In previous articles, I have outlined the idea of the insulin load  which is similar to carbohydrate counting but also accounts for the effect of protein, fibre ad fructose.
insulin load = total carbohydrates – fibre + 0.56 x protein
show me the data!
Most people understand that dietary carbohydrate is the primary nutrient that influences blood glucose and insulin as shown in the charts below. However, indigestible fibre and glucogenic amino acids (protein)  also affect our blood glucose and our insulin response to food.
We can better predict the insulin and glucose response to our food if we also account for the effect of protein and indigestible carbohydrates (i.e. fibre). People aiming to follow ketogenic diet will want to eat foods towards the bottom left of these charts.
I was pleased to see Jason Fung even mention the food insulin index and the Optimising Nutrition blog at the recent low carb conference in Vail Colorado and it has been great to see a handful of people like Patricia and Mike put this theory into practice with great results as detailed in this article.
This comment from Patricia Berry Moore made my day.
Marty! Are you the Low Carb Down Under Marty??!
You and Sarah Hallberg are why I started LCHF. And went from a very unhealthy type 2 diabetic at 156 lbs to a very healthy 113 lbs.
Patricia had seen my presentation on the food insulin index, applied the theory, and it worked!
I use the insulin load concept.
I find it helps me refine my macros. A little less protein a bit more carbs and you can find that sweet spot. For me 50g per day is perfect.
My doctor threatened me with insulin and so I started went digging and found your lectures.
Over 10 months I lost 43 lbs (I’m 5’2″). I was pre-diabetic for ten years and then type 2 diabetic for ten years.
I am now off all my meds. I was on eight different ones for high blood pressure, high cholesterol, arthritis, re-flux, diabetes.
I’m never going back, so thank you!
This is Patricia’s “before photo.” You can see a ‘puffiness’ in her face characteristic of insulin resistance and hyperinsulinemia, which causes fluid retention. I showed this photo to my 12-year-old daughter who said “that’s how you used to look.”
If you’ve hit a plateau it might be worth tracking the insulin load of your food for a while to fine-tune your diet. Patricia says:
I started at around 80g per day. As I decreased it, my blood sugars improved.
At this point my fasting blood glucose run at 65 – 75 mg/dL with an insulin load around 50g per day or so.
LCHF has really saved my life Marty.
This is Patricia now. Congratulations Patricia!
a little closer to home
As mentioned by my daughter, this is me before and after trying out my low insulin load, high nutrient density foods. I don’t think my hair moved in the 18 months between when these work profile photos were taken, but some inflammation and weight certainly did. My family assures me that at my worst I was bigger and unhealthier looking than the photo on the left!
The photo below on the left is my daughter’s “before photo” after spending 9 months in a high insulin environment. Children born to mothers who are type 1 diabetic and dosing with lots of insulin tend to be delivered early via C-section due to their excessive size caused by the high levels of insulin from the mother. The photo on the right is her twelve years later, all grown up!
The photos below are the same child, “JL,” who was one of the first type 1 diabetic children to receive insulin treatment in 1922. Without insulin he’s wasting away, literally eating his own fat and muscle, unable to metabolise carbohydrates. Two months later the photo on the right shows that he’s been able to make a full recovery with insulin injections.
The photo below is of another Type 1 sufferer before and after receiving exogenous insulin.
Hopefully from these photos, you can see how there’s a “Goldilocks zone” for insulin. Not too little. Not too much. Just right. You can use the quantification of insulin load to find your sweet spot.
I received similar feedback recently from Mike Alward who has also successfully applied the insulin load theory. Mike says:
I just wanted to say thanks for your work on insulin load, food insulin index and glucose : ketone index. It really helped me to understand what was holding me back from reaching and being able to maintain a state of optimal ketosis.
I manage my insulin load to ~75g per day. My BG has come down and my ketones are now in the optimal range. My GKI is now below 3.
I used to be pre-diabetic with blood glucose up around 6.5 mmol/L. Now, I am in the 4.5 – 4.7mmol/L range.
Being in optimal ketosis has helped to control my appetite and cravings (especially sugar), which has made intermittent fasting so much easier.
Keep up this important work!
With this reduced insulin approach, Mike is able to accommodate a solid amount of protein into his diet while maintaining excellent blood glucose and ketone levels. Like anything, you can have too much of a good thing, including protein.
