Tag Archives: weight loss

which nutrients is YOUR diet missing?  

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

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

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

USDA foods database

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

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

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

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

Optimising nutrient density

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

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

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

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

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

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

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

Therapeutic ketogenic diet

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

The chart below shows the vitamins and minerals provided by a therapeutic ketogenic dietary approach if we simply prioritise for low insulin load (red bars)[13] in comparison to the average of all foods in the USDA database (orange bars).  If you don’t pay attention to nutrient density, then a therapeutic ketogenic diet will provide lower levels of nutrition.  As shown in the chart below if we ate a little of all the foods in the USDA database, we would be deficient in six essential nutrients, whereas if we follow a therapeutic ketogenic diet, we will likely be lacking in ten essential nutrients.

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

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

Low carb

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

Weight loss (insulin sensitive)

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

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

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

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

Zero carb

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

Vegan

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

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

Higher insulin load foods for bulking

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

Paleo

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

What does this all mean?

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

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

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

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

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

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

Food lists

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

approach average glucose waist : height

(mg/dL)

(mmol/L)
therapeutic ketosis

> 140

> 7.8
diabetes and nutritional ketosis

108 to 140

6.0 to 7.8
weight loss (insulin resistant)

100 to 108

5.4 to 6.0

> 0.5

weight loss (insulin sensitive)

< 97

< 5.4

> 0.5

bulking

< 97

< 5.4

< 0.5

nutrient dense maintenance

< 97

< 5.4

< 0.5

Getting even more personal

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

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

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

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

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

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

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

Epilogue…  limitations

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

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

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

referecnes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The most nutrient dense superfoods (how to get more of the harder to find micronutrients per calorie)

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.

2017-02-14.png

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]

sugargraph_custom-9b4b159cf8de858ae0b5715776a3981c57a91989-s900-c85

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.

image08

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).

image12

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!

image13

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.

image05

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.

image11

 

Vegetables

image01

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.

food ND
watercress 16
endive 16
spinach 16
broccoli 13
escarole 13
asparagus 13
chicory greens 13
coriander 13
parsley 13
okra 12
lettuce 12
arugula 12
zucchini 12
brown mushrooms 12
Chinese cabbage 12
beet greens 11
seaweed 11
chard 11
chives 10
dandelion greens 10
cauliflower 10
turnip greens 10
celery 10
summer squash 10
yeast extract spread 10
alfalfa 9
radicchio 9
spirulina 9
white mushroom 9
pickles 8
cucumber 8
cabbage 8
mung beans 8
portabella mushrooms 8
mustard greens 8
collards 8
edamame 8
shiitake mushroom 8
snap beans 8
peas 8
artichokes 7
banana pepper 7
onions 7
soybeans (sprouted) 7
radishes 7
sauerkraut 7
pumpkin 7
kale 6
red peppers 6
butternut squash 6
Brussel sprouts 6
shiitake mushrooms 6
chayote 6
eggplant 6
jalapeno peppers 6
bamboo shoots 6
winter squash 5
turnips 5
rhubarb 5

Herbs and spices

image04

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

image03

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

image14

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

image06

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.

approach average glucose waist : height
(mg/dL) (mmol/L)
therapeutic ketosis > 140 > 7.8
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 > 0.5
weight loss (insulin sensitive) < 97 < 5.4 > 0.5
bulking < 97 < 5.4 < 0.5
nutrient dense maintenance < 97 < 5.4 < 0.5

Getting even more personal

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!

references

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

[2] http://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html

[3] http://sydney.edu.au/science/outreach/inspiring/news/cpc.shtml

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

[5] https://books.google.com.au/books?id=gtQyAgAAQBAJ&pg=PA185&lpg=PA185&dq=%22nutrient+hunger%22&source=bl&ots=VMRPgGgALA&sig=bCs4K5AKbQdQadtSfIniBizMsQA&hl=en&sa=X&ved=0ahUKEwjL7d2eqYvSAhWRq5QKHaAjA9AQ6AEIJjAC#v=onepage&q=%22nutrient%20hunger%22&f=false

how to use your bathroom scale as a fuel gauge

“Complete abstinence is easier than perfect moderation.”

St Augustine

image13

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.

image00

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.

image22

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
< 7 day average if hungry, enjoy nutrient dense foods that align with your insulin sensitivity
< 73mg/dL or 4.0 mmol/L 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.

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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.

Rebecca has been following a low carb diet since the start of February 2009.  She was featured in the 2010 New Atkins for a New You[1]  as well as on the Atkins site as an example success story.[2]  She was a guest on Episode 404 of Jimmy Moore’s Livin’ La Vida Low Carb podcast.

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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.

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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.

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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.

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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!

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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.

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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.

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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!

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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.

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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.

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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.

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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.

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“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.

As you can see in the chart below from Differences in fat, carbohydrate, and protein metabolism between lean and obese subjects undergoing total starvation the proportion of energy from lean body mass increases as our level of available level of body fat decreases.

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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.

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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:

  1. 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),
  2. 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
  3. waist to height ratio (this is going to be more useful than BMI to tell you if you still need to lose a bit of weight).
approach average glucose ketones (mmol/L) waist : height
(mg/dL) (mmol/L)
therapeutic ketosis > 140 > 7.8 < 0.3
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8 < 0.3
weight loss (insulin resistant) 97 to 108 5.4 to 6.0 < 0.3 > 0.5
weight loss (insulin sensitive) < 97 < 5.4 > 0.2 > 0.5
nutrient dense maintenance < 97 < 5.4 > 0.2 < 0.5

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]

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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]

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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 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.

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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.

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  • 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, whne 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 categories won’t mean much for you.  For reference, during 2016 Rebecca’s waist to height ratio went from 0.54 to 0.44.

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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.

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Chris Masterjohn recently did an excellent podcast How I Lost 30 Pounds in Four Months and How I Knew It Was Time which I highly recommend if you’re hoping to lose some serious weight.

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.

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references

[1] http://www.why-low-carb-diets-work.com/atkins-forum.html

[2] https://www.carbsmart.com/low-carb-success-story-rebecca-latham.html

[3] https://www.ncbi.nlm.nih.gov/pubmed/24355667

[4] https://www.ncbi.nlm.nih.gov/pubmed/18198319

[5] https://www.ncbi.nlm.nih.gov/pubmed/14668267

[6] https://www.ncbi.nlm.nih.gov/pubmed/20921964

[7] https://optimisingnutrition.com/2016/10/29/the-complete-guide-to-fasting-book-review/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

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

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

[11] http://livinlavidalowcarb.com/blog/the-llvlc-show-episode-1161-qa-medical-panel-2016-low-carb-cruise/26797

[12] https://www.youtube.com/watch?v=2KYYnEAYCGk

[13] http://www.artandscienceoflowcarb.com/

[14] http://www.ketoisland.com/blog/is-keto-high-fat-or-low-fat/

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

[16] http://www.nature.com/ejcn/journal/vaop/ncurrent/full/ejcn2016256a.html?platform=hootsuite

[17]  https://optimisingnutrition.com/2016/12/03/finding-your-optimal-insulin-load/

[18] https://www.facebook.com/groups/MyLowCarbRoadFastingSupport/permalink/147072942381538/

 

eggs florentine with chicken livers and bacon

This recipe for eggs florentine with chicken livers and bacon is from Rebecca Latham who runs the My Low Carb Road – Fasting Support Facebook group.

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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″).

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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.

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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!

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The nutritional analysis for this recipe is shown below.  This recipe comes in at #52 of 400 in the nutrient dense meals ranking and #67 in the diabetes and nutritional ketosis meal ranking.

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However if we sub out some of the onion and add some spinach it comes up to #23 of 400 in the nutrient nutrient dense meals ranking and #27 in the diabetes and nutritional ketosis.  Not bad.

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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.

net carbs insulin load carb insulin fat protein fibre
6g 30g 19% 56% 44g 6g

 

the complete guide to fasting (review)

Considering the massive amount of research and interest in the idea of fasting, not a lot has been written for the general population on the topic.

Brad Pilon’s 2009 e-book Eat Stop Eat was a great, though fairly concise, resource on the mechanisms and benefits of fasting.

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Martin Berkhan’s LeanGains blog had a cult following for a while in the bodybuilding community.

image17Michael Mosley’s 2012 documentary Eat, Fast and Live Longer documentary piqued the public interest and was followed by the popular 5:2 Diet book.

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 seems to be better when I’ve fasted for a few days.

My key fasting takeaways are:

  1. Fasting is not that hard. Give it a try.
  2. You can build up slowly.
  3. 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).

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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.

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Desperate times call for desperate measures!

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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.

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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.

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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 Complete  Guide 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.

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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, full colour production 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.

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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).

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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.

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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.

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fasting to optimise blood glucose levels

In the long run, neither high insulin nor high glucose levels are optimal.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

protein

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.

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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).

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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.

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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.

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optimal ketone levels

Measuring ketones is really fascinating but confusing as well.

“Don’t be a purple peetone chaser.”

