Someone looking to “go low carb” will typically try to make a decision on whether a food meets their goals simply based on the number of carbohydrates per serving or per 100g shown on the label.
This approach has limited benefit though, as the food may or may not contain a lot of water which makes it hard to compare in terms of carbohydrates per calorie.
Another way is to look at the amount of protein and fat in relation to the carbohydrates, but again this is a difficult calculation to make when you’re looking at the nutritional label in the shopping isle.
If we take the concept of “net carbs” and the idea that protein has some insulinogenic effect we can calculate the proportion of insulinogenic calories using the following formula:
This calculation could be useful to determine whether one food is better than another if you’re trying to reduce your insulin load to the point that your pancreas can keep up.
As demonstrated by the chart below, the lower the proportion of insulinogenic calories in your food the less likely your meal is going to require large amounts of insulin, raise your blood glucose or cause you to store fat.
Sure, this is not a simple calculation we can quickly while we’re out shopping. However using readily available nutritional data we can compare and rank a wide range of foods, making us better informed when we prepare our shopping list.
The original 1997 paper by Susan Holt et al  looking at the food insulin index suggested that dairy and meat proteins may be more insulinogenic than vegetable proteins. The problem with this study was that 38 data points weren’t really enough to draw a meaningful conclusion.
You may have also heard it said that “diary is insulinogenic”, suggesting that perhaps dairy products have some special hormonal property that requires more insulin than other foods. 
In order to test whether particular groups of foods might have unique insulinogenic properties I have plotted the insulin response for various types of proteins separately (note: without taking fibre into account).
Fish (based on only four data points) and dairy (based on thirteen data points) seem to have the greatest insulin reaction while vegetables and animal protein have the lowest insulin response.
However if we account for the indigestible fibre (i.e. net carbs) then legumes (based on only five data points) appear to require more insulin while fruit and vegetables require less insulin.
Based on the available data it does not appear that that insulin response is influenced significantly by anything other than carbohydrates, fibre and protein in a food.
So in summary, there is very little difference in the insulin response of the various foods once fibre is taken into account.
non-fibre carbohydrates require insulin;
protein requires about half as much insulin as carbohydrate; and
fibre does not require insulin or raise blood sugar.
One of our go to meals is steak on the BBQ with halloumi cheese with veggies.
We have a solid serving of steamed broccoli and beans with some butter on top to make sure all those good fat soluble vitamins get digested – and the butter tastes amazing.
Being the inquisitive type I wondered whether it would be better to have more steak or more veggies in this meal.
After running a few scenarios what I found was that, while it’s hard to get B vitamins and an excellent protein score without eating some meat, the best score actually came when you max out the veggies and keep the meat reasonably low.
Piling on the veggies and decreasing the meat can increase the total carbs but at the same time you’ve got heaps of fibre which mutes the insulinogenic effect of the carbs in the veggies. By maxing out the veggies you’re also reducing the protein which requires insulin.
The best balanced nutritional profile between the meat, cheese and vegetables is achieved with 150g steak, three cups of beans, a full head of broccoli, and 200g of broccoli.
You’ll notice in the NutritionSELF plot below that I’ve used liberal amounts of butter to make the veggies go down and increase the fat content and taste sensation of the meal.
So the learning is, if you’re looking to maximise nutrition while getting adequate protein then eat as many veggies as you can fit in and keep the meat and cheese servings moderate.
I’m not however advocating for a vegetarian diet as the meat and the cheese will give you things like vitamin B12 that the spinach won’t by itself.
Once you’ve mastered maxing out your veggies, the next step is to try organ meats. The best nutritional score came when I dropped out the steak and subbed in liver. You get a much better bang for your buck if you eat organ meats instead of the veggies and the normal muscle meat.
We’re still working up to that, but in theory it’s amazing!
Eating a low carb, high fibre, moderate protein diet will often naturally lead to elimination of processed high carb foods, increased satiety and reduced energy intake. Reducing insulin will then allow stored body fat to be used for fuel.
However if someone was trying to lose weight I would not recommend emphasising dietary fat once they were fat adapted in order to allow energy to be supplied from body fat.
Ketones can rise to high levels in fasting as we burn our own body fat (endogenous ketosis), but chasing this state with exogenous ketones or heaps of processed fat can lead to a high energy state (endogenous ketosis) which can drive insulin resistance and fat storage.
Some people aiming for ketosis to lose weight can overdo the fat calories and not achieve the weight loss. If your aim is weight loss it’s better to be in calorie deficit and be burning stored body fat, than to have high blood ketones produced by MCT oil and butter.
