke recently on Mark Sisson’s Primal Blueprint podcast[12] about how he believed that type 2 diabetes relates to changes in the gut bacteria and noted that this condition has been reversed through faecal transplants, which transfers healthy gut bacteria from one person into another.

Perlmutter promotes foods high in inulin[13] to feed the gut bacteria.  Unfortunately, the issue for people with carbohydrate intolerance is that many of these foods are high in digestible carbohydrates that may also drive their blood glucose levels up.

I thought it would be useful to combine Perlmutter’s list of high inulin foods[14] with an evaluation of their proportion of insulinogenic calories and nutrient density.

As shown in the table below, the highest weighting used in the multi-criteria ranking is given to the insulinogenic properties of the foods (i.e. in order to prioritise foods that will not raise blood glucose levels), with some weighting given to fibre per calorie and fibre per weight, then to nutrient density per calorie and nutrient density per weight, and then calories per weight.

I find that it is important to consider the nutrient and fibre density in terms of both weight and calories.  Considering calories alone will bias towards leafy veggies and herbs while considering weight will bias towards nuts and seeds.  The best approach seems to be to consider both to get a balance.

ND / cal ND / weight fibre / cal fibre / weight calories / 100g insulinogenic (%) total
7.5% 7.5% 15% 15% 10% 45% 100%

Shown below are Perlmutter’s recommended probiotic foods from his Brain Maker book[15] sorted based on their insulinogenic properties, fibre content per calorie and nutrient density.    The foods with the lowest percentage of insulinogenic calories will have the lowest effect on blood glucose levels.   You can see more detail of the analysis here.

name % insulinogenic fibre (g) / kcal fibre (g) / 100g
asparagus 47% 0.08 2.1
dandelion greens 47% 0.07 2.9
onion 56% 0.06 2.4
leek 81% 0.03 1.8
garlic 85% 0.01 2.1
Jerusalem-artichoke 87% 0.02 1.6
chicory root 87% 0.02 1.5

It’s worth noting that Perlmutter generally recommends eating these foods raw.  As detailed in this article, cooking will change the fibre content of the foods, but perhaps not as much as you might think.

FODMAP foods

Limiting FODMAP foods (i.e. Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) is a way of improving digestion in those with irritable bowel syndrome (IBS).[16]   However, eliminating FODMAP foods may not be ideal in the long term.  Once you have digestive issues under control it may be beneficial to slowly reintroduce FODMAP foods to promote a more diverse bacteria as well as increasing your nutrients.

After a period of avoiding FODMAP foods, the overgrowth of undesirable gut bacteria should diminish and you may be able to tolerate small amounts introduced slowly.[17]

In order to understand which FODMAP foods contain the most fibre and would be gentlest on blood glucose levels, I have run the FODMAP foods through the multi-criteria analysis with the weightings shown above.   A shortlist of the highest ranking FODMAP foods is shown below.  You can download the full detailed list here.

name % insulinogenic fibre(g) / kcal fibre (g) / 100g
celery seed 34% 0.03 12
peanuts 14% 0.02 10
peanut butter 17% 0.01 6
pistachio nuts 19% 0.02 10
cashew nuts 23% 0.01 3
beans 57% 0.07 25
broad beans 55% 0.07 25
lentils 50% 0.09 31

our experience

Personally, I can eat pretty much anything and not have it bother me.  However, I know that eating nutrient dense foods with a lower insulin load has helped me to feel brighter, less inflamed, and less fat.

On the other end of the spectrum, my wife Monica has type 1 diabetes and a host of digestive issues that seem to be part of the autoimmunity package deal.  For her, feeling good, getting enough rest, having good gut health, and staying on top of her health is a constant battle.

I’ve been banging on about low carb diets for a while, but Monica’s ability to increase the amount of fat in her diet has been limited.  Whenever she’d have a high fat meal she would end up with stomach distress with the same situation occurring with anything that was meant to be ‘helpful’ for the gut like resistant starch, MCT oil or glucomannan.

Late last year we found an excellent naturopath, Elizma Lambert from Realize Health, who was able to identify from her symptoms and testing that she had small intestinal bacterial overgrowth (SIBO) which was stopping her from being able to digest the fats that were critical to succeeding on a low carbohydrate diet.

Elizma was able to guide Moni through a process of cleansing the small intestine and then repopulating it with a diverse range of good bacteria.  After testing her faecal microbiota through the Bioscreen lab in Melbourne[18] Elizma was able to identify areas where there was an overgrowth that needed to be treated followed by re-population with a diverse range of new good bacteria.

Individuals suffering from diabetes often struggle to metabolise fats and she also helped her, through supplementation of L-carnitine, to get her fat metabolism moving which has also enabled her to better clear the LDL cholesterol in her blood.[19]  Once the digestion and blood glucose levels improved, her depression also lifted and she was able to decrease medications.

More recently however Moni had to have antibiotics for an infection.  Unfortunately, the antibiotics also blew away the newly established good gut bacteria for a while, and a lot of the gut distress and depression issues regressed and she has had to work again to rebuild the good gut bacteria.

We’re blessed to have Elizma just around the corner from us in Brisbane Australia, however if you’re dealing with autoimmune or digestive issues then I encourage you to find someone who can guide you through the process, or even contact Elizma directly as she is now able to do consults via Skype.  Similarly, Chris Kelly of Nourish Balance Thrive in California, United States, will be able to guide you through the minefield back to metabolic health.

Jimmy Moore’s n=1

I’ve got a lot of time for prolific podcaster Jimmy Moore.  I have learned a great deal from his eager pursuit of information from all the experts that he interviews on his show.  After a life of morbid obesity, his brother dying at 41, and both grandfathers dying in their early 50s, Jimmy is on a quest to improve his own health and share his journey and learnings with the world in the process.

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Jimmy did a very public n=1 ketosis experiment where he lost 78 pounds (35kg) over a year of eating to optimise his blood glucose and maintain nutritional ketosis.  Launching from this he wrote the books Cholesterol Clarity and Keto Clarity which has done a lot to increase the profile of the ketogenic diet in the public consciousness.

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More recently however Jimmy has struggled to keep the weight off and blood glucose levels down in spite of continuing with a high fat ketogenic diet and keeping his calories reasonably low.  Jimmy has been quite up-front about this, even sharing all his test data and two podcast interviews with Chris Kelly of Nourish Balance Thrive.[20]

In the first interview[21] Chris recommended that Jimmy get into a regular exercise routine, eat more veggies, and stop donating blood due to his low iron levels.

After his interview with Chris, Jimmy’s Facebook and Instagram accounts started showing a lot of great looking plates of food piled with heaps of colourful veggies under the hashtag #howIreallyeat.

It seemed that Jimmy has moved on from his position of minimising total carbohydrates to maintain ketosis in favour of maximising veggies and nutrient density.

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In their second interview[22] Chris discussed Jimmy’s gut bacteria and possible overuse of dairy, and noted that Jimmy had a particularly limited population of gut bacteria.

Chris: And it’s very unusual for me to see what I saw on your test result, Jimmy, which is really low levels of all of the markers that come from bacteria. I wouldn’t like to say for sure that this means that there’s no bacteria there or undergrowth or anything like that. Again, I think it’s definitely — Once you seen this, it’s worth doing the experiment especially since I’ve seen on the CHRON-O-Meter results that your fibre was only a third of what the RDA is.

Jimmy: It’s higher now.

It seems that after finding that he was not keeping the weight off with the very high fat ketogenic approach that had helped him initially, he was eager to listen to Chris and try more nutrient dense veggies and fibre.  It’s also worth noting that Chris himself eats a very high fat ketogenic diet, but at the same time manages to get very high levels of fibre and nutrient density as detailed in this article.

It’s hard to know if Jimmy’s limited diversity of gut bacteria is the reason for his lifelong struggle with obesity or if it has more recently been exacerbated by his restricted palette of high fat foods low in prebiotic fibre.   Jimmy is not the first person I have seen struggle to balance their blood glucose levels in spite of following a disciplined high fat ketogenic diet.

