Tag Archives: plant based

vegan vs keto for diabetes… which is one optimal?

I recently watched the Mastering Diabetes teleseminar on ketogenic diets with high hopes of picking up some gems of wisdom from the rising stars of the plant-based diabetes community.

Unfortunately, I was underwhelmed with what I heard.

I shared my frustration on Facebook.

Robb Wolf suggested I put together a response to some of the misinformation in the teleseminar.  Hence this post.  [Robb did an excellent breakdown on the claims in the What the Health Netflix doco, What the Health: A Wolf’s Eye View, which I highly recommend checking out if you haven’t already.]

What’s actually wrong with the keto diet for diabetes?

Cyrus Khambatta (aka Mangoman) and Robby Barbaro (The Mindful Diabetic) should be uniquely qualified, both academically and experientially having themselves lived with type 1 diabetes for decades.

If I were was going to attack keto for diabetes management, then there would have been a couple of ‘free kicks’ I think they could have taken.  So, in fairness to both sides, I’ll touch on a few of what I see as legitimate issues with ‘popular keto’ before I dissect the Mastering Diabetes presentation.

Giving fat a free pass

Humans like things to be straightforward and binary.

Yes or No.

Black or white.

High fat or low fat.

Low carb or high fat.

High protein or low protein.

Plants only or animals only.

For the last four decades, we have been told that fat, particularly saturated fat, is bad because it causes heart diseases and should be avoided.

The tide is now turning.  However, there will always be people who take things to the extreme.

Now fat is healthy.  But is more is better?

Ketones are good.  So more is better?

For many people, a higher fat diet will be more satiating, particularly compared to processed grains and sugars.  However, not everyone can ‘eat fat to satiety’ without some level of restraint and self-discipline.  We can’t all trust our appetite to kick in to effortlessly provide the lean and chiselled body that they dream of.

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My personal experience is that you can overdo the fat and drive insulin resistance by pushing fat too hard.  If you exceed your ‘personal fat threshold’[1], your adipose tissues will become insulin resistant, and the body will start pushing excess energy to the vital organs.

While there is no need to fear fat, there is no reason to go hog wild to compensate for the butter and bacon deficiencies that we all developed over the past four decades.

When it comes to nutrition, you need to get your big rocks in place first (i.e. the nutrient dense foods).  You can then fill up with fuel such as fattier foods if you do not want to burn any body fat.  You could even add some starchy carbs if your blood sugars all.

Having some level ketones is an indication that your insulin levels aren’t too high and your metabolism is working.  However, if you are not yet metabolically healthy, chasing ‘fauxtosis’ by loading up on butter, coconut oil, cream and exogenous ketones to achieve high blood ketone levels can be a recipe for hypercaloric metabolic disaster that will drive insulin resistance.

People with type 1 diabetes (such as the Mastering Diabetes guys and my wife Monica) have a unique insight into the various factors that affect their insulin sensitivity.  They can monitor their daily insulin dose.

I know some people with type 1 diabetes who have made an effort to chase higher ketones with more refined fat and less protein but found that they ended up needing more insulin.  Retreating to a moderate to high protein approach with less added fat (as per Dr Bernstein’s recommended approach for Type 1 diabetes) enabled them to improve their insulin sensitivity (e.g. check out Allison’s Nutrient Optimiser analysis here).

This phenomenon is not unique to people with type 1 diabetes.  There seem to be more and more people start out believing calories don’t count, only hormones.  They then put their faith in the ‘magic ketone fairy’ and end up driving insulin resistance and obesity chasing ‘optimal ketone levels’ with more and more added fat.[2]

I have a dream

Before we get into the nutritional analysis, permit me this indulgence to share my vision (with a hat tip to Martin Luther King) from Martin Laurence Kendall.

I have a dream that one-day nutrition will be defined by the nutrients that a food contains and the health benefits that it confers rather than religious and ethical beliefs or commercial interests.

I have a dream that all people, mothers and children, fathers and brothers, would be able to clearly understand the foods that are truly optimal for them.

I have a dream that one day all people afflicted with diabetes will be able to choose foods that will enable them to achieve normal blood sugars and restore the health and vitality that they deserve. 

Further, that they will be able to choose optimal foods, with engineering precision, without being affiliated with the needless ridicule that they will needlessly die of a heart attack due to unnecessary fears about ‘artery clogging saturated fat’ or ‘harmful animal proteins’. 

I have a dream that one day people will have, freely in their grasp, quality nutritional information that enables them to make informed choices that will, in turn, bring about a new day in the commercial food environment. 

I dream that one day all people, obese, diabetic, children and athletes alike,  will be free from the corruption of Big Food and Big Pharma working through diabetes educators, diabetes associations, heart associations, medical institutions and animal welfare advocates.   

Free at least.  Free at last. 

I hope that one day we will be free at last. 

Indulgence over.  On with the data.

On with the data.

Nutrient deficiencies in a high-fat diet

Another fact that I thought Cyrus and Robby would mention was that very high-fat foods tend to have a weak nutrient profile, especially compared to non-starchy vegetables.

The chart below shows the nutrients provided by the 800 highest fat foods out of the 8000 foods in the USDA database.   If we prioritise fat, we will likely be lacking in around half of the essential nutrients.

A summary of some of the highest fat foods is shown below.

[For some real life examples of the poor nutrient profiles achieved by people chasing high ketone levels in the misguided pursuit of weight loss check out the Nutrient Optimiser reports here, here, here here and here.]

Vitamins and minerals,  in particularly electrolytes such as potassium, magnesium and calcium are critical to support our mitochondria, enabling them to produce energy and maximise insulin sensitivity.

People in the keto community are conscious that electrolytes are essential and go out of their way to supplement with magnesium, calcium, sodium and potassium as well as taking bone broth.

The kidneys let go of water and electrolytes when insulin levels drop.  A ketogenic diet without attention to green leafy veggies is at risk of being very low in electrolytes.  This will cause the pancreas to secrete more insulin to hold onto the scarce electrolytes.  This increase in insulin levels may[3] ironically drive insulin resistance.

Whether you call them electrolytes or alkaline foods[5], our bodies need enough substrate to allow our kidneys to maintain a good acid/base balance without having to work too hard.  Focussing on minerals can helps us maximise insulin sensitivity and ensure oxygen is efficiently be carried around our bloodstream.

There are plenty of foods available to provide the micronutrients that you need if you actually require therapeutic ketosis as an adjunct to cancer, epilepsy or dementia.  We can achieve the Daily Recommended Intake (DRI) for most of the nutrients while still maintaining a low dietary insulin load.

The short list of foods that comprise a ‘well formulated ketogenic diet’ are shown below.

However, if you just need to manage diabetes with a low carb diet (rather than therapeutic ketosis), you can achieve even higher levels of nutrition while maintaining stable blood sugars.

Given my family history of Type 2 and my wife Monica’s Type 1 diabetes, we generally focus on the foods listed below.  Lots of people have found these lists useful.  You can pin them to the fridge as a reminder of what you should focus on or print it out to take shopping next time when you need some inspiration.   (There is a complete list of nutrient dense foods to suit different goals at the end of this article.)

Now my blood glucose levels are more stable, I’ve been trying to back off on the higher fat foods and focus on more nutrient dense foods to build muscle and lose fat.

The ‘problem’ with the most nutrient dense foods (as shown below) is that they typically have a very low energy density, so it will be nearly impossible to get enough energy to prevent rapid weight loss.

Prioritising nutrient dense foods is the secret to obtaining the nutrients you need with the lowest energy intake.  If you don’t want to keep losing weight or want to run a marathon then adding some higher energy density foods will be useful.

High carbohydrate foods are not  nutritious

After watching the Mastering Diabetes teleseminar, you will get the feeling that the Mastering Diabetes guys believe carbohydrate can do no wrong and we should only fear fat.

The reality, however, is that the foods with the least fat are generally even more nutritionally corrupt than the highest fat foods.

Not all of the low-fat foods are going to be beneficial.

Defining your nutritional approach as ‘high carbohydrate’ is not wise, especially if you are trying to manage diabetes.  The foods with the most carbohydrates in our food system are typically very nutritionally deficient as well as highly insulinogenic.

If a ‘low carb diet’ leads you to avoid processed foods you may be better off.  However, I don’t think defining nutrition in terms of macronutrient extremes is particularly useful. [6]

Plant based versus animal based

One area where vegans potentially have it over carnivores is vitamins and minerals.  As shown in the chart below, a zero carb diet does not provide really high levels of many nutrients.

2017-06-26-5[1]

At the same time, there are plenty of people who appear to be thriving on a zero carb dietary approach.  Many people with severe autoimmune related digestive issues succeed when they switch to a zero carb approach.   Zero carb advocates will also tell you that they don’t need the recommended daily intake levels of the various micro nutrients that are based on limited data or deficiency studies in people eating a standard high carb western diet.

2017-06-26-4[1]

A plant based diet can provide a reasonably nutrient dense outcome.  However, it will be hard to get adequate levels of omega 3, vitamin D and vitamin B-12.  People following a strictly plant based approach may need to supplement with these nutrients.

Achieving the minimum protein intake levels is possible.  However, many people have concerns about reduced bioavailability of plant based proteins and whether or not the minimum protein intake levels are actually optimal, particularly if you are active or older.

