Tag Archives: low carb

which nutrients is YOUR diet missing?  

I recently took a look at which nutrients might be missing from various popular dietary approaches in preparation for a recent on nutrient density.  At a population level, the chart below shows the proportion of the US population that are deficient in various micronutrients.  Many people are not getting enough vitamin D, vitamin E, magnesium, calcium, etc.

While your body hasn’t read the World Health Organisation’s reports on the Daily Recommended Intake of the various essential nutrients,[1] it’s likely that your appetite will drive you to seek out the nutrients that are lacking.  If we are deficient in something that is required the body kicks in “nutrient hunger” and cravings that will make sure it gets what it needs.[2] [3] [4]

If you work hard to restrict your food intake to a certain dietary approach, but the body doesn’t receive the nutrients it needs, it may slow down and not function at full capacity.   By contrast, adequate nutrition, without too much energy, slows many of the modern diseases of aging such as diabetes, Alzheimer’s and cancer and improves your chance of living healthfully to a ripe old age.[5]

USDA foods database

The chart below shows the nutrients that are both easiest and hardest to obtain from the eight thousand foods in the USDA foods database.  At the bottom of this plot we have iron, various amino acids, and vitamin C, all of which are easy to obtain in adequate quantities.

However, at the top of the chart, we can see that it is much harder to obtain adequate quantities of six essential nutrients (omega 3 fatty acids, vitamin D, choline, vitamin E, and potassium).  We would obtain sufficient quantities of all the other essential nutrients if we ate just a little of each of the foods in the USDA food database.

If we want to maximise nutrient density, it makes sense to prioritise foods that contain more of the harder-to-obtain nutrients.  The chart below shows the nutrients for the top 10% of the 8000 foods in the USDA database (blue bars) when we prioritise for those.  Not only do we get an increase in the more difficult to obtain nutrients, we also get a massive boost in all nutrients.  Rather than being inadequate in six nutrients, we are now lacking only one (alpha-Linolenic acid, an Omega 3 fatty acid).

Limiting our food selection to the most nutrient dense foods makes it easier for us to consume the required nutrients without excessive energy, which is ideal if we are trying to lose fat or reduce calorie intake to slow the diseases of ageing.[6] [7]  Nutrient density becomes even more important if you’re fasting or restricting calories to achieve long term weight loss.

Optimising nutrient density

If you’re reading this, then you’re likely aware that there is a wide variety of dietary approaches that people follow to optimise their health depending on their preferences and beliefs.

I’ve tried to turn many of these beliefs about nutrition into a quantitative algorithm that we can use to evaluate and compare these approaches, and make sure we’re getting the outcome we want (e.g. low insulin, blood glucose control, nutrient density, or low/high energy density).

After testing a number of options, the three quantitative parameters that I have found the three parameters that are most useful are:

  • insulin load,
  • nutrient density, and
  • energy density.

My aim in this post is to show how considering nutrient density can improve various dietary approaches, from therapeutic ketogenic, vegan, paleo, and low fat.   This post highlights which nutrients you will most likely be lacking with each of the different nutritional approaches, which foods you can use to fill these nutritional gaps, and perhaps which supplements you may need if you are still looking for some added nutritional insurance.

There’s been a lot of talk lately by Taubes[8] and Lustig[9] about how bad sugar and fructose are, but I think these nutritive sweeteners are just extreme examples of nutrient poor foods that are highly insulinogenic and energy dense.  At the other end of the spectrum, we have foods like liver, broccoli, and spinach.  Everything else is somewhere in the middle and will support or work against your goals, whatever they may be, to different degrees.

My aim here is to help you see where each of these foods sits on that continuum and use this information to help you refine your food choices to reach your personal goals.

Therapeutic ketogenic diet

Let’s start with the therapeutic ketogenic dietary approach.   I have previously noted that a number of the issues and concerns with the ketogenic diet seem to relate to being able to obtain essential nutrients rather than consuming excessive levels of fat.[10] [11] [12]  On one hand, I’m excited that the concepts of insulin load and percentage of insulinogenic calories have been helpful for people with chronic conditions such as epilepsy, cancer, dementia, Alzheimer’s etc.  However, I think there is a risk their ultra-high fat diet will not contain the nutrients which are critically important for mitochondrial function and energy production.

The chart below shows the vitamins and minerals provided by a therapeutic ketogenic dietary approach if we simply prioritise for low insulin load (red bars)[13] in comparison to the average of all foods in the USDA database (orange bars).  If you don’t pay attention to nutrient density a therapeutic ketogenic diet can provide lower levels of nutrition.

As shown in the chart below if we ate a little of all the foods in the USDA database, we would be deficient in six essential nutrients, whereas if we follow a therapeutic ketogenic diet, we will likely be lacking in ten essential nutrients.

The chart below shows the effect of how thinking in terms of nutrient density can improve the therapeutic ketogenic dietary approach (blue bars) compared to prioritising for insulin load only (red bars).  All nutrients are boosted, particularly the harder to obtain ones.

While lots of people find that higher fat whole foods are hard to overeat, there are still some hyper palatable high fat foods that go down easily.  We talk about eating “fat to satiety”, but what happens when nutrient hunger kicks in and your body is craving more potassium, magnesium, calcium, or one of the other nutrients that are harder to obtain in a very high fat dietary approach?  If you keep on consuming large amounts of processed fats that don’t contain the nutrients you require, your appetite may not automatically turn off before you’ve consumed a lot of excess energy!

Low carb

The chart below shows the boost in nutrients when we consider nutrient density combined with a low carbohydrate approach.  It appears that, based on this analysis, that without a focus on nutrient density, a low carbohydrate diet is likely to be deficient in folate, vitamin D, choline, potassium, magnesium, pantothenic acid, calcium, vitamin E and manganese.  With a focus on nutrient dense foods, a low carb diet provides adequate amounts of the majority of nutrients.

Weight loss (insulin sensitive)

The weight loss approach is intended for people who are insulin sensitive but still have excess body fat to lose.  Foods with a lower energy density (e.g. spinach, broccoli cucumber, celery, lettuce etc) typically are harder to overeat because they are bulky.

This approach doesn’t pay any attention to insulin load because it is assumed that people using this approach are not insulin resistant and are able to maintain good blood glucose levels.  Practically, it’s also difficult to achieve a really high insulin load with these foods because they do not contain a large amount of processed carbs and are hard to overeat.

Without consideration of nutrient density, the essential fatty acids tend to be low along with vitamin B-12, choline, and tyrosine.  However, once we factor in nutrient density all these nutrients dramatically improve.

This approach may not be viable for long term maintenance due to the extremely low energy density which would make it hard to get in enough energy.  However, in the short term, it may be appropriate for a period of substantial energy restriction, and will provide maximum nutrition with a minimum amount of energy.

Zero carb

Getting adequate protein on a zero-carb approach is not a problem.  However, unless there is a major focus on organ meats, there are a large number of vitamins and minerals, such as   vitamin K, manganese, vitamin C, vitamin E, vitamin D, potassium, magnesium and calcium that may be worth supplementing.

Vegan

At the other extreme, the chart shows the nutritional analysis of the vegan diet.  The main deficiencies in a vegan approach are omega 3s and vitamin B-12, which are hard to obtain without animal products.  It may be prudent for vegans to consider fish oil supplementation and B-12 injections, or alternatively adding some seafood occasionally.

While it appears possible to obtain the recommended levels of protein, it’s hard to get very high levels of it.    If you are insulin resistant, the fat levels can be increased using added coconut products and nuts.

Higher insulin load foods for bulking

The bulking approach is designed for people who are looking to gain strength and size by combining nutrient density with more calories and insulin load.  Without consideration of nutrient density, a high insulin load means very low nutrient density foods.  However, once we factor in nutrient density, we get a range of highly nutritious foods that may be helpful if you want to gain size and strength, while still maximising health and nutrition.

Paleo

The chart below shows the nutrients provided by the Paleo approach (i.e. no processed foods, dairy or grains) both with and without consideration of nutrient density.  While ‘going Paleo’ eliminates many of the nutrient-poor processed food, it appears to be beneficial to also consider nutrient density as well in addition.

What does this all mean?

So, how do we decide which approach is best?  Unfortunately, it’s not straightforward so I’ll look at this a number of ways.

