This is simple, but unfortunately not optimal when it comes to ensuring optimal nutrition.
Nutrient-dense whole foods don’t come in prepackaged satchels of protein, carbs, fat, fibre and calories that you can mix together to meet specific macronutrient and calorie targets.
In real life, nutritious whole foods have a range of macronutrients and micronutrient profiles. Some days you might crave more energy or different nutrients based on your needs.
While calories and macros still play a role, chances are that you will do better if you initially focus on nutrient-dense whole foods rather than achieving specific macronutrient and calorie targets. Once you remove nutrient poor highly processed foods from your diet you will be able to better trust your food cravings and appetite.
Where to focus
The personalised foods and meals in your free Nutrient Optimiser report will help you re-balance your micronutrient profile, stabilise your blood sugars and provide the energy you need from your food (but not too much, particularly if your goal is fat loss).
To help you make the transition from just thinking in terms of macronutrients and calories, the Nutrient Optimiser provides you with personalised macro and calorie ranges.
The image below shows my macronutrient and energy ranges as someone who is currently 95kg with about 16% body fat and good blood sugars. My current goal, after building some strength in the gym last year, is to lose some body fat while holding onto as much hard earned muscle mass as I can.
Working within target ranges enables me to still listen to my appetite which may guide me to eat more on days that I am more active and when I tend to crave more protein and/or carbs. Conversely, there may be other days when I am less active and less hungry and hence don’t need to eat more than my body is craving.
For me, as someone who has become fairly insulin sensitive with good blood sugars, these macronutrient ranges are fairly wide. I could consume between 32 and 142 g of fat or up to 151g of non-fibre carbohydrates as long as I’m not overdoing my overall energy intake.
For contrast, I have shown below the macro and energy ranges that the Nutrient Optimiser would give for a woman who was also 95kg but had 50% body fat and type 2 diabetes and looking to lose weight.
Her overall energy requirement is lower because she has less metabolically active lean mass. Her target carbohydrate range is much lower to help her control her blood sugars.
At just over 500 calories per day, her lower limit of energy intake is also very low because she has a lot of body fat that can be mobilised. However, she still needs a minimum level of protein, essential fat intake and other vitamins and minerals.
These macronutrient and calorie ranges can act as a starting point. As you make progress with your weight loss or get your blood sugars under control, you can update your profile in the Nutrient Optimiser to update these numbers.
We’re also in the process of developing a Nutrient Optimiser Dashboard that will allow you to track your biometric data (e.g. blood sugars, waist, weight, blood ketones, breath ketones, body fat percentage etc.) help you fine-tune your macro and calorie targets to ensure you are moving towards your goal.
Lots of people are wannabe biohackers but end up getting caught up chasing markers that don’t help them reach their goals (e.g. chasing high ketones for weight loss). Alternatively, they don’t adapt their approach as they progress (e.g. they don’t transition to a more nutrient-dense lower energy density approach once their blood sugars have stabilised on a lower carb diet).
If you have run your free Nutrient Optimiser report we’ll be sure to let you know once the dashboard is ready.
Calories
There is endless debate whether calories, hormones or nutrients matter more.
While most people agree that you need an energy deficit to lose weight and an energy surplus to gain weight, the way your body processes energy is complicated and hence impossible to calculate precisely.
Focusing on calories alone may be short-sighted. Without attention to food quality and macros, it may be harder to manage your energy intake.
If you are healthy, your metabolism will increase to burn off any excess energy. You will fidget more and naturally move around more (i.e. non-exercise activity thermogenesis).
However, most people can’t do this forever, particularly if their food is nutrient poor and causes inflammation. A chronic energy excess that drives body fat levels higher will most likely cause you to become overweight and insulin resistant once your fat stores cannot take in any more.
Conversely, if you restrict calories, your body will become more efficient. You will adapt to cope with less energy. Due to this ‘adaptive thermogenesis’ over time you will need to take in less energy if you want to keep losing weight.
This adaption is often seen as a bad thing. But for most people, other than not getting to enjoy as much yummy food, training your body to do more with less is highly beneficial.
Metabolic efficiency
If your car is running well, it uses less fuel and gets the job done efficiently.
But if your car is getting old and blowing heaps of fumes, it’s probably burning more fuel than it really needs.
We want fuel-efficient cars to minimise cost and the impact on the environment. But when it comes to choosing the fuel for our body, many of us want to know how much food we can get away with without looking too fat.
Energy is conserved
While our bodies are complex systems and we don’t understand everything that goes on inside them, energy is conserved.
We would love to be able to eat lots and lots of yummy stuff and stay lean, typically doesn’t work out in the long term.
If you are losing weight off your body, you are burning more than you are eating.
If you are gaining weight, you are taking in more energy than you are burning.
However, while energy intake still matters, your primary focus should ideally be on consuming nutrient-dense foods that don’t spike your blood sugars. Once we have food quality dialled in quantity will fall into place. Your appetite will start to work the way it is meant to. Food that contains the micronutrients you need tend to help to prevent nutrient cravings, are more satiating and help you to consume less energy.
Is intermittent fasting better than calorie counting?
The unfortunate reality is that it’s not easy to maintain an energy deficit over a long period of time.
In the low carb or keto world, many people find some version of intermittent fasting helpful.
Others find calorie cycling or a targeted ketogenic diet (i.e. more carbs and/or calories on workout days) to be useful.
Still, others find that refeeds or diet breaks can be helpful to reset your hormones and appetite after a number of days or weeks of conscious and careful restriction.
Personally, I’ve done my share of intermittent fasting but found that I would always manage to compensate for my deprivation and congratulate myself with enough food at the end to maintain my weight over the long term. And it was hard at the end of the fast to make sure I was eating the most nutrient-dense foods. Once I started eating I would always find myself reaching for the energy-dense cream and peanut because I had earned it.
After a period of gaining strength in the gym last year and gaining a bit more fat than I would have liked, this year I have been more diligent in tracking my intake and making sure I’m eating nutritiously with adequate protein to support my recovery while maintaining enough of a deficit to ensure ongoing weight loss.
This has also included a couple of “diet breaks” programmed around intense periods at work when I didn’t want to be thinking about food all the time. After the period of mental and physical relaxation, once I dialled things back in the water weight dropped off and the weight loss continued.
However, you want to structure it, allowing some room to listen to your body’s signals can be useful. In the long run, you will need to maintain a deficit if your goal is to lose weight or an overall surplus if your goal is to build muscle.
While not many people find tracking their food intake fun, many people find that they need to track to stay accountable and achieve their goals. Even a short period of tracking can be helpful to help re-train your eating habits.
Your calorie range for weight loss
Rather than a fixed energy target, if you are trying to lose weight, the Nutrient Optimiser gives you a starting calorie range.
The lower limit calorie intake level is based on the maximum rate of weight loss you can achieve without excessive loss of muscle mass (i.e. 21 calories per pound of body fat)[1][2] while also getting a minimum amount of protein. The more fat you have to lose, the more aggressive your deficit can be without risking muscle loss.[3]
If you aim is weight loss, your upper limit calorie intake level is based on your basal metabolic rate (BMR) minus 15%. This is a reasonably comfortable deficit for moderate fat loss that won’t generate excessive hunger for most people.
If you are feeling ambitious, you can aim for the lower calorie intake level. But then one day you may feel more hungry or be more active so you can allow yourself to eat up to the upper limit without feeling guilty.
Most people under-report their food intake,[4] so targeting a lower intake will accommodate your optimism bias and crappy reporting.
Example calories and macronutrient ranges
The table below shows my recommended macro ranges from the Nutrient Optimiser in weight loss mode. My target calorie intake for weight loss is 1,606 to 1,962 calories per day. For me, this is a 15 to 30% deficit below my theoretical basal metabolic rate of 2,308 calories per day.
lower
upper
protein (g)
144
260
fat (g)
32
142
net carbs (g)
0
151
energy (cal)
1,606
1,962
deficit (calories)
702
344
deficit (%)
30%
15%
The image below shows how these lower limits look when entered into Cronometer.
If you click on the energy bar in the web interface or the app, we get this popup where you enter this calorie range.
While these values are calculated to four significant figures, they are only estimates of how much energy is in the food you are consuming. Theoretical calculations should only be used as a starting point and refined based on actual progress.
If you find after a week or two that you are not achieving the weight loss you were hoping for you should reduce the maximum allowable calorie intake to ensure that you are losing weight. A reasonable rate of weight loss is somewhere between 0.5 and 1.0% of your total body weight per week. If you’re aggressive and very disciplined, you might be able to achieve a 1.5% loss per week for a short time.
Many people have found that they can sustain a more aggressive rate of weight loss over the long term if they have adequate protein and micronutrients. You will also find it hard to overeat on the foods and meals recommended by the Nutrient Optimiser.
Similarly, if you find that your blood sugars are not trending down, you can reduce your carb target. Once your blood sugars are dialled in you can loosen your carb target a little to allow more nutrient-dense foods.
If you’re not looking for weight loss
If you’re a lean athlete not aiming for weight loss, you will be able to ‘eat to satiety’ to ensure you recover. If you’re looking to gain muscle without too much fat, you will want to target a slight energy excess.
Be careful eating back the calories from exercise if you are trying to lose weight. Your Fitbit or Strava may tell you that you just burned a lot of calories, but if you enter that into Cronometer and then have the extra ice cream that it says you are allowed, you may find you are not getting the results you hoped for.
Getting enough protein is important when losing weight to prevent loss of lean muscle mass. The minimum protein intake in the Nutrient Optimiser is based on 1.8 g/kg lean body mass (LBM).
Nutrient density starts to drop off once protein drops too. Getting adequate protein is as much about maintaining overall nutrient density as it is about getting protein for muscle growth and repair.
It can be helpful to target higher levels of protein if you are in an aggressive energy deficit. The upper limit provided by the Nutrient Optimiser is based on the optimum protein intake level or about 45% of your maintenance energy intake. Beyond this point, any extra protein starts to have a negative impact on nutrient density.
Similar to your calorie ranges, you can click on the protein bar in Cronometer and enter your minimum and maximum protein intake as per the example below.
If you find that you’re starting to lose too much muscle mass rather than body fat you can increase your minimum protein intake. It’s hard to track muscle loss vs fat loss accurately, but the chart below is my attempt using my bioimpedance scales. You can see during the first six weeks (during the Ketogains Bootcamp) I was losing twice as much fat compared to lean mass. Later in my journey when I’m not working out as much you can see the ratio of lean mass loss vs fat-free mass loss is drifting up.
Loss of hard-earned lean muscle mass in weight loss is real and you would be wise to do everything you can to avoid it. Other than taking testosterone, steroids or choosing different parents, resistance training and a higher protein intake are the only things I’m aware of that will help you lose more fat and retain more muscle.
Fat
As shown in the chart below, a very low-fat diet (less than 10% energy from fat) may leave you struggling to achieve a good micronutrient profile. Hence we recommend getting a minimum fat intake of 0.4 g/kg LBM. While this is less fat than most people eat you will easily be able to achieve the daily recommended minimum requirements.
My fat range is shown in the figure below. If you’re in fat loss mode, you will likely be closer to the lower limit. If you are trying to gain muscle or are very active, you will likely be eating more fat.
Carbohydrates
You don’t need a lot of carbs to get a reasonable level of vitamins and minerals. Non-starchy veggies like spinach and asparagus provide a range of vitamins and minerals that are typically harder to find in animal-based foods.
The image below shows how this looks when entered into Cronometer.
If you are managing diabetes?
If you are insulin resistant or have diabetes, the allowable upper limit of carbohydrates provided by the Nutrient Optimiser will be limited to help stabilise your blood sugars. As you can see from the chart below, there is a balance between nutrient density and a lower dietary insulin load.
Managing the insulin load of your diet will require a reduction in protein intake if you need a therapeutic ketogenic diet. Most people find that they get the outcome they need by reducing refined carbohydrates.
Summary
So, in summary:
You should use the Nutrient Optimiser to focus on nutrient-dense whole foods that align with your goals without worrying too much about macronutrients.
Logging your food in Cronometer enables the Nutrient Optimiser to fine tune your food and meal choices to rebalance your food choices and improve your micronutrient profile.
The calorie and macro ranges provided by the Nutrient Optimiser can be used to double check that you are on the right path.
In the next instalment, we’ll look at how the nutrient score is calculated and what it takes to get yourself to the top of the Nutrient Optimiser leaderboard.
This article unpacks each aspect of the Ketogains system.
Protein as a goal
The Ketogains macro calculator recommends a minimum protein intake of 0.8g per pound of lean body mass (LBM) (i.e. 1.8g/kg LBM), increasing to 1.0g/lb LBM (or 2.2g/kg LBM) on lifting days.
This protein intake level is more than would be recommended in a therapeutic ketogenic approach or even the average protein intake for the general population.[2][3] It does, however, align with Steve Phinney’s recommended protein intake level for athletes and performance and represents a more optimal protein intake for active people.[4][5][6]
From a sports nutrition standpoint, more than 2.2 gram per kilogram of total body weight is regarded as “high protein”.[7] This could be as high as 3.0g/kg LBM when fat mass is taken into account. So, while the Ketogains protein recommendations might be considered high in therapeutic keto and vegan circles, the Ketogains recommendations would be ‘moderate’ in a sports nutrition and bodybuilding circles.[8]
This chart above (from Lemon, 1998[9]) shows that, for a strength athlete, muscle protein synthesis is maximised when they consume at least 1.8g/kg BW of protein.
Protein intake even more important when you are trying to lose weight. The higher the energy deficit, the greater is our need for protein to prevent loss of lean muscle mass. If we are active and/or doing resistance training, then our requirement for protein is even higher again. As shown in the chart below from a recent review paper by Stuart Phillips, muscle mass is best preserved best when we have higher levels of protein, particularly if you are targeting an aggressive deficit.[10][11] If you are targetting a moderate energy deficit (e.g. 10%) then a protein intake of around 1.5g/kg BW is appropriate. However, if we are targetting a very aggressive energy deficit then higher levels, up to 2.6g/kg BW will be beneficial to prevent loss of lean muscle mass. If we are active then we will also need more (dashed line) while we need less if we are sedentary (dotted line).
While it’s actually difficult to consume such high levels of protein due to the satiety effect, more protein won’t turn to chocolate cake. [12]
Protein contributes to your energy intake. So if your goal is fat loss, then you want to target the minimum effective dose of macronutrients and micronutrients.
As a general rule, a higher protein intake tends to lead to a better nutritional profile[13] and increased satiety.[14][15] Very high protein diets (i.e. above than 80% energy from protein) will likely rely on supplements and may minimise other foods that provide more vitamins and minerals. As you can see on the far left of this chart, actively targeting a low protein intake can lead to a poor nutritional outcome.[16]
protein (%) vs nutrient density score [click to enlarge][note: If your goal is therapeutic ketosis for the management of epilepsy, dementia, cancer, Parkinson’s or Alzheimer’s you will need to pay particular attention to ensure you get your share of micronutrients.]
Carbs as a limit
As you can see in the chart below,[17] you can get a reasonable level of nutrition if you consume anywhere between 0 and 60% of your energy from non-fibre carbs.[18] However, with an exploding diabetes epidemic,[19][20][21] it’s probably fair to say that the majority of people would do better if they reduced their consumption of refined grains and sugars.
carbohydrates (%) vs nutrient density score [click to enlarge]If you have already developed insulin resistance or diabetes, then reducing your carbohydrate intake to the point you achieve normal blood glucose levels is a good idea,[22] both in terms of overall health and controlling appetite that can be driven by excessive blood sugar swings.
The fact that much of the population is already insulin resistant is likely part of the reason the Ketogains approach, with its limit on carbs, has been so successful.
Low carbers are fond of saying “there is no such thing as an essential carbohydrate”. However, unless you are focusing on getting lots of organ meat, shellfish, or fresh meat, you may benefit from consuming some non-starchy veggies to get your essential vitamins and minerals.
Twenty or thirty grams of non-fibre carbs doesn’t sound like much in the context of grains or sugars, but it can feel like a LOT of food to consume if it’s from non-starchy veggies.[23]
Fat as a lever
So to recap before we get into discussing fat:
Adequate protein is critical to support muscle growth and repair.
Non-starchy veggies (which contain a small amount of non-fibre carbohydrates) provide vitamins and minerals (unless of course, you are eating heaps of shellfish, organ meat or drinking blood like the Maasai).
Recently, many people are swinging back from their fear of fat to embrace dietary fat again. Carbohydrate is a more explosive fuel source for emergencies, while fat is a slower burning and more efficient fuel source.
While there are essential fats, we don’t require much to meet our minimum requirements of essential fats.[24] Beyond this, where you get your energy doesn’t matter that much.
Many people do fine on a diet that obtains a lot of the energy from carbs while other do well on a diet that get the majority of energy from fat. However, where things seem to go wrong is when people consume diet that is high in energy dense nutrient poor fat and carbs with minimal amounts of protein.
