By using her regular fasting routine and nutrient dense feasting she has been able to lose 37.5 lb (17kg) of body fat during 2016 (which is significant given she is only 5′ 3″).
This was one of her favourite go to recipes during her weight loss. Rebecca says:
I originally started eating ketogenically a few years ago by eating very high fat, lower protein, and very low (sometimes zero) carbs.
That worked for a while, and I lost weight, but as time went on, I found that I was eating so much fat and so little protein that I was getting hungry all the time.
I now get plenty of protein on my eating days. I am 5’3″ and eat 125g on the days that I feast
It seems that as you approach your goal weight your body works increases appetite to maintain lean muscle mass. I think this style of higher protein meal will maximise your chance of managing appetite during weight loss as well as maximising nutrient density to prevent rebound binges due to cravings for nutrients.
Rebecca’s recipe is:
114g (4 oz.) raw chicken livers, cut into small pieces
1/4 tsp. chopped, dried rosemary
1/4 tsp. ground, dried thyme
1/4 tsp. garlic powder
1/4 tsp. sea salt
114g (4 oz.) frozen, chopped spinach, cooked, drained, warm
1 Tbs. butter, divided
57g (2 oz.) raw onion, chopped
114g (4 oz.) raw white mushrooms, chopped
2 thick slices bacon, cooked and cut into small pieces
1 Tbs. whiskey
2 raw eggs
Additional sea salt, as desired
In a small bowl, combine chicken livers, spices, and salt, stirring to combine. Set aside.
Preheat a small cast iron skillet on medium-low heat, then add 1/2 Tbs. butter. Add onions, cover and cook for 1 minute. Add mushrooms, cover and cook for an additional 2 minutes, or until veggies start to brown. Add chicken livers to the skillet, and continue to cook, stirring, until liver is cooked medium well. Add bacon and whiskey and stir again.
Cut the remaining 1/2 Tbs. butter into a several pieces and add to the skillet, allowing it to melt down into the bottom of the pan. Do not stir it in.
Carefully break the eggs into the skillet, letting them rest on top of the mixture. Cover the skillet and cook just long enough for the eggs to cook to however you like them. For the whites to be firm and the yolks to be runny, it may take 2-3 minutes.
Arrange the warm spinach on a plate, and with a spatula, carefully lift out the food from the skillet and set on top of the spinach. If there is any butter left in the skillet, pour it over the eggs. Add additional sea salt if desired, and enjoy!
While a lot of attention is often given to macronutrient balance, quantifying the vitamin and mineral sufficiency of our diet is typically done by guesswork. This article lists the foods that are highest in amino acids, vitamins, minerals or omega 3 refined to suit people with different goals (e.g. diabetes management, weight loss, therapeutic ketosis or a metabolically healthy athlete).
I’ve spent some time lately analysing people’s food diaries, noting nutritional deficiencies, and suggesting specific foods to fill nutritional gaps while still being mindful of the capacity of the individual to process glucose based on their individual insulin sensitivity and pancreatic function. The output from nutritiondata.self.com below shows an example of the nutrient balance and protein quality analysis.
In this instance the meal has plenty of protein but is lacking in vitamins and minerals, which is not uncommon for people who are trying to reduce their carbohydrates to minimise their blood glucose levels.
The pink spokes of the nutrient balance plot on the left shows the vitamins while the white shows the minerals. On the right hand side the individual spokes of the protein quality score represent individual amino acids.
A score of 100 means that you will meet the recommended daily intake (RDI) for all the nutrients with 1000 calories, so a score of 40 in the nutrient balance as shown is less than desirable if we are trying to maximise nutrition. 
I thought it would be useful to develop a ‘shortlist’ of foods to enable people to find foods with high levels of particular nutrients to fill in possible deficiencies while being mindful of their ability to deal with glucose.
The list of essential nutrients below is the basis of the nutrient density scoring system used in the Your Personal Food Ranking System article, with equal weighting given to each of these essential nutrients. 
The only essential nutrients not included in this list are the omega-6 fatty acids which we typically get more than enough of in our western diet. 
essential fatty acids
alpha-Linolenic acid (omega-3) (18:3)
docosahexaenoic acid (omega-3) (22:6)
Previously I’ve developed short lists of nutrient dense foods also based on their insulin load or other parameters (see optimal foods lists).
But what if we want to get more specific and find the optimal foods for a diabetic who is getting adequate protein but needs more vitamins or minerals? What about someone whose goal is nutritional ketosis who is trying to maximise their omega-3 fats to nurture their brain?
To this end the next step is to develop more specific lists of nutrient dense foods in specific categories (i.e. omega-3, vitamins, minerals and amino acids) which can be tailored to individual carbohydrate tolerance levels.
