“Low carb”, “ketogenic” or “nutrient dense” mean different things to different people. Defining these terms numerically can help us to choose the right tool for the right application.
Decreasing the insulin load of your diet can help normalise blood glucose levels and enable your pancreas to keep up. However, at the same time a high fat therapeutic ketogenic approach is not necessarily the most nutrient dense option, and may not be optimal in the long term, particularly if your goal is weight loss.
Balancing insulin load and nutrient density will enable you to identify the right approach for you at any given point in time.
This article suggests ideal macro nutrient, protein and insulin load, and carbohydrate levels for different people with different goals to use as a starting point as they work to optimise their weight and / or blood glucose levels.
context matters
Since I started blogging about the concepts of insulin load and proportion of insulinogenic calories many people have asked:
“What insulin load should I be aiming for?”
Unfortunately, it’s hard to give a simple answer without some context.
The answer to this question depends on a person’s current metabolic health, age, activity level, weight, height and goals etc.
This post is my attempt to provide an answer with some context.
disclaimers
Full disclosure… I don’t like to measure the food I eat. I have developed the optimal foods lists to highlight what I think are the best foods to suit different goals and levels of metabolic health.
I think food should be nutritious and satiating. If you goal is to lose weight it will be hard to overeat if you limit your food choices to things like broccoli, celery, salmon and tuna.
At the same time, some people like to track their food. Tracking food with apps like MyFitnessPal or Cron-O-Metre can be useful for a time to reflect and use as a tool to help you refine your food choices. If you’re preparing for a bodybuilding competition you’re probably going to need to track your food to temporarily override your body’s survival to force it to shed additional weight.
Ideal macronutrient balance is a contentious issue and a lot has already been said on the topic. I’ll try to focus on what I think I have to add to the discussion around the topics of insulin load and nutrient density.
If you want to and skip the detail in the rest of this article, this graphic from Dr Ted Naiman does a good job of summarising optimal foods and ideal macronutrient ranges. If you’re interested in more detail on the topic, then read on.
insulin is not the bad guy
The insulin load formula was designed to help us more accurately understand the insulin response to the food we eat, including protein and fibre.
insulin load = total carbohydrates – fibre + 0.56 * protein
The first thing to understand is that insulin per se is not bad. Insulin is required for energy metabolism and growth. People who can’t produce enough insulin are called Type 1 Diabetics and typically don’t last long without insulin injections after they catabolise their muscle and body fat.
Insulin only really becomes problematic when we have too much of it (i.e. hyperinsulinemia[1]) due to excess processed carbohydrates (i.e. processed grains, added sugar and soft drinks) and/or a lack of activity which leads to insulin resistance.
The concepts of insulin load and proportion of insulinogenic calories can provide us with a better understanding of how different foods trigger an insulin response and how to quantitatively optimise the insulin load of our diet to suit our unique situation and goals.
different degrees of the ketogenic diet
Words like “ketogenic”, “low carb” or “nutrient dense” mean different things to different people. This is where using numbers can be useful to better define what we’re talking about and tailor a dietary approach. For clarity, I have numerically defined a number of terms that you might hear.
ketogenic ratio
The therapeutic ketosis community talk about a “ketogenic ratio” such as 3:1 or 4:1 which means that there are three or four parts fat (by weight) for every part protein plus carbohydrate.[2]
For example, a 3:1 ketogenic diet may contain 300g of fat plus 95g of protein with 5g of carbs. This ends up being 87% fat. A 4:1 ketogenic ratio is an even more aggressive ketogenic approach that is used in the treatment of epilepsy,[3] cancer or dementia and ends up being 90% fat.
These levels of ketosis is hard to achieve with real food and is hard to sustain in the long term. Hence, it is typically used as a short term therapeutic treatment.
ratio of fat to protein
People in the ketogenic bodybuilding scene (e.g. Keto Gains) or weight loss might talk about a 1:1 ratio of fat to protein (by weight) for weight loss. A diet with a 1:1 ratio of fat to protein could be 120g of fat plus 120g of protein. If we threw in 20g of carbs this would come out at 66% fat (which is still pretty high by mainstream standards). A 1:2 protein:fat ratio would end up being around 80% fat.
protein grams per kilogram of lean body weight
Some people prefer to talk in terms of terms of percentages or grams of protein per kilo of lean body mass. For example:
The generally accepted minimum level of protein is 0.8g/kg/day of lean body mass to prevent malnutrition.[4] This is based on a minimum requirement of 0.6kg to maintain nitrogen balance and prevent diseases of malnutrition plus a 25% or two standard deviations safety factor.[5]
In the Art and Science of Low Carb Performance Volek and Phinney talk recommend consuming between 1.5 and 2.0g/kg of reference body weight (i.e. RW). Reference weight is basically your ideal body weight say at a BMI of 25kg/m2. So, 1.5 to 2.0kg RW equates to around 1.7 to 2.2g/kg lean body mass (LBM).