As you can see from the chart below, we can achieve a respectable nutritional outcome with a fat intake of between 10 and 65%. More fat is not necessarily better, but very low-fat levels are not great either as they tend to have minimal amounts of protein and other essential nutrients.
fat (%) vs nutrient density score [click to enlarge]If you are trying to reduce body fat, then maximising the nutrient density and reducing the energy density of your food is a worthy goal. A protein sparing modified fast, an extreme version of this, provides adequate protein while limiting both fat and carbohydrates.
If you are looking to gain weight, add muscle or perform extended feats of endurance exercise on a regular basis, it may be beneficial to load up on more energy dense foods. However, conversely, if are not an endurance athlete but trying to use your body fat for fuel (like most of us these days living in a sedentary environment full of hyperpalatable food), you may want to wind your dietary fat intake back.
Micronutrients
Once you’ve worked out your macros using the Ketogains calculator and got the hang of using fat as a lever to manage energy intake, the next step is to ensure you are getting your share of micronutrients.
Focusing purely on macros (e.g. Flexible Dieting, IIFYM, etc.) is short-sighted because it fails to consider micronutrients. Chronic energy restriction without attention to micronutrients can lead to chronic nutrient deficiencies,[25] a lack of energy, increased hunger,[26] rebound bingeing due to cravings and even death.[27]
You’re likely aware that the branched-chain amino acids (BCAAs) trigger muscle protein synthesis and ensure you use the rest of the amino acids to build and repair your muscles.[28] However, recent research has found that the amino acids arginine and lysine trigger satiety and hence we find foods that contain these amino acids more filling.[29][30]
The chart below shows what your micronutrient profile would look like if you focused on branched chain amino acids (valine, isoleucine, and leucine) and the satiety-related amino acids (lysine and arginine) while also keeping carbohydrates low.
While we get plenty of protein with this approach, we would not obtain the recommended minimum levels of a large number of the essential vitamins, minerals, and essential fatty acids.
As much as we like to focus on macronutrients (i.e. fat, protein, carbohydrates, fibre, ketones), micronutrients are arguably a more useful to assist us in our nutritional decision making.
Getting adequate minerals is especially important for:
The chart below shows what happens to our micronutrient profile when, in addition to BCAAs, we also prioritise foods that contain the harder to find micronutrients. The purple bars represent the nutrients contained in the average of all foods in the USDA foods database while the blue bars represent the nutrients contained in the shortlist of foods.
Optimal foods
In case you were wondering which foods will give you the most micronutrients while also having a lower energy density and fewer carbs, I have listed them below.
vegetables
endive
alfalfa
chicory greens
escarole
coriander
pumpkin leaves
asparagus
spinach
Chinese cabbage
lettuce
parsley
okra
zucchini
beet greens
watercress
arugula
portabella mushrooms
chives
chard
white mushroom
turnip greens
cauliflower
mustard greens
banana pepper
cucumber
pickles
sauerkraut
yeast extract spread
summer squash
radishes
broccoli
collards
shiitake mushroom
celery
artichokes
eggplant
cabbage
snap beans
turnips
red peppers
spices
basil
dill (fresh)
sage
marjoram
curry powder
thyme
caraway seed
mustard seed
dill seed
cloves
fruit
blackberries
avocado
raspberries
olives
seafood
salmon
sturgeon
halibut
fish roe
anchovy
crab
trout
caviar
crayfish
flounder
mackerel
sardine
oysters
mussel
rockfish
pollock
lobster
herring
haddock
perch
whiting
tuna
shrimp
white fish
cod
octopus
offal
liver
kidney
heart
brains
headcheese
brains
animal products
pork chops
pork shoulder
lamb
roast pork
pork loin
ground pork
pork ribs
roast ham
leg ham
sirloin steak
ground beef
chicken drumstick
chicken breast
veal
bratwurst
chuck steak
roast beef
ham
ground turkey
turkey
beef roast
lamb
ribeye fillet
bison
beef loin
ground beef
dairy & egg
whole egg
egg yolk
whey protein powder
You should ideally focus on the foods closer to the top of these lists. But once you’ve eaten as much endive, alfalfa, liver and caviar as you can, feel free to move down the list to more energy dense foods or ones that you might enjoy eating more.
Supplements
If you can’t get enough nutrient-dense foods, it may be beneficial to use supplements.[36] Keep in mind though, the nutrients from whole foods are likely to be better absorbed.
Too many minerals at once will ‘give you a dose of the salts’ and all your expensive supplements will end up in the toilet. Whole foods are also more likely to contain other beneficial non-essential nutrients that come along with nutrient-dense foods.
But we can only manage a handful of things at a time.
“If everything is a priority, nothing is a priority.”
Rather than trying to track everything all at once you need to identify a few things to track to ensure you are moving towards your goals.
In the context of losing fat and gaining muscle the best things to track appear to be:
weight/body fat,
macros/calories, and
performance (e.g. weight on the bar).
weight / body fat
Most people want to have more energy and look good naked. While it’s much easier to track body weight, this ultiamte goal really about losing body fat.
You can do your head in focusing on the fluctuations on the scale or body fat from day to day. But, you want to see your overall weight and body fat reducing toward your target levels. People who successfully lose weight and keep it off manage their food intake, measure their weight regularly and are active![38][39]
If you’re a fitness model you might want to measure yourself daily. If you’re just starting to focus on eating well and lifting, then you might just want to weigh yourself weekly or monthly.[40]
If you are not moving towards your goals over the long term, something needs to change.
But first, you need to set some realistic goals. Take the time to determine your current and target body weight, fat (in kg and %) and lean body mass (LBM).
current
target
body weight (kg)
body fat (%)
body fat (kg)
LBM (kg)
If you are disciplined, it is possible to lose 1% of your mass per week, but 0.5% is a more realistic and less aggressive target. If you are already lean, then it will be harder to lose fat without losing muscle so you may need a less aggressive deficit.[41]
It’s not all about the weight on the scale. You can be losing fat and gaining muscle, the weight on the scale probably is the most reliable indicator that you’ve got your inputs right. If you’re getting enough protein and working out, incrased muscle mass should be looking after itself, and any loss should be mainly fat.[42]
Keep in mind that body weight is a lagging measurement that tells you whether you’re on the right track. Tracking inputs (e.g. food intake and exercise) will be much more useful.
macros / calories
Personally, I don’t enjoy tracking my food, so I’ve designed a range of food lists and meals that will help most people improve from where they currently are. It will be pretty hard to get/stay morbidly obese if you eat only the foods and meals listed above.
But eating to satiety won’t guarantee you will lose weight. If you want to look like a fitness model, or you are not getting your desired results from ‘eating ad libitum’ you will likely need to track your food to overcome your inbuilt impulse to maintain a higher body weight and prepare for a possible famine ahead.
Tracking your food in an app like Cronometer can be a useful educational experience.
The Ketogains calculator will give you a starting point in terms of calorie intake based on your current weight and activity levels. If, after a few weeks, you are not seeing the progress you were hoping for you will need to adjust your inputs.
Performance/weight on the bar
Building muscle or achieving a performance goal is probably more important than weight loss, particularly if you are not trying to get down to a very low level of body fat.
The great thing about using a performance goal is that it is both a leading and lagging measure. By going harder, faster and heavier you are providing a greater stimulus for growth. And by measuring your performance outputs, you are ensuring that you are getting fitter/faster/healthier.
While being strong doesn’t guarantee weight loss, being stronger will improve your metabolic health, insulin sensitivity and ability to burn fat more effectively than nearly anything else.
Having more lean muscle mass will ensure you burn both glucose and fat more efficiently. Lean muscle mass is a key predictor of longevity.[43]
Don’t be surprised if your appetite ramps up during the first few months of intensive lifting as your body goes into anabolic overdrive to recover and build new muscle. This should settle down though after a while, and you can then focus on dialling your diet in if you want to gain strength as well as lose body fat.[44] You have a unique window of ‘newb gains’ during initial whne you can get stronger at in a way that you may never achieve again. You can focus on getting to single digit body fat later.
Other stuff that you could track
There are other things that you might like to track, but they will be less useful than the things mentioned above. Most people have limited time and don’t really want to live a completely quantified life. Unless this is your only hobby or you are a professional athlete or fitness model, you may quickly hit ‘analysis paralysis’ and give up.
There is no guarantee that technology will help you reach your goals. In fact, it seems that you are more likely to gain weight if you use wearables like a Fitbit.[45] It’s hard to know whether this is due to the EMF or perhaps the wearer is always allowing themselves to consume the extra calories that their technology told them that they just burned with exercise.
So, coming from a biohacker nerd…. don’t try to track too many things at once! OK?
Heart Rate Variability
Heart Rate Variability (HRV) is a measure of the variability between your heart beats. If you are stressed and/or exhausted your heart will be more rhythmically as well as more rapidly. If you are relaxed and well rested your heart will be more to stresses and quickly return to rest.
Measuring your Heart Rate Variability (HRV) can tell you if you’re pushing too hard and need to rest recover or you’re not pushing hard enough and should be working harder to maximise your progress. Training when you are burning out can be counterproductive and lead to injury or under recovery.
HRV tells you whether your sympathetic and parasympathetic nervous system is balanced.
If you are “parasympathetic nervous system dominant” you might be overstressed from too much activity, not enough sleep, too much caffeine or work stress.
If you are “sympathetic nervous system dominant”, then it probably means your body wants to rest. You’ll probably do better if you listen to it and let it recover.
If your overall HRV is dropping, it means you are burning out and should consider slowing down.
After 1.5 years of measuring my HRV each morning, it’s uncanny how many times I will see my HRV fall a few days before you get the flu or hit the wall. I don’t like to stay still long enough to meditate, so tracking each day with Elite HRV is part of my relaxation, breathing and focus at the start of each day.
Blood sugar
Your blood sugar and glucose control is a powerful indicator of metabolic health. But blood sugar readings can vary depending, not just due to the food you eat or your metabolic health, but also exercise and stress.
If you have diabetes, then refining your food choices to normalise your blood sugars is critical. However, regular blood sugar tracking is likely a waste of time and money for most people who are following a Ketogains style approach (i.e. tracking their food to ensure they are moving towards an optimal weight, getting adequate protein and lifting regularly) is unnecessary.
Blood ketones
Unless you require therapeutic ketosis to help manage epilepsy, cancer, Alzheimer’s or Parkinson’s measuring your blood ketones is also largely an irrelevant distraction.
Lots of people get caught up chasing ‘optimal ketosis’ by eating more dietary fat and less protein. However, this is exactly the opposite of what you need to gain strength and lose body fat.
Blood ketones do increase when we don’t eat. But high ketone levels don’t mean you are burning your own body fat. It could just be the three Bulletproof coffees and exogenous ketones you just had to get that are driving your high ketone levels.
Some people, especially those who are physically fit and/or have been practising a low carb diet for a long time, seem to have lower blood ketone levels, even if they are eating a ‘ketogenic’ diet. It’s hard to know whether this is due to the more efficient use of ketones or the fact they are burning more fat through non-ketogenic pathways.
Ketones are just one of a number of ways that we burn fat (chart from Dave Feldman)
Someone who is not so metabolically healthy can load up on exogenous ketones, butter and MCT oil and get a high blood ketone reading on their meter. But this may just mean that they have eaten a lot of fat that they are not burning (because of their lack of activity and/or poor metabolic health) and the fat is backing up in their bloodstream.
A healthy metabolism seems to keep the total energy circulating in the bloodstream fairly low (i.e. from glucose, ketones or free fatty acids). If you are metabolically healthy, you can easily access your fat stores so you don’t need to build up high energy stores in the blood. By contrast, someone with a less healthy metabolism seems to maintain higher energy stores in the blood (i.e. glucose, ketones, free fatty acids) as well as on their body.[46]
This chart shows more than 3000 data points of blood glucose and ketones together from a range of people following a low carb and ketogenic diet. Having high blood ketones and high blood sugar at the same time is not good! Healthy people tend to have lower blood sugar and moderate level ketones.
Most people don’t need to worry about their blood glucose and ketone levels consciously. If you focus on nutrient dense food to optimise your mitochondrial function and strength building to keep pushing your mitochondria to produce energy at peak efficiency, then your body will probably look after the rest.
[At the risk of getting too technical, it’s worth pointing out that blood ketones rise because there is a lack of Oxaloacetate (from protein and carbs) available to burn Acetyl CoA from fat in the Krebs cycle, so the body defaults to a starvation protocol to produce ketones (AcetoAcetate).
Figure from Amy Berger showing how fat can be burned in the Krebs cycle or via ketosis when there is not enough Oxaloacetate from protein and carbs turn the Krebs cycle.
If your NAD+ is low, AcetoAcetate will not be converted to Acetone so there will be lots of beta-hydroxybutyrate left in the blood to be measured on your meter. So, other than fasting and/or exercising to deplete your liver glycogen levels, one ‘hack’ to achieve high blood ketone is to avoid protein and eat a nutrient-poor diet low in niacin and other B vitamins (which produce NAD+). But don’t try this at home. It’s not a recipe for optimal health, just high blood ketone levels.]
Ketogains’ Tyler Cartwright has lost nearly three hundred pounds without exceeding 0.4mmol/L blood ketones on his ketone metre (other than that time he ate nothing but lard for two weeks as an experiment and got to 0.5mmol/L).[47]
Breath ketones
Breath ketones are an interesting indication of your metabolic health. But again, they’re not necessary if you are already focusing on a nutrient-dense diet without too much energy and plenty of activity.
Waist measurement
BMI is often used to assess whether or not someone is at a healthy weight.
However, BMI is notoriously problematic for people with more muscle.
Waist to height ratio is a much better predictor of the years of life that you will lose due to your poor health.[48]
Micronutrients and nutrient score
Focusing on the nutrient-dense whole foods above and the meals below will get you most of the way to optimal nutrition. However, you can also track your macronutrients in Cronometer to help you identify the nutrients you are not getting from your diet.
But then, once you’ve tracked your food in Cronometer, you are left wondering what foods and meals you should eat. and if need to supplement, how much of each supplement do you require and how much?
The Nutrient Score is a measure of the micronutrient quality of your diet. If you were able to get two times the recommended daily intake of all the essential micronutrients, you would get a perfect score of 100%.
To demonstrate what this looks like in practice, Ted Naiman’s diet got a very respectable nutrient score of 70%.
And sitting at the top of the leaderboard is Dr Rhonda Patrick with a score of 82%.
But the coolest competition is against yourself. Andy Mant managed to seriously up his nutritional game…
… by eating a LOT of nutrient-dense seafood…
… in preparation for his Paris wedding.
By following the recommendations of the Nutrient Optimiser analysis, Robin was able to improve her nutrient score to 32% (junk food diet) to 68% over a number of iterations (see report 1, report 2 and report 3).
In the process, she was able to significantly improve her blood glucose levels, dropping her HBA1c from 10.6% to 6.4%. Robin was also able to progress from taking hundreds of units of insulin per day to only needing occasional correcting doses to fine tune her blood sugars. She also managed to lose 2.6lbs per week!
And after a couple of rounds of following the Nutrient Optimiser recommendations and a couple of Ketogains boot camps the Matt Standridge (aka The Ketodontist) has stepped up from a nutrient score of 48% to 73%. He says he is feeling great and continues to gain muscle and lose fat.
The Nutrient Optimiser
While there are common themes, each person’s micronutrient fingerprint is unique. The optimal foods and meals that will balance your micronutrient profile are unique to you. The Nutrient Optimiser is the only tool that will tell you what foods are ideal to balance your diet while also aligning with your goals.
Currently, the Nutrient Optimiser is a manual report that will help you optimise your nutrition from the micronutrients based on your food log in Cronometer. We’re working hard to develop an automated system that will use your goals and whatever data you have to help you refine your nutrition to achieve your goals.
If you don’t want to track your food, the system will tell you what meals and foods will align with your goals. But if you want to step up your game and provide other data we can work with that to further refine your nutritional prescription to fill in your micronutrient gaps. The system will also adapt with you to improve your nutrition, ideally from diabetic to weight loss to achieving your performance goals.
The Ketogains protocol involves getting adequate protein (to support muscle growth and recovery) and adequate carbs to get essential vitamins and minerals. Fat is used as a level to manipulate energy intake to suit your goals.
If you are limiting your energy intake, maximising your nutrient : energy ratio is critical!
The Nutrient Optimiser can help you identify foods and meals that align with your goals and fill in your micronutrient deficiencies.
Chose what you track wisely. Trying to manage too many things can lead to ‘analysis paralysis’. If you manage the most important inputs, results should naturally follow.
Meals
I’ve been building a database of to help identify the meals that provide you with the nutrients you need more of and align with your goals.
If you are tracking in Cronometer, you can sign up for a Nutrient Optimiser analysis and report here to find out which foods and meals will help you move forward. I’ve also been working with Alex from Nutrient Hero for the past few months building a massive database of recipes we can use to optimise your nutrition.
