how to optimise the insulin load of your diet for better diabetes management

Insulin is the primary hormone that controls your metabolism.

You need some to survive.

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But too much can be bad news.

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Insulin helps drive amino acids into your muscles to help them grow.

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Insulin helps glucose enter the cells to fuel your mitochondria to produce energy.

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Meanwhile, insulin also works as a brake to keep energy in storage.

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When you eat, your pancreas secretes insulin to slow the release of energy from body fat stores through your liver until the energy coming in from your mouth and in your bloodstream are used up.

How do we become insulin resistant?

I don’t know about you, but I find it hard to resist the yummy food that always seems to be available.

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We no longer have to hunt or gather our food.  It is always available, relatively cheap and flavoured to ensure we can easily eat lots of it.

In our modern food environment, it’s hard to ‘eat to satiety’ without usually eating a little bit too much.  It’s like we’re saving for a winter that never comes.

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Then, to make it even harder, the food industry optimises their products for ‘bliss point’ (with just the right amount of sugar, salt, fat and artificial colours and sweeteners) and creates hyper-palatable foods to drive profit.

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Unfortunately, this all has an impact on more than just our taste buds.

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Eventually, as you continue to consume more energy than you can use, your fat stores become inflamed and can’t take in any more energy.[1] [2]

Your pancreas ramps up its efforts to hold back the pressure of excess energy in our liver and body fat stores.[3] [4]

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If excess energy keeps coming in, the pancreas re-doubles its efforts to clear the glucose from the blood with more and more insulin.

First, the fat stores become full, then the bloodstream and eventually insulin drives the excess energy into other areas in the body that are still insulin sensitive such as your liver, heart, pancreas, eyes and brain.

Over the long term, this combination of high insulin levels and high energy leads to heart disease, fatty liver, Alzheimer’s, Parkinson’s and a whole host of modern diseases.[5] [6] [7]

Type 1 diabetes

People with type 1 diabetes, like my wife Monica, give us an opportunity to understand how insulin works.

The picture below shows “JL” one of the first type 1 diabetics to receive insulin treatment in 1922.  The picture on the left is after diagnosis with diabetes but before treatment with insulin.  The photo on the right is the same child two months.

With insulin injections, he can stop the uncontrolled release of his fat and muscle stores and quickly put weight back on.

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For reasons we don’t fully understand, the pancreas can stop producing insulin.  People with type 1 diabetes need to inject insulin to “cover” the food they eat as well as “basal insulin” to mimic what a healthy pancreas does automatically between meals.

Wise food choices are critical to stabilising blood sugar levels.  Foods that require a significant amount of insulin tend to cause large swings in blood sugar levels.

If your blood levels are high, you will feel tired and will need to take a large dose of insulin to slow the release of glucose from your liver.

If your blood sugars are low, you will feel the need to eat food, preferably something sweet to raise your blood sugars quickly!

It’s hard to control your appetite with these rollercoaster-like swings in blood glucose like the one shown in the chart below.  Our appetite and survival instincts are strong, and we will eat to raise our blood glucose levels to feel good again.

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daily blood sugar data of type 1 diabetic on typical western diet

Foods with a lower insulin load allow people with type 1 diabetes to smooth out their blood sugar swings and stabilise their food cravings.

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daily blood sugar data for the same person with type 1 diabetes on a low carb diet

Type 2 diabetes

While the cause of the disease is different, people with type 1 and type 2 diabetes are in a similar situation.  They both have an overall insulin insufficiency.  People with type 1 don’t produce enough insulin and need to inject insulin.

The insulin resistance in people with type 2 diabetes means that their pancreas cannot produce enough insulin to keep their blood sugar levels stable.   Their fat stores cannot hold all the energy in the system, so it spills out into the bloodstream, and we see elevated blood glucose levels.

For people with type 2 diabetes, reducing the insulin load of the food they eat will enable their pancreas to keep up to maintain more stable blood sugars.  Once the wild swings of glucose and insulin stabilise, it is often easier to go longer between meals or make better food choices.

Insulin sensitivity

While insulin resistance and diabetes are often associated with obesity, you can be fat and still have normal blood sugars and be insulin sensitive.

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People who are insulin sensitive can easily store energy in their adipose tissue and release energy easily later when they are not eating.