It’s also worth noting that other nutrients such as iron, vitamin A and omega 3 will be more bioavailable from animal based sources.  So it’s not as simple as comparing the nutrients in the food, what gets into your body is what really matters.

If you are going to follow a plant based diet then prioritising the food listed below will give you the best chance of success.  Most people are going to do best somewhere on the spectrum between exclusively plant based and solely animal based foods.

The real problem comes when we start to heavily process our food.  Rather than prioritising the most nutrient dense and minimally processed vegetables, fruits and legumes, many vegans end up living on processed grains, cereal, sugar and soy products that have been treated with a host of fertilisers and pesticides.  Meanwhile, many zero carbers or keto peeps end up living on nothing but bacon or processed meats from animals that were fed nutrient poor corn and grains with added antibiotics to make them grow quicker.

The vegan echo chamber

I have spent a good chunk of time hanging out in many vegan or plant based groups trying to understand their position and gain insights about nutrient density.  I have learned a lot from people like Professor Christopher Gardner, Ray Cronise and Dr Joel Fuhrman.  Much of the analysis in this is based on the integration of my learnings their work with Dr Richard Bernstein and Dr Matt Lalonde.

Unfortunately, it seems that the vast majority of vegan/plant based education comes from Dr Michael Greger through his sanitised, highly processed and hyper palatable “Nutrition Facts” videos.

While Greger covers a lot of relevant research and raises some valid points, a lot of the time he seems to twist the science to ensure that the moral of the story is always ‘eat plants, not animals’.  Plant based is better.  Eating animals will be bad for your health.

Without evolutionary context, we are asked again and again to believe that fat (particularly saturated fat) and ‘animal protein’ (whatever the hell that is!) is the primary cause of heart disease, the complications of diabetes and practically every other modern health ill.

There is no demonstrated biochemical mechanism provided as to how we suddenly became allergic to animal products.  Meanwhile, vegans advocates generally give a free pass to sugar and processed grains.

With more than six million views and an estimated earnings of more than $100k per year from YouTube[7] (not to mention donations[8]), there appear to be a LOT of people eager to lap up the nutritional and medical justification of their ethical position.

Greger’s unique ‘interpretation’ of the scientific data all starts to make sense once you understand that he is the Director for Public Health and Human Agriculture for the Humane Society International.[9]

The mission of the Humane Society is to celebrate animals, confront cruelty and shape public opinion.

I wonder if Greger does his researching, writing, filming and editing the Nutrition Facts videos as a hobby after he gets home after working 50 hours a week and commuting?   Or perhaps he creates these videos as an employee of the Humane Society as part of their stated goal to shape public opinion on animal cruelty?

It seems Mangoman and Robby are pretty tight with Greger.[10]  Makes me wonder if Mastering Diabetes is a coordinated and strategic assault by the Humane Society on the low carb/keto/diabetes community who have become immune to Dr Greger.

I am by no means advocating animal cruelty.  However, as a human,  if you are looking for the best advice on human nutrition, is it wise to put your blind faith and unswerving trust in someone whose explicitly stated primary goal is animal welfare?

Do you really want to save the planet?

Worrying about whether we eat plants or animals exclusively is a modern luxury, an intellectual indulgence of sorts.

For the majority of human history, we have been opportunistic omnivores.  When plants were the only thing that was available, we would eat them.  When we could, we would chase down an animal to get the protein we need to thrive.  We never had to worry about nutrient density because the foods we ate grew in fertile soil without pesticides.  The animals we ate were eating their natural foods which were also nutritious for them.

Humans thrived and were able to populate the world because we learned to hunt, store, cook and process food.  We became very good at getting the nutrients we needed with the minimum amount of effort.[11][12] [13]

Unfortunately, we have now become too good at processing food.

Many of us are now fantasising nostalgically about Paleo times.

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It’s one thing to worry about saving animals, but ultimately we need to save the planet and our human race from accelerated extinction.

Our newfound ability to harvest fossil fuels enables us to move around in cars and grow a massive amount of food with chemical fertilisers.  These foods grow quickly and give us plenty of energy, but few nutrients that we then process and feed to animals or humans.[14]

Take a moment to think about how your life would be different if we had never discovered fossil fuels (e.g. coal or oil).  For as long as it lasts we are gorging ourselves on stored energy that is making us lazy and obese and driving not just us, but life as we know it to an early grave. If you want to care about something it should be the sustainability of the global environment (including animals and humans).

If you want to care about something it should be the sustainability of the global environment (including animals and humans).

While humans are probably the biggest threat to the long term sustainability of earth as we know it, most of us aren’t willing to volunteer ourselves or our family as the first ones to check out to save the planet.

[If you want some challenging thoughts on this topic you should check out Daniel Vitalis’ Why I Hunt podcast.]

The plural of anecdote is not data

So, finally, onto the Mastering Diabetes video.

Cyrus and Robbie look like genuinely nice guys.

They are both living with type 1 diabetes.

They look like they’re happy and thriving on a plant based diet full of fruits and vegetables.

To be honest, they look a lot healthier than many recovering diabetics in the low carb scene.

But at the same time, the zero carbers will hold up anecdotes of people who have not eaten a plant for decades and look as great as the Johnson Family.

Or Dr Shawn Baker who is setting world records as a masters athlete since cutting plants out of his diet.

Then the keto folks will point to Dr Dominic D’Agostino who thrives on high fat and exogenous ketones and is exceptionally smart and can lift very heavy stuff at the same time.

 [15]

While it’s useful to look at populations of people following a particular diet to look for trends, anecdote does not equal data.

It is more useful to look at underlying metrics (such as nutrient density and insulin load) that we can use to identify the optimal diet for humans.

I thought they would know better

Cyrus Khambatta is a smart guy.  He was studying mechanical engineering at Stanford before he got type 1 and changed course to study nutritional biochemistry.

However, for all his ability in nutrition, engineering and mathematics (I took those classes, and I know how hard they are!), I thought he would have more to offer than what was presented!

People with diabetes get screwed around by the mainstream medical system and ‘diabetes education’ system.  The system doesn’t really understand how it works, so they give them bad advice (e.g. “just eat like we tell everyone else to and cover it with insulin”)!

I remember clearly the anxiety and confusion we experienced after going to an appointment with the hospital endocrinologist when my wife Monica was pregnant with our daughter.

At her visits, she would routinely be told that she needed to reduce her blood sugars to avoid the many serious risks and complications and risks for her and the baby.  Monica asked what else she could do to get the blood sugars down, but they had no advice.  They just wanted to see them lower.

We now have two healthy and wonderful kids, but I if I can I would love to see other people spared the anxiety as well as minimise the genuine health risks related to diabetes.  Hence my quest to understand how we can make intelligent food choices to optimise blood sugar and insulin levels.

What is the actual relationship between insulin and the food we eat?

The food insulin index data is a highly valuable resource that helps us to understand what causes us to secrete insulin and our blood sugars to rise.   The chart below shows the results of the food insulin index testing on more than 100 different foods (click to enlarge).

The food insulin index testing demonstrates clearly that we have the lowest insulin response to fats and oils while we have the highest insulin response to high carbohydrate foods like jelly beans and rice bubbles.   However, when we plot this data, we see that carbohydrate does not fully explain our insulin response.

We get a much better prediction of our insulin response when we account for protein (which requires insulin to metabolise) and non-digestible fibre.

Eating more fat will decrease the amount of insulin required to keep our blood sugars stable.

Eating more protein will reduce the amount of insulin your pancreas has to produce because it will push the more insulinogenic processed carbohydrates and sugar out of your diet.

How to improve your insulin sensitivity

If you reduce your intake of processed carbs and sugars, your insulin requirements will come down.  Once your organs and muscles are no longer swimming in insulin, you will become more insulin sensitive (just like you become more sensitive to coffee or alcohol if you cut back your intake).

If you are injecting insulin, reducing the insulin load of your diet will enable you to significantly reduce your insulin dosage which will, in turn, allow you to more easily access your own body fat stores for fuel.[16]

This data is an inconvenient truth for both high carb vegans or the nutritional recommendations such Food Pyramid / My Plate generated by the US Dept of Agriculture.  But I think it could be beneficial for people who want to effectively manage their diabetes.

Granted, if you switch your processed grains and sugar for fruits and vegetables, you will do better.  But is it really optimal?

If you can’t win, move the goalposts!!!!

So what do you do if you can’t win with science?

You change the rules!  You move the goalposts.

It was Cyrus and Robby’s unique definition of insulin resistance that really frustrated me.

So you can understand my frustration, I need to explain the difference between basal and bolus insulin which is a daily reality for someone with type 1 diabetes.

  • Bolus insulin is taken with food and is proportional to the insulin load of the food they eat (i.e. carbs – fibre + half protein)[17].
  • Basal insulin is the insulin that your pancreas would produce through the day and night whether or not you eat anything.  It’s the basal insulin that keeps your fat in storage and your muscles from being used for fuel.

You need both, but their function is different.

For someone eating a standard western diet about one-third to a half of their insulin will be basal insulin with the majority being bolus insulin for the food you eat.

