hyperinsulinemia, food, infection and the monthly female cycle

  • A wide range of the major health issues that we face in the western world appear to be associated with high levels of insulin (hyperinsulinemia).
  • More people have impaired insulin sensitivity but wouldn’t know it just from looking at their blood glucose levels.
  • Insulin sensitivity is influenced by a wide range of factors including food, infections, fasting and hormones.
  • Fasting can be helpful for people who are unable to optimise their insulin with a low carbohydrate diet alone.
  • Insulin requirements tend to increase by about 10 to 15% in the three or four days leading up to the monthly menstrual period.

introduction

You may be aware of the work of Dr Joseph Kraft that has recently been re-discovered by Catherine Crofts and Ivor Cummins.  Dr Kraft carried out insulin response tests in more than 14,000 people and found that t he majority of them had some form of insulin resistance.  People who are insulin resistant need to secrete more insulin to maintain normal blood glucose levels.  These high levels of insulin can lead to fat gain and other metabolic issues.[1]

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Catherine Crofts, Caryn Zinn, Mark Wheldon and Grant Schofield recently published a paper looking at the various diseases that are affected by hyperinsulinemia including:

  • cancer
  • atherosclerosis
  • cardiomyopathy
  • endothelial dysfunction
  • thrombosis
  • diabetes (gestational and type 2)
  • non-alcoholic fatty liver disease
  • chronic inflammation
  • obesity
  • Alzheimer’s diseases and vascular dementia
  • retinopathy
  • osteoporosis
  • nephropathy [2]

In view of this ominous list of health issues it would make sense to try to actively avoid hyperinsulinemia.  Managing insulin resistance and optimising fat metabolism is critical for your overall health.  This article looks at the wide range of things that influence insulin sensitivity and what you can do about it.

food

While our food intake is not the only factor that influences hyperinsulinemia it is one that we can actively manage.

Measuring insulin in the blood stream is expensive and not commonplace.  Individuals with type-1 diabetes, however, provide a unique opportunity to understand the things that affect insulin demand.

Measuring the insulin requirement for someone with type 1 diabetes is as simple as downloading the data form their insulin pump into a spreadsheet.  My wife Monica’s daily insulin usage over eighteen months is shown in the chart below.

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Diabetes is an ongoing struggle!  Monica has been torn between mainstream advice that says that fat is bad and you’ll get fat and have a heart attack if you have too much of it, and her husband who keeps banging on about low carbohydrate, Paleo and ketogenic dietary approaches that might help her improve her diabetes control!

After generally trying to follow a paleo template for a couple of years in July 2014 she started taking the low carb thing a bit more seriously in an effort to gain control of her blood glucose levels.  Between August and December 2014 her insulin requirements came down from about 36 units per day to about 28 units per day!

Then, in January, when we came across the TYPEONEGRIT Facebook group and saw what people were eating to get flat line blood sugars, she ramped up her efforts to further refine how we ate, with a renewed motivation and belief that it could make a difference.

We also spent a week in Vanuatu around Christmas which likely helped to improve the cortisol levels and improve gut health with the sunshine, salt water and nutrient dense food.  In the period between January and March 2015 her insulin requirements came down even further to about 24 units per day from up to 40 units per day six months before.  During this period she had the best blood glucose levels in the thirty years of being a type 1 diabetic.

In April, because of her increased health and vitality, she started working more which may have affected her stress which may have influenced her insulin requirements.  In June she got a kidney infection with her insulin demand increasing significantly as her body fought the infection.  I even wonder if the period where the insulin requirement is building before June suggests that she might be getting run down and possible the insulin requirements building up.

People with diabetes who take insulin will also put on weight.  This is generally true for people with both type 1 and type 2 unless their carbohydrates are restricted.  Even though the insulin demand has varied during this time Monica has managed to lose about ten kilograms to achieve an ideal body weight that puts her in the middle of the ideal BMI range.

fasting

Jason Fung has been instrumental in highlighting that insulin drives obesity and notes that the most effective way to reduce insulin is to increase the time between meals.