There is also a practical maximum level where people just can’t eat more lean protein (i.e. rabbit starvation[6]) which kicks in at around 35% of energy from protein.
The table below shows a list of rule of thumb protein quantities for different goals in terms of grams per kilogram of lean body mass and as a percentage of calories assuming weight maintenance.[7]
scenario
% calories
g/kg LBM
minimum (starvation)
6%
0.4
RDI/sedentary
11%
0.8
typical
16%
1.2
strength athlete
24%
1.8
maximum
35%
2.7
gluconeogenesis
You may have heard that body will convert ‘excess protein’ to glucose via gluconeogenesis, particularly if there is minimal carbohydrates in the diet and/or we can’t yet use fat for fuel.
For some people this is a concern due to elevated blood glucose levels, but it may also mean that more protein is required because so much is being converted to glucose that you need more to maintain muscles growing your muscles. As we become more insulin sensitive we may be able to get away with less protein because we are using it better (i.e. we are growing muscles rather than making glucose).
Most people eat more than the minimum level of protein to prevent malnutrition. People looking to gain muscle mass will require higher levels. Although keep in mind you do need to be exercising to gain muscle, not just eating protein.
Ensuring adequate protein and exercise is especially important as people age. Sarcopenia is the process of age related muscle decline which is exacerbated in people with diabetes.
Sadly, many old people fall and break their bones and never get up again. When it comes to longevity there is a balance between being too big (high IGF-1) and too frail (too little IGF-1).
carbohydrate counting
Then there is carb counting.
People on a ketogenic approach tend to limit themselves to around 20g (net?) carbohydrates.
Low carbers might limit themselves to 50g carbs per day.
A metabolically healthy low carb athlete might try to stay under 100g of carbs per day.
Limiting non-fibre carbohydrates typically eradicates most processed foods (e.g. sugar, processed grains, sodas etc). Nutrient density increases as we decrease the amount of non-fibre carbohydrates in our diet.
protein, insulin load and nutrient density
In the milieu of discussion about protein I think it’s important to keep in mind that minimum protein levels to prevent the diseases of malnutrition may not necessarily optimal for health and vitality.
Protein is the one macronutrient that correlates well with nutrient density. Foods with a higher percentage of protein are typically more nutrient dense overall.
Considering minimum protein levels may be useful if you are looking to drop your energy intake to the bare minimum and while still providing enough protein to prevent loss of lean muscle mass (e.g. a protein sparing modified fast). However, if you are looking to fill up the rest of your energy intake with fat for weight maintenance then you should be aware that simply eating foods with a higher proportion of fat will not help you maximise nutrient density.
Practically though very high levels of protein will be difficult to achieve because they are very filling, thus it is practically difficult to eat more than around 35% of your energy from protein. Protein is also an inefficient fuel source meaning that you will lose around 25% of the calories just digesting and converting it to glucose via digestion and gluconeogenesis.
If you are incorporating fasting then I think you will need to make sure you are getting at least the minimum as an average across the week, not just on feasting days to maintain nitrogen balance. That is, you might need to try to eat more protein on days you are eating.
what is ketosis?
“Ketogenic” simply means “generates ketones”.
An increase in ketosis occurs when there is a lack of glucogenic substrates (i.e. non-fibre carbohydrates and glucogenic protein). It’s not primarily about eating an abundance of dietary fat.
I think reducing insulin load (i.e. the amount of food that we eat that requires insulin to metabolise), rather than adding dietary fat, is really where it’s at if you’re trying to ‘get into ketosis’. We can simply wind down the insulin load of our diet to the point that out blood glucose and insulin levels decrease and we can more easily access our stored body fat.
insulin load = total carbohydrates – fibre + 0.56 * protein
Whether a particular approach is ketogenic (i.e. generates ketones) will depend on your metabolic health, activity levels and insulin resistance etc.
Whether you want to be generating ketones from the fat on your excess belly fat rather than your plate (or coffee cup) is also an important consideration if weight loss is one of your goals.
While people aiming for therapeutic ketosis might want to achieve elevated ketone levels by consuming more dietary fat, most people out there are just looking to lose weight for heath and aesthetic reasons. For most people, I think the first step is to reduce dietary insulin load until they achieve normalised blood glucose levels (i.e. average BG less than 5.6mmol/L or 100mg/dL, blood ketones greater than 0.2 mmol/L). People with diabetes often call this “eating to your metre”.
