Thoughts on the Zone Diet

The Zone Diet seeks to create a fixed mix of macros by specifying fat, carbs and protein levels. The starting point is:

The numbers are in percentage of calories. On a “standard” 2000 calorie diet that would be:

  • Carbs = 2000 * 0.40 = 800 calories (200 grams)
  • Protein = 2000 * 0.30 = 600 calories (150 grams)
  • Fat = 2000 * 0.30 = 600 calories (67 grams)

Zone vs Standard American Diet (SAD)

According to the CDC (Trends in Intake of Energy and Macronutrients in Adults From 1999-2000 Through 2007-2008):

In 2007-2008 the average energy intake for men was 2,504 kilocalories (kcals) and for women it was 1,771 kcals.

The average carbohydrate intake was 47.9% of total kilocalories (% kcals) for men and 50.5% kcals for women; average protein intake was 15.9% kcals for men and 15.5% kcals for women; average total fat intake was 33.6% kcals for men and 33.5% kcals for women; and average saturated fat intake was 11.0% kcals for men and 11.1% kcals for women.

That means the Zone Diet is lower in carbohydrates, much higher in protein, and a lower fat than the Standard American Diet (SAD).

Macro SAD (Men) SAD (Women) ZONE Difference
Carb 47.9 50.5 40 Zone Lower
Protein 15.9 15.5 30 Zone Much Higher
Fat 33.6 33.5 30 Zone Lower

The main lever of the Zone then appears to be Protein. Doubling someone’s Protein should do some very good things for their health. Added to that is the advantage of the lower number of total calories on the zone.

But would the Zone be a good thing for a Type 2 Diabetic? Certainly it would help some who are diagnosed as pre-diabetic. Anything they do to reduce their carbohydrate consumption will help their pre-diabetes.

Zone vs Ketogenic Diet

The Ketogenic diet has various protein goals depending on you who follow. For a 200 lb male typical numbers would be (using a higher level of protein in this example):

Macro grams kCal/macro Calories % Cals
Carb 20 4 80 4%
Protein 160 4 640 32%
Fat 142 9 1280 64%
2000

Where the two diets differ are their fat and carbohydrate macros.

Macro ZONE Ketogenic
Carb 40% 4%
Protein 30% 32%
Fat 30% 64%

Carbohydrate Effects on a Type 2 Diabetic

Carbohydrates raise blood sugar and therefore Insulin levels much more dramatically in a Diabetic than in a non-Diabetic person. That’s what makes a person an Diabetic. Before I went on the Ketogenic diet I was averaging only 100 grams of carbohydrates per day. I know this since my Insulin pump required me to enter any carbohydrates I ate. And, in spite of being on an average of 100 units of Insulin a day, my blood sugars were all over the place.

My highs were over 200 and my lows never got to 100. Around the start of August I went on the Ketogenic diet. For me, that was going from 100 grams (on the average) of carbohydrates a day to less than 20 grams. I was also not tracking the other macros (fat, protein). Here are my blood sugar numbers from the first three months of the Ketogenic diet.

That chart is the very definition of stable blood sugars. It took being at 20 grams or less of carbs a day to get stable. And before the Ketogenic diet I was nowhere near the Zone Diet carbohydrate levels. I can only imagine how messed up my blood sugar numbers would have been if I had been on the “balanced” zone diet.

 

Christmas Status Letter

Reflections

Holidays provide time to reflect on the past year. It’s long overdue to circle back to the purpose of this BLOG. I started this journey of hacking my Type 2 Diabetes almost 18 months ago. In that time, I fixed my Diabetes and so much more.

No More Insulin or Medications

I am on ZERO medications. No diabetes medications. No hypertension medications. I still use a CPAP machine since I am afraid of quitting the machine.

Weight Loss

I have lost over 100 lbs. My starting weight was around 285 and it was 178 this morning. I’ve been in maintenance for a month now and my weight has stayed steady. I wish I had charted better in the beginning.

Added Exercise

After I lost most of my weight (around 80 lbs) I added exercise. I have been doing CrossFit for about four months now. I can lift weights that match the girl’s weights. I usually finish the Workout of the Day (WOD) last but I do finish – even the hard ones. I workout five days a week. The typical CrossFit workout is less than one hour. I take rest days Thursday and Sunday.

Blood Sugar Control

My blood sugar after working out last night was 65 (US units) which is really good. I most often see numbers in the mid 80s. My last HbA1C was taken this summer (before CrossFit) and it was 5.8 (which is at the bottom end of the prediabetes range).

My Macros

My diet consists largely of chicken, nuts and broccoli.

