Tag Archives: insulin index chart

insulin resistance, nutrient density, weight loss

how optimize your diet for your insulin resistance

January 15, 2017 Marty Kendall 25 Comments

Lately, I’ve seen a number of common themes come up at low carb conferences and online. The contentious questions tend to run along the lines of:

I did really well on a low carb diet initially, but my fat loss seems to have stalled. What gives? What should I do now?
If protein is insulinogenic should I actively avoid protein as well as carbs if my goal is to reduce insulin because low insulin = weight loss?
If eating more fat helped kick start my weight loss journey, then why does eating more fat seem to make me gain weight now?

This article outlines some quantitative parameters around these contentious questions and helps you chose the most appropriate nutritional approach.

the importance of monitoring blood glucose levels

Coming from a diabetes headspace, I’ve seen firsthand the power of a low carb diet in reducing blood glucose and insulin levels. As a Type 1 Diabetic, my wife Moni has been above to halve her insulin dose with a massive improvement in energy levels, body composition and mood.

If your blood glucose levels are high, then chances are your insulin levels are also high. Insulin is the hormonal “switch” that causes us to store excess energy as body fat in times of plenty.^[1] Lower levels of insulin in times of food scarcity then enable us to access to the stored energy on our body.^[2]

You can actively manage the fat storing potential of your diet by managing the insulin load of the food you eat.

The chart below shows that our glucose response is fairly well predicted by the carbohydrates we eat. (note: The “glucose score” is the area under the curve of glucose response to various foods tested over the three hours relative to glucose which gets a score of 100%.) ^[3] ^[4]

Having high blood glucose levels is bad news.^[5] The chart below shows the correlation between HbA1c (a measure of your average glucose levels over three months) and the diseases that will kill most of us, cardiovascular disease, coronary heart disease and stroke.^[6] It makes a lot of sense to do whatever it takes to reduce our blood glucose to the levels of a metabolically healthy person to postpone the major diseases of aging.

optimal ketone levels

Ketones in our blood rise when our insulin levels are low.^[7] As shown in the chart below, even better than carbohydrates, insulin levels are better predicted by the net carbohydrates plus about half the protein we eat.^[8] ^[9]

You may have seen this ‘optimal ketone zone’ chart from Volek and Phinney’s ‘Art and Science of Low Carb Living’.

The problem however with this chart is that it is difficult for most people to achieve “optimal ketone levels” (i.e. 1.5 to 3.0mmol/L) without fasting for a number of days or making a special effort to eat a lot of additional dietary fat (which may be counterproductive in the long run if you’re trying to lose weight).

Recently I had the privilege of having Steve Phinney stay at our house when he spoke at a Low Carb Down Under event in Brisbane (btw, he’s also a passionate cook if you let him lose in the kitchen). I quizzed Steve about the background to his optimal ketosis chart. He said it was based on two studies, one with cyclists who the adapted to ketosis over a period of six weeks and another ketogenic weight loss study. In both cases these ‘optimal ketone levels’ (i.e. between 1.5 to 3.0mmol/L) were observed in people who were transitioning into a state of nutritional ketosis.

Since the publication of this chart in the Art and Science books, Phinney has noted that well trained athletes who are long term fat adapted (e.g. the low carb athletes in the FASTER study^[10]) actually show lower levels of ketones than might be expected. It appears that over time many people, particularly athletes, move beyond simple keto adaption and are able to utilise fat as fuel even more efficiently and their ketone levels reduce further.

Metabolically flexible people are able to access and burn fat efficiently and hence only release free fatty acids or ketones into the bloodstream when they need the energy. If you’re metabolically healthy and can call on your fat stores as required there’s no need to be walking around with super high levels of glucose or ketones.

If you’ve been following a ketogenic diet for a while and / or are metabolically healthy then your ketone levels may not be as high as you might expect from looking at Volek and Phinney’s “optimal ketone zone” chart.

And as discussed in my Alkaline Diet vs Acidic Ketones article, higher ketone levels could even be an indication that you have some level of metabolic acidosis. People with untreated Type 1 Diabetes have very high ketone as well as blood glucose levels at the same time (i.e. ketoacidosis).

Phinney says he does not condone the “adolescent behaviour” of competing to see how high you can get your ketone levels and warns that you can risk loss of lean body mass by chasing high ketone levels with an inappropriately low insulin load approach (i.e. very low carb and very low protein).^[11]

People with higher NAD+ levels (an important coenzyme which declines with aging^[12]) and lower NADH levels are more likely to produce more breath acetone (which can be measured with the Ketonix) and less BHB ketones in the blood. Hence, higher consistent levels of breath acetone may be a more useful indication than blood ketones that you are burning fat rather than just eating fat.^[13]

“The ratio of β-OHB to AcAc depends on the NADH/NAD+ ratio inside mitochondria; if NADH concentration is high, the liver releases a higher proportion of β-OHB.”^[14]

While I think it’s good to have some ketones in the blood as an indication that your insulin levels aren’t too high, it can be hard to interpret what high or low level of blood ketones mean.

As noted in Peter Attia’s Fat Flux article, the BHB ketones you measure in your blood is a function of:

the dietary fat that you’re eating,
plus the fat being liberated from your body fat (lipolysis),
minus the BHB being used by your muscles, heart and brain.

High blood ketones could mean that your insulin levels are low and your level of lipolysis is high (i.e. lots of fat is being released from your body). In this case, high ketones are an indicator of metabolic health and may facilitate healthy appetite regulation and enable you to burn your stored body fat.

However, high blood ketone levels could also mean that you are eating a lot of dietary fat (or consuming a lot exogenous ketones) and your body isn’t well adapted to using ketones for fuel and hence unused ketones are building up in your blood stream. If this is the case, then loading up with more dietary fat in the pursuit of higher ketone levels may cause you to become more insulin resistant and inflamed as your ketone levels rise but the fat is not yet able to be efficiently oxidised for fuel.

The plot below shows a compilation of glucose and ketone values from a range of people following a low carb or “ketogenic” diet. It seems that the most metabolically healthy people have low blood glucose levels and moderate ketones at rest, however they can easily access plenty of glucose and fat from the body when required.

It makes sense to me from an evolutionary perspective that someone who is healthy would be able to conserve energy when not active (i.e. hiding in a cave) but then be able to quickly access stored energy when required (i.e. when being chased by a sabre-toothed tiger). The body doesn’t always need super high blood ketone levels and hence we secrete insulin to remove both glucose and ketones back into storage.

The exception to this seems to be in periods of extended fasting when the body is on high alert and we are in a super-fuelled state ready to chase down some food at a moment’s notice.

So, unless you’re fasting or exercising intensely, it seems that having a lower total energy (i.e. blood glucose plus blood ketones) might be a better place to be rather than having super high ketone levels.

There is also interesting emerging research suggesting that as we become more fat adapted we can obtain more fuel from fat and hence do not need to rely on ketones which are more of an emergency fuel source during starvation. It’s as if, just like in time we no longer measure high ketones in the urine as we utilise them better, we also start to show less ketones in the blood. Quoting my friend Mike Julian:

I think we become less ketogenic with further adaptation simply because as we improve our ability to utilize the fat we create spin off glucose from both glycerol and acetone that goes to restore beta oxidation of fatty acids.

The spin of glucose provides oxaloacetate and restores Krebs function in the liver and reduces ketogenesis in favour of complete oxidation of acetyl-CoA. In short, ketogenesis is a transitional state, not the end goal.

Ketones will be lower if you’re fit. Even Phinney has said that very adapted individuals are in ketosis starting at 0.3mmol. Look at how robust the GNG is in the low carb guys in the FASTER study. It is a direct result of the nearly doubled rate of fat oxidation.

All of the glycerol when fat is oxidised has to go somewhere and it is used to make glucose. This glucose is then used to restore the Krebs cycle which means that the can make even better use of fat etc, but reduces GNG via traditional means and in turn reduces ketogenesis.

It’s a system that feeds into itself. The better fat burner you are, the more glucose you make from fat, the better you are at fat burning and so on.

