Tag Archives: ketogenic diet

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

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

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[yes, I may be a Robb Wolf fan boy.]

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

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

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

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

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

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

OFT in the wild

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

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… gone to extraordinary lengths to obtain energy dense honey …

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

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OFT in captivity

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

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

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

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

 sweet = good = energy to survive winter

But now we have entered a brave new world.

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These days we have are surrounded by energy dense hyperpalatable foods that are designed to taste good without providing substantial levels of nutrients.

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When these foods are available our primal programming leaves us defenceless.

Our willpower or our calorie counting apps are no match for engineered foods with an optimised bliss point.

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

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

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

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

what happens when we go low fat?

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

Sounds logical, right?

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

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

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

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Maybe a little too well.

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

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

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

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

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

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

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


what happens when we go low carb?

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

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

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

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

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

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

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what happens when we go paleo?

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

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Well, maybe.  Maybe not.

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

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

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

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

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

enter nutrient density

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

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

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

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

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

optimal rehabilitation plan?

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

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

the solution

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

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

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

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

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

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

survey

I hope this helps.

Good luck out there!

references

[1] http://ketosummit.com/

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

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

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

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

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

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

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

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

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

At first it sounds like a bizarre food combination, but when the smartest guy in the room says that he has sardines, oysters, eggs and broccoli as his regular breakfast I wasn’t surprised to find that it scored highly in the nutritional analysis.

Before he started saving the world by progressing Warburg’s mitochondrial theory of cancer and oxygen toxicity seizures for DARPA Dominic D’Agostino studied nutrition and is rumoured to have done some bodybuilding.

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

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

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

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

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

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

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

“Do you blend that up in the Vitamix?”

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

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

net carbs

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

6g

oyster20at20ettas

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

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

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

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The ranking for the sans-oyster option is:

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

The stats for a 500 calorie serving are:

net carbs

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

6g

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

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

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

mackerel and celery

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

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

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

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

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

net carbs

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

6g

 

 

 

 

keto chocolate cake in a mug

This keto chocolate cake in a mug is another from Craig Clarke’s Rule.Me site.

This yummy looking dessert is certainly keto at only 4g net carbs due to the high amount of fibre in the coconut, almonds and cocoa.

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Unsweetened cocoa powder is a packed full of minerals and well worth trying to seek out when you have chocolate cravings.

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net carbs

insulin load carb insulin fat protein

fibre

4g 13g 34% 81% 9%

9g

Antonio C. Martinez II’s type 2 diabetes reversal

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

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

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

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

type 2 diabetes diagnosis

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

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

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

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

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

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

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heart attack!  

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

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

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

reduced carbohydrate approach

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

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

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

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

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tackling dawn phenomenon  

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

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

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

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

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

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

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

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

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

HbA1c

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

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ketones

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

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

glucose : ketone index

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

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

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

no turning back?

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

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

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

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

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

Antonio says:

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

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

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

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

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

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… Brussell sprouts salad…

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..some pate…

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…and Le Côte de Beouf.

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

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

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

cured?

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

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

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

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

Congratulations Antonio and keep up the great work!

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

references

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

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

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

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

contact

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

Fine tuning your diet to suit your goals – Darth Luiggi

It looks like Luis Villasenor is doing something right.

Luis (aka Darth Luiggi who runs the Ketogains Facebook Group) has been on a ketogenic diet for more than 14 years!

Here are a couple of video interviews where Luis explains his approach.

He is also very active in coaching the more than 7000 Ketogains members on his Facebook group and Reddit.

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Recently I was able to get a look at a few days of Luis’s food diary on My Fitness Pal so I thought it would be interesting to run some numbers on his diet.

My focus of the blog has been on optimising diet for diabetes management, however I wanted to also demonstrate that a nutritious low insulin load diet is also great for health and fitness.

The analysis below shows the combination of three meals.  Along with plenty of protein (beef, chicken, egg, pork) he also has a solid amount of vegetables (broccoli, lettuce and spinach) as well as a good amount of added fats (butter, olive oil and coconut oil) to maintain ketosis.

