Tag Archives: blood glucose

physiological insulin resistance and coffee addiction

I have a confession…  I like coffee.

I like coffee in the morning.

I like coffee in the afternoon.

I like coffee black.  I like it white.

I like it with sugar, with chocolate, or just plain.

I like the taste of coffee.

I like the way it makes me feel and helps me stay focused.

getting more out of my coffee

Do you know how I could enjoy coffee more?

I could stop drinking so darn much of it, that’s how.

If I drank less coffee I would restore my sensitivity to it.

It would then give me more of a hit when I did occasionally have it.

getting less out of my insulin

In a similar way that many of us have become addicted to coffee that leaves us less sensitive to the impact of caffeine, many of us have also become addicted to cheap processed simple carbohydrates that leave us insensitive to insulin.  We become more sensitive to carbohydrate and insulin if we have less of it.

the physiological insulin resistance straw man argument

One of the criticisms that is levelled at low carbohydrate diets is that it causes what is called ‘physiological insulin resistance’.

This can mean that a person who is restricting carbohydrates may end up with higher fasting blood sugars and may have higher blood sugars after a higher carbohydrate meal.

Check out this video to see how some interpret ‘physiological insulin resistance’ to be a bad thing and a reason to eat lots of carbohydrates.

diabetes diagnosis criteria

There are a number of factors that are considered in the diagnosis of someone with type 2 diabetes: [1]

  1. HbA1c, which is a measure of your average glucose over the past three months,
  2. random blood sugar,
  3. fasting blood sugar, and
  4. oral glucose test.

what is physiological insulin resistance?

One of the clearest explanations of physiological insulin resistance I’ve seen comes from Paul Jaminet who says that physiological insulin resistance is a protective response of the body that ensures that the brain gets the benefit of a limited supply of glucose.

Because the rest of the body is refusing to take up glucose, and the liver takes it up slowly, a meal of carbohydrates is followed by higher blood glucose levels in someone on a low carbohydrate diet.

The human body is very adaptive to different situations and different fuel sources.  Just because our reference data is from the past few decades when we have typically eaten large amounts of processed carbohydrates, we take that as the new normal.

Is physiological insulin resistance such a bad thing?

Maybe, maybe not.

Let’s look at what this means when it comes to the various tests that are done to diagnose diabetes.

oral glucose tolerance test

Yes, you may fail an oral glucose test if you are on a low carbohydrate diet due to physiological insulin resistance.  But this guy will probably see a rise in his blood sugars too if you fed him the equivalent of two cans of Coke in one hit. [2]

image001

If you have a large dose of fast digesting carbohydrates your body is not primed to dump a pile of insulin into the system.  It takes a while to wind up and adjust to large amount of carbohydrates. You also don’t have a high level of insulin washing around in your system from the last pizza meal.

It’s sort of like me and my coffee addiction.  Because there is not a lot of time when I don’t have some caffeine in my system I am not as sensitive to caffeine as I would be if I only had an occasional cup.

If you do want to pass an OGTT all you have to do is increase your carbohydrates for a few days before the test and your pancreas will increase the amount of insulin in your system and be better prepared for a high dose of carbohydrates. [3]

fasting blood sugar

Some people may find that their fasting blood sugars rise a little when they start consuming more fat and decrease carbohydrates, particularly if they increase their fat intake.

This is an area where your mileage may vary.  I have seen some people run at very low carbohydrate levels and end up with progressively higher fasting blood sugars.  Others see their fasting blood sugars continue to come down and ketones go up as they decrease the insulin load of their diet.

When on a lower carbohydrate diet you won’t have high levels of insulin floating around in your system and your body may choose to run blood glucose levels a little bit higher by secreting more glucose from the liver.  This is not really a problem if you feel OK.

Many people find this to be a passing phase and after a time of keeping the insulin load of their diet low see their blood sugars come down.

As you keep the glucose load of your diet low you will ‘dry up the root’ and eventually after glucose stores in the liver are depleted, your fatty liver is resolved and your body fat levels are reduced you just won’t have as much glucose available for your liver to keep pumping into your bloodstream.

If you find that you don’t feel good at very low carbohydrate levels then by all means increase your carbohydrates and protein particularly to ensure that you are getting adequate nutrition.  Check out the Goldilocks glucose zone article for more thoughts on how to find the right level of glucose for you.

Most people find that their calorie intake decreases with a LCHF approach, however as this study from Dr Thomas Syfriend shows long term excess calories even with a high fat diet is probably not going to end well.  Intermittent fasting or tracking your calories to make sure you’re not overdoing the butter may be helpful if you’re not achieving normal fasting blood sugars.

random blood sugar

Carbohydrates are the most potent thing that raises blood sugar.  If you are on a low carbohydrate diet chances are your random blood sugar (i.e. non-fasting) will be much lower than if you were on a high carbohydrate diet.

image003

With a smaller amount of dietary carbohydrates you should see much lower post meal blood sugars.