People with type 1 diabetes find that they require much less insulin during fasting and for a period after fasting due to improved sensitivity.

Those of us with a functioning pancreas can track insulin by measuring blood glucose and blood ketones at the same time.  Cancer researcher Dr Thomas Seyfried suggests that the glucose : ketone index (GKI) is a good proxy for insulin levels (see this article for more detail on how the GKI).

Jimmy Moore recently did a seventeen day fast with daily Periscope video updates[3] where he documented his blood sugar and ketones which are shown in the chart below.  Jimmy usually maintains good blood sugar levels and high ketone levels with his ketogenic diet, however a few days into the fast the ketone levels kicked up even more (see orange dots in the chart below).

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I’ve also plotted Jimmy’s GKI values through this period which also gives us a feel for his insulin levels.  You can see that in the first few days his GKI plummeted as he exhausts his glycogen stores and is forced to start burning body fat, with ketones rising and glucose levels dropping.

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Although Jimmy was hoping to make it through to three weeks of fasting, towards the end of the fast he started to feel poorly with travel and stress (and perhaps an infection) and chose to terminate the fasting.   Sickness is often linked with poor blood glucose levels or insulin resistance.

Chris Kelly of Nourish Balance Thrive says:

“My experience has been whenever there is high blood sugar, there is yeast overgrowth.”

RD Dikeman who runs the TypeOneGrit Facebook group said

“You can spot the infections with blood glucose rise and increased insulin demand typically before symptoms present. It’s also important to make sure you – if you are low carb – track your basal totals…  if you are in a non-physiologic zone, 20u or more a day for example, and are not overweight/IR, you might have a chronic (typically dental) infection. Bernstein recommends a tooth tapping performance by the dentist, but also a quick home test is to drink a glass of very cold water and look for pain.”

The theory that infection can lead to poor blood sugar control and increased insulin demand also ties in with the our experience with Monica requiring much more insulin during periods when she’s had infections as highlighted in the chart of her insulin levels above.

Heart Rate Variability (HRV) has become popular lately as a way to track your health, stress and exhaustion.  Diminishing HRV scores will often suggest that you’re heading for burnout and will sometimes indicate that you have a sickness coming on.  It seems that tracking your GKI can also provide a similar indication of your overall metabolic health and indicate when you are getting an infection or starting to burn out and get inflamed.

infection

A diet low in processed carbohydrates is not just about reducing blood glucose and obesity.  It also has benefits in reducing infections such as SIBO (small intestinal bacterial overgrowth) and other conditions such as thrush.[4]

A diet high in sugar and processed carbohydrates will feed the ‘bad bacteria’ that will lead to SIBO[5] and other infections such as thrush that are related to too much sugar.

When Monica started to try to increase the fat in her diet her digestion struggled due to SIBO which meant that she was not able to digest the fats.  She worked with our naturopath Elizma to cleanse the SIBO with a vitamin C flush and then re-populate the gut again.

A diet low in sugar and processed carbs is the best thing to starve unwanted bacterial infections.

Belinda Fettke also told me:

I don’t have diabetes, but I was plagued with yeast overgrowth on a high carb diet. Since going low carb there has been not a single sign of it!!

To me, this is the biggest improvement in my health.  Gary told me I should do a TEDx talk in the impact of high carb vs low carb for someone like me who has had such nasty yeast infections in the past. Sounds trivial, but if it is severe it makes you lose concentration, sleep and impacts your sex life. 

Since going low carb I’ve had no thrush. I am surprised that I have also had only minimal symptoms of menopause, despite a family history of marked symptoms and medication.

I think it is SO important to discuss reducing carbohydrates and sugar for all women’s health, not just for women with diabetes. Every woman I speak to has their own health story.

the monthly female hormonal cycle

Insulin sensitivity is also influenced by the monthly female hormonal cycle.

I noticed that a few of the women on the TYPEONEGRIT Facebook group who achieve excellent blood glucose levels were talking about using different basal insulin patterns around their monthly cycle.