Carrie Brown, The Ketovangelist Podcast Ep 78

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.

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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.

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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.

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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.

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summary

  1. 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.
  2. Fasting can help optimise blood glucose and weight in the long term, with a disciplined regimen.
  3. 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.
  4. 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.

references

[1] https://intensivedietarymanagement.com/of-traitors-and-truths/

[2] https://www.diabetes.org.uk/About_us/What-we-say/Diagnosis-ongoing-management-monitoring/New_diagnostic_criteria_for_diabetes/

[3] https://optimisingnutrition.com/2015/03/22/diabetes-102/

[4] https://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/

[5] https://www.dropbox.com/s/h3pi53njcfu4czl/Physiological%20adaptation%20to%20prolonged%20starvation%20-%20Deranged%20Physiology.pdf?dl=0

[6] https://www.facebook.com/groups/optimisingnutrition/permalink/1602953576672351/?comment_id=1603210273313348&comment_tracking=%7B%22tn%22%3A%22R9%22%7D

energy density, food hyper-palatability and reverse engineering optimal foraging theory

I’m looking forward to Robb Wolf’s new book Wired to Eat in which he talks about the dilemma of optimal foraging theory (OFT) and how it’s a miracle in our modern environment that even more of us aren’t fat, sick and nearly dead.[1]

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[yes, I may be a Robb Wolf fan boy.]

But what is  optimal foraging theory[2]?   In essence it is the concept that we’re programmed to hunt and gather and ingest as much energy us we can with the least amount of energy expenditure or order to maximise survival of the species.

In engineering or economics this is akin to a cost : benefit analysis.  Essentially we want maximum benefit for minimum investment.

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In a hunter gatherer / paleo / evolutionary context this would mean that we would make an investment (i.e. effort / time / hassle that we could have otherwise spent having fun, procreating or looking after our family) to travel to new places where food was plentiful and easier to obtain.

In these new areas we could spend as little time as possible hunting and gathering and more time relaxing.  Once the food became scarce again we would move on to find another land of plenty.

The people who were good at obtaining the maximum amount of food with the minimum amount of effort survived and thrived and populated the world, and thus became our ancestors.  Those that didnt’ didn’t.

So you can see how the OFT paradigm would be well imprinted on our psyche.

OFT in the wild

In the wild, OFT means that native hunter gatherers would have gone bananas for bananas when they were available…

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… gone to extraordinary lengths to obtain energy dense honey …

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… and eaten the fattiest cuts of meat and offal, giving the muscle meat to the dogs.

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OFT in captivity

But what happens when we translate OFT into a modern context?

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Until recently we have never had the situation where nutrition and energy could be separated.

In nature, if something tastes good it is generally good for you.

Our ancestors, at least the ones that survived, grew to understand that as a general rule:

 sweet = good = energy to survive winter

But now we have entered a brave new world.

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These days we have are surrounded by energy dense hyperpalatable foods that are designed to taste good without providing substantial levels of nutrients.

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When these foods are available our primal programming leaves us defenceless.

Our willpower or our calorie counting apps are no match for engineered foods with an optimised bliss point.

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These days diabetes is becoming a bigger problem than starvation in the developing world due to a lack of nutritional value in the the foods they are eating.[3]

The recent industrialisation of the world food system has resulted in a nutritional transition in which developing nations are simultaneously experiencing undernutrition and obesity.

In addition, an abundance of inexpensive, high-density foods laden with sugar and fats is available to a population that expends little energy to obtain such large numbers of calories.

Furthermore, the abundant variety of ultra processed foods overrides the sensory-specific satiety mechanism, thus leading to overconsumption.”[4]

what happens when we go low fat?

So if the problem is simply that we eat too many calories, one solution is to reduce the energy density of our food by avoiding fat, which is the most energy dense of the macronutrients.

Sounds logical, right?

The research into the satiety index demonstrates that there is some basis to the concept that we feel more full with lower energy density, high fibre, high protein foods.[5] [6]   The chart below shows how hungry people report being in the two hours after being fed 1000kJ of different foods (see the low energy density high nutrient density foods for weight loss article for more on this complex and intriguing topic).

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However the problem comes when we focus on reducing fat (along with perhaps reduced cost, increased shelf life and palatability combined with an attempt to reach that optimal bliss point[7]), we end up with cheap manufactured food like products that have little nutritional value.

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Grain subsidies were brought in to establish and promote cheap ways to feed people to prevent starvation.[8]  It seems now they’ve achieved that goal.[9]

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Maybe a little too well.

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The foods lowest in fat however are not necessarily the most nutrient dense.     Nutritional excellence and macronutrients are are not necessarily related.

In his blog post Overeating and Brain Evolution: The Omnivore’s REAL Dilemma Robb Wolf says:

I am pretty burned out on the protein, carbs, fat shindig. I’m starting to think that framework creates more confusion than answers.

Thinking about optimum foraging theory, palate novelty and a few related topics will (hopefully) provide a much better framework for folks to affect positive change. 

The chart below shows a comparison of the micronutrients provided by the least nutrient dense 10% of foods versus the most nutrient dense foods compared to the average of all foods available in the USDA foods database.

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The quantity of essential nutrients you can get with the same amount of energy is massive!  If eating is about obtaining adequate nutrients then the quality of our food, not just macronutrients or calories matters greatly!

Another problem with simply avoiding fat is that the foods lowest in fat are also the most insulinogenic so we’re left with foods that don’t satiate us with nutrients and also raise our insulin levels.  The chart below shows that the least nutrient dense food are also the most insulinogenic.


what happens when we go low carb?

So the obvious thing to do is to rebel and eliminate all carbohydrates because low fat was such a failure.  Right?

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So we swing to the other extreme and avoid all carbohydrates and enjoy fat ad libitum to make up for lost time.

The problem again is that at the other extreme of the macronutrient pendulum we may find that we have limited nutrients.

The chart below shows a comparison of the nutrient density of different dietary approaches showing that a super high fat therapeutic ketogenic approach may not be ideal for everyone, at least in terms of nutrient density.  High fat foods are not always the most nutrient dense and can also, just like low fat foods, be engineered to be hyperpalatable to help us to eat more of them.

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The chart below shows the relationship (or lack thereof) between the percentage of fat in our food and the nutrient density.   Simply avoiding or binging on fat does not ensure we are optimising our nutrition.

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While many people find that their appetite is normalised whey they reduce the insulin load of their diet high fat foods are more energy dense so it can be easy to overdo the high fat dairy and nuts if you’re one of the unlucky people whose appetite doesn’t disappear.

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what happens when we go paleo?

So if ‘paleo foods’ worked so well for paleo peeps then maybe we should retreat back there?  Back to the plantains, the honey and the fattiest cuts of meat?

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Well, maybe.  Maybe not.

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For some people ‘going paleo’ works really well.  Particularly if you’re really active.

Nutrient dense, energy dense whole foods work really well if you’re also going to the CrossFit Box to hang out with your best buds five times a week.

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But for the rest of us that aren’t insanely active, then maybe simply ‘going paleo’ is not the best option…

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… particularly if we start tucking into the energy dense ‘paleo comfort foods’.

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If we’re not so active, then intentionally limiting our exposure to highly energy dense hyperpalatable foods can be a useful way to manage our OFT programming.

enter nutrient density

A lot of people find that nutrient dense non-starchy veggies, or even simply going “plant based”, works really well, particularly if you have some excess body fat (and maybe even stored protein) that you want to contribute to your daily energy expenditure.

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Limiting ourselves to the most nutrient dense foods (in terms of nutrients per calorie) enables us to sidestep the trap of modern foods which have separated nutrients and energy.  Nutrient dense foods also boost our mitochondrial function, and fuel the fat burning Krebs cycle so we can be less dependent on a sugar hit for energy (Cori cycle).

Limiting yourself to nutrient dense foods (i.e. nutrients per calorie) is a great way to reverse engineer optimal foraging theory.

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If your problem is that energy dense low nutrient density hyperpalatable foods are just too easy to overeat, then actively constraining your foods to those that have the highest nutrients per calorie could help manage the negative effects of OFT that are engrained in our system by imposing an external constraint.

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But if you’re a lean Ironman triathlete these foods are probably not going to get you through.  You will need more energy than you can get from nutrient dense spinach and broccoli.

optimal rehabilitation plan?

So while there is no one size fits all solution, it seems that we have some useful principles that we can use to shortlist our food selection.

  1. We are hardwired to get the maximum amount of energy with the least amount of effort (i.e. optimal foraging theory).
  2. Commercialised manufactured foods have separated nutrients from food and made it very easy to obtain a lot of energy with a small investment.
  3. Eliminating fat can leave us with cheap hyperpalatable grain-based fat free highly insulinogenic foods that will leave us with spiralling insulin and blood glucose levels.
  4. Eating nutrient dense whole foods is a great discipline, but we still need to tailor our energy density to our situation (i.e. weight loss vs athlete).

the solution

So I think we have three useful quantitative parameters with which to optimise our food choices to suit our current situation:

  1. insulin load (which helps as to normalise our blood glucose levels),
  2. nutrient density (which helps us make sure we are getting the most nutrients per calorie possible), and
  3. energy density (helps us to manage the impulses of OFT in the modern world).

