Tag Archives: food insulin index

choosing the right sized low carb band aid

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

how important is insulin sensitivity?

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

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

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

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is low carb the best approach for everyone?

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

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

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

So who is right?

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

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As always, context matters.

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

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

As you can see from the chart below:

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

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

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

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

am I insulin resistant?

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

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

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

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

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

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

nutrient dense low carb foods for blood glucose control

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

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

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

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

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

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

Vegetables

Listed below are the highest ranking vegetables.

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

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

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

 

fruit

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

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

nuts, seeds and legumes

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

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

dairy and eggs

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

dairy20and20eggs

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

seafood

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

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

animal products

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

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

is low carb a band aid or cure?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  1. all foods,
  2. high nutrient density foods,
  3. nutrient dense low carbohydrate foods, and
  4. nutrient dense low calorie density foods.

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

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

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

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

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

 

references

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

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

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

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

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

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

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

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

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

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

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

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

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

the most nutrient dense foods for different goals

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

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

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

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

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

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

essential nutrients

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

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

essential fatty acids

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

amino acids

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

vitamins

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

minerals

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

the lists

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

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

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

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

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

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

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

all nutrients

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

no insulin index contribution

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

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

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

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

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It certainly seems to be working for him.

Duane Johnson 2 - Copy

athlete and metabolically healthy

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

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

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

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

Aaron Tait Photography

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

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

weight loss

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

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

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

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

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

diabetes and nutritional ketosis

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

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

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

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therapeutic ketosis

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

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

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

ganze und halbe reife avocado isoliert auf weissem hintergrund

fatty acids

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

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

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

no insulin index contribution

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

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

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

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

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athlete and metabolically healthy

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

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

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

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weight loss

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

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

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

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

diabetes, nutritional ketosis and therapeutic ketosis

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

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

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amino acids

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

no insulin index contribution

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

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

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

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

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

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athlete and metabolically healthy

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

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

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weight loss

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

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

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

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diabetes and nutritional ketosis

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

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

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Therapeutic ketosis

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

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

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vitamins

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

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

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

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

no insulin index contribution

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

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

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

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

athlete and metabolically healthy

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

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

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

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Good food doesn’t have to taste bland!

weight loss

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

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

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

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diabetes and nutritional ketosis

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

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

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

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therapeutic ketosis

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

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

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minerals

no insulin index contribution

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

Here’s your answer:

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

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

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

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athlete and metabolically healthy

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

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

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

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

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weight loss

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

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

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diabetes and nutritional ketosis

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

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

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therapeutic ketosis

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

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

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application

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

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

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

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

references

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

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

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

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

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

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

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

insulin dosing options for type 1 diabetes

  • This article reviews a range of approaches to calculating insulin requirements for people with type 1 diabetes.
  • The simplest approach is standard carbohydrate counting, which may be ideal for someone whose diet is dominated by carbohydrates.
  • Bernstein recommends standardised meals for which the insulin dose is refined based on ongoing testing and refinement.
  • Stephen Ponder’s ‘sugar surfing’ builds on carbohydrate counting, with correcting insulin given when blood glucose levels rise above a threshold due to gluconeogenesis.
  • The food insulin index approach predicts insulin requirements based testing in healthy people of the insulin response to popular foods.
  • The total available glucose (TAG) advocates a ‘dual wave bolus’ where insulin for the carbohydrates is given with the meal, with a second square wave bolus given for the protein which is typically slower to digest and metabolise.

introduction

In the article Standing on the Shoulders of Giants we met a handful of people who have achieved excellent blood sugar control in spite of having type 1 diabetes.  Common elements of their success include:

  • keeping carbohydrates low to prevent the blood sugar roller coaster,
  • accurately dosing for a controlled amount of dietary carbohydrate,
  • targeting normal blood sugar ranges (i.e. 83mg/dL or 4.6mmol/L) with regular correcting doses,
  • regular exercise and / or intermittent fasting to improve insulin sensitivity, and
  • having a reliable method to account for the insulinogenic effect of protein.

Everyone’s diabetes management regimen is going to be different.  There will be a degree of trial and error to find what will work best for you.  This article reviews a number of approaches that you can learn from to see what suits you.

carbohydrate counting

In the 1970s Dr Richard Bernstein got hold of a blood glucose meter (long before they were easily available) and started experimenting on himself to understand how much a certain amount of carbohydrate raised his blood glucose levels and how much insulin he required to bring his blood glucose back down.

From this style of experimentation we can determine the “carbohydrate to insulin ratio” (i.e. how much insulin is required for a certain amount of carbohydrates).