It’s surprisingly hard to find much information on the topic.  One useful piece of guidance is from Lois Jovanovic MD who says

Usually, a woman’s insulin requirement goes up 10 to 15% during the last 3 to 5 days of the menstrual cycle due to the hormone progesterone. This is the hormone that prepares the uterus to be full of extra tissue and blood to receive the egg, if it is fertilized. Rising levels of progesterone counteract that action of insulin.[6]

It seems that as progesterone increases through the luteal phase insulin resistance also increases.[7] [8] [9]

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For Monica it’s never been that scientific or precise.  There would typically be a time where she wouldn’t be feeling herself, “felt fat” and bloated and would then get frustrated that her blood sugars were all over the place and she’d lost control.  Then all of a sudden everything would be back to normal when her period hit.

On a Diabetes Unscripted podcast Katie Coleman discussed her approach to managing these variations, which includes tracking her monthly cycle with a reminder in her diary at ‘that time of the month’ including the new recommended basal insulin rates.  Katie uses the Kindara app to track her cycle and hence can forecast when she will need to adjust the basal rates on her pump.

After hearing Katie’s story I thought it would be interesting to see if we could learning anything from Monica’s insulin pump data.   While there is a lot of variation in the data in the plot above you can see that there is certainly a regular monthly cycle to the data.  When I looked at the numbers there was definitely one day every four weeks or so when the insulin requirement spiked in the lead up to her period.

The chart below shows the average of the monthly variation in insulin demand (in terms of percentage of average across that month).  The period proper hits one or two days after this insulin demand spike and everything returns to normal in terms of mood and insulin demand.  The lowest insulin demand appears to be around ovulation in the middle of the month.

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What this means is that in the four days leading up to the period each month a woman with type 1 diabetes could set her basal insulin to about 10% more than her normal basal insulin rate to manage her blood glucose levels over these four days.

For the rest of the population who do not have type 1 diabetes it’s interesting to see the correlations between higher insulin demand and water retention, mood, food cravings and blood sugar control that are often part and parcel with ‘that time of the month’.

other issues

I know from personal experience (as a male) that when I transition into ketosis with lower insulin levels my overall fluid retention and overall puffiness decrease.   I find myself heading to the toilet more often.  This makes me wonder to what degree oscillating insulin levels (along with estrogen and progesterone) play in the symptoms relating to the monthly female cycle.  Could a diet lower in processed carbohydrates that lowers insulin levels help decrease the mood swings and other fluctuations that come with the monthly hormonal cycle?

While there are anecdotal stories out there about how a paleo or ketogenic diet can lead to Amenorrhoea[10] (i.e. loss of regular menstrual cycle); however many would say that is the body’s response to a lack of calories rather than a well formulated ketogenic diet.  At the same time though there are heaps of anecdotes around the negative symptoms relating to ‘that time of the month’ being reduced on a ketogenic diet.[11] [12]

Perhaps this is another case for finding your optimal dietary glucose load where you can optimise blood glucose levels and possibly moderate hormonal fluctuations without going to the point of starvation where your body decides that survival is more important than reproduction.

it’s not just about the food

Again though, it’s not just about the food.  There are many other factors that will affect your insulin sensitivity such as sleep, genetics, exercise, circadian rhythms and gut bacteria as eloquently discussed in this video by Tommy Wood.

references

[1] https://optimisingnutrition.wordpress.com/2015/03/22/diabetes-102/

[2] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19

[3] https://vimeo.com/user21838277

[4] http://www.diabetes.co.uk/diabetes-complications/diabetes-and-yeast-infections.html

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/

[6] http://diabeticmommy.com/sp-pregnancy-diabetes-bd-faq-answers.html

[7] http://theathleterx.com/progesterone-and-insulin-what-is-the-relationship/

[8] http://www.ncbi.nlm.nih.gov/pubmed/23318859

[9] http://www.ncbi.nlm.nih.gov/pubmed/21768169

[10] https://en.wikipedia.org/wiki/Amenorrhoea

[11] https://zuzkalight.com/nutrition/my-experience-with-ketogenic-diet/

[12] https://www.youtube.com/watch?v=LunZgG8EvUk

nutrient dense superfoods for maintenance

These foods will help you maximise nutrient density and sustain health with adequate energy for weight maintenance.

