Tag Archives: glycemic index

the intimate relationship between carbohydrates, protein, insulin, fibre, fat, sugar and nutrient density exposed!

  • The food insulin index data demonstrates that the carbohydrate content of your food does not accurately predict insulin response.
  • Protein requires about half as much insulin as carbohydrate.
  • Indigestible fibre from whole foods tends to have a minimal influence on our glucose and insulin response.
  • Dietary fat does not require a significant amount of insulin.
  • Net carbohydrates plus approximately half protein correlates well with our insulin response.
  • This understanding can help select foods that will cause a lower insulin response and enable more accurate calculation of insulin dosing for people with diabetes.

background

I used to dabble in share trading.  I don’t know much about financial systems, but I spent a lot of time designing and testing “trend following” trading systems.

When the Global Financial Crisis hit in 2009 things got too volatile, and I got out of the market.  It was no longer fun.  However, the skills I learned as a quantitative trader, along with my day job as an engineering running multi-criteria analyses to identify motorway alignments and prioritise road investments and the like have given me a unique perspective on nutrition that people seem to have found useful.

On the Optimising Nutrition blog, I have tried to describe a system to manage nutrition that makes sense to me.  In these articles, I try to document the things that I wish someone had shown to Monica and me when we started out trying to understand diabetes and nutrition.

If we want to understand and predict the behaviour of insulin, the master regulator hormone, we need to first determine what we know that is accurate, significant and useful that we can use.

Kirstine Bell’s PhD thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus[1] (Sept 2014) details the results of the latest food insulin test data for more than one hundred foods.  It also evaluates the relationship between insulin demand and protein, fat, carbohydrates, glycaemic index, glycaemic load, indigestible fibre, individual amino acids and blood glucose.

Previously I have discussed how to calculate how much insulin may be required based on the carbohydrate, protein and fibre ingested.  Given the importance of this issue, this article looks in more detail at what can be learned from the test data included in this thesis about the relationship between these parameters, to better manage blood glucose and insulin demand.

carbohydrate

The amount of carbohydrate does an excellent job of explaining the amount our glucose levels increase.

Most people know that carbohydrates require insulin.  As shown in the chart below, the quantity of carbohydrate goes some way to explaining insulin response.  However it is far from a perfect relationship (R2 = 0.44, r = 0.67, p < 0.05).

fibre

Taking indigestible fibre into account (i.e. net carbohydrates) improves the relationship (R2 = 0.48, r = 0.69, p < 0.05).  The best correlation is achieved when we subtract all the indigestible fibre from the total carbohydrate value.  However, we can see from the cluster of data points on the vertical axis there is something going on that is not explained by carbohydrates alone.

The importance of dietary fibre should not be discounted, especially when trying to reduce insulin demand.  Some recommend that people with diabetes limit total carbohydrates, rather than considering net carbohydrates, or non-fibre carbohydrates.  The danger with a total carbohydrates approach is that people will avoid non-starchy fibrous vegetables that provide vitamins and minerals that cannot be obtained from other foods (unless you’re consuming a significant amount of organ meats), as well as feeding the gut bacteria which is also important to help improve insulin sensitivity and the body’s ability to digest fats. [2]

fat

The food insulin index data indicates that the highest fat foods have the lowest insulin response (R2 = 0.38, r = 0.631, p < 0.001).

 

The figure below shows a similar chart for the glucose score (i.e. the area under the curve of the blood glucose rise over three hours after ingestion of the food).  Blood glucose response is lowest for foods that contain a higher proportion of calories from fat (R2 = 0.45, r = 0.68, p < 0.001).