Carbohydrate counting is now the standard approach that most people with type 1 diabetes are taught.  This approach involves estimating the grams of carbohydrate in your food for each meal.  With this knowledge you can then program the amount of carbohydrates eaten into the insulin pump which calculates the insulin dose based on a pre-set carbohydrate to insulin ratio.

The advantage of this approach is that it is relatively simple.  However it does not consider the insulin required for protein which is typically addressed with correcting doses or sometimes basal insulin.

Carbohydrate counting is a good starting point, but it is by no means perfect. [1] [2]

Bernstein’s own approach

Dr Richard Bernstein advises that his patients, in addition to restricting carbohydrates (i.e. no more than 6g of carbohydrates for breakfast, 12g for lunch and 12g dinner), to have the same meals every day which allows insulin doses to be refined to optimise for blood sugars.  If your blood glucose levels run high one day you can add a little more insulin the next day or a little less if they are running low.

Bernstein also advises targeting an average blood glucose of 83mg/dL (4.6mmol/L), and that you correct if blood glucose levels go outside a ten point range from this target (i.e. 73mg/dL to 93mg/dL or 4.0mmol/L to 5.2mmol/L).  A small bolus of insulin is given to bring blood glucose levels down and a certain portion of a glucose tablet is used to bring blood sugars back up precisely.

Bernstein advises that people with type 1 diabetes modulate the quantity of protein to manage their weight.  If you’re a growing child, protein is essentially unrestricted.  If you’re trying to lose weight protein can be reduced to further reduce insulin.

Bernstein says that protein requires about half as much insulin as carbohydrates and outlines how to dose for it in this video from Dr Bernstein’s Diabetes University.  In practice, though, his approach to dosing for protein requires consistent meals and fine tuning of insulin dose.

sugar surfing

Another popular method is ‘sugar surfing’ which is effectively a ‘bolt-on’ to carbohydrate counting developed by Dr Stephen Ponder to manage the glucose response to things other than carbohydrates.

This approach involves dosing for carbohydrates with the meal, and then watching the continuous glucose monitor (CGM) and giving regular ‘micro doses’ of insulin to keep blood sugar under around 93mmol/L (5.2mmol/L).  Typically two or three separate doses will be required to bring a ‘protein spike’ under control for someone with type 1 diabetes.

Injected insulin works over a period of up to eight hours and it is difficult to match the timing of the insulin action with digestion.  The advantages of this approach are that it allows for the variability in the time of protein digestion which varies from person to person and is different for different foods and hence difficult to predict accurately.

image002

I think the secret to making ‘sugar surfing’ work is to turn the waves that you’re surfing into more manageable ripples by following a diet with a reduced insulin load.

food Insulin Index

“It is possible that other methods of matching insulin with food are not being studied because of the belief that carbohydrate counting is a well-founded, evidence-based therapy,” the researchers concluded. “Indeed, this meta-analysis shows the scarcity of high-level evidence.” [3]

One of the experiments documented in Clinical Application of the Food Insulin Index to Diabetes Mellitus (Bell, 2014) [4] demonstrated that type 1 diabetics calculating their insulin requirement using the food insulin index approach achieved significantly improved blood glucose control compared with those using standard carbohydrate counting.

Estimating the insulin required for the meal from carbohydrate and protein rather than carbohydrate alone is potentially a massive step forward in improving blood sugar control for people with type 1 diabetes.

The limitation of using the approach practiced in the study is that the food selection tested is limited to the one hundred or so popular processed supermarket foods.

If you’ve read my blog you’ll know that I’ve tried to develop a robust method for calculating the insulin requirement for foods based on their macronutrients without having to test them in vivo (i.e. in real, living people). [5] [6] [7]  The chart below shows how we can use the food insulin index test data to more accurately predict the insulin demand of a particular food using this formula.

image017

image005

Rather than separating doses for carbohydrates and protein, the food insulin index approach assumes that all of the insulin is given with the meal.  The risk with this is that the insulin will take action before the protein digests which will lead to low blood glucose.

Total Available Glucose (TAG)

The TAG (Total Available Glucose) approach is based on a book by Mary Joan Oexmann published in 1989. [8]  This method calculates the insulin required for carbohydrate, protein (54% of carbohydrate) and fat (10% of carbohydrate).

If we gave all the insulin calculated for both carbohydrates and protein when we sat down to eat a high protein meal it is possible that the insulin would take effect before the protein digested, leading to low blood glucose before the gluconeogenesis from the protein had time to kick in.