Generally the small amount of insulin that you generate after meals will bring your blood sugar down quickly.

HbA1c

With lower post meal blood sugars your average blood sugar will likely be much lower on a low carbohydrate diet.  Therefore your HbA1c, which is a measure of your average blood sugar over three months, [4] should be lower.

insulin levels

We are now understanding more and more that insulin resistance is public health enemy number one.  Insulin resistance is a better predictor of heart disease than HDL, LDL, BMI and smoking! [5]

Making sure you have some time when high levels of insulin are not floating around in your blood stream will help increase your insulin sensitivity and enable your body to manage your blood sugars.

Consistently high levels of carbohydrates will ensure that your insulin resistance stays high!

image005

I am probably not going to stop drinking coffee any time soon, but in view of the evidence I do try to make sure that I have periods where I give my body a chance to restore its sensitivity to insulin!

If you are interested in reducing your insulin load while ensuring that you achieve great nutrition that supports your goals, check out this list of optimal foods and meals.

 

[1] http://www.webmd.com/diabetes/tc/criteria-for-diagnosing-diabetes-topic-overview

[2] 1922 photograph of an Aboriginal hunter (from the National Museum of Australia) via http://www.primalbody-primalmind.com/the-australian-indigenous-health-project/ .  It’s sad to see how the Aborigines in Australia have done on the white man’s diet when they were such a proud healthy people before we came along!

[3] http://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/#axzz3besTwOta

[4] http://en.wikipedia.org/wiki/Glycated_hemoglobin

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628708/pdf/361.pdf

superfoods for diabetes & nutritional ketosis

These foods will help you to maintain excellent blood glucose levels by reducing the insulin load of your diet while at the same time maximising nutrient density to minimise cravings and allow you to get the nutrients you need with less food.

More than carbohydrates or the glycemic index, the food insulin index data suggests that our blood glucose and insulin response to food is better predicted by net carbohydrates plus about half the protein we eat.

There is a relationship between carbohydrate and our insulin response to the food we eat, but it is not that strong, particularly when it comes to high protein foods or high fibre foods.

insulin response to carbohydrate from the food insulin index testing

Accounting for fibre and protein enables us to more accurately predict the amount of insulin that will be required to metabolise a particular food.  This knowledge can be useful for someone with diabetes and / or a person who is insulin resistant to help them calculate their insulin dosage or to choose foods that will require less insulin.  People wanting to following a ketogenic diet will want to select foods towards the bottom corner of this chart.

insulin response to food = net carbs + 0.56 * protein

If your blood glucose levels are high you are likely insulin resistant (e.g.  type 2 diabetes) or not able to produce enough insulin (e.g. type 1 diabetes) it makes sense to reduce the insulin load of your food so your pancreas can keep up.

This list of foods has been optimised to reduce the insulin load while also maximising nutrient density.  These low insulin load, high nutrient density foods will lead to improved blood sugar control and normalised insulin levels.  Reduced insulin levels will allow body fat to be released and be used for energy to improve body composition and insulin resistance.

As shown in the chart below this selection of foods is also nutrient dense and provides a substantially greater amount of nutrients compared to the average of all foods available.

2017-02-27 (2).png

From a macronutrient perspective these foods have a similar protein content to the rest of the foods in the USDA database, more fibre but much less digestible non-fibre carbohydrate.  And the carbohydrates that are there come from nutrient dense veggies that are hard to overconsume compared to the processed nutrient poor carbs that are typically causing the issues for people.

2017-02-27 (3).png

Included in the tables are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score (MCA) that combines all these factors.  Why not use these lists to inspire you next shopping trip at the grocery store?

vegetables and fruit

image19

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
endive 17 23% 1 17 1.9
chicory greens 15 23% 2 23 1.8
alfalfa 12 19% 1 23 1.7
escarole 14 24% 1 19 1.7
coriander 14 30% 2 23 1.6
spinach 19 49% 4 23 1.3
curry powder 5 13% 14 325 1.3
beet greens 12 35% 2 22 1.3
basil 18 47% 3 23 1.3
zucchini 14 40% 2 17 1.3
asparagus 17 50% 3 22 1.2
paprika 8 27% 26 282 1.2
mustard greens 8 36% 3 27 1.1
parsley 14 48% 5 36 1.1
turnip greens 12 44% 4 29 1.1
banana pepper 7 36% 3 27 1.0
collards 8 37% 4 33 1.0
arugula 12 45% 3 25 1.0
lettuce 14 50% 2 15 1.0
chard 14 51% 3 19 1.0
eggplant 5 35% 3 25 1.0
pickles 8 39% 1 12 1.0
cucumber 8 39% 1 12 1.0
okra 13 50% 3 22 1.0
summer squash 10 45% 2 19 1.0
sage 4 26% 26 315 0.9
poppy seeds 1 17% 23 525 0.9
Chinese cabbage 14 54% 2 12 0.9
watercress 20 65% 2 11 0.9
chives 12 48% 4 30 0.9
broccoli 13 50% 5 35 0.9
edamame 8 41% 13 121 0.9
sauerkraut 6 39% 2 19 0.9
jalapeno peppers 4 37% 3 27 0.9
cloves 6 35% 35 274 0.9
cauliflower 11 50% 4 25 0.9
marjoram 4 31% 27 271 0.9
caraway seed 3 27% 28 333 0.8
thyme 5 34% 31 276 0.8
red peppers 6 40% 3 31 0.8
radishes 7 43% 2 16 0.8
celery 10 50% 3 18 0.8
portabella mushrooms 12 55% 5 29 0.8

