Macros to Reverse Insulin Resistance and Achieve Optimal Health

There are many beliefs about reversing insulin resistance by managing your macros — protein, fat and carbohydrates.

Many in the low-carb and keto communities believe swapping carbs for fat and even avoiding protein is the best way to reverse insulin resistance, also known as hyperinsulinemia!

However, the reality is a little more complex.

While switching your carbs for fat may help you manage one of the symptoms of insulin resistance (i.e., elevated blood glucose after eating), it may not address the root cause (energy toxicity) or improve your metabolic health.

• While carbohydrates raise your blood glucose and insulin the most in the short term, all foods drive an insulin response over the long term.  A functioning pancreas always produces just enough insulin to store all the energy you eat. 
• Most of the insulin produced by your pancreas acts to hold your energy in storage, and the more body fat you have, the higher your insulin levels will be.

So it’s not:

carbs -> insulin -> store fat

But rather:

low-satiety foods -> volatile blood glucose -> increased cravings -> increased energy intake -> fat storage -> increased insulin -> insulin resistance

Thus, the solution is:

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

As you will learn in this article, rather than simply avoiding carbs and protein, the best way to reduce your insulin is to prioritise nutrient-dense foods that increase satiety.

This will enable you to control your appetite, lose weight with less hunger, and improve your body composition and metabolic health over the long term.

Conditions Associated with Insulin Resistance

Hyperinsulinemia and insulin resistance are associated with many modern health conditions, including:

• heart disease
• stroke
• Alzheimer’s disease
• type 2 diabetes
• high cholesterol
• high blood pressure (hypertension)
• abdominal obesity
• non-alcoholic fatty liver disease (NAFLD)
• polycystic ovary syndrome (PCOS)
• endometriosis
• neuropathy
• cataracts
• depression
• gout
• atherosclerosis
• gastroesophageal reflux disease (GERD)
• obstructive sleep apnoea
• cancer

Yes, insulin gets blamed for a lot of things!  But correlation does not equal causation. 

As you will see, insulin is only the bad guy in the story if you inject too much of it.

Lowering your insulin is a worthy goal, but there is still much confusion about the best way to achieve it.

As you will see, insulin itself is not the fundamental problem.  The root cause of all these issues is NOT insulin toxicity; it’s energy toxicity.

Every degenerative disease you can think of is associated with the hyperinsulinemia of chronic energy toxicity.

? pic.twitter.com/kH263ChosQ

— Ted ?? Naiman (@tednaiman) May 14, 2019

Insulin is not the bad guy in this whodunit mystery.  Our bodies respond with more insulin when you have more energy stored in your body and coming in via your mouth.  Insulin is trying to help by stopping all your stored energy from flowing into your bloodstream!

What Causes High Insulin Levels? 

While insulin often gets blamed for many things, the root cause of insulin resistance and hyperinsulinemia is energy toxicity, driven by our modern food system, designed for maximum palatability, consumption and profit.  Modern foods are designed with a perfect combination of fat, carbs, minerals, and vitamins to hit our nutrient bliss points and make us buy and eat more.

But don’t worry.  

There’s good news.  

This article will show how to adjust your macros to maximize satiety and reverse your insulin resistance.

What Does Insulin Do In Your Body?

But before we discuss how to dial in your macros to reverse your insulin resistance, let’s examine the roles of insulin in your body.

Insulin plays several unique roles in the body, including:

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

We often consider insulin to be an anabolic hormone that pushes energy into storage and helps build and repair our muscles and organs.  

However, if your goal is to lower insulin and reverse your insulin resistance, it’s more helpful to focus on insulin’s role as an anti-catabolic hormone that stores energy and stops your body from breaking down.

The Problem With Injected Insulin

Insulin often gets a bad rap because it can cause people to put on weight rapidly.  However, the problem is not the insulin.  Insulin does not make us store food that we don’t eat. 

The problem with injected insulin is that it’s hard to match insulin doses perfectly to the food we usually eat.  People injecting insulin eat more than they otherwise would after their blood sugars drop too low because they compensate for injecting too much insulin. 