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The nutritional analysis of these three meals is shown below.  As you would expect from the dude who runs Ketogains, the carbs are low at 5% with the protein being fairly substantial at 29% of daily calories.

The protein score is excellent with 145% of the RDI being met with 1000 calories and 58% of the RDI for vitamins and minerals being met with 1000 calories.

A score of 100 means that you will meet the recommended daily intake (RDI) for all the nutrients with 1000 calories, as discussed in the previous ‘the most nutrient dense food for different goals’ article.

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The table below shows how Luis’s diet stacks up based on the nutritional ketosis weighting.

At 26g of fibre per day his fibre score is solid but not high compared to the other meals analysed.  His calorie density is high but that isn’t a big issue given that he is already fairly lean.

The insulin score is not extremely high as there is a solid amount of protein and he’s not worried about diabetes or achieving therapeutic ketosis.

The vitamin and mineral score is the one area that could be improved, though it is better than average.

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As you will hear on the videos, Luis is already a big advocate for leafy greens as an integral part of a ketogenic diet.

If we did want to improve the vitamin and mineral score we could simply add extra spinach and broccoli (or any of the nutrient dense veggies from this list).

I’ve dropped the lettuce (which is not as nutrient dense) and increased the broccoli and spinach so we have 400g of each across the three meals.

The resultant nutritional analysis for the revised food diary is shown below.  The nutrient balance score has increased from 58 to 70 and we’d only have 8g of net carbohydrates per meal in spite of the significant increase in vitamins and minerals.

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With the increase in non-starchy veggies we increase the fibre intake from 26g to 40g across the three meals which would mean that he would now meet the recommended daily fibre intake of 30g per day for men.

The other advantage of this approach is that it would be more filling which may lead to a decreased overall calorie intake.  While Luis knows the power of a ketogenic diet for weight loss he also knows that to get such a low percentage body fat you also need to run in a calorie deficit and this approach may assist in naturally controlling appetite and satiety.

He is currently in a ‘cutting phase’ which is why he is tracking his food intake in My Fitness Pal, so reducing his calorie density and increasing fibre might help him to spontaneously achieve a reduction in overall energy intake.

If you’re interested in using the ketogenic diet as part of a bodybuilding routine I would definitely recommend checking out Ketogains.  Even though he looks tough with all those muscles he’s really polite, gracious and only too willing to help other people on the journey.  And regardless of your goals, Luis’s Ketogains calculator is an excellent tool if you want to calculate your macros or target grams of protein, fat and carbs.

what is a ‘well formulated ketogenic diet’?

While everyone uses fat for fuel to some degree, a ketogenic diet aims to reduce insulin levels to a point where ketone levels are high enough to be measured in the blood, breath or urine. [1]

In starvation, insulin levels plummet with glucose levels coming down and ketone levels increase progressively.

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According to Dr Steve Phinney’s chart below, [2] a “well formulated ketogenic diet” (WFKD) contains between 3 and 20% carbohydrates and between 10 and 30% protein.  Other dietary templates such as the Mediterranean or Paleo diets typically contain more carbohydrates and less fat.

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There is a lot of knowledge encapsulated into this chart, so I encourage you to take the time to digest it, or even better, take the 20 minutes to watch this video from the man himself.

The concern typically expressed about restricted carbohydrate diets is that they will not provide adequate nutrition (i.e. vitamins, minerals and amino acids).

Diabetics, along with the general population, are advised to eat in line with the USDA Food Pyramid / My Plate guidelines which emphasise “healthy whole grains” while discouraging saturated fat and cholesterol.

Diabetics are told that they should not deprive themselves of any foods or not to risk getting inadequate nutrition, but rather to “cover” any carbohydrates they eat with insulin (or treat with medications such as Metformin for type 2 diabetics).

Even in health circles ketosis is sometimes considered to be extreme and not worth the effort for most people, but is it really that hard to achieve?