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I have used a multi criteria analysis to rank the foods for each goal.  The chart below shows the weightings used for each approach.

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The lists of optimal foods below have been developed to help you manage your primal impulses.  The table below contains links to seperate blog posts and printable .pdfs for a range of dietary approaches that may be of interest depending on your goals and situation.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant this survey may help you identify your optimal dietary approach.

survey

I hope this helps.

Good luck out there!

references

[1] http://ketosummit.com/

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

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

[4] https://www.ncbi.nlm.nih.gov/pubmed/24564590

[5] http://nutritiondata.self.com/topics/fullness-factor

[6] https://www.ncbi.nlm.nih.gov/pubmed/7498104

[7] https://www.nextnature.net/2013/02/how-food-scientists-engineer-the-bliss-point-in-junk-food/

[8] https://en.wikipedia.org/wiki/Agricultural_subsidy

[9] http://blog.diabeticcare.com/diabetes-obesity-growth-trend-u-s/

nutrient dense foods for weight loss and insulin resistance

I’ve talked to a number of people recently who use a combination of the optimal foods for diabetes and nutritional ketosis and the optimal foods for weight loss lists.

So I thought it would be useful to combine the two approaches into a single list of foods for people who want to lose weight but who were still somewhat insulin resistant.

If you’re someone who is moderately insulin resistant and also wants to lose weight then…  read on.

optimal foods for diabetes and nutritional ketosis

My food ranking system revolves around manipulating three parameters to suit different people with different goals:

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

The optimal foods for diabetes and nutritional ketosis list has a low insulin load, is fairly low in non-fibre carbs and moderately high fat while still being as nutrient dense as possible.

This approach suits someone who has Type 1 Diabetes or is lean and looking to achieve nutritional ketosis.  People who are at their goal weight can afford to eat a little more added dietary fat.

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While  most people looking to manage their blood glucose levels limit their carbohydrates to some arbitrary number that works for them, maximising nutrient density as well will help you to improve your mitochondrial function and increase your energy levels to ideally overcome your insulin resistance.  Maximising nutrient density also means that your body won’t keep on seeking out more and more food to obtain the nutrients it requires.

People who are very insulin resistant often do well on a higher fat dietary approach initially to let the insulin levels drop, however they often find further success in the long term if they drop their dietary fat to let more fat come from their body.

optimal foods for weight loss

The optimal foods for weight loss list is fairly low in dietary fat to allow for to come form the body during weight loss.  It’s heavy in lean proteins and non-starchy veggies and is VERY nutrient dense.  The chart below shows a comparison of a range of dietary approaches with the insulin sensitive weight loss approach being having the highest nutrient density while the diabetes and nutritional ketosis approach comes in at #8 of thirteen.

2016-10-16-4

This list of foods may look like a low fat dietary approach, but it’s not really low fat once you factor in your body fat.  The chart from Steve Phinney illustrates how your body fat makes a contribution to the weight loss phase of a well formulated ketogenic diet.

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The weight loss list of foods is also quite bulky (i.e. lots of fibre and water) so they would be very hard to overeat if you stick to just these foods.  The chart below show a comparison of the various approaches with the weight loss approach having the lowest energy density.

2016-10-16-6

Eating from the weight loss foods basically equates to a protein sparing modified fast (which is widely held to be the most effect way to lose weight in the long term) meaning that will fill you up so much you won’t be above to overeat while at the same time providing enough protein to preserve lean muscle mass during the weight loss phase.

The “problem” with the aggressive weight loss approach is that it is very low in energy dense comfort foods and it is higher in carbohydrates and protein than most low carbers might be used to, so it might be harder to stick to.  It may also raise your blood glucose levels if you’re still somewhat insulin resistant.

finding the optimal balance between the extremes

I have designed this list of foods for people who are insulin resistant and also looking to lose weight provides a balance between both extremes – high nutrient density, lowish levels of dietary fat and lower energy density.

The foods listed below represent the top 10% of the USDA food database using this ranking system.  I’ve included the nutrient density score, percentage of insulinogenic calories, insulin load (per 100g), energy density (per 100g) and the multicriteria analysis score score (MCA) that combines all these factors.

The chart below shows the amount of each nutrient provided by the more balanced approach compared to average of all the foods in the USDA food database.  As you can see you will still be able to obtain heaps of nutrients while the fat comes from your body.

weight-loss-insulin-resistant

vegetables

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
broccoli 23 36% 3 22 2.07
endive 15 23% 1 17 1.84
coriander 16 30% 2 23 1.79
zucchini 18 40% 2 17 1.75
chicory greens 14 23% 2 23 1.74
spinach 20 49% 4 23 1.66
escarole 11 24% 1 19 1.58
basil 17 47% 3 23 1.55
alfalfa 9 19% 1 23 1.51
watercress 22 65% 2 11 1.51
beet greens 13 35% 2 22 1.49
asparagus 16 50% 3 22 1.44
lettuce 14 50% 2 15 1.33
Chinese cabbage 15 54% 2 12 1.29
summer squash 12 45% 2 19 1.26
okra 13 50% 3 22 1.26
parsley 13 48% 5 36 1.25
cauliflower 13 50% 4 25 1.23
chard 13 51% 3 19 1.22
portabella mushrooms 14 55% 5 29 1.20
mustard greens 9 36% 3 27 1.20
arugula 11 45% 3 25 1.17
turnip greens 10 44% 4 29 1.17
chives 11 48% 4 30 1.14
banana pepper 8 36% 3 27 1.13
paprika 9 27% 26 282 1.11
cucumber 7 39% 1 12 1.08
pickles 7 39% 1 12 1.08
collards 7 37% 4 33 1.07
celery 10 50% 3 18 1.03
brown mushrooms 16 73% 5 22 1.01
avocado -0 8% 3 160 0.99
white mushroom 13 65% 5 22 0.99
shitake mushroom 12 58% 7 39 0.98
red peppers 6 40% 3 31 0.98
dandelion greens 10 54% 7 45 0.97
sauerkraut 5 39% 2 19 0.96
dill 11 59% 8 43 0.96
eggplant 4 35% 3 25 0.95
cloves 9 35% 35 274 0.95
radishes 6 43% 2 16 0.94
sage 7 26% 26 315 0.93
jalapeno peppers 5 37% 3 27 0.93
curry powder 3 13% 14 325 0.92
edamame 7 41% 13 121 0.89
chayote 5 40% 3 24 0.88
olives -5 3% 1 145 0.80
Brussel sprouts 6 50% 6 42 0.78
spirulina 11 70% 6 26 0.76
soybeans (sprouted) 6 49% 12 81 0.76
cabbage 7 55% 4 23 0.75
blackberries -1 27% 3 43 0.71
artichokes 5 49% 7 47 0.71

seafood

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
fish roe 18 47% 18 143 1.45
salmon 19 52% 20 156 1.44
trout 16 45% 18 168 1.36
caviar 13 33% 23 264 1.25
oyster 16 59% 14 102 1.19
cisco 9 29% 13 177 1.17
sturgeon 13 49% 16 135 1.13
mackerel 6 14% 10 305 1.08
anchovy 12 44% 22 210 1.08
crab 17 71% 14 83 1.01
sardines 9 36% 16 185 1.01
flounder 13 57% 12 86 1.01
herring 9 36% 19 217 0.97
sardine 9 37% 19 208 1.0
halibut 15 66% 17 111 0.96
tuna 12 52% 23 184 0.91
rockfish 13 66% 17 109 0.86
lobster 14 71% 15 89 0.85
crayfish 12 67% 13 82 0.82
shrimp 13 69% 19 119 0.81
pollock 13 69% 18 111 0.79
perch 10 62% 14 96 0.73

animal products

image09

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb liver 19 48% 20 168 1.47
lamb kidney 19 52% 15 112 1.45
turkey liver 16 47% 21 189 1.25
beef brains 8 22% 8 151 1.24
veal liver 17 55% 26 192 1.20
beef liver 17 59% 25 175 1.14
chicken liver 14 50% 20 172 1.13
beef kidney 14 52% 20 157 1.10
lamb brains 6 27% 10 154 1.05
chicken liver pate 7 34% 17 201 0.91
lamb heart 10 48% 19 161 0.90
ham 12 59% 17 113 0.88
ground turkey 6 30% 19 258 0.88
turkey heart 9 47% 20 174 0.85
rib eye steak 8 41% 21 210 0.84
roast pork 7 41% 20 199 0.83
roast beef 7 38% 21 219 0.83
beef tongue 1 16% 11 284 0.81
lamb sweetbread 6 43% 15 144 0.79
lamb chop 8 42% 25 234 0.79
lean beef 11 61% 23 149 0.78
beef heart 9 52% 23 179 0.78
park sausage 2 25% 13 217 0.78
pork liver 11 59% 23 165 0.77
turkey meat 8 52% 21 158 0.74
turkey drumstick 8 52% 21 158 0.74
chicken 10 60% 22 148 0.73

dairy and egg

image08

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
whole egg 9 30% 10 143 1.20
egg yolk 8 18% 12 275 1.15
sour cream 2 13% 6 198 1.02
cream 2 6% 5 340 0.93
cream cheese 2 11% 10 350 0.84
Swiss cheese 5 22% 22 393 0.80
cheddar cheese 5 20% 20 410 0.78
Greek yogurt 3 37% 9 97 0.74

other dietary approaches

The table below contains links to separate blog posts and printable .pdfs for a range of dietary approaches (sorted from most to least nutrient dense) that may be of interest depending on your situation and goals.   You can print them out to stick to your fridge or take on your next shopping expedition for some inspiration.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help identify the optimal dietary approach for you.

image02

Dominic D’Agostino’s breakfast – sardines, oysters, eggs and broccoli

At first it sounds like a bizarre food combination, but when the smartest guy in the room says that he has sardines, oysters, eggs and broccoli as his regular breakfast I wasn’t surprised to find that it scored highly in the nutritional analysis.