Refined carbs raise glucose and insulin quickly, but fat keeps them elevated longer.  So, the fat + carb combo foods we tend to overeat also keep us in storage mode, with elevated insulin and glucose, for much longer. 

We must inject even more insulin to lower glucose caused by low-satiety foods, and the cycle continues.  This gives them a front-row seat on what we commonly refer to as the blood sugar-insulin roller coaster.

One of the key benefits of a lower-carb diet is that it helps people normalise their glucose variability and restore healthy appetite signalling.  But that’s only the first part of the story if we want to address the root cause of insulin resistance.   

Bolus vs Basal Insulin

Living with two people who have type 1 diabetes — my wife and my son — has provided me with some unique insights into what insulin does in our bodies, particularly the underappreciated role of basal insulin.

Bolus Insulin (with Meals)

People with Type 2 diabetes inject bolus insulin with their meals, so bolus insulin usually gets most of the attention. 

Most of the testing of the insulin response to food is only carried out over two hours, as shown in the figure below from testing done to develop the Food Insulin Index. 

However, we know from Type 1 Diabetics using insulin pumps that can measure insulin throughout the day that the insulin response to the food we eat is only about half of the total daily dose (TDD). 

Basal Insulin (Throughout the Day)

The remainder of the daily insulin is known as basal insulin, which is required whether we eat or not. 

If your pancreas did not continually produce basal insulin, your body would release all your stored energy — fat, glucose and the protein in your muscles — into your bloodstream.  You would see extremely high glucose, ketone and free fatty acids in the bloodstream (i.e. diabetic ketoacidosis).  You would quickly waste away like an uncontrolled Type 1 Diabetic. 

People on a lower-carb or keto diet reduce their short-term bolus insulin requirement by reducing carbs.  But their basal insulin won’t lower unless they lower the fat in their diet and body. 

While your glucose and insulin variability may be smaller in a low-carb diet, you can still have high fasting insulin levels throughout the day if you’re carrying more fat than your body is comfortable with.  Because the total daily insulin is primarily a function of your body weight, the amount of insulin your pancreas still pumps out will still be is sky-high. 

The Fatal Flaw in the Carbohydrate–Insulin Hypothesis

The central tenet of the carbohydrate-insulin model of obesity is the belief that we can control our insulin by simply reducing our carbohydrate intake as if that’s the only thing that affects insulin.   

Although many of us think we would like to turn off our insulin to lose weight, it doesn’t work that way if you’re part of the 99.9% of the population with a working pancreas and not injecting insulin.

Diabulimia

People with Type 1 Diabetes can intentionally underdose insulin and run their glucose levels high to deliberately lose weight.  This practice is known as diabulimia and can lead to many dangerous complications, including diabetic ketoacidosis.  Fortunately, those of us who do not have Type 1 Diabetes cannot intentionally turn off our pancreas, regardless of what we eat. 

The Root Cause of Insulin Resistance Is Exceeding Your Personal Fat Threshold

Because carbs raise insulin and blood glucose more over the short term, many people see diabetes as a disease of carbohydrate intolerance or insulin toxicity.  

However, the root cause of insulin resistance is primarily exceeding your Personal Fat Threshold, leading to energy toxicity and a cascade of metabolic issues.

BODY COMPOSITION == METABOLIC HEALTH.

This actually simplifies things, as absolutely everyone has the same goal:

MORE MUSCLE

and

LESS FAT.

Which is accomplished with:

HIGHER P:E RATIO

and

RESISTANCE TRAINING.

? pic.twitter.com/UOInjgPtBb

— Ted ?? Naiman (@tednaiman) January 23, 2022

Once your fat cells fill to capacity and you exceed Your Personal Fat Threshold, any excess energy from your diet will overflow into your bloodstream as elevated blood glucose, ketones, and free fatty acids.   

Insulin signals your liver to slow the release of stored energy so long as you still have plenty of energy in your bloodstream.  But the good news is, when we consume higher-satiety foods that allow us to eat less, our pancreas dials back insulin.  Glucagon tells our liver to release stored energy into our bloodstream.