To deal with the fact that glucose from protein can take longer to show up in the blood stream people who follow the TAG approach typically use a ‘dual wave bolus’.  The insulin for the carbohydrates is dosed with the meal, while the insulin for the protein is infused slowly as a separate “square wave bolus” over a period of three hours or so.  The need for the carbohydrate and protein boluses to be split will depend on the amount of protein in your meal and how quickly protein raises your blood sugars.

image007

separate boluses for carbohydrates and protein

A few people who achieve excellent blood sugar control simply use two separate boluses – one for carbohydrates before the meal with another one for protein around an hour after the meal.

This approach requires that the insulin for the protein and carbohydrate are calculated separately with the protein bolus being given a number of hours after the meal.

This approach can be refined using a CGM to confirm when the blood sugar response to the protein kicks in and hence when the bolus for protein is required.

insulin calculator

To assist in calculating the bolus for carbohydrates and protein Ted Naiman of Burn Fat Not Sugar has created this insulin calculator.

You can run it on your computer or phone, enter the properties of the food that you are about to eat and it will calculate the appropriate dose for carbohydrate and protein.  The outputs from this calculator will give you all the required data to follow any of the insulin dosing strategies above.

People who have used it so far have found it beneficial.

image009

image010

An example screen grab from the calculator is shown below with the explanation of inputs and outputs following.

image013

inputs

  • If you are using a manufactured food product in a packet you can simply use the nutritional details per serve (protein, fat, carbohydrates) and then factor for the number of serves.
  • If you are in the US you will need to enter the total carbohydrates and fibre values. If you’re in the UK or Australia you don’t need to enter the fibre as it is already subtracted from the carbohydrate count.
  • The protein multiplier is based on the food insulin index testing in non-diabetic people, [9] however you can modify this if you want, based on your own trial and error testing. The analysis of the quantity of amino acids (as detailed in the article the insulin index v2) suggests that this value is unlikely to exceed 80 to 90%.
  • A default carb to insulin ratio of 22 has been used, however you can enter yours from your pump or calculate it based on this article.  [10]
  • You can enter your bolus insulin on board (BoB) which will be subtracted from the carbohydrate insulin dose.

outputs

  • The first line of the outputs is the percentage of insulinogenic calories. As a reference keep in mind that a whole egg is about 25% insulinogenic calories.  A high percentage of insulinogenic calories is not ideal for people with diabetes and insulin resistance.  It may be helpful to select nutritious foods with a low insulin load from this list.
  • The insulin load is calculated using the following formula (i.e. for both carbohydrates and protein).

image015

  • The percentage of glucose from carbohydrate could be used if you were going to split your dose into an initial bolus for carbohydrates with a separate bolus for protein. This value can be entered into your pump if you’re using a dual wave bolus, with the protein bolus typically given over a longer period.
  • You can use the grams of carbohydrates or the quantity of insulin for the carbohydrates and the protein if you’re using separate boluses.

meals

If you are following the meals from the blog you will notice that the net carbs, total insulin load and percentage of insulin for carbohydrates have been included in a table at the end of each recipe assuming a standardised 500 calorie meal.

our experience

Moni has experimented with dosing separately for the protein component of the meal, however it typically turns out that her blood glucose has risen by the time she doses for the protein.  It seems that for her, the glucose from the protein (via gluconeogenesis) hits her bloodstream quickly and hence delaying the dose for protein is not appropriate for her.

We are also trying to focus on a handful of nutrient dense meals with pre-determined insulin doses.  The table below shows the insulin required for a 500 calorie serving for a range of meals.  All of these have limited carbohydrates and the insulin dose for the protein is greater than the carbohydrate dose.  I have provided hyperlinks to some of the meals that are already published on the blog.

If you can’t handle the thought of weighing and measuring and then calculating the insulin dose for everything you eat, as a ‘rule of thumb’ all of these meals require dosing as if they were about 20 to 25 grams of carbs.  If you are choosing meals with a low insulin load then the insulin dosing for food ends up representing only about 20% of the daily dose.

meal

carbs (g)

protein (g)

 insulin load (g)

bacon, eggs, avocado and spinach

4

15

19

spinach and cheddar scrambled eggs

6

18

24

steak, broccoli, spinach, haloumi

6

20

26

coffee with cream and stevia

1

1

2

chia seed pudding – no fruit

7

4

11

broccoli, bacon, cream and mozzarella

3

17

20

sausages, avocado, sour cream, tomato

7

13

20

bacon, eggs, spinach and pesto

4

16

20

bacon and eggs

3

18

21

bacon, eggs, avocado and sauerkraut

5

21

26

fathead pizza with anchovies and pesto

4

13

17

bacon asparagus and eggs

3

18

21

For us, this approach combines a number of aspects from the various approaches discussed above:

  • all of these meals having less than 12g of carbs as recommended by Bernstein,
  • calculated insulin dose for both protein and carbohydrates,
  • nutrient dense meals, and
  • relatively low percentage of insulinogenic calories (i.e. high fat meals) meaning that the overall insulin dose stays relatively low.