“A nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to minimising appetite and eliminating hunger at minimal caloric intake.”

Paul Jaminet

2016-07-06 (11)

The downside of the most nutrient dense foods is that they have such a low energy density that it can be hard to maintain your body weight.   The chart below shows that these foods still rank at #4 of the 13 approaches analysed in terms of nutrient density despite containing a little more fat!

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These foods still have a fairly low energy density (#4 of 13), but not as much as the more aggressive weight loss approach.  The addition of some nuts and dairy brings means it will be easier to maintain body weight and satiety, especially if you are active.

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The chart below shows that the nutrients provided by these foods is well above the average of all the foods in the USDA database.

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The tables below show the

vegetables and spices

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food ND % insulinogenic insulin load (g/100g) calories/100g MCA
endive 14 23% 1 17 2.7
coriander 14 30% 2 23 2.6
chicory greens 13 23% 2 23 2.5
asparagus 15 50% 3 22 2.4
brown mushrooms 17 73% 5 22 2.3
escarole 11 24% 1 19 2.2
spinach 14 49% 4 23 2.2
watercress 16 65% 2 11 2.2
alfalfa 10 19% 1 23 2.2
basil 13 47% 3 23 2.1
beet greens 11 35% 2 22 2.0
portabella mushrooms 13 55% 5 29 2.0
zucchini 11 40% 2 17 2.0
arugula 11 45% 3 25 1.9
chard 12 51% 3 19 1.9
white mushroom 14 65% 5 22 1.9
mustard greens 10 36% 3 27 1.9
parsley 11 48% 5 36 1.8
lettuce 11 50% 2 15 1.8
paprika 8 27% 26 282 1.8
shiitake mushroom 12 58% 7 39 1.8
Chinese cabbage 11 54% 2 12 1.7
okra 11 50% 3 22 1.7
dandelion greens 11 54% 7 45 1.7
broccoli 10 50% 5 35 1.6
curry powder 6 13% 14 325 1.6
summer squash 9 45% 2 19 1.6
yeast extract spread 11 59% 27 185 1.6
banana pepper 8 36% 3 27 1.6
pickles 8 39% 1 12 1.5
cucumber 8 39% 1 12 1.5
celery 9 50% 3 18 1.5
collards 7 37% 4 33 1.4
chives 8 48% 4 30 1.4
cauliflower 8 50% 4 25 1.4
turnip greens 7 44% 4 29 1.3
sage 5 26% 26 315 1.3
cloves 6 35% 35 274 1.3
artichokes 7 49% 7 47 1.2
thyme 5 34% 31 276 1.2
eggplant 5 35% 3 25 1.2
mustard seed 4 27% 37 508 1.2
seaweed (wakame) 10 79% 11 45 1.2
jalapeno peppers 5 37% 3 27 1.1
sauerkraut 5 39% 2 19 1.1
cabbage 7 55% 4 23 1.1
marjoram 4 31% 27 271 1.1
radishes 5 43% 2 16 1.1
chayote 5 40% 3 24 1.1
bamboo shoots 7 60% 5 27 1.1
radicchio 8 67% 4 23 1.1
red peppers 5 40% 3 31 1.1
dill 7 59% 8 43 1.1
edamame 5 41% 13 121 1.0
seaweed (kelp) 9 77% 10 43 1.0
poppy seeds 2 17% 23 525 1.0
caraway seed 3 27% 28 333 1.0
turnips 6 51% 3 21 1.0
snap beans 6 58% 3 15 0.9