What we ideally want is to identify the foods that will provide us with high amounts of all of the nutrients.   The blue bars in the chart below represents the average of the % daily recommended intake of all the nutrients in the various approaches evaluated above, without considering nutrient density.  The orange bars represent the average minus 0.5 x the standard deviation which is a measure of reliability.  The higher the reliability the more consistent and high are the nutrients over all.

This chart shows that, in comparison to the other approaches, Paleo foods have a high and consistent level of nutrients; while the vegan and low energy density weight loss foods have high levels of some individual nutrients, but low levels of some others.  Without consideration of nutrient density, the high insulin, low carb and zero carb approaches are a bit lacking in nutrients.

Things become a little more interesting once we factor in nutrient density.  The vegan, therapeutic keto, low carb and zero carb approaches do poorly against the paleo, higher insulin load, most nutrient dense of all foods, and the lower energy density weight loss foods.

Many people will benefit on a high fat therapeutic ketogenic dietary approach, at least until their blood glucose and insulin levels normalise.  However, in time, it may be beneficial to transition to more nutrient dense foods to continue their journey towards optimal health.

As detailed in the ‘how to optimise your diet for insulin resistance’ article, I think you should eat the most nutrient dense foods your pancreas can keep up with while maintaining good blood glucose levels.  In time, someone who is highly insulin resistant may be able to progress to a more nutrient dense and more moderate fat approach if your ultimate goal is to normalise blood glucose levels and lose weight.

Food lists

If you identify with any of these goals, you may be interested in following these food lists.   If blood glucose levels are sky high or you are managing a chronic condition such as epilepsy, cancer, Alzheimer’s or dementia, you may benefit from a higher fat therapeutic keto dietary approach, for a period.  As your glucose levels come under control, you can transition to more nutrient dense foods that will also help you to achieve your weight goals.

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

Getting even more personal

As you can see, nutrients are provided at different levels depending on the approach.  However, most people don’t follow any dietary approach strictly, so the nutrients in your diet will be different depending on your personal habits and preferences.

Rather than trying to pick up someone else’s nutrition plan, or live by a strict list, I think it’s better to refine your current habits, emphasising the good foods, minimising the bad, and progressively trying new foods that may be beneficial.

To this end, I’ve been developing a Nutrient Optimizer algorithm that can help you refine your food choices to suit your goals.  By identifying the foods you are currently eating that align most with your current goals, which ones don’t, and which new foods perhaps you should consider.

Most current nutritional advice is driven by the avoidance of fat, particularly saturated fat, and therefore ends up being next to useless.  Calorie counting apps like MyFitnessPal does nothing but count calories, which is also of limited use.  Cron-o-meter tracks your micronutrients and can recommend foods to boost a single nutrient.  However, there doesn’t seem to be anything available that will tell you which foods will help you actually correct multiple deficiencies and  achieve a diet that is truly balanced in micronutrients.

The Nutrient Optimiser also allows you to tailor the approach to your goals, such as:  therapeutic ketosis, diabetes management, weight loss or just nutrient dense maintenance.  Food preferences like vegan, pescetarian, autoimmune, or paleo can be factored in to the recommended food lists.

At the moment, the process involves manually exporting food intake data from Cron-o-meter, then analysing it in a spreadsheet to manually generate a personalised report.  I am eager to do this as a proof-of-concept for a range of people with various goals (particularly therapeutic ketosis, vegetarian, zero carb, fruitarian) to demonstrate how it works.  So, if you’re happy to have your report shared publicly, and have a couple of weeks of Cron-o-meter data, feel free to send it to me and  have your data analysed.

In time, the plan is to automate the process via an online interface and then ideally an independent mobile app.    To keep up-to-date with progress, watch this space and check out the various analysed examples on the Marty Kendall’s Nutrient Optimiser Facebook page.

Epilogue…  limitations

For completeness, I thought it would be worth mentioning a few limitations relating to calculating nutrient density…

  1. Measuring foods in terms of calories has its own limitations as different macronutrients provide different amounts of energy (ATP) in different people. Some smart friends of mine are working on calculating ATP yield for different foods based on their macronutrient content.  I’ll happily update this analysis in terms of nutrients per ATP as soon as that data is available.  Initial indications are that people who are fat-adapted are able to use fat more efficiently (i.e. less entropy/losses in metabolism) and hence require less calories to yield the same amount of energy in the body (i.e. ATP).  Hence, it appears that it is even more important for someone following a low carb or ketogenic approach to maximise nutrient density in terms of nutrients per calorie.
  2. The official dietary reference values are based on limited research.[14] Typically, they relate to the minimum amount of a nutrient to avoid disease rather than the amount required for optimal function.  They may also vary by person (e.g. someone who is more active may need more protein) and by their diet type (e.g. someone who is on a low carb diet may need less vitamin C to process the limited amount of glucose).  Hence, I think the DRI values should be seen as a minimum.  Ideally, we want to get more than the minimum while not having to ingest too much energy.  I also don’t think nutrients are meant to come as individual vitamins and minerals in a bottle.  The nutrients required to metabolise a certain food typically come packaged in whole foods, and often work synergistically.  Taking supplements or fortifying foods will always be inferior to obtaining nutrients from whole foods.
  3. Species-specific bioavailability and anti-nutrients are contentious topics. Zero carbers will tell you that nutrients in animal based foods are more bioavailable than plant based foods, while the vegans will tell you the opposite.  To date, I haven’t been able to find useful data that would enable me to quantitatively refine the nutrient data in the USDA database regarding bioavailability.  All we currently have is a measure of the nutrients contained in the food– rather than the nutrients that make it into your body after digestion.  Again, if this data ever comes to hand, I’ll eagerly update the analysis.

Overall, I don’t think these limitations make a difference in the outcomes of the analysis.  This is not an exact science and the body doesn’t operation like a rigid machine.  Calculation of nutrient density is just a way to identify the foods that contain the most raw materials with the least amount of calories that your body can work with.

referecnes

[1] http://www.who.int/nutrition/publications/nutrient/en/

[2] https://books.google.com.au/books?id=gtQyAgAAQBAJ&pg=PA185&lpg=PA185&dq=%22nutrient+hunger%22&source=bl&ots=VMRQ8EbvHx&sig=l_xJEksBS538UX3QwQNxVJBXTLw&hl=en&sa=X&ved=0ahUKEwjRj6mSs5DSAhWKyLwKHXBQAjEQ6AEIKDAC#v=onepage&q=%22nutrient%20hunger%22&f=false

[3] https://www.amazon.com/Perfect-Health-Diet-Regain-Weight/dp/1451699158

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

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

[6] http://ajcn.nutrition.org/content/78/3/361.full

[7] http://www.nature.com/articles/ncomms14063

[8] https://www.amazon.com/Case-Against-Sugar-Gary-Taubes/dp/0307701646

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

[10] https://www.thepaleomom.com/adverse-reactions-to-ketogenic-diets-caution-advised/

[11] http://ketotalk.com/2016/06/23-responding-to-the-paleo-mom-dr-sarah-ballantynes-claims-against-the-ketogenic-diet/

[12] http://www.thelivinlowcarbshow.com/shownotes/10888/868-dr-sarah-ballantyne-challenges-the-wisdom-of-low-carb-diets-for-women-2/

[13] In terms of macronutrients this high fat dietary approach comes out at 80% fat, 15% protein, 2% fibre and 3% net carbs.

[14] http://www.who.int/nutrition/publications/nutrient/en/

breakfast of champions

My Facebook feed has been flooded lately with stories about Tour de France cyclists going low carb.[1]

image05[1]

Or is it high protein?[2]

image10[1]

Whatever is going on, it seems helps them run well too![3]

image09[1]

While I’m not sure you can say that these elite cyclists have eschewed all carbohydrate-containing foods,  the trend away from processed carbs to whole foods is intriguing.

So if they’re going low carb does it mean they’re now butter, cream, MCT oil after starting the day with BPC?

Dr. James Morton, head of nutrition at Team Sky and an associate professor in the Faculty of Science at Liverpool John Moores University explains:[4] [5] [6] [7] [8]

We promote a natural approach to food.  Our riders eat food that grows in the ground or on a tree and protein from natural sources.

They need energy, but they also have to stay lean and healthy with a strong immune system. A natural diet is the best way to achieve this.

Fat is important for everything from energy release and muscle health to immunity, but by eating the right food the fat takes care of itself.  The riders eat eggs, milk, Greek yogurt, nuts, olive oil, avocados and some red meat for a natural mix of saturated and unsaturated fats.”