As we get better at fat utilisation we also get better at deriving glucose from fat metabolism. This source of glucose reduces the need for ketogenesis.^[15] ^[16]

So overall, measuring blood ketones is intriguing, but not always the most reliable measure of where your metabolic health status. Moreover, eating more dietary fat in an effort to raise your blood ketone levels is no guarantee that you’re going to lose body fat.^[17]

You may be “ketogenic” in that you are able to generate ketones, though they may not necessarily show up in high levels in the blood if you are also athletic and able to use your blood glucose and ketones effectively for energy.

the relationship between ketones and glucose

The chart below shows the generalised relationship between blood glucose and blood ketones for different people with:

Type 2 Diabetes,
Pre-diabetes,
Mild insulin resistance, and
someone who is metabolically healthy.

(note: Someone with uncontrolled Type 1 Diabetes would be literally ‘off the chart’ with high blood glucose and high blood ketones.)

The table below shows the HbA1c incident rates for cardiovascular disease, stroke and coronary heart disease from the chart above to average blood glucose levels and the corresponding ketone levels and glucose : ketone index values. This gives us a useful understanding of what different HbA1c risk levels look like in terms of average blood glucose levels, ketones and the glucose : ketone index.

metabolic health level	HbA1c	average blood glucose		ketones	GKI
metabolic health level	(%)	(mmol/L)	(mg/dL)	(mmol/L)	GKI
low normal	4.1	3.9	70	2.1	1.9
optimal	4.5	4.6	83	1.3	3.5
excellent	< 5.0	< 5.4	< 97	> 0.5	11
good	< 5.4	< 6	< 108	< 0.3	30
danger zone	> 6.5	7.8	> 140	< 0.3	39

While it can be interesting to measure ketones, as a general rule, if you have consistently high blood glucose levels you are likely to be insulin resistant and hence will benefit from a higher fat dietary approach.

If you have high insulin and glucose levels, when transitioning to a high fat diet your glucose and insulin levels will likely plummet to be closer to the levels of a metabolically healthy person and suddenly you will be able to access your body fat stores for fuel. You might quickly find yourself losing weight like it was magic and you’ll think the keto diet is the best thing ever! Amazingly, lots of people find that they can “eat fat to satiety” and still lose weight (at least during this initial stage).

For the last four decades we’ve been told to avoid fat, particularly saturated fat. Imagine the excitement, enthusiasm, and maybe even anger, when someone who has been avoiding fat finds that they suddenly start losing weight when the do the opposite to what they’ve been told to do!

it works until it doesn’t

The problem with adding more dietary fat is that it works until it doesn’t.

Let’s say (based on the levels of metabolic health in the table above) you are able to successfully “level up” from the “danger zone” though “good” blood glucose control to “excellent” blood glucose levels with a high fat dietary approach, but then your weight loss slows and then stops well short of your optimal body fat levels.

What gives?

What do you do now?

Do you listen to the people who say you should eat more fat or the people who say you should eat less fat?

It can be confusing on the interwebs!

I think the answer depends largely on whether you are insulin resistant or insulin sensitive. You should ‘level up’ to the most nutrient dense nutritional approach that your current level of insulin sensitivity allows.

It’s worth noting that while many people can achieve ‘excellent’ blood glucose levels through dietary manipulation, the people that I’ve seen get to truly optimal blood glucose control tend to be working hard with both their nutrition and training to maximise their lean body mass.

what is insulin resistance anyway?

In order to understand what we need to do when we stop losing weight on keto I think it’s important to understand what causes insulin resistance.

Many people think that people who are fat are simply insulin resistant. This is partly true. However, while insulin resistance and obesity are related, it’s not quite that simple. It’s useful to understand the difference.

A metabolically flexible insulin sensitive person stores excess energy eaten for later use in the fat stores on the body (i.e. adipose tissue). When they stop eating, someone who is insulin sensitive will experience a drop in blood glucose and insulin levels and stored body fat will be released. For the lucky people who are insulin sensitive, calories in calories out (CICO) largely works as advertised. They find it difficult to depart far from a healthy set point weight without a change in diet quality or insulin load.

However, as we keep eating more and more low nutrient density foods to obtain the micronutrients we need, we get to a point where the adipose tissue can no longer hold all that excess energy and starts to channel it into the organs because the fat stores are full.

The body knows that this isn’t such a great idea though because our vital organs are, well, vital, so the body becomes insulin resistant as a defence mechanism to avoid damage to vital organs, and hence the levels of sugar in our blood rise to avoid storing the extra energy in the organs. The body even starts dumping the excess sugar into the urine to avoid having to pump it into the liver, pancreas, eyes and brain.

The a of the major problems with insulin resistance is appetite dysregulation. That is, when you are insulin resistant your insulin levels stay higher for longer which then makes it harder for you to access your body fat for fuel between meals. As shown in this chart, if your blood glucose levels are high the release of fat from your body (ketones) will be low, ghrelin will kick in^[18], and it will be hard to go very long without food. Your appetite will be more likely to win out over your willpower and thus make it hard to lose weight if your insulin levels are high.

Eating “low carb” or “keto” enables us to lower insulin levels to the point that our appetite works more in line with the way it’s meant to when we were metabolically healthy / insulin sensitive / metabolically flexible. Our appetite drives us to seek out nutrients and energy when required and stop when we have had enough. (note: keep in mind though that lower insulin levels are due to eating a lower dietary insulin load, not necessarily due to more dietary fat.)

Once our appetite is restored and we can more easily access our own body fat I think we need to change focus, especially if adding more fat isn’t moving you toward your weight loss goals.

be a nutrient chaser

Once your blood glucose levels are normalised but you’re stuck on a plateau and not sure where to turn I think it’s a good idea to turn your focus to chasing nutrients rather than ketones or even worrying about blood glucose levels quite so much.

As your blood glucose and insulin levels decrease, you should be able to release more body fat stores and hence have less need for dietary fat. When we focus on balancing micronutrients macronutrients largely look after themselves.

As well as adequate energy, the body works hard to make sure it gets the nutrients it needs to thrive. The vitamins and minerals that come with whole foods are like the spark that ignites the fuel they contain.^[19] We always get ourselves into trouble when we separate nutrients from energy. While refined sugars and grains are particularly problematic because they spike insulin, neither refined sugars or purified fats contain the same level of nutrients necessary to power our mitochondria that whole foods do.

The problem comes when we eat nutrient poor foods. We are left with a residual need for nutrients that are required to convert our food into energy (ATP). Our appetite will drive us to seek out more food to obtain the required nutrients.

“Added sugars displace nutritionally superior foods from the diet and at the same time increase nutritional requirements. Specifically, vitamins such as thiamine, riboflavin and niacin are necessary for the oxidation of glucose, and phosphates are stripped from ATP in order to metabolise fructose, which leads to cellular ATP depletion. The metabolism of fructose also leads to oxidative stress, inflammation and damage to the mitochondria, causing a state of ATP depletion. Hence, the liberation of calories from added sugars requires nutrients, and increases nutritional demands, but these sugars provide no additional nutrients. Thus, the more added sugars one consumes, the more nutritionally depleted one may become. This may be particularly extreme in individuals whose habitual diet is already lacking in key micronutrients.”^[20]

“A nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to minimising appetite and eliminating hunger at minimal caloric intake.”^[21]

“To produce ATP efficiently, the mitochondria need particular things. Glucose or ketone bodies from fat and oxygen are primary. Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine, riboflavin, niacin, pantothenic acid, minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants. Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.”^[22]

If we don’t get enough amino acids to prevent loss of lean muscle mass the body will also up-regulate appetite (i.e. protein leverage hypothesis).^[23] ^[24] While we can track our food intake to try to actively manage our energy intake, in the end, appetite, driven by the body’s need for nutrients, tends to win out.

Even if we are successful in limiting our intake, our body senses an energy crisis and slows down to make sure it has enough energy and stored fat to run our inefficient metabolism. However, when we consume whole foods with a higher nutrient density our appetite tends to be satisfied with less energy because it can run more efficiently with an optimal balance of the nutrients it needs.^[25]

If we want to lose weight we need to find a way to provide the body with the nutrients it needs to function optimally with the minimum amount of energy intake while still maintaining low enough blood glucose and insulin levels to allow energy to flow out of our fat stores.

ask the experts

There was an interesting panel discussion in Episode 1161 of Jimmy Moore’s Livin La Vida Low Carb Show “Q&A Medical Panel – 2016 Low Carb Cruise” where someone asked:

LCHF says calories don’t matter. But I still gain weight even when in ketosis. What’s up with that?