When we look at the relationship between ketones, blood sugar and HbA1c we see that someone with excellent blood glucose levels will have a moderate amount of blood ketones.

The chart and table below are based on my tracking of blood sugars and ketone values.  Optimal blood (i.e. 4.6mmol/L) glucose corresponds to a ketone value of about 1.3mmol/L.

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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 > 0.4
good < 5.4 < 6.0 < 108 < 0.3
danger > 6.5 > 7.8 > 140 < 0.3

In view of this it’s hard to see why ketosis is extreme.  It’s just what happens when someone has reduced their dietary insulin load to a point where they are achieving excellent blood sugars!

Ketosis is a sliding scale.  Some people will want to push their ketone levels to therapeutic levels though fasting and a higher fat diet, but this may not be necessary for general health.

Most people would benefit from reducing their dietary insulin load to a point where their blood sugars are close to excellent.

See Diabetes 102 for more info on what your blood sugars should be and the Goldilocks Glucose Zone for more thoughts on how to manipulate your diet to get excellent blood glucose levels.

I am a big fan of Steve Phinney (I attended a masterclass with him when he was in Brisbane last year), but I think he potentially alienates people when he starts off talking about the Inuit and Steffanson living off all meat diets.

I also understand why the people generally might baulk at the idea of mainlining butter and MCT oil to drive up ketones.  “How can eating all that extra fat really be healthy?” they ask.

I propose an alternative sales pitch for ketosis:

  1. ketosis occurs when your blood sugars are close to optimal,
  2. blood sugars can be optimised by reducing the insulin load of your diet, and
  3. once you optimise your blood sugars you will reduce your hunger, access your body fat for fuel and a whole host of other health markers will improve.

What’s not to like?

What do you think?

[this post is part of the insulin index series]

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

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

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

Cereal Killers 2: Run on Fat

If you’re interested in restricted carbohydrate athletic performance you have to check out Run on Fat:  Cereal Killes 2.

Sami Inkinen is a a triathalete who realised he was becoming diabetic on his high carb diet of gels and sports drinks and switched to a restrict carb approach.

He then decided to row from LA to Hawaii with his wife (the equivalent of two marathons per day for 40 days) without any added sugars, just to prove it could be done.

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The intriguing subplot is the story of Steve Phinney, the dejected scientist that everyone shunned that may actually have the solution to diabetes and obesity.  But will anyone listen?

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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.

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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.

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[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.

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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

your personalised food ranking system

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

Mat Lalonde’s nutrient density

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

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

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

Aggregate Nutrient Density Index (ANDI)

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

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

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

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

Dave Asprey’s Bulletproof Diet

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

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

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

nutrient density per dollar

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

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

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

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

cost per calorie

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

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

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

nutrient density per calorie

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

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

fibre per calorie

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

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

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

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

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

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

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

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

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

practical application

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

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

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

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

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

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

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

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

weighting for blood sugar control and ketosis

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

references

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

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

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

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

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

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

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

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

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

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

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

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

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

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

optimal foods for weight loss

  • Prioritising foods that provide adequate nutrition with minimal calories increases your chances of achieving health, satiety and weight loss.
  • Weight loss can be achieved by eating high fibre, nutrient dense, low calorie density, low carbohydrate foods.
  • Eating more on days when you are active and less on low activity days will be more effective in the long term than monotonous calorie restriction.
  • Eating more fat than required for satiety you may not be giving your body a chance to burn body fat.

how to lose weight

Looking for a sure fire diet to lose weight, guaranteed?  Try eating this every day:

Breakfast

  • mushroom – 200g
  • spinach – 4 cups
  • artichoke – 120g
  • raspberries – 200g
  • pepper – 6g
  • parsley – 1 cup

Lunch  

  • collard greens – 2 cups
  • Swiss chard – 1 cup
  • turnip – 200g
  • steamed broccoli – 5 cups
  • Brussel sprouts – 16 oz
  • mung beans – 0.5 cups

Dinner

  • lentils – 3 cups
  • asparagus – 200g
  • mushroom – 200g

Will this meal plan lead to fat loss?  Yes.