To achieve optimal weight Dr Morton asks the riders to “periodise” their carb intake by eating more when they train hard and cutting back when they’re less active.

They routinely train in the morning after eating a protein-rich omelette, instead of carbohydrate-dense bread, to encourage their bodies to burn fat for fuel.[9]

image03[1]

So how does low carb real food thing work?

According to Dr Terry Wahls it seems that nutrient density is a key part of maximising energy output.

To produce ATP efficiently, the mitochondria need particular things.  Glucose or ketone bodies from fat and oxygen are primary.  

Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine (vitamin B1), riboflavin (vitamin B2), niacinamide (vitamin B3), pantothenic acid (vitamin B5), minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants.  Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.  

If you don’t get all these nutrients or if you are exposed to too many toxins, your ATP production will become less efficient, which leads to two problems:

Your body will produce less energy so they may not be able to do everything they need to do.

Your cells will generate more waste than necessary in the form of free radicals.

Without the right nutrient sources to fuel the ATP production in the mitochondria – which in turn produce energy for the cellular processes required to sustain life – your mitochondria can become starved.  The cells then can’t do their job as effectively.[10] 

So let’s look at the macro and micronutrient analysis of Chris Froome’s “rest day breakfast” (pictured above).   The analysis indicates that it does very well in both the vitamins and minerals score as well as the amino acids score.

image12[1]

If we throw in some spinach Froomey would improve the vitamin and mineral score of his breakfast even further.  The addition of spinach increases the nutrient balance score from 57 to 77 while the amino acid score stays high.

image14[1]

Froome’s wife says eating more protein has been one of the keys to losing weight and building muscle leading up to the tour.[11]  Getting a quarter of your calories from protein is more than the 16% most people consume, however with 65% of the energy coming from fat you could also call this meal low carb, high fat, or even “ketogenic” depending on which camp you’re in.

image01[1]

This simple but effective meal would be a pretty good option for just about anyone.  Froome’s breakfast ranks well regardless of your goals.  Based on the ranking system of meals for different goals it comes in at:

  • #10 (with spinach) and #31 (without spinach) out of 245 meals analysed for the low carb diabetes ranking,
  • #18 and 52 on the therapeutic ketosis ranking, and
  • #26 and 64 on the overall nutrient density ranking.

image00[1]

It seems it’s not just the low carbers, “ketonians”[12] and people battling diabetes who are training their bodies to burn fat more efficiently.  Maximising your ability to burn fat is critical even if you are extremely metabolically healthy.

The chart below shows comparison of the fat oxidation rate of well trained athletes (WT) versus recreationally (RT) athletes (who are not necessarily following a low carb diet).[13]  The well trained athletes are clearly oxidising more fat, which enables them to put out a lot more power (measured in terms of their VO2max).   It seems that you ability to efficiently burn fat for fuel it a key component of what sets the elite apart from the amateurs whether you call yourself vegan, ketogenic or a fruitarian.[14]

image07[1]

While carbohydrates help to produce maximal explosive power, it seems that the glucose turbocharger works best when it sits on a big power fat fueled motor.  According to Peter Defty (who spent the last couple of years helping 2016 Tour de France second place getter Romain Bardet refine his ability as a fat adapted athlete using his Optimised Fat Metabolism protocol), fat can yield more energy more efficiently with less oxidative stress which requires less recovery time.[15]

Dr Morton also understand the importance of keeping carbohydrates low to maximise mitochondrial biogenesis and to access fat stores.  If you want to learn more about his thinking on the use of diet to drive mitochondrial biogenesis you might be interested in checking out his array of published papers on the topic.[16] [17] [18] [19] [20] [21] [22]   On the topic of carbohydrate intake Morton says:

Amateur riders are taught the importance of carbohydrates for training and racing, perhaps too much actually.

From our research at Liverpool John Moores University, we now know that deliberately restricting carbs around carefully chosen training sessions can actually enhance training adaptations.

But then of course we must ensure higher carbohydrate intakes for key training sessions and hard stages in racing.

I believe this concept of periodising daily carbohydrate intake is the most exciting part of sports nutrition in the last decade and our challenge now is to address how best we do this practically.

Essentially, exercising your mitochondria in a low insulin and low glucose state forces your body to adapt to using fat for fuel and to use glucose and oxygen efficiently and effectively.[23] [24]

image06[1]

Not only is this useful for endurance athletes and people battling diabetes, training your body to use fat and oxygen more effectively is also claimed to be important to minimise anaerobic fermentation which is said to increase your risk of cancer.[25] [26] [27]

Many of us struggle trying to cope in an environment of excess energy from low nutrient density highly insulinogenic food.  If we can’t obtain the necessary nutrients from our food to efficiently produce energy our bodies seek out more and more food in the hope of finding the required nutrients and enough energy to feel OK.

image13[1]

Our bodies do their best to use the energy that we give them, but they are working overtime to pump out insulin to store the excess energy that is not used.  Over time our bodies adapt by becoming resistant to insulin in order to stop the excess energy being stored in our liver, pancreas and eyes when our fat stores on our muscles and belly can’t take any more.[28]  Then to overcome the insulin resistance the body has to pump out more insulin which makes even less of the energy we eat available for use.

image04[1]

When we call on our mitochondria to produce intensive bursts of energy with minimal fuel (i.e. fasting) or glucose (i.e. low carb) we force our bodies to more efficiently the limited carbohydrate.  Suddenly our bodies become insulin sensitive.

Recent studies indicate that people who are fat adapted are able to mobilise higher rates of fat at higher excercise intensities.[29]

image08[2]

With a higher reliance on fat they are able to conserve the precious glucose for explosive efforts.

image02[1]

Then, when they really need the power they have both fuel tanks available to cross the  line first… and second!

image11[1]

 

references

[1] http://realmealrevolution.com/real-thinking/great-news-for-lchf-first-and-second-place-riders-of-the-tour-de-france-are

[2] http://www.businessinsider.com.au/chris-froome-weight-loss-tour-de-france-2016-7?r=US&IR=T

[3] https://www.youtube.com/watch?v=UPqxUA70ulo

[4] http://www.telegraph.co.uk/men/recreational-cycling/how-to-eat-like-a-tour-de-france-cyclist/

[5] http://www.teamsky.com/teamsky/home/article/68342#CpWWiwr2TyE0EA2P.97

[6] https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-science/sport-and-exercise-sciences/james-morton

[7] http://www.ncbi.nlm.nih.gov/pubmed/23364526

[8] http://www.ncbi.nlm.nih.gov/pubmed/23263742

[9] http://realmealrevolution.com/real-thinking/great-news-for-lchf-first-and-second-place-riders-of-the-tour-de-france-are

[10] https://www.amazon.com/Wahls-Protocol-Autoimmune-Conditions-Principles/dp/1583335544

[11]

[12] http://ketotalk.com/2016/04/19-inflammatory-keto-foods-build-muscle-on-moderate-protein-baby-boomer-ketonians/

[13] http://m.bmjopensem.bmj.com/content/1/1/e000047.full

[14] http://www.30bananasaday.com/profile/durianrider

[15] http://www.vespapower.com/mighty-mitochondria/

[16] https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-science/sport-and-exercise-sciences/james-morton

[17] http://ajpregu.physiology.org/content/304/6/R450

[18] http://www.ncbi.nlm.nih.gov/pubmed/23263742

[19] http://www.ncbi.nlm.nih.gov/pubmed/19265068

[20] http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=9000&issue=00000&article=97464&type=abstract

[21] http://www.sciencedirect.com/science/article/pii/S0891584916000307

[22] http://www.tandfonline.com/doi/abs/10.1080/17461391.2014.920926

[23] https://www.fightaging.org/archives/2011/04/calorie-restriction-increases-mitochondrial-biogenesis/

[24] http://www.marksdailyapple.com/managing-your-mitochondria/#axzz4G2D39DgB

[25] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493566/

[26] https://www.amazon.com/Tripping-Over-Truth-Metabolic-Illuminates/dp/1500600318

[27] https://www.youtube.com/watch?v=PuG5XZSR4vs

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

[29] http://www.vespapower.com/the-emerging-science-on-fat-adaptation/

Jimmy Moore’s slow cooked pork with veggies

Jimmy posted this meal on his Facebook feed a while ago.