While counting calories may be beneficial for some people to retrain their appetite initially, a better long term approach may be to try some form of intermittent fasting to reset insulin sensitivity and reduce overall calorie intake. You can use your blood sugar or your weight to help guide your fasting frequency.
If your body fat and blood sugars are under control then go ahead and indulge in supplemental MCT oil or some extra butter in your coffee for the mental buzz, but keep in mind that, while ketosis will lead to increased satiety for most people, calories matter in the long run.
In the end I think you should be consuming the most nutrient dense foods that will keep your blood sugars at normal healthy levels. The food lists in the table below to suit your blood sugar levels and body weight goals.
As shown below, this combination provides a great range of micronutrients and protein while staying quite low in net carbohydrates.
[The nutritional analysis below is for the whole recipe which would serve two or three. The table at the bottom shows net carbs, insulin load and fibre for a 500 calorie serving.]
Spinach really is a “super food” with a very rich nutrient profile and a solid array of proteins in its own right.
Eggs have a fab protein score, and the egg yolks are even higher in fat and more complete in proteins than the whole egg. It’s so sad that these little gems have been demonised because of their wrongfully alleged “artery clogging saturated fat” content for so long.
Egg yolks have the same nutritional balance score but an even better amino acid score than the whole egg in spite of having a lower percentage of calories from protein. They are also higher in fat which is great from a diabetes perspective.
I’ve been intrigued with Terry Wahls’ approach to intentionally maximising nutrition.
By following a highly nutrient dense ketogenic diet Dr Terry Wahls claims to have reversed her Multiple Sclerosis and is undertaking experiments to verify that this high nutrient density approach works for others with Multiple Sclerosis.
Her Mind your Mitochondria TED talk has hit more than two million views!
The aim of the Wahls Paleo Plus, as detailed in The Whals’ Protocol, is to achieve nutritional ketosis, while maximising nutrients as far as possible with non-starchy vegetables as well as coconut oil, coconut cream and MCT oil which help facilitate nutritional ketosis with a higher level of carbohydrates.
Whals’ approach aims to not just meet but exceed the recommended nutrient intake levels as shown in the comparison of both the Wahls Diet and the recommended US dietary daily intake for a range of key vitamins below.
While supplements can still be useful, it is ideal to obtain all your nutrients from real food as they are usually better absorbed in their natural form and with fats (fat soluble vitamins A, D, E and K) than in tablets and isolation.
Eating real food also ensures you get a wide range of nutrients that can be found in plants in nature rather than just the limited number of vitamins and minerals on the recommended daily allowance checklist.
I ran the number on lamb skillet meal and it went extremely well! With the broccoli, garlic, kelp and spinach the nutritional completeness is off the chart!
The insulin requirement of the protein is high, although this is not really a problem as protein is digested much more slowly than carbohydrates.
If you’re interested in checking out more highly nutrient dense meals I highly recommend reading The Whals’ Protocol.
The glycemic index (GI) compares the rise in blood sugar for a particular food relative to glucose. The theory goes that it is better to eat low glycemic index carbohydrates that will not raise our blood sugar too much and will take longer to digest.
Building on the glycemic index is the concept of glycemic load which is the GI of a food multiplied by the grams of carbohydrate eaten. Watermelon has a very high GI value, however because watermelon only contains a small quantity of carbohydrates (watermelon is mostly water) the overall glycemic load is small. A large glycemic load occurs when you eat a large quantity of a high glycemic index carbohydrate.
The limitation of the GI approach is that we can eat a diet full of low glycemic index carbohydrates and protein while still producing a large amount of insulin. Even though they are slow to digest and do not raise blood sugar significantly, a low GI moderate GL diet will still require substantial amounts of insulin. It’s the amount of insulin, not the grams of carbohydrates or even the rise in blood sugar that’s really at the nub of the problem.
The chart below shows the relationship between the glycemic load and insulin index. Reducing the glycemic load does not guarantee a low insulin response, particularly when it comes to high protein foods.
Even if you’re eating low GI foods that don’t spike your blood sugars you may still be generating a sustained requirement for insulin. Maintaining reasonable blood sugars in spite of a moderate glycemic load is just an indication that your pancreas is still keeping up, for now.
Various studies have shown that eating a low GI diet doesn’t help with weight loss.  We also now know that high insulin levels are also a massive health risk as well as high blood sugars. 
Rather than focusing on the glycemic load or the glycemic index, I believe it is more important to manage the overall insulin load of the diet, particularly if your aim is to achieve optimal blood sugars or reduce excess body fat.