Is Jimmy’s apparent limited microbial diversity due to years of poor nutrition before he found low carb, something weird in the water in North Carolina, or his prolonged extreme high fat diet?  Whatever the case, I think Jimmy would do well to take Chris’ advice and continue with his diet heavy in non-starchy veggies that look very tasty, nutrient dense and full of fibre.

Diabetes is a complex disease; however, it seems that gut health and fibre are part of the puzzle.

what does the research say?

I went looking for studies that support the idea that, as suggested by Dr Ruscio, a high fat diet can cause leaky gut and insulin resistance and found a handful of moderately useful references.

  • An article by Jamie Scott referenced a study where they found that people on a diet high in omega-6 rich seed oils developed leaky gut, however people on saturated fats fared much better.[23]
  • A rodent study from Thomas Seyfried suggested that a diet with excess calories and ketogenic macros can lead to weight gain and poor blood glucose outcomes.[24] However it’s worth noting that the food being tested in the experiment was a high fat powdered formula medical food.  It’s hard to know if you would get the same results whole foods.
  • In Episode 65 of Tim Ferris’s podcast Peter Attia talks about how he sees some people not thriving on a ketogenic diet, particularly if there is not an energy deficit.[25]
  • The study A High-Fat Diet Is Associated With Endotoxemia That Originates From the Gut[26] compares a ‘prudent diet’ (20% fat, 60% carbs, 31g fibre) with the ‘western diet’ (40% fat, 40% carbs and 12.5g fibre) for a month and finds that plasma endotoxin activity increases on the ‘western diet’ compared to the ‘prudent diet’. There are no further details of the diets, however given the difference in fiber it is likely that the ‘prudent diet’ was loaded with veggies while the ‘western diet’ was processed carbs.  I think it’s hard to draw any meaningful conclusions from this other than more fiber is better than less fiber, particularly given that 40% fat is not really a high fat low carbohydrate diet.
  • The study Comparative effects of very low-carbohydrate, high-fat and high carbohydrate, low-fat weight-loss diets on bowel habit and faecal short-chain fatty acids and bacterial populations[27] compares a low carbohydrate high fat diet (5% carbs, 13g fibre) with a high carbohydrate high fibre diet (including high fibre bran cereal and lentils) (46.4% carbs, 31.5g fibre) and found that the low carb diet group had less butyrate and bifidobacteria than the higher carbohydrate group.
  • A range of papers suggest high fat foods lead to metabolic disorders via the mechanism described graphically below. [28] I’m far from an expert in this emerging field of research, however it appears to me that the mechanism is more likely to relate to the lack of fibre and nutrients rather than necessarily the presence of fat in the diet.

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Overall, I would say that research in this area is interesting but not clear cut and subject to prejudice (i.e. people just ‘know’ that high fat diets are bad for you) and bias (e.g. an experiment where the ‘prudent diet’ is full of nutrient dense veggies and fibre while the high fat approach is nutritionally limp by comparison).

Paleo ambassadors such as Chris Kresser,[29] and Robb Wolf[30] have been getting excited lately about a paper by Ian Spreadbury Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity.[31]  ‘Acellular carbohydrates’ refers to carbohydrates that are not contained within cellular storage vacules. This includes cereal grains and flours, whereas roots and tubers contain starch within cells (cellular).  The title of the paper pretty much says it all.

The paper makes a lot of sense, however what is missing is the ability to quantify ‘acellular carbohydrate’.  If we were to try to tie this back to something quantifiable I would say fibre is good, while processed non-fibrous carbohydrates are bad.

My takeaway learnings from the research is that:

  1. For whatever reason, some people don’t do well long term on an extreme high fat approach.
  2. Omega-3 fats are better when it comes to gut and metabolic health compared to omega-6 polyunsaturated fats.[32]
  3. A hypocaloric ketogenic diet is better than a hypercaloric ketogenic diet.
  4. More fibre is better than less fibre unless you are recovering from digestive issues such as SIBO or IBS. Reducing fermentable fibre is a temporary solution until the yeasts or bacteria are cleared from the small intestine, and in no way a long-term approach to a healthy diet and biochemistry.

From an evolutionary point of view I cannot see a mechanism that demonstrates how naturally occurring fats that we have been eating for many generations (e.g. olive oil, butter, coconut oil, cream, etc.) have suddenly become the cause of the gut distress and autoimmunity that we have seen flourish in recent decades when the use of sugar and highly processed grains have also exploded.

butyrate

According to Wikipedia:

Butyrates are important as food for cells lining the mammalian colon (colonocytes). Without butyrates for energy, colon cells undergo autophagy (self-digestion) and die.

Short-chain fatty acids, which include butyrate, are produced by beneficial colonic bacteria (probiotics) that feed on, or ferment prebiotics, which are plant products that contain adequate amounts of dietary fibre.

These short-chain fatty acids benefit the colonocytes by increasing energy production and cell proliferation and may protect against colon cancer.[33]

There have been two recent health fads which attempt to increase butyrate:

  • resistant starch, and
  • Bulletproof coffee.

Increasing the amount of resistant starch in the diet, as promoted by Richard Nikoley[34] and Tim ‘Tater Tot’ Steele,[35] aims to actively feed the good gut bacteria and increase butyrate in the gut from the bacterial fermentation of the resistant starch.  Robb Wolf’s sensitive digestion seems to have benefited from adding resistant starch.  Mark Sisson also came out with a definitive guide to resistant starch that was overall in favour of it.[36]

Personally I’ve tried resistant starch.  It definitely does something in your gut.  I can’t say that my life was changed markedly for the better, but it may be a useful supplement.  Though as with all supplements, it’s probably not ideal to be taking them for the rest of your life but rather find the required nutrients in real whole food if possible.

One of the claimed benefits of Bulletproof coffee is that high butyrate content of the grass-fed butter is beneficial for the gut.[37]  What is not clear though is whether the ingested butyrate actually gets to the lower intestine, as it is a small molecule which would likely be absorbed before it reaches the large intestine.  Using butyrate as a suppository or part of an enema is an option, but it seems a better idea to have the colonic bacteria present to produce butyrate and other short chain fatty acids for gut health.

safe starches

Paul Jaminet is a proponent of safe starches to improve gut health.  In his Perfect Health Diet he recommends eating some carbohydrate foods such as white rice, white potato, and sweet potato.[38]

These minimally processed whole foods are better than processed carbohydrate and I can understand how these safe starches could be beneficial to feed gut bacteria, which may lead to an overall improvement in health.  However, for a diabetic these high GI and high carbohydrate foods likely do not provide an acceptable solution when it comes to blood glucose levels.

sugar, processed carbohydrates and gut health

It seems most people agree that that cutting out sugar and processed foods is a good thing.

Dropping sugar and processed carbohydrates will reduce your chance of feeding an overgrowth of ‘bad bacteria’ (especially Streptococcus, Enterococcus and yeasts such as Candida albicans).

Enter the low carb paleo approach with plenty of nutrient dense fibre.[39] [40]

fibre and satiety

Fibre makes us feel full.  While high fat foods are calorie dense (at nine calories per gram), high fibre foods increase the bulk of our food without necessarily increasing calories.

Glucomannan is a water soluble dietary fibre with some clear research findings behind it, showing that it absorbs water and swells in your stomach to promote a feeling of fullness, as well as working as a prebiotic to increase the diversity of bacteria in the gut.[41]

The other good thing about high fibre foods is that they often come packaged with plenty of nutrients.

Real whole foods will be more likely to contain the essential nutrients, as well as other beneficial nutrients that we have not yet identified.  Isn’t the ideal food something that will give us plenty of fibre to feed our gut, keep us full, give us nutrients and keep us regular?

While there are lots of fibre supplements out there (e.g. glucomannnan, potato starch, and psyllium husk) I think the ideal way is to maximise the nutrient dense high fibre foods.

In line with the idea that we want to promote a good range of healthy gut bacteria, we also want to eat a wide range of fibre in our food (soluble, insoluble and mucilaginous) to promote a wide range of gut bacteria.

so how do we get fibre without raising blood sugars?

