• 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.

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

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

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.

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

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

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

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

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

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

improved calorie density and nutrient density

So in Wendy’s case, in order to improve the vitamin and mineral score, I’ve reduced the chicken from lunch and added 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 [6]).

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.

references

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

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

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

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

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

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