How to really reverse your insulin resistance

  • There are so many misconceptions about insulin, it’s role your body and how to optimise it.  
  • Many believe in the low carb and keto community believe the best way is to avoid carbohydrates and even protein (which tend to raise insulin levels the most over the short term).
  • While your insulin levels will increase over the short term in response to food, the insulin produced across the rest of the day is proportional to the amount of body fat you currently hold in storage.  The more body fat you have the higher your insulin levels will be across the day.  
  • Rather than simply avoiding carbs, the best way to reduce your insulin requirement across the day is to prioritise foods and meals that provide greater satiety and nutrient density. This will enable you to control your appetite and achieve a healthy body composition in the long term.   

It’s not:

Carbs -> insulin ->  fat storage 

But rather:

Low satiety nutrient-poor foods -> increased cravings and appetite -> increased energy intake -> fat storage -> increased daily insulin

The real solution to managing your diabetes, blood sugar, insulin levels and avoiding the myriad of complications of metabolic syndrome is:

High satiety nutrient-dense foods and meals -> decreased cravings and appetite -> decreased energy intake -> fat loss -> healthy insulin levels

Background 

Hyperinsulinemia and insulin resistance are associated with many of our modern health conditions (e.g. diabetes, Alzheimer’s, metabolic syndrome, heart disease, fatty liver, infertility, PCOS, obesity, etc.).

More recently, we have added severe complications of COVID-19 to that list, with recent studies showing that people with a higher BMI are being more likely to need hospital care and mechanical ventilation.

Managing your insulin your insulin levels is super important. However, there is still a lot of confusion about the best way to achieve optimal levels.  

A recent interaction with Andreas Einfeldt (a.k.a. Diet Doctor) on Twitter got me thinking about what I’d learned after 18 years tracking my wife’s insulin and working to optimise our diet to help her better manage her Type 1 Diabetes and optimise my family’s health.   

This article is my attempt to bring some clarity to the topic.

What does insulin do?

We have historically thought of insulin as a hormone that pushes energy into cells and helps to build and repair our muscle and organs.  This is the anabolic role of insulin.  

However, it’s really more useful to think of insulin as holding energy in storage and stopping your body from breaking down. This is the anti-catabolic role of insulin.

If you’re not clear on these different roles of insulin, let me outline them briefly in terms of it’s role in:

  • glucose uptake,
  • anabolism, and 
  • anti-catabolism.  

Glucose uptake 

Insulin helps glucose enter cells to be used for energy.  

One popular analogy (that my wife Monica was taught when she was diagnosed with Type 1 Diabetes at 10 years of age) is that insulin is like a “key” that unlocks the cell to allow glucose in.  

While insulin fulfils this function if necessary, insulin isn’t always required for us to use glucose.  Non-insulin mediated glucose uptake occurs when you’re active or your cells are hungry for energy, and glucose enters your cells without needing to be pushed in by insulin.  

Insulin pushing glucose into cells is really a crisis management situation.  

Although it is commonplace in our current world where many people are obese, prediabetic or have type 2 diabetes, this function of should ideally occur only in extreme circumstances when your blood sugar levels are extremely elevated.   

Insulin is anabolic

Insulin also helps you use your food to build your muscles, repair your vital organs and store fat.  Some bodybuilders even use insulin to help grow bigger muscles (NOT recommended if you value your metabolic health).  

However, while insulin does play a role in building and repairing your muscles, the primary function of insulin is to stop your muscles breaking down.

“… physiologic elevations in insulin promote net muscle protein anabolism primarily by inhibiting protein breakdown, rather than by stimulating protein synthesis.” 

Gelfand and Barret, 1987

“… it is demonstrated that in healthy humans in the postabsorptive state, insulin does not stimulate muscle protein synthesis and confirmed that insulin achieves muscle protein anabolism by inhibition of muscle protein breakdown.” 

Nair et al, 2006

Insulin is anti-catabolic

Perhaps the least understood (but yet most important) role of insulin is its anti-catabolic function.  Insulin ensures your body doesn’t break down, with all your stored energy flowing into your bloodstream.

It’s useful to think of what happens to someone with uncontrolled diabetes who cannot produce enough insulin.  Without the ability to produce enough insulin in their pancreas, someone with poorly controlled Type 1 Diabetes will release their stored energy (i.e. glucose, body fat, muscle and organs) through the liver into their bloodstream in an uncontrolled manner.  They quickly develop diabetic ketoacidosis and see extremely elevated glucose, ketones and free fatty acids in their blood.  