It feels like it’s been a long time coming, but it won’t be too long before it’s all automated and online. If you want to be the first to trial the beta version then make sure you enter your email in the pop on this page or head over to NutrientOptimiser.com now to learn more.
The recipes below are some of the highest ranking when we prioritise some of the harder to find vitamins and minerals (potassium, magnesium, calcium, zinc, vitamin D, thiamine and choline) as well as higher protein and a lower energy density.
I have included the link to the Cronometer entry as well as the nutritional profile and a list of foods that will help you balance the nutritional profile of the recipe.
Bootcamp omelette
Gayle Louise created this simple omelette recipe for her Ketogains boot camp workout days. Nutritional yeast has a fantastic nutritional profile and adds a cheesy taste without the calories, minimising fat and maximising nutrient density.
Everyone loves coffee, and most people find potassium harder to get in their diet than sodium. So why not potassium coffee?!?! The milk and caramel syrup are not essential, but they give you that indulgent salted caramel taste.
Getting adequate minerals is critical to ensuring insulin sensitivity, nutrient partitioning, muscle building and recover and avoiding diabetes.
While most people don’t need to worry about getting too much salt, having a potassium : sodium ratio greater than two is hard to achieve for most people, even if they do eat a lot of greens.
My friend Raymund Edwards of Optimal Ketogenic Living has been doing a LOT of research into the wide-ranging benefits of alkalising electrolytes, in particular, potassium. This recipe was inspired by Raymund after hearing that he was adding potassium to his coffee.
Raymund said, “A potassium enriched coffee in the morning really wakes the muscles. It’s better than any warm up. Loose and alive we can feel the difference as they soak up actively the potassium especially after the night fast (where muscles have been releasing potassium). And the coffee in my view tastes so much better too.”
It’s hard to get a significant amount of potassium from tablets as they are limited to 99 mg which is only a fraction of the 3,800 mg of potassium that we need each day (you would need to take forty tablets to get the DRI for potassium!).
You can also add the potassium citrate powder to your drinking water, coffee or pre-workout mix. You would need more than 10g of the citrate powder to get your recommended daily intake of potassium, but, like all things, start slowly. However, in time, it might just make you feel amazing!
Dom D’Agostino infamously told Tim Ferriss in his sound check that his breakfast was sardines, oysters, eggs and broccoli. It might sound bizarre, but it packs a nutritional punch.
Most days my breakfast is some variant on frozen greens (spinach, broccoli, kale) + eggs + seafood (sardines, mackerel, oysters, mussels, anchovies) + nutritional yeast.
If you’re not focusing on losing body fat you can add cheese or peanuts for some extra indulgent taste, but leaving these out will help you increase your protein : energy and nutrient : energy ratio which is ideal if you are trying to lose body fat (and will make Ted Naiman and Luis Villasenor proud).
You could take more time to fry these ingredients up and plate them up nicely, but most of the time breakfast only needs to be time efficient and doesn’t need to look good. If you can start the day with a high protein nutrient dense breakfast, you’ll be less likely to succumb to other cravings later in the day.
ingredients:
250g frozen veggies. Spinach is always best, but broccoli or kale work too.
Three eggs. Consider removing the yolks if you are focussed on lower fat higher protein fat loss phase, though this will decrease the overall nutrient profile. The yolk is where all the vitamins and minerals are!
1 can of seafood (e.g. mackerel, sardines, oysters, mussels or anchovies).
1 teaspoon of nutritional yeast
Peanuts (optional, only if not looking to lean out)
1 oz mozzarella cheese (optional, only if not looking to lean out)
Defrost greens in bowl for five minutes in the microwave.
Add eggs and cook for a further minute or until done. (I often find that the eggs need a bit more cooking but stir everything in at around three minutes and then cook for another two minutes).
Photos of other variants (hey, they ain’t pretty, but they work).
Bacon, egg, spinach and mushroom
This is a variant on the common bacon and eggs recipe. The spinach mushroom and tomato round out the nutritional profile of the stock standard bacon and eggs.
The spinach provides a wide range of vitamins and minerals, particularly vitamin K and vitamin A. Most people think kale is the ultimate nutrient-dense green vegetable. However, kale just has a lot of Vitamin K1 and not so as much of everything else. Spinach has a much better nutritional profile across the board.
If you are focusing on reducing body fat and maximising nutrient density, consider eliminating the cream, draining the bacon fat and keeping the butter to a minimum for cooking. If your goal is bulking and recover, then you can be more liberal with the cream and cheese to taste. Remember, fat is a lever.
Fry bacon separately. If your priority is reducing body fat then you can let the bacon rest on a paper towel to drain the fat. Alternatively, bacon grease can be used to fry the spinach, mushroom and eggs.
The Protein Sparing Modified Fast (PSMF) is regarded by many to be the most effective way to lose body fat while preventing loss of lean muscle and rebound binge eating due to nutrient deficiencies.
First developed in the 1970s, the PSMF has seen various permutations in weight loss clinics and the bodybuilding community.
While the details vary depending on context, a PSMF generally defined as an energy-restricted diet with adequate protein while simultaneously limiting carbohydrates and fat.
Technically, the PSMF will be ketogenic because a significant amount of body fat will be burned due to a restricted energy intake.
Adequate protein is provided to prevent loss of lean muscle mass. Supplements are often used to prevent nutrient deficiencies.
This article outlines the key principles of the PSMF that can be applied to weight loss or maintenance over the long-term.
Optimal nutrient-dense foods are identified for someone looking for an aggressive weight cut (e.g. a bodybuilder leading up to a competition) as well as a hybrid low carb – PSMF approach for someone who is insulin resistant wanting to lose a significant amount of weight over a longer period.
Medical applications of the PSMF
In the medical application of the PSMF patients obtain the majority of their energy from protein while keeping energy from carbohydrates and fat low.[1]
Protein levels are set at 1.2 to 1.5 g/kg of ideal body weight per day. (For someone with 30% body fat wanting to get to 10% body fat this would be equivalent to 1.5 to 1.9g protein per kilogram of lean body mass or LBM.)
Carbohydrate intake is typically restricted to less than 20 to 50 g/day.
Additional dietary fat beyond what comes from lean protein sources is minimised.
Patients in the weight loss clinic setting are restricted to less than 800 kcal/day.
The Cleveland Clinic has done extensive research into the use of adequate protein low-calorie diets for aggressive weight loss with the following encouraging findings:[2][3][4]
patients are encouraged by the initial period of rapid weight loss which leads to a lower dropout rate;[5]
meal replacements in the form of commercial shakes or bars can be used, however learning to make meals from whole foods critical to developing habits that lay the foundation for long-term success;
the PSMF is effective for people with normal glycemic control as well as pre-diabetes or type 2 diabetes;[6]
people on a whole food-based PSMF are significantly less hungry and preoccupied with eating compared to those on a liquid-formula based version of the PSMF; and
most of the weight lost during a PSMF is from fat tissue rather than muscle.[7]
Adherence to a very-low-calorie, ketogenic PSMF program results in major short-term health benefits for obese patients with type 2 diabetes. These benefits include significant weight loss, often more than 18kg, within 6 months.
In addition, significant improvements in fasting glucose and haemoglobin A1c levels are linked to the caloric and carbohydrate restriction of the PSMF.
Insulin resistance was also attenuated, with possible partial restoration of pancreatic beta-cell capacity.[8][9]
Bodybuilding applications
Lyle McDonald reinvented the PSMF in bodybuilding community with his 2005 Rapid Fat Loss Handbook.
McDonald details how someone can individualise the PSMF based on their goals and context.
Someone who is already very lean and undertaking heavy weight training will need higher levels of protein.
Someone who isn’t yet lean may do better with a less aggressive approach over a longer period.
McDonald’s recommended protein intake ranges from 2.2g/kg LBM to 4.4g/kg LBM!
Unlimited green leafy fibrous veggies are strongly encouraged as they are filling and provide the vitamins and minerals with minimal calories.
McDonald also recommends supplementing with a good multivitamin, sodium potassium, magnesium, taurine, calcium and fish oil.
A PSMF is typically not a long-term proposition due to nutrient deficiencies.
McDonald’s recommendations seem “massive” to most people due to the book being geared toward strength athletes who DO require more protein as they are effectively breaking it down when strength training.
Bodybuilders who diet down to 4 – 5% bodyfat need an increased protein intake when preparing for a contest as their aim is to maintain as much as lean mass as possible; and for that, one needs protein and resistance exercise.
With my clients, to avoid nutrient deficiencies, we use a “Ketogains PSMF” which adds 3-4 whole eggs a day, at least 150g spinach, plus other green veggies, and some avocado. The rest is lean sources of protein and more veggies, plus electrolytes. This effectively puts the person in between 35 to 50g fats and 20g net carbs. The rest of their energy comes from lean protein.
Protein drives satiety
The body actively defends loss of muscle mass by increasing appetite after periods of fasting or low protein consumption to ensure that muscle mass is retained.[10]
Conversely, the Protein Leverage Hypothesis (Simpson, 2005) suggests that we continue to eat food until we get enough protein for critical bodily functions.[11][12]
“Protein generally increases satiety to a greater extent than carbohydrate or fat and may facilitate a reduction in energy consumption under ad libitum dietary conditions.”[13][14]
If we eat lower protein foods, we may end up consuming more energy to obtain our adequate protein. Conversely, we can ‘hack’ our appetite by prioritising adequate protein while minimising energy from carbohydrate and fat.
Minimum carbohydrate requirement: While there is a need for the vitamins and minerals that are often packaged with carbohydrate containing foods (i.e. vegetables), there is indeed no such thing as an essential carbohydrate.
Minimum fat requirement: Most people have plenty of body fat stores that they can draw on and hence do not have an immediate need for dietary fat other than the essential Omega 3 fatty acids.
So, theoretically, if we get adequate protein as well as vitamins, minerals, the essential fatty acids can go a long way to providing everything that we need for long-term survival with less energy which is really the holy grail of weight loss and long-term maintenance.
Thermic effect of food
The other advantage of consuming a higher protein diet is increased thermogenesis (i.e. the energy lost in the process of converting food into energy). The thermic effect (or specific dynamic action) is 5 to 15% for carbohydrates and fat and 20 to 35% for protein.[15]
The thermic effect of food is illustrated nicely by these images from Physioqonomics.[16] We lose a lot more calories metabolising protein compared to fat or carbohydrates.
While we can convert protein to glucose (i.e. gluconeogenesis), it is really hard, and our body doesn’t like to do unless it has to.[17]
Satiety typically kicks in quickly once we have had adequate protein and we go in search of fat or carbs which are easier to convert to energy. Just think, you can only eat so much steak, but you always have a ‘dessert stomach’, even after a big meal.
While there is much debate over the “metabolic advantage” of fat vs. carbohydrates with claims that we can eat more calories of fat than carbs, there is actually an advantage’ when it comes to how many calories of protein we eat versus how much we can convert to energy.
Should you just eat the highest protein foods?
So, the obvious question is:
What should I eat on a PSMF?
The table below lists the foods with the highest protein content as a percentage of energy. These foods may be useful if you are looking to boost your protein intake.
food
% protein
cod
92%
haddock
92%
white fish
92%
orange roughy (fish)
92%
crab
91%
lobster
91%
egg white
91%
mozzarella cheese (non-fat)
90%
pollock
90%
protein powder (whey)
89%
turkey breast (fat-free)
88%
halibut
86%
crayfish
86%
whiting
86%
rockfish
86%
molluscs
86%
veal
84%
perch
81%
shrimp
81%
trout
81%
chicken breast
79%
lean beef
79%
whey protein concentrate (WPC)
78%
octopus
77%
ground beef
76%
pork chop
75%
flounder
74%
beef tripe
74%
pork shoulder
74%
scallop
74%
leg ham
74%
sirloin steak
73%
ham (lean only)
73%
beef heart
73%
turkey (skinless)
72%
clam
72%
turkey gizzard
72%
top round steak (fat trimmed)
72%
lamb kidney
71%
beef heart
70%
beef kidney
70%
I have summarised these in this image for easy reference.
The problem with a very high protein diet
But wait!
While you may be getting plenty of essential amino acids if you focus purely on high protein foods, there is a good chance that you may not be getting all the vitamins and minerals you need.
As shown in the chart below, there is a strong relationship between protein and nutrient density. However, if we just focus on high protein foods, we may still end up missing out on the harder to find vitamins and minerals.[18]
The chart below shows the micronutrients provided by the top 10% of the foods in the USDA database when sorted for maximum protein content.
Now imagine, that rather than getting 2000 calories, we are getting only 800 or 400 calories during long-term fasting or extreme dieting. We have a higher chance of becoming deficient in many key nutrients which may in turn increase appetite and drive us to eat more than we would like to.
Ensuring you are getting adequate micronutrients is a key component to long-term success in weight loss and maintenance.
In the Rapid Fat Loss Handbook McDonald mentions ‘The Last Chance Diet’ which was popular in the 1970s and 80s. It was essentially a PSMF centred around liquid nutrition which led to the death of a number of devotees due to some fatal flaws.[19][20]
First, they picked the cheapest protein source available, collagen; a protein that provides essentially zero nutrition to the body. Second, they provided zero supplemental vitamins and minerals (some of which would have been obtained if the dieters had been eating whole foods in the first place). This caused a couple of problems including cardiac heart loss (from the total lack of protein) and arrhythmias from the lack of minerals.
Basically, the problem wasn’t with the approach so much as with the food choices.
PSMF’s based around whole foods (which provide high quality proteins as well as vitamins and minerals) and with adequate mineral supplementation have shown no such problems.[21]
Bruce Ames’ Triage Theory
Nutrient density becomes even more important when we consciously try to limit our energy intake.
Attaining adequate micronutrients can help to mitigate metabolic/mitochondrial slow down and adaption to the severe calorie deficit. If we are getting the range of micronutrients we need, the body is more likely to keep on feasting on our own excess fat stores without reacting like there is a famine and holding onto our excess fat stores.
Similar to the protein leverage hypothesis, it seems if we provide the body with low nutrient density food it is driven to consume more energy to ensure that it gets the nutrients it needs.
I get some comments in response to the Nutrient Optimiser analysis suggesting that the Daily Recommended Intakes (DRI) for various micronutrients are excessive because an individual person has done fine on a diet per for a period of time with a less than optimal nutrient profile.
While we can argue that the some of the DRIs for various nutrients are overly conservative, you also don’t have to look too far to find people that argue that we need multiple times the DRI for another particular nutrient to optimise our health and longevity.
I don’t think we need to worry about precisely meeting the daily recommended intake for every single micronutrient every single day. There is no diet that meets the daily recommended intake for every nutrient without overdoing others. I think a healthy well-balanced diet will achieve the DRI for the majority of the essential micronutrients most of the time.
More research is required to understand whether our requirements for different nutrients change depending on our diet (e.g. how much less vitamin C do we need if we are not consuming as much glucose) and how much more bioavailable nutrients are from plants versus animals.
However, if you are an order of magnitude under the DRI for a handful of nutrients, perhaps you should consider focussing on foods that contain that contain higher levels of that cluster of nutrients. If you are an order of magnitude over the DRI for a particular group of nutrients you don’t need to prioritise foods that contain those nutrients.
Bruce Ames’ sobering Triage Theory suggests that if we are low in critical nutrients, the body will prioritise those nutrients for functions essential to short term survival rather than longevity and preventing the diseases of ageing (e.g. cancer, heart disease, Parkinson’s, Alzheimer’s, etc.).
“The triage theory posits that some functions of micronutrients (the approximately 40 essential vitamins, minerals, fatty acids, and amino acids) are restricted during shortage and that functions required for short-term survival take precedence over those that are less essential. Insidious changes accumulate as a consequence of restriction, which increases the risk of diseases of ageing.”[22][23]
So, while we might do OK with poor nutrition for a period of time, we will probably do better if we obtain a solid amount of all the essential nutrients. Ideally, we would get these nutrients from whole foods which are more likely to contain all the non-essential but also beneficial vitamins and minerals that we don’t track.
Low energy density
Another way to maximise nutrient density and prioritise protein at the same time is to reduce the energy density of the food we eat.
As shown in the chart below there is a relationship between the harder to find nutrients and energy density.[24] While fat is a great fuel source and should not be feared or avoided, refined high-fat foods do not typically contain high levels of the harder to find vitamins and minerals that we need to thrive. Foods with more fibre and water are also more filling and are more difficult to overeat and will lead to increased short term satiety.
If we prioritise adequate protein while minimising fat and carbohydrates we make up the deficit from our own body fat stores. Hence there is no need to prioritise dietary fat.
The nutrient dense adequate protein diet
So, to recap:
getting adequate protein is important, especially if we are fasting or restricting energy intake, and
not getting adequate nutrients is potentially dangerous and possibly the fatal flaw of the PSMF.