Once you’ve achieved normal blood glucose levels and some ketones the next step towards weight loss is to increase nutrient density while still maintaining ketosis. Deeper levels of ketosis do not necessarily mean more fat loss, particularly if if you have to eat gobs of eating processed fat to get there.
Ray Cronise and David Sinclair recently published an article “Oxidative Priority, Meal Frequency, and the Energy Economy of Food and ACtivity: Implications for Longevity, Obesity and Cardiometabolic Disease” which does an interesting job of looking at the ‘oxidative priority’ of various nutrient and demonstrate that the body will burn through nutrients in the following order:
alcohol,
protein (not used for muscle protein synthesis),
non fibre carbohydrate, and then
fat.
What this suggests to me is that if you want to burn your own body fat you need to minimise the alcohol, protein and carbohydrate which will burn first. To me this is another angle on the idea that insulin levels are the signal that stops our body from using our own body fat in times of plenty. And if we want to access our own body fat we need to reduce the insulin load of our diet to the point we can release our own body fat.
insulin load versus nutrient density
The risk however with the insulin load concept is that people can take things to extremes. If our only objective is to minimise insulin load we’ll end up just eating bacon, lard, MCT, olive oil… and not much else.
In his “Perfect Health Diet” book Paul Jaminet talks about “nutrient hunger”, meaning that we are more likely to have an increased appetite if we are not missing out on a particular nutrient. He says
“A nourishing, balanced diet that provides all the nutrients in the right proportions is the key to eliminating hunger and minimising appetite.“
In the chart below shows nutrient density versus proportion of insulinogenic calories. The first thing to note is that there is a lot of scatter! However, on the right-hand side of the chart there are high carb soft drinks, breakfast cereals and processed grains that are nutrient poor. But if we plot a trendline we see that nutrient density peaks somewhere around 40% insulinogenic calories.
If you are metabolically challenged, you will want to reduce the insulin load of your diet to normalise blood glucose levels. But if you reduce your insulin load too much you end up living on purified fats that aren’t necessarily nutrient dense.
If we are trying to avoid both carbohydrates and protein we end up limiting our food choices to macadamia nuts, pine nuts and a bunch of isolated fats that aren’t found in nature in that form. Rather than living on copious amounts of refined oils I think we’re in much safer territory if we maximise nutrient density with whole foods while still maintaining optimal blood glucose levels.
The chart below shows the proportion of insulinogenic calories for the highest-ranking basket of foods (i.e. top 10% of the foods in the USDA foods database) for a range of approaches, from the low insulin therapeutic ketosis, through to the weight loss foods for someone who is insulin sensitive and a lot of fat is coming from their body. At one end of the scale a therapeutic ketogenic may only contain 14% insulinogenic calories while a more nutrient dense approach might have more than half of the food requires insulin to metabolise.
macronutrient splits
It’s one thing to set theoretical macronutrient targets, but real foods don’t come in neat little packages of protein, fat and carbohydrates. The chart below shows the macronutrient split of the most nutrient dense 10% of foods for each of the four nutritional approaches. The protein level for the weight loss approach might seem high but then once we factor in an energy deficit from our body fat it comes back down.
In reality you’re probably not going to be able to achieve weight maintenance if you just stick to the nutrient dense weight loss foods. You’ll either become full and will end up using your stored body fat to meet the energy deficit or you will reach for some more energy dense foods to make up the calorie deficit.
If you look at the macronutrient split of the most nutrient dense meals for the different approach you find they are lower in protein and higher in fat as shown in the chart below.
nutrient density
The chart below shows the percentage of the daily recommended intake of essential vitamins, minerals, amino acids and fatty acids you can get from 2000 calories for each of the approaches.
You can meet most of your nutritional requirements with a therapeutic ketogenic diet, however you’ll have to eat enough calories to maintain your weight to prevent nutritional deficiencies.
As you progress to the more nutrient dense approaches you can meet your nutrient requirements with less energy intake. The beauty of limiting yourself to nutrient dense whole foods is that you can obtain the required nutrition with less energy and you’ll likely be too full to overeat.
As far as I can see the holy grail of nutrition, health and longevity is adequate energy without malnutrition.
If we look in more detail we can see that the weight loss (blue) and nutrient dense approaches (green) provide more of the essential micronutrients across the board, not just amino acids.
While the protein levels in the “weight loss” and “most nutrient dense” approaches are quite high, keep in mind that the food ranking system only prioritises the nutrients that are harder to obtain.