Without enough insulin, they will basically disintegrate.  In the absence of insulin to apply the brake on the liver (which releases stored energy into your bloodstream), glucagon will cause an uncontrolled breakdown of their stored energy into their bloodstream.  Large amounts of glucose will be peed out and high levels of ketones lost on their breath. Thankfully, when people with Type 1 Diabetes inject insulin, the liver is able to hold back the stored energy on their body.  

The before and after photo below is of the same Type 1 Diabetic child before (left) and after (right) starting insulin therapy.  It doesn’t take too long for the insulin to go to work to ensure that the food they eat can be stored on their body again.  

Unfortunately, for people with insulin-dependent diabetes, it’s hard to perfectly match insulin requirements with the food they eat (especially on a high carb diet).  People injecting insulin often end up eating more than they otherwise would after their blood sugar has dropped too low because they injected too much insulin. Then, they find their blood sugars are elevated and they need to inject more insulin to bring their blood sugars down again.  Thus, they end up on what is commonly referred to as the blood sugar-insulin roller coaster.  

The good news here is that reducing the processed carbs in the diet enables people injecting insulin to more accurately match their insulin requirements with their diet.

Although not a recommended method of weight loss, some people with Type 1 Diabetes employ a dangerous practice known as diabulimia in which they intentionally underdose insulin to lose weight.  This is effectively what many people believe they are doing when they reduce the carbs in their diet to “switch off” insulin production.

The fatal flaw in the Carbohydrate – Insulin Hypothesis 

The central tenant of the Carbohydrate Insulin Hypothesis of Obesity is that we can control our insulin simply by controlling our carbohydrate as if that was the only variable that influenced our insulin levels.   

Unfortunately, while many of us would like to be able to turn off our insulin production to lose weight, it just doesn’t work that way if you are part of the 99.99% of the population that is not injecting insulin.  

If you have a healthy functioning pancreas, your insulin works in a well-controlled manner to keep your energy in storage while you have energy coming in via your mouth.  

When you consume less energy, your insulin levels decrease to allow stored energy to be released into your circulation. Like most things in nature, your pancreas is highly efficient, and never produces more insulin than it absolutely needs to.

Your pancreas does not produce more insulin than you require  

The image below from Optimising Nutrition advisor Dr Ted Naiman explains how your insulin works like a dam wall holding back the stored energy (see this post for more details). 

Once your fat cells become full (i.e. you reach your Personal Fat Threshold) any excess energy from your diet starts to overflow into your bloodstream as elevated blood glucose, ketones and free fatty acids.  

When you stop eating, your pancreas dials back insulin secretion and glucagon kicks in to release stored energy into your bloodstream.  Unless you have an insulinoma (a rare condition which causes the pancreas to over secrete insulin), your pancreas will not produce more than it needs in order to balance your stored body fat and the energy from your diet.  

Reducing carbohydrates in your diet is helpful to stabilise insulin and blood glucose.  However, if you have excessive body fat, both your fasting insulin and your total insulin levels across the day will be elevated (regardless of whether you prefer a low carb or high carb diet).  As shown in the chart below, rather than your carbohydrate intake, your insulin levels across the day are highly correlated with your BMI.  

How the food you eat affects your insulin levels

Food insulin index

While it has its limitations, the food insulin index is a great tool to help us understand the short term insulin response to food in your body.  However, we need to keep in mind that the insulin response is only measured over the first three hours after a meal.  

The chart below shows the change in insulin levels for the two hours after someone is fed different foods.  While understanding the short term insulin response is valuable when it comes to helping stabilise insulin, blood sugar and calculating short-term insulin dosing, we don’t understand that much about how different foods affect our insulin levels over the longer term

It’s worth noticing in this chart that, while the insulin response to glucose rises and fall quickly, the insulin response to milk (i.e. fat and carbs together) continues on well past the two-hour mark.

Recently, we’ve been working on refining a closed-loop artificial pancreas system for Monica using AndroidAPS. It’s been a fascinating learning journey to see which meals require more and less insulin.

  • A glucose tablet will raise her blood sugars quickly, but it doesn’t take long for a bit of insulin to bring it back down.
  • A low carb meal with fat and protein takes 8 to 12 hours of continual insulin dosing to bring her blood sugars back to normal levels.
  • Meanwhile, the occasional fat+carb meal can take more than a day to clear from her system even with continual hammering with insulin to try to get her blood sugars back to target levels!

Carbohydrates 

Of all the macronutrients, carbohydrates do elicit the largest insulin response over the short term.  High-glycemic processed carbs make our blood sugar and insulin levels rise quickly.   