I’ve exported the top foods using each of the ranking criteria from the 8000 foods in the database. You can click on the ‘download’ link to open the .pdf to see the full list. Each .pdf file shows the relative weighting of the various components of the multi criteria ranking system. The top five are highlighted in the following discussion below.
It’s worth noting that the ranking system is based on both nutrient density / calorie, and calorie density / weight. Considering nutrient density / calorie will preference low calorie density foods such as leafy veggies and herbs. Considering calorie density / weight tends to prioritise animal foods. Evenly balancing both parameters seems to be a logical approach.
You’re probably not going to get your daily energy requirements from basil and parsley so you’ll realistically need to move down the list to the more calorie dense foods once you’ve eaten as much of the green leafy veggies as you can. The same also applies if some foods listed are not available in your area.
This section looks at the most nutrient dense foods across all of the essential nutrients shown above. Consider including the weighting tables.
no insulin index contribution
If we do not consider insulin load then we get the following highly nutrient dense foods:
white fish, and
spirulina / seaweed
Liver tops the list. This aligns with Matt Lalonde’s analysis of nutrient density as detailed in his AHS 2012 presentation.
It’s likely the nutrient density of cod, which is second on the list of the most nutrient dense foods, is the reason that Dwayne Johnson (a.k.a. The Rock) eats an inordinate amount of it. 
It certainly seems to be working for him.
athlete and metabolically healthy
If you have no issue with obesity or insulin resistance then you’ll likely want to simply select foods at the top of the nutrient dense foods list. However most people will also benefit from considering their insulin load along with fibre and calorie density. Most of us mere mortals aren’t as active or metabolically healthy as Dwayne.
When we consider insulin load we get the following foods at the top of the list:
We grow basil in a little herb garden and use it to make a pesto with pine nuts, parmesan and olive oil. It’s so delicious! (And when I say ‘we’ I mean my amazing wife Monica.)
You’ll note that spices and herbs typically rank highly in a lot of these lists. The good news is that they typically have a very low calorie density, high nutrient density and are high in fibre.
The challenge again is that it’s hard to get all your energy needs from herbs alone, so after you’ve included as many herbs and green leafy veggies as you can fit in, go further down the list to select other more calorie dense foods to meet your required intake.
If we reduce calorie density, increase fibre and pay some attention to insulin load for the weight loss scenario we get the following foods:
wax gourd (winter melon),
If you’re wondering what a winter melon looks like (like I was), here it is.
The winter melon does well in this ranking because it is very fibrous, has a very low calorie density and a very low 8% insulinogenic calories which means that it has very few digestible carbohydrates.
Again, basil does pretty well along with a range of nutrient dense herbs. Basil is more nutrient dense than the winter melon while still having a very low calorie density.
diabetes and nutritional ketosis
If we factor carbohydrate tolerance into the mix and want to keep the insulin load of our diet low we get the following foods:
wax gourd (winter melon),
Wax gourd does well again due to its high fibre and low calorie density; however if you’re looking for excellent nutrient density as well, then chia seeds and flax seeds may be better choices. When it comes to flax seeds are best eaten ‘fresh ground’ (in a bullet grinder) for digestibility and also freshness and that over consumption may be problematic when it comes to increasing estrogens.
Then if we’re looking for the most nutrient dense foods that will support therapeutic ketosis we get the following list:
Good nutrition is about more than simply eating more fat. When you look at the top foods using this ranking you’ll see that you will need to use a little more discretion (e.g. avoiding vegetable oils, margarine and fortified products) due to the fact that nutrients and fibre have such a low ranking.
Omega-3 fats are important and most of us generally don’t get enough, but rather get too many omega-6 fats from grain based processed foods.
Along with high levels of processed carbohydrates, excess levels of processed omega-6 fats are now being blamed for the current obesity epidemic. 
The foods highlighted in the following section will help you get more omega-3 to correct the balance.
no insulin index contribution
If we’re looking for the foods that are the highest in omega 3 fatty acids without consideration of insulin load we get:
fish oil, and
I like salmon, but it’s not cheap. I find sardines are still pretty amazing but much more cost effective.  If you’re going to pay for salmon to get omega 3 fatty acids then you should make sure it’s wild caught to avoid the omega 6 oils and antibiotics in the grain fed farmed salmon.
Sardines have a very high nutrient density but still not as much omega 3 fatty (i.e. 1480mg per 100g for sardines versus 2586mg per 100g for salmon).
athlete and metabolically healthy
If we factor in some consideration of insulin load, fibre and calorie density we get:
It’s interesting to see that there are also excellent vegetarian sources of omega-3 fatty acids such as marjoram (pictured below) and chia seeds (though some may argue that the bio-availability of the omega 3 in the salmon is better than the plant products).