We’re all on a journey.  I hope this helps you move towards finding a strategy that is optimal for you.

References

[1] http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70144-X/abstract

[2] http://www.medpagetoday.com/Endocrinology/Diabetes/42610

[3] http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70144-X/abstract

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

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

[6] https://optimisingnutrition.wordpress.com/the-insulin-index/

[7] https://optimisingnutrition.wordpress.com/?p=2637

[8] http://www.amazon.com/T-A-G-A-Diabetic-Food-System/dp/0688084583

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

[10] http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7303

the Goldilocks glucose zone

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

background

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

the Goldilocks glucose zone

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

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

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

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

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

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

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

Not too hot.  Not too cold.

Not too hard.  Not too soft.

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

the safe starches debate

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

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

the case for limiting carbohydrates

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

1. Non-fibre carbohydrates are:

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

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

natural glucose utilisation level

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

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

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

image001

some perspective

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

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

image003

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

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

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

minimum carbohydrate requirement

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

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

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

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

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

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

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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]

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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/

carbohydrates, protein, type 1s and canaries

Quantification of insulin demand is of particular interest for type 1 diabetics who have to inject insulin to manage their blood sugars.

Insulin_Application (1)

Before diagnosis, a type 1 diabetic whose pancreas is failing will have extremely high blood glucose levels and lose weight fast because they can’t access the sugar that they’re eating without insulin.

type-1-diabetes (1)

Without insulin the body kicks into (what some call a backup survival mechanism) ketosis which is where the body uses fat for fuel rather than sugar from dietary carbohydrates.

When combined with very high levels of blood glucose, this scenario is called diabetic ketoacidosis and can be a life threatening if left untreated.  This is rare though and only occurs in type 1 diabetics.

After commencing insulin therapy the diabetic regains weight.  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 three months after starting insulin injections.

Some type 1 diabetics injecting with needles will get localised hypertrophy where they inject their insulin, particularly if they don’t rotate their injection sites and / or are on a lot of insulin.

Though not recommended for health, some body builders will inject insulin in conjunction with their workouts to maximise muscle growth (warning: insulin promotes both fat and muscle growth).

Another example of how insulin affects body fat is the fact that children born to diabetic mothers are much heavier due to the the insulin circulating in the mothers’ blood stream.   The photos below show my two kids at birth (my wife is a type 1 diabetic and had good control through her pregnancies)…

jazmine-anouncement

snug as a bug

…and now on a high fat diet.

10897891_10152568650940544_4242356593267053071_n

It’s a bit hard to argue the calories in / calories out theory saying that the in-utero kids should better manage their portion sizes and exercise more!

Carbohydrates raise blood sugars and insulin works to remove the sugar from the blood to store as fat.  In practice it’s impossible to perfectly match the insulin action with the rate of carbohydrate digestion.

While type 1 diabetics are an extreme case, they can be considerd the “canary in the coal mine” of weight maintenance and metabolic health.  To some extent everyone’s body is working to balance the effect of carbohydrates and protein driving up blood sugar and with the pancreas secreting insulin to bring the blood sugar back down.

One thing that’s not well understood is how type 1 diabetics should deal with protein.  Conventional wisdom is that type 1 diabetics should dose with about half the insulin for protein containing foods, however the basis of this is not clear.

With the food insulin index data now maybe we can better understand the insulin requirements of protein containing foods?

[next article…  protein and the foods insulin index… Atkins versus the vegans]

[this post is part of the insulin index series]

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

food insulin index

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

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

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

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

foods that require the least insulin

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

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

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

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

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

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

Unfortunately, things get a little more complex once we move away from foods that contain more than just fat.

[next article…  latest food insulin index data]

[this post is part of the insulin index series]

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

References

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

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

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

the most ketogenic diet foods

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

food insulin index

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

insulinindex

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

FII versus time chart.jpg

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

more food insulin index data

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

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

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

food insulin index - fresh start 9052016 52737 AM.bmp

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

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

food insulin index - fresh start 9052016 52727 AM.bmp

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

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

insulin load = total carbohydrate – fibre + 0.56 x protein

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

image016

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

insulin load, the common denominator

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

image02

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

insulin load = total carbohydrate – fibre + 0.56 x protein

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

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

possible applications

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

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

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

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

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

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

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

the most ketogenic foods

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

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

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

2016-07-06 (11)

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

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

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

image02

 

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

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

eggs

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

 Fried-Egg-Wallpaper-5

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

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

dairy

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

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

cheese

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

milk and cream

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

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

yoghurt

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

greek-yogurt

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

fruit

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

spanish-olives

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

vegetables

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

vegetable-03

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

nuts and seeds

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

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

seafood

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

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

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

animal products

7450703_orig

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

optimal foods for different goals

We can prioritise the foods we eat using the sometimes competing parameters of nutrient density, insulin load and energy density to suit out individual goals and current metabolic health.