Their fat stores of insulin sensitive people are still functioning well.  They take in energy from the food they eat and relatively quickly release it when they are not eating.[8]

If you are insulin sensitive with stable blood sugar levels and want to lose body fat you will probably do well if you focus on eating foods with a higher nutrient density and a lower energy density.  However, if you are insulin resistant, you will likely also benefit from eating foods with a smaller insulin load, at least until your blood sugars stabilise.

Which approach is best for you?

Nutrition is complex, and there is still a lot of disagreement about the role that insulin resistance plays in health and weight loss.  However ultimately, most of us are trying to hack our system to get the nutrients we need without excessive energy.

The Nutrient Optimiser algorithm considers your blood sugars, HbA1c, triglyceride:HDL ratio and waist:height ratio to optimise your blood sugars are while also maximising nutrient density as much as possible.

The food insulin index data

Now we’re going to take a quick look under the hood of the Nutrient Optimiser algorithm to see how the insulin load parameter works.

The chart below shows the relationship between the carbohydrate content of our food and our insulin response.[9] [10] [11] [12]

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carbohydrates vs insulin response (click to enlarge)

The quantity of carbohydrate in your diet explains the majority of your insulin response.  However, if you look carefully in the bottom left corner of the chart above, you will see that there are high protein foods that cause a large insulin response and high fibre foods that cause a smaller insulin response.

Once we account for the effect of fibre and protein, we get a much better prediction of our insulin response to food.  This understanding of the various factors that influence insulin response enables you to prioritise foods that cause a smaller insulin response, as well as more accurately calculate insulin dosing for people with diabetes.

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insulin load (carbohydrates – fibre + 0.56 * protein) vs insulin response

If you are injecting insulin to manage your diabetes then understanding how to quantify the insulin load of your diet can help you more accurately calculate your insulin dose (as detailed in this post).  If you require therapeutic ketosis, you can also identify foods that will minimise your insulin response.

Protein

While protein does require some insulin to build and repair our muscles, the chart below shows us that increasing the proportion of energy from protein will typically force out processed carbohydrates and trigger a lower insulin response.

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Higher levels of protein also tend to generate a smaller glucose response compared to carbohydrates.

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It’s also important to note that protein is the most satiating macronutrient.  If you want to reduce your energy intake without having to meticulously track calories and without excessive hunger it’s important not to avoid protein.  Reducing the amount of energy in your diet will allow the energy in your bloodstream (i.e. glucose, ketones and free fatty acids) to be used up and your insulin levels will come down even further.  

Fat

Obtaining more of your energy from fat will decrease your insulin response…

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…as well as your glucose response.

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However, keep in mind that, as well as the food you eat, your insulin levels are influenced by the food you eat as well as the amount of energy already in your system.

High-fat foods are often energy dense and easy to overeat.  Your pancreas will still need to elevate insulin levels while your body uses up the energy from your diet, so they can still drive insulin resistance if eaten to excess.

The insulin load is a great tool to manage the short-term volatility of your blood sugar levels.  However, if you look at the big picture, lower insulin levels correspond to lower energy in your system (i.e. from your diet and body fat).

Once your blood sugars are stable, it may be prudent to focus on reducing the fat in your diet if you want to use your excess body fat.  This will help to further reduce your blood sugars and insulin levels floating around in your blood towards optimal levels.

Insulin load vs nutrient density

Like many things in life, there is a trade-off as we push things to extremes.  The chart below shows that we tend to optimise nutrient density with about 40% insulinogenic calories.[13]

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If you are insulin resistant, you will probably do better if you maintained less than 40% insulinogenic calories.   If you have diabetes, then you’ll probably need to stay below 25% insulinogenic calories.  If you require a therapeutic ketogenic diet (i.e. for the treatment of cancer, epilepsy, Alzheimer’s, dementia or Parkinson), then you will need to maintain a very low insulin load, which typically means consuming more fat and even reducing your protein intake.

It may not be ideal to maintain such a low insulin load for a long time.  The more you push the insulin load of your diet to either extreme the more you will compromise your micronutrient profile.

What do I do with all this information?

While you may find all this detail a little confusing, you don’t have to worry too much about all the numbers.