We can use the Nutrient Optimiser to prioritise foods with the nutrients we want to obtain more of. Listed below are the 20 nutrients that have been prioritised in the following list of prioritised foods.
Alpha-linolenic acid
EPA + DHA
Vitamin E
Vitamin D
Choline
Calcium
Magnesium
Potassium
Thiamine
Phosphorus
Pantothenic acid
Manganese
Folate
Zinc
Niacin
Riboflavin
Valine
Selenium
Leucine
Tyrosine
Prioritising amino acids is usually unnecessary because maximising vitamins and minerals generally leads to more than adequate protein. However, in a PSMF where we are severely limiting energy we want to increase protein as well (hence valine, leucine and tyrosine have been included). As well as nutrient density, we have also prioritised low energy density foods in the multicriteria analysis.
The chart below shows the resultant micro nutrient profile achieved if we ate 2000 calories per day of these foods. In the chart above we saw that if we just focus on protein, we will not be meeting the DRI for eleven nutrients. However, when we focus on nutrient density, we get adequate quantities of all nutrients other than the Omega 3 fatty acid alpha-linolenic acid.
The chart below shows the same foods if we only ate 600 calories per day rather than 2000. Even with these highly nutrient dense foods, we miss the DRI for eight of the essential nutrients. Hence, we may still benefit from supplementing with Omega 3, vitamin D, calcium, magnesium and potassium. The nutrients provided by an energy restricted diet without also prioritising nutrient density would be much worse.
It’s not hard to imagine that our ability to maintain a low energy intake and achieve sustained weight loss is likely related to getting adequate levels of the various essential micronutrients without having to over consume energy. Conversely, a nutrient poor diet will likely drive us to consume excess energy which will lead to obesity.
Best foods for a PSMF
The tables below summarise highest ranking 10% of foods in the USDA database when we prioritise for high nutrient density and low energy density.
Also included in the tables are:
the nutrient density score (based on the 20 nutrients listed above),
energy density, and
the MCA which is the overall ranking from the multi criteria analysis.
Compared to the highest protein food listed above which are 80% protein, these foods work out to be 59% protein, 20% fat, 13% net carbs and 8% fibre. While this may seem high, as we will see in the ‘calorie math’ section below, it becomes more reasonable once we account for the energy from body fat.
Vegetables
It would be hard to imagine getting fat by overeating the vegetables listed below.
Maximising your intake of these vegetables will ensure you are getting adequate vitamins and minerals and hence maximise your chance of long-term success.
While these vegetables have a very high nutrient density score (ND) in terms of nutrients per calorie, they also have a low energy density which means you need to eat a lot of them to get the nutrients you need.
The downside of vegetables is that they can be expensive and take time to prepare fresh.
food
% protein
ND
calories/100g
MCA
watercress
60%
25
11
3.1
spinach
41%
23
23
2.9
seaweed (laver)
50%
22
35
2.7
asparagus
34%
21
22
2.7
basil
44%
20
23
2.5
endive
25%
19
17
2.5
white mushroom
43%
19
22
2.4
brown mushrooms
36%
18
22
2.4
portabella mushrooms
36%
18
29
2.4
Chinese cabbage
42%
17
12
2.3
lettuce
30%
16
15
2.2
coriander
31%
16
23
2.1
chicory greens
24%
16
23
2.1
alfalfa
52%
16
23
2.1
spirulina
64%
16
26
2.1
chard
30%
15
19
2.1
zucchini
24%
15
17
2.1
seaweed (wakame)
22%
15
45
2.0
parsley
27%
15
36
2.0
escarole
25%
15
19
2.0
okra
27%
15
22
2.0
beet greens
32%
14
22
2.0
shiitake mushroom
29%
15
39
2.0
turnip greens
36%
14
29
1.9
chives
35%
14
30
1.9
broccoli
23%
14
35
1.8
mung beans
35%
13
19
1.8
arugula
33%
12
25
1.7
dill
27%
12
43
1.7
cauliflower
26%
12
25
1.7
celery
16%
11
18
1.6
summer squash
18%
10
19
1.5
seaweed (kelp)
13%
11
43
1.5
yeast extract spread
52%
12
185
1.5
radicchio
22%
9
23
1.4
pickles
14%
9
12
1.4
cucumber
14%
9
12
1.4
mustard greens
34%
9
27
1.4
peas
26%
9
42
1.4
snap beans
18%
9
15
1.4
collards
27%
9
33
1.3
cabbage
18%
8
23
1.3
soybeans (sprouted)
34%
8
81
1.2
onions
19%
7
32
1.2
pumpkin
12%
7
20
1.2
kale
23%
7
28
1.2
radishes
16%
7
16
1.2
banana pepper
21%
7
27
1.2
bamboo shoots
43%
7
11
1.2
Brussel sprouts
28%
7
42
1.1
edamame
37%
8
121
1.1
artichokes
23%
6
47
1.1
sauerkraut
17%
5
19
1.0
red peppers
13%
6
31
1.0
eggplant
13%
5
25
1.0
chayote
9%
5
24
1.0
Animal products
These animal products are both nutrient dense and have a low energy density compared to fattier cuts of meat. While the nutrient density scores are not as high as for the vegetables, the energy density is higher so you will be able to get more nutrients in using these foods.
food
% protein
ND
calories/100g
MCA
lamb kidney
71%
19
112
2.2
chicken liver
62%
19
172
2.2
beef liver
63%
18
175
2.1
veal liver
61%
18
192
2.0
lamb liver
61%
17
168
2.0
turkey liver
59%
17
189
2.0
ham (lean only)
73%
16
113
1.9
pork liver
66%
16
165
1.9
beef kidney
70%
15
157
1.7
chicken breast
79%
13
148
1.6
pork chop
75%
13
172
1.5
veal
84%
12
151
1.5
pork shoulder
74%
12
162
1.4
lean beef
79%
11
149
1.4
leg ham
74%
11
165
1.4
ground pork
69%
11
185
1.4
turkey heart
60%
11
174
1.3
lamb heart
65%
11
161
1.3
beef tripe
74%
9
103
1.3
ground beef
76%
10
144
1.2
sirloin steak
73%
10
177
1.2
beef heart
70%
10
179
1.2
turkey meat
66%
10
158
1.2
turkey drumstick
66%
10
158
1.2
bison
69%
9
171
1.1
chicken liver pate
27%
9
201
1.1
turkey gizzard
72%
8
155
1.1
lamb sweetbread
59%
8
144
1.0
chicken drumstick
62%
8
149
1.0
veal loin
63%
8
175
1.0
roast pork
53%
8
199
1.0
Seafood
Omega 3 fats (EPA, DHA and ALA) are essential and harder to get so you should prioritise fish in your nutrient dense PSMF.
food
% protein
ND
calories/100g
MCA
crab
91%
20
83
2.4
fish roe
58%
19
143
2.2
crayfish
86%
18
82
2.2
lobster
91%
18
89
2.2
halibut
86%
17
111
2.1
pollock
90%
16
111
1.9
salmon
68%
16
156
1.9
rockfish
86%
15
109
1.9
flounder
74%
14
86
1.8
oyster
46%
14
102
1.8
shrimp
81%
14
119
1.8
haddock
92%
14
116
1.8
perch
81%
14
96
1.7
cod
92%
16
290
1.7
sturgeon
64%
14
135
1.7
whiting
86%
13
116
1.6
trout
59%
13
168
1.6
octopus
77%
13
164
1.5
white fish
92%
12
108
1.5
anchovy
57%
13
210
1.5
clam
72%
12
142
1.5
tuna
68%
11
184
1.3
scallop
74%
9
111
1.3
caviar
36%
11
264
1.2
orange roughy
92%
8
105
1.2
sardine
49%
10
208
1.2
molluscs
86%
8
130
1.1
Egg and dairy
Eggs are nutritious. Only a couple of low fat dairy products make the list. Higher fat foods such as butter and cream need to be minimised on a PSMF to allow your body to use the fat from your butt and your belly.
food
% protein
ND
calories/100g
MCA
cream cheese (low fat)
61%
11
105
1.5
whole egg
36%
9
143
1.2
egg white
91%
7
52
1.1
cottage cheese (low fat)
51%
7
81
1.1
These nutrient dense PSMF foods are summarised in this image for easy reference.
Calorie math
To make this a little more practical let’s look at some calorie math using a hypothetical scenario.
Let’s say Super Ted is looking to get shredded for the Ketogains conference in two weeks where he wants to pose for shirtless but also wants to stay strong and to win the arm wrestle and beat the reigning champion, Mighty Mouse.
Super Ted currently weighs 160 lbs or 73kg and has 10% body fat. His maintenance energy intake is 2336 cal/per day.
While getting the majority of your energy intake from protein might seem excessive…
… it’s not so dramatic when you also take into account the body fat being burned.
Between the 8% dietary fat (8%) his body fat stores (60%) Super Ted will be getting a ketogenic level of 68% of his energy from fat while also adequate protein to maintain his muscles and enough carb containing vegetables to get the vitamins and minerals that are also critical to his long-term success.
The details of the calorie math are shown below. Once you take the energy deficit into account Super Ted is consuming 2.2g/kg LBM.
body weight (kg)
73
body weight (lbs)
160
body fat (%)
10%
lean body mass (kg)
62
maintenance (cal)
2336
deficit
60%
diet (calories)
934
protein (% diet)
59%
fat (% diet)
20%
net carbs (% diet)
13%
diet protein (g)
138
dietary fat (g)
21
body fat (g)
156
body fat (kg/week)
1.1
net carbs (g)
30
fibre (g)
19
protein (% energy burned)
24%
dietary fat (% energy burned)
8%
carbohydrate (% energy burned)
5%
protein (g/kg LBM)
2.2
These calculations assume that Super Ted’s insulin levels are going to be low enough to allow him to yield a significant amount of energy from his body fat stores. Similar to fasting, it may take a few days before glycogen stores to be depleted enough for his insulin levels to drop which will allow his fat stores to more easily flow out of storage.
These calculations also do not account for the metabolic slowdown that you will get during long term energy restriction. This is the same with any way of eating that consciously restricts energy intake. However, I think if we can minimise nutrient deficiencies we will have a better chance of avoiding an increase in which could drive our body to seek out the missing nutrients that it is not getting enough of.
When you look at his Nutrient Optimiser analysis, you see that Ted Naiman (aka Super Ted) is actually consuming 2.4g/kg LBM.
Meanwhile, Luis Villasenor (aka Mighty Mouse) is also consuming protein at 2.4g/kg LBM during his PSMF. Luis says his regular protein intake is around 140g increases this up to 180g during a strict PSMF.
Insulin resistant long-term fat loss scenario
For most of us, such an aggressive fat loss approach might be hard to maintain long-term. So, let’s consider another scenario with another hypothetical character.
Introducing… Big Ted.
As you can see, Big Ted doesn’t post shirtless for photos on the internet.
At 110kg and 30% body fat Big Ted is far from shredded.
Big Ted is also pre diabetic.
His doctor has warned him that if he doesn’t lose a significant amount of weight he will need to take Metformin and then insulin before too long.
Big Ted is motivated to drop a large amount of weight with perhaps a calorie deficit of 30% which will take him about 30 weeks to get to his goal weight of 90kg.
We can refine Big Ted’s PSMF approach given that his circumstances and goals are different from Super Ted’s.
Nutrients to prioritise
Given Big Ted is not looking to be as dramatically calorie restricted we only need to prioritise the following nutrients.
Alpha-linolenic acid
EPA + DHA
Choline
Vitamin D
Vitamin E
Calcium
Magnesium
Potassium
Phosphorus
Zinc
Although amino acids are not prioritised the resultant list of foods is still 36% protein, 30% fat and 20% net carbs.
Rather than just prioritising nutrient density and energy density, this scenario also prioritises a lower insulin load given Big Ted’s looming pre diabetes situation.
This is basically a hybrid between a PSMF and a low carb diet.
The chart below shows the nutrient profile of these foods once we take a 30% energy deficit into account. Big Ted will be meeting the DRI for all his nutrient other than Omega 3s which he may need to supplement.
Calorie math
The charts below show the energy consumed and energy burned.
There is a significant amount of fibre which will not be metabolised for energy but rather feed his gut bacteria. There is still a solid amount of net carbs from veggies. However, there is no sugars or processed grains to be seen, so they’re not about to boost his insulin or send him on a blood sugar roller coaster.
Once his body fat loss is accounted for, half of Big Ted’s energy expenditure is still coming from fat.
Although we didn’t prioritise amino acids we still get a solid 2.2g protein per kilogram LBM.
body weight (kg)
110
body weight (lbs)
242
body fat (%)
30%
lean body mass (kg)
77
maintenance (cal)
3000
deficit
30%
diet (cals)
1875
protein (% diet)
36%
fat (% diet)
30%
net carbs (% diet)
20%
fibre (%)
14%
diet protein (g)
169
dietary fat (g)
63
body fat (g)
100
body fat (kg/week)
0.7
net carbs (g)
94
fibre (g)
66
protein
23%
dietary fat
19%
carbohydrate
13%
protein (g/kg LBM)
2.2
Optimal foods for Big Ted are listed below.
Vegetables
food
% protein
ND
calories/100g
MCA
endive
25%
11
17
2.5
chicory greens
24%
11
23
2.4
coriander
31%
10
23
2.2
escarole
25%
9
19
2.1
spinach
41%
12
23
2.1
basil
44%
11
23
2.0
alfalfa
52%
7
23
2.0
zucchini
24%
9
17
1.9
chard
30%
11
19
1.9
arugula
33%
10
25
1.9
beet greens
32%
8
22
1.9
mustard greens
34%
8
27
1.8
watercress
60%
12
11
1.7
asparagus
34%
9
22
1.7
parsley
27%
9
36
1.7
Chinese cabbage
42%
9
12
1.6
curry powder
14%
6
325
1.6
collards
27%
7
33
1.6
summer squash
18%
8
19
1.6
lettuce
30%
8
15
1.6
paprika
15%
7
282
1.6
turnip greens
36%
7
29
1.5
broccoli
23%
8
35
1.5
cloves
6%
7
274
1.4
sauerkraut
17%
6
19
1.4
banana pepper
21%
5
27
1.4
okra
27%
7
22
1.4
pickles
14%
5
12
1.4
cucumber
14%
5
12
1.4
chives
35%
7
30
1.3
celery
16%
7
18
1.3
brown mushrooms
36%
10
22
1.3
sage
11%
5
315
1.3
artichokes
23%
6
47
1.3
marjoram
14%
5
271
1.3
thyme
10%
6
276
1.3
cauliflower
26%
6
25
1.3
edamame
37%
5
121
1.2
portabella mushrooms
36%
7
29
1.2
radishes
16%
5
16
1.2
eggplant
13%
4
25
1.2
cabbage
18%
6
23
1.2
blackberries
11%
3
43
1.2
shiitake mushroom
29%
6
39
1.1
radicchio
22%
8
23
1.1
jalapeno peppers
12%
3
27
1.1
caraway seed
19%
4
333
1.1
chayote
9%
4
24
1.1
rhubarb
15%
5
21
1.0
avocado
5%
-0
160
1.0
snap beans
18%
6
15
1.0
red peppers
13%
3
31
1.0
olives
3%
-1
145
1.0
turnips
26%
5
21
1.0
white mushroom
43%
7
22
1.0
dill
27%
6
43
1.0
poppy seeds
13%
3
525
1.0
kale
23%
5
28
0.9
seaweed (kelp)
13%
8
43
0.9
raspberries
8%
1
52
0.9
seaweed (laver)
50%
8
35
0.9
soybeans (sprouted)
34%
4
81
0.9
seaweed (wakame)
22%
8
45
0.9
Brussel sprouts
28%
4
42
0.9
celery flakes
14%
6
319
0.9
cumin
16%
4
375
0.8
bamboo shoots
43%
3
11
0.8
carrots
6%
3
37
0.8
onions
19%
5
32
0.8
carrots
9%
5
23
0.8
dill seed
15%
3
305
0.7
mustard seed
19%
2
508
0.7
Animal products
food
% protein
ND
calories/100g
MCA
beef brains
32%
5
151
1.5
turkey ham
63%
4
124
1.0
lamb brains
36%
2
154
1.0
lamb sweetbread
59%
4
144
0.9
turkey (skinless)
72%
3
170
0.8
turkey liver
59%
4
189
0.8
ground turkey
39%
2
258
0.8
lamb liver
61%
4
168
0.8
turkey drumstick (with skin)
50%
1
221
0.8
turkey bacon
29%
0
226
0.8
headcheese
36%
– 0
157
0.8
lamb kidney
71%
4
112
0.8
turkey heart
60%
3
174
0.8
sweetbread
16%
– 1
318
0.7
Seafood
food
% protein
ND
calories/100g
MCA
fish roe
58%
9
143
1.6
oyster
46%
10
102
1.5
mackerel
25%
4
305
1.4
caviar
36%
6
264
1.4
molluscs
86%
8
130
1.4
crab
91%
10
83
1.3
sardine
49%
6
208
1.2
flounder
74%
7
86
1.2
trout
59%
6
168
1.2
cisco
38%
4
177
1.2
sturgeon
64%
6
135
1.2
crayfish
86%
8
82
1.2
salmon
68%
7
156
1.2
lobster
91%
9
89
1.1
halibut
86%
8
111
1.1
anchovy
57%
5
210
1.0
perch
81%
7
96
1.0
herring
47%
4
217
1.0
rockfish
86%
7
109
1.0
pollock
90%
7
111
1.0
cod
92%
8
290
0.9
shrimp
81%
7
119
0.9
whiting
86%
6
116
0.8
white fish
92%
6
108
0.8
haddock
92%
6
116
0.7
Egg
food
% protein
ND
calories/100g
MCA
egg yolk
21%
4
275
1.4
whole egg
36%
4
143
1.3
Nut sand seeds
food
% protein
ND
calories/100g
MCA
tofu
43%
3
83
1.0
sunflower seeds
13%
2
546
0.9
pumpkin seeds
20%
3
559
0.8
flax seed
13%
1
534
0.8
almonds
13%
2
607
0.7
This image below summarises these foods for easy reference.