Slow cooked pastured pork Boston butt cooked in @BareBonesBroth, local organic kale, broccoli, cauliflower, snow peas, home garden zucchini, local organic squash, home garden herbs (cilantro, dill, basil), local Garden blend sauerkraut, avocado, grass-fed butter, sea salt, and pepper. #lowcarb#highfat #ketogenic #realfood #howireallyeat

The meal does really well in both the nutrient balance score and the protein quality score while still being fairly high in fat.

The total carbs are up a bit but you’re only looking at about 15g net carbs per 500 calories which is pretty good for most people unless you are really insulin resistant.

image029.jpg

It would be interesting to see how Jimmy does with his ketones and blood sugars after eating something like this.  Over the short term he might see a rise in his blood sugars, however, over the long term the reduced calorie density, higher nutrient density and higher fibre might work really well for him.

As always, if you’re struggling with blood glucose control you should ‘eat to your meter’ and make sure the foods you eat don’t drive up your blood glucose levels too much.

net carbs insulin load carb insulin fat protein fibre
15g 39g 39% 64% 18%

14g

optimising blood sugars with RD Dikeman

It has been a transformational journey for RD Dikeman since his son Dave was diagnosed with Type 1 Diabetes, both as a parent and for himself as he has implemented a regimen of what he likes to call “meal skipping” (a.k.a. intermittent fasting) guided by his own blood glucose levels.

image02

I came across Dave Dikeman, a young man with Type 1 Diabetes, in Episode 831 of Jimmy Moore’s LLVLC Show.  I still remember ten year old Dave saying “finger pricks now or amputations later, the choice is pretty simple”.   Dave’s pragmatic attitude to his condition was another light bulb moment in our family’s journey to learning to manage diabetes.

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It has also been quite a journey for RD Dikeman, Dave’s dad, who recently posted a few comments on the Optimising Nutrition Facebook Group that I thought were worth capturing.

I’ll tell you a quick story about how this whole low carb thing started.

Dave is near death, in the hospital, diagnosed with T1. The doctor rolls in to meet us. A kindly doctor – no Bernstein – but a very kindly man (he took an injection of insulin to show Dave not to be afraid).

So the doctor is talking to Dave and finds out they both went to the same school. So there’s some kinship.  And the doctor recognizes that Dave is a pretty sharp guy and Dave starts asking questions ‘will I die young?’ And Doc is brutally honest ‘you have to control your blood sugars – amputations, blindness and those things are on the table’.  And doc starts to give us a lecture on how to do that.

He has an easel and a sharpie. Anyway, he draws a rollercoaster blood sugar graph and he says ‘carbo makes blood sugar go up and insulin go down and you want to be between 80 and 180 (sigh) mg/dL.’

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And Dave goes ‘I just won’t eat carbo’.  TRUE STORY.!

And ME!! I interrupt and say (throw me down and kerb stomp me everyone) ‘You need carbo for… ENERGY’. LOL!

So I spent the next month force feeding Dave oatmeal. I am heckled daily for this. Every time there is oatmeal. Oatmeal on a TV commercial.  Oatmeal at restaurant.  Heckled!

About a month later guess who discovered ‘The Bernstein Book‘!!! NOT ME!! It was Roxanne (my wife).  So that is two fails for me.

I will say the happiest moment of my life was reading Bernstein’s ‘law of small numbers’. I knew then that we had a way out of this mess.

Being 100% wrong never felt so good.  I have a good leader. The whole thing was his idea.

Since then, RD has become passionate about the low carb way of eating and helping other people learn more about diabetes.  He is an admin on the Type One Grit Facebook Page which is a great source of support and inspiration for people with Type One Diabetes.  He and Dave also produce Dr Bernstein’s Diabetes University which captures nuggets from Dr B on YouTube.

RD lives low carb theory…

I don’t eat any carbohydrate-glucose foods. No sugar, manipulated sugar fruits, grains or starch. Ever. Carbs are only from fibrous veggies and nuts.

and it seems to be working.

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Dr Bernstein’s recommended target blood glucose is 83mg/dL (or 4.6mmol/L) with a recommendation that people with Type 1 Diabetes actively work to keep within a ten point range of this target number (i.e. 73 to 93mg/dL or 4.0 to 5.2mmol/L).

Dr B tells the story of how, back in the day, blood glucose meter sales reps would come to his office.  He would get them to demonstrate how it worked by testing it on themselves so he could see their blood glucose number.  Sure enough, the blood glucose levels of these healthy young non-diabetic sales reps was always around 83mg/dL.

Since then there has been  plenty of research that showing the benefits of having an average blood glucose level of around 83mg/dL including reducing your risk of cancer, obesity, heart disease and a range of other metabolic issues.

Some people operate happily at the lower end of this range, particularly if they are younger and / or insulin sensitive and producing ketones.  Generally though, the body of someone with a healthy metabolism will bring them back to a blood sugar of around 83mg/dL (or 4.6mmol/L).

Not too high.  Not too low.  Just right.

The table below shows a generalised relationship between blood glucose, ketones, HbA1c and the glucose : ketone ratio (GKI).  There’s no perfect number for everyone, however typically the lower your HbA1c, without using blood glucose lowering medications, the lower your risk of metabolic syndrome and related diseases (see the Diabetes 102 article for more details).

ketone BG (mmol/L) BG (mg/dL) GKI HbA1c Comment
0.20 5.9 106 29.5 5.32 good
0.50 5.3 95 10.6 4.93 high normal
0.60 5.2 93 8.6 4.85 high normal
0.70 5.1 91 7.2 4.79 high normal
0.80 5.0 90 6.2 4.74 high normal
0.90 4.9 88 5.5 4.69 high normal
1.00 4.8 87 4.8 4.66 high normal
1.50 4.6 83 3.1 4.51 optimal
2.00 4.5 80 2.2 4.41 low normal
2.50 4.3 78 1.7 4.33 low normal
3.00 4.2 76 1.4 4.27 low normal
3.50 4.2 75 1.2 4.22 low normal
4.00 4.1 74 1.0 4.18 low normal

RD is not technically diabetic himself however he understands the dangers of high blood glucose levels.  RD found that the low carb way of eating helped him lower his own blood glucose, however he still wasn’t consistently achieving Dr Bernstein’s target blood glucose level of 83mg/dL.

What he did find was that when he waited to eat his blood glucose would come down as the body used up the glucose in his blood.  Over time RD developed a practice of meal timing guided by his glucose meter that finally enabled him to optimize his own blood glucose levels.

My blood sugar tells me when it’s time to get some insulin sensitizing exercise at the gym also.

I would say if blood sugar is above normal (83 mg/dL) then beta cells are ‘on’ and insulin is a fat storage hormone (obviously other functions).

It’s your table exactly Marty Kendall!

This is the table that RD is excited about (from the using your glucose meter as a fuel gauge article).

blood glucose action
>  7 day average, well slept and low stress consider delaying eating and / or exercising
< 7 day average if hungry, enjoy nutrient dense foods that align with your insulin sensitivity
< 73mg/dL (4.0 mmol/L) if hungry, eat higher insulin load foods and delay exercise

If your glucose is higher than YOUR average then you may not need to eat right now.

If you are insulin resistant, when you do eat, you should focus on foods that won’t spike your blood glucose levels.

Eating when your blood glucose is less than YOUR current average will allow you to progressively lower your blood glucose.

Decreasing average blood glucose = winning!

For most people it will take some time before they can get their blood glucose down to Dr B’s target of 83mg/dL.  Using this method RD has been able to decrease his HbA1c from 5.3% to 4.8%.

If your blood glucose is below 73mg/dL (4.0mmol/L) then you may benefit from foods with a higher insulin load to replenish glycogen stores.

The continuous glucose meter plot below shows RD’s blood glucose levels after a few years of implementing Dr Bernstein’s advice in his family.  Not bad!

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I am able to lower my HbAc1 about 0.1% every six months. It’s not easy.

If you aren’t at mid 4s, look to belly fat and/or treating your body like an amusement park in younger days (guilty!)

One big takeaway from the journey has been how long it takes to heal the metabolism…. not a surprise if you’ve been sabotaging it for decades, I guess.

RD says it’s more than just the exercise.  It’s the food and the fasting too.

I worked out plenty in 2006.  Same gym.

RD understands that it is important for his long term health to do whatever he can to strip the fat from his body, particularly from his organs.

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As we reverse fatty liver and fatty pancreas  normal insulin sensitivity can be restored which in turn leads to normal blood glucose levels and normal body weight.