Chicken is a good Protein and different cuts provide different amounts of fat. Kim Chee (from Walmart refrigerated veggie section) is a good probiotic (good for stomach biome). Broccoli is a good veggie and easy to heat in a microwave bag. Finally, nuts fill in the fat numbers in a healthy way.

My Macros

My daily macros are:

My current macros are 1800 calories with 125g of Protein, 20g of Carbohydrates and 136g of Fat. Protein is a minimum. Carbs are a maximum. Fat fills up the remaining calories to meet the limit. If I go over on Protein I will go under on Fat to match. In percentages of daily calories this is 27% Protein, 5% Carbohydrates, and 68% fat.

Supplements

Here is what I take daily.

Breaking Stalls

I had a long stall this year which lasted for maybe six months. I did some extended fasts which helped a little bit. I then tripped across the idea of doing Protein Sparing Modified Fasting. That broke the fast and gave me a way to make progress with the last 25 lbs that I needed to lose.

My Goals

My goals have shifted over the past 18 months. They started with hacking my Diabetes. I wanted to get off Insulin. That took two weeks.

Since then I have worked at improving my Insulin Sensitivity. For me, the main tool was Intermittent Fasting (IF). One thing that interferes with this is getting in enough Protein. I have added a Protein meal at lunch time. This hasn’t hurt my Blood Sugar numbers.

Another way of improving Insulin Sensitivity is High Intensity Training. I do CrossFit. Training with increasingly heavier weights and intensity will improve Insulin Sensitivity. I hope to keep up this training and there are plenty of goals to reach. I got my first box jump and pullup in the past month.

 

Cholesterol and Low Carb Diets

There’s long been a concern about cholesterol and Low Carb diets. For many people, Low Carb diets improve their LDL and HDL numbers. Nearly everyone has a significant increase in their HDL. But some people actually have an increase in their LDL on Low Carb diets (wrong direction).

HDL to LDL Ratio

Sometimes the increase in LDL is small (but the wrong direction) and the increase in HDL is significant. This yields an improved ratio in spite of the increase in the LDL. That’s probably still a good thing relatively. From (the Mayo Clinic):

To calculate your cholesterol ratio, divide your high-density lipoprotein (HDL, or “good”) cholesterol number into your total cholesterol number. An optimal ratio is less than 3.5-to-1. A higher ratio means a higher risk of heart disease.

So if your LDL goes up but the ration goes below 3.5 then the Mayo Clinic would call that a good thing.

LDL Big/Small Fluffy Particles

The LDL gives a single number for something that is more complicated. LDL consists of two types of particles, big fluffy ones and small sticky ones. The big fluffy ones don’t stick to the arteries. It’s the small sticky ones that stick to the arteries. For many of the people who have increases in LDL.

This is based on various studies like (JAMA. 1996;276(11):875-881. Association of Small Low-Density Lipoprotein Particles With the Incidence of Coronary Artery Disease in Men and Women. Christopher D. Gardner, PhD; Stephen P. Fortmann, MD; Ronald M. Krauss, MD):

Results.  —LDL size was smaller among CAD cases than controls (mean ±SD) (26.17±1.00nm vs 26.68±0.90nm;P<.001).The association was graded across control quintiles of LDL size. The significant case-control difference in LDL size was independent of levels of high-density lipoprotein cholesterol (HDL-C), non—HDL cholesterol (non-HDL-C), triglyceride, smoking, systolic blood pressure, and body mass index, but was not significant after adjusting for the ratio of total cholesterol (TC) to HDL-C (TC:HDL-C). Among all the physiological risk factors, LDL size was the best differentiator of CAD status in conditional logistic regression. However, when added to the physiological parameters above, the TC:HDL-C ratio was found to be a stronger independent predictor of CAD status.

There is a test that can be done to differentiate the particle sizes. It is the NMR (Nuclear Magnetic Resonance) Test. From The NMR and Your Risk of Heart Disease.

The NMR uses advanced spectroscopy to uniquely provide rapid, simultaneous and direct measurement of LDL particle number and size of LDL particles, as well as a direct measurement of HDL and VLDL subclasses.  This detailed lipoprotein particle information allows clinicians to make more effective individualized treatment decisions as compared to standard lipid panel testing.

If you get an increase in LDL when you do Low Carb don’t just give up on Low Carb. Ask for the NMR test. Your doctor may not be familiar with this test. Mine was aware of the test but doesn’t regularly prescribe the test. There may be some cost associated depending on your coverage.