Again, we seem to have a balancing act between maximising fibre and nutrition on one hand and managing blood glucose levels on the other.

Microsoft Word Document 3102015 50428 AM.bmp

So what foods can we eat that will give us all the good stuff without negatively impacting our blood glucose levels?

Rather than just looking at high inulin foods or FODMAP foods as discussed above, I have analysed all of the USDA foods database to find the foods that have the highest amount of fibre that will provide us with plenty of nutrients and be gentle on our blood glucose levels.

The highest ranking foods are shown below while a more extensive list can be downloaded here (note: this list is sorted based using a multi criteria analysis that considers fibre, nutrient density and insulinogenic properties).  Foods with a lower percentage of insulinogenic calories will be gentler on your blood glucose levels while the foods with more fibre will be great for your gut.

As you look down this list you will see that most of these foods are nutrient dense seeds, herbs or leafy vegetables.  Rice and wheat feature in the mix, but only in their natural unprocessed form.

food % insulinogenic fibre (g) / kcal fibre (g) / 100g
flaxseed 8% 0.05 27
sesame seeds 12% 0.03 17
caraway seed 22% 0.09 38
chili powder 24% 0.09 35
rosemary 23% 0.10 43
basil 29% 0.12 38
sage 26% 0.10 40
sunflower seeds 11% 0.02 12
sesame seeds 14% 0.02 12
hazelnuts 8% 0.02 11
paprika 28% 0.09 35
savory 30% 0.13 46
marjoram 31% 0.11 40
parsley 32% 0.10 33
curry powder 31% 0.08 33
almonds 14% 0.02 12
mustard seed 22% 0.02 12
pine nuts 9% 0.08 43
almond butter 12% 0.02 10
Kellogg’s all-bran w/ ex fibre 35% 0.13 50
oregano 36% 0.12 43
thyme 36% 0.10 37
cloves 35% 0.08 34
spearmint 39% 0.09 30
sesame butter (tahini) 18% 0.02 9
peanuts 14% 0.02 10
pepper, red or cayenne 34% 0.06 27
pistachio nuts 19% 0.02 10
cumin seed 39% 0.02 11
turmeric 51% 0.06 21
celery flakes 53% 0.09 28
avocados 7% 0.04 7
pepper, black 54% 0.08 25
chives 54% 0.07 26
peanut flour 39% 0.03 13
radishes 60% 0.08 24
peppers 45% 0.07 22
coconut meat 6% 0.02 16
chia seeds 13% 0.07 34

As shown in the formula below the percentage of insulinogenic calories is lower the more fibre we have.

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If you are concerned about your blood sugar then try to choose foods with a lower percentage of insulinogenic calories, keeping in mind that a whole egg is about 25%.

summary

In summary, I think a ‘well formulated ketogenic diet’ that will be beneficial for both blood glucose and overall health looks less like this…

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… and more like this.

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A high fibre nutrient dense diet will give you a better chance of achieving health without messing up your blood glucose levels.

acknowledgements

  • Thanks to Alex Leaf and Elizma Lambert of Realize Health for reviewing this article and providing some of the more technical detail. If you feel like you’ve tried everything and still need some help I highly recommend contacting Elizma who can arrange some additional testing and get to the bottom of the issue.
  • Thanks to Jimmy Moore for chasing Dr Ruscio for some more references on the subject and Michael Ruscio for providing references.

references

[1] https://microbewiki.kenyon.edu/index.php/Link_Between_Microbes_and_Obesity

[2] http://drruscio.com/probiotics-weight-loss-test-810/

[3] http://humanfoodproject.com/please-pass-microbes/

[4] http://www.marksdailyapple.com/prebiotics/#axzz3j5eI13iu

[5] http://www.marksdailyapple.com/prebiotics/#axzz3j5XIihW8

[6] https://proteinpower.com/drmike/2006/08/30/a-cautionary-tale-of-mucus-fore-and-aft/

[7] http://talkfeed.co.za/web-hold-lchf-diet-answers/

[8] http://authoritynutrition.com/10-myths-within-the-low-carb-community/

[9] http://www.webmd.com/diet/guide/fiber-how-much-do-you-need

[10] http://humanfoodproject.com/sorry-low-carbers-your-microbiome-is-just-not-that-into-you/

[11] http://www.humansarenotbroken.com/plant-paleo-part-2-grains-legumes-fiber-and-antinutrients/

[12] http://blog.primalblueprint.com/episode-70-dr-david-perlmutter/

[13] https://en.wikipedia.org/wiki/Inulin

[14] http://www.amazon.com/Brain-Maker-Power-Microbes-Protect/dp/0316380105

[15] http://www.drperlmutter.com/about/brain-maker-by-david-perlmutter-md/

[16] http://shepherdworks.com.au/disease-information/low-fodmap-diet

[17] http://www.thepaleomom.com/2012/09/reintroducing-foods-after-following-the-autoimmune-protocol.html

[18] http://www.bioscreenmedical.com/

[19] http://www.suppversity.com/2015/04/acute-l-carnitine-tartrate.html#vo2

[20] http://www.nourishbalancethrive.com/

[21] http://www.thelivinlowcarbshow.com/shownotes/12392/961-christopher-kelly-analyzes-latest-functional-health-tests-for-jimmy-moore/

[22] http://www.nourishbalancethrive.com/podcasts/nourish-balance-thrive/diet-consultation-jimmy-moore/

[23] http://thatpaleoguy.com/2012/01/05/dietary-fat-can-modulate-intestinal-tight-junction-integrity/

[24] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

[25] http://fourhourworkweek.com/2015/03/18/mark-hart-raoul-pal-peter-attia/

[26] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978718/

[27] http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN101_10%2FS0007114508094658a.pdf&code=b061b827201900699a5cdd4ecca8b84c

[28] http://www.slideshare.net/aeislas/the-role-of-the-gut-microbiota-in-nutrition-and-health

[29] https://chriskresser.com/are-vegetarian-diets-better-for-the-microbiome/

[30] http://robbwolf.com/wp-content/uploads/2015/07/Paleo-Solution-279.pdf

[31] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/

[32] http://www.ncbi.nlm.nih.gov/pubmed/23249760

[33] https://en.wikipedia.org/wiki/Butyrate

[34] http://freetheanimal.com/

[35] http://vegetablepharm.blogspot.com.au/

[36] http://www.marksdailyapple.com/the-definitive-guide-to-resistant-starch/#axzz3iL8QNff1

[37] https://www.bulletproofexec.com/real-superfoods-that-destroy-inflammation-in-your-brain-the-body-response-that-may-change-your-mental-health-forever/

[38] http://perfecthealthdiet.com/

[39] https://iquitsugar.com/it-all-starts-in-your-gut/

[40] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1379072/

[41] http://authoritynutrition.com/glucomannan/

why we get fat and what to do about it v2

  • Although protein does not raise blood sugars as much as carbohydrate, it still requires insulin.
  • Dietary fat does not raise your blood glucose and is not insulinogenic.
  • Optimal nutrition is about maximising micronutrients while managing your glucose load so your pancreas can keep up.
  • In addition to managing carbohydrates, moderating protein, increasing fibre and maximising nutrition, are important to optimise body fat and normalise blood glucose.

background

Gary Taubes [1] has moved the needle in terms of the wider acceptance of the hormonal theory of obesity with his books Good Calories Bad Calories and Why We Get Fat and What to Do About It. 

The hormonal theory of obesity revolves around the idea that the food we eat affects our insulin levels which in turn governs how much fat is stored or used for fuel. [2] [3]

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With his focus primarily on carbohydrate, Taubes has not directly address the fact that protein also requires insulin, stating:

“the assumption has always been that the effect of protein has is small compared to that of carbohydrates, and that it is muted because protein takes considerably longer to digest.” [4]

This may be true to an extent, but could a better understanding of the insulinogenic effect of protein help us further refine the hormonal theory of obesity and our ability to improve blood glucose control, particularly for those who are not able to achieve their goals by simply reducing carbohydrates?