2016-07-06 (11)

Click on the links below to see the optimal foods for each goal, or read on for an overview of the system.

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

insulin load

Insulin is an important hormone that helps us to regulate growth and energy storage as well as fat loss and cellular repair.  However too much insulin, due excess processed foods or insulin resistance can be a problem.

While many people go low carb to reduce their insulin levels,  as you can see from the plot of carbohydrates versus insulin index below, carbohydrates only tells us part of the story.

image11

Carbohydrates minus fibre plus about half of the protein we eat provides a better estimation of the insulin demand of our food.

image02

We can use this understanding to prioritise foods that will require more or less insulin for:

  • growth and bulking, or
  • fat loss, autophagy and normalisation insulin levels.

nutrient density

The problem is, the foods with the lowest insulin load are refined oils and fats which typically don’t contain a large amount of essential nutrients (i.e. vitamins, minerals and amino acids).

Maximising the nutrient density of the foods we eat is important for a wide range of reasons.  Ideally, to minimise cravings and maximise satiety, we want to maximise the nutrients per calorie of the foods we eat (i.e. nutrient density).

Nutrient dense foods are typically whole foods that have been subjected to minimal processing.

We  can quantify nutrient density by comparing the amount of essential nutrients in a food to the rest of the foods available and adding up all these scores for the essential vitamins, minerals, amino acids and fatty acids.  We can then refine this approach to only prioritise the nutrients that are harder to obtain.

This chart shows the difference that focusing on the most nutrient dense foods can make compared to other approaches

2016-07-14 (2)

energy density

Lastly, less energy dense foods (i.e. foods that contain more fibre and water and less fat) help us to feel full with less energy and help us to use our own body fat for fuel.  Low energy density foods are also typically more nutrient dense.  Focusing on foods with a lower energy density can be particularly helpful if we already have great blood glucose levels but still have more fat to lose.

which approach is right for me?

The focus of the system is to help you find the foods that will help you maintain great blood glucose levels while maximizing nutrient density.  The right approach for you will depend on your current metabolic health and weight loss goals.  In the end we want to ingest adequate energy while avoiding malnutrition and ideally maintain normal insulin and blood glucose levels at the same time.  energy-density-vs-nutrient-density

Simply minimising insulin load is great if you have a chronic health condition such as cancer, epilepsy or dementia that will benefit from a therapeutic ketogenic approach.  Someone with very high blood glucose and insulin levels may also benefit from a therapeutic ketogenic approach as they adapt.  However in time, as blood glucose levels improve, you will ideally be able to transition to more nutrient dense dietary approach.

The table below gives some guidance on which nutritional approach would be ideal based on your average blood glucose levels and your waist to height ratio.

approach

average glucose

waist : height

(mg/dL)

(mmol/L)

therapeutic ketosis

> 140

> 7.8

diabetes and nutritional ketosis

108 to 140

6.0 to 7.8

weight loss (insulin resistant)

100 to 108

5.4 to 6.0

> 0.5

weight loss (insulin sensitive)

< 97

< 5.4

> 0.5

bulking

< 97

< 5.4

< 0.5

nutrient dense maintenance

< 97

< 5.4

< 0.5

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

 

ketosis… the cure for diabetes?

  • A reduced insulin load diet will lead to normalised blood sugars and improved insulin sensitivity.
  • A reduced insulin load diet can be achieved by reducing carbohydrates, moderating protein and choosing higher fibre foods.
  • Intermittent fasting also reduces insulin load.
  • Measuring your blood sugars is a simple and cost effective way to check that your metabolic health is on track.
  • A diet of nutrient dense, high fibre, high fat foods is the best way to optimise nutrition and minimise the risks associated with diabetes.

how to become diabetic…

In the “good old days” there were periods of feast and famine.  Food was typically eaten with the fibrous packing that it came with. In today’s modern food environment we are encouraged by the food industry (and those sponsored by it) to eat breakfast, lunch, dinner, snacks, pre-workout meals, post workout stacks, sports gels during exercise, and maybe some Gatorade to speed recovery.