Before he started saving the world by progressing Warburg’s mitochondrial theory of cancer and oxygen toxicity seizures for DARPA Dominic D’Agostino studied nutrition and is rumoured to have done some bodybuilding.

Both physical and mental performance are undoubtedly critical to Dom, so it’s not surprising that he is very intentional about what he puts in his mouth to start each day.

As you can see in the plot from Nutrition Data below Dom’s breakfast scores a very high 93 in the vitamins and minerals score and a very solid 139 in the protein score.

You could say this meal was high protein (44%), low carb (10%) and moderate fat (46%), although his fatty coffee and high fat deserts would boost the fat content to make it more “ketogenic”.

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Dom’s breakfast scores well against the 250 meals analysed to date in the meal rankings for different goals coming in at:

  • therapeutic ketosis – 176
  • diabetes and nutritional ketosis – 87
  • nutrient density – 9
  • weight loss – 16

I’ve heard Dom say that he aims for a ‘modified Atkins’ approach with higher protein levels rather than a classical therapeutic ketogenic diet which is harder to stick to and might be used for people with epilepsy, cancer, dementia etc.  It was intriguing to see that Dom’s standard breakfast ranks the highest in nutrient density rather than therapeutic or nutritional ketosis.

Image result for tim ferriss dom d'agostino

Dom first mentioned his favourite breakfast concoction in his first interview with Tim Ferriss (check out the excellent three hour podcast here).   You can hear the shock and slight repulsion in Tim’s voice in the sound check as he responds with

“Do you blend that up in the Vitamix?”

But now Tim, rather than following his own slow carb approach, has made sardines and oysters a regular breakfast staple and mentions it as one of the top 25 great things he learned from podcasts guests in 2015.

The stats for a 500 calorie serve of Dom’s breakfast are shown in the table below.

net carbs

insulin load carb insulin fat protein fibre
6g 38g 18% 46% 44%

6g

oyster20at20ettas

I was aware that broccoli, eggs and sardines are nutritionally amazing, but then the oysters fill out the vitamin and mineral score to take it a little bit higher.  Dom obviously understands the importance of Omega 3s which are hard to get in significant quantities from anything other than seafood.

I was surprised to see that oysters can be ‘carby’ (at 23% carbs) which is apparently due to their glucose pouch which varies in size depending when they’re harvested.

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If you wanted to skip the oysters due to taste or cost considerations, the combination of sardines, egg and broccoli still does pretty well.  This option gives less carbs, a slight decrease in the vitamin and mineral score with an slight increase in the amino acid score.

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The ranking for the sans-oyster option is:

  • therapeutic ketosis –  159
  • diabetes and nutritional ketosis –  67
  • nutrient density –  11
  • weight loss – 20

The stats for a 500 calorie serving are:

net carbs

insulin load carb insulin fat protein fibre
3g 30g 10% 48% 44%

6g

The combination of nutrient dense seafood with nutrient dense vegetables is hard to beat.  The chart below shows my comparison of the nutrients in the various food groups in terms the proportion of the Daily Recommended Intake (DRI) from 2000 calories (click to enlarge).

2016-08-15

I couldn’t get any photos of Dom’s breakfast, but I did get a photo of my current go to lunch.   Each weekend I get a bunch of good quality celery and chop it up into tubs to take to work each day.  I have cans of mackerel and sardines in my drawer at work.

Celery does really well in terms of nutrient density per calorie and sardines and mackerel are high on the nutrient density lists without being outrageously expensive (e.g. caviar, anchovy, swordfish, trout).

mackerel and celery

When I feel hungry I might start munching on the celery which is pretty filling and hard to binge on.  Then if I’m still hungry I’ll have as many cans of mackerel or sardines as it takes to fill me up (which is usually 2 to 4).

At around 2pm this is my first meal of the day (other than espresso shots with cream) at around 2pm.  If I start to feel hungry before then I might check my blood glucose to see if I really need to refuel or if I think I’m hungry because I’m bored.   I’ll then go home and have an early dinner with the family around 6pm.

I’ve been known to indulge in some peanut butter with, cream, Greek yogurt or even butter if I’m still hungry (e.g. if I’ve ridden to work) but I try to not overdo it as I’m not as shredded as Dom yet.

The simple combination of celery and mackerel also does pretty well in the ranking of 250 meals and aligns well with my current goal of maximising nutrient density and ongoing weight loss now that I’ve been able to stabilise my blood glucose levels.

  • therapeutic ketosis – 137
  • diabetes and nutritional ketosis – 36
  • nutrient density – 16
  • weight loss – 8

net carbs

insulin load carb insulin fat protein fibre
8g 33g 25% 51% 35%

6g

low energy density high nutrient density foods for weight loss

  • Reducing the energy density of the foods you eat can help you feel full with less calories as well as improving nutrient density per calorie.
  • Some people who benefit from a LCHF approach initially may, as their blood glucose and insulin levels normalise, also benefit by decreasing the energy density and increasing the nutrient density of their diet.
  • The low energy density foods highlighted in this article will help you to increase the nutrient density of your diet with a lower calorie intake.

context

Human appetite is an intriguing, multifaceted and complex system that works to keep us alive and drives us to obtain fuel to survive and nutrients to thrive.  Three key drivers of appetite are:

  1. metabolic flexibility,
  2. satiety, and
  3. satiation.

Someone who is metabolically flexible can easily switch between available fuel sources.  Their insulin levels are lower and when food is not available they can easily transition to using body fat for fuel and not be as compelled by their appetite to eat as often.

You can develop metabolic flexibility through intermittent fasting (which is the most effective thing to lower insulin levels) and tailoring the insulin load of your diet to optimise your blood glucose levels (which we looked at in the last article).

Satiety is a longer term process that occurs when we have of obtained adequate nutrients (vitamins, minerals, amino acids and fatty acids).  We looked in detail at how we can maximise the nutrient density of the food we eat in the Building a Better Nutrient Density article.  Satiation occurs when when we have had a good meal and feel full and no longer feel like eating.

If you want a more thorough discussion of these topics I highly recommend checking out J. Stanton’s excellent series  on satiety, satiation and hunger.  This article focuses on how we can identify and prioritise foods that maximise satiety (increasing nutrient density to reduce cravings) and satiation (feeling of full with less calories) for people who are metabolically flexible (i.e. reasonable blood glucose level) but still have some more weight to lose.

vegetarian / HCLF context

The message to reduce our intake of high fat foods is not new.  It has been the cornerstone of much of the ‘conventional nutritional wisdom’.  We are told not to consume too much fat because it contains more than twice as many calories per gram as carbohydrates and protein.[1] [2] [3] [4] [5] [6]

People who promote a vegan lifestyle point out that high fat foods are not as filling as fruits and vegetables as shown in the diagram below from forksoverknives.com. [7]   This makes sense intuitively but appears initially to be at odds with the low carb high fat approach.

image11

Plant based diet advocates like Joel Fuhrman[8] [9] and Neal Barnard[10] [11] talk about low energy density as a key element of the effectiveness of their program.

Professor Barbara Rolls  has also published the Ultimate Volumetrics Diet[12] based on her research  into low energy density foods.[13]  [14] [15] [16] [17] [18]

The logic is that people typically eat a constant weight of food and hence if we can decrease the calories per gram we will decrease overall energy intake.[19]

image01

While I’m not sure I agree that 100g of celery will leave you as satisfied as 100g of butter, it’s worth noting that you would need to eat more than four kilograms (or 9lbs) of celery to get as much energy as you would from the 100g of butter.  So if the theory is partly true it could make for an interesting ‘hack’ to limit energy intake (satiation)

It’s also worth noting that the nutrient density for these non-starchy veggies are very high per calorie (high satiety) while the net carbs and insulin load are still quite low.   Most people would need to eat a lot of these to significantly affect their blood glucose or insulin levels (maintaining metabolic flexibility).

food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
celery 2.63 88% 1 4 17
broccoli 1.21 86% 4 9 42
beef steak 0.16 28% 0 21 305
butter  0.09 0% 0 1 734

A low fat dietary approach however approach has its own challenges.  In the process of avoiding fat people often end up eating highly processed, highly insulinogenic foods which tend to be problematic for people.  These foods can drive people to become less metabolically flexible which in turn will affect appetite control.