Recently people such as Steve Phinney [5] and Jimmy Moore [6] have brought increased attention to the ketogenic diet which takes the low carbohydrate dietary approach to the next level.  One of the observations from those measuring blood ketones and trying to achieve nutritional ketosis is that, in addition to limiting carbohydrates, protein needs to be moderated in order to register meaningful blood ketone levels.  Too much protein raises insulin and reduces fat burning.

So, using Gary Taubes analogy [7], what does the food insulin index data [8] tell us that would help us ‘push the rock a bit further up the hill’?

do calories count?

The antagonists to the hormonal theory of obesity point to numerous studies that show that if you put people in a metabolic ward and feed them a set number of calories and make them exercise the same amount they will lose or gain roughly the same amount of weight regardless of the macronutrient composition of the diet. [9]

This may be largely true, other than some exceptions as discussed below.  However in the real world most people eat when they are hungry and stop when full.  Most people do not count every morsel that goes into their mouth.

It should not be necessary to consciously control our appetite.  As the Paleo community point out, somehow we seemed to have done pretty well regulating our own appetite before recent times.  Something seems to have changed for the worse. [10]

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Most low carbohydrate diet studies allow the low carbohydrate group to eat to satiety while the low fat group has to count calories so they do not exceed their target intake.  Even under these conditions though, the low carbohydrate typically usually wins out. [11] [12]

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Isn’t finding a way of eating that will make us satisfied with fewer calories the dietary Holy Grail?  When a ‘diet’ becomes enjoyable and self-regulating it is no longer a ‘diet’, it’s just a way of eating!

So what is it about higher fat dietary approaches that leave people naturally satisfied on fewer calories?

what does insulin do?

The hormone insulin is a tangible reality in our family.  We have vials of it sitting in the fridge!

My wife has had type 1 diabetes for nearly three decades and wears a pump to deliver insulin through the day with extra doses at meals.

Helping her to refine her insulin doses has become a regular pastime for me, especially through our two pregnancies to try to give our kids the best chance of success.

I think it is helpful to look at diabetics to see what happens when we have too much or too little insulin.

Type 1 diabetics, before they start on insulin, are typically wasting away because their pancreas has stopped making enough insulin. Extremely low levels of insulin cause them to use body fat and muscle for fuel to a point where they waste away.

At the other extreme, diabetics often find that they gain weight quickly when they start injecting insulin.  Insulin is an anabolic hormone that regulates how we grow muscle and store fat.

The picture below shows “JL” one of the first type 1 diabetics to receive insulin in 1922.  The photo on the left is after diagnosis but before insulin.  The photo on the right is the same child two months after starting insulin injections.

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Check out this post to see photos of my kids when they were born after spending nine months in a high insulin environment.  It’s hard to argue that they were born big due to gluttony and sloth in utero!

I found this explanation from Robert Lustig helpful to understand how insulin affects our appetite, energy levels and fat storage.

If we are consuming highly insulinogenic meals a little bit extra energy gets stored away each time we eat.  Unfortunately this extra food does not help us feel full or provide more energy, it just gets stored as fat and we just have to eat more at the next meal.  If we also try to restrict calories to lose weight we feel sluggish and have low energy and our metabolism down-regulates to compensate!

This chart from Richard Feinman’s The World Turned Upside Down illustrates the process of cumulative fat storage in a high insulin environment.

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The Atkins approach recommends that you reduce your carbohydrates to less than 20g per day during the two week ‘induction phase’ and then allows you to wind them back up slowly to the point that you stop losing weight. [13]

With Atkins however there is no consideration of the insulinogenic effect of protein.  Unlimited fat and protein are allowed as long as you are limiting carbohydrates.  The problem is if you just increase protein and still fear fat you may not get enough reduction in insulin to allow your body to properly access fat for fuel.

Richard Feinman uses the analogy that insulin is like a tap that controls fat storage.  Without high levels of insulin we can not store as much fat, and thus we have more calories available for energy and therefore do not feel the need to eat as much.

Conversely, if we eat meals that generate less insulin we will be more likely to be able to access our body fat stores for fuel (i.e. ketosis).

This net flow of energy from (rather than into) our fat cells leaves us a little less hungry at each meal because we are getting calories from our fat stores, and hence we are less like likely to overeat without consciously trying.

meal timing

In the past, the nutritional community has looked to the ‘healthy’ body building community as the model to follow.  Bodybuilders often eat five or six meals a day to make sure they gain muscle and ‘keep their metabolism high’.  Food manufacturers have been only too willing to design foods for every occasion, with a burgeoning protein and supplement industry.

The problem is, unless you’re a body builder aiming for ‘mad gainz’, working out intensely, meticulously planning your meals and tracking every calorie, increased meal frequency  is probably not going to end well for you.

The figure below demonstrates how obese people generally have elevated insulin levels throughout the day.  By contrast, lean people tend to have more punctuated bursts of insulin, with the bursts balanced by  with periods of lower circulating insulin when the body is able to access stored body fat for fuel.

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Like me with my caffeine addiction, constant use of anything will lead to tolerance and insensitivity. [14]  Many find they become insulin resistant due to a diet of fsat digesting highly processed carbohydrate based foods.

One option that has become more popular in recent times is the concept of intermittent fasting. [15]  [16] [17] Going for period without food (or at least carbohydrates) enables your body to decrease insulin levels and allows it to access body fat for fuel.

The increased use of body fat for fuel during the fasting period typically results in a reduction of total food intake across the day.

Some people who have tried low carbohydrate diets with limited success find that intermittent fasting is what allows them to achieve the improved blood glucose and / or weight loss they are after.

I know for me it was intermittent fasting that helped me to improve my blood sugars, raise ketone levels and kick-start fat loss that I had been striving for but not achieving, even on a low carbohydrate Paleo approach.

when a calorie is not a calorie

You may be aware that gluconeogenesis is the process where the body can produce glucose from protein.  I only realised recently that protein is made up of glucogenic amino acids (approx. 78%), ketogenic amino acids (approx. 12%) and amino acids that can be either glucogenic or ketogenic (approx. 14%). [18]

Digestion breaks protein down into amino acids which circulate in our bloodstream until they are required for muscle growth and repair (i.e. protein synthesis) or to balance blood sugars (i.e. via gluconeogenesis).

When we do not eat protein or carbohydrate for a long period the body can obtain glucose from muscle via gluconeogenesis.  This is how we can survive long periods of starvation and still supply adequate glucose to the brain.

“In fasting and on a low carbohydrate diet as much of the amino acid carbon as possible will be used for gluconeogenesis.” [19]

For someone on a low carbohydrate diet this means that nearly 90% of protein not used for muscle growth and repair can be converted to glucose!

The fact that protein can turn to glucose just like carbohydrate at first sounds absurd, then scary.  However it is possible to use the glucogenic properties of protein as a ‘hack’ to help you achieve weight loss and / or normal blood glucose levels.

The first benefit is that glucose from protein is accessed as required from the amino acids circulating in the blood stream rather than raising blood sugar immediately, as is typically the case for carbohydrate, particularly if our liver and muscle glycogen is already full.

The second benefit is that it takes extra energy to convert protein to glucose before it can be used for energy.  This is sometimes known as the ‘thermic effect of food’. [20]

You are likely aware that one gram of carbohydrate will digest into on gram of glucose that will provide four calories to be used by the body for energy.  If you burn one gram of protein in a calorimeter you’ll get four calories of heat.

However to convert one gram of protein to glucose takes approximately one calorie, so you only get three calories for energy or body fat storage.  [21]  Viola!  A calorie is not a calorie when it comes to protein being converted to glucose via gluconeogenesis.

Sam Feltham did an interesting n=1 experiment where he compared the effect of 21 days of excess calories on a high carb diet versus the same number of calories on a LCHF approach.  The results are summarised in this chart.  The weight gain on the LCHF approach was minimal, with waist measurements coming down.  However on the high carbohydrate approach the weight gain was basically as per the calories in calories out formula.  Interestingly, the vegan approach was only slightly better than the high carbohydrate approach.

Day21Results

fat and insulin

When it comes to insulin demand and fat storage, dietary fat is unique.