Could most people do this in long term?  Probably not.

On first glance it doesn’t look like a ketogenic diet, however given that you probably couldn’t actually eat all that food in a day and you’d end up using so much of your own body fat it would probably be ketogenic.

This high fibre, high nutrient density low calorie density would require you to eat a massive four kilograms (nine pounds) of food a day to get 2000 calories.

The positives of this approach are:

  • extremely low calorie density,
  • extremely high fibre (150g per day compared to the average western intake of 17g per day),
  • extremely high nutrient density,
  • extremely filling, and
  • although 70% carbohydrates, the massive amount of fibre means the insulin load is only moderate, making it better for a diabetic than the typical western diet.

The negatives of this approach are:

  • without any fat in the diet you may not be able to actually absorb all the nutrition from the fat soluble vitamins A, E and K,
  • vitamin B, vitamin D, cholesterol and saturated fat are non-existent,
  • protein quality is only moderate without any animal protein, and
  • it may be hard to cook many of these foods without any added fats.

If you’re interested in a ketogenic diet you’re probably not going want to follow this sort of extreme vegetarian-style diet.  However there are a few things that we can learn from this approach that we could incorporate into a ketogenic approach.

high fibre, low calorie density

Eating high fibre, low calorie density foods will help to keep you full.  Non-starchy vegetables are bulky, contain a lot of water, fibre as well as lot of nutrients.

protein hunger

While counting calories will work over the short term, your body will win out over your mind and your iPhone app in the long term if you’re not giving it the nutrients it needs.

Recent research [1] suggests that we will keep eating until we get enough protein and eating foods low in protein leads people to eat more calories than they need.

Ensuring that you’re getting adequate protein (say 15 to 30% of calories) will cause you to be satiated with less calories.

nutrient hunger

In a similar way, if you’re not giving your body the vitamins and minerals it needs it will keep on seeking out more food.

In his Perfect Health Diet [2] Paul Jaminet notes that a nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to eliminating hunger and minimising appetite and eliminating hunger at minimal caloric intake.  

intermittent fasting

If you keep your calorie intake consistently low for an extended period of time your body will sense an impending famine and slow down your metabolism, leaving you tired, cold, depressed and miserable.

Don’t be afraid to mix it up a bit with restricted calories a few days a week by missing a few meals on low activity days and then eating to satiate your hunger on higher activity days.

In our current food environment we don’t give our body any time when it’s not awash with calories and insulin than enable your bodies to use our stored body fat for energy.

Eat when you’re hungry.  But conversely, don’t be afraid to not eat when you’re not hungry.

“Break-fast” is an important meal, even if it occurs at 3pm in the afternoon!

eat fat to lose fat?

The reason that eating a high fat diet leads to increased satiety is that your body can access your stored body fat.

In most people eating a ketogenic diet leads to greater satiety because you’re using body fat for fuel, which leads to a reduction in food intake.

Conversely if you are eating a diet full of simple carbohydrates your insulin levels will stay high and your body fat will be locked away.

When you lose fat, your body burns the saturated fat on your body.  If at first you don’t succeed by reducing your insulinogenic load and intermittent fasting consider cutting back your dietary fat intake to create a caloric deficit which will be filled by your body fat. [3]

Some people can eat massive amounts of fat while keeping carbs low and lose weight, [4] however others can lose their way on a LCHF or ketogenic diet by eating too much dietary fat and end up not getting the results they hoped for.

Jimmy Moore emphasis that you need to eat fat to satiety[5]  If you mainline dietary fat and are not hearing your natural satiety signals you’re not going to give your body the best chance to burn body fat.

insulin sensitivity

One of the most famous diet studies looking at low carb diets is Dr Chris Gardner’s A to Z Study. [6]  Gardner, a practicing vegan, was surprised to find that it was the Atkins dieters who lost the most weight in his study.