Now, while getting more of your energy from fat will help to reduce your insulin requirements and stabilise your blood sugar, you should keep in mind:

  1.  The glycerol backbone in fat can be converted to glucose if necessary via gluconeogenesis, so there can still be some insulin and glucose response to refined fat.
  2. Refined fat typically does not contain a broad spectrum of micronutrients.
  3. While type 2 diabetes appears on the surface to be a condition of glucose intolerance, it is fundamentally an issue with your adipose tissue being full.  Once you exceed your personal fat threshold your body fat is no longer able to hold excess energy and it spills over into the bloodstream.  Reducing the carbohydrates in your diet will stabilise the blood glucose swings, however, you will need to reduce your overall energy intake to enable the excess energy to flow from your body fat stores before you become truly insulin sensitive and lower your blood glucose levels.

protein

Another observation from trading is that you can learn a lot by considering outliers.  You have to decide whether the data points that don’t quite fit the trend are garbage or ‘black swans’ need to be accounted for in the system.

In the carbohydrate vs insulin relationship, the outliers are the high protein foods that trigger a higher insulin response than can be explained by considering carbohydrates alone.  When we zoom in on the bottom left corner of the carbohydrate vs insulin response chart we see that high-fat foods such as butter, bacon, avocado, olive oil and walnuts do not have a significant insulin response.  However, high protein foods such as fish, steak and tuna still have a significant insulin response.

As a general rule, as we increase the protein content of our food our insulin requirements come down.  High protein foods force out the processed carbohydrates which require the greatest amount of insulin.  Choosing higher protein foods will generally reduce insulin (R2 = 0.10, r = 0.47, p < 0.001).

Increasing protein will also typically lead to a spontaneous reduction in intake due to the thermic and satiety effects of protein. [3] [4]   It is vital to eat adequate protein, but it is hard to overeat protein due to the strong satiety response.

However, protein in excess of the body’s needs for growth and repair can be converted to glucose.  The fact that protein can turn to glucose represents a potential ‘hack’ for people with diabetes trying to manage their blood glucose as they can get the glucose required for brain function without spiking blood glucose as much as carbohydrates.

Choosing higher protein foods will lead to better blood glucose control.  Although high protein foods still raise the blood glucose somewhat, particularly if you are not insulin sensitive, however, the blood glucose response is gentler, and hence the pancreas can secrete enough insulin to balance blood glucose.

For most people, transitioning to a reduced carbohydrate whole foods diet will give them most of the results they are after.  However, for people who require a therapeutic ketogenic diet, consideration of protein may be necessary to achieve the desired outcomes.

For a healthy bodybuilder, the glucogenic and insulinogenic effect of protein might be an anabolic advantage, with the post-workout protein shake providing an insulin spike to help build muscle.

sugar

The sugar content of a food is not a particularly useful predictor of insulin demand (R2 = 0.10, r = 0.32, p = 0.001) compared with net carbohydrates (R2 = 0.48, r = 0.69, p < 0.05). Most people struggling with diabetes will need to consider the total sugar in their diet to optimise blood.

insulin load vs food insulin index

If we, take out indigestible fibre (net carbs), assume that fat has a negligible insulin response and refine the protein factor to maximise the correlation with the test data, we end up with this chart which has an improved correlation compared to the model above (R2 = 0.49, r = 0.70, p < 0.001).

nutrient density

One of the shortcomings of the insulin load concept is that extremes of insulin load can lead to a nutrient-poor outcome.  As shown in the chart below, nutrient density seems to peak at about 40% insulinogenic calories.  If you are insulin resistant, you will want to choose food that has less than 40% insulinogenic calories.

If you have diabetes, you may want to tweak your diet to less than 25% insulinogenic calories.  Meanwhile, if you are chasing therapeutic keto, then you will want less than 15% insulinogenic calories.  But keep in mind that this will have negative impacts on your ability to get the essential nutrients you need.

the Nutrient Optimiser

We’ve been working hard to build a tool that will make all this info easier to understand and apply.    If you head on over to NutrientOptimiser.com and tell us some details about yourself this exciting new free tool will give you target macronutrient ranges, optimal food choices and suggested meals that will help you reach your goals.

We’re very excited to have this tool now available for you to use.  We’d love your feedback on how we can improve it to help more people.