Many people find that as their insulin resistance improves they are able to handle a higher insulin load diet which may enable a higher nutrient density and less fat. If you are highly insulin resistant you may need to focus on a very low insulin load, high-fat approach. As your blood glucose levels stabilise you will be able to transition to more nutrient-dense foods that may have a higher insulin load.
My insulin load target is ~90g – 100g of protein / day. I am 6’0″.
Mike likes to track a range of different health makers.
I track my weight calories, macros, calculated insulin load, blood glucose, blood ketones and GKI.
Not everybody “geeks out” on this stuff. I am totally into “nerd safaris” to research non-conventional wisdom health.
You can see in the chart below how Mike’s ketones have increased as he has reduced the insulin load of his diet.
Tracking the insulin load of your diet is a little more complex than just counting carbs, but not that much more work if you’re already tracking your food intake. Personally, I’m not a big fan of tracking everything you eat forever, but it can be useful to keep a food diary for a time to reflect and refine.
If you just want to know what you should eat these lists of optimal foods for different goals may be useful for you.
how to calculate your insulin load
So how do you calculate the insulin load of your diet?
If you’re already tracking your food intake it’s a pretty simple thing to do. Below is an example output from MyFitnessPal showing the food intake for the day comprising of:
- carbohydrates (70g),
- fibre (63g), and
- protein (104g)
So we start with the insulin load formula:
insulin load = carbohydrates (g) – fibre (g) + 0.56 x protein (g)
Insert our values:
insulin load = 70g carbohydrates – 63g fibre + 0.56 x 104g protein
and calculate insulin load:
insulin load = 65g
It’s not that much different to tracking net carbs, but instead, you also account for protein which also requires insulin.
I initially developed this calculation for people with Type 1 Diabetes (like my wife) who need to calculate their insulin dosage but it can work in a similar way for someone wanting to reduce the demand on their pancreas to the point that it can keep up and maintain normal blood glucose levels.
Reducing your insulin levels to normal healthy levels will allow your stored fat to be used for energy and manage your appetite. As you track your insulin load you can keep eliminating the foods that are driving it up until the point that you see the weight loss and blood glucose levels that you’re chasing. More recently I have incorporated this as a metric you can track in the Nutrient Optimiser to achieve your target glucose and ketone levels.
The appropriate insulin load will vary from person to person. A small woman aiming for weight loss using a lower protein ketogenic approach might have an insulin load as low as 40g per day while a larger man looking who is active and looking to build muscle might have an insulin load as high as 300g per day.
A higher insulin load diet would allow more plant-based foods, less fat and potentially a higher nutrient density (e.g. 40 to 50% of insulinogenic calories). The first priority will be to reduce the insulin load of your diet to the point where you can normalise your blood glucose levels and reduce insulin (e.g. 20 to 30% of insulinogenic calories).
The best idea is to start tracking where you’re currently at and look to reduce your daily insulin load until you achieve excellent blood glucose levels (i.e. average less than 5.6 mmol/L or 100 mg/dL). Once you normalise your blood glucose levels you could keep winding it down further until you achieve your desired level of ketones. As your body heals and you start to reduce the amount of fat around your organs you may be able to tolerate a higher insulin load diet and a more nutrient-dense diet in time.
a little more on the insulin load theory
So is it all about the insulin load? What about calories and conservation of energy?
In a metabolic ward context, we typically find conservation of energy / CICO holds true. If anything someone on a high-fat diet may be able to maintain their weight with fewer calories because fat is easier to digest and products less wasted energy (enthalpy). But in a free-living environment how much we eat is influenced by our appetite which is influenced by the nutrient density of our food choices as well as our levels of insulin resistance.
This video gives a good overview of how insulin (either injected or from our own pancreas) affects whether we store fat on our body or release it to be used for fuel and how excess insulin can be problematic.
Most people think of macronutrients in terms of carbohydrates, protein and fat as per the picture below. They think that if we eat too much fat it will be stored as body fat. But the reality is a little bit more complex than that.
In the chart below the grey slices of the pie chart (i.e. the non-fibre carbohydrate and the glucogenic protein) are the components of your food that are glucogenic and will require insulin to metabolise.
The blue components are ketogenic (i.e. the dietary fat and the ketogenic protein) and do not require insulin to metabolise. If you’re lucky enough to be insulin sensitive you will burn the food you eat and your appetite will be well regulated with minimal change in body weight.