When you switch to a low carb or keto diet this ratio flips and the majority of your insulin is basal insulin.  You only need a little bit of bolus insulin to cover the small amount of carbohydrates and protein that you eat.   With less glucose to deal with, you don’t need as much insulin, and your blood sugars stabilise.[18]

A significant portion of the Mastering Diabetes video was devoted to explaining their new creative definition of insulin sensitivity.  The fundamental problem with this central piece of the Mastering Diabetes argument is that it conflates basal and bolus insulin.  Your basal insulin is irrelevant if you are trying to do this sort of insulin sensitivity calculation!

It’s just the bolus insulin (i.e. for food) that matters when it comes to insulin sensitivity.  The calculations in the table below demonstrate my point.   If you take the denominator to your insulin sensitivity calculations to be the basal + bolus insulin then the high carb approach has a better insulin sensitivity.  If you only consider the bolus insulin (the only sensible approach in my view), then you declare the low carb approach to be the winner.

  low carb high carb conclusion
ISF (g carb/unit insulin) 6 5
carbs (g) 50 500
bolus insulin (units) 8.3 100
basal insulin (units) 20 20
total daily insulin (per day) 28 120
24 carb / 24-hour insulin (basal + bolus) 1.8 4.2 High carb is better
24 carb / 24-hour insulin (bolus only) 6.0 5.0 Low carb is better

The chart below shows the difference in the daily blood sugar fluctuations of someone on a standard western diet and then after switching to a lower carb diet.  The difference in the blood sugar levels is night and day!  The difference in the quality of life between these two situations when it comes to energy levels, anxiety, depression, mood etc is also immensely different.

I pinged Mastering Diabetes on their Facebook page to clarify if the cornerstone of their whole argument includes basal and bolus insulin.  Unfortunately, my fears were confirmed (though they have since deleted their response and kicked me out of their Facebook Group).

Tight blood sugar control isn’t that important after all?

The next argument they try to run is that tight blood sugars really aren’t that necessary.

Cyrus (who is very active and practices intermittent fasting) has a Hba1c in the high 5s.

Robbie has a Hb1c in the low 6s.

Granted, this is good compared to the majority of the Type 1 population. They’ll have a better chance of thriving with good blood sugars if they are eating lots of vegetables and fruit compared to more processed grains and sugars that make up the typical diet.  But it’s still a far cry from the blood sugar control of people following the type of low carb approach advocated by Dr Richard Bernstein.

The problem I see with defining your diet as vegan or plant based is that most people don’t have the self-discipline to stick with eating only vegetables and fruit and end up filling up on more processed (but still technically vegan) processed junk food.

Cyrus and Robbie argue that normal blood glucose fluctuations are between 70mg/dL to 145 mg/dL or 3.8 to 8.0mmol/L.

The problem with this argument is that what currently passes for ‘normal’ is far from optimal.[19]  Complications from diabetes start to kick in well below what is widely considered “normal”.


Just because it’s normal for most people to do Facebook on their phone while they drive doesn’t mean it’s ideal or optimal.  Just because it’s normal to have poor blood sugar and most people are dying of metabolic diseases doesn’t sound like a persuasive argument for plant based diet being optimal to me!

If you’re happy to settle for less than optimal blood sugar control because you have a strong ethical position, then that’s fine, but don’t construe it as optimal for everyone when it’s not.

The reality is that many people over at Type 1 Grit following Dr Bernstein’s approach are doing fabulously!  Not everyone will achieve optimal, but it’s useful to know what to aim for and how to get there.

If you had a child or loved one with Type 1 diabetes would you want the opportunity to choose the approach that would yield the best results or would you prefer your advice to be tainted with ethical or commercial bias?

Check out the video the Type 1 Grit group put together for Dr B’s 83rd birthday to thank him for changing their lives.

Insulin resistance and metabolic syndrome are a big deal, so let’s not ruin more lives than we need to with bad advice that is based on bad math or putting ethical convictions or religious beliefs ahead of human health.

Understanding physiological insulin resistance

Cyrus and Robbie argue that someone on a low carb diet won’t deal with carbohydrate well when they are exposed to them.  This phenomenon is real, but is typically due to what is termed ‘physiological insulin resistance’.

Someone who eats a lot of carbohydrates will have high levels of insulin floating around in their bloodstream.  Then when they eat a carb bolus, their pancreas is primed to shoot out some more insulin to mop up the glucose and stop more glucose being released into the bloodstream via the liver.  By contrast, someone who doesn’t eat a lot of carbohydrates will have low levels of insulin in their bloodstream and need to wind up their pancreas to produce insulin to bring down the glucose.

This phenomenon is also referred to the first phase versus second insulin response.  Someone who is not eating a lot of carbs will have a slower first phase insulin response.

It’s like comparing someone’s time over 100m when they are starting from a standstill versus someone using a rolling start.  It’s not a relevant comparison.  This phenomenon will go away after a few days on a high carb diet.

At the same time though, micronutrients such as potassium, magnesium and calcium are critical to maintaining healthy insulin sensitivity and glucose uptake.   Metabolic acidosis (caused by a lack of dietary electrolytes) appears to cause an upregulation in insulin by the pancreas to hold onto precious electrolytes.  Over the long term, this could be another driver of insulin resistance, metabolic syndrome and diabetes. [20]

Getting adequate dietary electrolytes from green leafy vegetables will make it easier for our body to maintain acid/base balance.  However, I don’t think we need to feed all diabetics a high carbohydrate exclusively plant based diet to achieve this.

Eating fat makes you fat?

The vegan community seems to confuse eating fat and storing fat.  The Ancel Keys / vegan story is that we store fat in our body because we overeat dietary fat.  However, the reality is that we get fat because we eat more than we burn.

As shown in the graphic from Ray Cronise’s Oxidative Priority paper, we will only burn fat (from our body or diet) once we’ve burned through the alcohol, ketones, protein and carbohydrate and fat that we eat (in that order).[21]

When we eat our body prioritises the refilling of our glucose and glycogen stores in our blood stream and liver (which can hold about 1200 to 2000 calories) before we start to store the excess energy in our adipose tissue.  Our body fat stores can hold a lot more energy, but not an unlimited amount.  Once our fat stores are full and can hold no more, they become insulin resistant.  We then start to store the excess energy in our vital organs such as our liver, kidney, brain, eyes, heart, etc.

The trick to weight loss is to keep your blood sugar levels low enough so that your liver glycogen is being replenished from your body fat rather than always having overfull glycogen stores, so we need to offload excess energy to our fat stores.[22]

One of the many roles of insulin is to shut off the flow of stored energy from the liver into the blood stream.  If energy is coming in the pancreas will upregulate insulin to stop the flow of glucose from the liver back into the blood stream (regardless of whether you’re eating carbs, fat or protein from animal or plant based sources).  The best way to reduce insulin is to stop eating and let your stored energy flow back into your blood stream.

In a way, you can think of your liver as your fuel tank and you your blood glucose meter as the fuel gauge.  If your blood sugars are high, you should think twice about whether you really need more fuel now.

If you are insulin sensitive, the bad news is that you can easily store excess energy as body fat very effectively.  Insulin is an anabolic hormone that will help you to grow.  However, when you are insulin sensitive, you can lose fat relatively easily when you reduce energy intake.  If you are insulin sensitive your circulating insulin levels will be low, and fuel will more easily flow from storage.  Hence you won’t be such a mindless slave to your uncontrollable appetite.

If you are insulin resistant and have high levels of circulating insulin, you may struggle to release your stored body fat.  Your appetite will drive you to seek out food because you can’t efficiently access it from your body stores.   You won’t be able to go very long between meals.

A low carb diet can be helpful for someone who is insulin resistant because it can help lower insulin which in turn help them to normalise their appetite.  Teaching that we get fat because we eat fat is just outdated science.

Even Dr Joel Fuhman will tell you that actively avoiding fat is stupid.  He will also tell you that there is some value in eating fish on a regular basis to ensure you get adequate amounts of omega 3s and vitamin B-12.

Complications on a ketogenic diet

There are plenty of studies that show the shortcomings of a ketogenic diet.  Sarah Ballantyne did a great job of summarising these on her Paleo Mom Blog here.

When you look in detail however you find that the adverse reactions the ketogenic diet are typically due to ‘keto in a can’ formula products.

While these food substitutes will help achieve therapeutic ketosis to help manage epilepsy or other chronic conditions, many of these keto formula products end up being very low in micronutrients.[23]

Obtaining a significant amount of your energy intake from processed food-like products that have been separated from nutrients is not a good idea (e.g. whether it be sugar, processed grains, refined oils or exogenous ketones).

Is a low carb diet actually good for diabetes?

Unfortunately, Cyrus and Robby didn’t mention the benefits of a low carb diet for people with diabetes which are fairly well documented.  The seminal paper that summarises much of the latest work in this area is documented in Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base.

Anyone who is on the fence about using a low carb diet to manage diabetes should check out this paper which shows that a low carb diet is better for weight, HbA1c, glucose, HDL and triglycerides compared to low GI or a grain based diet.

Another well-known study is Christopher Gardener’s A to Z trial[24]  where they found that the Atkins diet did much better than the low fat, particularly if you were already insulin resistant.[25]

Image result for atkins at to z

What should you eat if you are a vegan with diabetes?