The major theme that reappears throughout Richard Feinman’s The World Turned Upside down is that

“carbohydrate and protein can be turned to fat but, while glucose can be made from protein, with a few exceptions, you can not make glucose from fat.”

Excess glucose from carbohydrate and protein enters our blood stream and is removed, with the help of insulin, to be stored as fat (i.e. lipogenesis).

The chart below shows that the body secretes less insulin in response to higher fat foods. [22]

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If you turn things around to look at insulin demand in terms of non-fat calories (i.e. carbohydrates plus protein) we see that there is effectively no insulin response to fat!

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What this means is that the low fat foods we have all been eating to avoid getting fat and getting heart disease are the number one way to increase insulin, which facilitates fat storage as well as increasing insulin resistance which is the primary thing that drives heart disease! [23] [24]

If we eat fewer calories overall the body will use our body fat for energy, but only if insulin levels are low enough to allow the fat to be released for fuel.

If we are trying to lose weight the highest priority is to reduce the insulin load of our diet.  We can then eat fat to satiety while maximising nutrition.

can you eat too much fat?

So can eating too much fat make you fat?  Yes and no.

If we eat a high fat diet that is also high in carbohydrates and protein we will have high insulin levels and most likely a calorie excess.  This will lead us to store the glucose from the carbohydrates and protein as fat. [25]

However if our diet is low in carbohydrate and moderate in protein such that our insulin levels are reduced, we will be able to access our body fat for fuel, and therefore be less hungry.

In the absence of significant amounts of insulin we typically do not overeat fat.  A low carbohydrate, moderate protein, high fat diet will typically lead to reduced hunger, reduced calorie intake and typically lead to weight loss.

If you are struggling to drop weight on a high fat diet, then a period of intermittent fasting and/or tracking your food in a food diary (e.g. MyFitnessPal or Cronometre) might help establish your target macronutrient ratios and avoid overdoing the calories.  After this period of ‘retraining’ you should ideally be able to just eat when you’re hungry and stop when you are full.

The figure below shows the macronutrient ratio of four phases of a ketogenic diet according to Steve Phinney. [26]   Note how in the early phases of the ketogenic approach the dietary fat percentage does not necessarily have to be high.  Carbohydrates are low enough to reduce insulin levels to the point that body fat can be used for fuel.

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Once the desired weight loss is achieved carbohydrate levels can come up a little with fat increasing significantly to supply adequate calories for weight maintenance.

carbohydrate

The food insulin index data below shows us that carbohydrates are the primary macronutrient that generates insulin. [27]

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Carbohydrate is typically the body’s primary source of glucose.  We need some glucose for the brain to function (about 40g to 160 calories per day minimum), however the body can obtain this from protein via glycogenesis if there is no carbohydrate available.

You may have heard that the body has no need for carbohydrates and that there is no such thing as an essential carbohydrate.  This is true, however you should keep in mind that many important vitamins come packaged with carbohydrates (e.g. vegetables).

The optimal approach is to obtain high levels of nutrients while avoiding excessive insulin and normalising blood sugar.   We can do this by selecting high nutrient density, low insulin, and high fibre vegetables such as those contained in the food lists here.

fibre

While the low carbohydrate diet crowd tend to prioritise avoidance of carbohydrate-containing foods to improve blood glucose levels and achieve weight loss, many people also do well using a high fibre high vegetable approach. [28]

Most agree that eating lots of vegetables is a good idea.  As discussed in this article there is a strong basis for a low calorie density, high nutrient density diet for weight loss and health.

The insulin index data also supports this approach.  As detailed this article, the insulin demand of foods is better predicted by net carbohydrates (i.e. total carbohydrates minus indigestible fibre) than by only considering carbohydrates.

The insulin index data also supports this approach.  As detailed in this article, the insulin demand of foods is better predicted by net carbohydrates (i.e. total carbohydrates minus indigestible fibre) than by only considering carbohydrates.

Indigestible fibre effectively neutralises the insulinogenic effect of carbohydrates. Fibre also adds to the bulk of our food which helps with satiety and also feeds our gut bacteria, which is highly beneficial. [29]  [30]

Rather than taking fibre supplements, the ideal approach is to select high fibre foods that also have a low insulin load.  Some examples of these are spinach, mushroom, broccoli, and Brussels sprouts.  More options are detailed in these optimal food lists.

High fibre foods also often have a high nutrient density and a low calorie density.   By eating this type of food we ensure we are getting excellent nutrition, tend to be satisfied on fewer calories and also keep our insulin load down.

We are now learning the importance of fibre for our gut bacteria which influences the rest of our health.  Reducing the sugar and process carbohydrates will help to avoid manage any overgrowth in ‘bad bacteria’.

People who do not have blood sugar issues may do well on things like sweet potato, rice, lentils and tomatoes (these foods are included in this list of foods for the metabolically healthy).  However if you’re struggling to control your blood sugars you should be mindful that these foods will add to your insulin load and should be minimised (these lists of optimal foods for weight loss or optimal foods diabetes and nutritional ketosis are more ideal if you are struggling with high blood glucose levels).

In summary, maximising fibre is another tool that we can use, in addition to minimising carbohydrates, moderating protein and eating fat to satiety, to manage blood sugars and obesity.

protein

High protein foods do not generate a sharp rise in blood sugar compared to high carbohydrate foods because the digested amino acids circulate in the blood for use as required to raise blood sugar, rather than directly spilling into the blood stream in the same way that simple carbohydrates would raise your blood sugar if your glycogen stores were already full.

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Protein is also satiating and typically leads to a reduction in overall calories.  Your body will continue to search out food until it obtains adequate protein.  Once you obtain adequate protein you will be more likely to stop eating. [31]

Protein also contains a range of essential and non-essential amino acids that are required for muscle growth and repair as well as mental function.  Maximising the amount and variety of amino acids that come from our diet is the ideal approach rather than trying to supplement.

As noted above, increasing your protein intake is a possible ‘hack’ for diabetics to obtain glucose without spiking blood sugars.

Diabetics and ‘low carbers’ will often limit carbohydrates but compensate by increasing protein.  This is generally not a problem because protein is slower to digest than carbohydrate and hence the blood sugar rise from protein is slower and more manageable in comparison to carbs.  The body also releases glucagon to offset the protein used in protein synthesis which also helps to stabilise blood sugars.

However, just because protein does not spike blood sugars as aggressively as carbohydrate does not mean that it does not require insulin.    The food insulin index data indicates that while the blood sugar response is less than carbohydrates, the insulin demand of protein is still significant.

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According to Nuttall and Gannon between 32 and 46g of high quality dietary protein is required to maintain protein balance.  This represents around 6 to 7% of the calories in a 2000 to 2500 calorie diet being taken off the top for growth and maintenance.  Protein in excess of this level is available for gluconeogenesis.

This should not be taken to mean that extremely low amounts of protein are optimal for health or obtaining glucose from protein via gluconeogenesis is necessarily bad thing.   As noted in Phinney’s WFKD below protein levels can range between 10% and 30% while still being ketogenic.  The optimal approach revolves around maximising the amount of amino acids from protein and vitamins and minerals from generally carbohydrate based foods while at the same time keeping the glucose load low enough for your pancreas to keep up to optimise your blood sugars.

Ingested protein not used for growth and repair of the body does not magically disappear.  A small amount (approx. 12%) will be converted to ketones and used as it if were fat.  About 14% can be used either as glucose or fat.  But around 80% of protein can only be used as glucose.

This glucogenic protein in excess of the body’s requirements will also require insulin to be used for energy in the mitochondria or to be stored in the fat cells.

High levels of protein will generate insulin which will reduce fat metabolism (i.e. lower levels of ketones).  If your pancreas is struggling to supply enough insulin to maintain blood sugars then the insulin load from protein will make it harder for your pancreas to keep up and achieve optimal blood sugars.

If you are trying to lose weight then excess insulin (over and above the amount used for protein synthesis that receives glycogen) will also promote fat storage.

nutrient hunger

Similar to the concept of protein hunger, if you are not giving your body the vitamins and minerals it needs it will keep on seeking out more food.