The nutrient profile of these foods is also excellent. These foods will help Big Ted to minimise his chance of developing nutrient deficiencies which may lead to rebound binge eating and derail his long term weight loss efforts.
How often should I eat on a PSMF?
Big Ted is fond of intermittent fasting. He finds it easier to not eat for a day or two and then eat to satiety rather than trying to count calories or restrict energy.
Meanwhile, Super Ted likes to eat two meals per day which save him time and helps him not overeat.
Personally, I don’t think it matters exactly when you eat as long as you stick to the foods that align best with your goals. Recent research suggests that in the fasted state we can use up to 3.5 g/kg/day and digest up to 4.3 g/kg/day.[25] This makes sense in an evolutionary context when there wouldn’t have been a regular supply of food but we would have needed to be able to use the food when we came across a big hunt after a long famine.
Either Super Ted or Big Ted could still utilise their required protein intake if they followed an alternate day fasting or 5:2 plan or indeed any other permutation of fasting. What is important though is that they ensure that they stick to their nutrient dense diet when they break their fast rather than reaching for the more energy dense foods when they eat again.
How low can you go?
Hopefully, this article has given you some actionable principles:
During weight loss, you should ensure that you get adequate protein while fat and carbs can be limited to achieve the energy deficit required to suit your target rate of loss.
As well as protein intake, we should aim to maximise all micro nutrients (vitamins, minerals, essential fatty acids and amino acids) ideally using whole foods.
You will find it hard to obtain adequate vitamins, minerals and essential fatty acids at one extreme or the other of protein intake.
As discussed in the ‘How Much Protein is Too Much’ article I noted that the minimum intake of protein and minimum essential fats tally up to around 314 calories as shown in the table below.
If we could stick to this approach, we would have a massive and highly ketogenic 85% of our energy coming from our body fat. However, you would be at an increased risk of inadequate vitamins, mineral and fatty acids with such a low energy intake.
macro
DRI (g)
DRI (calories)
% energy
minimum protein
56
224
71%
essential fats
10
90
29%
total
66
314
100%
If you’re starving to death and only have lean protein available you might call it “rabbit starvation”. However, if you still have plenty of body fat to burn it’s a PSMF.
#context matters
PSMFs for aggressive weight loss in a medical context generally aim for around 800 calories per day.
Lyle McDonald suggests that people following a PSMF for aggressive weight loss over a short period (e.g. cutting in the lead up to a bodybuilding show) might be eating between 400 and 800 calories per day.
Each person needs to find the ideal approach that they can live with for the long-term.
How to do a nutrient dense PSMF
Eat mostly foods from the lists below.
The nutrient dense PSMF diet foods are ideal for aggressive short term weight loss (i.e. leading up to a bodybuilding comp).
The nutrient dense weight loss foods for insulin resistancemay be more appropriate if you have more weight to lose over a longer period.
Minimum protein intake in a weight loss clinic setting is 1.2g/kg total body weight.
Appetite will likely drive you to eat more protein if you are working out. 2.4g/kg lean body mass is typical for someone lifting heavy.
The highest protein foods can be used to increase protein intake if required.
Focusing on these foods will ensure you still get adequate protein as well as vitamins and minerals while minimising energy consumption.
Limit carbs to what comes with non-starch veggies (i.e. no processed grains or sugars).
Limit fat to what comes with the lean protein foods.
Don’t eat too much
It will be hard to overeat these high nutrient density low energy density foods.
You may not have to consciously limit your food intake if you can focus only eat these foods.
It may be beneficial to track or plan your energy intake to achieve your goals.
Ratchet down your energy intake until you achieve your desired rate of weight loss.
Lift heavy / exercise (optional)
Working out will help you to use the protein to build lean muscle and keep your metabolic rate up.
Repeat
Summary
The protein sparing modified fast (PSMF) provides adequate levels of protein to support lean muscle mass while restricting energy from carbohydrates and fat.
Protein intakes vary widely depending on the goals and the level of energy restriction between.
Providing adequate nutrients, ideally from whole foods, is critical to long term weight loss and maintenance.
Just maximising protein may not provide optimal levels of vitamins and minerals. Therefore, it’s important to prioritise nutrient dense foods to improve your chances of long-term success.
While the PSMF is commonly used in weight loss clinics and in the bodybuilding community, the principle can also be applied in other situations.
I recently took a look at which nutrients might be missing from various popular dietary approaches in preparation for a recent on nutrient density. At a population level, the chart below shows the proportion of the US population that are deficient in various micronutrients. Many people are not getting enough vitamin D, vitamin E, magnesium, calcium, etc.
While your body hasn’t read the World Health Organisation’s reports on the Daily Recommended Intake of the various essential nutrients,[1] it’s likely that your appetite will drive you to seek out the nutrients that are lacking. If we are deficient in something that is required the body kicks in “nutrient hunger” and cravings that will make sure it gets what it needs.[2][3][4]
If you work hard to restrict your food intake to a certain dietary approach, but the body doesn’t receive the nutrients it needs, it may slow down and not function at full capacity. By contrast, adequate nutrition, without too much energy, slows many of the modern diseases of aging such as diabetes, Alzheimer’s and cancer and improves your chance of living healthfully to a ripe old age.[5]
USDA foods database
The chart below shows the nutrients that are both easiest and hardest to obtain from the eight thousand foods in the USDA foods database. At the bottom of this plot we have iron, various amino acids, and vitamin C, all of which are easy to obtain in adequate quantities.
However, at the top of the chart, we can see that it is much harder to obtain adequate quantities of six essential nutrients (omega 3 fatty acids, vitamin D, choline, vitamin E, and potassium). We would obtain sufficient quantities of all the other essential nutrients if we ate just a little of each of the foods in the USDA food database.
If we want to maximise nutrient density, it makes sense to prioritise foods that contain more of the harder-to-obtain nutrients. The chart below shows the nutrients for the top 10% of the 8000 foods in the USDA database (blue bars) when we prioritise for those. Not only do we get an increase in the more difficult to obtain nutrients, we also get a massive boost in all nutrients. Rather than being inadequate in six nutrients, we are now lacking only one (alpha-Linolenic acid, an Omega 3 fatty acid).
Limiting our food selection to the most nutrient dense foods makes it easier for us to consume the required nutrients without excessive energy, which is ideal if we are trying to lose fat or reduce calorie intake to slow the diseases of ageing.[6][7] Nutrient density becomes even more important if you’re fasting or restricting calories to achieve long term weight loss.
Optimising nutrient density
If you’re reading this, then you’re likely aware that there is a wide variety of dietary approaches that people follow to optimise their health depending on their preferences and beliefs.
I’ve tried to turn many of these beliefs about nutrition into a quantitative algorithm that we can use to evaluate and compare these approaches, and make sure we’re getting the outcome we want (e.g. low insulin, blood glucose control, nutrient density, or low/high energy density).
After testing a number of options, the three quantitative parameters that I have found the three parameters that are most useful are:
insulin load,
nutrient density, and
energy density.
My aim in this post is to show how considering nutrient density can improve various dietary approaches, from therapeutic ketogenic, vegan, paleo, and low fat. This post highlights which nutrients you will most likely be lacking with each of the different nutritional approaches, which foods you can use to fill these nutritional gaps, and perhaps which supplements you may need if you are still looking for some added nutritional insurance.
There’s been a lot of talk lately by Taubes[8] and Lustig[9] about how bad sugar and fructose are, but I think these nutritive sweeteners are just extreme examples of nutrient poor foods that are highly insulinogenic and energy dense. At the other end of the spectrum, we have foods like liver, broccoli, and spinach. Everything else is somewhere in the middle and will support or work against your goals, whatever they may be, to different degrees.
My aim here is to help you see where each of these foods sits on that continuum and use this information to help you refine your food choices to reach your personal goals.
Therapeutic ketogenic diet
Let’s start with the therapeutic ketogenic dietary approach. I have previously noted that a number of the issues and concerns with the ketogenic diet seem to relate to being able to obtain essential nutrients rather than consuming excessive levels of fat.[10][11][12] On one hand, I’m excited that the concepts of insulin load and percentage of insulinogenic calories have been helpful for people with chronic conditions such as epilepsy, cancer, dementia, Alzheimer’s etc. However, I think there is a risk their ultra-high fat diet will not contain the nutrients which are critically important for mitochondrial function and energy production.
The chart below shows the vitamins and minerals provided by a therapeutic ketogenic dietary approach if we simply prioritise for low insulin load (red bars)[13] in comparison to the average of all foods in the USDA database (orange bars). If you don’t pay attention to nutrient density a therapeutic ketogenic diet can provide lower levels of nutrition.
As shown in the chart below if we ate a little of all the foods in the USDA database, we would be deficient in six essential nutrients, whereas if we follow a therapeutic ketogenic diet, we will likely be lacking in ten essential nutrients.
The chart below shows the effect of how thinking in terms of nutrient density can improve the therapeutic ketogenic dietary approach (blue bars) compared to prioritising for insulin load only (red bars). All nutrients are boosted, particularly the harder to obtain ones.
While lots of people find that higher fat whole foods are hard to overeat, there are still some hyper palatable high fat foods that go down easily. We talk about eating “fat to satiety”, but what happens when nutrient hunger kicks in and your body is craving more potassium, magnesium, calcium, or one of the other nutrients that are harder to obtain in a very high fat dietary approach? If you keep on consuming large amounts of processed fats that don’t contain the nutrients you require, your appetite may not automatically turn off before you’ve consumed a lot of excess energy!
Low carb
The chart below shows the boost in nutrients when we consider nutrient density combined with a low carbohydrate approach. It appears that, based on this analysis, that without a focus on nutrient density, a low carbohydrate diet is likely to be deficient in folate, vitamin D, choline, potassium, magnesium, pantothenic acid, calcium, vitamin E and manganese. With a focus on nutrient dense foods, a low carb diet provides adequate amounts of the majority of nutrients.
Weight loss (insulin sensitive)
The weight loss approach is intended for people who are insulin sensitive but still have excess body fat to lose. Foods with a lower energy density (e.g. spinach, broccoli cucumber, celery, lettuce etc) typically are harder to overeat because they are bulky.
This approach doesn’t pay any attention to insulin load because it is assumed that people using this approach are not insulin resistant and are able to maintain good blood glucose levels. Practically, it’s also difficult to achieve a really high insulin load with these foods because they do not contain a large amount of processed carbs and are hard to overeat.
Without consideration of nutrient density, the essential fatty acids tend to be low along with vitamin B-12, choline, and tyrosine. However, once we factor in nutrient density all these nutrients dramatically improve.
This approach may not be viable for long term maintenance due to the extremely low energy density which would make it hard to get in enough energy. However, in the short term, it may be appropriate for a period of substantial energy restriction, and will provide maximum nutrition with a minimum amount of energy.
Zero carb
Getting adequate protein on a zero-carb approach is not a problem. However, unless there is a major focus on organ meats, there are a large number of vitamins and minerals, such as vitamin K, manganese, vitamin C, vitamin E, vitamin D, potassium, magnesium and calcium that may be worth supplementing.
Vegan
At the other extreme, the chart shows the nutritional analysis of the vegan diet. The main deficiencies in a vegan approach are omega 3s and vitamin B-12, which are hard to obtain without animal products. It may be prudent for vegans to consider fish oil supplementation and B-12 injections, or alternatively adding some seafood occasionally.
While it appears possible to obtain the recommended levels of protein, it’s hard to get very high levels of it. If you are insulin resistant, the fat levels can be increased using added coconut products and nuts.
Higher insulin load foods for bulking
The bulking approach is designed for people who are looking to gain strength and size by combining nutrient density with more calories and insulin load. Without consideration of nutrient density, a high insulin load means very low nutrient density foods. However, once we factor in nutrient density, we get a range of highly nutritious foods that may be helpful if you want to gain size and strength, while still maximising health and nutrition.
Paleo
The chart below shows the nutrients provided by the Paleo approach (i.e. no processed foods, dairy or grains) both with and without consideration of nutrient density. While ‘going Paleo’ eliminates many of the nutrient-poor processed food, it appears to be beneficial to also consider nutrient density as well in addition.
What does this all mean?
So, how do we decide which approach is best? Unfortunately, it’s not straightforward so I’ll look at this a number of ways.
What we ideally want is to identify the foods that will provide us with high amounts of all of the nutrients. The blue bars in the chart below represents the average of the % daily recommended intake of all the nutrients in the various approaches evaluated above, without considering nutrient density. The orange bars represent the average minus 0.5 x the standard deviation which is a measure of reliability. The higher the reliability the more consistent and high are the nutrients over all.
This chart shows that, in comparison to the other approaches, Paleo foods have a high and consistent level of nutrients; while the vegan and low energy density weight loss foods have high levels of some individual nutrients, but low levels of some others. Without consideration of nutrient density, the high insulin, low carb and zero carb approaches are a bit lacking in nutrients.
Things become a little more interesting once we factor in nutrient density. The vegan, therapeutic keto, low carb and zero carb approaches do poorly against the paleo, higher insulin load, most nutrient dense of all foods, and the lower energy density weight loss foods.
Many people will benefit on a high fat therapeutic ketogenic dietary approach, at least until their blood glucose and insulin levels normalise. However, in time, it may be beneficial to transition to more nutrient dense foods to continue their journey towards optimal health.
As detailed in the ‘how to optimise your diet for insulin resistance’ article, I think you should eat the most nutrient dense foods your pancreas can keep up with while maintaining good blood glucose levels. In time, someone who is highly insulin resistant may be able to progress to a more nutrient dense and more moderate fat approach if your ultimate goal is to normalise blood glucose levels and lose weight.
Food lists
If you identify with any of these goals, you may be interested in following these food lists. If blood glucose levels are sky high or you are managing a chronic condition such as epilepsy, cancer, Alzheimer’s or dementia, you may benefit from a higher fat therapeutic keto dietary approach, for a period. As your glucose levels come under control, you can transition to more nutrient dense foods that will also help you to achieve your weight goals.
As you can see, nutrients are provided at different levels depending on the approach. However, most people don’t follow any dietary approach strictly, so the nutrients in your diet will be different depending on your personal habits and preferences.
Rather than trying to pick up someone else’s nutrition plan, or live by a strict list, I think it’s better to refine your current habits, emphasising the good foods, minimising the bad, and progressively trying new foods that may be beneficial.
To this end, I’ve been developing a Nutrient Optimizer algorithm that can help you refine your food choices to suit your goals. By identifying the foods you are currently eating that align most with your current goals, which ones don’t, and which new foods perhaps you should consider.
Most current nutritional advice is driven by the avoidance of fat, particularly saturated fat, and therefore ends up being next to useless. Calorie counting apps like MyFitnessPal does nothing but count calories, which is also of limited use. Cron-o-meter tracks your micronutrients and can recommend foods to boost a single nutrient. However, there doesn’t seem to be anything available that will tell you which foods will help you actually correct multiple deficiencies and achieve a diet that is truly balanced in micronutrients.
The Nutrient Optimiser also allows you to tailor the approach to your goals, such as: therapeutic ketosis, diabetes management, weight loss or just nutrient dense maintenance. Food preferences like vegan, pescetarian, autoimmune, or paleo can be factored in to the recommended food lists.
At the moment, the process involves manually exporting food intake data from Cron-o-meter, then analysing it in a spreadsheet to manually generate a personalised report. I am eager to do this as a proof-of-concept for a range of people with various goals (particularly therapeutic ketosis, vegetarian, zero carb, fruitarian) to demonstrate how it works. So, if you’re happy to have your report shared publicly, and have a couple of weeks of Cron-o-meter data, feel free to send it to me and have your data analysed.