 

last updated January 2018

references

[1] http://ses.library.usyd.edu.au/handle/2123/11945

[2] http://www.amazon.com/Brain-Maker-Power-Microbes-Protect/dp/0316380105

[3] http://wholehealthsource.blogspot.com.au/2013/04/glucagon-dietary-protein-and-low.html

[4] http://www.ncbi.nlm.nih.gov/pubmed/16002798

[5] http://wholehealthsource.blogspot.com.au/2013/04/glucagon-dietary-protein-and-low.html

[6] http://ses.library.usyd.edu.au/handle/2123/11945

[7] http://ses.library.usyd.edu.au/handle/2123/11945

[8] http://www.amazon.com/Brain-Maker-Power-Microbes-Protect-ebook/dp/B00MEMMS9I

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 follow 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.

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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.

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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 your next trip to the grocery store?

vegetables and fruit

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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

the latest food insulin index data

Understanding the various factors that affect your insulin requirement is critical to diabetes management and optimal health.

Living with someone who has Type 1 Diabetes for seventeen years I’ve gained a deep appreciation of how different foods affect your blood glucose levels.  Poor food choices can send you on a blood glucose rollercoaster that can affect your appetite, mood and energy levels.

Luckily, the latest insulin index testing data can help us to better manage our food choices to manage our blood sugars and insulin levels.

In this article, I will share my analysis, experience and insights about how we can use the insights from insulin index testing to optimise your metabolic health.

The blood glucose roller coaster

Since she was ten, my wife Monica has had to manually manage her blood sugars as they swing up with food and then drop again when she injects insulin.

The continuous glucose monitor chart below shows a typical daily experience for someone with Type 1 Diabetes.

image16

High blood glucose levels make her feel “yucky”.  Then, plummeting blood glucose levels due to the mega doses of insulin don’t feel good either.

Low blood glucose levels drive you to eat until you feel good again.  This wild blood glucose roller coaster ride leaves you feeling exhausted.

These days Monica has an insulin pump which means she doesn’t have to insert a needle six times or more a day.  But we’ve found that good blood glucose control still comes down to managing the food you eat.  To stabilise the massive swings in blood sugars you need to make intelligent food choices to reduce the amount of insulin you need.

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The dietary advice that Monica has received over the past three decades living with Type 1 has been sketchy at best.  When she was first diagnosed with Type 1, Monica tells the story of being told to eat so much high carb food that she hid it in the pot plants in her hospital room.

These days the story is pretty much the same.  The photo below is of the daughter of some friends of ours, Lucy Smith, in the hospital just after she was diagnosed with Type 1 Diabetes.

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When we decided we wanted to have kids, we found a great doctor who helped us to understand how to match insulin with carbs.  However, no one told us how to make better food choices to reduce the amount of insulin required, including physicians, endocrinologists or diabetes educators.

We eventually stumbled across the low carb, and Monica has been able to significantly improve her blood glucose control.  This has enabled her to have a lot more energy to invest in to being a mother as well as going back to work as a teacher which she is loving.

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So, low carb produces great results for people trying to stabilise their blood sugars.  But there is still more to the story for people who need to actively manage insulin.

The latest food insulin index data

In early 2014, I came across Jason Fung’s Aetiology of Obesity series on YouTube where he discussed the food insulin index research that had been carried out at predominantly the University of Sydney which seemed to provide more insight into our insulin response to food.

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I hoped that by gaining a better understanding how different foods affect our requirement for insulin, I might be able to help further optimise our food to normalise Monica’s blood glucose swings.

However, unfortunately, while the concept of insulin index testing is exciting, the data that is commonly available is hard to make sense of.  The initial research into the food insulin index was detailed in a 1997 paper An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods by Susanne Holt, Jennie Brand-Miller and Peter Petocz who tested the insulin response to thirty-eight different foods.  The insulin score of the various foods tested is shown in the image below.

insulinindex

The food insulin index score of various foods was determined by feeding 1000kJ (or 239 kcal) of a range of foods to non-diabetic participants and measuring their insulin response over three hours.  Some example insulin responses to different foods are shown in the chart below

FII versus time chart

This value is then compared to the insulin response to pure glucose (which is assigned a value of 100%) to arrive at a “food insulin index” value for each food.  All foods tested were then ranked relative to pure glucose.