People tend to try to ‘game the system’ eat foods with higher energy density and more food reward, regardless of the approach.

“Replacement of saturated fat by carbohydrates, particularly refined carbohydrates and added sugars, increases levels of triglyceride and small LDL particles and reduces high-density lipoprotein, cholesterol, effects that are of particular concern in the context of the increased prevalence of obesity and insulin resistance.”[20]

Most people agree that highly processed low nutrient density carbohydrates are bad news as they will drive appetite and lead to obesity.

low carb / keto context

In low carb circles some people hear the ‘don’t fear the fat’ and ‘butter is back’ message a little too loud and get caught overdoing added dietary fat.

It’s not uncommon to see messages along the lines of “I’m keeping to the keto macros but still not losing weight” or “I’ve hit a stall” on LCHF forums and Facebook groups.

image07

“Eat fat to satiety” is useful advice for people who are insulin resistant and starting out on a low carb approach to manage blood glucose levels.  Eating adequate fat while minimising processed carbohydrates will decrease insulin levels and allow body fat stores to be used for energy which will in turn lead to improved metabolic flexibility and better appetite regulation.

However it’s still possible to over consume high fat foods, particularly for people who have a history of struggling to control their appetite.   Weight loss involves some level of energy restriction, especially if you are approaching your “goal weight”.  The sad reality is that there is no magic macro nutrient or food (other than perhaps indigestible fibre) that you can eat in unlimited quantities and still lose weight.  The key is to find what how we can manage appetite while minimizing the feeling of hunger.

The Godfather of the ketogenic diet Dr Steve Phinney points out that in weight loss a significant proportion of energy comes from our body fat.[21]

In the “adapt phase” of the ketogenic diet scenario shown below 75% of the person’s energy is from fat, however most of this fat is actually coming from body fat.

image12

One benefit of a low carbohydrate dietary approach to weight loss is the reduction in blood sugar spikes meaning that people are often less “hangry” with less processed carbs.  Smoothing out the blood glucose swings means that people often can more easily extend the period between meals without feeling compelled to snack.

image14

Some people hear the message that having high blood ketones means that the body is burning fat, and so they load up on dietary fat in an effort to attain high ketones.

image05

In the video below Dr Eric Westman points out that on his ADAPT program

“very high calorie foods and drinks like cheese and cream are limited so your body will draw on its own store of fat energy”.

energy density and satiety

One of the most interesting pieces of research into the area of satiation is a 1995 paper by Susanne Holt, Jennie Brand-Miller and Peter Petocz, “A satiety index of common foods”.[22]  (Incidentally, this is the same team that did the original research into the insulin index a couple of years later.[23])   This research indicates that how much we eat at subsequent mealstends to be influenced by how much our stomach stretches, not just the calorie content of our food.

The chart below shows SELFNutritionData.com‘s analysis of the data from the 1995 paper which they have used to develop their Fullness Factor[24] parameter which is associated with energy density (i.e. calories per 100g), protein content and fibre.  Fat appears to be negatively correlated with satiety.

image16

As we can see from the ‘building a better nutrient density index’ article, ranking foods by nutrient density per calorie gives us very high levels of fibre and protein, so we only need to add energy density to the system to improve satiety.

another step on the journey towards health

Does this mean that everyone looking to lose weight or normalise their blood glucose should adopt a low energy density approach?

Not necessarily.  Context matters.

Chris Gardner’s recent pilot study provides some useful guidance as to which approach might be best for a particular person.[25]

image03

The chart below summarises the results of this study indicating that:

  • everyone does better with nutrient dense whole foods;
  • people who are insulin resistant do better on a reduced carbohydrate approach; while
  • people who are insulin sensitive do better on a low fat low energy density

image15

It’s debatable where this cut over between insulin resistant and insulin sensitive lies, but the take home message  seems to be that if you are achieving normal blood glucose levels then increasing your non-starchy veggies in exchange for added fat might be a good idea if you want to keep losing weight.

is blood glucose management the only consideration?

As we’ve seen previously in many charts like the one below,[26] [27] managing your blood glucose levels and improving your insulin sensitivity may be the most important thing you can do for your health.[28]  Having an HbA1c less than 5.0% greatly reduces your risk of heart attack and a range of other common diseases.

image17

Simply eating more fat won’t automatically lead to more weight loss.  It’s the reduction in non-fibre carbohydrates that leads to decreased blood glucose and insulin levels, not the consumption of higher levels of fat.

Once you normalise your blood glucose and insulin levels you will  need to make sure make sure fat is coming from your body rather than your food if you want to continue your weight loss journey.

As someone loses weight improves their insulin sensitivity they may then benefit by incorporating more foods with a lower energy density to ensure that their weight loss and improvement in insulin sensitivity continue.

So, if you’ve had success on a LCHF approach that has enabled you to normalise your blood sugars but you’re not achieving everything you’d hoped for you could consider incorporating more foods that have:

  1. reduced energy density (i.e. less calories per 100g),
  2. a higher nutrient density, and
  3. high fibre.

Ideally this transition would be guided by regular monitoring to ensure that you’re still achieving excellent blood glucose levels.   If your blood glucose levels start to drift up you might retreat back to the higher fat options, ideally with some intermittent fasting.

on a personal note

On a personal note I have had some good results  recently following the intermittent protocol detailed in the how to use your blood glucose as a fuel gauge article.  My blood glucose levels are consistently lower, down from an average in the mid 5s to typically under 5.0mmol/L.

image13

After reading Keto Clarity and living in the low carb / diabetes head space for a while I have come to enjoy snacks like peanut butter with cream, cheese or butter.  These foods are satiating and yummy.  I find they turn off my appetite more than the simple carbs that would spike my blood glucose levels and make me feel hungrier.  When I’ve been active (e.g. riding to work which burns about 1200 calories in a day) or fast form a time energy dense foods can be an effective way to quickly refuel.

However, now my blood glucose levels seem to have now stabilised I’m now making an effort to snack on less calorie dense foods like the ones listed below and fill up on celery, spinach, broccoli, carrots and other green leafy veggies m that don’t spike my blood glucose levels.

comparison of approaches

The table below shows a comparison of the macro nutrients, percentage insulinogenic calories and the energy density for the highest ranking 1000 for different approaches.

approach % protein % fat fibre (g) % insulinogenic weight (g) / 2000 cals
all foods 25% 30% 19 55% 933
nutrient dense foods 34% 25% 60 31% 1118
nutrient dense low carb foods 26% 55% 22 30% 621
low energy high nutrient density 38% 19% 70 54% 1841
  • The most nutrient dense foods have a lower energy density than the average of all the foods (i.e. weight per 2000 calories).
  • Low carb foods have a higher energy density due to the higher fat content.
  • The low energy density foods have half the energy density of the average of all foods and a third of the energy density of the low carb foods.
  • The low energy density foods are also very high in indigestible fibre which will make it very hard to over consume these foods.
  • While the low energy density foods may have a higher percentage of insulinogenic calories it will also be harder to eat as much of these foods so the insulin load will likely still be quite low.

The chart below (click to enlarge) of the nutrients provided by each approach shows that focusing on lower calorie density foods enables us to increase nutrient density per calorie even more!

image19

The chart below (click to enlarge) compares the nutrient density of this low energy density approach compared to all 7000+ foods in the USDA database and the moderated nutrient density approach (see the building a better nutrient density index article) as well as the average minus 0.8 times the standard deviation.  In both of these measures the low energy density high nutrient density approach outperforms the other two approaches.

image18

low calorie density high nutrient density foods for weight loss

Listed below is a summary of the top 1000 foods in the USDA foods database using this low energy density high nutrient density approach.

The list of vegetables is long as always.  However the list of animal products is also significant, with a particular emphasis on seafood which provides essential fatty acids which are hard to obtain in significant quantities from other sources.

You may also be interested in this interactive analysis of nutrient density versus energy density using Tableau that I think is pretty snazzy!

Notably absent from this list of low energy density foods are dairy and nuts.   Many people find that they do better in terms of weight loss when they cut out dairy and nuts.

If you have type 1 diabetes or are very insulin resistant you may not do so well with the cereals, fruit, legumes, sweet potato or sweet corn in these lists, though you may find some of the other higher ranking foods useful.   As always you should ‘eat to your metre’.

vegetables

You can see from the data below that the energy density (i.e. calories per 100g) of these vegetables is very low.  It would be physically difficult to overeat these foods.    If you’re managing your blood glucose levels you will notice that the amount of non-fibre carbohydrates is also very low.

image09

The charts below from Nutrition Data Self  show that broccoli has a really wide distribution of vitamins and minerals and would give you 92% of your DRI for vitamins and minerals and 83% of your protein in 1000 calories.