In his Perfect Health Diet, Paul Jaminet notes that

“a nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to eliminating hunger and minimising appetite and eliminating hunger at minimal caloric intake.”

It makes sense that eating a nutrient dense diet would help our body to heal and recover from anything else that might be causing insulin resistance and obesity.

Many people talk about the benefits of various supplements for different ailments and performance enhancement, but surely the best approach is to maximise the quality and range of nutrition from the food you eat every day before investing in supplements?

liver storage and insulin sensitivity

A healthy insulin sensitive person will store glucose in their liver as glycogen with minimal rise in blood sugars after eating, regardless of the macronutrients.

A person with type 2 diabetes however will often spill excess glucose into the blood stream which will cause the blood glucose levels to rise and thus additional insulin will be necessary to clear excess glucose from the blood.  Excess protein not used for protein synthesis will contribute to refilling the glucose stores in the liver and muscles. [32]

It makes sense in this situation that you would want to limit the insulin load (i.e. carbs and excess protein) to starve the liver (or ‘dry up the root’ to quote Bob Briggs) such that it is not over full in order to reduce spilling of excess glucose into the blood.

practical application

Steve Phinney is probably the most well respected authority on the ketogenic diet.  His ‘well formulated ketogenic diet’ versus other dietary approaches shown in the chart below is quite useful.

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You will notice that the WFKD space is a triangle indicating that you need to balance your carbohydrates and protein levels in order to manage your insulin load and achieve nutritional ketosis.

You can have 30% protein and 5% carbs, or 20% carbs and 10% protein and still be within the bounds of the WFKD triangle.

However if you run with 30% protein and 20% carbs you will be well outside the realms of a ketogenic diet because you will be producing too much insulin, meaning that you will be ‘kicked out of ketosis’ (i.e. your fat burning will be slowed).

Understanding your insulin load may be the difference between achieving your desired goals from a low carbohydrate diet and not quite getting there.

For a more detailed discussion of how to tweak your glucose load to achieve your goals check out the article the Goldilocks glucose zone.

summary

  • Although protein does not raise blood sugars as much as carbohydrate, it still requires insulin.
  • Dietary fat does not raise your blood glucose and is not insulinogenic.
  • Optimal nutrition is about maximising micronutrients while managing your glucose load so your pancreas can keep up.
  • In addition to managing carbohydrates, moderating protein, increasing fibre and maximising nutrition, are important to optimise body fat and normalise blood glucose.

[1] http://garytaubes.com/

[2] https://intensivedietarymanagement.com/tag/hormonal-obesity-theory/

[3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC329588/pdf/jcinvest00481-0161.pdf

[4] http://www.healthcentral.com/diabetes/c/36758/20088/gary-round-3/

[5] http://www.amazon.com/Keto-Clarity-Definitive-Benefits-Low-Carb/dp/1628600071

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

[7] http://ses.library.usyd.edu.au/handle/2123/11945

[8] https://www.bulletproofexec.com/gary-taubes-bad-science-gut-health-nusi-223/

[9] https://www.youtube.com/watch?v=aRCv5RWXWx8

[10] http://nchstats.com/2010/01/14/obesity-americans-still-growing-but-not-as-fast/

[11] http://www.sciencedirect.com/science/article/pii/S0899900714003323

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

[13] http://www.atkins.com/how-it-works/atkins-20/phase-1

[14] My 23andMe genetic testing tells me that I am likely to be able to metabolise caffeine quickly however I am prone to type 2 diabetes and obesity!

[15] https://intensivedietarymanagement.com/category/fasting/

[16] http://www.eatstopeat.com/

[17] http://thefastdiet.co.uk/

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

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

[20] http://en.wikipedia.org/wiki/Specific_dynamic_action

[21] If you want to dive into the detail on this I recommend you check out Chapter 14 of Richard Feinman’s The World Turned Upside Down.

[22] http://ses.library.usyd.edu.au/handle/2123/11945

[23] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628708/pdf/361.pdf

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

[25] http://www.sciencedirect.com/science/article/pii/S0026049514001115

[26] https://www.youtube.com/watch?v=8NvFyGGXYiI&index=1&list=PLrVWtWmYRR2BlAsGG9tr6T-B4xSum8SCc

[27] Data from http://ses.library.usyd.edu.au/handle/2123/11945

[28] http://www.mangomannutrition.com/

[29] http://www.drperlmutter.com/health-depends-gut-bacteria/

[30] http://www.drperlmutter.com/tag/type-2-diabetes/

[31] http://jn.nutrition.org/content/137/6/1478.full

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

the Goldilocks glucose zone

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

background

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

the Goldilocks glucose zone

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

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

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

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

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

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

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

Not too hot.  Not too cold.

Not too hard.  Not too soft.

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

the safe starches debate

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

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

the case for limiting carbohydrates

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

1. Non-fibre carbohydrates are:

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

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

natural glucose utilisation level

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

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

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

image001

some perspective

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

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

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

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

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

minimum carbohydrate requirement

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

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

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

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

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

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

image005

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

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

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

what is the minimum protein requirement?

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

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

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

three macros or two fuel sources?

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

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

  glycogenic ketogenic both
non-essential Alanine

Arginine

Asparagine

Aspartate

Cysteine

Glutamate

Glutamine

Glycine

Proline

Serine

Tyrosine
essential Histidine

Methionine

Valine

Leucine

Lysine

Isoleucine

Phenylalanine

Tryptophan

Threonine

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

the “well formulated ketogenic diet”

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

image007

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

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

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

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

the Goldilocks glucose zone

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

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

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

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

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

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

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

what about the Kitavans?

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

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

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

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

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

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

comparison of dietary approaches

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

image011

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

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

image014

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

what is our light on the horizon?

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

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

image016

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

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

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

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

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

what gauges do we use to steer the boat?

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

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

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

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

image017

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

image017

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

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

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

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

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

image021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[18] http://thenoakesfoundation.org

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

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

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

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

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

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

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

are dairy and red meat uniquely insulinogenic?

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

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

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

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

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

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

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

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

.

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

[this post is part of the insulin index series]

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

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

is sugar really toxic?

You may have noticed a lot of people quitting sugar [1] or saying sugar is toxic. [2]

But what does the food insulin index data have to say about sugar?  Is it any different to other forms of carbohydrate?

The chart below of sugar content versus insulin demand indicates that sugar plays some role in insulin, however the correlation is weak, at least compared to carbohydrate.  If we want to manage our insulin load we’re probably best to consider our total carbohydrates rather than isolating sugar alone as the only problem.

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I ran a correlation analysis on the food insulin index data to see if sugar had a unique effect on insulin compared to non-sugar carbohydrate.

The data suggests that sugar does not generate more insulin than other forms of carbohydrates.  If anything sugar requires slightly less insulin on a gram for gram basis compared to carbohydrates.

This could be because sugar is metabolised quickly and the body pushes out a short burst of insulin to clear the sugar from the blood rather than a long persistent effort which might be the case for a lower glycemic index carbohydrate.

sugar

This is not to say that sugar is good for you.  There are obvious issues with consuming significant amounts of sugar including:

  1. Sugar has no fibre and has a very high calorie density so it is not filling and you can end up eating lots of it without feeling full.
  2. Refined sugar has a very low nutrient density, and your body is left searching for nutrition in more food and hence will be prone to over consume calories.
  3. Sugar will cause your blood sugar to rise quickly, your body will produce a burst of insulin which will cause your blood sugar to subsequently crash after the insulin surge and leave you feeling hungry again, craving more sugar to make you feel ‘right’ again.

By contrast, the carbohydrates in non-starchy veggies (e.g. spinach, kale, avocado, asparagus) come packaged with fibre, digest slowly and will leave you feeling full, raise your blood sugar gently and are very hard to overeat. [3].

If you have some form of metabolic dis-regulation (e.g. diabetes, obesity etc) then you need to be thinking about everything that raises your insulin, not just sugar.

[next article… glycemic load versus insulin load…  which one is best?]