The table below shows the various nutrients that are switched on in the food ranking system for each approach.
This table shows the number of vitamins, minerals, amino acids and fatty acids counted for each approach.
In the weight loss and nutrient dense approach, of the twelve essential amino acids, only Tyrosine and Phenylalanine has been counted in the density ranking system.
It just so happens that protein levels are high in whole foods that contain essential vitamins, minerals and fatty acids.
It appears that if you set out to actively avoid protein it may be harder to get other essential nutrients. The risk here is that you may be setting yourself up for nutrient hunger, and rebound/stall inducing cravings in the long term as your body becomes depleted of the harder to obtain nutrients.
choosing the right approach for you
I believe one of the key factors in determining which nutritional approach is right for you is your blood glucose levels which gives you an insight into your insulin levels and insulin sensitivity.
As shown in the chart below, if your blood glucose levels are high then it’s likely your insulin levels are also high which means you will not be able to easily to access your fat stores. I have also created this survey which may help you identify whether you are insulin resistant and which foods might be ideal for you right now.
While you may need to start out with a higher fat approach, as your glucose levels decrease and ketone levels rise a little you will be able to transition to more nutrient dense foods.
The table below shows the relationship between HbA1c, glucose, ketones and GKI. Once you are getting good blood glucose levels you can start to focus more on nutrient density and weight loss.
Risk level
HbA1c
average blood glucose
ketones
GKI
(%)
(mmol/L)
(mg/dL)
(mmol/L)
low normal
4.1
4.0
70
5.5
0.7
optimal
4.5
4.6
83
2.5
1.8
excellent
< 5.0
< 5.3
< 95
> 0.2
< 30
good
< 5.4
< 6.0
< 108
< 0.2
danger
> 6.5
7.8
> 140
< 0.2
more numbers
The table below shows what the different nutritional approaches look like in terms of:
ketogenic ratio
ratio of fat to protein
protein (g)/kg LBM
insulin load (g/kg LBM)
approach
keto ratio
fat : protein
protein g/LBM
insulin load (g/LBM)
therapeutic ketosis
1.8
2.2
1.0
0.9
diabetes
0.9
1.0
1.8
1.5
weight loss (incl. body fat)
0.5
0.6
2.5
2.4
nutrient dense
0.3
0.3
3.0
2.8
The 1.0g/kg LBM for therapeutic ketosis is greater than the RDA minimum of 0.8g/kg LBM so will still provide the minimum amount while still being ketogenic. It’s hard to find a lot of foods that have less than 1.0g/kg LBM unless you focus on processed fats.
At the other extreme most nutrient dense foods are very high in protein but this might also be self-limiting meaning that people won’t be able to eat that much food. As mentioned earlier, it will be hard to eat enough of the nutrient dense foods to maintain your current weight. Either you will end up losing weight because you can’t fit as much of these foods in or reaching more energy dense lower nutrient density foods. Also, if you found you were not achieving great blood glucose levels and some low-level ketones with mean and non-starchy veggies you might want to retreat to a higher fat approach.
The table below lists optimal foods for different goals from most nutrient dense to most ketogenic. Hopefully over time you should be able to work towards the more nutrient dense foods as your metabolism heals.
dietary approach
printable .pdf
weight loss (insulin sensitive)
download
nutrient dense (maintenance)
download
weight loss (insulin resistant)
download
diabetes and nutritional ketosis
download
therapeutic ketosis
download
what about mTOR?
Many people are concerned about excess protein causing cancer or inhibiting mTOR (Mammalian Target of Rapamycin).[8] [9]
From what I can see though, the story with mTOR is similar to insulin. That is, constantly elevated insulin or constantly suppressed mTOR are problematic and cause excess growth without being interspersed with periods of breakdown and repair.
Our ancestors would have had times when insulin and mTOR were low during winter or between successful hunts. But during summer (when fruits were plentiful) or after a successful hunt, insulin would be elevated and mTOR suppressed as they gorged on the nutrient dense bounty.
These days we’re more like the futuristic humans from Wall-E than our hunter gather ancestors. We live in a temperature controlled environment with artificial lighting and tend to put food in our mouths from the moment we wake up to the time we fall asleep.[10]
Rather than chronic monotony (e.g. eating five or six small meals per day every day), it seems that periods of growth (anabolism) and breakdown and cleaning (catabolism) are optimal to thrive in the long term. We need periods of both. One or the other chronically are bad news.
As my wise friend Raymund Edwards from Optimal Ketogenic Living says
“FAST WELL, FEED WELL.”
how much protein?