Because your body has limited storage capacity for carbohydrates, your pancreas quickly shuts down the release of stored energy until you use the carbohydrates coming in from your food.

Protein 

Dietary protein requires about half as much insulin compared to carbohydrates in the first few hours.  But while protein does require insulin, it’s important to note that (as shown in the chart below from my analysis of the food insulin index data) higher protein foods tend to decrease the insulin response to the food we eat as protein replaces carbohydrates.

The fact that protein requires insulin is not a bad thing.  You need insulin to help build and repair your muscles and vital organs.  If you are eating fewer carbohydrates, your body can also convert protein to glucose to meet its needs. 

Unless your pancreas is not able to produce enough insulin, foods with more protein tend to decrease blood glucose levels. The fact that protein requires insulin and can be converted to glucose should not be a concern unless you need to calculate your injected insulin dose. 

Protein is the most satiating macronutrient, so you will tend to eat less across the whole day, which, as we will discuss in more detail later, tends to reduce your overall insulin requirements.  

Fat

Fat also requires insulin too, but the response occurs over a more extended period.  

Fat also has a lower oxidative priority and is last in line to be used for energy, so your body doesn’t have such an abrupt insulin response to shut off the release of stored energy in response to fat.

We don’t have a lot of data for the long term insulin response to fat.  It’s also important to keep in mind that you don’t need as much insulin to store dietary fat on your body, partly because your body likes to store fat for later use. 

While your body has limited storage capacity for carbs and protein (and hence raises your insulin levels more to ensure they are burned off quickly), your body is happy to store excess dietary fat for later use.  

Basal vs bolus insulin 

Unfortunately, when thinking about insulin, most people only consider the short term response to the food we eat (i.e. bolus insulin) and don’t consider their basal insulin (which is required to keep their fat in storage over the longer term).  

For someone with Type 1 Diabetic on a high carb diet, their basal insulin makes up around 30% of their daily insulin requirement, with 70% injected in response to the food they eat.  For someone on a low carb or keto diet, this ratio is typically reversed, and their basal makes up the vast majority of their insulin requirements.   

The majority of insulin for someone on a low carb or keto diet is produced in the pancreas to keep their fat in storage.  Once you have stabilised your blood sugars the next step is NOT to try to achieve flat line blood sugars by avoiding carbs and protein and just eating fat. You need to reduce your amount of stored body fat to reduce your insulin levels.  

Personal fat threshold vs the carbohydrate-insulin hypothesis

Because carbs raise insulin and blood glucose more over the short term, many people see diabetes as a disease of carbohydrate intolerance.  But more recently, we have come to understand that diabetes is a condition of energy toxicity.  

Once your fat stores become overfull and can no longer absorb extra energy (i.e. you exceed your Personal Fat Threshold), excess energy from your diet backs up in your system and shows up as elevated blood glucose, ketones and free fatty acids in the bloodstream.  

If you continue to eat more than you need, the excess energy is stored in your vital organs (e.g. your liver, pancreas, heart and brain).  

The real solution to reversing type 2 diabetes (rather than just managing the symptoms of elevated blood sugars) is to drain both your glucose and fat stores.  

How to really optimise your insulin levels

If you have diabetes, the first logical step should be to reduce the processed carbs in your diet to the point where you achieve normal blood glucose levels.   It’s important to note here that this does not require flat line blood sugar with no variance.

In an effort to achieve this, many people resort to avoiding protein and all carbohydrate and end up with a nutrient-poor low satiety diet.  Dialling back your carbohydrate intake to the point that you don’t see a rise of more than 1.6 mmol/L or 30 mg/dL is a reasonable goal.  There doesn’t appear to be any benefit in dialling back carbs and protein further and further to achieve even more stable blood sugars.

Some people assume that fat is a “free food” because it does not raise insulin levels as much.  However, the reality is that your pancreas is still ratcheting up your basal insulin to hold your body fat in storage while you burn off the fat coming in through your mouth.  

The only practical way to reduce your basal insulin and to reverse diabetes, insulin resistance and all the diseases associated with metabolic syndrome is to find a way to create a sustained energy deficit while still getting the nutrients you need from your food.  

This is preferable to the “keep calm and keto on” attitude or “add more fat” (based on the mistaken belief that fat does not trigger an insulin response). 

Reduction in insulin requirements on a high satiety nutrient-dense diet  

To demonstrate how this works in practice, the chart below shows my wife Monica’s total daily insulin dose (i.e. bolus + basal) over the past ten years that she’s had an insulin pump.   

For reference, this is a photo of us around that time.