So, after all this, what should we eat to maintain optimal blood sugar levels?  Cyrus and Robby’s view is shown below.    Unfortunately, it appears that their recommendations are driven more by their philosophical and ethical views rather than the nutrient content of the food or their ability to stabilise blood sugars.

  • In the green column, most people with diabetes aren’t going to do too well with a lot of fruits, starchy veggies, and beans. Intact whole grains do contain substantial nutrients but are very hard to find in our modern food system.  Who actually eats wheat bran as a substantial part of their diet?  The vast majority of grains are processed with the nutrients discarded so they are tasty and shelf stable.
  • In the red column, dairy eggs, meat, fish and poultry can be nutrient dense and keep your blood sugars stable (as long as you’re not afraid of fat in whole foods or ‘animal protein’).
  • In the orange column, higher fat foods like nuts, seeds, avocados, coconut and olives can be useful to help stabilise your blood sugars, but it is possible to overconsume them if your goal is to lose weight.

We want to maximise nutrient density as much as possible while keeping the insulin load of our diet down to the point that we keep blood sugars stable.

This does not end up being super high fat or super low fat.  Fat just comes along with nutritious whole foods.

If you have diabetes, then a little more dietary fat initially may help to stabilise blood sugars.  Once your blood glucose levels have stabilised, you can start to decrease the dietary fat and increase nutrient density as much as you can while still maintaining excellent blood sugar levels.

A low insulin load diabetes-friendly plant based nutritional approach will be lacking omega 3 and vitamin B-12.

The shortlist of nutrient dense low insulin load plant based foods is shown below.  The foods at the top of each section should be reasonably safe for most people with diabetes.  You should test your blood sugars to see how you respond to some of the foods further down the list.

Many people who are conscious of animal welfare will eat fish (i.e. pescetarian).  Adding some fish will provide a much better nutritional profile than eating plants alone, with plenty of vitamin B12 and omega 3 available from the seafood.

I hope this is helpful for people who want to choose a plant based approach to maximise nutrient density and maintain excellent blood sugar control.

If you’re still confused, I have designed the Nutrient Optimiser to identify what foods you should add or remove from your diet to ensure you are getting the nutrients you need while maintaining excellent blood sugar levels.

So which approach is optimal?

It depends.

The optimal approach for you will depend on your situation and goals.

Going plant based may be an improvement if your diet is currently full of sugar and processed grains, but it is not the singular solution to every ill.  (For an excellent example of a very nutrient dense plant based dietary approach check out David’s Nutrient Optimiser analysis here.)

To help you make more informed food choices I have devised two different ways of measuring food quality:

  • Proportion of insulinogenic calories, and
  • Nutrient density.

The proportion of insulinogenic calories is the percentage of the food you eat that will require insulin to metabolise.  The table below lists a range of nutritional approaches ranked by the percentage of insulinogenic calories (right-hand column).

If you’re interested in any of these approaches you can download the list and save it to your phone or print it out to take shopping for some inspiration.

approach pdf foods nutrient profile % insulinogenic
well formulated ketogenic diet pdf foods profile 21
low carb pdf foods profile 34
plant based (diabetes friendly) pdf foods profile 56
weight loss and insulin resistance pdf foods profile 59
low carb pescitarian pdf foods profile 61
the most nutrient dense foods pdf foods profile 67
plant based pdf foods profile 68
plant based (without ND) profile 73

Simply switching to a plant based nutritional approach will leave you with 73% of your diet requiring insulin to metabolise.  The diabetes friendly plant based approach will be an improvement, but a low carb or ketogenic diet may be better if your goal is stable blood glucose levels.

Another way to look at things is nutrient density.  You may have noticed the nutrient profiles shown above have a red dotted box.  If a particular nutritional approach provides two times the Daily Recommended Intake for all essential nutrients then you would get a perfect score of 100%.  You can see below that the most nutritious foods below are pretty close to 100%.

By contrast, if we only focus on ‘plant based foods’ nutritional outcome is not so flash.  Thinking only in terms of plant based is not automatically nutrient dense.

I have sorted the various food lists in the table below based on their nutrient score.  My suggestion is to start at the top with the most nutrient dense foods and work your way down until you find an approach that suits your ethical framework or religious beliefs that will also enable you to stabilise your blood glucose levels (i.e. lower % insulinogenic calories).

approach score pdf foods nutrient profile % insulinogenic
the most nutrient dense foods 99.7% pdf foods profile 67
weight loss and insulin resistance 99.3% pdf foods profile 59
low carb pescitarian 94.5% pdf foods profile 61
low carbohydrate 81.0% pdf foods profile 34
plant based 78.0% pdf foods profile 68
plant based (diabetes friendly) 76.0% pdf foods profile 56
well formulated ketogenic diet 74.0% pdf foods profile 21
plant based (without ND) 57.0% profile 73

Summary

  • While many people chose exclusively plant based foods, they are not necessarily a better dietary choice compared to a more varied diet.
  • Someone following an exclusively plant based approach will require supplementation with vitamin B-12, vitamin D and omega 3s.
  • Fat is not necessarily good or bad. Swinging to macronutrient extremes will not lead to an optimal outcome.
  • Reducing the insulin load of your diet will help to normalise your blood sugar and insulin levels.
  • Ideally, you should aim to achieve the blood sugars of a metabolically healthy person while maximising nutrient density at the same time.

 

references

[1]https://www.ncbi.nlm.nih.gov/pubmed/25515001

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

[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC301822/

[4]https://www.quackwatch.org/01QuackeryRelatedTopics/DSH/coral2.html

[5]https://authoritynutrition.com/the-alkaline-diet-myth/

[6]https://optimisingnutrition.com/2017/03/19/micronutrients-at-macronutrient-extremes/

[7]https://socialblade.com/youtube/user/nutritionfactsorg

[8]https://nutritionfacts.org/donate/

[9]http://www.hsi.org/about/who_we_are/leadership/subject_experts/michael_greger.html

[10]https://www.facebook.com/mangomannutrition/videos/656469947843978/

[11]https://optimisingnutrition.com/2016/10/23/energy-density-food-hyper-palatability-and-reverse-engineering-optimal-foraging-theory/

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

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

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

[15]https://fineartamerica.com/featured/8-muscleart-marius-poser-classic-jake-hartz.html

[16]https://www.ncbi.nlm.nih.gov/pubmed/21241239

[17]https://optimisingnutrition.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes/

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

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

[20]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC301822/

[21]http://online.liebertpub.com/doi/full/10.1089/met.2016.0108

[22]https://optimisingnutrition.com/2016/02/15/how-to-use-your-glucose-meter-as-a-fuel-gauge/

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

[24]http://jamanetwork.com/journals/jama/fullarticle/205916

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

nutrient dense diabetic friendly vegan foods

  • Eating plant-based foods can be a great way to improve nutrient density and reduce the amount of highly insulinogenic processed carbohydrates in your diet.
  • This article looks at how we can optimize a plant-based diet for nutrient density as well as diabetic friendly by reducing insulin load.
  • Finally, we will look at whether adding additional food groups such as seafood, dairy or eggs would diminish or improve the nutrient density of a plant based approach.

nutrient density

A nutrient dense diet is key to maximizing health and satiety with a minimum of calories.  Maximising nutrient density enables our mitochondria to do more with less.

If our world is full of beneficial nutrients our body realises that there is no longer an energy crisis and is more likely to stop searching for more nutrients and lets go of our stored body fat and decrease appetite.

As detailed in the ‘Building a Better Nutrient Density Index’ article, quantifying nutrient density enables us to prioritise foods that contain the highest amount of essential nutrients that are harder to obtain.[1]

The chart below (click to enlarge) shows the percentage of the recommended daily intake of various essential nutrients provided by:

  • all 7000+ foods in the USDA foods database,
  • plant based foods, and
  • the most nutrient dense plant based foods.

2016-10-22

Restricting ourselves to ‘plant based’ foods will improve the vitamin and mineral content of the foods we eat.  However, focusing on the most nutrient dense plant based foods allows us to improve nutrient density even further

most nutrient dense plant based foods

Listed below is a summary of the most nutrient dense plant based foods sorted by their nutrient density score.  The nutrient density score (ND) is shown for each of the foods.

As you can see from the plot below from Nutrition Data, celery, which has a very high nutrient density score (ND), will provide you with a range of vitamins and minerals equivalent to 92% of your recommended daily intake with 1000 calories and 83% of your protein intake with 1000 calories.  Keep in mind though that you would need to eat five bunches of celery to get that 1000 calories though.

2016-10-22-1

The fact that broccoli has a low energy density may be a benefit if you are trying to lose weight, but perhaps would not be so helpful if you are fueling for an Ironman Triathlon.

Also shown in the tables below is the net carbohydrates and calories per 100g for each of the foods listed.

The great thing about most of these foods is that they will provide you with heaps of nutrients while having a low energy density which will make it hard to over consume them to a point that they will spike your blood glucose levels.