seafood

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food ND % insulinogenic insulin load (g/100g) calories/100g MCA
fish roe 11 47% 18 143 1.9
crab 13 71% 14 83 1.8
salmon 11 52% 20 156 1.7
caviar 9 33% 23 264 1.7
oyster 12 59% 14 102 1.7
trout 9 45% 18 168 1.6
anchovy 9 44% 22 210 1.6
lobster 12 71% 15 89 1.6
halibut 12 66% 17 111 1.6
crayfish 11 67% 13 82 1.5
sturgeon 9 49% 16 135 1.5
mackerel 4 14% 10 305 1.4
sardine 7 37% 19 208 1.4
cod 11 71% 48 290 1.4
flounder 9 57% 12 86 1.3
pollock 10 69% 18 111 1.3
rockfish 9 66% 17 109 1.2
herring 5 36% 19 217 1.2
perch 8 62% 14 96 1.2
shrimp 9 69% 19 119 1.1
haddock 9 71% 19 116 1.1
cisco 4 29% 13 177 1.1
whiting 7 66% 18 116 1.0
octopus 8 71% 28 164 0.9
tuna 6 52% 23 184 0.9

animal products

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food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb kidney 11 52% 15 112 1.8
lamb liver 10 48% 20 168 1.7
turkey liver 10 47% 21 189 1.7
chicken liver 9 50% 20 172 1.6
beef brains 6 22% 8 151 1.5
ham (lean only) 10 59% 17 113 1.5
veal liver 8 55% 26 192 1.3
beef kidney 8 52% 20 157 1.3
beef liver 9 59% 25 175 1.3
chicken breast 8 60% 22 148 1.1
turkey heart 6 47% 20 174 1.1
lamb brains 4 27% 10 154 1.1
turkey ham 6 45% 14 124 1.1
pork chop 7 57% 23 172 1.1
pork liver 7 59% 23 165 1.1
beef heart 5 41% 16 165 1.0
chicken liver pate 4 34% 17 201 1.0
ground turkey 3 30% 19 258 1.0
roast pork 5 41% 20 199 1.0
turkey drumstick 6 52% 21 158 1.0
turkey meat 6 52% 21 158 1.0
turkey (skinless) 4 40% 16 170 1.0
ground pork 6 54% 25 185 0.9
pork shoulder 6 56% 22 162 0.9
pork loin 4 41% 19 193 0.9
pork ribs 4 39% 21 216 0.9
roast ham 4 41% 18 178 0.9
ham 2 29% 11 149 0.9
leg ham 5 56% 22 165 0.8
lamb sweetbread 4 43% 15 144 0.8
lamb heart 4 48% 19 161 0.8
lean beef 6 61% 23 149 0.8
pork 4 44% 22 209 0.8
chicken (leg with skin) 3 42% 18 184 0.8

dairy and egg

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food ND % insulinogenic insulin load (g/100g) calories/100g MCA
egg yolk 6 18% 12 275 1.6
whole egg 6 30% 10 143 1.4
whey powder 10 95% 82 339 0.8
kefir 6 64% 7 41 0.7
cheddar cheese -2 20% 20 410 0.4
feta cheese -2 22% 15 264 0.4
Swiss cheese -2 22% 22 393 0.4
mozzarella -1 34% 26 304 0.4
gruyere cheese -2 22% 23 413 0.4
limburger cheese -2 19% 15 327 0.4
blue cheese -2 21% 19 353 0.4
sour cream -3 13% 6 198 0.4
camembert -2 21% 16 300 0.4
cream -4 6% 5 340 0.3

legumes, nuts and seeds

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food ND % insulinogenic insulin load (g/100g) calories/100g MCA
sunflower seeds 4 15% 22 546 1.3
brazil nuts 1 9% 16 659 1.0
flax seed 1 11% 16 534 1.0
pumpkin seeds 1 19% 29 559 0.9
almond butter -0 16% 26 614 0.7
almonds -0 15% 25 607 0.7
walnuts -1 13% 22 619 0.7
sesame seeds -1 10% 17 631 0.7

other dietary approaches

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.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

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.

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post last updated April 2017

further support

Do you have questions or something you’d like to share?  Then please join the Optimising Nutrition Facebook Group.

This group of really smart people are eager to share their learnings and help others on their journey towards health.

Not everyone agrees with each other, but that’s where the real learning comes, when people debate their position  share their evidence and research.

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Managing the insulin load of your diet and maximising nutrient density is only part of the story.  Sometimes you may need some more specific or specialised advice to help you work through a more serious metabolic issue.  That’s where these friends might be able to offer suggestions and provide expert guidance.

