Living with someone who has Type 1 Diabetes for fifteen years I’ve gained an intimate understanding of how food and insulin can take your blood glucose levels on a wild ride. Since she was ten, my wife Monica’s had to manually manage her blood sugars as they swing up with food and then drop again when she injects insulin.
how to get off the the blood glucose rollercoaster
High blood glucose levels make her feel “yucky”. Plummeting blood glucose levels due to the mega doses of insulin don’t feel good either. Then low blood glucose levels drive you to eat until you feel good again. This wild blood glucose rollercoaster ride leaves you exhausted.
The dietary advice she received over the past three decades living with Type 1 has been sketchy at best. When she was first diagnosed Monica tells the story of being made to eat so much high carb food that she hid it in the pot plants in her hospital room.
When we decided we wanted to have kids we found a great doctor who helped us to understand how to match insulin with carbs, but moderating the input of carbohydrate that necessitates insulin was never mentioned by doctors, endocrinologists or diabetes educators.
We eventually stumbled across low carb and she was above to significantly improve her blood glucose control.
the latest food insulin index data
Then in early 2014 I came across Jason Fung’s Aetiology of Obesity series on YouTube where he discussed the food insulin index research that had been carried out at the University of Sydney which seemed to provide more insight into our insulin response to food.
I hoped that by gaining a better understanding how different foods affects our requirement for insulin I might be able to further refine our food choices to further reduce the amplitude of Monica’s blood glucose swings.
The initial research into the food insulin index was detailed in a 1997 paper An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods by Susanne Holt, Jennie Brand Miller and Peter Petocz who tested the insulin response to thirty eight different foods.
The food insulin index score of various foods was determined by feeding 1000kJ (or 239 kcal) of different foods to non-diabetic participants and measuring their insulin response over three hours. This was then compared to the insulin response of pure glucose, which is assigned a value of 100%, to arrive at a “food insulin index” value for each food.
Considering how significant this information could be for people trying to manage their insulin levels (e.g. people with diabetes, “low carbers” or “ketonians”) I was surprised that there hadn’t been much further research or discussion on the topic. I found a few references and mentions in podcasts, but no one was quite sure what to do with the information, mainly due to the fact that only a small number of foods been tested.
After some searching I came across a PhD thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus (Kirstine Bell, September 2014). Appendix 3 of the thesis contained an extensive food insulin index database of foods that had now been tested. I plotted the relationship between carbohydrates and the food insulin index data.
As you can see, the relationship between carbohydrates and insulin is not straightforward. There are a number of high protein and low fat foods sitting quite high up on the vertical axis while there are a number of high fibre foods with a lower insulin response that you might expect. However, once we account for the effect of protein, fibre and fructose we get are able to more accurately predict our body’s response insulin response to food.
If you want to dig into this data a bit more you can check out the interactive Tableau version here.
As detailed in the most ketogenic diet foods article, this improved ability to quantify our insulin response to food enables us to identify foods that require less insulin and reduce the amplitude of our blood sugar swings in response to food. This understanding could also prove invaluable for who require a therapeutic ketogenic dietary approach as an adjunct to cancer treatment, epilepsy or dementia.
Calculating the proportion of insulinogenic calories is useful for people who require a very low insulin therapeutic ketogenic diet while the insulin load is useful for people managing hyperinsulinemia, insulin resistance or diabetes.
Monica’s daily insulin dose has dropped from more than fifty units a day to closer to 20 units of insulin per day and the amplitude of her blood glucose swings is much smaller.
While living with Type 1 will never be fun, the journey towards normal blood glucose levels has been more than worth it, with Moni’s energy levels improving to the point she can go back to work and look forward to a long, healthy and happy life.
the problem with the food insulin index
The problem with looking at things purely from a food insulin index perspective is that the resultant high fat foods do not provide a broad range of micronutrients.
A diet with a very low proportion of insulinogenic calories also tends to be very energy dense which can make portion control more challenging for people wanting to lose weight.
This refined understanding of how to calculate our insulin response to food is a useful parameter, along with nutrient density and energy density, which enables us to prioritise our food choices to suit different goals.
optimals foods for different goals
The table below contains links to separate blog posts and printable .pdfs detailing optimal foods for a range of dietary approaches (sorted from most to least nutrient dense) that may be of interest depending on your situation and goals. You can print them out to stick to your fridge or take on your next shopping expedition for some inspiration.
If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help identify the optimal dietary approach for you.
the Nutrient Optimiser
Building on the ability to quantify insulin load, nutrient density and energy density, more recently I have been developing a novel tool. The Nutrient Optimiser reviews your food log diet and helps you to initially normalise your blood glucose and insulin levels by gradually retraining your eating habits by eliminating foods that boost your insulin level and blood glucose levels.
Once your glucose levels are normalised the Nutrient Optimiser focusses on your micronutrient fingerprint to identify foods that will fill in your micronutrient deficiencies with real food.
If you still have weight to lose, the Nutrient Optimiser will focus on the energy density of your diet until you have achieved your desired level of weight loss. Alternatively, the Nutrient Optimiser can help you if you were looking to increase your insulin levels for bulking or identify higher energy density foods for athletes.
It’s early days for the Nutrient Optimiser, but the initial results are very promising.
Last updated: April 2017