What Should My Macros Be to Reverse Insulin Resistance?

While eating more protein and fibre with fewer carbs and fat is essential, everyone has different demands based on their activity level, metabolic rate, muscle mass, and many other factors. 

Reducing carbohydrates is a helpful first step to stabilising insulin and blood glucose.  However, simply switching carbs for fat is primarily symptom management.  To reverse the root cause — energy toxicity — you must optimise your diet for greater satiety per calorie.

If you want a ballpark estimate of your target macros, use our macro calculator to calculate your theoretical protein, carb and fat targets.  But the best way is to track and tweak your macros. 

Step 1:  Reduce Carbohydrates

If you have diabetes and are investigating how to reverse insulin resistance and lose weight, your first logical step should be to reduce processed dietary carbs. 

As shown below, moving from 48% to 20% carbs aligns with greater satiety.   If your glucose levels after meals rise by more than 30 mg/dL or 1.6 mmol/L, it’s safe to assume you consume more carbs than your body needs.  

However, it’s also important to note that while lower carb is good, zero carb are not necessarily better.

• Cutting out all carbohydrates also eliminates non-starchy vegetables, which provide minerals and vitamins that complement the nutrient profile of lower-carb foods like meat, seafood and dairy.  Our analysis also shows that the diet quality score peaks at around 20% carbohydrates. 
• Your body can produce the glucose it needs from protein.  However, gluconeogenesis is more effort than getting some carbohydrates from your food.  Hence, your carb cravings may increase if both carbs and protein are very low, especially if you are doing a lot of intense activity and may eat more overall. 

Step 2:  Prioritise Protein

One key benefit of a lower-carb diet is that most people increase their protein intake.  However, prioritising protein is crucial if your goal is to reverse your insulin resistance. 

This doesn’t necessarily mean you need to eat a lot more protein.  Instead, you must ensure you get the protein you need with less energy from carbs and fat.  This leads to a higher protein %, which aligns with higher satiety and eating less.  

Step 3:  Use Fat as a Lever

Fat is an excellent fuel source on a lower-carb diet.  But, it’s also the lowest satiety of the three macronutrients and the easiest to manipulate to reduce our energy intake to ensure the fat loss continues. 

So if your carbs are low and you’re getting adequate protein, the final weight loss and puzzle of reversing insulin resistance is to dial back your dietary fat to allow your body to use your body fat.   

Need Some Extra Help?

If you need some extra help dialling in your macros to achieve your goals, particularly for insulin resistance, diabetes, or weight loss, we’d love you to join our Optimising Nutrition Community.  Here, we have many free tools and resources, including food lists, meal plans, and recipes optimised for your unique goals and preferences.

Thus, there is no perfect ‘insulin resistance macros ratio’ or ratio breakdown of macronutrients that’s universal for everyone with insulin resistance.  Besides, jumping from a diet of X amount of protein directly to Y amount can shock the system (and the mind) and push someone to tap out quickly.

If you want a structured approach to fine-tuning your macros to increase satiety, stabilise your blood glucose, and help you lose weight and reverse insulin resistance, we’d love for you to join our next Macros Masterclass.

Summary

Reducing processed carbohydrates will help to stabilise your blood glucose and insulin levels.  But if you want to lower your basal insulin and avoid the long-term complications of hyperinsulinemia and metabolic syndrome, you need to optimise your body composition.  

So it’s not:

carbs -> insulin -> store fat

But rather:

low-satiety foods -> volatile blood glucose -> increased cravings -> increased energy intake -> fat storage -> increased insulin -> insulin resistance

Thus, the solution is:

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

How have you adjusted your macronutrient ratios to manage insulin resistance, and what results have you experienced? Share your journey with us in the comments!

More

• How to Reverse Insulin Resistance: A Comprehensive Guide
• Ditch the Fads: This Interactive Tool Reveals the Perfect Foods for YOU
• Conquer Type 2 Diabetes: Your Fork-Powered Roadmap to Remission
• Macros Masterclass
• Decipher the Insulin Code: How to Lower Your Insulin Levels