There was a range of responses from the panel of medical doctors, not all in agreement, but my favourite answer was from Dr Ted Naiman (pictured below on the cruise) who said:

I have tons of patients who absolutely plateau out on this diet. Everyone who goes on LCHF loses a ton of weight, and then hits a plateau. This is extremely common. Almost universal.

If you eat enough fat, the flow of fat into your adipose sites will equal the flow of fat out of your adipose sites and you’re just going to plateau.

My number one priority is nutrient density. Eat less fat bombs and instead eat the highest nutrient density foods you possibly can and then more of the fat that you’re burning comes from your internal body stores.

I recommend really high fat diets for people who are really glucose dependent to help them get fat adapted. Then, once you have reached your ideal body weight you have to eat a high fat diet then as well because you’re burning fat. But there is a period in the middle when you’re plateaued when you do want to eat less fat because you want your fat to come off stored body fat.

are you really insulin resistant?

I think the critical question here is whether you are really insulin resistant. The most useful measure is simply to test your blood glucose levels.

If you have been diagnosed with diabetes, then you will have a glucose meter and you’ll be able to easily test your blood glucose levels to know where you’re at. Glucometers are fairly cheap to purchase and often come with a rebate.

There are many people who are fatter than they want to be but still have reasonable insulin sensitivity and normal blood glucose. For these people, eating more fat doesn’t always get them where they want to be.^[26] ^[27]

At the same time, many skinny people are actually insulin resistant (TOFI). It of depends on how much energy your belly is willing to store before it starts pumping the excess fat into your vital organs.

The irony here is that you may look healthier if you are skinny, but it may mean that your adipose tissue is able to store less energy before it transitions to start storing excess energy in your vital organs.

For those of you that don’t like testing your blood glucose level I have outlined a number of other ways to determine whether you are actually insulin resistant. This understanding can then be used to understand whether you may need more or less dietary fat.

oral glucose tolerance test

An Oral Glucose Tolerance Test (OGTT) is the generally accepted medical test for insulin resistance and diabetes. An OGTT measures someone’s rise in blood glucose in response to a large amount of ingested glucose. If it goes up too much after a standard amount of glucose then you are deemed to be insulin resistant.

The problem is most people following a low carb approach will likely fail an OGTT because of physiological insulin resistance. Someone following a low carb diet won’t have a lot of insulin circulating in their body, so when they ingest a large amount of fast acting glucose their pancreas will respond from a “standing start” and has to pump out a lot of insulin to respond to the glucose. The glucose levels of someone following a low carb dietary approach may rise quite a lot before the pancreas can catch up.

By comparison, someone eating more carbohydrates would have higher levels of insulin circulating that will act on the glucose as soon as it was ingested with only a little bit of extra insulin needing to be secreted in response to the food and hence the glucose response would be lower.

kraft test

A Kraft Insulin Assay, which measures insulin response over time to a certain amount of glucose, will give you an accurate idea of whether you’re insulin resistant, however these tests are expensive and fairly hard to obtain. A Kraft Test might be a useful way to see if your are becoming insulin resistant even if your glucose levels are keeping up, for now.

oral protein tolerance test

Whether or not your blood glucose levels rise or decrease in response to a high protein meal with no carbohydrate is also a useful way to understand if you are insulin resistant.

Someone who is metabolically healthy will release glucagon and insulin in response to protein as it is metabolised to maintain a stable glucose level.^[28] Someone who is insulin resistant may not produce adequate insulin to counteract the glucagon released by the liver and hence they may see their blood glucose levels rise.

If you find your glucose levels do rise significantly response to protein, it may be a sign that you need to slow down a little on the protein (or at least limit processed protein powders and opt for whole food sources of protein which are harder to overeat).

Realistically though, unless you’re severely insulin resistant, have Type 1 Diabetes or are using therapeutic ketosis to manage a chronic health condition such as cancer, epilepsy, alzheimers or dementia, most people don’t need to micromanage their protein intake if they are eating a range of unprocessed whole foods.

Your ability to handle protein may improve with time as your insulin resistance improves or you build a bit more muscle mass. Actively avoiding protein to minimise insulin may be counterproductive in the long term if it leads to loss of lean body mass.

optimal dietary approach survey

While testing blood glucose is a pretty good indicator of your insulin resistance status, there are a number of reasons that you may not want to test, including:

you don’t yet own a blood glucose meter,
you don’t like the sight of your own blood, or
test strips can be expensive, especially if not covered by insurance.

Beyond testing your blood glucose and / or ketone levels, there are a wide range of other indicators that you may be insulin resistant and may need a higher fat dietary approach. I have prepared this multiple choice survey to help people better understand which dietary approach might be ideal for them based on their situation and goals.

You may be insulin resistant and / or benefit from a higher fat diet if you answer yes to most of these of these questions.^[29] If you answer no to most of these questions then you may do better if you focus on nutrient dense foods rather than more fat.

Do you have a chronic health condition such as cancer, epilepsy, dementia, Alzheimer’s, Parkinson’s, severe insulin resistance or traumatic brain injury?
Have you been diagnosed with diabetes?
Is your HbA1c greater than 6.4%?
Is your fasting glucose greater than 7.0 mmol/L?
Is your post meal glucose level greater than 11.0mmol/L or 200 mg/dL?
Is your triglyceride:HDL ratio greater than 3.0?
Are your triglycerides greater than 1.1mmol/L or 100mg/dL?
Are your blood ketone levels less than 0.3mmol/L?
Is your fasting insulin greater than 20 uIU/mL or 120 pmol/L?
Is your C-reactive protein greater than 1.0 mg/dL?
Does your blood glucose level rise significantlyafter eating a large protein only meal?
Do you have a big hard belly (fat stored around the organs , ot on the surface)?

can I take my insulin levels to zero?

You cannot eliminate your need for insulin by eating a 100% fat diet, or even not eating at all.

Back in the 70s Dr Richard Bernstein worked out by self experimentation that people with Type 1 Diabetes require both basal and bolus insulin. Basal insulin is required, regardless of food intake, to stop the body from breaking down its own lean body mass. Bolus insulin is required to metabolise the food eaten.^[30]

Someone on a typical western diet has about a 50:50 ratio of basal to bolus insulin. Someone on a low carb diet will require less insulin, however 80% of their insulin dose required as basal insulin and the remaining 20% for their food. While the body typically doesn’t secrete insulin in response to fat, and appetite is often reduced on a high fat diet, if we force an energy excess with high levels of processed fats there will always be enough basal insulin circulating in the blood to remove the excess energy to our fat stores.

Someone with Type 1 will modify their insulin sensitivity factor in their insulin pump to match their insulin sensitivity to optimise their blood glucose control. People without Type 1 Diabetes can change their insulin sensitivity (and hence require less insulin) by, amongst other things, being exposed to less insulin^[31] and improving our level of lean body mass (muscle) and mitochondrial function. It is important to ensure your diet has adequate protein to build muscle as well as exercising that muscle to make sure our body is well trained and efficient at using that energy.

Having well trained lean muscle mass is critical to glucose disposal and insulin action and thus reducing overall insulin levels.^[32] In addition to avoiding foods that quickly raise our blood glucose levels, we need to train our body to dispose of the glucose effectively and efficiently with less reliance on large amounts of insulin through building lean body mass. This is achieved by (amongst other things like sleep, sunlight, reduced stress etc) eating nutrient dense foods that power up the mitochondria to enable us to burn the energy efficiently.

so just tell me what to eat!

I have prepared the table below to guide people to the most optimal foods based on their blood glucose levels and current level of insulin resistance and whether you need to lose weight (based on your waist to height ratio^[33]).

approach	average glucose		waist : height
approach	(mg/dL)	(mmol/L)	waist : height
therapeutic ketosis	> 140	> 7.8
diabetes and nutritional ketosis	108 to 140	6.0 to 7.8
weight loss (insulin resistant)	100 to 108	5.4 to 6.0	> 0.5
weight loss (insulin sensitive)	< 97	< 5.4	> 0.5
nutrient dense maintenance	< 97	< 5.4	< 0.5

There’s no nutrient poor processed grains or added sugars in any of these lists.