In time, the plan is to automate the process via an online interface and then ideally an independent mobile app. To keep up-to-date with progress, watch this space and check out the various analysed examples on the Marty Kendall’s Nutrient Optimiser Facebook page.
Epilogue… limitations
For completeness, I thought it would be worth mentioning a few limitations relating to calculating nutrient density…
Measuring foods in terms of calories has its own limitations as different macronutrients provide different amounts of energy (ATP) in different people. Some smart friends of mine are working on calculating ATP yield for different foods based on their macronutrient content. I’ll happily update this analysis in terms of nutrients per ATP as soon as that data is available. Initial indications are that people who are fat-adapted are able to use fat more efficiently (i.e. less entropy/losses in metabolism) and hence require less calories to yield the same amount of energy in the body (i.e. ATP). Hence, it appears that it is even more important for someone following a low carb or ketogenic approach to maximise nutrient density in terms of nutrients per calorie.
The official dietary reference values are based on limited research.[14] Typically, they relate to the minimum amount of a nutrient to avoid disease rather than the amount required for optimal function. They may also vary by person (e.g. someone who is more active may need more protein) and by their diet type (e.g. someone who is on a low carb diet may need less vitamin C to process the limited amount of glucose). Hence, I think the DRI values should be seen as a minimum. Ideally, we want to get more than the minimum while not having to ingest too much energy. I also don’t think nutrients are meant to come as individual vitamins and minerals in a bottle. The nutrients required to metabolise a certain food typically come packaged in whole foods, and often work synergistically. Taking supplements or fortifying foods will always be inferior to obtaining nutrients from whole foods.
Species-specific bioavailability and anti-nutrients are contentious topics. Zero carbers will tell you that nutrients in animal based foods are more bioavailable than plant based foods, while the vegans will tell you the opposite. To date, I haven’t been able to find useful data that would enable me to quantitatively refine the nutrient data in the USDA database regarding bioavailability. All we currently have is a measure of the nutrients contained in the food– rather than the nutrients that make it into your body after digestion. Again, if this data ever comes to hand, I’ll eagerly update the analysis.
Overall, I don’t think these limitations make a difference in the outcomes of the analysis. This is not an exact science and the body doesn’t operate like a rigid machine. Calculation of nutrient density is just a way to identify the foods that contain the most raw materials with the least amount of calories that your body can work with.
There’s a lot of talk about “nutrient density” and “superfoods”, but what do these terms really mean? Which foods actually give the most nutritional bang for your calorie buck? That is, which foods provide the most nutrients for the least number of calories?
Some approaches to quantifying nutrient density (e.g. Joel Fuhrman’s Aggregate Nutrient Density Index) have looked at vitamins and minerals (along with other parameters that are only available for fruits and vegetables) per calorie, but do not consider essential fatty acids and amino acids.
Meanwhile, Registered Dietitians’ recommendations and mainstream food ranking approaches revolve around avoiding nutrients such as saturated fat, cholesterol and salt. Unfortunately, this avoidance based approach to ranking foods does nothing to increase beneficial nutrients.
Avoidance of these demonised food elements typically ends up ignoring the whole unprocessed foods that contain the most nutrients. Instead, current ranking systems encourage prioritisation of processed foods that have been manufactured to be low in fat, saturated fat, salt or cholesterol.
The resultant fat-free manufactured products are so nutrient poor that they must be fortified with a smattering of synthetic vitamins to prevent the malnutrition that would otherwise occur. Food manufacturers also add sugar and synthetic flavours to make them palatable. After a few decades, food scientists have now learned to optimise sweetness to target “bliss point”[1] which continues to drive upwards in sweetness.[2]
With synthetic flavourings, we can make hyperpalatable food stuffs that taste so much more intense than real foods that are found in nature. After a generation or two of fake food we have forgotten what real food, in its natural form, tastes or even looks like. Unfortunately, at the same time our food production is becoming more reliant on fertilisers to grow crops bigger and faster but the end result is food that doesn’t naturally taste as good as they used to because they don’t contain the same number of nutrients. Our senses of taste and smell don’t have a chance of being able to find real nutrients amongst the plethora of super sweet and unnaturally flavoured foods. This industrialized chemical storm also taxes your liver, kidneys, and digestive system and encourages disease instead of leading to health.
So, if we can’t trust our senses anymore to find the nutrients we need what can we do?
As much as food technology has got us into this mess, the good news is that by quantifying nutrient density we can identify the foods that contain the most nutrients. Then after a period without the distraction of sweeteners and artificial flavours and we can re-learn trust our tongue, nose, appetite and cravings to find the real nutrients that our body need.
The chart below shows the nutrients contained in the eight thousand foods in the USDA database per 2000 calories. While it’s easy to get the minimum levels of iron, vitamin C and several the amino acids (at the bottom of the chart), it’s harder to obtain adequate quantities of omega 3 fatty acids, vitamin D, choline, vitamin E and potassium (shown at the top of the list).
Rather than trying to get more of all the essential micronutrients, we can prioritise the following nutrients that are harder to find:
alpha-Linolenic acid (Omega 3 fatty acids)
Vitamin D
Choline
Vitamin E
EPA + DHA (Omega 3 fatty acids)
Potassium
Calcium
Magnesium
Pantothenic acid
Tyrosine
Thiamin
Zinc
The chart below lists the nutrients provided by the average of all food in the USDA database (orange bars) compared to the nutrients provided by the most nutrient dense foods (blue bars). But focusing on the most nutrient dense foods, not only do we get more of the harder-to-find nutrients, we also improve the quantity of all the essential nutrients!
Macronutrient split
The chart below shows a comparison of the macronutrients in the most nutrient dense foods compared to the average of all foods in the USDA database. Although we have prioritised for only one amino acid (Tyrosine), it appears that the food that contain the most essential fatty acids, vitamins and minerals are also higher in protein.
The quantity of fibre also increases substantially. Nutrient dense vegetables come with large amounts of fibre which makes these foods more filling and harder to overeat.
The most nutrient dense foods also have a much lower energy density. This makes these nutrient dense foods harder to overeat. As well as feeling physically full, your body is likely to feel satiated once it has obtained the nutrients it needs.[3][4]
Notice the proportion of fat and non-fibre carbohydrates are lower in the most nutrient dense foods. In a way, I think we need to consider foods as nutrients and fuel separately. The initial goal is to eat the foods that contain the nutrients to live an awesome life and support your bodily functions. The secondary goal is to get enough fuel from higher energy density foods to support your activity and maintain ideal body fat. Too often we sacrifice essential nutrients and nutrient density and instead choose irresistibly tasty and high calorie food products for a “quick rush”.
The most nutrient dense foods
The most nutrient dense foods (i.e. the top 10% of the eight thousand foods in the USDA database) are listed below along with their nutrient density scores (ND) which is based on the harder to find nutrients.
If you’re interested in all the gory details of the nutrient density score is calculated you can check out the Building a Better Nutrient Density Index article. But in short the system compared the nutrients per calorie across all the foods in the USDA database. A score is given based on the standard deviation from the mean. If a certain food contains a lot of a certain nutrient it gets a large score. If it contains an average amount of a certain nutrient it gets a zero score. If it contains a little bit or none it gets a negative score. We then sum all these individual nutrients scores for the nutrients that are harder to find that we want to emphasise.
If you want to check whether a particular food is nutrient dense I recommend Googling “nutrient data self [insert your favourite food here]” to see how it ranks. For example, the image below shows that spinach does exceptionally well in both the nutrient balance (vitamins and minerals) and protein quality score.
Vegetables
Fibrous green vegetables are the highest-ranking nutrient dense foods. Few people argue with the idea that veggies are good for you. The nutrient density analysis confirms this.
Spices add flavour and nutrients and plenty of vitamins and minerals.
food
ND
basil
14
dill
9
paprika
7
cloves
6
thyme
6
sage
6
curry powder
5
marjoram
5
tarragon
4
pepper
3
Seafood
Seafood provides amino acids as well as Omega 3 fatty acids which are harder to get from other foods.
food
ND
crab
12
lobster
11
fish roe
10
oyster
9
crayfish
9
caviar
8
salmon
8
cod
8
trout
8
halibut
8
pollock
8
rockfish
7
sturgeon
7
shrimp
7
white fish
7
flounder
7
octopus
7
haddock
6
perch
6
whiting
6
anchovy
6
clam
6
sardine
5
scallop
5
tuna
5
Dairy and eggs
Only low fat cream cheese makes the list in terms of nutrients per calorie as other dairy products typically have more fat and not as many essential nutrients per calorie.
It’s true that eggs are a nutritional powerhouse of vitamins, minerals and protein. However, when it comes to the harder to find nutrients per calorie non-starchy veggies still win out.
It’s a similar story for nuts which don’t make the list. Full fat dairy and nuts can be a great source of energy and nutrition, particularly if you are insulin resistant or have diabetes, but if you’re just looking to maximise the harder to find nutrients per calorie the list of dairy and nuts isn’t that long.
food
ND
cream cheese (fat free)
8
whole egg
6
egg yolk
5
cottage cheese (low fat)
4
egg white
2
Animal products
Organ meats do well as well.
food
ND
turkey liver
9
veal liver
9
chicken liver
8
lamb liver
8
lamb kidney
7
ham (lean only)
6
pork liver
6
chicken breast
5
pork chop
5
turkey drumstick
4
turkey meat
4
lamb heart
4
leg ham
4
chicken liver pate
4
pork shoulder
4
veal
4
Pros and cons of nutrient density
The most obvious benefits of eating the most nutrient dense foods are that they:
provide the most essential nutrients with the fewest calories,
assist to normalize body weight (both lean tissue and body fat),
minimise cravings and the binge eating relating to nutrient hunger[5],
provide the nutrients your body needs to thrive and optimise mitochondrial health, and
help achieve and maintain overall good health.
Maintaining a healthy weight with adequate protein and while avoiding excess energy intake will help you to avoid a lot of the diseases of aging. These foods will also be quite filling and hard to overeat due to the low energy density and high fibre content.
At the same time, it will be hard to get enough energy if you just ate from the foods in this list. If you are very active you will also find it hard to in down enough energy for a lot of intense activity. If you are insulin resistant you may want to start out with higher fat foods that will still provide plenty of energy without raising causing blood sugar swings.
Nutrient density plus…
Eating exclusively from the list of the most nutrient dense foods may not be appropriate for everyone, particularly if you are just starting out on your health food journey. The table below lists several nutritional approaches that are suitable for different people depending on their blood glucose levels / insulin resistance and weight goals.
If you’re interested in optimising your diet for nutrient density as well as tailoring it to your blood glucose and weight loss goals I would love you to check out an a new tool I’ve been developing, the Nutrient Optimiser. It will review your food log and, rather than just tracking calories it will identify your biggest nutrient deficiencies and the most nutrient dense foods to fix them. You can also tailor the insulin load of the food recommendations to help normalize blood sugars and then energy density if you still have weight to lose. It’s still early days, but the future looks very exciting!
“Complete abstinence is easier than perfect moderation.”
St Augustine
This article is a follow up to the “How to use your glucose metre as a fuel gauge” article, which has been quite popular, with lots of people reporting success in lowering their blood glucose and recalibrating their hunger signals by using the numbers they see on their glucose metre.
To recap, the process revolves around the idea that, perhaps even better than calorie counting or carbohydrate counting, the numbers you see on your blood glucose metre are a good indication of whether you are running low on fuel and need to eat or whether you are just eating out of habit, routine, social boredom or for entertainment.
While eating for pleasure occasionally or as part of a celebration is fine and part of enjoying life, in the long run, most of us need to find a way to obtain the nutrients we need with less energy if we want to avoid obesity, diabetes and all the associated negative consequences.
If we eat highly insulinogenic low nutrient density foods regularly our insulin levels stay high and our fat stays locked in storage and hunger drives us to eat more frequently. However, if we reverse this cycle to lower our glucose and insulin to normal levels we start to eat less frequently and we allow our stored energy to flow out of our fat cells, our appetite decrease and there is a good chance we will lose weight and gain health.
The table below shows the simple process whereby someone could decide if they really need to eat. Using this process would ensure that their blood glucose levels continue to trend down as their excess energy in their bloodstream and vital organs (pancreas, liver etc) flows out of storage.
blood glucose
action
> 7-day average, well slept and low-stress
delay eating and/or exercise and wait for blood glucose to come down
if hungry, eat higher insulin load foods and delay exercise
Using numerical outputs to guide our decision making
There is no end of debate as to whether a calorie is a calorie or whether calories matter. Rather than tracking estimates of inputs like calories eaten or calories burned in exercise, there is nothing like tracking outputs such as your blood glucose levels, waist or weight to understand what your body is doing with the food you are eating and whether you are eating too much or too little.
If your glucose levels, insulin, waist or weight are increasing then chances are you’re eating too much, too often or the wrong type of food.
The plot below is a stark reminder that our chances of living longer improve if we have lower body fat levels or a waist to height ratio close to 0.5.
The problem with tracking glucose levels
The ‘problem’ with tracking blood glucose levels is that, in time, with regular fasting, our glucose levels will normalise to healthy levels but we may still be left with excess weight. So where do we turn once our blood glucose levels are optimal but our body fat levels are still above optimal?
This brings us to the star of this article, Rebecca Latham, who is a great example of how you can use your body measurements to guide your feast / fast cycle to achieve your long-term goals.
After a stressful time towards the end of 2015 Rebecca Latham decided she needed to make a focused effort to her lose some extra weight that had crept on. Rebecca is also particularly motivated by her family history of ALS, Parkinson’s Disease, dementia and cancer and her own ongoing battle with Type 2 Diabetes.
Rebecca’s Protocol
On 1 January 2016, Rebecca set an initial goal to lose 0.2 pounds per day over three months. Rebecca was also eager to reduce her fasting blood glucose levels from the 100mg/dL back to the 70mg/dL that they had been at before she regained her weight.
Part of Rebecca’s inspiration comes from her uncle, Buell Carlton Cole.
He was general surgeon to the President of the United States, who would control his weight by simply not eating until he returned to his goal weight. I initially thought this was an unhealthy approach until I read up a more about intermittent fasting.
Rather than simply not eating until she achieved her goal weight, Rebecca’s system involved not eating on days when her weight in the morning was above her target weight. Her only exception was to be special occasions and celebrations.
Here are Rebecca’s weight loss results during her initial 90-day challenge. Initial weight loss can be quite quick as the insulin levels drop and the body releases water. However, it gets a bit harder to continue with straight line weight loss as time goes on as you can see towards the end.
After the reached her initial goal, Rebecca had some issues that she needed to look after and ended up regaining some of the weight as you can see in the plot below of her weight over the past year. However, once these challenges were behind her she got back on her program. For the final part leading up to the end of the year she has dropped her goal weight loss back to 0.06lbs per day to hit her goal on 31 December 2016. See if you can spot the few ‘blips’ around Thanksgiving and Christmas.
This chart shows that she needed to fast for about one day in three through the year to lose nearly a quarter of her body weight over the year!
Reflecting on her journey, Rebecca says:
I reached my highest lifetime weight in February 2009, when I weighed in at 158 pounds, with a body fat percentage of 43.7%. This is my scale weight chart for this past almost eight years since I started eating low carb high fat (LCHF) and nutritional ketosis.
Each time I lost weight and stopped tracking and weighing myself, I gradually put most of the weight back on again. As you can see by the chart, this happened several times, and the last few times it happened, my weight was going up a little higher each time.
On January 1, 2016, I developed and started using my Protocol. Since starting the Protocol, I took two breaks, once in May 2016 when my husband had a heart attack and I was too concerned with his health to care about my own, but I got back on the Protocol within a couple of weeks and started seeing success again.
The next time I took a break was in July 2016, when I had to eat high carb and not fast for a week in preparation for some metabolic testing. As soon as the testing was over, I was back on the Protocol and started losing again. I have been going strong ever since, with small gains here and there brought on by restaurant meals and Thanksgiving.
I have now I reached my ultimate goal for scale weight, weighing in at 122.4 pounds with a body fat percentage of 25.7%, which means that I have lost approximately 37.5 pounds of body fat. The Protocol is the only thing that has brought me sustained weight loss, and I plan to follow it for the rest of my life!
Many people have a love/hate or even just a hate/hate relationship with their bathroom scale. It would be nice if low carb or nutrient dense achieved optimal health outcomes without any restriction for everyone. However, unfortunately, sustaining weight loss in the long term often takes discipline, some form of accountability and some level of restriction for most of us.
While weighing yourself every day isn’t much fun, the national weight control registry data indicates that people who have successfully lost weight and kept it off weigh themselves regularly.[3] [4] [5] Rebecca’s intended long term maintenance plan will likely be to weigh herself regularly and fast again once her weight goes outside her target range.
Better than calorie counting?
Some people who first try low carb or keto find that they initially lose a lot of weight eating to satiety as their blood glucose and insulin levels drop to healthier levels. However, in the long term, many people find that they need to be more disciplined and mindful of how much and/or how often they are eating to reach their optimal level of body composition.