Optimal protein levels are a contentious topic. There is research out there that says that excess protein can be problematic from a longevity perspective. Protein promotes growth, IGF-1, insulin and cell turnover which can theoretically compromise longevity. At the same time, there are plenty of studies that indicate that we need much more protein than the minimum RDI levels.[11]
In the end, you need to eat enough protein to prevent loss of lean muscle and maintain strength. If you’re trying to build lean muscle and working out, then higher levels of protein may be helpful to support muscle growth. If you are trying to lose weight, then higher levels of protein can be useful to increase satiety and prevent loss of lean muscle mass. Maintaining muscle mass is critical to keeping your metabolic rate high and avoiding the reduction that can come with chronic restriction.[12] [13]
In addition to building our muscles, protein is critical for building our bones, heart, organs and providing many of the neurotransmitters required for mental health. So protein from real whole foods is generally nothing to be afraid of. It’s typically the processed high carb foods that make the detrimental impact on insulin levels.
The table below shows a starting point for protein in grams depending on your height. This assumes that someone with a lean body mass (LBM) of 80 kg is burning 2000 calories per day and your lean body mass equates to a BMI of 20 kg/m2. There are a lot of assumptions here so you will need to take as a rule of thumb starting point and track your weight and blood glucose levels and refine accordingly. It’s unlikely that you will get to the high protein levels of the most nutrient dense approach because either you would feel too full or your glucose levels may rise and ketones disappear, so most people, unless your name is Duane Johnson, will need to moderate back from that level.
Example: Let’s say for example you were 180cm and were managing diabetes and elevated blood glucose levels. You would start with around 117g of protein per day as an initial target and test how that worked with your blood glucose levels. If your blood glucose levels on average were less than say 5.6mmol/L or 100mg/dL and your ketones were above 0.2mmol/L you could consider increasing transitioning to more nutrient dense foods.
If you want to see what this looks like in terms of real foods and real meal meals check out the optimal food list and the optimal meals for the different approaches.
insulin load
Using a similar approach, we can calculate the daily insulin load (in grams) depending on your height and goals. The values in this table can be used as a rule of thumb for the insulin load of your diet.
If you are not achieving your blood glucose or weight loss goals, then you can consider winding the insulin load back down. If you are achieving great blood glucose levels, then you might consider choosing more nutrient dense food which might involve more whole protein and more nutrient dense green leafy veggies.
Example: Let’s say for example you are a 180cm person with good glucose control but still wanting to lose weight, your initial target insulin load would be 156g from the superfoods from fat lost list. If you were not losing weight at this level, you could look to wind it back a little until you started losing weight. If you are consistently achieving blood glucose levels less than 5.6mmol/L or 100mg/dL and ketones greater than 0.2mmol/L you could consider transitioning to more nutrient dense foods.
summary
In summary, reducing the insulin load of your diet is an important initial step. However, as your blood glucose and insulin levels normalise there are a number of other steps that you can take towards optimising nutrient density on your journey towards optimal health and body fat.
Reduce the insulin load of your diet (i.e. eliminate processed carbage and maybe consider moderating protein if still necessary) to normalise blood glucose levels and reduce insulin levels to facilitate access to stored body fat.
If your blood glucose levels are less than say 5.6 mmol/L or 100mg/dL and your ketone levels are greater than say 0.2 mmol/L then you could consider transitioning to more nutrient dense foods.
If further weight loss is required, maximise nutrient density and reduce added fats to continue weight loss.
Consider also adding an intermittent fasting routine with periods of nutrient dense feasting. Modify the feasting/fasting cycles to make sure you are getting the results you are after over the long term.
Once optimal/goal weight is achieved, enjoy nutrient dense fattier foods as long as optimal weight and blood glucose levels are maintained.
If blood glucose levels are greater than optimal blood glucose levels, return to step 1.
If current weight is greater goal weight return to step 3.
references
[1] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19
[2] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet
[3] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet
[4] http://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096
[5] https://intensivedietarymanagement.com/how-much-protein-is-excessive/
[6] https://en.wikipedia.org/wiki/Protein_poisoning
[7] https://optimisingnutrition.com/2015/08/31/optimal-protein-intake/
[8] https://www.youtube.com/watch?v=Yv-M-5-s9B0
[9] http://nutritionfacts.org/video/prevent-cancer-from-going-on-tor/
[10] https://www.youtube.com/watch?v=qPpAvvPG0nc
[11] https://www.ncbi.nlm.nih.gov/pubmed/27109436
[12] http://ajcn.nutrition.org/content/87/5/1558S.long
[13] https://en.wikipedia.org/wiki/Protein-sparing_modified_fast