RD doesn’t use the scale to track his health, but rather his blood glucose meter.

I know if I eat too much food or if I stop working out, my blood sugar starts rising and I start to put on weight.  This happens even with a low carb diet.

If I fast and work out, my blood sugar returns to normal.  I feel better.

So really, I don’t use the (weight) scale, I can use my blood sugar meter instead.

Fixing your metabolism by learning how to eat and losing weight after years of eating the standard…  well it takes some time…  a few years in my case.

I’m still seeing improvement and motivated.  I’m definitely not going back.

Congrats RD!

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For more details on how to use your blood glucose meter as a fuel gauge check out this article.

fine tuning your diet to suit your goals – Jane

  • Optimising blood glucose, nutrients and gut bacteria can be a delicate balancing act.
  • Some people require a very low carbohydrate approach to achieve normal blood glucose levels, while some may also need to implement a fasting regime as well.
  • Some may also benefit from increased fibre and / or reduced calorie density to improve gut health and achieve further weight loss, however for others this may have unacceptable impacts on their blood glucose.

background

Jane is an experienced ketogenic dieter who has found over years of testing that she is now able to manage her blood sugars to consistently between 70 and 100mg/dL (3.9 to 5.6mmol/L).   Her HbA1c is now 5.1% which is good and her blood lipid numbers are great.

After a long period of fighting and trying to normalise her blood glucose levels using a ketogenic diet, Jane has come to a point where she has stopped monitoring her blood sugars throughout the day and dropped back to occasional checking.

As you can see from the plot below of protein versus net carbs, Jane’s diet is definitely ketogenic (note: the unlabelled points are based on her actual daily food diary, the labelled points are the variations discussed below).

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nutritional analysis of base case diet

The table below shows the comparison of one day from Jane’s food diary with the more than two hundred meals and food diaries that I have analysed to date.  Jane’s base diet ranks at 52 out of 200 when we use the diabetes ranking, so she is doing pretty well overall, with very high scores in the insulin load and protein categories.   As you can see from the scores on the bottom row of the table below, the area where there is still some room for improvement is the fibre as well as vitamins and minerals.

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The nutritional analysis of Jane’s food diary is shown below.  A score of 100 in the nutrient balance and / or the protein quality score would equate to obtaining 100% of the FDA Daily Value (DV) for the various nutrients with 1000 calories.[1]  So  especially given that Jane’s priority is blood glucose control, a score of 40 for the nutrients is good .  A score of 139 for protein quality is excellent , meaning that she is more than meeting her protein requirements.  At 5g per day, her dietary fibre is less than the DV of 25g per day recommended for women.[2]

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with added spinach and mushroom

If Jane wanted to improve her vitamin and mineral score she could add some high fibre nutrient-dense veggies that would not significantly raise blood sugar.  To this end, I have added some extra mushrooms and spinach to the analysis of Jane’s food diary.  The addition of the extra mushroom and spinach produces an improved vitamin and mineral score.  However, this approach would be less ketogenic with 37g of net carbs compared to 15g in the base scenario (see chart and table above).

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with egg

Jane told me that she would be worried these extra carbohydrates from the veggies would raise her blood glucose too much, plus she doesn’t like mushrooms.  She suggested adding egg, which improved the vitamin and mineral score compared to the base but decreased the insulin score as shown below.  The added egg increases the vitamin and mineral score from 40 to 65 (nearly as much as the spinach and mushroom scenario) with only 21g of net carbohydrates per day.

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While the spinach and mushroom option does do better in terms of vitamins and minerals, the egg gives a better total score in the multi criteria analysis.  Hence adding the egg, rather than the spinach and mushrooms would align better with Jane’s goals.

weight loss approach – reduced calorie density and increased fibre

If Jane was looking to reduce body fat and potentially improve her health and vitality through consuming nutrient dense lower calorie density foods she could consider adding more high fibre, low calorie density foods that would make her feel satiated and possibly feed gut bacteria.

Jane says,

I strongly believe in the tie to gut health, enzymes and nutrition as a key.  If LCHF isn’t working then there is some major gut health, hormone or enzyme deficiency going on.

As discussed in the ketogenic fibre article, focusing on a nutrient dense, low calorie density approach that has minimal carbohydrates may help with improvement in both gastrointestinal and overall health.  In the longer term though adding in some more fibrous foods may be beneficial for people to promote good gut bacteria.

The revised food diary shown below has a significant amount of spinach and broccoli and gives a very solid 26g of fibre per day with only 22g of net carbohydrates, which is still “low carb” by most standards.  Some people prefer to use total carbohydrates rather than net carbohydrates.  However, plant based fibre is typically not digestible and thus is unlikely to impact blood sugar significantly.

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While food packaging in the USA shows total carbohydrates with fibre listed separately, in the UK and Australia food labelling already shows net carbohydrates.

This option with egg also has a lower calorie density along with a higher nutrient density compared to the base option meaning that Jane is likely to feel more satiated and find it harder to overeat which may be useful if weight loss is a goal.

Jane may be concerned that this type of approach would adversely affect her blood glucose levels that she’s worked so hard to reduce.  It would be worth going slowly and monitoring post-meal blood sugars while she makes her transition to more nutrient dense high fibre foods.

If she was seeing post meal blood sugars greater than 120 mg/dL (6.7mmol/L), fasting blood sugars drifting above 90 mg/dL (5.0mmol/L) and an average of greater than 100mg/dL (5.4mmol/L) she may want to revert back to her more ketogenic approach.

discussion

Overall, Jane’s ketogenic diet approach is working well for her at the moment, but her situation raises a number of questions.

If Jane was struggling to achieve normal blood sugars with a ketogenic diet, then it is possible that she has a beta cell burnout meaning that her pancreas is no longer able to produce enough insulin (which is not the case given her HbA1c of 5.1%).  If this were the case, then it may be useful to measure her fasting insulin and c-peptide levels to determine whether she is still producing significant amounts of insulin (refer to the article Balancing Diet and Diabetes Medications for more discussion).  However this does not appear to be the case for Jane as she has a good HbA1c although it does require a very highly ketogenic diet approach to achieve this.

Another approach to reducing blood sugars is to focus on stripping the glucagon from the liver through fasting and more intense carbohydrate restriction (as per Westman’s carbohydrate restriction[3] and Fung’s fasting protocols[4]).   However with a very low carbohydrate diet of 1600 calories per day Jane probably does not need to pursue further calorie or glucose restriction, although it would be interesting to see if some periods of fasting help to further improve insulin sensitivity.

Yet another approach would be to focus on healing the gut and other factors that cause someone to become insulin resistant.  Inflammation and infection will often lead to insulin resistance.  If diabetes is an autoimmunity issue that starts in the gut, then the question is what can we do to balance gut bacteria that will enable the body to heal through maximising nutrition together with probiotics and prebiotics (as per Perlmutter[5] and the paleo approach to diabetes[6])?

If Jane desires to go down this road she might need to tolerate slightly higher blood sugars as her body adjusts to plant-based carbohydrates (refer to the Ketogenic Fibre article for a list of foods that will provide fibre without raising blood glucose levels).  Over time, she may find that blood glucose levels settle down as the gastrointestinal microflora balance adapts and she progresses beyond the initial physiological insulin resistance.

As you can see, there is no simple or perfect approach here but rather a number of options that may be useful to consider and test depending on the individual’s circumstances and goals.

 

references

[1] http://nutritiondata.self.com/help/nutrient-balance-indicator

[2] https://www.nrv.gov.au/nutrients/dietary-fibre

[3] https://www.youtube.com/watch?v=dSLf4bzAyOM

[4] https://intensivedietarymanagement.com/tag/intermittent-fasting/

[5] http://www.drperlmutter.com/new-understanding-obesity-epidemic/

[6] http://robbwolf.com/category/real-life-testimonials/diabetes-real-life-testimonials/

fine tuning your diet to suit your goals – Wendy

  • There is no single dietary template that works for everyone.
  • Different individuals have particular needs and goals, and nutrition should be adjusted accordingly.
  • It can be useful to compare how your diet stacks up against other dietary approaches to identify where you might further refine and improve your diet.
  • The insulin load of your diet should not exceed the capacity of your pancreas to keep up and achieve normal blood glucose levels.
  • Once excellent blood glucose levels are achieved, reviewing your nutrient density, calorie density and fibre intake can be a useful  refinement to optimise your diet to achieve your goals.

keeping it simple…

Eating should not be complex!