Considering how significant this information could be for people trying to manage their insulin levels I was surprised that there hadn’t been a lot of further research or discussion on the topic.  I found a few references and mentions in podcasts, but no one was quite sure what to do with the information.  The chart showing the insulin index of the original 38 foods tested was really more confusing than useful for most people.

But then I found the mother load of data!

But then, after searching some more, I came across a PhD thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus (Kirstine Bell, September 2014).   Appendix 3 of the thesis contained an extensive food insulin index database of foods that had now been tested.  The figure below shows all the foods tested plotted from smallest to largest insulin response.

[I know this is a bit hard to read.  You can click on the image to expand it.  I’ve uploaded these charts to Tableau online here so you can make more sense of the data.]

food insulin index for all foods tested.png

The chart below shows the relationship between carbohydrates and insulin response for all the foods tested to date.

carbohydrates vs food insulin index.png

As you can see, the relationship between the carbohydrates we eat and the insulin we require to metabolise our food is not straightforward.

Some high protein and low-fat foods (e.g. fish and steak) are sitting quite high up on the vertical axis while there are some high fibre foods (e.g. all bran and navy beans) and high fructose foods (e.g. raisins and apples) with a lower insulin response than you might expect.

However, once we account for the effect of protein, fibre we are able to more accurately predict our body’s insulin response to food.  The foods in the bottom left corner of this chart will require the least insulin (e.g. butter, olive oil and avocado) while the foods in the top right will require the most insulin (e.g. rice bubbles, cornflakes and jellybeans)

carbohydrates fibre protein and vs food insulin index.png

It’s also interesting to note that fructose (a form of sugar found in fruit) requires only about 25% as much insulin as glucose.  The glycerol backbone in fat can also be converted to glucose via gluconeogenesis if there is no other glucose availabe from glucose or protien in the diet.  However, neither of these have a massive influence compared to carbohydrates, protein and fibre.

How is this useful?

This improved ability to quantify our insulin response to food enables us to precisely identify foods that require less insulin and reduce the amplitude of our blood sugar swings in response to food.

Many people trying to follow a therapeutic ketogenic diet (for the management of cancer, epilepsy, Alzheimers, dementia etc.) have found it very useful to reduce their insulin requirements and increase their ketone levels.

Similarly, people with diabetes who are injecting insulin have also found it be invaluable to help them more accurately.

Calculating the proportion of insulinogenic calories is useful for people who require a very low insulin therapeutic ketogenic diet while insulin load is useful for people managing hyperinsulinemia, insulin resistance or diabetes (see Insulin dosing for Type 1 Diabetes article)

Monica’s daily insulin dose has dropped from more than fifty units a day to closer to 20 units of insulin per day, and the amplitude of her blood glucose swings is much smaller.  The improvement in the quality of life, energy levels and mood for someone with diabetes when they stabilise their blood sugars is massive.  I’ve seen and experience this first hand, hence my passion to get this message out!

image004-copy1

The problem with the food insulin index

The problem with looking at things purely from a food insulin index perspective is that the resultant high-fat foods do not provide a broad range of micronutrients.

A diet with a low proportion of insulinogenic calories also tends to be very energy dense which can make portion control more challenging for people wanting to lose weight.

While stabilise the glucose swings is related mainly to the quality of the food we eat, bringing down the overall blood sugar levels is mostly about weight loss and the quantity of food we eat.

Once we stabilise blood sugars with a lower insulin load diet, we then need to focus on reducing the energy density of your food to enable you to lose weight and allow then fat stores to function optimally.

Diabetes occurs when our fat stores become too full, and they can no longer expand and contract to absorb and release the food from our meals, and the excess energy spills into the bloodstream.  Increasing the nutrient:energy ratio of our food will allow us to get the nutrients we need with less energy which will, in turn, help us to achieve and maintain an optimal body fat level.