Some of the top ranking foods with omega-3 fatty acids for weight loss are:
While seafood is expensive, brain is cheap, though a little higher on the gross factor.
Cancer survivor Andrew Scarborough tries to maximise omega 3 fatty acids to keep his brain tumour and epilepsy at bay and makes sure he eats as much brain as he can.
diabetes, nutritional ketosis and therapeutic ketosis
And if you wanted to know the oils with the highest omega-3 content, here they are:
Fish oil – menhaden,
Fish oil – sardine,
Fish oil – salmon,
Fish oil – cod liver, and
Oil – seal
This section will be of interest to people trying to build muscle by highlighting the foods highest in amino acids.
no insulin index contribution
So what are the best sources of protein, regardless of insulin load?
soy protein isolate,
Again, Dwayne Johnson’s cod does well, but so does the humble egg, either the whites or the whole thing.
We have been told to limit egg consumption over the last few decades, but now, in case you didn’t get the memo, saturated fat is no longer a nutrient of concern so they’re OK again.
And while egg whites do well if you’re only looking for amino acids, however if you are also chasing vitamins, minerals and good fats I’d prefer to eat the whole egg.
athlete and metabolically healthy
If you have some regard for the insulin load of your diet you end up with this list of higher fat foods:
whole egg, and
If we aim for lower calorie density foods for weight loss we get this list:
chia seeds, and
The bratwurst sausage does really well in the nutrition analysis because it is nutrient dense both in amino acids and high fat which keeps the insulin load down.
diabetes and nutritional ketosis
If you’re concerned about your blood glucose levels then this list of foods may be useful:
And those who are aiming for therapeutic ketosis who want to keep their insulin load from low protein may find these foods useful:
chia seeds, and
People focusing on reducing their carbohydrate load will sometimes neglect vitamins and minerals, especially if they are counting total carbs rather than net carbs which can lead to neglecting veggies.
I think most people should be trying to increase the levels of indigestible fibre as it decreases the insulin load of their diet,  feeds good gut bacteria, leaves you feeling fuller for longer and generally comes packaged with heaps of good vitamins and minerals.
At the same time it is true that some high fibre foods also come with digestible carbohydrates which may not be desirable for someone who is trying to manage the insulin load of their diet.
The foods listed in this section will enable you to increase your vitamins while managing the insulin load of your diet to suit your goals.
no insulin index contribution
These foods will give you the biggest bang for your buck in the vitamin and mineral department if insulin resistance is not an issue for you:
Peppers (or capsicums as they’re called in Australia) are great in omelettes.
Liver is also very high in vitamins if you just can’t tolerate veggies.
athlete and metabolically healthy
If we bring the insulin load of your diet into consideration then these foods come to the top of the list:
red peppers, and
It’s interesting to see so many spices ranking so highly in these lists. Not only are they nutrient dense but they also make the foods taste better and are more satisfying.
Good food doesn’t have to taste bland!
If weight loss is of interest to you then this list of lower calorie density foods might be useful:
It will be very challenging to eat too many calories with these foods. We find spinach to be pretty versatile whether it is in a salad or an omelette.
diabetes and nutritional ketosis
These foods will give you lots of vitamins if you are trying to manage your blood glucose levels:
turnip greens, and
Most green leafy veggies will be great for people with diabetes as well as providing excellent nutrient density and heaps of fibre.
If you really need to keep your blood sugars down then getting your vitamins from these foods may be helpful:
egg yolk, and
no insulin index contribution
Ever wondered which real whole foods would give you the most minerals per calorie without resorting to supplements?
Here’s your answer:
Even if you found a vitamin and mineral supplement that ticked off on all the essential nutrients there’s no guarantee that they will be absorbed by your body, or that you’re not missing a nutrient that is not currently deemed ‘essential’. Real foods will always trump supplements!
As you look down these lists you may notice that herbs and spices top the list of foods that have a lot of minerals. Once you have eaten as much coriander, basil, parsley and spearmint as you can and still feel hungry keep doing down the list and you will find more calorie dense foods such as spinach, eggs, sunflower seeds, and sesame seeds etc which are more common and easier to fill up on.
athlete and metabolically healthy
If we factor in some consideration of insulin load then we get this list:
wheat bran (crude),
Wheat bran (crude) features in this list but it’s very rarely eaten in this natural state. Most of the value is lost when you remove the husk from the wheat.
As much as we’re told that we shouldn’t eliminate whole food groups, grain based products just don’t rate well when you prioritise foods in terms of nutrient density.