The only ‘problem’ here is that you will need to eat five bunches of broccoli to get 1000 calories!   You can see how you might be able to drastically drop your energy intake if you only ate low energy density high nutrient density foods.

image04

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
celery 2.63 49% 1 2 17
rhubarb 1.46 57% 3 3 21
lettuce 1.34 52% 2 2 17
turnip greens 1.31 39% 1 4 37
winter squash 1.22 80% 7 8 39
broccoli 1.21 57% 4 6 42
asparagus 1.12 46% 2 3 27
Chinese cabbage 1.02 60% 1 2 16
summer squash 1.00 65% 2 3 19
okra 0.94 57% 4 5 37
bamboo shoots 0.90 52% 3 4 28
bell peppers 0.86 64% 6 7 43
artichokes 0.83 33% 3 4 54
cabbage 0.81 53% 3 4 30
kale 0.75 74% 8 10 56
snap green beans 0.74 47% 4 5 40
seaweed (kelp) 0.74 43% 4 5 50
parsnip 0.73 38% 7 7 76
radishes 0.70 50% 2 2 19
peas 0.69 58% 5 7 51
mushrooms 0.65 70% 2 5 30
jalapeno peppers 0.52 54% 4 5 35
onions 0.52 77% 7 8 41
sweet potato 0.51 82% 17 18 87
collards 0.44 46% 2 5 40
dill 0.42 30% 2 4 52
pinto beans 0.44 60% 16 21 142
sweet corn 0.43 47% 10 13 111
eggplant 0.39 67% 7 7 41
mung beans 0.33 46% 1 3 26
beets 0.34 44% 4 5 48
mustard greens 0.27 45% 2 3 30
chives 0.27 34% 1 3 37
Brussels sprouts 0.24 54% 5 7 52
carrots 0.20 55% 5 5 39
shallots 0.27 60% 46 56 377
banana pepper 0.17 41% 3 4 39
parsley 0.15 49% 3 5 44
thyme 0.27 21% 14 19 359

fruit

The net carbs, energy density and percentage of insulinogenic calories is higher for the fruit in comparison to vegetables.  It is possible to overeat fruits, particularly if you are insulin resistant.

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food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
cherries 0.72 84% 10 11 54
orange 0.49 77% 10 11 55
apples 0.48 77% 10 10 53
grapes 0.45 80% 15 15 77
figs 0.37 81% 16 17 82
mandarin oranges 0.31 63% 9 9 59
blueberries 0.32 72% 16 16 91
honeydew melon 0.30 88% 8 9 40
passion fruit 0.24 54% 13 15 109
litchis 0.20 80% 14 15 73
pear 0.14 69% 11 11 64

 grains and cereals

The net carbs, energy density and proportion of insulinogenic calories for the cereals and grains are higher than for the vegetables.  If you are insulin resistant make sure you eat to your metre.

image08

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
oatmeal 0.77 58% 8 10 67
teff 0.70 54% 11 14 101
spelt 0.58 54% 14 18 135
rice noodles 0.54 87% 22 23 105
quinoa 0.45 55% 14 16 120
millet 0.34 76% 20 22 118
oat bran bread 0.35 57% 29 38 264
rye bread 0.30 64% 37 45 282
rice bran bread 0.25 54% 31 37 273

legumes

Similar to grains, the legumes have a moderate energy density so are a good option to provide additional calories if you have filled up on the vegetables.

image10

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
lima beans 0.56 71% 16 23 129
navy beans 0.47 55% 15 20 143
lentils 0.35 62% 12 18 118
hummus 0.26 32% 8 14 175
tofu 0.17 28% 2 8 112

seafood

It is important to prioritise either regular fish intake or supplementation of omega 3 fatty acids.   I’ve included the insulin load rather than net carbs for the fish animal products which may be of interest if you are injecting insulin.

image02

food ND % insulinogenic insulin load (g/100g) calories/100g
oyster 0.31 57% 14 98
lobster 0.30 69% 14 84
anchovy 0.34 42% 21 203
tuna 0.30 50% 17 137
white fish 0.27 67% 17 102
salmon 0.28 50% 15 122
crab 0.26 69% 13 78
halibut 0.27 63% 16 105
mackerel 0.28 45% 17 149
Pollock 0.27 66% 17 105
rainbow trout 0.28 43% 17 162
shrimp 0.26 66% 19 113
swordfish 0.28 41% 17 165
sturgeon 0.26 47% 15 129
snapper 0.25 64% 15 94
octopus 0.26 69% 27 156
haddock 0.24 67% 18 110
caviar 0.30 32% 22 276
crayfish 0.21 64% 12 78
herring 0.26 34% 18 210
haddock 0.21 69% 15 85
abalone 0.21 76% 19 99
whiting 0.21 63% 17 109
sardine 0.24 36% 18 202
mussel 0.22 61% 25 165
clam 0.20 71% 24 135
cod 0.17 67% 17 99
perch 0.16 59% 13 91

animal products  

Similar to sea food, the energy density of the animal products is moderate.  Not as low as the non-starchy veggies but similar to the fruit, grains and legumes.

7450703_orig

food ND % insulinogenic insulin load (g/100g) calories/100g
beef liver 0.46 58% 24 169
chicken liver 0.43 48% 20 165
ham 0.26 55% 20 146
pork 0.25 54% 21 154
emu 0.24 63% 25 159
veal (leg) 0.25 56% 25 174
turkey breast 0.22 70% 22 127
chicken breast 0.22 56% 25 178
beef 0.22 50% 25 197

so how does it work?

This style of nutrient dense lower energy density approach is likely to be successful because it provides:

  1. nutrient dense proteins that will improve satiety,
  2. more fibre, water and bulk that will lead to increased satiation with lower levels of calories compared to a higher energy density,
  3. negligible levels of processed carbs which will help to keep insulin and blood glucose levels at normal levels which will allow body fat to be accessed for fuel,
  4. high levels of nutrition across the board (vitamins, minerals, amino acids and fatty acids) meaning that the body will be able to obtain adequate nutrition with a lower energy intake, and
  5. lower levels of dietary fat which will allow body fat to be used.

While many people from the LCHF head space might think of this as heresy, you might be interested to see that once we take the body fat into account this style of approach is actually quite high in fat.

The table below shows the macronutrient split for a low carb approach versus the low energy density high nutrient density approach.  The last column shows that if we apply a 40% deficit with 800 calories per day coming from body fat then the macronutrients are quite similar to the LCHF approach, with more than half the energy coming from fat.

approach nutrient dense low carb foods low energy high nutrient density (2000 calories) low energy high nutrient density (40% deficit)
% protein 26% 38% 23%
% dietary fat 55% 19% 11%
% net carbs 15% 29% 17%
% fibre 4% 14% 8%
fibre (g) 22 70 42
% insulinogenic 30% 54% 32%
deficit 0% 0% 40%
dietary energy (cal) 2000 2000 1200
body fat (cal) 0 0 800
total fat 55% 19% 51%

summary

If you have lost some weight on a LCHF approach and have normalised your blood glucose levels, you may benefit from transitioning to a lower energy density high nutrient density approach.

If you want to fine tune this a little further it might be worth tracking your insulin load  and tweak it to the point that you achieve excellent blood glucose levels (i.e. HbA1c < 5.0%, average blood glucose less than 5.4 mmol/L or 100 mg/dL) while also maximising nutrient density and minimising energy density.

 

references

[1] http://www.andjrnl.org/article/S2212-2672(12)00132-3/abstract

[2] http://www.sciencedirect.com/science/article/pii/B978012410540900003X

[3] http://www.ncbi.nlm.nih.gov/pubmed/18439712

[4] http://www.ncbi.nlm.nih.gov/pubmed/23128764

[5] http://www.ncbi.nlm.nih.gov/pubmed/14995052

[6] http://www.ncbi.nlm.nih.gov/pubmed/6303104

[7] http://www.forksoverknives.com/the-calorie-density-approach-to-nutrition-and-lifelong-weight-management

[8] https://youtu.be/XZGgeGHU1Bs?t=31

[9] https://www.drfuhrman.com/library/eat_more_often_gain_weight.aspx

[10] https://youtu.be/2UPQfdIlzaA?t=466

[11] https://books.google.com.au/books?id=C6KTATgbTacC&pg=PA264&lpg=PA264&dq=neal+barnard+energy+density&source=bl&ots=JomyWaNJn7&sig=nAPHWYJL_V-NtSZeKl_82DigERU&hl=en&sa=X&sqi=2&ved=0ahUKEwjQjJqtiJvMAhVDHJQKHWe7AXsQ6AEIIzAB#v=onepage&q=neal%20barnard%20energy%20density&f=false

[12] http://www.amazon.com/Ultimate-Volumetrics-Diet-Science-Based-Strategies-ebook/dp/B007JLK9HW/ref=sr_1_1?s=books&ie=UTF8&qid=1461080587&sr=1-1