We have designed the Nutrient Optimiser algorithm to calculate your target macronutrient ranges to suit your goals and suggest foods and meals that will help you keep your blood sugars stable and normalise your insulin levels while also maximising the nutrient content of your diet.

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Once you attain normal blood sugars, you will ‘level up’ to the next stage of your nutritional journey.

Stay tuned…

In our next instalment, where we will discuss how we can manage the energy density of your food to enable you to get more calories in if you are running a marathon, or help you to feel more satiated with less energy if you are trying to lose weight.

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References

[1] https://www.ncbi.nlm.nih.gov/pubmed/25733684

[2] https://www.ncbi.nlm.nih.gov/pubmed/25515001

[3] https://www.youtube.com/watch?v=i2WRi7mP1ck

[4] https://www.youtube.com/watch?v=Cdork0TA90U

[5] https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

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

[7] https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

[8] https://en.wikipedia.org/wiki/Metabolically_healthy_obesity

[9] https://optimisingnutrition.com/2015/03/30/food_insulin_index/

[10] https://optimisingnutrition.com/2015/03/23/most-ketogenic-diet-foods/

[11] https://www.researchgate.net/profile/Peter_Petocz/publication/13872119_Holt_SHA_Brand_Miller_JC_Petocz_P_An_insulin_index_of_foods_the_insulin_demand_generated_by_1000-kJ_portions_of_common_foods_Am_J_Clin_Nutr_66_1264-1276/links/00b495189da41714fa000000.pdf/download?version=vs

[12] https://ses.library.usyd.edu.au/handle/2123/11945

[13] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[14] https://examine.com/nutrition/low-fat-vs-low-carb-for-weight-loss/

[15] https://www.sciencedirect.com/science/article/pii/S1551714416302166

[16] http://onlinelibrary.wiley.com/doi/10.1002/oby.21331/full

[17] https://drruscio.com/high-carb-low-carb-science-actually-says-episode-43/

5 thoughts on “how to optimise the insulin load of your diet for better diabetes management”

  1. Marty

    Beautiful work! many thanks

    Where can i find insulogenic index for whey protein that i take almost daily 1-2 spoonfuls with kale, corriander, carrot and tomato?

    Does having fibre in protein shake decrease its insulin response?

    Thanks

    Sudhir

  2. I think you have done a great job in outlining the some key principles of nutrition in this article.

    Also the importance of looking at other parameters than just insulin load.

    This should prevent people from focussing on one variable at the cost of others.

    Some things to consider when using the food insulin index.

    1. The measurements of insulin levels in response to the foods of all of the studies were measured over two hours.

    This is an issue for a few reasons.

    All High fat foods will show low insulin levels because they are still being digested, and there main effect on insulin resistance will not have started yet.

    This is seen clearly in studies on type 1 diabetes patients who eat high fat and protein meals needing insulin for up to 8-10 hours after consumption.

    Similar issue for very high protein meals that need insulin initially to cover the increase in glucagon secretion, but also later when gluconeogenisis happens from the excess amino acids.

    As you mention in the article people must be aware that kcal intake from fat needs to be considered, as the food insulin index could encourage people to “go for it” because supppsedly low insulin load.

    2. The food insulin index looks mainly at foods in isolation. E.g 50g protein from meat. 25g olive oil etc

    But we mormally eat a combination of foods, and when foods are combined there additive effects on insulin load are often greater than if you just added the single
    Effects together.

    For example pizza needs more insulin than would be expected than if you just added the individual lnsulon loads of bread, cheese and tomato.

    So we must be careful in extrapolating.

    This is especially true for people with type 1 diabetes who know insulin requirements for meals is a 4-8 hours game – not the two hour game measured by the food insulin index.

    I love the work of this blog.

    But just wanted to identify a few things for people reading and maybe taking too much stock in the food insulin index.

    Especially people with type 1

    Keep up he great work!

    1. Thanks John. The devil is always in the detail. My aim in this post was to give a fairly high level overview of the concept rather than getting into the nitty gritty which I have done on a range of other posts. See https://optimisingnutrition.com/food-insulin-index/

      Regarding #2, I would say that the insulin index testing has been done on fairly mixed macro meals. Though I agree that it doesn’t take into account the long term, though I agree that three hours is not enough to account for the full insulin response to foods.

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