Listed below are the most nutrient dense plant based foods.  In the second half of this article we will look at how we can choose foods that will be more gentle on blood glucose levels for those of us that are more insulin resistant.

vegetables and spices 

food ND insulin load (g/100g) calories/100g MCA
watercress 13 2 11 2.2
white mushroom 10 5 22 1.8
spinach 10 4 23 1.7
portabella mushrooms 10 5 29 1.7
asparagus 10 3 22 1.7
spirulina 9 6 26 1.5
alfalfa 9 1 23 1.5
brown mushrooms 8 5 22 1.3
basil 8 3 23 1.3
chard 8 3 19 1.3
endive 7 1 17 1.2
shiitake mushroom 7 7 39 1.2
seaweed (wakame) 7 11 45 1.1
zucchini 6 2 17 1.0
cauliflower 6 4 25 1.0
Chinese cabbage 6 2 12 1.0
turnip greens 5 4 29 0.9
chicory greens 5 2 23 0.9
escarole 5 1 19 0.9
mung beans 5 4 19 0.9
lettuce 5 2 15 0.9
parsley 5 5 36 0.8
radicchio 4 4 23 0.7
edamame 4 13 121 0.7
bamboo shoots 4 5 27 0.7
peas 4 7 42 0.7
soybeans (sprouted) 4 12 81 0.7
seaweed (kelp) 4 10 43 0.6
shiitake mushrooms 3 72 296 0.6
chives 3 4 30 0.6
paprika 3 26 282 0.6
coriander 3 2 23 0.6
collards 3 4 33 0.5
summer squash 3 2 19 0.5
beet greens 3 2 22 0.5
okra 3 3 22 0.5
mustard seed 3 37 508 0.5
celery 2 3 18 0.5
curry powder 2 14 325 0.4
arugula 2 3 25 0.4
Brussel sprouts 2 6 42 0.4
pumpkin 2 4 20 0.3
snap beans 1 3 15 0.3
carrots 1 4 23 0.2
chayote 1 3 24 0.2
cabbage 1 4 23 0.2
cloves 1 35 274 0.2
kale 1 5 28 0.2
radishes 0 2 16 0.1
jalapeno peppers 0 3 27 0.1
dandelion greens 0 7 45 0.1
pickles 0 1 12 0.1
cucumber 0 1 12 0.1
turnips 0 3 21 0.1
eggplant -0 3 25 0.1
red peppers -0 3 31 0.0
lima beans -0 20 113 0.0
yeast extract spread -0 27 185 0.0
sauerkraut -0 2 19 0.0

legumes

food ND insulin load (g/100g) calories/100g MCA
tofu 5 8 83 0.9
soybeans 2 49 446 0.3
lentils 1 19 116 0.2
natto 1 22 211 0.2
navy beans 1 22 140 0.2
cowpeas 0 68 336 0.1
broad beans -0 54 341 0.0
peas -0 57 352 0.0

nuts and seeds

food ND insulin load (g/100g) calories/100g MCA
sunflower seeds 3 22 546 0.6
pumpkin seeds -0 29 559 0.0
brazil nuts -0 16 659 0.0
walnuts -1 22 619 -0.1
almond butter -2 26 614 -0.2
almonds -2 25 607 -0.2
flax seed -2 16 534 -0.3
pistachio nuts -2 34 569 -0.3
sesame seeds -3 17 631 -0.4
coconut water -3 3 19 -0.4
hazelnuts -3 17 629 -0.4
cashews -3 40 580 -0.4
sesame butter -3 33 586 -0.4
pine nuts -3 21 673 -0.4
butternuts -3 28 612 -0.5

fruit

food ND insulin load (g/100g) calories/100g MCA
carambola -1 5 31 -0.1
blackberries -2 3 43 -0.3
cranberries -2 8 46 -0.3
avocado -2 3 160 -0.3
kiwifruit -2 9 61 -0.3
apricots -3 10 48 -0.4
raspberries -3 4 52 -0.4
peaches -3 8 39 -0.4
grapefruit -3 8 33 -0.4
mulberries -3 9 43 -0.5
boysenberries -3 8 50 -0.5
strawberries -3 4 32 -0.5
nectarines -3 9 44 -0.5

diabetic friendly nutrient dense vegan foods

While the foods listed above would represent a significant dietary improvement for most people, those who are insulin resistant may struggle to keep their blood glucose levels stable if they eat too much non-fibre carbohydrate that can be found in plant based foods (e.g. bread, sweet potato, quinoa, rice, beans or spaghetti).

It is hard to get too many calories and / or spike your glucose levels if you restrict yourself to vegetables like celery, broccoli and spinach.

The problem comes if you are still hungry after you have eaten your fill of non-starchy veggies and are not wanting to lose more weight.  People using a plant based approach may end up filling up on energy dense higher carbohydrate foods which are more likely to raise their blood glucose and insulin levels.

As shown in the chart below, our insulin response to food is only partially explained by the quantity of carbohydrates in our food.

image01

The analysis of the food insulin index data indicates that our insulin response is also influenced by the fibre and the protein in the foods we eat.

image02

We can use the formula below to estimate the amount of insulin that our food will require as shown by the formula below.  Foods with a lower insulin load will enable your pancreas to keep up with demand and maintain normal blood glucose levels without the ‘blood glucose roller coaster’.

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

The higher fat foods actually have a lower nutrient density than the most nutrient dense vegetarian foods listed above.  Ideally in time someone with insulin resistance would be able to restore their insulin sensitivity through eating nutrient dense, low insulin load foods along with perhaps intermittent fasting and exercise.  However, in the meantime the lower insulin load foods will enable you to maintain normal blood glucose levels.

The list of foods below is prioritised by both nutrient density and the proportion of insulinogenic calories.  These foods will provide high levels of nutrition while also being gentle on your blood glucose levels with lower levels of insulin required.

vegetables

The vegetables in this list have a lower percentage of insulinogenic calories, lower amounts of net carbohydrates and a low energy density and therefore will have a minimal impact on blood glucose levels.   While the percentage of insulinogenic calories is often high, the net carbohydrates is low so the effect on blood glucose will be minimal.

food ND insulin load (g/100g) calories/100g MCA
curry powder 2 14 325 1.5
alfalfa 9 1 23 1.5
endive 8 1 17 1.3
poppy seeds -2 23 525 1.3
chicory greens 5 2 23 1.3
escarole 6 1 19 1.2
paprika 3 26 282 1.1
mustard seed 3 37 508 1.1
caraway seed -0 28 333 1.0
coriander 2 2 23 1.0
nutmeg -8 32 525 0.9
sage -5 26 315 0.9
mace -8 34 475 0.8
beet greens 3 2 22 0.8
marjoram -6 27 271 0.7
collards 3 4 33 0.7
eggplant -0 3 25 0.7
cloves -0 35 274 0.7
zucchini 6 2 17 0.7
thyme -2 31 276 0.7
banana pepper -2 3 27 0.6
edamame 5 13 121 0.6
jalapeno peppers -1 3 27 0.6
mustard greens -2 3 27 0.6
cinnamon -5 30 247 0.6
turnip greens 8 4 29 0.6
spinach 13 4 23 0.6
sauerkraut -1 2 19 0.6
pickles -1 1 12 0.6
cucumber -1 1 12 0.6
chayote 0 3 24 0.5
basil 9 3 23 0.5
red peppers -1 3 31 0.5
asparagus 11 3 22 0.5
radishes -1 2 16 0.4
cumin -6 44 375 0.4
summer squash 3 2 19 0.4
dill seed -3 43 305 0.4
parsley 5 5 36 0.4
chard 9 3 19 0.4
chives 5 4 30 0.4
arugula 0 3 25 0.4
lettuce 6 2 15 0.4
soybeans (sprouted) 5 12 81 0.4
cauliflower 6 4 25 0.3
portabella mushrooms 11 5 29 0.3
okra 4 3 22 0.3
Chinese cabbage 8 2 12 0.3
Brussel sprouts 1 6 42 0.2
carrots -1 5 37 0.2
celery 2 3 18 0.2
turnips -0 3 21 0.2
artichokes -2 7 47 0.2
shiitake mushroom 7 7 39 0.1
watercress 17 2 11 0.1
dandelion greens -1 7 45 0.0
cabbage 0 4 23 0.0
celery flakes -4 42 319 -0.0
red cabbage -3 5 29 -0.0
white mushroom 11 5 22 -0.1
snap beans 1 3 15 -0.1
bay leaf -7 53 313 -0.1
bamboo shoots 4 5 27 -0.1
rhubarb -4 3 21 -0.1
pepper -2 47 251 -0.1
kale 1 5 28 -0.1
yeast extract spread -2 27 185 -0.2
carrots 1 4 23 -0.2
spirulina 13 6 26 -0.2
peas 5 7 42 -0.2
turnips -3 4 22 -0.3
turmeric -2 52 312 -0.3
radicchio 4 4 23 -0.3
onions -0 6 32 -0.3
carrots -1 7 41 -0.3
potatoes -4 26 158 -0.4

nuts and seeds

Nuts and seeds have a lower proportion of insulinogenic calories as well as being lower in net carbs which makes them diabetic friendly.  They do have a considerably higher energy density and hence, unlike the veggies, it is possible to overeat nuts and seeds if you’re keeping an eye on your weight.