[13] http://health.usnews.com/wellness/slideshows/the-10-best-diets-for-healthy-eating

[14] http://ajcn.nutrition.org/content/67/3/412.abstract

[15] http://ajcn.nutrition.org/content/88/6/1459.abstract?sid=238201eb-6207-4843-886b-9e1410e5a716

[16] http://ajcn.nutrition.org/content/86/1/174.abstract?sid=238201eb-6207-4843-886b-9e1410e5a716

[17] http://www.ncbi.nlm.nih.gov/pubmed/14995052

[18] http://www.ncbi.nlm.nih.gov/pubmed/17490955

[19] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182946/

[20] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943062/

[21] https://www.youtube.com/watch?v=2KYYnEAYCGk

[22] https://www.researchgate.net/publication/15701207_A_Satiety_Index_of_common_foods

[23] http://ajcn.nutrition.org/content/66/5/1264.abstract

[24] http://nutritiondata.self.com/topics/fullness-factor

[25] https://www.dropbox.com/s/n8tzuiixb1n1cxi/Weight%20Loss%20on%20Low-Fat%20vs.%20Low-Carbohydrate%20Diets%20by%20Insulin%20Resistance%20Status%20Among%20Overweight%20Adults%20and%20Adults%20With%20Obesity-%20A%20Randomized%20Pilot%20Trial%20%281%29.pdf?dl=0

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

[27] https://optimisingnutrition.com/2015/03/22/diabetes-102/

[28] http://diabetesupdate.blogspot.com.au/2007/05/misunderstanding-ukpds-7-is-not-good.html

choosing the right sized low carb band aid

  • This article identifies nutrient dense low insulin load foods that can help to stabilise your blood glucose levels and allow your own pancreas to keep up.
  • Once you normalise your blood glucose and lose some weight the progressive addition of nutrient dense low energy density foods may help continue your weight loss and improve your metabolic health.

how important is insulin sensitivity?

Managing your blood glucose levels through diet seems to be a major issue, if not THE most significant issue when it comes to health, longevity and reducing your risk of the leading causes of death (i.e. heart attack, stroke, cancer, Alzheimer’s and Parkinson’s Disease).[1]

As indicated by the charts below the lowest risk of the diseases associated with metabolic disease occurs when your HbA1c is less than 5% (i.e. an average blood glucose levels less than 100 mg/dL or 5.4 mmol/L).[2]

image10

image12

image11

image13

Insulin is an anabolic hormone that helps store nutrients and prevent their breakdown.   High levels of insulin (hyperinsulinemia) can lead to excess fat storage.  Excess insulin can also prevents us from accessing stored body fat.

image15

is low carb the best approach for everyone?

There are people who will argue that you can eat as much fat as you want.

At the same time there are people who will argue that you can eat as much protein as you want.

And you guessed it, there are also people who argue that you can eat as much carbohydrate as you want.

So who is right?

It seems that Christopher Gardner’s recent study Weight loss on low-fat vs. low-carbohydrate diets by insulin resistance status among overweight adults and adults with obesity: A randomized pilot trial[3] might bring some clarity to the macro nutrient wars.[4]

image17

As always, context matters.

It seems that there is no one single approach that is optimal for everyone all the time.

As well as encouraging participants to eat nutrient dense whole foods, Gardener’s study divided the participants up based on their insulin sensitivity and asked them to restrict carbohydrates or restrict fat as much as they could over a period of six months living in the real world without tracking calories.

As you can see from the chart below:

image14

This observation from Gardener’s study also aligns with the findings of the results of a 2005 study Insulin Sensitivity Determines the Effectiveness of Dietary Macronutrient Composition on Weight Loss in Obese Women (Cornier et al, 2005)[5] which also found that people who were insulin resistant did better with LCHF while those who were insulin sensitive did better on the HCLF approach.

image16

Similarly, people who are insulin resistant improve their fatty liver on a low GI diet.[6]

image08

Again, the results from Pitas (2005) show that people who are insulin sensitive lose more weight on a high glycemic diet while the people who were insulin resistant lose more on the low glycemic load diet.

image04

In this video David Ludwig explains why someone who is insulin resistant might do better with a reduced carbohydrate approach.

am I insulin resistant?

So the obvious question then is whether or not you are insulin resistant and how do you tell?

Insulin resistance, and the compensatory hyperinsulinemia that follows, appear to be caused primarily by excess body fat, particularly around the abdomen and organs, which leads to inflammation, insulin resistance and elevated blood glucose levels.[7]

image18

So if you have big belly there’s a pretty good chance you are also insulin resistant and have elevated blood glucose and / or high insulin levels.  So having a waist circumference greater than half your height is a good indication you are insulin resistant.[8]  [9] [10]

image07

Unfortunately your size is not a perfect indicator of your metabolic health.  Some people manage to store more fat before inflammation and insulin resistance sets in.[11]  These people are called metabolically healthy obese.[12]    Conversely some people can look thin on the outside but still have fat around their organs which causes insulin resistance.  These people are called TOFIs (thin outside, fat inside).[13]

A more accurate way to ascertain if you are insulin resistant is to test your blood glucose levels. If your blood glucose levels are consistently above 5.0mmol/L or 90 mg/dL before meals then you might have a problem.  If you wanted to get more serious you could get a fasting insulin test, a HOMA-IR test, test your glucose : ketone ratio or get an oral glucose tolerance test.

If you have elevated blood glucose and insulin levels you probably need to eat less processed carbohydrates.  If you are obese but have great blood glucose levels then it’s probably time to incorporate some more lower energy density higher nutrient density foods to help you reduce your calorie intake.

nutrient dense low carb foods for blood glucose control

For most people, the nutrient dense foods shown in the ‘building a better nutrient density’ article would be a major improvement.

People who are insulin sensitive but still want to lose weight would do well with low calorie density high nutrient density foods.

However, for someone who is insulin resistant, the most nutrient dense foods, which have about 50% insulinogenic calories, may lead to unacceptable blood glucose swings.   People who are unable to produce enough insulin or are insulin resistant need to manage their insulin budget and make sure that the insulinogenic foods that they do eat maximise nutrient density in order to provide adequate amino acids for muscle growth and repair and sufficient vitamins and minerals.

Where this gets more interesting is when we combine nutrient density with the proportion of insulinogenic calories to optimise both glucose levels and nutrient density.   Listed below is a summary of the top 1000 foods of the 7000+ foods in the USDA database when we prioritise by both nutrient density and insulin load.

Included in the tables below are a number of parameters that may be useful:

  1. The nutrient density score is based on the number of standard deviations above the average that a particular food is from the average.
  2. The percentage of insulinogenic calories is the proportion of the energy in the food that can turn to glucose and require insulin.
  3. The net carbs per 100g is the amount of digestible non-fibre carbohydrates in the food that can raise your blood glucose levels.
  4. The insulin load is the weight of food per 100g that will require insulin to metabolise.
  5. The energy density is the number of calories per 100g of the food. If you’re watching your weight as well as your blood glucose numbers than keeping the energy density down will also be of interest.

Vegetables

Listed below are the highest ranking vegetables.

While many of these vegetables have a high proportion of insulinogenic calories (i.e. digestible non-fibre carbohydrates that can raise blood glucose levels) they are also highly nutritious and have very low levels of non-carbohydrates and energy per 100g.  Most people would have to eat a lot of these to have a significant impact on blood glucose levels.

Most of us would do well to focus on filling up on any of these vegetables to help keep overall calories down to assist with weight loss which is critical for improving insulin resistance.  If you typically avoid vegetables due to blood glucose concerns then you could start out slowly  and progressively increase your intake of these vegetables while keeping an eye on your blood glucose levels.

image06

food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
celery 2.63 49% 1 2 17
turnip greens 1.31 39% 1 4 37
rhubarb 1.46 57% 3 3 21
lettuce 1.34 52% 2 2 17
broccoli 1.21 57% 4 6 42
asparagus 1.12 46% 2 3 27
winter squash 1.22 80% 7 8 39
artichokes 0.83 33% 3 4 54
Chinese cabbage 1.02 60% 1 2 16
okra 0.94 57% 4 5 37
summer squash 1.00 65% 2 3 19
bamboo shoots 0.90 52% 3 4 28
seaweed (kelp) 0.74 43% 4 5 50
bell peppers 0.86 64% 6 7 43
cabbage 0.81 53% 3 4 30
snap green beans 0.74 47% 4 5 40
radishes 0.70 50% 2 2 19
peas 0.69 58% 5 7 51
kale 0.75 74% 8 10 56
dill 0.42 30% 2 4 52
thyme 0.27 21% 14 19 359
mushrooms 0.65 70% 2 5 30
jalapeno peppers 0.52 54% 4 5 35
collards 0.44 46% 2 5 40
paprika 0.19 17% 8 16 389
black pepper 0.24 36% 24 29 327
beets 0.34 44% 4 5 48
chives 0.27 34% 1 3 37
bay leaf 0.21 37% 34 38 406
mung beans 0.33 46% 1 3 26
onions 0.52 77% 7 8 41
mustard greens 0.27 45% 2 3 30

fruit

This list of diabetic friendly fruits is quite short compared to the veggies.