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optimal foods for different goals

This refined understanding of how to calculate our insulin response to food is a useful parameter, along with nutrient density and energy density, which enables us to prioritise our food choices to suit different goals.

Building on the ability to quantify insulin load, nutrient density and energy density, more recently I have been developing an exciting new tool.

2017-03-082

The Nutrient Optimiser reviews your food log diet and helps you to normalise your blood glucose and insulin levels by gradually retraining your eating habits by eliminating foods that boost your insulin level and blood glucose levels using our ability to calculate the insulin load.

As shown in the chart below, some nutrients are easy to find.  However, most of us have a large number of micronutrient gaps and need to prioritise the foods and meals that will provide those harder to find nutrients.  Once your glucose levels are normalised, the Nutrient Optimiser starts to focus more on providing you with the nutrients you need with less energy.

2017-03-08-2

Then, if you still have weight to lose, the Nutrient Optimiser will focus on the energy density of your diet until you have achieved your desired level of weight loss.

It’s early days for the Nutrient Optimiser, but the initial results are very promising.   I’d love it if you’d head over to NutrientOptimiser.com to get your free report to find your optimal dietary approach and which foods, meals will be ideal for you.

 

 

Post last updated January 2018

ketosis… the cure for diabetes?

  • A reduced insulin load diet will lead to normalised blood sugars and improved insulin sensitivity.
  • A reduced insulin load diet can be achieved by reducing carbohydrates, moderating protein and choosing higher fibre foods.
  • Intermittent fasting also reduces insulin load.
  • Measuring your blood sugars is a simple and cost effective way to check that your metabolic health is on track.
  • A diet of nutrient dense, high fibre, high fat foods is the best way to optimise nutrition and minimise the risks associated with diabetes.

how to become diabetic…

In the “good old days” there were periods of feast and famine.  Food was typically eaten with the fibrous packing that it came with. In today’s modern food environment we are encouraged by the food industry (and those sponsored by it) to eat breakfast, lunch, dinner, snacks, pre-workout meals, post workout stacks, sports gels during exercise, and maybe some Gatorade to speed recovery.

Today’s food is plentiful, typically highly processed and low in fibre.  Carbohydrate and sugar based foods have a long shelf life, can be transported long distances and therefore cheap. Win, win?  Maybe not.

As we keep loading our bodies with simple sugars and carbohydrates our pancreas has to work overtime to produce insulin to shuttle excess sugar from the blood to your fat stores.

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Over time we become insulin resistant and the pancreas can’t keep up. Once your blood sugars get high enough you will be diagnosed with “type 2 diabetes” and put on medication to improve your insulin sensitivity, for a time. If nothing changes in your food intake your insulin sensitivity will continue to deteriorate until you reach a point when you’ll need to inject insulin to keep your blood sugars down.

Injecting excessive amounts of insulin will cause you gain even more body fat. Recently we have learned that it’s not just the high blood sugars that are diabolical for your health, high levels of insulin are also toxic. [1]

Doesn’t sound like much of a solution does it?

…and how to reverse it

While there are many aspects to managing diabetes including stress, sleep, food quality and environmental toxins, the simplest and most effective thing you can do to achieve optimal blood sugars is to do the opposite of what caused the problem in the first place.

Listed below are the main things that cause diabetes and what we can do to reverse it.

leads to diabetes reverses diabetes
Excessive sugar and simple carbohydrates in the diet generate high insulin load Reduce foods in your diet that require insulin [2]
Constant food with no significant periods between meals when insulin levels are reduced Create periods when your body does not have significant amounts of circulating insulin (i.e. intermittent fasting).

Sounds simple.  But it’s not easy or quick to reverse years of metabolic damage.   Your body is hard-wired to retain fat so it can survive the next famine.

Worth the effort?  People who have done it say yes.  That’s why they’re so annoyingly passionate about it!