I could understand how some people might find all this discussion about nutrition a bit daunting and / or irrelevant.

If all this talk about food is confusing and leaves you a bit perplexed then I apologise.

The reality is that if most people ate a range of whole foods from natural sources they would be pretty much OK.   Most people will not turn into ripped physique competitors with bulging six packs without meticulously tracking food intake, however most would be able to achieve good health and vitality.

A good diet is something that people will stick to and enjoy without tracking and obsessing over too much.  At the point it becomes enjoyable, effortless and normal it stops being a diet and becomes just a way of eating!

To this end I’ve created a list of optimal foods and optimal meals to suit different goals that people can just run with without too much hassle or conscious thought.

finding your path in all the noise

Unfortunately many of us have spent too long either eating poorly and need some more intense intervention, or have more specific dietary needs (e.g. diabetes, cancer, epilepsy etc) that require more targeted approaches.

My key aim in all of this is to demonstrate how a nutrient dense diet with a managed glucose load can be optimal, and modified to suit a person’s goals.  Rather than giving general platitudes I hope I can add something to the discussion and help people tweak their diet to achieve specific goals.

There is a lot of sometimes-conflicting dietary guidance out there that makes it hard to synthesise it all into a coherent plan that’s right for you.  You may be ketogenic, vegetarian, LCHF, LCHP, Paleo, ‘peagan’, or zero carb, or just do ‘everything in moderation’ (whatever that means).

taking it to the next level

No one eats optimally all the time, however it’s useful to know what can be done to improve things if you want to move further in a particular direction.

If you’re not getting the results from your current approach, you might be motivated enough to refine your current regimen to move further forward in the desired direction.   Unfortunately a lot of people fall into this category and are left looking for a bit more specific guidance on what they can do to reach their goals.

Some people are already putting a lot of thought and effort into what they eat, but sometimes not getting everything they hoped for, whether it be athletic performance, blood sugar control or weight loss.

Quantification of insulin load, nutrient density and fibre are powerful tools to further manipulate your diet in the pursuit of specific goals.  In this article we look at how we can review and refine our current diet to suit specific goals.

I hope that reviewing the application of a number of tools to real life examples can demonstrate how we can manage the glucose load of our diet while at the same time optimising the vitamins, minerals and amino acids.

I think it’s useful to review, refine and tweak someone’s existing diet rather than trying to get them to adopt a whole new way of eating that might be hard to stick to in the long term.  So to this end I’ve reviewed a number of people’s actual food diaries to see what the system would tell us about how they can move forward in a particular direction.

The plan is to profile a dietary analysis every couple of weeks to see how we might apply the tools detailed throughout this blog to optimise their nutrition while keeping in mind their insulin load.

so let’s meet Wendy…

Wendy describes herself as being obese for her entire adult life, except for a few short-lived diet-induced periods (using “eat less, move more” diet templates).  Despite obesity, Wendy had good blood lipids and fasting glucose until early 2014, when fasting glucose crept into the pre-diabetic range.  She had been hypertensive since her mid-20’s, diagnosed as essential or idiopathic hypertension (i.e. no known cause), but was advised it was caused by her obesity.

In early 2014, at age 44, Wendy began exercising regularly and then changed her diet first to lower-carb (inspired by Robert Lustig) and then ultimately low-carb.  She lost over 70 pounds over eighteen months, going from a BMI of 39 to 27.  Wendy says she is comfortable with low-carb eating as a life-long proposition, along with regular exercise (mostly yoga and strength training, with some HIIT).

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Wendy had some insulin resistance before making these changes, but now has blood sugars that are “typically in the 70s, 80s or 90s” and a fasting insulin of 5.1mIU/ml (i.e. upper end of the excellent range).

Wendy’s most recent HbA1C was 5.2% which is pretty good (see Diabetes 102 for more details of target blood sugar and HbA1c levels), so it appears that her insulin resistance has improved with her recent weight loss or at least is in remission with her improved diet and exercise regimen.  Wendy has also been able to drop all hypertension medications and now regularly home-tests blood pressure at slightly-below-normal levels.

Wendy has been very active on the Optimising Nutrition, Managing Insulin blog with a heap of insightful questions and comments.  Lately she’s also been helping me with reviewing and editing of some of the posts on the blog.  She’s certainly an educated, motivated and seasoned nutrition nerd.  You can also read more about Wendy’s journey on her own blog https://fitteratfortyish.wordpress.com/.

If you look at her food diaries you’ll see that the reason she’s lost so much weight already is that she’s eating pretty darn well!  But let’s look at what she could do to further move towards her weight loss goals.

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review of glucose load

First up I’ve analysed Wendy’s macronutrients to determine the insulin load, percentage insulinogenic calories and macronutrient split as shown in the table below.

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With less than 20g net carbohydrates per day, an average of 5% calories from carbohydrates and 23% insulinogenic calories, Wendy’s diet definitely qualifies as low carb!

I’ve plotted the macronutrients from her daily diaries in the chart below (labelled 8, 9 and 10 June).  Two of the three days sit just outside the threshold of Steve Phinney’s well formulated ketogenic diet triangle (i.e. the orange line in the figure below).  This analysis would indicate that Wendy is eating a good diet that would be great for normalisation of blood glucose.

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If Wendy was still having blood sugar issues (say average of greater than 97mg/dL or 5.3mmol/L) she might benefit from reducing her protein to bring her macros back towards the bottom left corner of this chart in order to reduce the total glucose load of the diet and make it more ketogenic.

This is not the case for Wendy though as her blood sugars are now reasonably well controlled, with her insulin resistance improved after her already significant weight loss.  So reducing the insulin load of her diet is not the primary issue.

nutritional analysis – diabetes weighting

I’ve written before about the theory of balancing glucose load while maximising nutrition.  I thought it would be interesting to look at how we could apply this in practice with Wendy’s food diary data.

Using the nutritiondata.self.com recipe analyser I have compared a range of meals and daily food diaries as discussed in the article The Most Nutritious Diabetic Friendly Meals [1] and dietary approaches as discussed in the article Diet Wars…  Which One is Optimal? [2]  In line with this I’ve analysed Wendy’s food diary from 9 June 2015.  The results of the analysis are shown below.

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A score of 100 in either the “nutrient balance” or “protein quality” scores means that you’re covering the recommended daily intake of each of the nutrients with 1000 calories.   What this means in Wendy’s case is that she’s doing pretty well with her protein score at 140.  However there are some possible deficiencies with her vitamins and minerals which are only at 52.

The table below shows a comparison of scores for the 9 June 2015 food diary with the suggested refinements discussed below.  Based on the diabetes weighting (which prioritises low insulin load) Wendy’s diet from 9 June ranks at #77 of 175 which is fairly solid, however there is some room for improvement.

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A score of zero would mean that it is average in comparison to the other meals, greater than zero (blue) means that it is better, while less than zero (red) means that it is worse than average.

The areas that the food from the 9 June 2015 food diary doesn’t do so well is calorie density, vitamins and minerals, and fibre.

so why is fibre and calorie density important?

Every individual is different.  What will work for one person may not work so well for another.  For example, simply applying a body builder or a diabetes dietary approach to Wendy’s situation may not be appropriate given that she wants to continue on her weight loss journey.

The comparison of Wendly’s base diet to the other diets analysed indicates that she could benefit from adding fibre and reducing her calorie density. But why would increasing fibre and reducing calorie density be useful for someone trying to lose weight, particularly when the low carbohydrate approaches advocated by Westman and Eades may likely recommend continuing to focus on a low total carbohydrates (i.e. not net carbohydrates) until goal weight is achieved.

I think the “magic” of the low carbohydrate dietary approach is that it normalises blood glucose levels and reduces insulin so that you can release rather than store fat.  For more detail on the importance of insulin in fat loss check out the article why we get fat and what to do about it v2.

Without a reduction in insulin levels it is difficult to unlock the fat stores for energy. It get frustrated when I hear ‘experts’ in the body building scene just saying that fat people need to achieve a calorie deficit and they’ll be all good, apparently not understanding the effect that a highly insulinogenic diet can have on fat loss and appetite for people who are insulin resistant.

Chris Gardner’s A to Z trial [3] identified that people who are insulin resistant typically only lose weight on a low carbohydrate diet.[4]  The reduced insulin load allows energy to be released from fat stores which in turn leads to increased satiety and decreased calories.  However people who don’t have insulin resistance issues can lose weight with reduced calories regardless of the carbohydrate level as long as they create a calorie deficit.