[this post is part of the insulin index series]

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[1] https://iquitsugar.com/

[2] https://www.youtube.com/watch?v=dBnniua6-oM

[3] I’m not going to deliver into the fructose / glucose issue.  If you want to go there check out https://www.youtube.com/watch?v=dBnniua6-oM or the condensed Shaun Croxton version at https://www.youtube.com/watch?v=tdMjKEncojQ

how do you like your veggies… cooked or raw?

So what effect does cooking have on veggies?  Is raw better than cooked when it comes to fibre and insulin demand?

To help us understand the effect of cooking the table below shows a comparison of the fibre in a selection of one hundred grams of cooked and raw vegetables.

food

raw

cooked

carbs

fibre % insulin carbs fibre

% insulin

spinach 4 2 40% 4 2 40%
broccoli 7 3 54% 7 3 49%
eggplant 6 3 40% 8 3 63%
artichoke 11 5 49% 12 9 29%
mushroom 5 1 55% 5 2 44%
carrots 10 3 66% 8 3 60%

Spinach and broccoli when cooked don’t seem to lose a lot of their fibre.

You could eat 600g of spinach or 300g of broccoli and still have a Bernstein-compliant lunch of dinner (i.e. no more than 12g of carbs).

Eggplant seems to lose some fibre relative to carbohydrates and ends up with an increased percentage of insulinogenic calories.

If you boil something to a mush then it’s probably not going to have the same quality of fibre as if you were to eat it in its raw unprocessed form.  It’s also going to be easier to eat a lot more cooked veggies than lightly steamed or raw veggies.

Lightly steamed is probably your best bet to retain the nutrients and fibre in your veggies.  If you want to check out how your favourite veggies fare before and after cooking you can find out at nutritiondata.self.com.

In view of the growing body of research showing that fibre is good for gut health which is in turn good for diabetes, insulin sensitivity and a whole host of other issues I think it’s hard to build a strong case for avoiding vegetables altogether just to minimise carbohydrates.

[next article…  putting it all together… protein and net carbs]

[this post is part of the insulin index series]

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fibre… net carbs or total carbs?

Looking at the foods sitting above the trend line the chart below it appears that the foods with the greatest insulin response compared to what would be predicted by carbohydrate and protein tend to be the ones that are more processed such as ice-cream, baked beans, pancakes and Jelly Beans.

On the lower side of the trend line we have less processed foods (e.g. full cream milk, navy beans, porridge and All Bran with added fibre).

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Processed foods tend to contain less fibre, while carbohydrates in their original state typically contain more fibre.  Fibre is indigestible carbohydrate and hence does not raise blood sugars or require insulin.

Fibre is also important for the health of our gut and feeds the good bacteria in our digestive tract.

Could it be possible to also use fibre as a proxy for the level of processing to help refine the prediction of insulin demand by different foods?

In order to test whether fibre is useful to predict insulin demand I tested the relationship between carbohydrates plus different amounts of the fibre in the various foods.

The best correlation was achieved by removing all of the fibre.  Using net carbs gives an increased correlation compared to the carbohydrates alone (i.e. R2 = 0.435 compared to R2 = 0.482).

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Considering the carbohydrates, protein and fibre in a food enables us to more accurately predict insulin demand.

This concept is known in the low carb community as “net carbs”.  If you’re trying count carbohydrates to manage insulin people are often advised to consider the total carbohydrates minus the fibre as fibre cannot be digested but is rather digested by our intestinal bacteria.

This aligns with the understanding that carbohydrates consumed with the packaging that they came with (i.e. fibre) do not have as big an effect on insulin.

This relationship might be part of the reason why many populations have maintained good health on a higher level of carbohydrate consumed in their raw natural state compared to when they come from the supermarket in boxes with barcodes.

There is some disagreement on how to deal with fibre on a restricted carbohydrate diet:

  • Some people say you should ignore fibre because “net carbs” is just a marketing ploy.
  • Some people choose to count half the fibre as carbs as a middle ground.
  • Experienced type 1 diabetics who monitor their blood sugars using continuous glucose meters will tell you that the fibre in their veggies will not raise their blood sugars however they ignore the fibre in packaged foods because it does raise their blood sugar.

My interpretation of the food insulin index data indicates that real fibre in foods is indigestible and hence does not raise blood sugar and require insulin.  However excess cooking and processing will soften this fibre and make it digestible.

It appears that the fibre in a food is a useful proxy for the level of processing and helps us to better predict the insulin demand of a food.

If you want to reduce your insulin load you can increase the amount of non-starchy veggies such as spinach, broccoli, mushrooms, Brussel sprouts and kale in your diet.

If you’re using packaged diet products then I suggest you ignore the fibre content, or maybe don’t buy them in the first place.

The major problem I see with encouraging people to consider total carbohydrates rather than net carbohydrates is that it will encourage people to avoid vegetables which not be optimal for health in the long term.  The reality is, when you take fibre into account, you can eat a lot of non-starchy vegetables without significantly impacting your net carbohydrates.

[next article…  how do you like your veggies… cooked or raw?]

[this post is part of the insulin index series]

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how do you like your veggies… cooked or raw?

your personalised food ranking system

  • A number of attempts have been made to develop food rankings.
  • We can combine the concept of insulin load with nutrient density to help us make optimal food choices based on our goals, situation and budget.
  • This article looks at other ways to prioritise our our food choices quantitatively to design a food ranking to suit your situation, goals and budget.

Mat Lalonde’s nutrient density

Dr Mat Lalonde developed a ranking of foods based on nutrient density in terms of nutrients per gram using the USDA food database. [1]  This analysis identified organ meats as one of the more nutritious foods, with vegetables coming in second.  Fruits and grains landed much further down the list.

Lalonde noted that people wanting to lose weight may wish to prioritise in terms nutrient density per calorie, however he had chosen to analyse nutrient density in terms of weight as that might be more relevant for athletes (Lalonde is a CrossFit athlete as well as a biochemist). [2]

I was left excited, yet a little unsatisfied, wondering what the ranking might look like in terms of calories, or maybe some other measure.

Aggregate Nutrient Density Index (ANDI)

Joel Fuhrman’s Aggregate Nutrient Density Index (ANDI) ranks foods based on micronutrients per calorie [3] but excludes a number of essential vitamins and minerals while placing extra emphasis on the oxygen radical absorbance capacity.

This approach heavily biases plant foods and seems to ignore the nutritional benefits of animal foods. [4]  Kale ranks at the top of the list, largely due to its massive amount of vitamin K.

Unfortunately a massive dose of vitamin K isn’t much use to us in the context of a low fat given that vitamin K (along with vitamin D and E) is a fat soluble vitamin.  It’s also not much use having a food that ranks off the chart in one nutrient but it’s that good in a number of other areas.   Vitamin K is important but you can only absorb so much in one day.

Another criticism that has been levelled at ANDI is that simply using nutrition per calorie prioritises very low calorie density foods that may not be viable for anyone doing a significant amount of activity.

Dave Asprey’s Bulletproof Diet

Dave Asprey developed the Bulletproof Diet Infographic [5] which is a simple ranking of foods to avoid and preference based on both nutritional density and toxins.

The downside of this is that it shows only a select range of foods and doesn’t explain why each of the foods has the ranking that is has been given (though there is a good discussion of the toxins and various issues in his book [6]).

Most people would be happy with this visual list of foods to preference and avoid, and I recommend you check it out, however I wanted to see the numbers to understand why one food ranked above another.

nutrient density per dollar

I also came across a food ranking system in terms of nutrient density per dollar.  Dale Cumore of the blog Solving Nutrition [7] had created a ranking based on nutrient density per dollar cost of that food to arrive at the cheapest way to get nutrition for around 1000 foods that he could find cost data for.

Dale included a link to his  spreadsheet on his blog (in which he has mimicked Lalonde’s analysis [8]) for people to have a play with.  So I downloaded it to see what I could do with it. [9]     After dropping out the fortified products, we get the following list of foods based ranked on nutrient density per dollar.