The great thing about combining fasting with working to a goal like this is that it makes sure you don’t overdo the feasting days. I’ve found personally that it can be hard to know how much to eat after a fast. A quantitative system like this helps to manage and calibrate your appetite when you’re feasting.
If you eat to satiety, and not beyond, then you won’t have to fast again as soon as compared to if you binge after your fast. Eating to satiety on a regular basis means that your body’s metabolism doesn’t slow and adjust in the same way that it would if you maintained a constant caloric restriction.[6]
Life extension benefits
There are a number of benefits to fasting:
You can reduce your insulin levels more than if eating small but regular meals which keeps your insulin levels consistently elevated.
Fasting gives your body a chance to repair through a process called autophagy which is where the old cells are cleaned up which allow space for the fresh new cells to grow.
Fasting trains your body to become ‘metabolically flexible’ so you can use your body fat stores for and your food for fuel.
There is less need to focus on the quantity of food eaten at every single meal.
It’s not ideal to always be in growth mode with mTOR switched on. Alternating periods of growth and repair appear to be more beneficial in the long term.[7]
Fasting makes sense from an ancestral point of view when we wouldn’t have had constant access to plentiful food the way we do now. Periods of intentional restriction mimic what we have become adapted to and follow the seasons of the past.
Fasting also seems to have some special anti-aging effects. When food is scarce 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 to a time when food is more plentiful and you can reproduce and pass on your genes. Unfortunately, this emergency repair function doesn’t happen when food is plentiful.
Fasting and blood glucose levels
During the first three months following her protocol, Rebecca added a blood glucose target to also bring her blood sugar down by 0.25 mg/dL per day. As you can see in the chart below her blood glucose levels have dropped pretty much in parallel with her weight loss during this time.
More recently, she tested her blood glucose levels and found that they were consistently great so she ended up discontinuing the testing because it was becoming monotonous and not helping her make useful decisions.
While it’s useful to track a few things, it can be overwhelming and time-consuming to keep track of too many things at once and lead to analysis paralysis. It’s good to find a handful of things to track that will help you make useful decisions.
Do we lose fat or muscle during fasting?
One hot topic of discussion is the amount of lean mass (i.e. or muscle) that one may lose in long term fasting.
The reality is that any weight loss is going to consist of a combination of water, fat and muscle (or lean muscle mass). The chart below from Kevin Hall’s model shows that we initially lose a lot of carbohydrate (glycogen) and with it a lot of water.
Protein / muscle loss is the smallest component of loss from the body and this decreases as we adapt more to using fat and ketones rather than relying on glucose. It takes a few days to adapt to using fat and ketones, but in the long run they are by far the greatest proportion of energy used during fasting.
Rebecca’s experience aligns with this. She didn’t get a DEXA scan, but she does take regular body measurements which she uses to calculate her body fat percentage (see US Navy Circumference Method). Based on these measurements she lost 28.6 lbs of fat and 3.0 lbs of lean mass. So, more than 90% of her weight loss over the past year was fat.
“Problems” with fasting
Jason Fung has recently popularised the concept of fasting in the low carb community via his blog and videos and published The Complete Guide to Fasting. There is a ton of convincing evidence on the benefits of fasting which is an age old practice for a variety of reasons.
However, Dr Steve Phinney has come out highlighting his concerns with long term fasting with respect to loss of lean tissues as well as vitamins and minerals. A number of others have expressed concerns that fasting without due care and attention to refeeding will not be beneficial in the long term.
One way to reconcile the differences is to see these concerns as two ends of the spectrum. Jason’s focus is very sick people who come to him with major kidney issues due to their advanced Type 2 Diabetes, while Steve’s focus is more around maximising athletic performance for those whom maintaining muscle mass is critical to performance.
Also, if you are more fat adapted your body will be able to more easily draw energy from stored body fat rather than requiring glucose which can be drawn from the protein in your body via gluconeogenesis.
Most people don’t fit neatly into either of the extremes, so how do you refine the approach to suit your current situation? That is where optimising your food choices to suit your current situation comes in.
How much to eat after your fast?
Personally, one challenge I find with fasting is that it’s easy to overdo it when you get to eat again. I think some people experience this more than others. Dr Phinney made the analogy that telling someone not to binge at the end of a fast is like telling someone to hold their breath but then not to take too big a breath when they come up for air.
While some people can eat normally the next day after a fast, personally I find that it’s easy to reach for the energy dense lower nutrient dense foods or to give yourself liberty to eat foods that you may not normally eat if you were being disciplined all the time. By doing this, I’ve found it’s still possible to maintain or gain weight when fasting more days that you eat if you’re not disciplined with what you eat on your feasting days.
If you find yourself reaching for energy dense low nutrient density foods like processed carbs, a block of chocolate or litre of cream after your fast then you could take that as a sign that you need to revert to shorter fasting periods until you’re more fat adapted.
Another challenge with fasting is that it will deplete your system of vital nutrients in the long term meaning that you may be more inclined to binge when you do eat unless you’ve focusing on maximising nutrient density in your feasting periods.[8]
What to eat after you fast
One of the unique things about fasting is that it forces your body into the cleansing process of autophagy and primes the body to rebuild. Hence, it’s especially important to feed the parts of the body you want to grow (lean muscle mass is critical for long term health[9]) and maximise the nutrient density during the initial refeed.
In some ways, a fast is only as good as the feast afterwards that your body is highly primed to absorb. For me that means trying to plan some nutrient dense greens and a solid amount of protein for my first meal so I don’t end up reaching for the energy dense cream, butter or peanut butter or indulge in some junk carbage because I feel like I’ve earned it.
If your goal is to lose fat during the fast then it’s important to build back the essential vitamins, minerals and amino acids during the feeding period. The body will fight to get what it needs in the long run and I think you’ll have a better chance of avoiding cravings and involuntary binging if you maximise the essential nutrients of your food when you do this. And if you are using fasting to achieve long term weight loss I think it makes sense to try to get the maximum number of nutrients with the least amount of energy (a.k.a. avoiding empty calories and maximising nutrient density).
People looking to use fasting for long term weight loss may benefit from starting out with a higher fat dietary approach if they are very insulin resistant. However, as blood glucose levels progressively improve you should be able to transition to a more nutrient dense nutritional approach which will allow you to get your required nutrients with less energy.
I see a lot of arguments online regarding whether high fat keto or high protein is optimal. I think these arguments come down to context. The table below gives some guidance as to which approach might be right for you initially based on:
your blood glucose levels (if your glucose levels are high you will likely benefit from a higher fat keto approach, at least initially until your glucose levels start to normalise),
ketones (some is better than none, but there’s no need to chase high ketones with heaps of extra dietary fat, especially if you are trying to lose body fat), and
waist to height ratio (this is going to be more useful than the BMI chart to tell you if you still need to lose a bit of weight).
This graphic from Dr Ted Naiman demonstrates how foods are all somewhere on the sliding scale between maximum energy density and maximum nutrient density. If we are aiming for long term weight loss, we want to maximise nutrient density as much as we can while keeping blood glucose levels and insulin levels low. Then as we improve blood glucose levels and insulin sensitivity we will be able continue to move towards the right to more nutrient dense approaches which will help to provide satiety and adequate nutrition with less energy.[10]
If / when we reach our ideal weight or level of body fat, we can afford to add back in some more energy dense foods because we are no longer trying to use the glucose in our liver (glycogen) and body fat from our belly.[11] [12]
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. I find with this approach I am less hungry and my Protocol requires me to fast less often.[13][14]
Losing lean muscle mass is bad news whether you’re a bodybuilder, a diabetic or an older person battling sarcopenia.[15] Not only will losing muscle decrease your metabolic health, glucose disposal and metabolic rate, your body will also increase appetite to regain the muscle, making it harder to keep on losing the fat.[16]
It’s not just about looking buff and building muscles, amino acids are critical to fueling mitochondrial function and creating neurotransmitters that assist in staying happy and sleeping well. For example, the amino acid tryptophan produces serotonin which makes us happy and melatonin which helps us sleep.[17]
For reference, Rebecca’s 125g of protein per day ends up being 3g/kg LMB. This equates to 2g/kg LBM per day on average if you factor in the fact that she fasts every third day. This aligns with Volek and Phinney’s recommendations in the Art and Science of Low Carb Living (i.e. 1.5 – 2g/kg reference body weight) which equates to 1.7 to 2.2g/kg LBM . In Lyle McDondald’s Rapid Fat Loss Handbook he recommends between 1.8 to 4.4g/kg LBM protein, with a higher level of protein if you are lean and more active, and less if you are obese and inactive, to prevent muscle loss during a protein sparing modified fast.
The optimal food lists have been designed to help maximise nutrient density (including ensuring adequate amino acids) ideally without needing to rely on tracking calories. Rebecca does track what she eats, but mainly to make sure she is getting adequate protein on her feasting days.
The Protocol does not *require* tracking food intake, but I strongly recommend it. I found, for myself, that if I did not track on feast days, I ate too much fat and not enough protein, and I was having to fast a lot more to make my daily goals. Starting in April, I did start using the OKL macros and recommending the same to others.[18]
Rebecca also practices early time restricted feeding (eTRF) which means she eats earlier in the day due to better insulin sensitivity which seems to be producing good results for a lot of people. I have heard a lot of reports from people that have found that eating earlier rather than later helps with sleep, appetite and blood sugar.
Variations
I encourage you to check out Rebecca’s Facebook group where she has documented her daily progress and learnings and supports others using the Protocol. You can download a spreadsheet and start tracking and sharing your own progress. Public accountability and a supportive community are always going to be helpful in achieving such a long-term goal.
Rebecca has ‘stacked’ several different techniques from her learnings to ensure her long term success this time around to fight her genetics and tendency to regain her weight.
Before launching in, there are several considerations to tailor Rebecca’s approach to suit your situation and goals such as:
Target rate of weight loss. Rebecca recommends that people aim for a maximum weight loss of 0.2lbs or 0.1kg per day. Anything more is typically hard to sustain in the long term. You might be feeling ambitious and this level might be easy to achieve when things are going well but it may be hard to sustain in the longer term, especially if you have a few social gatherings or parties that leave you with some catching up to do. As you approach your goal weight you may be glad you chose a less aggressive goal as the weight loss becomes a little harder to achieve.
Social context. This type of approach can be hard to work around family or social commitments. I like to enjoy good food with my family on the weekends and save my fasting for work days when it’s easier to skip food. When I’ve followed this protocol, it leaves me fasting Monday and Tuesday and eating dinner Tuesday night with the family or ideally a hearty breakfast Wednesday morning. Based on my scale weight I may end up fasting another day or two on Thursday and / or Friday.
What’s your maximum fasting tolerance? Fasting gets easier with practice. You might want to start with just skipping a couple of meals, then going for 36 hours, then a couple of days. If you find your cravings are leading you to binge or sacrifice food quality, then you may want to stick with shorter fasting periods or aim for a less aggressive target rate of weight loss.
What else do you want to measure? The good thing about measuring weight is that it’s easy. It can however be problematic in that there are a ton of things that influence your weight other than fat gain or loss (e.g. muscle, water, how full is your gut, when did you go to the toilet etc); it’s an easy way to measure your progress day to day. In the long term, you want to see a trend in the right direction. If you have diabetes, then you may also want to track your glucose and even your ketone levels. It will also be useful to track your waist measurement periodically to see whether you’re getting closer to your optimum waist to height ratio of 0.5, particularly if you are building muscle and hence the BMI chart categories won’t mean much for you. For reference, during 2016 Rebecca’s waist to height ratio went from 0.54 to 0.44.
How full is your stress bucket?
A word of warning, again from personal experience, is that this approach is simple, but it’s not necessarily easy. Wondering what number you will see on the scale each day can be exciting but a bit stressful. It can be frustrating when you see the number going in the wrong direction or not keeping up with your target rate of weight loss.
A regular fasting routine is another thing that you will add to your “stress bucket” and if you don’t already have your sleep, nutrition, relationships, stress, circadian rhythm and regular activity in check then the cortisol and related insulin spikes may make achieving long term success with this approach harder than it would otherwise be.
If you do have these things ticked off and you’re feeling relaxed after a Christmas holidays but may have overdone the celebratory food then you can download a copy of the spreadsheet from My Low Carb Road – Fasting Support and give it a go.
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!
Look out for the article detailing Rebecca’s fasting / feasting Protocol which will be published on 1 January 2017 just in time for your New Years resolutions.
The table below shows the nutritional data per 500 calorie serving.
Then in 2013, Jason Fung emerged onto the low carb scene with his epic six part Aetiology of Obesity YouTube Series in which he detailed a wide range of theories relating to obesity and diabetes.
Essentially, Jason’s key points are that:
simply treating Type 2 diabetes with more insulin to suppress blood glucose levels while continuing to eat the diet that caused the diabetes is futile,
people with Type 2 diabetes are already secreting plenty of insulin, and
insulin resistance is the real problem that needs to be addressed.
Jason’s Intensive Dietary Management blog has explored a lot of concepts that made their way into his March 2016 book, The Obesity Code. However surprisingly, given that Jason is the fasting guy, the book didn’t talk much about fasting.
my experience with fasting
I have benefited personally from implementing an intermittent fasting routine after getting my head around Jason’s work. I like the way I look and perform, both mentally and physically, after a few days of not eating. I also like the way my belt feels looser and my clothes fit better.
Complete abstinence is easier than perfect moderation.
St Augustine
I recently did a seven day fast and since then I’ve done a series of four day fasts, testing my glucose and blood and breath ketones with a range of different supplements (e.g. alkaline mineral mix, exogenous ketones, bulletproof coffee/fat fast and Nicotinamide Riboside) to see if they made any difference to how I feel and perform, both mentally and physically.
Fasting does become easier with practice as your body gets used to accessing fat for fuel.
I love the mental clarity! My workout performance and capacity even seem to be better when I’ve fasted for a few days.
My key fasting takeaways are:
Fasting is not that hard. Give it a try.
You can build up slowly.
If you don’t feel good. Eat!
The more I learn about health and nutrition, the more I realise how critical it is to be able to burn fat and conserve glucose for occasional use. We get into all sorts of trouble when we get stuck burning glucose.
Our body is like a hybrid car with a slow burning fat motor (with a big fuel tank) and high octane glucose motor (with a small fuel tank). If you’re always filling the small high octane fuel tank to overflowing, you’ll always be stuck burning glucose and your fat burning engine will start to seize up (i.e. insulin resistance and diabetes).
Reducing the processed carbs in our diet enables us to lower our insulin levels and retrain our body to burn fat again. But nothing lowers insulin as aggressively and effectively as not eating.
Even though lots of Jason’s thoughts on fasting seem self-evident, his blog elucidating them has been very popular, perhaps because the concept of fasting is novel in the context of our current nutritional education.
We’ve been trained, or at least given permission, to eat as often as we want by the people that are selling food or sponsored by them.[1]
context
Jason’s angle on obesity and diabetes comes from his background as a nephrologist (kidney specialist) who deals with chronically ill people who are a long way down the wrong track before they come to his office. Jason also talks about how he had tried to educate his patients about reducing their carbs, however, after eating the same thing for 70 years, this is just too hard for many people to change.
Desperate times call for desperate measures!
Many of these patients come to him jamming in hundreds of units a day of insulin to suppress blood glucose levels, even though their own pancreas is still likely secreting more than enough insulin.
Rather than continuing to hammer more insulin to suppress the symptom (high blood glucose), the solution, according to Jason, is to attack the ultimate cause (insulin resistance) directly.
Jimmy Moore is well known to most people that have an interest in low carb or ketogenic diets. Whether you agree with his approach, it’s safe to say that low carb and keto would not be as popular today without his role.
Meanwhile, Jason talks about trying to educate people about reducing the processed carbs from their diet not working, not because of the science but more due to people not being able to change their eating habits after 70 years.
the Complete Guide to Fasting
You’ve probably heard by now that Jason has teamed up with Jimmy to write The CompleteGuide to Fasting which captures Jason’s extensive thoughts on fasting from the blog along with Jimmy’s n=1 experiences and wraps them up in a cohesive comprehensive manual with a colourful bow.
Jason and Jimmy both sent me a copy of their new 304-page book, The Complete Guide to Fasting, to review (thanks guys). So here goes…
Similar to The Obesity Code, TCGTF is a compilation of ideas that Jason has developed on his Intensive Dietary Management blog. Blogging is a great way to get the ideas together and thrash them out in a public forum. Some people love to read the latest blog posts and debate the minutiae, however, most people would rather spend the $9 and sit down with a comprehensive book and get the full story.
Unlike The Obesity Code, TCGTF is a bright, ffull-colourproduction with great graphics that will make it worth buying the hard copy to have and to hold.