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However, once you’ve normalised your blood glucose levels and insulin I think all bets are off.  There may be a limit to how far a diet with liberal quantities of added fat will take you when it comes to weight loss.  Somehow you do need to work out a sustainable way to burn more calories than you consume.  However I don’t think this is as simple as just counting calories and maintaining deficit.

While a low carbohydrate / ketogenic diet in maintenance mode involves high levels of dietary fat, you don’t necessarily need to be adding extra dietary fat while you’re trying to lose weight.  If you’re trying to lose weight ideally the energy from fat can come from your body fat stores as shown diagrammatically below in Steve Phinney’s four phases of a ketogenic diet diagram.

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I’ve got a lot of time for Jonathan Bailor who isn’t a big fan of calorie counting.  He prefers rather to manipulate diet so that you naturally feel satiated with fewer calories.  As noted in this video he advocates for nutrient dense foods that have plenty of water, fibre and protein to naturally feel full so you don’t need to manually track calories.  This video gives a good overview of Bailor’s philosophy which I think makes sense for most people.

In my food ranking system I have tried to codify Bailor’s approach using the USDA foods database, and have used a similar approach in the meal ranking system.  The highest ranking meal using the weight loss weighting is Terry Wahls’ lamb skillet meal which is shown below.

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While this meal might have 24g of total carbohydrate there is 16g of fibre, meaning that there is only 8g of net carbs.  So if we abandon the concept of total carbohydrate and focus on net carbohydrates when it comes to real unprocessed whole foods, we can keep our insulin load low and achieve satiety naturally by eating a larger volume of nutrient dense high fibre foods.  This will ideally allow us stop worrying about counting calories while still keeping our insulin load fairly low.

One of the criticisms of Terry Wahls’ diet approach is that there is just so much food and it’s hard to eat it all to get your calories.  If you do not want to lose weight Wahls recommends adding MCT or coconut oil to increase the calorie density.  However you can see how not being able to fit in enough calories (as opposed to just counting calories) would help you to sustain a lower calorie approach without as much conscious effort.

Similarly, Dave Asprey criticises Joel Fuhrman’s ANDI score as a recipe for starvation, which is sort of what we’re after if we are trying to lose weight. [5]  So sure, maybe you’re not going to feel full eating parsley and watercress, but that doesn’t mean you shouldn’t try to eat as many non-starchy veggies as you possibly can as your first priority, and then fill up on the other foods.

While counting calories can be useful and effective as an educational tool, I your appetite will probably win out in the long run unless you find a way of eating that will naturally keep you satiated.  I believe a high fibre, nutrient dense, lower calorie density approach can be helpful to achieve this goal.

See the optimal foods for weight loss article for more details on this topic or this list of foods that are ranked based on these criteria.

improved calorie density and nutrient density

So in Wendy’s case, in order to improve the vitamin and mineral score I’ve reduced the chicken from lunch and added in some spinach and mushroom.  This has raised the “Nutrient Balance” score from 52 to 75.  The chicken is quite calorie dense in comparison to the spinach and mushroom, and you can eat a lot of these veggies without increasing calories very much.

This updated food diary then ranks at #50 of 175 meals analysed (previously #77) based on the diabetes weighting as shown above.  The overall fibre increases from a fairly low 13g to a more reasonable 21g.  This is closer to the recommended daily minimum fibre intake of 25g for women and 30g for men [6]).

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This change does increase the net carbohydrates from 11g to 32g and the insulin load from 60g to 77g, so someone who did have serious insulin resistance or diabetes should monitor their blood sugars to make sure they were not adversely affected by shifting to this approach.

For most people this increase in net carbohydrates would not be a major concern, particularly as the increase in carbohydrates is from low glycemic whole foods which tend to raise blood sugars much less than manufactured products.   You might also find that you end up naturally eating fewer calories because of the high volume of food and the high nutrient density which might leave you satisfied with fewer calories.

reducing calorie density for weight loss

For Wendy, though, blood glucose / insulin resistance is not the primary issue.  Her current priority is to move forward with her weight loss which has now stalled, more than a year into continuous weight loss.

Eliminating processed carbohydrates is critical to the success of the low carbohydrate approach but what do you replace them with?  As per Terry Wahls’ approach I would recommend trying to maximise nutrient dense non-starchy veggies in the first instance and then supplementing with added fats (if required) to make sure you’re satiated.  If we focus on eating as much high fibre, nutrient dense, low calorie density foods as we can we no longer have to worry about limiting how much we eat!

So if we want to tweak Wendy’s meal plan more towards the weight loss goal by decreasing calorie density we can:

  • use a whole avocado rather than half an avocado to increase the fibre,
  • drop the added olive oil (to the extent that is practical for cooking),
  • drop the “half and half” cream to one tablespoon rather than four in the coffee, and
  • drop the calorie dense macadamias.

If we sort the meal revisions based on the weight loss weighting (which emphasises high fibre and low calorie density) we can see that the revised diabetes diet has a ranking of 43.

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With these changes we’ve nearly doubled the weight of the food for the day while keeping the total calories the same.  Fibre has gone up from 13 to 26g which meets the minimum recommended minimum fibre intake.  This approach will be a lot more filling, which is useful if weight loss is the goal.

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Net carbs have gone from 10g in the original scenario to 50g per day.  This is still considered low carbohydrate; however Wendy should keep an eye on her blood sugars as her HbA1c is good but not yet in the excellent range.  If they go outside the normal range (see criteria here), she should revert to the nutrient dense diabetes approach (see criteria and foods here).

Different people will have different carbohydrate tolerances, and these can change as your body heals and releases fat from your belly, liver and pancreas.  Most reasonably healthy people would be able to deal with this level of carbohydrate, particularly given that it is from low calorie density, low GI carbohydrates from vegetables.

As shown in the updated nutritional analysis below, the protein quality score is still pretty high at 135 (down from 140) and the quantity of protein is still quite high at 26% of calories (down from 27%).  The only way to increase the protein quality score without increasing calories further would be to incorporate organ meats, which is not everyone’s cup of tea.   The nutritional completeness score has increased to 88 which is a significant change from the base diet that had 52!

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Reducing excess insulin (as indicated by poor blood sugar control and high body fat levels) is the first priority, however once blood glucose and insulin are stabilised, targeting high fibre nutrient dense foods (while still keeping the insulin load as low as possible) is likely to be the next step when it comes to weight loss.

If there were any nutritional issues that were causing the body to hold onto weight, these may be improved with the highly nutrient dense diet and possibly help to break through the weight stall.

references

[1] https://optimisingnutrition.wordpress.com/2015/03/22/the-most-nutritious-diabetic-friendly-meals/

[2] https://optimisingnutrition.wordpress.com/2015/03/22/best_diet/

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

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

[5] https://www.bulletproofexec.com/cdc-superfoods-andi-score-debunked/

[6] https://www.nrv.gov.au/nutrients/dietary-fibre

coffee with cream and stevia

The reality is, coffee is a ‘food group’ for many people, including me.

I think this is fine in the context of a balanced life that contains adequate rest and sleep and not too much stress.  Chris Kresser recently did a great podcast on the case for and against coffee that you can check out here.

We used to do great lattes with coconut sugar or chocolate powder (mocha).  These taste amazing, but once we started to get serious about blood sugar control we realised that a massive proportion of our carbs were coming from the milk and sugar in our coffees.

This option with cream and Stevia is my current default option when I’m not just having it black (which I’m slowly getting more and more used to).

As you can see below, the cream will give you some nutrition while having minimal carbohydrates.

The cream does contain calories, so if you’re going to have a few you should consider it as a meal alternative as you might bulletproof coffee.

We’ve started getting liquid Stevia these days which comes in all sorts of yummy flavours that the kids love in milk rather than something like Milo.

The nutritional analysis below shows that the coffee with cream will have a negligible insulinogenic effect, while the cream is a good source of fat and protein.  Don’t count on it to give you your vitamins and minerals though.

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We get this amazing unprocessed cream from a Malaney Dairies that is not watered down.  It tastes amazing!  And only 3.6% insulinogenic calories (using this calculator).

And thanks to Kyle Masterman for sending through this photo of his CGM after double cream in his black coffee showing that cream and coffee is very vengle on the blood glucose levels.