The therapeutic ketosis foods have higher levels of added fat. The nutrient dense weight loss foods contain more lean proteins and non-starchy veggies and less added fat.

Someone with poorly controlled Type 2 Diabetes may start out on a high fat ketogenic approach (say 2:1 fat to protein by weight), in time they should be able to progressively ‘level up’ to more nutrient dense foods as their insulin sensitivity improves and they find their blood glucose levels can tolerate it.

Someone who has long standing diabetes or who has Type 1 Diabetes may settle on a 1:1 for maintenance. Someone who becomes more insulin sensitive may be able to cut their dietary fat down even more as they are more easily able to release fat from their body fat stores. Even if someone wants to lose weight got down to a 1:0.5 protein to fat ratio by weight the majority of their energy is still coming from fat, they’re just given their body a better chance of needing to use dietary fat.

I hope this helps you find the optimal approach for you. I would love to hear how it goes.

references

^[1] https://optimisingnutrition.com/2015/06/22/why-we-get-fat-and-what-to-do-about-it-v2/

^[2] http://bja.oxfordjournals.org/content/85/1/69.long

^[3] https://optimisingnutrition.com/2015/06/29/trends-outliers-insulin-and-protein/

^[4] https://ses.library.usyd.edu.au/handle/2123/11945

^[5] https://optimisingnutrition.com/2015/03/22/diabetes-102/

^[6] http://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

^[7] https://optimisingnutrition.com/2015/03/23/most-ketogenic-diet-foods/

^[8] https://optimisingnutrition.com/2015/06/29/trends-outliers-insulin-and-protein/

^[9] https://ses.library.usyd.edu.au/handle/2123/11945

^[10] http://www.sciencedirect.com/science/article/pii/S0026049515003340

^[11] https://youtu.be/r8uSv6OgHJE?t=2080

^[12] https://en.wikipedia.org/wiki/Nicotinamide_adenine_dinucleotide

^[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/pdf/OBY-23-2327.pdf

^[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102118/

^[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140964/

^[16] https://www.facebook.com/groups/198981013851366/permalink/261051057644361/?comment_id=261276760955124&comment_tracking=%7B%22tn%22%3A%22R4%22%7D

^[17] https://www.youtube.com/watch?v=r8uSv6OgHJE&feature=youtu.be

^[18] http://www.nature.com/ejcn/journal/v67/n7/abs/ejcn201390a.html

^[19] https://www.amazon.com/Nutritional-Approach-Revised-Model-Medicine-ebook/dp/B00CXECDI8/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=

^[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975866/

^[21] http://perfecthealthdiet.com/

^[22] http://terrywahls.com/about-the-wahls-protocol/

^[23] http://sydney.edu.au/science/outreach/inspiring/news/cpc.shtml

^[24] http://www.nature.com/ejcn/journal/vaop/ncurrent/full/ejcn2016256a.html

^[25] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

^[26] https://optimisingnutrition.com/2016/06/13/low-energy-density-high-nutrient-density-foods-for-weight-loss/

^[27] https://www.dropbox.com/s/n8tzuiixb1n1cxi/Weight%20Loss%20on%20Low-Fat%20vs.%20Low-Carbohydrate%20Diets%20by%20Insulin%20Resistance%20Status%20Among%20Overweight%20Adults%20and%20Adults%20With%20Obesity-%20A%20Randomized%20Pilot%20Trial%20(1).pdf?dl=0

^[28] https://optimisingnutrition.com/2015/06/15/the-blood-glucose-glucagon-and-insulin-response-to-protein/

^[29] http://www.thebloodcode.com/

^[30] https://www.youtube.com/watch?v=6lrbxITXAVA

^[31] https://www.ncbi.nlm.nih.gov/pubmed/21241239

^[32] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2343294/

^[33] https://en.wikipedia.org/wiki/Waist-to-height_ratio

post last updated July 2017

articles, insulin index, insulin load, nutrient density

optimising protein and insulin load

December 3, 2016 Marty Kendall 8 Comments

“Low carb”, “ketogenic” or “nutrient dense” mean different things to different people. Defining these terms numerically can help us to choose the right tool for the right application.
Decreasing the insulin load of your diet can help normalise blood glucose levels and enable your pancreas to keep up. However, at the same time, a high fat therapeutic ketogenic approach is not necessarily the most nutrient dense option, and may not be optimal in the long term, particularly if your goal is weight loss.
Balancing insulin load and nutrient density will enable you to identify the right approach for you at any given point in time.
This article suggests ideal macro nutrient, protein and insulin load, and carbohydrate levels for different people with different goals to use as a starting point as they work to optimise their weight and/or blood glucose levels.

context matters

Since I started blogging about the concepts of insulin load and proportion of insulinogenic calories many people have asked:

“What insulin load should I be aiming for?”

Unfortunately, it’s hard to give a simple answer without some context.

The answer to this question depends on a person’s current metabolic health, age, activity level, weight, height and goals etc.

This post is my attempt to provide an answer with some context.

disclaimers

Full disclosure… I don’t like to measure the food I eat. I have developed the optimal foods lists to highlight what I think are the best foods to suit different goals and levels of metabolic health.

I think food should be nutritious and satiating. If your goal is to lose weight it will be hard to overeat if you limit your food choices to things like broccoli (which contains sulforaphane), celery, salmon and tuna.

At the same time, some people like to track their food. Tracking food with apps like MyFitnessPal or Cron-O-Meter can be useful for a time to reflect and use as a tool to help you refine your food choices. If you’re preparing for a bodybuilding competition you’re probably going to need to track your food to temporarily override your body’s survival to force it to shed additional weight.

Ideal macronutrient balance is a contentious issue and a lot has already been said on the topic. I’ll try to focus on what I think I have to add to the discussion around the topics of insulin load and nutrient density.

If you want to and skip the detail in the rest of this article, this graphic from Dr Ted Naiman does a good job of summarising optimal foods and ideal macronutrient ranges. If you’re interested in more detail on the topic, then read on.

insulin is not the bad guy

The insulin load formula was designed to help us more accurately understand the insulin response to the food we eat, including protein and fibre.

insulin load = total carbohydrates – fibre + 0.56 * protein

The first thing to understand is that insulin per se is not bad. Insulin is required for energy metabolism and growth. People who can’t produce enough insulin are called Type 1 Diabetics and typically don’t last long without insulin injections after they catabolize their muscle and body fat.

Insulin only really becomes problematic when we have too much of it (i.e. hyperinsulinemia^[1]) due to excess processed carbohydrates (i.e. processed grains, added sugar and soft drinks) and/or a lack of activity which leads to insulin resistance.

The concepts of insulin load and proportion of insulinogenic calories can provide us with a better understanding of how different foods trigger an insulin response and how to quantitatively optimise the insulin load of our diet to suit our unique situation and goals.

different degrees of the ketogenic diet

Words like “ketogenic”, “low carb” or “nutrient dense” mean different things to different people. This is where using numbers can be useful to better define what we’re talking about and tailor a dietary approach. For clarity, I have numerically defined a number of terms that you might hear.

ketogenic ratio

The therapeutic ketosis community talks about a “ketogenic ratio” such as 3:1 or 4:1 which means that there are three or four parts fat (by weight) for every part protein plus carbohydrate.^[2]

For example, a 3:1 ketogenic diet may contain 300g of fat plus 95g of protein with 5g of carbs. This ends up being 87% fat. A 4:1 ketogenic ratio is an even more aggressive ketogenic approach that is used in the treatment of epilepsy,^[3] cancer or dementia and ends up being 90% fat.

These levels of ketosis are hard to achieve with real food and are hard to sustain in the long term. Hence, it is typically used as a short term therapeutic treatment.

ratio of fat to protein

People in the ketogenic bodybuilding scene (e.g. Keto Gains) or weight loss might talk about a 1:1 ratio of fat to protein (by weight) for weight loss. A diet with a 1:1 ratio of fat to protein could be 120g of fat plus 120g of protein. If we threw in 20g of carbs this would come out at 66% fat (which is still pretty high by mainstream standards). A 1:2 protein:fat ratio would end up being around 80% fat.

protein grammes per kilogramme of lean body weight

Some people prefer to talk in terms of terms of percentages or grammes of protein per kilo of lean body mass. For example:

The generally accepted minimum level of protein is 0.8g/kg/day of lean body mass to prevent malnutrition.^[4] This is based on a minimum requirement of 0.6kg to maintain nitrogen balance and prevent diseases of malnutrition plus a 25% or two standard deviations safety factor.^[5]
In the Art and Science of Low Carb Performance Volek and Phinney talk recommend consuming between 1.5 and 2.0g/kg of reference body weight (i.e. RW). Reference weight is basically your ideal body weight say at a BMI of 25kg/m². So, 1.5 to 2.0kg RW equates to around 1.7 to 2.2g/kg lean body mass (LBM).
There is also a practical maximum level where people just can’t eat more lean protein (i.e. rabbit starvation^[6]) which kicks in at around 35% of energy from protein.