Today’s food is plentiful, typically highly processed and low in fibre.  Carbohydrate and sugar based foods have a long shelf life, can be transported long distances and therefore cheap. Win, win?  Maybe not.

As we keep loading our bodies with simple sugars and carbohydrates our pancreas has to work overtime to produce insulin to shuttle excess sugar from the blood to your fat stores.

AVPageView 23042015 33836 AM.bmp

Over time we become insulin resistant and the pancreas can’t keep up. Once your blood sugars get high enough you will be diagnosed with “type 2 diabetes” and put on medication to improve your insulin sensitivity, for a time. If nothing changes in your food intake your insulin sensitivity will continue to deteriorate until you reach a point when you’ll need to inject insulin to keep your blood sugars down.

Injecting excessive amounts of insulin will cause you gain even more body fat. Recently we have learned that it’s not just the high blood sugars that are diabolical for your health, high levels of insulin are also toxic. [1]

Doesn’t sound like much of a solution does it?

…and how to reverse it

While there are many aspects to managing diabetes including stress, sleep, food quality and environmental toxins, the simplest and most effective thing you can do to achieve optimal blood sugars is to do the opposite of what caused the problem in the first place.

Listed below are the main things that cause diabetes and what we can do to reverse it.

leads to diabetes reverses diabetes
Excessive sugar and simple carbohydrates in the diet generate high insulin load Reduce foods in your diet that require insulin [2]
Constant food with no significant periods between meals when insulin levels are reduced Create periods when your body does not have significant amounts of circulating insulin (i.e. intermittent fasting).

Sounds simple.  But it’s not easy or quick to reverse years of metabolic damage.   Your body is hard-wired to retain fat so it can survive the next famine.

Worth the effort?  People who have done it say yes.  That’s why they’re so annoyingly passionate about it!

Remember the type 1 diabetic roller coaster blood sugars in the last post?  The CGM plot shows the blood sugars of the same person a few months later on a low insulin load diet. [3] [4] [5]

image004 - Copy

foods that require insulin

You’re likely already aware that foods containing carbohydrates require your pancreas to produce insulin.

Recently I stumbled across some recent food insulin index test data [6] that indicates:

  • protein requires about half as much insulin as carbohydrates per gram on average, [7] and
  • carbohydrates in the form of indigestible fibre do not require insulin. [8]

So if you’re trying to reduce the insulin load of your diet you should:

  • limit simple processed carbohydrates that do not contain fibre,
  • choose high fibre foods (such as non-starchy vegetables) to obtain vitamins and minerals while keeping net carbohydrates low, and
  • back off on the protein if you’re not achieving the normalised blood sugars, weight loss or nutritional ketosis results you’re after.

insulin load

Rather than simply counting carbs, you could get a bit fancy and calculate your total insulin load using this formula:

Microsoft Word Document 25032015 45826 AM.bmp

Most people will achieve nutritional ketosis with an insulin load of around 100 to 150 grams. Athletes and weight lifters will be able to tolerate more without messing up their blood sugars.  Inactive people aiming for weight loss may need to reduce their insulin load further. I don’t think that it’s ideal for most people to weigh and measure their food for extended periods.

If you’re not getting the results you want then tracking your food in MyFitnessPal or something similar can be a useful in the short term to retrain your dietary habits.

measuring for ketones versus measuring blood sugar

Once you get over seeing a little drop of your own blood, measuring your own blood sugar is pretty simple and painless, and is much cheaper than measuring blood ketones. In Australia and Canada blood sugar strips are about $0.16 compared to blood ketone strips which are about $0.80. [9]  In the US ketone strips are much more expensive, and basically unaffordable. Ketostix (which measure ketones in your urine) will typically only work for a little while until your body learns to use fat for fuel.

relationship between blood sugars and ketones

Blood sugar can be a useful way to see if you’re in ketosis. The chart below shows my blood sugars versus ketones over the last nine months or so that I’ve been trying to achieve nutritional ketosis.

tracking BGs [Last saved by user] 16042015 82501 AM.bmp IMG_7191

Based on my n=1 experience I’ve added the ketone levels which correlates HbA1c, average blood sugar and ketones.  This suggests that excellent blood sugar control for me is achieved when I’ve got ketone levels between 0.5 and 1.3mmol/L.

HbA1c average blood sugar ketones
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1
optimal 4.5 4.6 83 1.3
excellent < 5.0 < 5.4 < 97 > 0.5
good < 5.4 < 6 < 108 < 0.3
danger > 6.5 7.8 > 140 < 0.3

is more ketosis better?