You can see the step-change in her insulin requirements at the start of 2011 when we switched to a low carb paleo-style diet.  This made a massive difference in her ability to control her blood sugar and insulin dosing and enabled her to lose a significant amount of weight.  Processed hyper-palatable foods not only make it hard not to overeat but also makes it very hard to dose insulin accurately, so she was forever overcorrecting with her insulin and having to eat more to get out of lows.

Towards the end of 2014, I started to unpack the insulin load concept and develop optimised food lists to stabilise insulin, and we saw further improvements.    

Fast forward to the start of 2019 when we had the Nutrient Optimiser Challenge (a prototype of the Nutritional Optimisation Masterclass) where she focused on high satiety nutrient-dense meals.  Her daily insulin requirements plummeted to the lowest in three decades of having Type 1 Diabetes! 

While Monica was the only person in the Nutrient Optimiser Challenge with Type 1 Diabetes, people with type 2 diabetes saw their blood sugars improve significantly, with an average reduction from 7.4 mmol/L to 6.1 mmol/L (or 134 mg/dL to 110 mg/dL) on average as they focused on nutrient-dense foods and meals that were designed for greater satiety

We also saw people lose a significant amount of weight, regardless of whether they thought they were insulin resistant or insulin sensitive.  

Participants also gained lean muscle mass while losing fat. 

In line with the Personal Fat Threshold Theory of Diabetes, we saw weight and blood glucose moving together as demonstrated in this chart from Paul.

The photo below shows Paul, who saw the largest reduction in blood sugars after the six-week challenge.

Brishti was able to reduce her HbA1c from 9.1 to 6.5% in just two months as a Nutrient Optimiser Beta tester!  

Insulin change in response to weight loss 

As discussed earlier, we need to think more terms of total daily insulin requirements rather than just the short term change in insulin after meals.  Being able to measure insulin in someone with Type 1 Diabetes is really the only way to see how this works in practice.  

The chart below shows Monica’s insulin dose in the period leading up to and during the challenge.   You can see that as soon as she started with the high satiety meals her insulin requirements plummeted to the lowest in the past 30 years!

During the six weeks, Monica was able to lose 7.5 kg or 10.7% of her body weight during the six-week challenge.  The photos below show Monica and me before and after the six weeks.

Monica’s insulin demand dropped by up to 50% once she started on the nutrient-dense, high satiety meal plans.    The main difference from her previous approach during the challenge was a significant reduction in her intake of nuts, cheese and cream (which are low carb/keto staples and help maintain stable blood sugars).   

Although a high-fat dietary approach can cause a more stable insulin demand, high-fat foods still affect insulin requirements.  While low carb foods like nuts, cheese and cream can be a good way for people managing diabetes to obtain adequate energy, they do seem to trigger a long term insulin response. Focusing on nutrient-dense higher satiety foods tends to reduce overall demand across the day, not just in response to the meal.  

While you can count calories in an effort to eat less, most people don’t find long term sustainable success in managing their diet quantity until they modify their diet quality.  

Our extensive satiety analysis has shown that the best way to do this is to prioritise foods and meals that maximise satiety and nutrient density to enable you to feel fuller and to avoid nutrient cravings.  This approach tends to align with less easy energy from both fat and carbs (and therefore a higher percentage of calories from protein).  However, in addition to macronutrients, our analysis also shows that micronutrients also play a key role in satiety

Nutrient-dense high satiety recipes 

Many people have asked for more detail about the recipes we used in the Nutrient Optimiser Challenges to help people lose weight and we realised that recipes are really the ideal place for people to start their journey of Nutritional Optimisation.  So, we spent six months working intensely to refine our recipes for different goals. We ended up creating 22 recipe books!  

I’ll give you a quick snapshot of some of the books relevant to this discussion on insulin and how they differ to suit different goals.

Therapeutic keto

We designed a suite of therapeutic ketogenic recipes for people who require therapeutic ketone levels (e.g. for epilepsy, dementia, or Parkinson’s).  These meals have a very low insulin load while keeping an eye on nutrient density as much as possible. However, if your goal is fat loss, these recipes are not ideal because they are not as satiating and tend to be easier to overconsume.  

As you can see in the chart below, the therapeutic keto recipes have fairly low protein, low carbs and high fat compared to the therapeutic keto recipes.  

Nutritional keto 

The nutritional keto recipes are designed for someone who enjoys a ketogenic way of eating (without therapeutic ketone levels). They may be active and not need to lose weight.

They have a higher nutrient density, more protein and a little less fat.  