The table below shows a list of rule of thumb protein quantities for different goals in terms of grams per kilogram of lean body mass and as a percentage of calories assuming weight maintenance.^[7]

scenario	% calories	g/kg LBM
minimum (starvation)	6%	0.4
RDI/sedentary	11%	0.8
typical	16%	1.2
strength athlete	24%	1.8
maximum	35%	2.7

gluconeogenesis

You may have heard that body will convert ‘excess protein’ to glucose via gluconeogenesis, particularly if there are minimal carbohydrates in the diet and/or we can’t yet use fat for fuel.

For some people, this is a concern due to elevated blood glucose levels, but it may also mean that more protein is required because so much is being converted to glucose that you need more to maintain muscles growing your muscles. As we become more insulin sensitive we may be able to get away with less protein because we are using it better (i.e. we are growing muscles rather than making glucose).

Most people eat more than the minimum level of protein to prevent malnutrition. People looking to gain muscle mass will require higher levels. Although keep in mind you do need to be exercising to gain muscle, not just eating protein.

Ensuring adequate protein and exercise is especially important as people age. Sarcopenia is the process of age related muscle decline which is exacerbated in people with diabetes.

Sadly, many old people fall and break their bones and never get up again. When it comes to longevity there is a balance between being too big (high IGF-1) and too frail (too little IGF-1).

carbohydrate counting

Then there is carb counting.

People on a ketogenic approach tend to limit themselves to around 20g (net?) carbohydrates.
Low carbers might limit themselves to 50g carbs per day.
A metabolically healthy low carb athlete might try to stay under 100g of carbs per day.

Limiting non-fibre carbohydrates typically eradicates most processed foods (e.g. sugar, processed grains, sodas etc). Nutrient density increases as we decrease the amount of non-fibre carbohydrates in our diet.

protein, insulin load and nutrient density

In the milieu of discussion about protein, I think it’s important to keep in mind that minimum protein levels to prevent the diseases of malnutrition may not necessarily optimal for health and vitality.

Protein is the one macronutrient that correlates well with nutrient density. Foods with a higher percentage of protein are typically more nutrient dense overall.

Considering minimum protein levels may be useful if you are looking to drop your energy intake to the bare minimum and while still providing enough protein to prevent loss of lean muscle mass (e.g. a protein sparing modified fast). However, if you are looking to fill up the rest of your energy intake with fat for weight maintenance then you should be aware that simply eating foods with a higher proportion of fat will not help you maximise nutrient density.

Practically though very high levels of protein will be difficult to achieve because they are very filling, thus it is practically difficult to eat more than around 35% of your energy from protein. Protein is also an inefficient fuel source meaning that you will lose around 25% of the calories just digesting and converting it to glucose via digestion and gluconeogenesis.

If you are incorporating fasting then I think you will need to make sure you are getting at least the minimum as an average across the week, not just on feasting days to maintain nitrogen balance. That is, you might need to try to eat more protein on days you are eating.

what is ketosis?

“Ketogenic” simply means “generates ketones”.

An increase in ketosis occurs when there is a lack of glucogenic substrates (i.e. non-fibre carbohydrates and glucogenic protein). It’s not primarily about eating an abundance of dietary fat.

I think reducing insulin load (i.e. the amount of food that we eat that requires insulin to metabolise), rather than adding dietary fat, is really where it’s at if you’re trying to ‘get into ketosis’. We can simply wind down the insulin load of our diet to the point that out blood glucose and insulin levels decrease and we can more easily access our stored body fat.

insulin load = total carbohydrates – fibre + 0.56 * protein

Whether a particular approach is ketogenic (i.e. generates ketones) will depend on your metabolic health, activity levels and insulin resistance etc.

Whether you want to be generating ketones from the fat on your excess belly fat rather than your plate (or coffee cup) is also an important consideration if weight loss is one of your goals.

While people aiming for therapeutic ketosis might want to achieve elevated ketone levels by consuming more dietary fat, most people out there are just looking to lose weight for health and aesthetic reasons. For most people, I think the first step is to reduce dietary insulin load until they achieve normalised blood glucose levels (i.e. average BG less than 5.6mmol/L or 100mg/dL, blood ketones greater than 0.2 mmol/L). People with diabetes often call this “eating to your meter”.

Once you’ve achieved normal blood glucose levels and some ketones the next step towards weight loss is to increase nutrient density while still maintaining ketosis. Deeper levels of ketosis do not necessarily mean more fat loss, particularly if if you have to eat gobs of eating processed fat to get there.

Ray Cronise and David Sinclair recently published an article “Oxidative Priority, Meal Frequency, and the Energy Economy of Food and ACtivity: Implications for Longevity, Obesity and Cardiometabolic Disease” which does an interesting job of looking at the ‘oxidative priority’ of various nutrient and demonstrate that the body will burn through nutrients in the following order:

alcohol,
protein (not used for muscle protein synthesis),
non-fibre carbohydrate, and then
fat.

What this suggests to me is that if you want to burn your own body fat you need to minimise the alcohol, protein and carbohydrate which will burn first. To me, this is another angle on the idea that insulin levels are the signal that stops our body from using our own body fat in times of plenty. And if we want to access our own body fat we need to reduce the insulin load of our diet to the point we can release our own body fat.

insulin load versus nutrient density

The risk however with the insulin load concept is that people can take things to extremes. If our only objective is to minimise insulin load we’ll end up just eating bacon, lard, MCT, olive oil… and not much else.

In his “Perfect Health Diet” book Paul Jaminet talks about “nutrient hunger”, meaning that we are more likely to have an increased appetite if we are missing out on particular nutrients. He says

“A nourishing, balanced diet that provides all the nutrients in the right proportions is the key to eliminating hunger and minimising appetite.“

In the chart below shows nutrient density versus proportion of insulinogenic calories. The first thing to note is that there is a lot of scatter! However, on the right-hand side of the chart, there are high carb soft drinks, breakfast cereals and processed grains that are nutrient poor. But if we plot a trend line we see that nutrient density peaks somewhere around 40% insulinogenic calories.

If you are metabolically challenged, you will want to reduce the insulin load of your diet to normalise blood glucose levels. But if you reduce your insulin load too much you end up living on purified fats that aren’t necessarily nutrient dense.

If we are trying to avoid both carbohydrates and protein we end up limiting our food choices to macadamia nuts, pine nuts and a bunch of isolated fats that aren’t found in nature in that form. Rather than living on copious amounts of refined oils I think we’re in much safer territory if we maximise nutrient density with whole foods while still maintaining optimal blood glucose levels.

The chart below shows the proportion of insulinogenic calories for the highest-ranking basket of foods (i.e. top 10% of the foods in the USDA foods database) for a range of approaches, from the low insulin therapeutic ketosis, through to the weight loss foods for someone who is insulin sensitive and a lot of fat is coming from their body. At one end of the scale, a therapeutic ketogenic may only contain 14% insulinogenic calories while a more nutrient dense approach might have more than half of the food requires insulin to metabolise.

macronutrient splits

It’s one thing to set theoretical macro nutrient targets, but real foods don’t come in neat little packages of protein, fat and carbohydrates. The chart below shows the macro nutrient split of the most nutrient dense 10% of foods for each of the four nutritional approaches. The protein level for the weight loss approach might seem high but then once we factor in an energy deficit from our body fat it comes back down.