The point way out to the right with a high ketone level of 2.1mmol/L and a blood sugar of 4.0mmol/L occurred after I cycled to work two days in a row on Bulletproof Coffee with a good amount of MCT oil.

In The Art and Science of Low Carbohydrate Performance [10] Volek and Phinney say that “light nutritional ketosis” occurs when blood ketones are between 0.5mmol/L and 1.0mmol/L and “optimal ketosis” is between 1.0mmol/L and 3.0mmol/L.

Based on the fact that an optimal blood sugar corresponds to a ketone reading of 1.3mmol/L and the low end of healthy normal blood sugars corresponds to a ketone reading of 2.1mmol/L I wonder if there is really any value in aiming for higher ketone values?

It’s interesting to note that Sami Inkenen, when rowing from the US to Hawaii on an 80% fat diet, [11] [12] was only getting ketones of around 0.6mmol/L [13]. If you’re striving for mental focus then loading up with butter, coconut oil and MCT oil to jack up your ketones might be for you.

If your aim is exercise performance or fat loss then ketones between 0.5mmol/L and 1.3mmol/L might be all you need to aim for. I also think loading up on dietary fat at the expense of getting adequate protein, vitamins and minerals may be counterproductive in the long term.

On the other end of the argument though, if you have good control of your blood sugars you should be showing some level of ketones in your blood.  If you consistently measure at a ketone value of less than 0.2mmol/L then it’s likely your blood sugar is not yet optimal.

what to do?

If you find this interesting and want to experiment I recommend that you buy a blood glucose metre and track your blood sugars for a while. I enter my results into a spreadsheet and look at the average of the past twenty results.

You can adjust your insulin load (i.e. less carbs, more fibre, moderate protein) until you achieve your target blood glucose level. As you test you’ll also notice that some foods cause your blood sugars to rise more than others.  Make sure you scratch those off your “do again” list.

You might also notice as you get your blood sugars under control you will get a metallic taste in your mouth, stronger smelling urine or a different body odour.  These are all signs that you’re transitioning into ketosis.  These symptoms typically don’t last for too long. If at first you don’t succeed, throw in some intermittent fasting.  I use bulletproof Coffee [16] to help me skip breakfast and sometimes lunch a couple of times a week.

Intermittent fasting is more effective than constant calorie restriction which can cause your metabolism to slow down due to conserve energy for the famine it thinks is coming. [17] [18] Having extended periods when insulin levels are low allows your body to learn to use body fat for fuel.

Once you begin to reset your insulin sensitivity you might start to notice a lack of inflammation and puffiness.  You may also find that you’re finally losing that stubborn weight and breaking through that dreaded plateau.  You may notice you feel great and your head is clearer than it’s been for a long time.  Or that that may just be my experience.

physiological insulin resistance

Some people find that as they reduce their carbohydrates that their fasting blood sugars will drift up.  This has been termed ‘physiological insulin resistance’ and is where the body develops a level of insulin resistance in the muscles to prioritise glucose for the brain. For some people this can be a transitionary phase on the way to stable ketosis.  It’s not thought to be something to be concerned about as it doesn’t cause elevated levels of insulin which is what can be really detrimental.

However some type 1 diabetics find it to be an issue long term and choose to increase the carbohydrates and protein in their food so they are just outside nutritional ketosis to reduce this effect.

My experience is that during this phase my post meal blood sugars were great even though the fasting blood sugars were higher than optimal.  As I continued to persist with more fat and added some intermittent fasting this went away and I was able to achieve lower fasting blood sugars.

Particularly during this time it is important to keep an eye on your average blood sugar (i.e. both fasting and after meals) and make sure it’s under 5.4mmol/L (100mg/dL).

can you eat too much fat?

It’s good to see medical researchers [19] and the media [20] coming out and admitting that the fear of fats over the past 30 years has led to diabolical health outcomes.

The fear of fat has forced people to eat more simple carbohydrates which has led to the diabetes epidemic. I analysed a number of dietary scenarios to see if there is any truth to the fear that low carbohydrate diets do not provide adequate nutrition and that you need your “heart healthy whole grains” to achieve optimal health, provide enough sugar for the brain, support growth in children etc. While a grain-based diet can be cheaper, my analysis suggest that a high fat diet that focuses on high fibre, high nutrient density, non-starchy vegetables is better in terms of the nutrition it provides and managing insulin demand.

The optimal diet to balance vitamins and minerals, amino acids and insulin load appears to contain between sixty and eighty percent calories from fat. It is possible to meet the recommended daily intake for most vitamins and minerals with 80% of calories coming from fat.

At the other end of the scale, higher levels of carbs may leave you storing more fat than you want to due to high insulin levels.

which foods are optimal?