 

Revisiting the Calories-In / Calories-Out (CICO) Model of Weight Loss

The Calories-In / Calories-Out model is often criticized by Low Carb diet advocates and there is evidence that the criticism has some validity. A well designed and executed study compared Low Carb to Low Fat diets (Bonnie J. Brehm, Randy J. Seeley,Stephen R. Daniels, David A. D’Alessio. A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 4, 1 April 2003, Pages 1617–1623).

The results were very interesting. The Very Low Carb group did quite well on the diet and of course much better than the Low Fat group. But most significantly to this subject was that the Low Fat group weight loss was explained well by their caloric restriction, but the weight loss of the Low Carb test subjects was not accounted for in their caloric intake.

As the study noted:

The mechanism of the enhanced weight loss in the very low carbohydrate diet group relative to the low fat diet group is not clear. Based on dietary records, the reduction in daily caloric intake was similar in the two groups. For the greater weight loss in the very low carbohydrate group to be strictly a result of decreased caloric consumption, they would have had to consume approximately 300 fewer calories/d over the first 3 months relative to the low fat diet group. Although the inaccuracy of dietary records for obese individuals is well documented, it seems unlikely that a systematic discrepancy of this magnitude occurred between groups of subjects who were comparably overweight. Therefore, it is difficult to explain the differences in weight loss between the two groups primarily as a function of differing caloric intake. Despite instructions to maintain baseline levels of activity, it is possible that the women in the very low carbohydrate diet group exercised more than those in the low fat diet group. Additionally, it is possible that consuming a very low carbohydrate diet increases resting or postprandial energy expenditure. The possibility that differences in the macronutrient composition of the diet alter energy expenditure is an interesting question that bears further investigation.

To take it a step further, in this diet they put the Low Fat people on a restricted Calorie diet but the Low Carb test subjects were allowed to eat as much as they wanted. The study noted:

Another unexplained, but important, observation was the spontaneous restriction of food intake in the very low carbohydrate diet group to a level equal to that of the control subjects who were following a prescribed restriction of calories. This raises the possibility that the very low carbohydrate diet may have been more satiating. Previous studies have suggested that, calorie for calorie, protein is more satiating than either carbohydrate or fat, and it may be that the higher consumption of protein in the very low carbohydrate diet group played a role in limiting food intake. Another explanation for restricted food intake in the very low carbohydrate group is that food choices were probably greatly limited by the requirements of minimizing carbohydrate intake, and that dietary adherence per se may have forced caloric restriction due to practical factors. Although it has been proposed that ketosis developing from severe carbohydrate intake contributes to a decrease in appetite, this does not seem likely based on our data. Although the women following the very low carbohydrate diet developed significant ketonemia, the elevation of circulating β-hydroxybutyrate was mild, well below what is seen in other clinical states of ketosis, such as starvation and diabetic ketoacidosis, and was noted only at 3 months. In addition, there was no correlation between the level of plasma β-hydroxybutyrate and weight loss (r = 0.29; P = 0.43).

Keto for the win. Calories-In / Calories-Out loses once again.

 

How Much Glycogen Stores in Low Carb?

It’s often claimed that Glycogen stores are reduced in Low Carb diets. I wondered by just how much and there’s a paper out there which has specific numbers in it (Scandinavian Journal of Clinical and Laboratory Investigation Volume 32, 1973 – Issue 4. Pages 325-330. Liver Glycogen in Man –- the Effect of Total Starvation or a Carbohydrate-Poor Diet Followed by Carbohydrate Refeeding. Depts. of Gastroenterology and Clinical Chemistry, L. Hson Nilsson & E. Hultman, S:t Eriks Sjukhus, Stockholm, Sweden & E. Hultman).

Liver glycogen content was determined in specimens obtained by repeated percutaneous biopsies during starvation and under various dietary conditions in 19 human subjects. During rest and following an overnight fast, there was a decrease in liver glycogen content by a mean of 0.30 mmol glucosyl units per kg wet liver tissue per min during a further 4 hours’ starvation. Prolonged starvation or carbohydrate-poor normocaloric diet decreased the liver glycogen from a mean of 232 to 24–55 mmol glucosyl units per kg within 24 hours. During an additional period of up to 9 days on the carbohydrate-poor diet the liver glycogen remained at a low level. Refeeding with a carbohydrate-rich diet gave a rapid increase of the liver glycogen to supernormal values, 424–624 mmol glucosyl units per kg wet liver tissue.

Wow! That’s a pretty dramatic drop in liver glycogen in just 24 hours.

Glycogen Refill

Maybe even more amazing is the very fast refill to 2x-3x the “normal” levels. That goes a long way to explaining weight gain when leaving the Low Carb diet.