In reality, you’re probably not going to be able to achieve weight maintenance if you just stick to the nutrient dense weight loss foods. You’ll either become full and will end up using your stored body fat to meet the energy deficit or you will reach for some more energy dense foods to make up the calorie deficit. If you look at the macronutrient split of the most nutrient dense meals for the different approach you find they are lower in protein and higher in fat as shown in the chart below.

nutrient density

The chart below shows the percentage of the daily recommended intake of essential vitamins, minerals, amino acids and fatty acids you can get from 2000 calories for each of the approaches.

You can meet most of your nutritional requirements with a therapeutic ketogenic diet, however, you’ll have to eat enough calories to maintain your weight to prevent nutritional deficiencies.

As you progress to the more nutrient dense approaches you can meet your nutrient requirements with less energy intake. The beauty of limiting yourself to nutrient dense whole foods is that you can obtain the required nutrition with less energy and you’ll likely be too full to overeat.

As far as I can see the holy grail of nutrition, health and longevity is adequate energy without malnutrition.

If we look in more detail we can see that the weight loss (blue) and nutrient dense approaches (green) provide more of the essential micronutrients across the board, not just amino acids.

While the protein levels in the “weight loss” and “most nutrient dense” approaches are quite high, keep in mind that the food ranking system only prioritises the nutrients that are harder to obtain.

The table below shows the various nutrients that are switched on in the food ranking system for each approach.

This table shows the number of vitamins, minerals, amino acids and fatty acids counted for each approach.

In the weight loss and nutrient dense approach, of the twelve essential amino acids, only Tyrosine and Phenylalanine has been counted in the density ranking system.

It just so happens that protein levels are high in whole foods that contain essential vitamins, minerals and fatty acids.

It appears that if you set out to actively avoid protein it may be harder to get other essential nutrients. The risk here is that you may be setting yourself up for nutrient hunger, and rebound/stall inducing cravings in the long term as your body becomes depleted of the harder to obtain nutrients.

choosing the right approach for you

I believe one of the key factors in determining which nutritional approach is right for you is your blood glucose levels which give you an insight into your insulin levels and insulin sensitivity.

As shown in the chart below, if your blood glucose levels are high then it’s likely your insulin levels are also high which means you will not be able to easily to access your fat stores. I have also created this survey which may help you identify whether you are insulin resistant and which foods might be ideal for you right now.

While you may need to start out with a higher fat approach, as your glucose levels decrease and ketone levels rise a little you will be able to transition to more nutrient dense foods.

The table below shows the relationship between HbA1c, glucose, ketones and GKI. Once you are getting good blood glucose levels you can start to focus more on nutrient density and weight loss.

Risk level	HbA1c	average blood glucose		ketones	GKI
Risk level	(%)	(mmol/L)	(mg/dL)	(mmol/L)	GKI
low normal	4.1	4.0	70	5.5	0.7
optimal	4.5	4.6	83	2.5	1.8
excellent	< 5.0	< 5.3	< 95	> 0.2	< 30
good	< 5.4	< 6.0	< 108	< 0.2
danger	> 6.5	7.8	> 140	< 0.2

more numbers

The table below shows what the different nutritional approaches look like in terms of:

ketogenic ratio
ratio of fat to protein
protein (g)/kg LBM
insulin load (g/kg LBM)

approach	keto ratio	fat : protein	protein g/LBM	insulin load (g/LBM)
therapeutic ketosis	1.8	2.2	1.0	0.9
diabetes	0.9	1.0	1.8	1.5
weight loss (incl. body fat)	0.5	0.6	2.5	2.4
nutrient dense	0.3	0.3	3.0	2.8

The 1.0g/kg LBM for therapeutic ketosis is greater than the RDA minimum of 0.8g/kg LBM so will still provide the minimum amount while still being ketogenic. It’s hard to find a lot of foods that have less than 1.0g/kg LBM protein in weight maintenance without focussing on processed fats.

At the other extreme most nutrient dense foods are very high in protein but this might also be self-limiting meaning that people won’t be able to eat that much food. As mentioned earlier, it will be hard to eat enough of the nutrient dense foods to maintain your current weight. Either you will end up losing weight because you can’t fit as much of these foods in or reaching more energy dense lower nutrient density foods. Also, if you found you were not achieving great blood glucose levels and some low-level ketones with mean and non-starchy veggies you might want to retreat to a higher fat approach.

The table below lists optimal foods for different goals from most nutrient dense to most ketogenic. Hopefully, over time you should be able to work towards the more nutrient dense foods as your metabolism heals.

dietary approach	printable .pdf
weight loss (insulin sensitive)	download
nutrient dense (maintenance)	download
weight loss (insulin resistant)	download
diabetes and nutritional ketosis	download
therapeutic ketosis	download

what about mTOR?

Many people are concerned about excess protein causing cancer or inhibiting mTOR (Mammalian Target of Rapamycin).^[8] ^[9]

From what I can see though, the story with mTOR is similar to insulin. That is, constantly elevated insulin or constantly stimulated mTOR are problematic and cause excess growth without being interspersed with periods of breakdown and repair.

Our ancestors would have had times when insulin and mTOR were low during winter or between successful hunts. But during summer (when fruits were plentiful) or after a successful hunt, insulin would be elevated and mTOR suppressed as they gorged on the nutrient dense bounty.

These days we’re more like the futuristic humans from Wall-E than our hunter gather ancestors. We live in a temperature controlled environment with artificial lighting and tend to put food in our mouths from the moment we wake up to the time we fall asleep.^[10]

Rather than chronic monotony (e.g. eating five or six small meals per day every day), it seems that periods of growth (anabolism) and breakdown and cleaning (catabolism) are optimal to thrive in the long term. We need periods of both. One or the other chronically are bad news.

As my wise friend Raymund Edwards from Optimal Ketogenic Living says

“FAST WELL, FEED WELL.”

how much protein?

Optimal protein levels are a contentious topic. There is research out there that says that excess protein can be problematic from a longevity perspective. Protein promotes growth, IGF-1, insulin and cell turnover which can theoretically compromise longevity. At the same time, there are plenty of studies that indicate that we need much more protein than the minimum RDI levels.^[11]

In the end, you need to eat enough protein to prevent loss of lean muscle and maintain strength. If you’re trying to build lean muscle and working out, then higher levels of protein may be helpful to support muscle growth. If you are trying to lose weight, then higher levels of protein can be useful to increase satiety and prevent loss of lean muscle mass. Maintaining muscle mass is critical to keeping your metabolic rate high and avoiding the reduction that can come with chronic restriction.^[12] ^[13]

In addition to building our muscles, protein is critical for building our bones, heart, organs and providing many of the neurotransmitters required for mental health. So protein from real whole foods is generally nothing to be afraid of. It’s typically the processed high carb foods that make the detrimental impact on insulin and blood glucose levels.

The table below shows a starting point for protein in grammes depending on your height. This assumes that someone with a lean body mass (LBM) of 80 kg is burning 2000 calories per day and your lean body mass equates to a BMI of 20 kg/m². LBM is current weight minus fat mass minus skeletal mass which again is hard to estimate without a DEXA.

There are a lot of assumptions here so you will need to take as a rule of thumb starting point and track your weight and blood glucose levels and refine accordingly. It’s unlikely that you will get to the high protein levels of the most nutrient dense approach because either you would feel too full or your glucose levels may rise and ketones disappear, so most people, unless your name is Duane Johnson, will need to moderate back from that level.

Example: Let’s say for example you were 180cm and were managing diabetes and elevated blood glucose levels. You would start with around 117g of protein per day as an initial target and test how that worked with your blood glucose levels. If your blood glucose levels on average were less than say 5.6mmol/L or 100mg/dL and your ketones were above 0.2mmol/L you could consider increasing transitioning to more nutrient dense foods.

If you want to see what this looks like in terms of real foods and real meal meals check out the optimal food list and the optimal meals for the different approaches.

insulin load

Using a similar approach, we can calculate the daily insulin load (in grammes) depending on your height and goals. The values in this table can be used as a rule of thumb for the insulin load of your diet.

If you are not achieving your blood glucose or weight loss goals, then you can consider winding the insulin load back down. If you are achieving great blood glucose levels, then you might consider choosing more nutrient dense food which might involve more whole protein and more nutrient dense green leafy veggies.