Indigestible fibre (black slice) doesn’t significantly affect our insulin response or even contribute to calories for us but rather is used to feed the bacteria in our gut. Fibre is a true ‘free food’.
If the insulin load of our diet is too high we are more likely to store a portion of the food. If we are insulin resistant our body will have to generate more insulin to deal with the non-fibre carbohydrate and glucogenic protein while increasing our chances that some of the food we eat will be stored on our body. We feel hungry and need to keep eating to obtain adequate energy. Calories still matter, but outside a controlled metabolic ward, body fat accumulation is more about managing fat storage and appetite than about counting calories.
Calories still matter, but outside a controlled metabolic laboratory, body fat accumulation is more about managing fat storage and appetite than consciously counting calories. Many people refer to insulin as the thermostat that controls our metabolism and our fat storage.
The good news here is that we can use our understanding of the storage properties of insulin to our advantage. If we are able to decrease the insulin load of our diet we are less likely to store fat and more likely to be able to use some of our stored body fat for energy. This will mean that we feel less compelled to eat because we are able to use up our own body fat rather than constantly eating. This reduced dietary insulin load scenario will lead to lower insulin levels, less storage, more use of body fat for fuel, a decreased appetite and a reduction in energy intake.
So, to reduce the insulin load of diet include you can:
- eat more fibre,
- eat less digestible carbohydrates, and
- make sure your protein intake is not excessive.
can you eat too much fat?
Can you still eat too fat much while keeping the insulin load of your diet low?
The short answer is yes, especially if you’re chasing a certain macronutrient value or high ketone values. Some people are able to stay very lean on a high fat ketogenic diet, but others need to also manage their dietary fat inputs to achieve their goal of body fat output.
The good news is that a low insulin load nutrient-dense diet will typically lead to increased satiety and reduced energy intake.
The bad news is that excess energy, whatever the source, will lead to fat gain, inflammation and insulin resistance.
Many people recommend that you should eat ‘fat to satiety’. Unfortunately, high-fat foods can be easy to overeat, at least for some individuals. There is no need to force yourself to eat extra fat if you are trying to lose weight. There’s no need to go out of your way to add extra fat and oils to your food. If your goal is weight loss, you can obtain more than enough fat from whole-food sources.
basal insulin and insulin resistance
The other unfortunate fact is that the insulin produced in response to food is less than half of the amount of insulin that your body produces. Your pancreas is constantly producing basal insulin to manage the flow of energy out of your liver and to remove excess energy from your bloodstream.
In addition to reducing the insulin load of your diet, you may also need to increase the periods between your meals (intermittent fasting) and focus on building lean muscle mass to improve your insulin sensitivity. This will allow your insulin levels to decrease even more so that body fat can be accessed for fuel.
Implementing an intermittent fasting regimen can be useful for people who find that reducing the dietary insulin load doesn’t lead to enough reduction in appetite.
As detailed in the how to use your glucose metre as a fuel gauge article, waiting until your blood glucose levels drop can be a useful way to increase the timing between meals and to understand whether your hunger is real. Once your blood glucose levels normalise you can even use your bathroom scale to help time your fasting/feasting cycle to achieve your weight loss goals.
You can get a substantial decrease in insulin levels with a regular 18 to 24 hour fast. After this drop in insulin, you may find your hunger levels actually decrease after a longer period of not eating.
- To regain control of your appetite you need to insulin load of your diet to the point that your pancreas can keep up and maintain normal blood glucose levels consistent with your personal metabolic health and level of insulin sensitivity.
- If your blood glucose and insulin level are high then you should work to decrease the insulin load of your diet.
- As the insulin load of your diet decreases you should see your blood glucose levels come down, your appetite reduces and your ketone levels come up.
- If you’re still not seeing the results you want then the next step is to try intermittent fasting to further reduce your insulin and blood glucose as well as mitigate your overall food take.
- As your blood glucose levels start to normalise you can start to focus on more nutrient-dense foods with a lower energy density that may be helpful if weight loss is your goal.
- Making sense of the Food Insulin Index
- What foods raise your blood sugar and insulin levels (other than carbs)?
- Does protein raise blood sugar?
- The blood glucose, glucagon and insulin response to protein
- Insulin calculator for Type 1 Diabetes (including protein and fibre)
- What is the difference between glycemic index, the insulin index and insulin load?
- How to Reverse your Insulin Resistance
- What Does Insulin Do in Your Body?