Remember the type 1 diabetic roller coaster blood sugars in the last post?  The CGM plot shows the blood sugars of the same person a few months later on a low insulin load diet. [3] [4] [5]

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foods that require insulin

You’re likely already aware that foods containing carbohydrates require your pancreas to produce insulin.

Recently I stumbled across some recent food insulin index test data [6] that indicates:

  • protein requires about half as much insulin as carbohydrates per gram on average, [7] and
  • carbohydrates in the form of indigestible fibre do not require insulin. [8]

So if you’re trying to reduce the insulin load of your diet you should:

  • limit simple processed carbohydrates that do not contain fibre,
  • choose high fibre foods (such as non-starchy vegetables) to obtain vitamins and minerals while keeping net carbohydrates low, and
  • back off on the protein if you’re not achieving the normalised blood sugars, weight loss or nutritional ketosis results you’re after.

insulin load

Rather than simply counting carbs, you could get a bit fancy and calculate your total insulin load using this formula:

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Most people will achieve nutritional ketosis with an insulin load of around 100 to 150 grams. Athletes and weight lifters will be able to tolerate more without messing up their blood sugars.  Inactive people aiming for weight loss may need to reduce their insulin load further. I don’t think that it’s ideal for most people to weigh and measure their food for extended periods.

If you’re not getting the results you want then tracking your food in MyFitnessPal or something similar can be a useful in the short term to retrain your dietary habits.

measuring for ketones versus measuring blood sugar

Once you get over seeing a little drop of your own blood, measuring your own blood sugar is pretty simple and painless, and is much cheaper than measuring blood ketones. In Australia and Canada blood sugar strips are about $0.16 compared to blood ketone strips which are about $0.80. [9]  In the US ketone strips are much more expensive, and basically unaffordable. Ketostix (which measure ketones in your urine) will typically only work for a little while until your body learns to use fat for fuel.

relationship between blood sugars and ketones

Blood sugar can be a useful way to see if you’re in ketosis. The chart below shows my blood sugars versus ketones over the last nine months or so that I’ve been trying to achieve nutritional ketosis.

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Based on my n=1 experience I’ve added the ketone levels which correlates HbA1c, average blood sugar and ketones.  This suggests that excellent blood sugar control for me is achieved when I’ve got ketone levels between 0.5 and 1.3mmol/L.

HbA1c average blood sugar ketones
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1
optimal 4.5 4.6 83 1.3
excellent < 5.0 < 5.4 < 97 > 0.5
good < 5.4 < 6 < 108 < 0.3
danger > 6.5 7.8 > 140 < 0.3

is more ketosis better?

The point way out to the right with a high ketone level of 2.1mmol/L and a blood sugar of 4.0mmol/L occurred after I cycled to work two days in a row on Bulletproof Coffee with a good amount of MCT oil.

In The Art and Science of Low Carbohydrate Performance [10] Volek and Phinney say that “light nutritional ketosis” occurs when blood ketones are between 0.5mmol/L and 1.0mmol/L and “optimal ketosis” is between 1.0mmol/L and 3.0mmol/L.

Based on the fact that an optimal blood sugar corresponds to a ketone reading of 1.3mmol/L and the low end of healthy normal blood sugars corresponds to a ketone reading of 2.1mmol/L I wonder if there is really any value in aiming for higher ketone values?

It’s interesting to note that Sami Inkenen, when rowing from the US to Hawaii on an 80% fat diet, [11] [12] was only getting ketones of around 0.6mmol/L [13]. If you’re striving for mental focus then loading up with butter, coconut oil and MCT oil to jack up your ketones might be for you.

If your aim is exercise performance or fat loss then ketones between 0.5mmol/L and 1.3mmol/L might be all you need to aim for. I also think loading up on dietary fat at the expense of getting adequate protein, vitamins and minerals may be counterproductive in the long term.

On the other end of the argument though, if you have good control of your blood sugars you should be showing some level of ketones in your blood.  If you consistently measure at a ketone value of less than 0.2mmol/L then it’s likely your blood sugar is not yet optimal.

what to do?