Low carb & blood sugar 

The low carb & blood sugar recipe book is designed for stable blood sugars and weight maintenance on a nutritious low carb diet.   

They have a higher level of protein, less fat and more nutrients.  

Blood sugar & fat loss 

As discussed above, many people managing type 2 diabetes also need to lose weight, so the blood sugar & fat loss book is designed to maintain stable blood sugars while also promoting fat loss to truly reverse insulin resistance (rather than simply managing the symptoms).

The blood sugar and fat loss book provides more protein, more nutrients and a greater satiety while still keeping carbs low to stabilise blood sugars.  

Fat loss 

But if you just want to get on with losing fat, the fat loss recipe book will provide greater satiety and fewer cravings due to nutrient deficiencies along with adequate protein to prevent muscle loss. 

It also has a spectacular nutrient density profile and will provide the nutrients you need without excessive calories.

High Protein:Energy Ratio

For all the Ted Naiman fans, we designed a High Protein:Energy Recipe Book.

These recipes will still provide plenty of nutrients while being extremely satiating and hard to overeat. These would be ideal a body builder trying to get lean or someone with a lot of weight to lose quickly.

The good news is that you don’t need to start with the aggressive fat loss foods.  You can work your way up the scale, first by balancing your blood sugars with a lower carbohydrate diet. From there you can focus on nutrient density and satiety to ensure you keep moving forward.   By prioritising food quality means you don’t have to rely so much on food quantity.  

Summary 

To summarise, reducing the processed carbohydrates in your diet will help to lower both your blood glucose and insulin levels over the short term.  But if you want to reduce your basal insulin and avoid the complications of hyperinsulinemia and metabolic syndrome, you need to focus on optimising your body composition (i.e. losing body fat and/or gaining muscle). 

Optimising your insulin levels is not as simple as:

Carbs -> insulin ->  fat storage 

But rather:

Low satiety nutrient-poor foods -> increased cravings and appetite -> increased energy intake -> fat storage -> increased daily insulin

Reducing the processed carbs in your diet will help you stabilise your blood sugars (i.e. symptom management).  But if you want to reverse your diabetes, you should focus on nutrient-dense high satiety foods and meals that will enable you to reduce your insulin levels across the whole day.

The real solution to managing your diabetes, blood sugar, insulin levels and avoiding the myriad of complications of metabolic syndrome is:

High satiety nutrient-dense foods and meals -> decreased cravings and appetite -> decreased energy intake -> fat loss -> optimised insulin levels

To kickstart your journey towards optimal get your free program and one of 70+ food lists personalised just for you!  

Marty Kendall
 

  • Judy McDonald says:

    Hey Marty
    The blood sugar thing is still a mystery thing for me. A friend of mine is taking Diabex, to supposedly make insulin use the glucose more efficiently. I’m thinking she is really Type 2 but won’t admit it. Any thoughts?

    • Marty Kendall says:

      Diabex appeards to be metformin which is a popular drug for people with diabetes. Generally seems to have positive benefits (with some minor draw backs). Fundamentally, as detailed in this article, diabetes is a condition of energy toxicity (too much food, too much body fat) that tends to come back into line if you can focus on less processed high satiety nutrient dense foods.

  • Rob says:

    Hey Marty,

    My case is the perfect example to back up everything you and Ted Naiman are putting out there. I have a physiological change because of childhood radiation therapy simulating an acquired lipodystrophy in my subcutaneous adipocytes. I’ve been part of studies where I allowed harvesting of these cells for analysis at Rockefeller University in NY. (Search for total body radiation and metabolic syndrome /adipocytes/ adipokines in pubmed for more info). I am very lean (on the surface and simply cannot gain subcutaneous fat, BUT, I can easily store visceral fat. This has led to fasting triglycerides of 300 at age 12, and anywhere from 600 to 1000 during my 30’s. It also has caused the associated hyperinsulinemia, multiple cancers, gout, an early heart attack and Pre-diabetic glucose levels for over 20 years. There is a perfect linear relationship between my total fat load (measured by dexa) and my insulin levels, glucose levels. My LDL P is also affected by the triglycerides as any excess leads to overproduction of oversized VLDL, subsequent small dense remnants, despite very low LDL -direct readings.

    The bottom line is that both keto and low carb approaches have not corrected any of the hyperinsulinemia, hyperhomocystemia, hyper triglyceride levels, and a few other side effects.

  • joss says:

    question about some of the nutrient levels…specifically vit d, B1 and Zinc. None of these plans reach this, even with 2000 calories which is too much for someone of my size. What is the recommendation on this? Supplement?

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