More interestingly though were the results of a follow-up analysis where he assessed peoples’ insulin resistance.  He found was that people who were insulin resistant lost the most weight on the low carb diet while the insulin resistant lost nothing on the higher carbohydrate diets. [7]

How do you know if you’re insulin resistant?  Your weight and waist line are pretty good indicators, but your average blood sugar is even better.  If you want to know what diet is right for you, pick up a blood sugar metre from your local chemist and do some testing.

If your average blood sugars are in the excellent range according to the values below then focussing on carbohydrates as your primary goal may not be ideal.

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

food choices for weight loss

We can use the food prioritisation system [9] to identify foods that align with these goals by prioritising nutrient density (20% weighting), fibre (10% weighting), and low calorie density (30% weighting).

ND / calorie fibre / calorie ND / $ ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 5% 20% 30% 10%

The resultant foods are listed below, in order of priority, using these weightings.

A few items that you would not generally expect to see on a ketogenic diet come to the top of the list such as lentils and mung beans due to their low calorie density, high fibre content and low cost.

This weighting system does not give a high priority to fats and oils as they are coming from the body fat stores.  The list of nuts and seeds is also quite short in view of their high calorie density.

I’ve also developed this ‘cheat sheet’ using this approach to highlight optimal food choices depending, wither they be reducing insulin, weight loss or athletic performance.   Why not print it out and stick it to your fridge as a helpful reminder or when you’re looking for some inspiration for your next shopping expedition?

vegetables & spices

  • spinach
  • chives
  • turnip greens
  • coriander
  • mushrooms
  • broccoli
  • Brussel sprouts
  • kale
  • artichokes
  • Bok choy
  • peas
  • kidney beans
  • lettuce
  • sweet potato
  • carrots
  • lima beans
  • seaweed
  • asparagus
  • celery

animal products

  • organ meats
  • oyster
  • herring
  • sardine
  • pork sausage
  • ham
  • chicken
  • pork
  • turkey
  • salmon
  • mackerel
  • anchovy
  • crab
  • lobster
  • trout
  • beef

fruits

  • avocado
  • olives
  • guavas
  • raspberries
  • kiwifruit

dairy

  • whole egg
  • egg yolk
  • ricotta cheese
  • parmesan cheese
  • feta cheese
  • milk

nuts, seeds & legumes

  • lentils
  • chick peas
  • mung beans
  • kidney beans
  • lima beans
  • coconut milk
  • peanut butter
  • peanuts
  • brazil nuts
  • coconut meat

fats and oils

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

example daily diet

Below is an example daily meal plan for someone wanting to lose weight by reducing calorie density and maximise nutrition using the prioritised list of foods above.  There’s nothing radical or objectionable here other than the high amounts of nutrient dense green veggies you need to eat in a day.  Some added fat is used for cooking.  There are no snacks and no calorie dense nuts and seeds.

image007

Using this approach we achieve great nutrition and protein scores along with an impressive 36g of fibre per day.

This approach involves eating nearly two kilograms of food which would leave you feeling quite full.

Although this diet is full of veggies it still has 60% of the dietary calories coming from fat.  If we ran a 1/3 calorie deficit in the early stages of a weight loss program we would have 73% of the calories coming from fat when your body fat is included.  This would very likely be ketogenic.

With the high amount of fibre, the net carbs are quite low at 44g per day which would still qualify as low carb diet.

If you find your blood sugars are unacceptably high you should consider backing off on the carbohydrate containing foods.   On the other hand if your blood sugars were excellent you could even consider increasing the non-starchy veggies to increase satiety and reduce the calorie density.

In our next article we’ll look at nutrient dense foods options that might work for you if your blood sugars are excellent and you’re doing intense exercise.

references

[1] https://www.youtube.com/watch?v=4ATDvhZQo4A&t=1677

[2] http://perfecthealthdiet.com/the-diet/

[3] http://livinlavidalowcarb.com/blog/tag/ron-rosedale

[4] http://live.smashthefat.com/why-i-didnt-get-fat/

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

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

[7] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3504183/

[8] https://www.facebook.com/BurnFatNotSugar

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