If you find this interesting and want to experiment I recommend that you buy a blood glucose metre and track your blood sugars for a while. I enter my results into a spreadsheet and look at the average of the past twenty results.

You can adjust your insulin load (i.e. less carbs, more fibre, moderate protein) until you achieve your target blood glucose level. As you test you’ll also notice that some foods cause your blood sugars to rise more than others.  Make sure you scratch those off your “do again” list.

You might also notice as you get your blood sugars under control you will get a metallic taste in your mouth, stronger smelling urine or a different body odour.  These are all signs that you’re transitioning into ketosis.  These symptoms typically don’t last for too long. If at first you don’t succeed, throw in some intermittent fasting.  I use bulletproof Coffee [16] to help me skip breakfast and sometimes lunch a couple of times a week.

Intermittent fasting is more effective than constant calorie restriction which can cause your metabolism to slow down due to conserve energy for the famine it thinks is coming. [17] [18] Having extended periods when insulin levels are low allows your body to learn to use body fat for fuel.

Once you begin to reset your insulin sensitivity you might start to notice a lack of inflammation and puffiness.  You may also find that you’re finally losing that stubborn weight and breaking through that dreaded plateau.  You may notice you feel great and your head is clearer than it’s been for a long time.  Or that that may just be my experience.

physiological insulin resistance

Some people find that as they reduce their carbohydrates that their fasting blood sugars will drift up.  This has been termed ‘physiological insulin resistance’ and is where the body develops a level of insulin resistance in the muscles to prioritise glucose for the brain. For some people this can be a transitionary phase on the way to stable ketosis.  It’s not thought to be something to be concerned about as it doesn’t cause elevated levels of insulin which is what can be really detrimental.

However some type 1 diabetics find it to be an issue long term and choose to increase the carbohydrates and protein in their food so they are just outside nutritional ketosis to reduce this effect.

My experience is that during this phase my post meal blood sugars were great even though the fasting blood sugars were higher than optimal.  As I continued to persist with more fat and added some intermittent fasting this went away and I was able to achieve lower fasting blood sugars.

Particularly during this time it is important to keep an eye on your average blood sugar (i.e. both fasting and after meals) and make sure it’s under 5.4mmol/L (100mg/dL).

can you eat too much fat?

It’s good to see medical researchers [19] and the media [20] coming out and admitting that the fear of fats over the past 30 years has led to diabolical health outcomes.

The fear of fat has forced people to eat more simple carbohydrates which has led to the diabetes epidemic. I analysed a number of dietary scenarios to see if there is any truth to the fear that low carbohydrate diets do not provide adequate nutrition and that you need your “heart healthy whole grains” to achieve optimal health, provide enough sugar for the brain, support growth in children etc. While a grain-based diet can be cheaper, my analysis suggest that a high fat diet that focuses on high fibre, high nutrient density, non-starchy vegetables is better in terms of the nutrition it provides and managing insulin demand.

The optimal diet to balance vitamins and minerals, amino acids and insulin load appears to contain between sixty and eighty percent calories from fat. It is possible to meet the recommended daily intake for most vitamins and minerals with 80% of calories coming from fat.

At the other end of the scale, higher levels of carbs may leave you storing more fat than you want to due to high insulin levels.

which foods are optimal?

What foods are optimal?  It all depends on your unique situation, goals and even finances.

I have developed a system to prioritise food choices based on the insulin properties of various foods as well as a range of other factors including:

  • nutrient density per calorie,
  • fibre per calorie,
  • nutrient density per dollar,
  • calorie density per weight, and
  • calories per dollar.

The list of foods below is a summary of the highest ranking foods using the weighting shown below in order to identify low insulin, high nutrient density food choices will lead to improved blood sugar control, mood, mental clarity, weight loss and overall health.

ND / calorie fibre / calorie ND / $ ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 5% 5% 10% 50% 10% 5%

Next time you’re wanting a nutritious meal that will push you into ketosis or lower your blood sugars you could consider some of these foods.

