🥗Dietary Optimization Meta-Protocol

This is the master document for dietary optimization. Click through the summary points to dive into the decision-tree for picking the right diet and caloric energy balance for you.

Last updated: May 12, 2024

Conflicts to declare: None.

Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here.

SUMMARY POINTS

Why does diet matter for human optimization?

• Importance: Dietary optimization can improve physical performance, cognitive performance, and human longevity. By combining dietary optimization with an exercise protocol, you will receive a synergistic effect greater than solely optimizing for one of these domains alone.

• For all of the reasons noted above, we offer the ability to monitor your metabolic markers when implementing a new dietary protocol of your choosing. Many individuals may, for example, change their diet in order to lower their cholesterol or improve their metabolic health. By checking your biomarkers following a dietary intervention, you can get objective information about how your body is responding to a dietary change.

Is there a general framework that you can use to think about dietary optimization?

Yes. The following framework is taken from Peter Attia's Outlive:

• The first principle when providing any kind of standardized dietary protocol is the relevance of personalization: what constitutes an optimal diet for you is contingent on a variety of individual factors related to your metabolism, biomarker profile, body composition, and personal goals. Thus, it is not possible to recommend a universally-optimal diet for all persons in all circumstances.

• The second principle is that a dietary protocol generally falls into one of two goal-oriented categories: to treat a medical issue (e.g. Type 2 diabetes, obesity, hypercholesterolemia), or, to maintain a generally optimal state of health (e.g. in patients who have already achieved metabolic optimization). To give but one example, an optimal diet for weight loss is not the same as an optimal diet for maintaining your existing, already-optimized body composition.

• The third principle is that there are numerous systemic limitations with regard to the study of human nutrition that are related pragmatic constraints in possible study designs: human beings aren't lab rats that we can confine and surveill for the purposes of nutritional research! Further to that, food is a composed of an enormous variety of biochemical compounds which impact each person differently, creating a sort of combinatorial explosion of complex interactions between food particles and your body. This makes it very challenging to identify an optimal dietary pattern with extreme precision (which is one reason why post-diet-implementation biomarker monitoring can be useful).

What's the first step in approaching dietary optimization?

• There are multiple valid ways of thinking about dietary optimization. Peter Attia has a simple three-step approach to crafting a strategy for dietary optimization, which he outlines in his book, Outlive. We've tweaked this approach and summarized it as follows:

• First, figure out if you're in energy balance or not. Are you overeating calories, causing ongoing fat gain? Are you under-eating calories and in particular, are you under-eating protein, causing ongoing muscle loss? Ideally, you are eating calories at a maintenance rate that matches your metabolic needs?

  • If you're eating too many calories and gaining fat, you will need to reduce the number of calories you consume.

  • If you're eating too few calories and/or too little protein, you'll need to increase your calories and/or protein intake.

  • Irrespective of your energy balance, you will still need to determine your daily protein needs, you can use this daily recommended protein calculator here. A good overview of the literature around protein requirements is available here.

What's the second step in approaching dietary optimization?

• Second, figure out if you are metabolically healthy or not. Metabolic health can be determined through a combination of body measurements (e.g. waist circumference to measure fatty tissue around your abdomen, blood pressure, etc.) and lab biomarkers (e.g. fasting glucose levels, lipid levels, etc.) with the assistance of your healthcare provider.

  • If you are not metabolically healthy, a dietary intervention is typically required as part of a broader strategy to return your body to a state of metabolic health.

  • These dietary interventions can include specific diets like the low glycemic-load diet discussed in the 2021 Canadian Cardiovascular Society Guideline document for dyslipidemia (high cholesterol).

What's the third step in approaching dietary optimization?

• Third, figure out if you're adequately muscled or not. Strength, which is correlated to muscularity, is an important driver of human longevity (it is also, by definition, a measure of human performance).

• Strength is vital for lengthening both healthspan and lifespan. If you lack strength for your age cohort, you will be at increased risk of frailty and catastrophic falls as you age.

• While it is not necessary for most people to count macronutrient ratios (e.g. fats, carbs, etc.), it's important to have an approximate idea of how many of grams of protein you're getting on a daily basis, particularly if you're physically active or looking to change your body composition (e.g. gain muscle). This comes out of the data on grip strength and longevity as grip strength is a lagging indicator of functional strength.

• To help you to determine how you stack up in strength relative to your age cohort, we are developing a service to assess your strength (from a longevity perspective) in-person.

• Approximate benchmarks that Attia uses in his longevity clinic include:

  • Be able to farmer carry your body weight (half your body-weight in each hand) for 2 minutes for males (this is a grip strength measure), and 75% of your body weight for females. (Grip-strength measure)

  • Be able to dead hang at least 2 minutes for a 40 yo male, 1.5 minutes for a 40 yo woman. (Grip-strength measure)

  • Be able to do a 90-degree air squat for 2 minutes for 40 yo males or females. (Functional strength measure)

  • If you lack strength for your age cohort, it may be necessary to undergo a strength-building program that requires a small caloric surplus so that you can increase your muscularity. Using a so-called "dirty-bulk" (where you eat a large caloric surplus that includes junk food) is not an optimal way to do this due to the risks that it poses to your metabolic health. Also remember that muscle-building diets require more daily protein intake relative to maintenance-only diets, so you can use this daily recommended protein calculator here.

Okay - I've gone through the three steps - which diet do I select for myself?

• To select your optimal diet using the general framework and strategy outline above, click here to see the 'sub-protocol.'

How effective are the specific diets recommended in the dietary 'sub-protocol' for changing cholesterol biomarkers?

• Click here to see the evidence summarized in a table.

Potential Biomarker Impact of Protocol

Biomarkers this protocol can improve:

• Hemoglobin A1c

• Fasting insulin level

• Fasting glucose level

• ApoB

• LDL

• HDL

• Total Cholesterol

Non-biomarker metrics this protocol can improve:

• Increased VO2 max

• Decreased Blood Pressure

• Improves Cognitive Performance

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What's coming next from Optimal's dietary optimization protocols?

We are currently working on adding the following services to provide full-stack human optimization services to our members:

1. Continuous Glucose Monitoring (CGM) dietary optimization program - for monitoring your blood glucose and insulin levels in response to specific dietary foods. This can assist in the overall process of dietary optimization.

2. An Optimal meal-delivery service with optional individualized portion/calorie-control (for those in need of caloric restriction).

Disclaimer: The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others.