Realize Health

Elzima Lambert (BHSc Hom, Adv Dip Nat) is our local naturopath who has invested a massive amount of time and love into helping improve our family’s health.

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After decades of seeing health professionals, my wife Monica, who was skeptical at first, has been highly impressed with the results Elizma has been able to achieve in improving her digestion and energy levels despite suffering from thirty years of autoimmune disease and type 1 diabetes.

I’ve been inspired by Elizma’s passion for ongoing learning and research and using new techniques to restore health and vitality.  Rather than prescribing a drug to mask the symptoms Elizma works tirelessly to get to the root of the problem.

Elizma specialises in analysing genetic data (e.g. 23andme) and the MTHFR (methylation / energy cycle) combined with other metabolic testing such as the organic acids test (OATs) to gain an understanding of the cause and effect of blockages in the energy system.

Looking for triggers of mitochondrial dysfunction such as infections and environmental toxin exposure allows for better treatment outcomes and more success in balancing the biochemistry.

MINDD-profile-pic[1]

I think the combination of understanding your own genes along with testing how your metabolism is currently performing is a very exciting area in health.  It’s certainly still an evolving area, but from what I’ve seen Elizma is certainly on the cutting edge.

Elizma is now accepting Skype consultations if you are interested in booking a consultation.

Nourish Balance Thrive

Chris Kelly and Tommy Wood of Nourish Balance Thrive have been really generous with their time contributing to the Optimising Nutrition Facebook Group.

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Chris is an ex-software engineer for a hedge fund who is also a pro mountain biker. He has developed a niche in optimising health for athletes who don’t just want to be normal, but rather exceptional and perform at the top of their field.

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If you’re not getting the results from standard dietary interventions, exercise and sleep Nourish Balance Thrive can do targeted metabolic testing to find the root of your issue and address it.  I’ve learned a pile from Chris’s podcast where he’s interviewed some of the biggest names in health and nutrition as well as being on their shows.

Chris’s partner in NBT is Dr Tommy Wood, who is probably THE smartest person I know in this area.   He’s a medical doctor (from Oxford), with a previous degree in biochemistry (from Cambridge), is a research scientist (currently finalising his PhD in neonatal brain metabolism at the University of Oslo) and an accomplished athlete.  Tommy has been very generous with his time in the group and has explored the area of insulin resistance and metabolic health more than just about anyone.

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Amy Berger

Amy Berger (Certified Nutrition Specialist) of Tuit Nutrition releases a pile of killer blog posts laced with a cutting whit.

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Amy is a certified Nutritional Therapy Practitioner and has a masters degree in human nutrition.  Amy specialises in nutritional support for Alzheimer’s, paleo, WAFP, low carb.   If you’re looking for some extra guidance in your nutrition journey then it might be a good idea to contact Amy.

Patricia Daly

Patricia Daly is a qualified Nutritional Therapist (BA Hons, dipNT, mBANT, mNTOI) based in Dublin, Ireland.

Following her cancer diagnosis, she left her corporate career and started studying nutrition, specialising in the area of Integrative Cancer Care. As a Swiss native, she regularly attends training courses in Switzerland/ Germany, including at the renowned Tumor Biology Center in Freiburg, Germany.

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I think the therapeutic ketogenic diet is where the insulin load concepts start to get really exciting.  However it’s also a specialist area where it helps to have someone who has walked the path before.

If you need a bit of guidance from someone who has already trodden this path then it might be worth contacting Patricia.

broccoli, cheddar and bacon chowder

Creamy, delicious, and very filling.  This chowder recipie from Craig Clarke’s RuleMe will have anyone that loves bacon, cheese, and broccoli demanding more (see recipe here).

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Broccoli is an amazing go to food with very night vitamin and mineral sores, solid protein score and minimal net carbs with all that fibre.

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To complete the picture bacon has a very high protein score with some vitamins and minerals as well.

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net carbs

insulin load carb insulin fat protein fibre
5g 22g 23% 68% 24%

5g