I’ve also developed this ‘cheat sheet using this approach to highlight optimal food choices depending, whether they be reducing insulin, weight loss or athletic performance.   Why not print it out and stick it to your fridge as a reminder of your optimal foods or to inspire your next shopping expedition?

vegetables

  • turnip greens
  • coriander (cilantro)
  • rosemary
  • spinach
  • parsley
  • peppers / capsicum
  • chives
  • mustard greens
  • collards
  • mushrooms
  • Swiss chard
  • artichokes
  • broccoli
  • Brussel sprouts
  • kale

fats and oils

  • butter
  • coconut oil
  • olive oil
  • fish oil
  • flaxseed oil

fruits

  • avocados
  • olives

eggs & dairy

  • whole egg
  • goat cheese
  • goat cheese
  • parmesan cheese
  • cheddar
  • cream
  • camembert
  • feta
  • cream cheese
  • blue cheese
  • Colby cheese
  • Swiss cheese
  • edam cheese
  • brie
  • gouda
  • mozzarella
  • ricotta
  • cottage cheese

nuts & seeds

  • brazil nuts
  • sunflower seeds
  • pecans
  • pumpkin seeds
  • almonds
  • macadamia nuts
  • pine nuts
  • coconut milk
  • coconut meat
  • pistachio nuts
  • cashews

animal products

  • organ means (liver, kidney, heart etc)
  • chorizo
  • bratwurst
  • herring
  • chicken
  • frankfurter
  • mackerel
  • duck
  • beef sausage
  • bacon
  • turkey
  • anchovy
  • ground beef
  • lamb
  • bologna
  • turkey
  • beef steak

In the next article we’ll look at which foods are optimal for weight loss by prioritising low calorie density, high fibre high nutrient density foods that will also help stabilise your blood sugars.

references

[1] https://www.youtube.com/watch?v=4oZ4UqtbB_g

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

[3] http://www.diabetes-book.com/

[4] https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag

[5] https://www.facebook.com/Type1Grit

[6] http://ses.library.usyd.edu.au/handle/2123/11945

[7] Some anecdotal evidence and studies such as http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342171/pdf/IJE2015-216918.pdf indicate that it’s the protein in excess of the body’s needs for muscle growth and repair that gets turned to glucose and requires insulin.

[8] http://healthyeating.sfgate.com/indigestible-carbohydrates-1023.html

[9] http://www.ebay.com.au/itm/BEST-PRICE-10-X-ABBOTT-FREESTYLE-OPTIUM-KETONE-TEST-STRIPS-10-TOTAL-100-STRIPS/181527585627?_trksid=p2054897.c100204.m3164&_trkparms=aid%3D222007%26algo%3DSIC.MBE%26ao%3D1%26asc%3D20140407115239%26meid%3Db2cedda776824d9f8ed5d131a3232ea7%26pid%3D100204%26rk%3D3%26rkt%3D24%26sd%3D281508543955

[10] http://www.amazon.com/The-Art-Science-Carbohydrate-Performance/dp/0983490716

[11] https://gumroad.com/l/CK219

[12] http://www.fatchancerow.org/

[13] https://twitter.com/samiinkinen/status/451089012166385664

[14] https://www.facebook.com/ketogains

[15] https://www.facebook.com/ketogains

[16] https://www.bulletproofexec.com/bulletproof-fasting/

[17] https://www.youtube.com/watch?v=4oZ4UqtbB_g

[18] http://www.bodybuilding.com/fun/drsquat6.htm

[19] http://www.touchendocrinology.com/articles/nutrition-revolution-end-high-carbohydrates-era-diabetes-prevention-and-management [20] http://time.com/2863227/ending-the-war-on-fat/

[21] https://www.dropbox.com/s/h0zd5pjgw0gfqgq/Appendix%20D%20-%20Nutritional%20analysis%20of%20typical%20diets.docx?dl=0

[22] https://www.dropbox.com/s/ninuwyreda0epix/Optimising%20nutrition%2C%20managing%20insulin.docx?dl=0