If you’re looking for some lower calorie density options the list changes slightly:
wheat bran (crude), and
diabetes and nutritional ketosis
If you’re trying to manage your blood sugars then this is your list of foods that are packed with minerals:
chilli powder, and
If you’re aiming for therapeutic ketosis then the higher fat nuts come into the picture to get your minerals:
pine / pinon nuts,
sunflower seeds, and
So what does all this mean and how can we apply it?
I don’t think it’s necessary or ideal to track your food all the time, however it’s well worth taking a typical day of food and entering it into the recipe builder at nutritiondata.self.com to see where you might be lacking.
Are your vitamins or minerals low? Protein? What about fibre.
If you find these are lacking you can use these food lists to fill nutritional gaps while keeping in mind your ability to process carbohydrates and attaining your personal goals.
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).
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.
review of glucose load
First up I’ve analysed Wendy’s macro nutrients to determine the insulin load, percentage insulinogenic calories and macronutrient split as shown in the table below.
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 macro nutrients 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.
If Wendy was still having blood sugar issues (say an 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.
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.
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 Wendy’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 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. I 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  identified that people who are insulin resistant typically only lose weight on a low carbohydrate diet. 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.
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 a 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.
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.
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.  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, 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.
So in Wendy’s case, in order to improve the vitamin and mineral score, I’ve reduced the chicken from lunch and added some spinach and mushroom. This has raised the “Nutrient Balance” score from 52 to 75. The chicken is quite a 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 ).
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.
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.
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!
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.
If we have the bread the fibre and nutrients comes up only slightly however the net carbs increases to 17g and the overall score decreases due to the higher insulin load. So the bread is certainly not a great option if you have blood sugar issues.
My nine year old son was asking what he could have for breakfast that would be healthy.
This is pretty much the simplest and healthiest recipe that I could design that a nine year old can put together unsupervised.
I’m teaching him to just put some frozen spinach, eggs, cream and cheese into a microwave bowl.
Eggs are a wonderfully complete protein. Cheese and cream add to the taste as well as adding in other proteins and fat not in the eggs.
Spinach is such a great superfood with so many micronutrients while being low in net carbs due to the high fibre content.
You can add coconut oil or butter to get extra good fats into your meal to create something wonderfully indulgent, nutritious and that will be gentle on your blood sugars.
If you’re short on time frozen spinach is quicker than using fresh spinach. I figure if you’re going to skip the spinach because it takes too long to fry up, then it’s better to go with the frozen option. I will use frozen kale sometimes too which gives a slightly different taste and texture.
If I’m cooking for the family and have bit more time I’ll do the fresh spinach in the fry pan. If I’m putting this together for the family before we run out the door in the morning I will use some frozen spinach or kale.
With only 7g net carbs and heaps of well rounded nutrition (in terms of both vitamins and minerals and amino acids) it’s pretty hard to go wrong with this for any meal.
The stats for a 500 calorie serving are shown below. The net carbs are low, the fibre is fairly high with the spinach and most of the insulin requirement is for the slower digesting protein rather than the carbohydrates.
The more spinach the better if you want to maximise the nutrition. The highest overall score occurs when we we use 700g of spinach. Though this may be pushing the limits of optimising nutrition, not necessarily palatability or eating pleasure.
If you found 7g of net carbs raised your blood sugar you could certainly reduce some of the spinach, although most people find that counting net carbs in real food (rather than processed / manufactured foods) are OK (see the article fibre… net carbs or total carbs for more info)
Since working through the nutrition analysis comparing different meals, this meal has basically become our preferred go to meal, which you can make as simple or as complex as you want. If you’re an insulin dependent diabetic you could use this as a regular meal and refine your insulin dosing based what you see on your BG metre after the meals.
I’ve run the analysis below with the kale rather than the spinach. As much as people rave about kale, it actually does not do as well on the nutrient balance score as spinach! Spinach scores better in both the nutrient completeness and the amino acids. Kale also has more total carbohydrates and less fibre which makes less diabetic friendly.
As shown below, this combination provides a great range of micronutrients and protein while staying quite low in net carbohydrates.
[The nutritional analysis below is for the whole recipe which would serve two or three. The table at the bottom shows net carbs, insulin load and fibre for a 500 calorie serving.]
Spinach really is a “super food” with a very rich nutrient profile and a solid array of proteins in its own right.
Eggs have a fab protein score, and the egg yolks are even higher in fat and more complete in proteins than the whole egg. It’s so sad that these little gems have been demonised because of their wrongfully alleged “artery clogging saturated fat” content for so long.
Egg yolks have the same nutritional balance score but an even better amino acid score than the whole egg in spite of having a lower percentage of calories from protein. They are also higher in fat which is great from a diabetes perspective.