image21

food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
olives 0.02 15% 3 3 90
avocado 0.01 18% 5 6 131
raspberries 0.09 42% 6 6 58

nuts, seeds and legumes

The great thing about nuts and seeds is that they have a low percentage of insulinogenic calories and are often low in non-fibre carbohydrates.   The drawback is that they have a much higher energy density due to their higher fat content and are not as high in nutrients as the non-starchy green veggies.  Keep in mind that you can overdo the nuts if you are keeping an eye on your weight as well as your blood glucose levels.

image05

food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
pecans 0.15 5% 4 9 762
pine nuts 0.16 11% 9 18 647
tahini 0.17 16% 13 26 633
peanuts 0.17 18% 7 28 605
sunflower seeds 0.18 20% 11 24 491
macadamia nuts 0.12 5% 5 9 769
hummus 0.26 32% 8 14 175
pistachio nuts 0.16 23% 19 34 602
sesame seeds 0.12 18% 14 27 603
almonds 0.11 16% 15 27 652
brazil nuts 0.09 9% 4 15 704
chia seeds 0.10 16% 8 21 511
tofu 0.17 28% 2 8 112
walnuts 0.10 15% 7 25 683
coconut meat 0.09 11% 16 20 703
hazelnuts 0.10 16% 15 27 692
cashew nuts 0.11 22% 24 33 609
flaxseed 0.08 12% 2 16 568

dairy and eggs

Eggs and cheese are great in terms of proportion of insulinogenic calories.   The nutrient density of these foods is above average but not as high as the non-starchy vegetables.  As with the nuts, keep in mind that the energy density of these foods is high so it is possible to overdo them if you are keeping an eye on your weight as well as your blood glucose levels.

dairy20and20eggs

food ND % insulinogenic insulin load  (g/100g) calories/100g
butter 0.11 0% 1 734
cream cheese 0.15 10% 8 348
goat cheese 0.18 22% 25 451
egg yolk 0.18 19% 15 317
Gruyère cheese 0.18 21% 22 412
sour cream 0.12 9% 4 197
Limburger cheese 0.17 18% 15 327
cream 0.10 5% 5 431
Edam cheese 0.18 22% 20 356
blue cheese 0.17 20% 18 354
Gouda cheese 0.18 23% 20 356
cheddar cheese 0.16 20% 20 403
Muenster cheese 0.16 20% 18 368
Camembert cheese 0.17 20% 15 299
Monterey 0.16 20% 19 373
Colby 0.16 20% 20 394
feta cheese 0.17 22% 14 265
brie cheese 0.15 19% 16 334
provolone 0.17 24% 21 350
Swiss cheese 0.18 26% 25 379
parmesan cheese 0.19 30% 31 411
mozzarella 0.15 23% 18 318
whole egg 0.17 29% 10 138

seafood

Getting an adequate intake of omega 3 essential oils is important and it’s hard to do without eating fish. Higher protein lower fat fish such as cod will require more insulin to process though this is typically not an issue unless you have type 1 diabetes and need to calculate and time your insulin doses or have advanced type 2 where your insulin response is not well matched to your glucagon response from the protein.

seafood-salad-5616x3744-shrimp-scallop-greens-738

food ND % insulinogenic insulin load (g/100g) calories/100g
caviar 0.30 32% 22 276
anchovy 0.34 42% 21 203
herring 0.26 34% 18 210
sardine 0.24 36% 18 202
swordfish 0.28 41% 17 165
rainbow trout 0.28 43% 17 162
mackerel 0.28 45% 17 149
tuna 0.30 50% 17 137
sturgeon 0.26 47% 15 129
salmon 0.28 50% 15 122

animal products

Higher fat animal products will have a lower insulin response but but they also have a higher energy density.  All these foods have more nutrients than average but not as many as the non-starchy vegetables.

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food ND % insulinogenic insulin load (g/100g) calories/100g
chicken liver 0.43 48% 20 165
beef liver 0.46 58% 24 169
bacon 0.18 23% 30 522
pepperoni 0.13 14% 17 487
chorizo 0.15 17% 19 448
foie gras 0.11 11% 13 459
pate 0.13 16% 13 315
beef ribs 0.11 13% 12 349
duck (with skin) 0.12 17% 14 331
salami 0.12 18% 12 258
lamb 0.14 24% 18 308
beef steak 0.16 28% 21 305
frankfurter 0.10 14% 11 322
ground turkey 0.19 37% 19 203
chicken drumstick 0.17 36% 22 238

is low carb a band aid or cure?

Some people say that a reduced carbohydrate approach only addresses the symptom (high blood glucose) rather than the cause (insulin resistance).  However, the studies highlighted above suggest that the low carb “band aid” also helps with the healing process (e.g. fat loss).

If you are insulin resistant, then reducing the insulin load of your diet using the foods listed above to the point you achieve excellent blood glucose levels will most likely be helpful.

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

As shown in the plots below, it’s the non-fibre carbohydrates, and to a lesser extent the protein, that drives our insulin and blood glucose response to food.

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I’ve hit a plateau in my low carb diet, what now?

Let’s say you’re someone who has done well with a low carb diet.  You’ve heard the message not to fear fat, reduced your carbs and seen a near miraculous improvement in your blood glucose and insulin levels.  But, you haven’t quite reached your goal weight yet.

Listed below is a range of pieces of advice that you might hear given to people in this situation:

  1. Just eat more fat.
  2. Reduce total carbs.
  3. Focus more on nutrient dense low calorie density more satiating foods.
  4. Reduce net carbs.
  5. Reduce the insulin load of your diet.
  6. Eat more fibre.
  7. Exercise more.
  8. Lift heavy things to build lean muscle.
  9. Develop a fasting routine.
  10. Eat more plant based foods.
  11. Get more sunshine.
  12. Get less blue light at night.
  13. Eat only during daylight hours.
  14. Sleep more.
  15. Do some high intensity exercise.
  16. Cut out nuts and dairy.
  17. Track your calories and reduce them until you start losing weight.
  18. Stop stressing about your blood glucose levels so much, you’re just raising your cortisol!
  19. Get another hobby and stop navel gazing so much!

In the list above I’ve crossed out (a) and (b) which I think could be counter productive.

As suggested by the studies noted above, there may be a point as you achieve normal blood glucose levels that someone would benefit from focussing on higher nutrient density and lower energy density rather than just low carbs.

The million-dollar question is, what is the cut over point where you can move on from the LCHF blood glucose rehabilitation approach and start focusing on weight loss in order to further improve your metabolic health?

I think the point at which you deem yourself to have become metabolically flexible is when your average blood glucose levels are less than 100mg/dL or 5.4mmol/L.  At this point you will also be starting to show low level blood ketones.[14]  It is at this point you can start adding some of the nutrient dense low energy density foods to see what effect they have on your blood glucose levels.

When to start focussing on high nutrient density low energy density foods

The chart below (click to enlarge) shows a comparison of the nutrient density for the following dietary approaches:

  1. all foods,
  2. high nutrient density foods,
  3. nutrient dense low carbohydrate foods, and
  4. nutrient dense low calorie density foods.

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The low carbohydrate foods listed above will be more nutritious compared to the average of all of the foods available.  However, if you have normal blood glucose levels it might be a good idea to try to incorporate more nutrient dense low energy density foods that may be more filling and nutritious to help you to continue to progress on your weight loss journey.

If your appetite is influenced by obtaining adequate nutrients from your diet and / or energy density then it may be wise to reduce the carbs in your diet only as much as you need to normalise your blood glucose levels, otherwise you may risk compromising the nutrient density of your diet.

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The extent of the carbohydrate restriction (or the size of the band aid required) depends on the extent of the metabolic damage that you have sustained.  It may not be sensible to sign up for a full body cast (e.g. very high fat therapeutic ketogenic diet) if you only have a broken toe (e.g.  mild insulin resistance).

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As you start to heal your insulin resistance you may be able to progress from the higher fat diabetic friendly list of foods above to incorporate more more nutrient dense, lower energy density foods.

Then maybe in the long run, once you optimise your weight loss, you might be able to focus on the most nutrient dense foods for optimal health.

references

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

[2] http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

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

[4] The results of Gardner’s full study should be available in late 2016.

[5] http://onlinelibrary.wiley.com/doi/10.1038/oby.2005.79/epdf

[6] http://ajcn.nutrition.org/content/84/1/136.full.pdf+html

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

[8] https://en.wikipedia.org/wiki/Waist-to-height_ratio

[9] https://www.google.com.au/search?q=obesity+code&spell=1&sa=X&ved=0ahUKEwjpg8b94P7LAhUCE5QKHS63AP4QvwUIGSgA&biw=1218&bih=939

[10] http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-13-91

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

[13] https://en.wikipedia.org/wiki/TOFI

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