The term opportunity cost is a term used in economics which refers to the reality that whenever you decide to do one thing, you are giving up the opportunity to do something with your resources (time or financial). I apply this concept to what we eat, calling it nutrition economics. We can think of every time we eat as an opportunity to provide signals to our health and physiology. Those signals can do good things or bad things, but as we will see, sometimes the good or bad depends on your own genetic make-up and health status.

There is a finite amount of time and opportunity in the day to eat, and there are a huge variety of signals that are needed to promote optimal health. This is where it becomes important to consider the opportunity cost of what you decide to put into your body each and every time you eat.

Requirements vs Limits

These are 2 important concepts when deciding our daily food intake. There are some variables should be measured against a minimum requirement for optimal health. Some variables are ones to be limited to below a maximum allowance, or even to as little as possible for optimal health. Depending on your individual genetic make up and health status, certain variables like calories for example could be placed in either category.

Here is a table of examples of nutritional variables that are usually (not always) considered in terms of daily minimum requirements or maximum upper limits:

Requirements	Limits
Protein – essential amino acids	Saturated fats and trans fats
Omega 3 fats and essential fatty acids	Carbohydrate/sugar
Micronutrients – vitamins, minerals	Calories
Fibre – soluble, insoluble
Calories
Phytonutrients

If you notice in this table, there are more requirements than limits. This generally speaks to my ethos on the matter that most people should generally focus more on what to eat more of, than what to restrict. I have found that this approach automatically leads to appropriate restriction of the things you need to limit because you will tend to use up your daily meal opportunities (and stomach space) ingesting the good things you require more of.

Now ideally everything we eat through the day would build up towards our daily target requirements, while not eating into our allowance for the things we must limit. Foods however are not designed with this in mind. Even healthy natural foods when taken in isolation cannot meet this challenge. Again, there is an opportunity cost to everything we consume. This emphasises the importance of diversity and balance in our diet.

For example, a healthy portion of organic chicken breast will have adequate protein but no significant healthy fats, nor fibre. A side of organic wild salmon will have plenty of protein and omega 3s, but again no significant fibre. A well curated salad with virgin olive oil dressing and fresh vegetables will have plenty of fibre and healthy unsaturated fat, but insufficient protein or even calories to support optimal health. Hopefully this illustrates the point.

Tunnel Vision Is Never Good

Further complicating matters is that too much focus on limiting one variable will inevitably lead to consuming an excess of another, in order to meet simple energy requirements of our daily activities. At the end of the day, you need food for fuel! Like with most things in life, too much of even a good thing can sometimes be bad.

For example, excessive limitation on fat intake will often mean that one is consuming more carbohydrates in order to meet energy requirements. This may be better in reducing one’s risk of atherosclerosis by improving our lipid markers, but may end up increasing our insulin production with the knock-on effect of fat storage and insulin resistance, diabetes, etc.

Conversely, excessively restricting carbohydrates (a ketogenic diet) will almost always require a large increase in consumption of fats to meet energy requirements. Now if you were able to only have the healthy fats (polyunsaturated, monounsaturated, omega-3s), this would not be such a problem. This is however quite tricky to achieve as the foods that contain the right healthy balance of fats are generally things like nuts, seeds, oily fish, avocado or extra virgin olive oil.

Most people can only tolerate eating so much of these items due to simple taste and texture preferences, not to mention the cost of these items can also be prohibitive. It can also be more of a challenge to obtain enough fibre on a ketogenic diet for some people. One can only chug down so many glugs of extra virgin olive oil and you would also have to eat a bucket load of nuts and seeds!

As a result people on a ketogenic diet can sometimes develop abnormal raised lipid markers, potentially increasing their risk of atherosclerotic cardiovascular disease. How important and relevant this risk is can vary based on the individual’s genetic makeup as well as current health status.

Diet Wars

This is where the importance of personalised nutrition and precision medicine comes into play. Individual requirements and tolerance of macronutrients and micronutrients will vary on the basis of many health and genetic factors. Precise tracking of biomarkers of nutritional adequacy and the downstream effects of our nutrition is the only way to effectively ensure someone’s nutrition is optimal FOR THEM.

The world of nutrition is full of extreme views. Everyone has their opinion on “the best diet” for weight loss, health or other goals. Keto, paleo, vegan, vegetarian, pescatarian, carnivore, Mediterranean, this list goes on. The reality is there is much more nuance to what is the ideal nutritional strategy for YOU, than the simple label of what kind of diet to choose. The truth is that any one of these diets COULD work for health, provided you could meet the nutritional requirements for optimal health.

The Agami Approach – Personalised Precision

My framework for advising patients on optimal nutrition is based on personalised goals and constant tracking of blood biomarkers and body composition to assess results. This first involves an assessment of somebody’s current health and nutritional status. This looks something like the following:

1. Are they over, under, or adequately nourished?
2. Do they have sufficient muscle, or do they need more?

These 2 questions allow us to start forming the basics of a nutritional strategy, firstly answering 2 important questions:

1. Calorie balance needed.
2. Protein requirements – most people in my view have suboptimal protein intake (more on this in an upcoming article)

With this starting point, we then look to optimise the 5 major aspects of physiology that are greatly impacted by food:

1. Inflammation
2. Insulin resistance and metabolic health
3. Lipid burden on cardiovascular disease
4. Gut health.
5. Body composition

We rigorously test these aspects of your physiology with a huge number of advanced biomarkers, many of which detect issues way before most tests that are done in the standard medical approach or “health check”. These give us an idea of the constraints and requirements of your individual physiology and health status, guiding us towards your personalised nutritional plan. Tracking these markers over time then allows us to further tweak things along the way as your physiology changes and responds.

General Principles

Given all the things I have said already here, it is clearly impossible for me to give you the ideal nutrition plan that works for everyone. The essence of our nutrition plans are that they are personalised to you. There are however some general principles that pretty much always apply:

1. Ensure calorie balance is aligned with goals.
2. Ensure sufficient fibre intake.
3. Eat whole fresh foods.
4. Sufficient quality protein and essential amino acids
5. Adequate amounts of healthy unsaturated fats, particularly omega-3s
6. Sufficient micronutrients – vitamins, minerals
7. Minimise saturated and trans fats.
8. Minimise ultra processed foods (UPFs)

Food is medicine, and truly the biggest input to our physiology on a daily, or even hourly basis. Getting this right requires the precision of personalised medicine. Doing so can really set the foundations for optimal health and longevity.

Contact us for a comprehensive assessment of your nutritional status and let us give you a tailored nutrition plan aligned and optimised towards achieving your health and longevity goals.