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As you can see form the data in the table below there’s probably no need to worry about dosing with insulin for this if you have diabetes.

net carbs

insulin load carb insulin fat protein

fibre

1g 2g 65% 94% 3%

0g

bacon, eggs, avocado and spinach

This is a pretty incredible combination of superfoods and a taste sensation in your mouth.

As you can see from the NutrientData plot below the nutrients are spectacular with every nutrient and mineral covered and the amino acid score is also very high.

Even though there are 13% carbs most of them (12g out of 17g total carbs) are fibre from the spinach and avocado.

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The table below shows the stats for a 500 calorie serving size.

net carbs

insulin load carb insulin fat protein

fibre

4g 18g 35% 83% 66%

12g

 

 

can you eat too much fat on a low carb diet?

Even though Wilder’s formula allows 10% for fat being anti-ketogenic, the insulin index data does not indicate that there is any effect on insulin from fat.  The best correlation with the food insulin index was achieved with zero times fat.  This aligns with what we see in type 1 diabetics who can eat fat without raising their blood sugars or requiring insulin.

Eating a low carb, high fibre, moderate protein diet will typically naturally lead to increased satiety and reduced calorie intake.  Reducing insulin will allow stored body fat to be used for fuel.

However if someone was trying to lose weight I would not recommend emphasising dietary fat once they were fat adapted in order to allow energy to be supplied from body fat.

Some people aiming for ketosis to lose weight can overdo the fat calories and not achieve the weight loss.  If your aim is weight loss it’s better to be in calorie deficit and be burning stored body fat, than to have high blood ketones produced by MCT oil and butter.

While counting calories may be beneficial for some people to retrain their appetite initially, a better long term approach may be to try some form of intermittent fasting to reset insulin sensitivity and reduce overall calorie intake.

If your body fat and blood sugars are under control then go ahead and indulge in supplemental MCT oil or some extra butter in your coffee for the mental buzz, but keep in mind that, while ketosis will lead to increased satiety for most people, calories matter in the long run.

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[next article…  proportion of insulinogenic calories]

[this post is part of the insulin index series]

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

superfoods for weight loss (high nutrient density, low energy density)

People who are insulin resistant typically benefit from eating foods with a lower insulin load which helps normalise insulin and blood glucose.  Managing appetite is easier if you’re not on the blood glucose roller coaster.

However people who are obese but are also insulin sensitive seem to benefit even more by reducing energy density and maximising nutrient density as much as possible.  The foods listed below have a very low 82 calories per 100g compared to the average of the USDA foods database of 231 calories per 100g which will make them very hard to overeat.

In terms of macronutrients these foods have:

  • more protein (which will prevent loss of lean muscle mass),
  • more fibre (which will make you full and slow digestion),
  • less fat (thus allowing a contribution from body fat),
  • less digestible carbohydrates (which will maintain stable blood glucose levels).

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Once your blood glucose levels have been brought under control by reducing the insulin load of your diet, foods with a low energy density and high nutrient density will likely help you continue your journey towards optimum health and weight.

As shown in the chart below, these foods are very nutrient dense, with all nutrients other than the Omega 3 fatty acids meeting the recommended daily intake levels.  These foods will provide a substantial improvement in nutrient density compared to the average of all the foods in the USDA food database.

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The chart below is from a recent pilot trial by Christopher Gardner of Stanford (Weight loss on low-fat vs. low-carbohydrate diets by insulin resistance status among overweight adults and adults with obesity: A randomized pilot trial) which showed that the people who were insulin resistant generally did better on a higher fat low carbohydrate diet while people who were more insulin sensitive did better on a lower fat, lower energy density approach.

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Everyone in the study did better by eating more more nutrient dense unprocessed foods regardless of the macronutrient composition!

These foods will enable you to minimise your energy intake (calories) without and minimise your chance of experiencing any nutritional deficiencies.  For example, if you were fasting or dieting, focusing on these foods would maximise your chance of long term successes and minimising cravings.

The foods listed below represent the top 10% of the USDA food database prioritised for high nutrient density and low energy density.  The highest ranking foods involve lean proteins, non starchy veggies and seafood.  High fat dairy, processed grains and energy dense nuts and seeds don’t make the list.

The nutrient dense, high fibre, low energy density foods listed below will help you feel full with fewer calories, increase satiety and make it easier to control appetite.  This approach is similar to a protein sparing modified fast which which reduces your dietary fat on the basis that it will be coming from your body. Adequate protein is also critical to building lean muscle mass which is critical to your metabolic health.

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

Paul Jaminet

Also included in the table are the nutrient density score, load, energy density and the multicriteria analysis score score (MCA) that combines all these factors.

vegetables

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food ND calories/100g MCA
spinach 17 23 3.7
watercress 17 11 3.5
endive 16 17 3.4
asparagus 15 22 3.3
chicory greens 14 23 3.1
basil 14 23 3.0
coriander 14 23 3.0
seaweed (wakame) 14 45 3.0
chard 13 19 2.9
brown mushrooms 13 22 2.9
arugula 13 25 2.8
escarole 13 19 2.8
lettuce 13 15 2.8
broccoli 13 35 2.8
zucchini 12 17 2.8
parsley 12 36 2.7
Chinese cabbage 12 12 2.7
beet greens 12 22 2.7
okra 11 22 2.5
seaweed (kelp) 11 43 2.5
alfalfa 11 23 2.4
pickles 10 12 2.4
celery 10 18 2.4
dandelion greens 10 45 2.3
cauliflower 10 25 2.3
chives 10 30 2.3
white mushroom 10 22 2.3
mung beans 10 19 2.3
yeast extract spread 11 185 2.3
summer squash 10 19 2.3
radicchio 10 23 2.2
snap beans 9 15 2.2
turnip greens 9 29 2.2
portabella mushrooms 9 29 2.2
mustard greens 9 27 2.1
sauerkraut 9 19 2.0
cucumber 8 12 2.0
spirulina 8 26 2.0
shiitake mushroom 8 39 2.0
cabbage 8 23 2.0
collards 8 33 1.9
artichokes 8 47 1.9
dill 8 43 1.9
radishes 7 16 1.8
jalapeno peppers 7 27 1.7
banana pepper 7 27 1.7
bamboo shoots 7 27 1.7
turnips 6 21 1.6
onions 6 32 1.6
edamame 7 121 1.6
pumpkin 6 20 1.6
peas 6 42 1.6
Brussel sprouts 6 42 1.6
soybeans (sprouted) 6 81 1.5
red peppers 5 31 1.4
chayote 5 24 1.4
kale 5 28 1.4
winter squash 5 40 1.4
eggplant 5 25 1.4
butternut squash 5 45 1.3
paprika 7 282 1.3
red cabbage 5 29 1.3
sage 7 315 1.3
carrots 4 23 1.2

seafood

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food ND calories/100g MCA
crab 13 83 2.8
lobster 12 89 2.6
crayfish 11 82 2.4
fish roe 11 143 2.3
cod 12 290 2.3
oyster 10 102 2.1
halibut 9 111 2.0
shrimp 9 119 1.9
flounder 9 86 1.9
pollock 9 111 1.9
salmon 9 156 1.9
perch 8 96 1.8
trout 9 168 1.8
rockfish 8 109 1.8
white fish 8 108 1.7
sturgeon 8 135 1.7
haddock 8 116 1.7
scallop 7 111 1.7
caviar 9 264 1.7
anchovy 8 210 1.6
whiting 7 116 1.6
octopus 7 164 1.5
clam 6 142 1.5
sardine 6 208 1.3

animal products

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food ND calories/100g MCA
ham (lean only) 9 113 1.9
lamb liver 9 168 1.9
veal liver 9 192 1.9
turkey liver 9 189 1.9
lamb kidney 8 112 1.9
beef liver 8 175 1.8
chicken liver 8 172 1.8
beef kidney 7 157 1.5
pork liver 6 165 1.3
chicken breast 5 148 1.2
lamb sweetbread 5 144 1.2
pork chop 5 172 1.1
turkey drumstick 5 158 1.1
turkey meat 5 158 1.1
lamb heart 5 161 1.1
leg ham 4 165 1.0
lean beef 4 149 1.0
veal 4 151 1.0

dairy and eggs

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food ND calories/100g MCA
cream cheese (low fat) 10 105 2.2
kefir 7 41 1.8
whole egg 6 143 1.3
low fat milk 5 56 1.3
egg yolk 6 275 1.3
milk 5 61 1.2

other approaches

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.

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