food ND insulin load (g/100g) calories/100g MCA
brazil nuts -1 16 659 1.6
pecans -6 12 691 1.6
macadamia nuts -7 12 718 1.6
sesame seeds -3 17 631 1.5
sunflower seeds 3 22 546 1.5
hazelnuts -4 17 629 1.5
coconut milk -6 5 230 1.5
coconut cream -7 7 330 1.5
flax seed -3 16 534 1.5
coconut meat -7 9 354 1.5
walnuts -1 22 619 1.5
pine nuts -4 21 673 1.5
almonds -3 25 607 1.4
almond butter -2 26 614 1.3
butternuts -3 28 612 1.3
pumpkin seeds -0 29 559 1.3
sesame butter -4 33 586 1.1
pistachio nuts -3 34 569 1.1
cashews -4 40 580 0.9
coconut -7 39 443 0.6
gingko nuts -6 15 111 -0.0
coconut water -3 3 19 -0.4

fruits

The list of diabetic friendly fruits with a lower proportion of insulinogenic calories ends up being quite short.  Some of these fruits will raise your blood glucose levels if you eat enough of them.  So if you are particularly insulin resistant then you will want to limit your quantity of fruit or stick to the lower insulin load fruits (e.g. olives and avocados rather than mango).

food ND insulin load (g/100g) calories/100g MCA
olives -6 1 145 1.7
avocado -4 3 160 1.6
blackberries -4 3 43 0.9
raspberries -4 4 52 0.8
strawberries -4 4 32 0.1
apples -7 7 52 0.0
gooseberries -6 6 44 -0.0
carambola -1 5 31 -0.0
kiwifruit -3 9 61 -0.1
boysenberries -5 8 50 -0.1
passionfruit -7 14 97 -0.1
apples -7 7 48 -0.1
pears -7 7 50 -0.1
blueberries -6 9 57 -0.2
blueberries -7 14 88 -0.3
watermelon -5 5 30 -0.3
cherries -7 9 50 -0.4
mango -5 11 60 -0.4
cranberries -3 8 46 -0.4

legumes

These legumes have a lower proportion of insulinogenic calories and lower carbohydrates, however there may still be some impact on blood glucose with the moderate levels of carbohydrates, so you may want to keep an eye on your blood glucose levels when you try these foods to see how you react to them.

food ND insulin load (g/100g) calories/100g MCA
tofu 9 8 83 1.1
peanuts -3 29 599 0.5
natto 2 22 211 0.5
soybeans 3 49 446 0.5
peanut butter -4 27 593 0.4
lupin seeds 1 50 371 0.2
miso -1 25 198 0.1
lentils 1 19 116 -0.0
navy beans 0 22 140 -0.0
broad beans 0 54 341 -0.1
hummus -4 20 177 -0.1
peas -0 57 352 -0.1
chick peas -2 27 164 -0.2
kidney beans -0 63 337 -0.3
black beans -1 63 341 -0.3
cowpeas 1 68 336 -0.4
garbanzo beans -2 67 378 -0.4
pinto beans -1 64 347 -0.4

what about pescetarian, lacto, ovo options?

In the development of this article I spoke with Barry Erdman who runs the Vegetarian Low Carb Diabetic Healthy Diet Society Facebook group.

Barry has been a strict vegetarian since 1970 and was diagnosed with Type 1 Diabetes nine years ago.  Barry maintained a nutrient dense plant based diet after his diagnosis, however found that he needed to incorporate dairy, eggs and some oils (e.g. MCT, coconut) into his vegetarian diet in order to achieve acceptable blood glucose control.  Barry told me that when he lost 30 lbs when he switched from a vegetarian diet to a LCHF keto lacto ovo vegetarian diet eliminating all grains, bad oils and fruit (except berries).

Barry also came to the conclusion that he would need to incorporate some fish oil into his diet in order to provide adequate levels of essential fatty acids which are not available in significant quantities in plant based products.

Barry asked me to have a look at how a lacto, ovo, pescitarian diet would stack up against the straight vegan approach.  So listed below are the most nutrient dense lacto (dairy), ovo (eggs), and pescetarian (seafood) diabetic friendly foods.

image11

For those who are interested in adding eggs or seafood I have listed them based on their nutrient density and proportion of insulinogenic calories.

eggs and dairy

food ND insulin load (g/100g) calories/100g MCA
butter -6 3 718 1.7
cream -5 5 340 1.6
egg yolk 5 12 275 1.5
cream cheese -4 10 350 1.4
sour cream -4 6 198 1.4
limburger cheese -2 15 327 1.2
cheddar cheese -2 20 410 1.2
camembert -2 16 300 1.2
whole egg 5 10 143 1.2
blue cheese -2 19 353 1.1
Monterey cheese -2 19 373 1.1
muenster cheese -2 19 368 1.1
brie -3 16 334 1.1
Swiss cheese -1 22 393 1.1
gruyere cheese -1 23 413 1.1
feta cheese -1 15 264 1.1
Colby -3 20 394 1.1
edam cheese -2 21 357 1.1
goat cheese -3 14 264 1.1
gouda cheese -2 21 356 1.1
ricotta -3 12 174 0.9
sour cream (light) -4 9 136 0.9
mozzarella -0 26 304 0.8
parmesan cheese -2 35 420 0.7
Greek yogurt -2 9 97 0.6
milk (full fat) -1 7 64 0.4

seafood

food ND insulin load (g/100g) calories/100g MCA
mackerel 2 10 305 1.6
caviar 8 23 264 1.1
cisco 4 13 177 1.1
sardine 6 19 208 0.9
herring 5 19 217 0.9
fish roe 12 18 143 0.8
trout 10 18 168 0.8
anchovy 8 22 210 0.8
sturgeon 10 16 135 0.7
salmon 11 20 156 0.6
tuna 5 23 184 0.4
oyster 10 14 102 0.3
flounder 9 12 86 0.3
halibut 11 17 111 0.1
crayfish 12 13 82 0.1
perch 8 14 96 0.1
crab 14 14 83 0.1
rockfish 9 17 109 0.0

macronutrient comparison

The image below shows a comparison of the macronutrients of these different approaches compared to the average of all of the foods in the USDA foods database.

The nutrient dense vegan approach will provide a lot of of fibre which will make these foods very filling and hard to overeat, however perhaps not particularly diabetes friendly.

The diabetes friendly approach has more protein and only 30% net carbohydrates so it will have are more gentle effect on blood glucose levels.

With higher levels of fat from fish, dairy and eggs, the pescetarian approach is 40% fat which will be more gentle on the blood glucose levels of someone with diabetes.

2017-02-26 (10).png

comparison of essential micronutrients

This chart shows the nutrients provided by the vegan approach compared to the average of all the foods in the USDA database.  We get a lot of vitamin K, vitamin C and vitamin A but no omega 3 fatty acids and lower quantities of vitamin B-12.

2017-02-26 (12).png

This chart shows the nutrients contained in the diabetes friendly vegan approach.  While this approach has more fat and less carbohydrates the nutrient density is lower overall.

2017-02-26 (14).png

This chart shows the nutrient density of the pescetarian approach which is higher overall.

2017-02-26 (15).png

summary

So in summary, there are some great nutrient dense options for people with diabetes who choose to follow a plant based dietary approach.  Supplementing a plant based diet with some seafood will provide essential fatty acids and boost protein levels.

more information

If you’re interested in learning more about the nutrient density ranking system check out:

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.

image02

want to live forever?

Living a long, vibrant, healthy life is a common goal.  But what can we do to extend our health span?

Should we eat more fruit and veggies?  Less processed foods?  More protein?  Less protein?  Exercise more?  Lose weight?  Sleep more?  Get more sun?  Less blue light?

Confused yet?

The numerous facets of health and longevity are complex and above my pay grade.  However, I am willing to add my two cents to the discussion in the areas of insulin, blood glucose, fasting and nutrition along with some input from people I respect.

image06

Dr Ted’s top tips

My wise mate Dr Ted Naiman recently commented on the topic of longevity.

I see centenarians at work, and as far as I can tell it is important to be:

– insulin sensitive,

– active, and

– relatively strong

Extreme careful protein restriction? Not so much.  I for one will focus on the first three.

image09

Not only is Ted enviably buff, he also has a neat way of condensing wisdom into short bites that are worth unpacking a little further.

insulin sensitive

The leading causes of death in adults in the western world (i.e. heart disease, stroke, cancer, Alzheimer’s and Parkinson’s)[1] all have something in common.  They are diseases of modern society, related to metabolic health and exacerbated by excessive insulin and / or high blood glucose levels.

People who live longer still die from these same diseases, they just succumb to them later.

This chart (from Barbieri, 2001) shows that insulin resistance generally deteriorates with age.  However if you’re one of the few to make it past 90 then chances are your insulin resistance is pretty spectacular!

1554485_10101621707332670_7301169958254701328_n.jpg

Ted’s infographic below explains how insulin resistance and metabolic syndrome leads to hyperinsulinemia (elevated insulin) and hyperglycaemia (elevated blood glucose) and then to heart disease and many of the other diseases of modern society.

image08

The chart below indicates that you have a much better chance of delaying the top two causes of death in western society (i.e. heart attack and stroke) if you have a lower HbA1c.[2] [3]

image11

And your chance of maintaining a big brain that is free of Alzheimer’s and Parkinson’s (causes of number four and five)[4] seems to be greatly improved if you keep your blood glucose levels low.

image10

We’ll come back to cancer, cause of death number three, a little later.

relatively strong

While you might be able to make an argument for longevity around restricting protein or even calories based on laboratory experiments, people live in the real world and need adequate strength to move around, stay active and be relatively strong.  People who are lean and strong intuitively look healthy and attractive to us.