As a reference on the liver (Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.Chapter 94 Evaluation of the Size, Shape, and Consistency of the Liver. Douglas C. Wolf.)

The liver weighs 1200 to 1400 g in the adult woman and 1400 to 1500 g in the adult man.

According to this article:

Liver glycogen provides about 400 calories or 100 grams of glycogen

If there’s 3-4 grams of water with every gram of glycogen that’s a total of 400-500 grams that are lost with reduction in glycogen. That’s less than 1 lb but a significant portion of a typical liver size (around 1/3 of the size).

 

CrossFit and Nutrition

CrossFit really gets nutrition.  A few caveats about this video:

  • Not sure I completely agree with their body fat percentage goals for older people – or at least making it the priority.
  • Also their initial macro mix has a much higher carb amount (1/3 of calories from carbs) than what Type 2 Diabetics should eat.

Video Points

  1. Eat real food.
  2. Not too much of it.
  3. Mostly plant based.
  • Living = grew out of the ground or had eyes.
  • Stay out of the middle aisles of the supermarket.
  • No man-made food like substances.
  • Don’t use your macros as a way of avoiding eating right.
    • Macros are your mix of Protein/Carbs/Fats within overall calorie limit.

Very-Low-Carbohydrate Diet Studies

This will be a growing list of Very-Low-Carbohydrate Diet Studies (and related subjects).

 

Blood Sugar Responses Compared

I asked a friend to be part of an experiment which involved him poking himself with a needle most of the morning. And he agreed. We are both fat adapted (me for 15 months and him for more than 6 months).

We both started fasted from the previous night (no breakfast for myself or my friend). We both ingested 50 g of Whey Protein (IsoPure Zero Carb Protein Powder) at the same time and measured our blood sugar responses over the course of the same morning.

I am a Type 2 Diabetic who has their Blood Sugar “under control” via diet and am no longer on meds. I am 57-years old and do some exercise (CrossFit) five times a week for the past two months.

My fried is a Tri-athlete in his mid-30’s. He’s not a Diabetic and runs frequently.

Here’s the two responses to the same amount of Whey Protein:

 

The results were very interesting.

  1. His fasted (starting) Blood Sugar number was higher than mine. We’ve compared numbers before and noted this same thing. We did not use the same meter since we were looking for relative differences not absolute values.
  2. After ingesting Protein, the Tri-athlete’s blood sugar went down. My blood sugar (the Type 2 Diabetic) went up.
  3. His Blood Sugar returned to normal much more quickly than mine (less than 2 hours. Mine took over three hours to return to normal.

I am not sure if his Blood Sugar went down due to him not having Insulin Resistance. If his Insulin went up in response to the Protein it could have driven his Blood Sugar down. Since I still have some degree of Insulin Resistance my Blood Sugar doesn’t go down nearly as well.

Support for this idea comes from (“Liver Metabolism“):

Overall, gluconeogenesis is stimulated by glucagon and
epinephrine and inhibited by insulin, as observed most
dramatically in insulin-dependent diabetes mellitus, in
which uninhibited gluconeogenesis contributes significantly
to the hyperglycemia.

Insulin favors oxidative decarboxylation of pyruvate and, therefore, also indirectly tends to diminish gluconeogenesis.

Interesting!

 

Protein Turns into Cupcakes?

Dr Fung makes the following statement on this webpage (Why Low Carb Is High in Fat – Not Protein):

Once again, these amino acids are absorbed into the portal circulation and directed towards the liver where excess amino acids get turned into glucose.

Turns out the process is much more complicated. To be fair Dr Fung may be simplifying the process for his readers, but the process is more like this (which is probably still an oversimplification). From (Amino Acid Metabolism and Synthesis Explained):

Amino acids that are in excess of the body’s needs are converted by liver enzymes into keto acids and urea. Keto acids may be used as sources of energy, converted into glucose, or stored as fat. Urea is excreted from everyone’s body in sweat and urine.

So it is not quite as simple as Dr Fung lays it out. And keto acids are exactly the goal of any Low Carb diet, ie, the production of ketone bodies. We know that the production of glucose from ketones is necessary to feed brain cells (and some other cells) since they don’t get glucose from carbohydrates when we are on a ketogenic diet. In the absence of any dietary carbohydrates we may actually need more Protein to fuel this very path.

Are the Low Protein LCHF folks then making a serious mistake with very low levels of Protein? Are they relying on studies for necessary Protein levels where subject were not in Ketosis? I will bet a donut they are.

What is the basis for “in excess of the body’s needs”? On what timeframe? Is that per day, meal, hour?