How Much Protein?

Dr Fung has a great article on how much protein a person needs. The recommended amount was determined in a rather distorted manner.

In 1985, the WHO reviewed studies of daily obligatory losses of nitrogen, and found that an average is 0.61 g/kg/day (total). Presumable, the diet should replace (roughly) this 0.61 g/kg/day being lost. In order to make sure everybody was covered, the WHO added 25% (2 standard deviations) above the mean to get 0.75 g/kg/day which sometimes gets rounded up to 0.8 g/kg/day. For a standard 70-kg male this is 52.5 g/day. Remember this is for absolutely healthy adults, not gaining or losing weight and the amount needed to cover the average amino acid losses are only 42 g/day (0.6g/kg/day). Remember, that if you want to lose weight, you should be eating less protein so that you can break some down.

Considering that protein leads to gluconeogenesis in diabetics then excess protein is a bad thing. The Ketocalculator said that I need 100 grams of protein a day. Rerunning my numbers on the Ketocalculator:

  • 1301 kcal Goal, a 40% deficit. (546 min, 2169 max)
  • 25g Carbohydrates
  • 44g Protein (97g min, 160g max)
  • 114g Fat (30g min, 210g max)


Does Fat in a Diet Increase Insulin Resistance?

A study answered that question (Dietary Fat and Carbohydrates Differentially Alter Insulin Sensitivity During Caloric Restriction).

The subjects were:

Twenty-two obese subjects (body mass index, 36.5 ± 0.8 kg/m2) were randomized to an High Carbohydrate (>180 g/day) or Low Carbohydrate (<50 g/day) energy-deficit diet. A euglycemic-hyperinsulinemic clamp, muscle biopsy specimens, and magnetic resonance spectroscopy were used to determine insulin action, cellular insulin signaling, and intrahepatic triglyceride (IHTG) content before, after 48 hours, and after ∼11 weeks (7% weight loss) of diet therapy.

They found:

Our results refute our original hypothesis that an LC diet will cause insulin resistance because of increased adipose tissue lipolytic rates and excessive free fatty acid release into the bloodstream. In fact, we found that LC intake rapidly caused a greater reduction in IHTG content, improvement in hepatic insulin sensitivity, and decrease in endogenous glucose production rate than consumption of an isocaloric low-fat diet.


Dr Jason Fung – “The Obesity Code”

From Dr Fung’s excellent book “The Obesity Code” (p 233).

There are five basic steps to weight loss:

1 – Reduce your consumption of added sugars.
2 – Reduce your consumption of refined grains.
3 – Moderate your protein intake.
4 – Increase your consumption of natural fats.
5 – Increase your consumption of fiber and vinegar.

Note this is not the final word in his excellent book.


Why is Keto Better than Low Glycemic?

The Glycemic Index rates food based on their impact on blood glucose levels with white bread coming in at 100. In theory, a system like that sounds like a great deal for Diabetics who need to control their blood sugar levels. If you eat foods which produce smaller increases in your blood sugar you shouldn’t have the excursions into the highs that damage people. And that is true, but is it enough?

As often used, the Glycemic Index puts food into two categories – either good (Low GI),  or bad (High GI). This GI chart breaks it into three categories:

(From here)

In a sense, a Ketogenic diet is the ultimate form of a Low Glycemic index diet. Keto only has food that have very, very low Glycemic Index items. The diet eliminates all of the food on the chart including most Low GI foods. Of course the chart is way out of proportion with actual food usages. Jellybean candy has its own value listed. Some other items, like French Fries, occupy a huge portion of the American diet through fast food.

By way of comparison, Meat has a GI of 0, most nuts have a GI of 10 and vegetables which grow above ground have a GI of 20. You can’t beat that for Low GI.

But why not just eat the Low GI foods? Well, for diabetics they aren’t quite good enough. As the last study listed shows, they do help, but not nearly as well at getting people off T2D medications.

Keto Diet vs Low Glycemic Index Diet

Which is better for T2D subjects, a ketogenic diet or a low glycemic index diet? Both are touted to help diabetics. The last study (on the previous post) showed a modest improvement in HbA1C using the Glycemic Index (about .5).

A 24-week study was done just to answer that question (The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus).

The study subjects were:

Eighty-four community volunteers with obesity and type 2 diabetes

The subjects were randomized and given:

either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID).

The goal of the study was to determine which group had the best HbA1C control. Once again, the Low Carb (Ketogenic) diet came out on top.

The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).

The Glycemic Index diet subjects had comparable results to the other study with an HbA1C drop of 0.5. More impressively around 50% more of the ketogenic dieters were able to reduce or eliminate diabetic medications.


Is Insulin Effective for Type 2 Diabetics?

Interesting study (Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials). The study reviewed:

A systematic literature review (Pubmed, Embase, Cochrane Library) including all randomised clinical trials (RCT) analysing insulin vs. hypoglycaemic drugs or diet/placebo, published between 1950 and 2013, was performed.

Twenty RCTs were included out of the 1632 initially identified studies. 18 599 patients were analysed:

The study looked at:

We included all RCTs reporting effects on all-cause mortality, cardiovascular mortality, death by cancer, cardiovascular morbidity, microvascular complications and hypoglycaemia in adults ≥ 18 years with T2D.

The conclusion was:

There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D. However, there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only benefit could be limited to reducing short term hyperglycemia.


Effects of Eating Low Glycemic Index Foods on HbA1C

Here’s an interesting study from 2003 (Low–Glycemic Index Diets in the Management of Diabetes).

The study looked at:

Literature searches identified 14 studies, comprising 356 subjects, that met strict inclusion criteria. All were randomized crossover or parallel experimental design of 12 days’ to 12 months’ duration (mean 10 weeks) with modification of at least two meals per day. Only 10 studies documented differences in postprandial glycemia on the two types of diet.

The results were:

Low-GI diets reduced HbA1c by 0.43% points (CI 0.72–0.13) over and above that produced by high-GI diets. Taking both HbA1c and fructosamine data together and adjusting for baseline differences, glycated proteins were reduced 7.4% (8.8–6.0) more on the low-GI diet than on the high-GI diet. This result was stable and changed little if the data were unadjusted for baseline levels or excluded studies of short duration. Systematically taking out each study from the meta-analysis did not change the CIs.

Low Glycemic diets provided some advantage in reducing HbA1C values but nowhere near what I (n=1) have seen with LCHF and IF together.

For me, this says that choosing between two foods which are otherwise equal that choosing the lower GI food is a good choice but choosing a low GI diet as a way of losing weight or controlling diabetes isn’t all that effective.