Example: Let’s say for example you are an 180cm person with good glucose control but still wanting to lose weight, your initial target insulin load would be 156g from the superfoods for fat loss list. If you were not losing weight at this level, you could look to wind it back a little until you started losing weight. If you are consistently achieving blood glucose levels less than 5.6mmol/L or 100mg/dL and ketones greater than 0.2mmol/L you could consider transitioning to more nutrient dense foods.

summary

In summary, reducing the insulin load of your diet is an important initial step. However, as your blood glucose and insulin levels normalise there are a number of other steps that you can take towards optimising nutrient density on your journey towards optimal health and body fat.

Reduce the insulin load of your diet (i.e. eliminate processed carbage and maybe consider moderating protein if still necessary) to normalise blood glucose levels and reduce insulin levels to facilitate access to stored body fat.
If your blood glucose levels are less than say 5.6 mmol/L or 100mg/dL and your ketone levels are greater than say 0.2 mmol/L then you could consider transitioning to more nutrient dense foods.
If further weight loss is required, maximise nutrient density and reduce added fats to continue weight loss.
Consider also adding an intermittent fasting routine with periods of nutrient dense feasting. Modify the feasting/fasting cycles to make sure you are getting the results you are after over the long term.
Once optimal/goal weight is achieved, enjoy nutrient dense fattier foods as long as optimal weight and blood glucose levels are maintained.
If blood glucose levels are greater than optimal blood glucose levels, return to step 1.
If current weight is greater goal weight return to step 3.

references

^[1] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19

^[2] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

^[3] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

^[4] http://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096

^[5] https://intensivedietarymanagement.com/how-much-protein-is-excessive/

^[6] https://en.wikipedia.org/wiki/Protein_poisoning

^[7] https://optimisingnutrition.com/2015/08/31/optimal-protein-intake/

^[8] https://www.youtube.com/watch?v=Yv-M-5-s9B0

^[9] http://nutritionfacts.org/video/prevent-cancer-from-going-on-tor/

^[10] https://www.youtube.com/watch?v=qPpAvvPG0nc

^[11] https://www.ncbi.nlm.nih.gov/pubmed/27109436

^[12] http://ajcn.nutrition.org/content/87/5/1558S.long

^[13] https://en.wikipedia.org/wiki/Protein-sparing_modified_fast

post last updated July 2017

articles, foods, insulin load, insulin resisatnce, insulin resistance, weight loss

nutrient dense foods for weight loss and insulin resistance

October 10, 2016 Marty Kendall 74 Comments

I found a number of people that were using a combination of the optimal foods for diabetes and nutritional ketosis and the optimal foods for weight loss lists. So I thought it would be useful to combine the two approaches into a single list of foods for people who want to lose weight but who were still somewhat insulin resistant.

optimal foods for diabetes and nutritional ketosis

The food ranking system revolves around manipulating these three parameters to suit different goals:

The optimal foods for diabetes and nutritional ketosis list has a low insulin load, is fairly low in non-fibre carbs and moderately high fat while still being as nutrient dense as possible.

This approach suits someone who has Type 1 Diabetes or is lean and looking to achieve nutritional ketosis. People who are at their goal weight can afford to eat a little more added dietary fat.

While most people looking to manage their blood glucose levels limit their carbohydrates to some arbitrary number that works for them, maximising nutrient density as well will help you to improve your mitochondrial function and increase your energy levels to ideally overcome your insulin resistance. Maximising nutrient density also means that your body won’t keep on seeking out more and more food to obtain the nutrients it requires.

People who are very insulin resistant often do well on a higher fat dietary approach initially to let the insulin levels drop, however they often find further success in the long term if they drop their dietary fat to let more fat come from their body.

optimal foods for weight loss

The optimal foods for weight loss list are fairly low in dietary fat to allow for to come from the body during weight loss. It’s heavy in lean proteins and non-starchy veggies and is VERY nutrient dense. The chart below shows a comparison of a range of dietary approaches with the insulin sensitive weight loss approach being having the highest nutrient density while diabetes and nutritional ketosis approach comes in at #8 of thirteen.

This list of foods may look like a low-fat dietary approach, but it’s not really low fat once you factor in your body fat. The chart from Steve Phinney illustrates how your body fat makes a contribution to the weight loss phase of a well formulated ketogenic diet.

The weight loss list of foods is also quite bulky (i.e. lots of fibre and water) so they would be very hard to overeat if you stick to just these foods. The chart below shows a comparison of the various approaches with the weight loss approach having the lowest energy density.

Eating from the weight loss foods basically equates to a protein sparing modified fast (which is widely held to be the most effect way to lose weight in the long term) meaning that will fill you up so much you won’t be above to overeat while at the same time providing enough protein to preserve lean muscle mass during the weight loss phase.

The “problem” with the aggressive weight loss approach is that it is very low in energy dense comfort foods and it is higher in carbohydrates and protein than most low carbers might be used to, so it might be harder to stick to. It may also raise your blood glucose levels if you’re still somewhat insulin resistant.

finding the optimal balance between the extremes

I have designed this list of foods for people who are insulin resistant and also looking to lose weight provides a balance between both extremes – high nutrient density, lowish levels of dietary fat and lower energy density.

The foods listed below represent the top 10% of the USDA food database using this ranking system. I’ve included the nutrient density score, percentage of insulinogenic calories, insulin load (per 100g), energy density (per 100g) and the multicriteria analysis score (MCA) that combines all these factors.

The chart below shows the amount of each nutrient provided by the more balanced approach compared to the average of all the foods in the USDA food database. As you can see you will still be able to obtain heaps of nutrients while the fat comes from your body.

vegetables

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
broccoli	23	36%	3	22	2.07
endive	15	23%	1	17	1.84
coriander	16	30%	2	23	1.79
zucchini	18	40%	2	17	1.75
chicory greens	14	23%	2	23	1.74
spinach	20	49%	4	23	1.66
escarole	11	24%	1	19	1.58
basil	17	47%	3	23	1.55
alfalfa	9	19%	1	23	1.51
watercress	22	65%	2	11	1.51
beet greens	13	35%	2	22	1.49
asparagus	16	50%	3	22	1.44
lettuce	14	50%	2	15	1.33
Chinese cabbage	15	54%	2	12	1.29
summer squash	12	45%	2	19	1.26
okra	13	50%	3	22	1.26
parsley	13	48%	5	36	1.25
cauliflower	13	50%	4	25	1.23
chard	13	51%	3	19	1.22
portabella mushrooms	14	55%	5	29	1.20
mustard greens	9	36%	3	27	1.20
arugula	11	45%	3	25	1.17
turnip greens	10	44%	4	29	1.17
chives	11	48%	4	30	1.14
banana pepper	8	36%	3	27	1.13
paprika	9	27%	26	282	1.11
cucumber	7	39%	1	12	1.08
pickles	7	39%	1	12	1.08
collards	7	37%	4	33	1.07
celery	10	50%	3	18	1.03
brown mushrooms	16	73%	5	22	1.01
avocado	-0	8%	3	160	0.99
white mushroom	13	65%	5	22	0.99
shitake mushroom	12	58%	7	39	0.98
red peppers	6	40%	3	31	0.98
dandelion greens	10	54%	7	45	0.97
sauerkraut	5	39%	2	19	0.96
dill	11	59%	8	43	0.96
eggplant	4	35%	3	25	0.95
cloves	9	35%	35	274	0.95
radishes	6	43%	2	16	0.94
sage	7	26%	26	315	0.93
jalapeno peppers	5	37%	3	27	0.93
curry powder	3	13%	14	325	0.92
edamame	7	41%	13	121	0.89
chayote	5	40%	3	24	0.88
olives	-5	3%	1	145	0.80
Brussel sprouts	6	50%	6	42	0.78
spirulina	11	70%	6	26	0.76
soybeans (sprouted)	6	49%	12	81	0.76
cabbage	7	55%	4	23	0.75
blackberries	-1	27%	3	43	0.71
artichokes	5	49%	7	47	0.71