Longevity research is typically done in yeast, worms, mice or other animals who live protected in captivity.  Unfortunately, real people don’t live in protected laboratory environments in a petri dish.  We live in the real world where real people break.

Loss of muscle as we age (i.e. sarcopenia) is a major issue.  Many older people become brittle and weak.  They take a fall, break their hip and never get up.  Maintaining strength and lean muscle mass is important.

You don’t see many fat animals in the wild, but at the same time you don’t see skinny animals, unless they are sick.  Animals that survive in their natural environment are lean, strong and fast.  They have to be to survive, to catch food and avoid being eaten.

Humans in the wild also tend to be strong and lean.

Similar to Ted Naiman, Ian Rambo (pictured below), 62, is a fan of intermittent fasting and a moderate protein diet.  Rambo doesn’t look like he’s about to trip and break his hip any time soon.

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active

A lot can be said about exercise, longevity and metabolic health.

Peter Attia, who recently left NUSi to go back to practice medicine with a focus on longevity, says:

Glucose disposal is everything. The best way to get there is by increasing the muscle’s capacity to take up glucose and make glycogen, and that’s best accomplished through lifting heavy weights. Doing so also increases health span (i.e. reducing injuries, lowering pain, and increasing mobility through life).[5]

Exercise depletes the glucose in our blood, liver and muscles and causes us to tap into our fat stores.  But it’s more than just about using up energy.

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As metabolic health and mitochondrial density improves through exercise, our fat oxidation rate increases.  We become metabolically flexible which means that we can easily use glucose or fat for fuel.  Once we improve our fitness and insulin sensitivity we get to the point that we can even obtain some of the glucose we need from fat.

My friend Mike Julian commented:

Every triglyceride that is broken down gives up one glycerol molecule.  Two glycerol molecules will make one glucose.   So the more fat we are capable of burning, the more glucose we can make from fat oxidation, thus the better we get at restoring muscle glycogen without eating carbohydrates.

Also the glycogen that we do burn produces lactate, which is then recycled to make more glucose in the cori cycle, which also contributes to muscle glycogen stores during recovery.

The goal is to increase mitochondrial density so that we are very good at oxidizing fats. When we have poor mitochondrial density we are far more prone to switching over to anaerobic metabolism at low activity levels and anaerobic activities require glucose.

So if we can’t burn fat at high rates due to low numbers of mitochondria, we can’t make much glucose from glycerol via fat oxidation, so in turn our bodies go to plan B which is to make it out of amino acids in order to make up for the rest of what it needs.

So if you increase your mitochondrial density through exercise, you’ll oxidize a higher volume of fat, which will give a higher yield of glucose from glycerol and thus reduce your body’s need to break down aminos from dietary protein and lean mass.

Post exercise increased fat oxidation due to mitochondrial density produces more ketones during the recovery period which get used preferentially so the increased glucose production during that time can go towards refilling of glycogen stores rather than be oxidized for energy. This is why many top keto athletes will fast for a few hours post training. If they eat straight away they miss out on this phenomenon and actually will recover slower.

caloric restriction

Building on the prior trials in yeast and worms, the current dietary restriction longevity experiments in rhesus monkeys are looking positive.  You can see the monkey on the right who has been living on 30% less calories looks younger and healthier than the monkey on the left who is the same age.

The monkeys who eat less have less age related disease and live longer.[6]

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While avoiding excess energy intake is beneficial, there are differing opinions on how this translates to humans in the real world in terms of increased life span.

Peter Attia says:

Most people in this space, the super-in-the-weeds people on this topic that I’ve spoken with at length, do not believe caloric restriction actually enhances survival in the wild. 

Nobody disputes that for most species it enhances survival in the laboratory, but once you get into the wild, you’re basically trading one type of mortality for another.[7]

So many things in life are a balance and involve compromise.  While you need adequate nutrition to be strong and active, our bodies also age more slowly if we don’t subject ourselves to excess energy.

Another problem with calorie restriction is that unfortunately most of us don’t have the self-discipline to limit our food intake all the time.  When we do eat we find it hard to stop until we are satisfied.  Our survival instincts don’t know about the studies in the monkeys, the worms and the yeast.

Most people find it hard to maintain constant caloric restriction when they have free will and unlimited access to food.  And then the cruel trick for people who do have the discipline to consistently reduce their energy intake is that the body will scale back its energy expenditure to stay within the reduced energy intake.

intermittent fasting

 “Complete abstinence is easier than perfect moderation.”

Saint Augustine[8]

So if caloric restriction doesn’t necessarily work, then what’s the solution?  Jason Fung makes a compelling case for the benefits of intermittent fasting rather than chronic calorie restriction.

When there is a lack of food a process called autophagy (from the Greek auto, “self” and phagein, “to eat”) kicks in and we turn to our own old cells for nutrients.  Autophagy is nature’s way of getting the energy we need when we don’t eat in addition to cleaning out the old junk in our bodies and brains.  When we get to eat again we build up new, fresh healthier cells.

But this process of cell clean up and regeneration cannot occur without giving the body the chance to clean out the old cells first.[9]  We regenerate and slow aging when we don’t always have a constant supply of energy.  One of the advantages of intermittent fasting over simply reducing calories is that you get a deeper cleanse of the old cells with total restriction of energy inputs.

In the video below David Sinclair explains how our body makes a special effort to repair itself when there is a lack of food.  In a famine your body senses an emergency and sends out Sirtuin proteins to maximise the health of our mitochondria to increase the chance that you will survive the famine and have the best chance of living until a time when food is more plentiful and you can reproduce and pass on your genes.  Unfortunately, this emergency repair function just doesn’t happen when food is plentiful.  They’re working on drugs that will mimic this effect, but in the meantime, intermittent fasting is free.

As detailed in the how to use your glucose meter as a fuel gauge article, it can be useful to track blood glucose or weight to help guide the frequency and duration of intermittent fasting to make sure you’re moving towards your goals.

protein restriction?

Many people hypothesise that restricting protein is an important component to slow aging.

Dr Ron Rosedale talks a lot about the dangers of glycation and the kinase mTOR.  His hypothesis, as articulated in the Safe Starches Debate and AHS 2012, is that we should avoid carbohydrates to avoid the dis-benefits of glycation, particularly as we can get the glucose we need from protein and to a lesser extent from fat.  When you see that all the major diseases of aging are correlated with high blood sugars and high insulin levels you might think that he is onto something.

In his AHS 2012 talk Rosedale discusses the dangers of mTOR (mammalian target of rapamycin).  mTOR is activated when we eat protein and raise insulin and leads to suppression of autophagy.  In view of this Rosedale recommends relatively low levels of protein for people with diabetes (e.g. 0.6g/kg) and even lower for people who are battling cancer (e.g. 0.45g/kg).

Vegan luminary Dr Michael Gregor points to the various drawbacks of excess dietary protein and makes a compelling case for restricting animal protein by focusing on plant foods rather than caloric restriction or intermittent fasting.

There’s a fascinating August 2015 paper by Valter Longo et al that gives an overview of the current thinking in longevity.[10]   While it mentions protein restriction as a possible area for future investigation, discussion of protein restriction generally seems to be in the context of intermittent restriction with subsequent re-feeding.

To date, very few studies have been performed in humans on the potential beneficial effects of protein and/or amino acid restriction on aging processes or age-associated chronic diseases. [11]

There are obvious benefits in having periods where the body can clean out old proteins, however you also need high quality nutrition to build back the new shiny parts.

While I have gone to great lengths to bring attention to the fact that protein contributes to the insulin load of the diet, I struggle with the concept of chronic protein avoidance when so many of the things I read talk about the mental health benefits of protein,[12] [13] the benefits of lean muscle mass for metabolic health, the satiety benefits of protein and the importance of lean muscle as we get older to ensure we can be active and strong rather than brittle.[14]

Like everything though it’s a balancing act.  Binging on protein supplements and egg whites to get big and jacked is not going to lead to optimal health and longevity.  Some of these guys are even injecting extra insulin for its anabolic hypertrophy effects on top of the anabolic hormones.  This is not healthy and not natural.

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So how much protein do you need when you do eat?   I think you need enough to be strong and active but at the same time without raising insulin and blood sugars and decreasing ketones.

Lean muscle = good

Insulin sensitivity = good

Excess body fat = bad

High insulin = bad

cancer

There’s also a growing momentum around the metabolic theory of cancer (the number three leading cause of death) which hypotheses that excess glucose feeds cancer growth and restricting glucose through a therapeutic ketogenic diet with intermittent fasting will reduce your risk of cancer.

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There is some great work by Thomas Seyfried, Travis Christoferson and Domonic D’Agostino that is well worth your time if you haven’t already seen it.

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When you hear Seyfriend talk he seems very proud of and excited about the glucose : ketone index (GKI) which he developed as a proxy for a person’s insulin levels.  As you can see in the chart below, as our blood glucose levels decrease ketone levels rise.

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More than blood glucose or ketones alone, the relationship between your blood glucose and ketones seems to be a good proxy for your insulin sensitivity.

It seems that someone with a GKI of less than 10 has fairly low insulin levels, someone with a GKI of less than 3 has excellent metabolic health, while someone battling cancer might want to target a GKI of 1.0.