  • bagels
  • French rolls
  • croissants
  • muffins
  • lentils
  • tortillas
  • rice
  • parsley
  • beef liver
  • spaghetti
  • Chinese cabbage (Bok Choy)
  • sunflower seeds
  • White bread
  • chicken liver
  • peanut butter
  • skim milk
  • peanuts
  • chives
  • whole eggs
  • brown rice
  • sweet potato
  • cabbage
  • orange juice

Grains are actually a cost effective way to get nutrients, however not necessarily the most healthy.    People believe that most if not all grains should be avoided. [10]  My ten year old daughter knows that if she eats bread she will end up tired, with a stomach ache and dark circles around her eyes.  However if  cost is your number one priority you might find this list useful.

cost per calorie

Cost will always be a consideration to some degree.  Some people may not have the finances to buy grass fed organic while others will have the means to invest in food as preventative medicine.  Listed below are the cheapest foods in terms of cost per calorie.  Again, grains (including white rice), candy and sugar rank up there with some of the cheapest ways to get calories. [11]

While it’s true that grass fed beef, salmon and organic vegetables can be more expensive than boxed cereals and sugar, it’s also worth noting that obtaining significant proportion of your calories from fats such as coconut oil and butter can actually be very cost effective on a per calorie basis.

  • pumpernickel rolls
  • croissants
  • bagels
  • canola oil
  • French rolls
  • margarine
  • what muffins
  • coconut oil
  • granulated sugar
  • rice
  • brown sugar
  • mayonnaise
  • doughnuts
  • tortillas
  • cake mix
  • peanut butter
  • cranberry juice
  • spaghetti
  • sausage
  • corn starch

nutrient density per calorie

Nutrient density per calorie is a useful measurement for someone wanting to lose weight while maximising nutrition.   One line of health and weight loss thinking says that once the body obtains adequate nutrients it will stop searching for food and overeating will be minimised. [12]  Using this approach vegetables shoot to the top of the list with things like spinach, liver, seafood oysters, kale and broccoli rank really well.

  • spinach
  • chicken liver
  • beef liver
  • beet greens
  • veal liver
  • pork liver
  • duck liver
  • goose liver
  • turnip greens
  • mustard greens
  • parsley
  • chard
  • oyster
  • coriander
  • dandelion greens
  • basil
  • caviar
  • kale
  • broccoli
  • All bran
  • collards

fibre per calorie

One of the more exciting concepts in the diet space recently is the concept that what you eat could possibly change your gut bacteria for better or worse.

While this area is still in its infancy the thinking is that lean people have a higher bacteriodes : fermicutes ratio and that this can be influenced by eating more fibre and taking prebiotics.

Typical daily fibre intake is around 17g for those of us in western civilisation. It is said that African hunter gatherer children obtain more than 150g of fibre per day from eating unprocessed foods in their natural state [13] and before the invention of fire and cooking our ancestors were eating more than 100g of fibre per day. [14]

Fibre in carbohydrate-containing foods neutralises the insulinogenic effect of the carbohydrate.  Fibre is not digestible by the human gut and hence it does not provide energy or cause a rise in blood sugar or insulin.

The typical western recommendation is to get at least 30g of fibre per day to improve your blood sugar and cholesterol levels.  Most people don’t achieve these levels even when eating “healthy whole grains”, largely due to the high level of processing in most popular foods.

It’s also worth noting that it’s better to lightly steam your veggies rather than cooking them until they’re soft so that the fibre remains intact.

Ironically the number one recommended source for fibre is from “healthy whole grains”.  While whole grains will be marginally better than processed grains such as white bread, they also have a high glycemic load and will be much more insulinogenic than other options such as non-starchy vegetables.  The end result of eating the whole grains is increased blood sugars and cholesterol, which is exactly what “healthy whole grains” was meant to help us avoid!

If we rank for fibre per calorie we end up with a few spices such a cinnamon, curry powder, or cocoa at the top of the list along with vegies such as turnip, artichoke, sauerkraut, cauliflower.  All Bran features in the list but only because it has been fortified with extra fibre.

  • cinnamon
  • turnip greens
  • artichoke
  • curry powder
  • sauerkraut
  • cauliflower
  • raspberries
  • lettuce
  • blackberries
  • lemon peel
  • All Bran (w/ added extra fibre)
  • oregano
  • wheat bran
  • eggplant
  • basil

practical application

These lists of foods ranked based on one measurement or another are interesting, however they are not particularly useful by themselves.  If we went by Lalonde’s system we’d be eating bacon and organ meats all the time.  If we went by the ANDI system we’d be living off kale.  And if we just looked at the proportion of insulinogenic calories we would be living off butter, cream and oils.

But it gets interesting though when you can combine the various measurements to highlight foods to suit your individual goals.

In my previous articles on diets for weight loss, blood sugar management and athletes I provide a list of optimal foods for using different weightings for the following:

  • nutrient density per calorie,
  • fibre per calorie,
  • nutrient density per dollar,
  • nutrient density per 100g,
  • proportion of insulinogenic calories,
  • calories per 100g, and
  • cost per calorie.

Listed below are the weightings that I’ve devised for each situation.

I’ve also developed a suite of ‘cheat sheets’ to highlight optimal food choices to suit your goals, whether they be weight loss,  normalising weight loss or or athletic performance.

Why not print one out and stick it to your fridge as a helpful reminder or use them for some inspiration for your next shopping expedition?

In the next article we’ll look at how we can use this style of analysis to identify diabetic friendly, ketogenic, nutrient dense meals.

weighting for blood sugar control and ketosis

ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 5% 5% 10% 50% 10% 5%
weighting for weight loss
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 5% 20% 30% 10%
weighting for athletes and metabolically healthy
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 30% 20% 5% 10%
weighting for theraputic ketosis
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
5% 5% 5% 5% 70% 5% 5%

references

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

[2] https://www.youtube.com/watch?v=HwbY12qZcF4

[3] http://www.wholefoodsmarket.com/healthy-eating/andi-guide

[4] http://www.westonaprice.org/book-reviews/eat-to-live-by-joel-fuhrman/

[5] http://www.bulletproofexec.com/wp-content/uploads/2014/01/Bulletproof-Diet-Infographic-Vector.pdf

[6] http://www.amazon.com/The-Bulletproof-Diet-Reclaim-Upgrade/dp/162336518X

[7] http://blog.paleohacks.com/ultimate-guide-paleo-diet-budget/

[8] The analysis considers the relative amount of calcium, iron, magnesium phosphorus, potassium, zinc, copper, manganese, selenium, vitamin C, thiamine, riboflavin, niacin, panto acid, vitamin B6, choline, vitamin B12, Vitamin A, vitamin D, Vitamin E and Vitamin K across more than 1000 foods.  No weighting of these vitamins based on a view of their relative importance, though this refinement could be made to the analysis for a specific need.  This unweighted approach however highlights foods that have a broad spectrum of nutrients at significant levels.

[9] The statistical analysis in the spreadsheet downloaded compares the value of a nutrient in each food to the average of the full database of foods and gives it a score based on the number of standard deviations from the mean.  I also modified the spreadsheet such that a score for one nutrient could not be greater than three (i.e. three standard deviations from the mean).   Just because Kale has an inordinate amount of Vitamin K doesn’t mean that it ranks at the top of the list on the basis of just one nutrient.

[10] https://www.youtube.com/watch?v=VvfTV57iPUY

[11] If you wanted to view this cynically you could say that the fact that grains and sugars have the lowest cost per calorie enables food manufacturers to place the largest mark up on these foods when reselling them in cardboard boxes in the supermarket.  It’s harder to put a bar code on generic vegetables and meat products that are already relatively expensive.

[12] See discussion in chapter 17 Nutrient Hunger in Paul Jaminet’s Perfect Health Diet where he notes that a nourishing, balanced diet that provides all nutrients in the right proportions is the key to eliminating hunger an minimising appetite and eliminating hunger at minimal caloric intake is a key to weight loss.  

[13] http://www.abc.net.au/catalyst/stories/4067184.htm

[14] http://www.gregdavis.ca/share/paleo-articles/academic/The%20Ancestral%20Human%20Diet%20by%20S.%20Boyd%20Eaton.pdf