What foods are optimal?  It all depends on your unique situation, goals and even finances.

I have developed a system to prioritise food choices based on the insulin properties of various foods as well as a range of other factors including:

  • nutrient density per calorie,
  • fibre per calorie,
  • nutrient density per dollar,
  • calorie density per weight, and
  • calories per dollar.

The list of foods below is a summary of the highest ranking foods using the weighting shown below in order to identify low insulin, high nutrient density food choices will lead to improved blood sugar control, mood, mental clarity, weight loss and overall health.

ND / calorie fibre / calorie ND / $ ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 5% 5% 10% 50% 10% 5%

Next time you’re wanting a nutritious meal that will push you into ketosis or lower your blood sugars you could consider some of these foods.

I’ve also developed this ‘cheat sheet using this approach to highlight optimal food choices depending, whether they be reducing insulin, weight loss or athletic performance.   Why not print it out and stick it to your fridge as a reminder of your optimal foods or to inspire your next shopping expedition?

vegetables

  • turnip greens
  • coriander (cilantro)
  • rosemary
  • spinach
  • parsley
  • peppers / capsicum
  • chives
  • mustard greens
  • collards
  • mushrooms
  • Swiss chard
  • artichokes
  • broccoli
  • Brussel sprouts
  • kale

fats and oils

  • butter
  • coconut oil
  • olive oil
  • fish oil
  • flaxseed oil

fruits

  • avocados
  • olives

eggs & dairy

  • whole egg
  • goat cheese
  • goat cheese
  • parmesan cheese
  • cheddar
  • cream
  • camembert
  • feta
  • cream cheese
  • blue cheese
  • Colby cheese
  • Swiss cheese
  • edam cheese
  • brie
  • gouda
  • mozzarella
  • ricotta
  • cottage cheese

nuts & seeds

  • brazil nuts
  • sunflower seeds
  • pecans
  • pumpkin seeds
  • almonds
  • macadamia nuts
  • pine nuts
  • coconut milk
  • coconut meat
  • pistachio nuts
  • cashews

animal products

  • organ means (liver, kidney, heart etc)
  • chorizo
  • bratwurst
  • herring
  • chicken
  • frankfurter
  • mackerel
  • duck
  • beef sausage
  • bacon
  • turkey
  • anchovy
  • ground beef
  • lamb
  • bologna
  • turkey
  • beef steak

In the next article we’ll look at which foods are optimal for weight loss by prioritising low calorie density, high fibre high nutrient density foods that will also help stabilise your blood sugars.

references

[1] https://www.youtube.com/watch?v=4oZ4UqtbB_g

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

[3] http://www.diabetes-book.com/

[4] https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag

[5] https://www.facebook.com/Type1Grit

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

[7] Some anecdotal evidence and studies such as http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342171/pdf/IJE2015-216918.pdf indicate that it’s the protein in excess of the body’s needs for muscle growth and repair that gets turned to glucose and requires insulin.

[8] http://healthyeating.sfgate.com/indigestible-carbohydrates-1023.html

[9] http://www.ebay.com.au/itm/BEST-PRICE-10-X-ABBOTT-FREESTYLE-OPTIUM-KETONE-TEST-STRIPS-10-TOTAL-100-STRIPS/181527585627?_trksid=p2054897.c100204.m3164&_trkparms=aid%3D222007%26algo%3DSIC.MBE%26ao%3D1%26asc%3D20140407115239%26meid%3Db2cedda776824d9f8ed5d131a3232ea7%26pid%3D100204%26rk%3D3%26rkt%3D24%26sd%3D281508543955

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

[11] https://gumroad.com/l/CK219

[12] http://www.fatchancerow.org/

[13] https://twitter.com/samiinkinen/status/451089012166385664

[14] https://www.facebook.com/ketogains

[15] https://www.facebook.com/ketogains

[16] https://www.bulletproofexec.com/bulletproof-fasting/

[17] https://www.youtube.com/watch?v=4oZ4UqtbB_g

[18] http://www.bodybuilding.com/fun/drsquat6.htm

[19] http://www.touchendocrinology.com/articles/nutrition-revolution-end-high-carbohydrates-era-diabetes-prevention-and-management [20] http://time.com/2863227/ending-the-war-on-fat/

[21] https://www.dropbox.com/s/h0zd5pjgw0gfqgq/Appendix%20D%20-%20Nutritional%20analysis%20of%20typical%20diets.docx?dl=0

[22] https://www.dropbox.com/s/ninuwyreda0epix/Optimising%20nutrition%2C%20managing%20insulin.docx?dl=0