Reducing the insulin load of your diet can reduce your glucose levels, increase your ketones and reduce your risk of metabolic syndrome and the most prominent causes of death (i.e. heart disease, stroke, cancer, Alzheimer’s and Parkinson’s).

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Just to be clear, you people who achieve these excellent insulin resistance levels don’t get get there by simple adding more fat to their morning coffee but through disciplined intermittent fasting which tends to lead to reduction in body fat which improves insulin resistance.

finding the optimal balance

On one extreme too much food will make us fat and insulin resistant and stop the body from repairing itself.

On the other extreme calorie restriction will make us frail and vulnerable to disease and accidents.

So how do we find the middle ground?

On the topic of carbohydrates Peter Attia says:

You want to consume basically as much glucose as you can tolerate before you start to get out of glucose homeostasis. For me there’s a different number than for the next person, and you have to find what the level is.

I’ve been wearing a continuous glucose monitor for several months now. Every day I just have it spit out my 24-hour average of glucose plus a standard deviation, and I now know my sweet spot. I like to have a 24-hour average of between 91 and 93 mg/dL with a standard deviation less than 10.

We can’t measure insulin in real time. To me, the Holy Grail would be to have an area under the curve of insulin, but this becomes a pretty good proxy.

It’s fascinating to see that Attia, who is a super fit semi pro athlete is going to the effort of wearing a continuous glucose meter full time.  CGMs are generally worn by people with type 1 diabetes like my wife.

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The process he is describes of reducing dietary glucose intake to a point where blood glucose levels are normalised is essentially the process used by the people we see who are managing type 1 diabetes as well as possible.

The food insulin index testing measured the area under the curve response to various foods (i.e. what Attia describes as the Holy Grail) and has been really useful for us to understand which dietary inputs cause the greatest blood glucose swings and require largest amounts of insulin.

I think the reason that Attia is recommending ‘as much glucose as you can tolerate’ is to fuel your energy needs for activity, maximise nutrition and dietary flexibility.  This level of blood glucose control will give him an HbA1c of 4.8% which will put him in the lowest risk category for the most common diseases of aging.  But to maintain such a tight standard deviation he’s going to be managing the net carbs and protein in his diet so his blood sugar doesn’t go over 100mg/dL or 5.6mmol/L too often.

Dr Roy Taylor recently released an interesting paper where he proposes that each person has a personal fat threshold[15].  Rather than the BMI chart or body fat, there is a certain level at which the body fat becomes inflamed and insulin resistant which leads to diabetes and all the issues related to metabolic syndrome.  What this means in practice is if your blood glucose levels are rising above optimal you need to eat less to lose body fat.

When it comes to protein Attia says:

What I’m telling my patients is really you only need as much protein as is necessary to preserve muscle mass.

You have a sliding scale, which is carbohydrate goes up until you hit your glucose and insulin ceiling, protein comes down until you’re about to erode into muscle mass and slip into positive nitrogen balance, and then fat becomes the delta.

So in somebody like me, that’s probably about 20% carb, 20% protein 60% fat.

I’ve done everything from vegan to full ketogenic.  I’ve experimented with the entire spectrum of religions, but nevertheless, that’s the framework.[16]

It’s worth noting here that this quote from Peter is in the context him talking at length about mTOR, ROS, glucose control and protein restriction.  Attia is one of the smartest guys in nutrition, medicine and anti-aging science, but he’s not avoiding protein.  He’s making sure he gets enough to maintain lean muscle mass but not so much that it messes with his glucose levels or requires a significant glucose response.

Attia also talks about maximising glucose and minimising protein to normalise blood glucose and insulin.  Given that the focus is on managing insulin levels, I think you could also take the opposite approach to minimise carbs and maximise protein as much as you can without disrupting glucose or losing ketones.   People with type 1 diabetes will tend to consume medium to higher protein levels (which provide glucose but without the same degree of glucose swing) with lower levels of carbohydrates.

Or alternatively find your own balance of net carbs and protein that gives excellent blood glucose levels and some ketones.

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When it comes to finding the optimal level of protein and energy Dr Tommy Wood said:

The anti-IGF-1 (insulin like growth factor) crowd confuse me. Lots = bad (cancer). Very little = also bad (sarcopenia and broken hips).[17]

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caloric restriction

One of the pioneers in the field of longevity is Roy Walford,[18] who developed the concept of Calorie Restriction with Optimal Nutrition (CRON).  Many of the ideas in this article and the blog overall are built around Walford’s ideas regarding optimising nutrition for health and longevity.

While Walford lived his theories in practice, he unfortunately died at 79 of ALS so we didn’t really get to find out whether calorie restriction delayed the major diseases of aging for him.  The pictures below are taken of Dr Walford before and after two years living in Biosphere 2.[19]

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Walford was the crew’s physician and meticulously recorded the health markers of the Biosphere 2 ‘crew members’[20].  It’s interesting to see how markers like the BMI chart, glucose, insulin and HbA1c all improved markedly with the semi-starvation conditions during the experiment, however they reverted to more normal levels after resuming normal eating.

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optimal nutrition

If we are going to fast and / or restrict calories to optimise our metabolic health it’s even more important that we make sure that the food we do eat, when we eat it, provides all the nutrients that we need to thrive and build back new shiny parts of our body.  Unfortunately it seems that the optimal nutrition component of Walford’s CRON concept is not discussed much these days.

In the article optimal foods for different goals I have detailed a system that can be tailored to identify nutrient dense foods for different goals to balance nutrient density and insulin load.  I hope this will help to spark further discussion around the topic of nutrient density and which foods would be most helpful for different people.

summary…

So what does all this mean?  What do we know about maximising our metabolic health and avoiding the primary diseases of aging?

Is too much energy bad… yes.

Is eating all the time bad…. yes.

Is excess protein bad… maybe, maybe not, however the vegans would say that we should avoid animal protein and stick to only plant based foods.

Are excess carbohydrates bad… maybe, maybe not, however the low carb / keto crowd would say that you need to avoid carbohydrates because they raise your insulin.

Is excess protein and excess non-fibre carbohydrates bad… most likely, yes.

Both carbohydrates and protein will raise insulin, blood glucose, IGF-1 and upregulate mTOR which all accelerate aging.

In the end though we have to eat.  We are programmed for survival.   While not eating too much and intermittent fasting are important considerations, when we do eat though we should maximise the nutrient density and prioritise foods that do not not raise our insulin and blood glucose levels.  I think if you get that right a lot of the other things will follow.

There is no perfect dietary solution for all.  What is best for you will come down to your situation, goals and preferences.

Some people will prefer zero carb with lots of meat.

Some people feel strongly about avoiding animal products and do well on a plant based diet with minimal processed foods.

Some will aim for a therapeutic ketosis approach to tackle major metabolic issues.

All of these extremes are viable but a balance somewhere in the middle might be easier to maintain in the long term while also maximising the nutrient density of the calories we consume.

What is almost certainly dangerous for most people is the low fat, high insulin load approach that has been recommended for the past few decades and seems to have led to increased consumption of low nutrient density highly processed food products by many.

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references

[1] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[2] http://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

[3] http://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/1749-8090-3-63

[4] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[5] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[6] http://www.nature.com/ncomms/2014/140401/ncomms4557/fig_tab/ncomms4557_F1.html

[7] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[8] http://www.goodreads.com/quotes/6741-complete-abstinence-is-easier-than-perfect-moderation

[9] https://intensivedietarymanagement.com/fasting-and-autophagy-fasting-25/

[10] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531065/

[11] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531065/

[12] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738337/

[13] https://www.moodcure.com/safe_alternatives_to_antidepressants.html

[14] http://www.webmd.com/healthy-aging/sarcopenia-with-aging

[15] http://www.clinsci.org/content/128/7/405

[16] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[17] http://press.endocrine.org/doi/full/10.1210/jc.2011-1377

[18] https://en.wikipedia.org/wiki/Roy_Walford

[19] https://en.wikipedia.org/wiki/Biosphere_2

[20] https://m.biomedgerontology.oxfordjournals.org/content/57/6/B211.full

[21] http://www.walford.com/cronmeals1.htm

[22] https://www.drfuhrman.com/library/andi-food-scores.aspx

[23] https://www.youtube.com/watch?v=ZVQmPVBjubw

Atkins versus the vegans

Dr Fung also noted that the Atkins approach often doesn’t work over the long term because things other than carbohydrates require insulin.

The food insulin index data demonstrates that a number of high protein foods such as steak, cheddar cheese, white fish and tuna cause a significant insulin response even though they contain minimal carbohydrate.

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The irony of low carbers eating protein to avoid carbs to minimise insulin secretion although the insulin index data shows that protein foods cause a significant insulin effect has not been lost on the vegan community as shown in this thought provoking video below.

In response to this, Gary Taubes has acknowledged that protein does stimulate insulin, however has stated that

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

Is protein a significant issue an issue for people trying to control blood sugar and reduce the insulinogenic load of their food?

Does the fact that protein takes longer to digest mean that the insulin secreted in response to protein doesn’t matter?

Perhaps the food insulin index data can help us find the answer.

[next article…  how much insulin is required to cover protein?]

[this post is part of the insulin index series]

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