TCGTF did originally have the working title Fasting Clarity as a follow on from Jimmy’s previous Cholesterol Clarity and Keto Clarity. However, other than Jimmy’s discussion of his n=1 fasting experiences, TCGTF is predominantly written in Jason’s voice building from his blog, so it wouldn’t be appropriate for it to have become the third in Jimmy’s Clarity series.
What is similar to Jimmy’s clarity series is that it’s easy to read and accessible for people who are looking for an entry level resource. This book will be great for people who are interested in the idea of fasting. It is indeed the complete guide to fasting and is full of references to studies, however, it doesn’t go into so much depth as to lose the average reader with scientific detail and jargon.
The book covers:
Jimmy’s n=1 experience with fasting,
Dr George Cahill’s seminal work on the effects of fasting on metabolism, glucose, ghrelin, insulin, and electrolytes,
the history of fasting over the centuries,
myth busting about fasting,
fasting in weight loss,
fasting and diabetes, physical health, and mental clarity,
managing hunger during a fast,
when not to fast, and
when fasting can go wrong.
The book is complete with a section on fasting fluids (water, coffee, tea, broth) and a range of different protocols that you can use depending on what suits you. What did seem out of place are the recipes for proper meals. Apparently, the publisher insisted they include these to widen the appeal (If you don’t like the fasting bit you’ve still got some new recipes?)
Overall, the book will be an obvious addition to the library (or Kindle) of people who are already fans of Jason and / or Jimmy and want a polished, consolidated presentation of all their previous work with a bunch of new material added.
TCGTF will also be a great read for someone who is interested learning more about fasting and wants to start at the beginning. TCGTF is the most comprehensive book on the topic of fasting that I’m aware of.
my additional 2c…
Jason doesn’t mind weighing into a controversial argument, using some hyperbole or dropping the occasional F-bomb for effect and Jimmy’s no stranger to controversy either, so I thought I’d take this opportunity to give you my 2c on some of the topical issues at the fringe that aren’t specifically unpacked in the book. We learn more as we thrash out the controversial issues at the fringes. Many arguments come down to context.
target glucose levels
Jason has come under attack for using the word ‘cured’ in relation to HbAc1 values that most diabetes associations would consider non-diabetic,[2] though are not yet optimal.[3]
In the book Jason does discuss relaxing target blood glucose levels during fasting. This makes sense for someone taking a slew of diabetic medications. They’re probably not going to continue the journey if they end up in a hypoglycaemic coma on day one.
The chart below shows the real life blood glucose variability for someone with Type 1 Diabetes on a standard diet. With such massive fluctuations in glucose levels, it’s impossible to target ideal blood glucose levels (e.g. Dr Bernstein’s magic target blood glucose number of 4.6 mmol/L or 83 mg/dL).
If your glucose levels are swinging wildly due to a poor diet coupled with lots of medication, your glucose levels are simply going to tank when you stop eating. Hence, a safe approach is to back off the medication, at least initially, until your glucose levels have normalized.
Being married to someone with Type 1 Diabetes, I have learned the practical realities of getting blood glucose levels as low as possible while still avoiding dangerous lows.[4] My wife Monica doesn’t feel well when her blood glucose levels are too low, but neither does she feel good with high blood glucose levels. Balancing insulin and food to get blood glucose levels as low as possible without experiencing lows requires constant monitoring.
The chart below shows how scattered blood glucose levels can be even if you’re fairly well controlled. Ideally you want the average blood glucose level to be as low as possible while minimising the number of hypoglycaemic episodes (i.e. below the red line). If you can’t reduce the variability you just can’t bring the average blood glucose level down. The last thing you want is to be eating to raise your blood glucose levels because you had too much blood glucose lowering medication.
Pretty much everyone agrees that it’s dumb to be eating crap food and dosing with industrial levels of insulin to manage blood glucose levels. High levels of exogenous insulin just drive the sugar that is not being used to be stored as fat in your belly, then your organs, and then in the more fragile places like your eyes and the brain.
Jason’s perspective is that people who are chronically insulin resistant and morbidly obese are likely producing more than enough insulin. The last thing they need is exogenous insulin which will keep the fat locked up in their belly and vital organs. Dropping insulin levels as low as possible using a low insulin load diet and fasting coupled with reducing medications will let the fat flow out.
fasting to optimise blood glucose levels
In the long run, neither high insulin nor high glucose levels are optimal.
Once you’ve broken the back of your insulin resistance with fasting, you can continue to drive your blood glucose levels down towards optimal levels.
One of the most popular articles on the Optimising Nutrition blog is how to use your glucose meter as a fuel gauge which details how you can time your fasting based on your blood glucose levels to ensure they continue to reduce.
Your blood glucose levels can help calibrate your hunger and help you to understand if you really need to eat. I think this is a great approach for people whose main issue is high blood glucose levels and who aren’t ready to launch into longer multi day fasts.
In a similar way, a disciplined fasting routine can help optimise blood glucose levels in the long term. The chart below shows a plot of Rebecca Latham’s blood glucose levels over three months where she used her fasting blood glucose numbers AND body weight to decide if she would eat on any given day.
While there is some scatter in the blood glucose levels, you can see that regular fasting does help to reduce blood glucose levels over the long term.
Once you’ve lost your weight , broken the back of your insulin resistance and stopped eating crap food, you may find that you still need some exogenous insulin or other diabetic medication to optimise blood glucose levels if you have burned out your pancreas.
fasting frequency
The TGTF book covers off on several fasting regimens such as intermittent fasting, 24 hours, 36 hours, 42 hours and 7 to 14 days. One concept that I’m intrigued by, similar to the idea of using your glucose meter as a fuel gauge, is using your bathroom scale as a fuel gauge.
The reality, at least in my experience, is that we can overcompensate for our fasting during our feasting and end up not moving forward toward our goal.
If your goal is to lose weight I like the idea of tracking your weight and not eating on days that your weight is above your goal weight for that day.
Again, Rebecca Latham has done a great job building an online community around the concept of using weight as a signal to fast through her Facebook group My Low Carb Road – Fasting Support.
The chart below shows Rebecca’s weight loss journey through 2016 where she initially targeted a weight loss of 0.2 pounds AND a reduction of 0.25 mg/dL in blood glucose per day. After three months, she stabilized for a period (during a period when she had a number of major family issues to look after). She is now using a less aggressive weight loss goal as she heads for her long-term target weight at the end of the year.
The chart below shows the fasting frequency required to achieve her goals during 2016. Tracking her weight against her target rate of weight loss has required her to fast a little more than one day in three to stay on track.
Eating quality food is part of the battle, but managing how often you eat is also an important consideration. After you’ve fasted for a few days, you can easily excuse yourself for eating more when you feast again. And maybe it’s OK to enjoy your food when you do eat rather than tracking every calorie and trying to consciously limit them.
The obvious caveat is that there are a lot of other things that influence your scale weight such as muscle gain, water, GI tract contents etc, but this is another way to keep yourself accountable over the long term.
FAST WELL, FEED WELL
Fasting is a key component of the metabolic healing process, but it’s only one part of the story.
Fasting is like ripping out your kitchen to put in a new one. You have to demolish and remove the old stovetop to put the new shiny one back in. You don’t sticky tape the new marble bench top over the crappy old Laminex. You have to clean out the old junk before you implement the new, latest, and greatest model.
In fasting, the demolition process is called autophagy, where the body ‘self eats’ the old proteins and aging body parts. The great thing about minimising all food intake is that you get a deeper cleanse than other options such as fat fast, 500 calories per day or a protein sparing modified fast (PSMF).
But keep in mind that it’s the feast after the fast that builds up the shiny, new body parts that will help you live a longer, healthier, and happier life.
“Fasting without proper refeeding is called anorexia.”
Mike Julian
Even fasting guru Valter Longo is now talking about the importance of feast / fast cycles rather than chronic restriction. In the end you need to find the right balance of feasting / fasting, insulin / glucagon, mTOR / AMPK that is right for you.
In TCGTF, Jason and Jimmy talk about prioritising nutrient dense, natural, unprocessed, low carb, moderate protein foods after the fast. I’d like to reiterate that principle and emphasise that nutrient density becomes even more important if you are fasting regularly or for longer periods.
In the long term, I think your body will drive you to seek out more food if you’re not giving it the nutrients it needs to thrive. Conversely, I think if you are providing your body with the nutrients it needs with the minimum of calories I think you will have a better chance of accessing your own body fat and reaching your fat loss goals.
optimising insulin levels AND nutrient density
It’s been great to see the concept of the food insulin index and insulin load being used by so many people! In theory, when people reduce the insulin load of their diet they more easily access their own body fat and thus normalizes appetite.
Some people who are very insulin resistant do well, at least initially, on a very high fat diet. However, as glycogen levels are depleted and blood glucose levels start to normalise, I think it is prudent to transition to the most nutrient dense foods possible while still maintaining good (though maybe not yet optimal) blood glucose levels.
The problem with doubling down on reducing insulin by fasting combined with eating only ultra-low insulinogenic foods is that you end up “refeeding” with refined fat after your fast.
While lowering carbs and improving food quality is the first step, I think that, as soon as possible you should start focusing on building up your metabolic machinery (i.e. muscles and mitochondria). A low carb nutrient dense diet is part of the story, but I don’t see many people with amazing insulin sensitivity that don’t also have a good amount of lean muscle mass which is critical to ‘glucose disposal’, good blood sugar levels and metabolic health.
This recent IHMC video from Doug McGuff provides a stark reminder of why we should all be focusing on maximising strength and lean muscle mass to slow aging.
The chart below shows a comparison of the nutrient density of the various dietary approaches. Unfortunately, a super high fat diet is not necessarily going to be as nutrient dense and thus support muscle growth, weight loss, or optimal mitochondrial function as well as other options.
The chart below (click to enlarge) shows a comparison of the various essential nutrients provided by a high fat therapeutic ketogenic dietary approach versus a nutrient dense approach that would suit someone who is insulin sensitive.
I developed a range of lists of optimal foods that will help people in different situations with different goals to maximise the nutrient density that should be delivered in the feast after the fast. The table below contains links to separate blog posts and printable .pdfs. The table is sorted from highest to lowest nutrient density. In time, you may be able to progress to a more nutrient dense set of foods as your insulin resistance improves.
Jason had a “robust discussion” with Steve Phinney over the topic of ideal protein levels recently during the Q&A session at the recent Low Carb Vail Conference.
To give some context again, Phinney is used to dealing with athletes who require optimal performance and are looking to optimise strength. Meanwhile Jason’s patient population is typically morbidly obese people who are on kidney dialysis and probably have some excess protein, as well as a lot of fat that they could donate to the cause of losing weight.
I also know that Jimmy is a fan of Ron Rosedale’s approach of minimising protein to minimise stimulation of mTOR. Jimmy and Ron are currently working on another book (mTOR Clarity?). Protein also stimulates mTOR which regulates growth which is great when you’re young but perhaps is not so great when you’ve grown more than enough.
The typical concern that people have with protein in a ketogenic context is that it raises blood insulin in people who are insulin resistant. ‘Excess protein’ can be converted to blood glucose via gluconeogenesis in people who are insulin resistant and can’t metabolise fat very well.
Managing insulin dosing for someone with Type 1 Diabetes like my wife Monica is a real issue, though she doesn’t actively avoid protein. She just needs to dose with adequate insulin for the protein being eaten to manage the glucose rise.
The chart below shows the difference in glucose and insulin response to protein in people who have Type 2 Diabetes (yellow lines) versus insulin sensitive (white lines) showing that someone who is insulin resistant will need more insulin to deal with the protein.
As well as insulin resistance, these people are also “anabolic resistant” meaning that some of the protein that they eat is turned into glucose rather than muscle leaving them with muscles that are wasting away.
People who are insulin resistant are leaching protein into their bloodstream as glucose because they can’t mobilise their fat stores for fuel. They are dependent on glucose and they’ll even catabolise their own muscle to get the glucose they need if they stop eating glucose.
While it’s nice to minimise insulin levels, I wonder whether people who are in this situation may actually need more protein to make up for the protein that is being lost by the conversion to glucose to enable them to maintain lean muscle mass. Perhaps it’s actually the people who are insulin sensitive that can get away with lower levels of protein?
As well as improving diet quality which will reduce insulin and thus improve insulin resistance, in the long term it’s also very important to maintain and build muscle to be able to dispose of glucose efficiently and also improve insulin resistance.
In TCGTF Jason talks about the fact that the rate of the use of protein for fuel is reduced during a fast and someone becomes more insulin sensitive. He goes to great lengths to point out that concern over muscle loss shouldn’t stop you trying out fasting (which is a valid point).
A big part of the magic of fasting is that you clean out some of your oldest and dodgiest proteins in your body and set the stage for rebuilding back new high quality parts. But the reality is that you will lose some protein from your body during a fast (though this is not altogether a bad thing).[5][6]
Bodybuilders often talk about the “anabolic window” after a workout where they can maximise muscle growth after a workout. Similarly, one of the awesome things about fasting is that you reduce your insulin resistance and anabolic resistance meaning that when at the end of your fast your body is primed to allocate the high quality nutrients you eat in the right place (i.e. your muscles not your belly or blood stream).
In the end, I think optimal protein intake has to be guided to some extent by appetite. You’ll want more if you need it, and less if you don’t.
I think if we focus on eating from a shortlist of nutrient dense unprocessed foods we won’t have to worry too much about whether we should be eating 0.8 or 2.2 g/kg of lean body mass.
However, avoiding nutrient dense, protein-containing foods and instead “feasting” on processed fat when you break your fast will be counter-productive if your goal is weight loss and waste a golden opportunity to build new muscle.
are you really insulin resistant?
Insulin resistance and obesity is a continuum.
Not everyone who is obese is necessarily insulin resistant.
If you are really insulin resistant, then fasting, reducing carbs, and maybe increasing the fat content of your diet will enable you to improve your insulin resistance. This will then help with appetite regulation because your ketones will kick in when your blood glucose levels drop.
However, if you continue to overdo your energy intake (e.g. by chasing high ketones with a super high fat, low protein diet), then chances are, just like your body is primed to store protein as muscle, you will be very effective at storing that dietary fat as body fat.
I fear there are a lot of people who are obese but actually insulin sensitive who are pursuing a therapeutic ketogenic dietary approach in the belief that it will lead to weight loss. If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help you identify your optimal dietary approach.
optimal ketone levels
Measuring ketones is really fascinating but confusing as well.
Urine ketones strips have limited use and will disappear as you start to actually use the ketones for energy.
In a similar way blood ketones can be fleeting. Some is better than none, but more is not necessarily better. As shown in the chart of my seven day fast below I have had amazing ketones and felt really buzzed at that point but since then I haven’t been able to repeat this. I think sometimes as your body adapts to burning fat for fuel the ketones may be really high but then as it becomes efficient it will stabilise and run at lower ketone levels even when fasting.
If your ketone levels are high when fasting then that’s great. Keep it up. They might stay high. They might decrease. But don’t chase super high ketones in the fed state unless you are about to race the Tour de France or if you want your body to pump out some extra insulin to bring them back down and store them as fat.
The chart below shows the sum of 1200 data points of ketones and blood glucose levels from about 30 people living a ketogenic lifestyle. Some of the time they have really high blood ketone levels but I think the real magic of fasting happens when the energy in our bloodstream decreases and we force our body to rely on our own body fat stores.
the root cause of insulin resistance is…
So we’ve worked out that large amounts of processed carbs drive high blood glucose and insulin levels which is bad.
We’ve also worked out that insulin resistance drives insulin levels higher, which is bad.
But what is the root cause of insulin resistance?
I think Jason has touched on a key component in that, as with many things, resistance is caused by excess. If we can normalise insulin levels, then our sensitivity to insulin will return, similar to our exposure to caffeine or alcohol.
However, at the same time, I think insulin resistance is potentially more fundamentally caused by our sluggish mitochondria that don’t have enough capacity (number or strength) to process the energy we are throwing at them, regardless of whether they come from protein, carbs, or fat.
A low carb diet lowers the bar to enable us to normalise our blood glucose levels. However, the other end of the spectrum is focusing on training our body and our mitochondria to be able to jump higher. In the long term this is achieved through, among other things, maximising nutrient dense foods and building lean body mass through resistance exercise.
summary
The Complete Guide to Fasting is, as per the title, the complete guide to fasting. It’s the most comprehensive guide to the nuances of fasting out there and there’s a good balance between the technical detail, while still being accessible for the general public.
Fasting can help optimise blood glucose and weight in the long term, with a disciplined regimen.
Fasting makes the body more insulin sensitive and primes it for growth. When you feast after you fast, it is ideal to make sure you maximise nutrient density of the food you eat as much as possible while maintaining reasonable blood glucose levels.
Understanding your current degree of insulin resistance can help you decide which nutritional approach is right for you. As you implement a fasting routine and transition from insulin resistance to insulin sensitivity you will likely benefit from transitioning from a low insulin load approach to a more nutrient dense approach.