eggs and dairy

dairy20and20eggs

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
egg yolk 5 18% 12 275 1.2
whole egg 6 30% 10 143 1.1
cream -6 6% 5 340 1.0
sour cream -5 13% 6 198 0.9
limburger cheese -1 19% 15 327 0.9
cream cheese -5 11% 10 350 0.9
camembert -1 21% 16 300 0.8
feta cheese -1 22% 15 264 0.8
Swiss cheese -0 22% 22 393 0.8
butter -7 2% 3 718 0.8
blue cheese -1 21% 19 353 0.8
gruyere cheese -0 22% 23 413 0.8
edam cheese -1 23% 21 357 0.8
cheddar cheese -2 20% 20 410 0.8
brie -3 19% 16 334 0.8
Monterey cheese -2 20% 19 373 0.8
goat cheese -3 21% 14 264 0.8
muenster cheese -2 21% 19 368 0.8
gouda cheese -1 24% 21 356 0.8
Colby -2 21% 20 394 0.7
ricotta -2 27% 12 174 0.7

nuts, seeds and legumes

image10

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
sunflower seeds 3 15% 22 546 1.0
flax seed 0 11% 16 534 1.0
coconut milk -6 8% 5 230 1.0
sesame seeds -2 10% 17 631 0.9
brazil nuts -2 9% 16 659 0.9
coconut cream -7 8% 7 330 0.9
pumpkin seeds 1 19% 29 559 0.9
hazelnuts -2 10% 17 629 0.9
coconut meat -6 10% 9 354 0.8
walnuts -1 13% 22 619 0.8
almonds -1 15% 25 607 0.8
pine nuts -3 11% 21 673 0.8
almond butter -1 16% 26 614 0.8
pecans -5 6% 12 691 0.8
macadamia nuts -6 6% 12 718 0.7

seafood

seafood-salad-5616x3744-shrimp-scallop-greens-738

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
mackerel 0 14% 10 305 1.1
fish roe 15 47% 18 143 1.1
caviar 9 33% 23 264 1.1
cisco 5 29% 13 177 1.0
trout 13 45% 18 168 1.0
sardine 9 37% 19 208 1.0
sturgeon 14 49% 16 135 0.9
salmon 15 52% 20 156 0.9
anchovy 11 44% 22 210 0.9
herring 7 36% 19 217 0.9

offal

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
beef brains 3 22% 8 151 1.1
lamb brains 5 27% 10 154 1.1
sweetbread -3 12% 9 318 1.0
lamb liver 14 48% 20 168 1.0
turkey liver 13 47% 21 189 1.0
chicken liver 14 50% 20 172 0.9
liver sausage -4 13% 10 331 0.9
chicken liver pate 5 34% 17 201 0.9
lamb kidney 14 52% 15 112 0.9
veal liver 15 55% 26 192 0.8
liver pate -4 16% 13 319 0.8
lamb sweetbread 7 43% 15 144 0.8
beef kidney 11 52% 20 157 0.7

animal products

7450703_orig

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
bratwurst 0 16% 13 333 1.0
ground turkey 5 30% 19 258 0.9
bacon -4 11% 11 417 0.9
pork sausage 1 25% 13 217 0.9
salami -1 18% 17 378 0.9
pork ribs -1 18% 16 361 0.9
kielbasa -3 15% 12 325 0.9
turkey bacon -3 19% 11 226 0.8
pork sausage -2 20% 16 325 0.8
knackwurst -4 16% 12 307 0.8
roast pork 8 41% 20 199 0.8
bologna -7 11% 9 310 0.8
pepperoni -4 13% 16 504 0.8
beef sausage -3 18% 15 332 0.8
lamb rib -2 19% 17 361 0.8
duck -3 18% 15 337 0.8
pork ribs 6 39% 21 216 0.8
blood sausage -5 14% 13 379 0.8
pork loin 7 41% 19 193 0.8
frankfurter -5 17% 12 290 0.8
meatballs -3 19% 14 286 0.8
headcheese -5 20% 8 157 0.8
roast ham 6 41% 18 178 0.8
chorizo -3 17% 19 455 0.8
roast beef 5 38% 21 219 0.7
turkey -2 20% 21 414 0.7
chicken (leg with skin) 6 42% 18 184 0.7
T-bone steak -1 26% 19 294 0.7
ground beef 1 30% 18 248 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.

image02