seafood

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
fish roe	18	47%	18	143	1.45
salmon	19	52%	20	156	1.44
trout	16	45%	18	168	1.36
caviar	13	33%	23	264	1.25
oyster	16	59%	14	102	1.19
cisco	9	29%	13	177	1.17
sturgeon	13	49%	16	135	1.13
mackerel	6	14%	10	305	1.08
anchovy	12	44%	22	210	1.08
crab	17	71%	14	83	1.01
sardines	9	36%	16	185	1.01
flounder	13	57%	12	86	1.01
herring	9	36%	19	217	0.97
sardine	9	37%	19	208	1.0
halibut	15	66%	17	111	0.96
tuna	12	52%	23	184	0.91
rockfish	13	66%	17	109	0.86
lobster	14	71%	15	89	0.85
crayfish	12	67%	13	82	0.82
shrimp	13	69%	19	119	0.81
pollock	13	69%	18	111	0.79
perch	10	62%	14	96	0.73

animal products

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
lamb liver	19	48%	20	168	1.47
lamb kidney	19	52%	15	112	1.45
turkey liver	16	47%	21	189	1.25
beef brains	8	22%	8	151	1.24
veal liver	17	55%	26	192	1.20
beef liver	17	59%	25	175	1.14
chicken liver	14	50%	20	172	1.13
beef kidney	14	52%	20	157	1.10
lamb brains	6	27%	10	154	1.05
chicken liver pate	7	34%	17	201	0.91
lamb heart	10	48%	19	161	0.90
ham	12	59%	17	113	0.88
ground turkey	6	30%	19	258	0.88
turkey heart	9	47%	20	174	0.85
rib eye steak	8	41%	21	210	0.84
roast pork	7	41%	20	199	0.83
roast beef	7	38%	21	219	0.83
beef tongue	1	16%	11	284	0.81
lamb sweetbread	6	43%	15	144	0.79
lamb chop	8	42%	25	234	0.79
lean beef	11	61%	23	149	0.78
beef heart	9	52%	23	179	0.78
park sausage	2	25%	13	217	0.78
pork liver	11	59%	23	165	0.77
turkey meat	8	52%	21	158	0.74
turkey drumstick	8	52%	21	158	0.74
chicken	10	60%	22	148	0.73

dairy and egg

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
whole egg	9	30%	10	143	1.20
egg yolk	8	18%	12	275	1.15
sour cream	2	13%	6	198	1.02
cream	2	6%	5	340	0.93
cream cheese	2	11%	10	350	0.84
Swiss cheese	5	22%	22	393	0.80
cheddar cheese	5	20%	20	410	0.78
Greek yogurt	3	37%	9	97	0.74

other dietary approaches

The table below contains links to separate blog posts and printable .pdfs 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.

Post last updated July 2017

articles, blood sugar, foods, fructose, insulin load, nutrient density

foods to avoid… the most processed, insulinogenic, energy dense low nutrient density foods

July 25, 2016 Marty Kendall 31 Comments

What are the most insulinogenic, low nutrient density and energy dense processed foods that everyone should avoid for heath and weight loss?

Generally I think it can be more useful to tell people what they should focus on rather than what they shouldn’t do. It’s like the proverbial hot plate or ‘wet paint’ sign. You can’t unsee it and you just want to touch it!

If you are busy focusing on the good stuff then you just won’t have any space left for the low nutrient density foods, especially once you start feeling the benefits.

Many people are coming to see sugar as universally bad news. But why sugar? Are there other foods that we should avoid for the same reasons?

what’s so bad about sugar anyway?

For the past four decades mainstream food recommendations have been dominated by a fear of fat, particularly saturated fat and cholesterol, which if, taken to the extreme can lead us towards more processed, insulinogenic, nutrient poor, low fat foods.

More recently, a growing number of people are advising that we should eat less sugar… from Sarah Wilson’s I Quit Sugar, to Robert Lustig’s Sugar: The Bitter Truth and Damon Gameau’s That Sugar Film. Even Gary Taubes seems to be softening his stance against carbohydrates and turning his attention to sugar as the bad guy in his new book The Case against Sugar.

The World Health Organisation are imploring people to reduce their sugar intake to less than 10% of energy, and ideally less than 5%.^{^[1]}

Investment bank Credit Suisse is predicting a turn away from sugar and and back towards fat, effectively advising people to ‘short sugar’.^{^[2]}

But what is it about sugar that makes it uniquely bad? It just the ‘evaporated cane juice’ that we should avoid?

What about whole foods that contain some sugar? Should we avoid them too?

While added sugars are not good, they’re also an easy target that everyone can get behind. It’s easy to swing from demonising one thing to another, from fat to carbs, to sugar.

But perhaps this paradigm is overly simplistic?

I think we need to avoid are foods that quickly boost insulin and blood glucose levels without providing any substantial nutrition in return.

Foods that should be considered universally bad are foods that are:

If you want to maximise the nutritional value of your food, give your pancreas a break so it can keep up, you should AVOID THESE FOODS. Most diet recommendations succeed largely because they eliminate these foods which are typically processed foods.

The chart below (click to enlarge) shows the weightings used in the multi criteria analysis for the various dietary approaches. The avoid list turns the system on its head to identify foods that have poor nutrient density as well as also being energy dense and insulinogenic.

The charts below shows that, compared to the other approaches, the foods on the avoid list are energy dense…

…highly insulinogenic…

…as well as being nutrient poor, all at the same time!

Considering any of these factors by themselves can be problematic. But when we combine all these parameters them they can be much more useful to identify the foods we should avoid, as well as the ones we should prioritise.

As you can see from this chart, the difference between the nutrients provided by the most nutrient dense foods and the avoid list is vast! You can see how you would be much more satiated with the more nutrient dense food and your cravings turned off.

Also included in the table are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score score (MCA) that combines all these factors.

So without further ado, here is the avoid list.

drinks

Soft drinks provide very little nutritional value, are very insulinogenic and have no fibre so will raise your blood sugar and insulin levels quickly.

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
cream soda	-20	100%	13	51	1.02
root beer	-20	100%	11	41	1.00
grape soda	-19	100%	11	43	1.00
cola	-20	99%	10	37	1.00
cranberry-apple juice	-19	98%	16	63	0.98
orange and apricot juice	-17	97%	13	51	0.86

sweets

Sweets provide minimal nutrition while being very energy dense and highly insulinogenic. Sugar tops the list of badness, however there are a bunch of other sweets not far behind.

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
candies	-20	100%	99	394	1.34
sugar	-20	100%	100	389	1.33
jellybeans	-20	100%	93	375	1.31
fructose	-20	100%	100	368	1.31
brown sugar	-19	99%	97	380	1.29
sucralose	-20	100%	91	336	1.29
fruit syrup	-20	100%	85	341	1.28
skittles	-20	90%	91	405	1.28
aspartame	-19	99%	91	365	1.24
twizzlers	-20	93%	81	348	1.24
marshmallows	-19	99%	83	318	1.24
high fructose corn syrup	-20	100%	76	281	1.23
maple sugar	-18	99%	91	354	1.21
jams and preserves	-19	98%	68	278	1.17
orange marmalade	-19	99%	66	246	1.17
chocolate frosting.	-18	86%	91	389	1.16
chocolate pudding	-18	91%	86	378	1.16
Candies, butterscotch	-17	92%	90	391	1.15
M&Ms	-20	61%	73	475	1.14
tootsie roll	-17	91%	89	387	1.13
Milky Way	-20	61%	70	463	1.13
chocolate syrup	-18	100%	67	269	1.12
butterscotch topping	-18	99%	58	216	1.08
Kit Kat	-19	49%	65	520	1.08
frosting	-18	65%	68	418	1.04
fudge	-15	87%	83	383	1.01
honey	-19	63%	52	304	0.99
caramels	-15	81%	80	382	0.98
tapioca pudding (fat free)	-18	94%	22	94	0.91
chocolate frosting	-16	61%	63	397	0.90
Twix	-16	41%	57	550	0.88

fruits and fruit juices

Fruit in its natural state provides fibre, nutrients with a lower energy density. However fruit juice and dried fruit has a much lower nutritional value and are much more insulinogenic.

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
candied fruit	-20	98%	81	322	1.25
dried apples	-17	85%	82	346	1.04
raisins	-17	89%	73	296	1.03
dried pears	-16	87%	64	262	0.96
dried currants	-16	88%	70	283	0.95
apple juice	-17	97%	12	47	0.88
litchis	-14	89%	69	277	0.87
dried pears	-17	83%	32	140	0.86

cereals and baked products

Processed grains are cheap and have a long shelf life, however the processing removes most of the fibre and most of the nutrients which means they are highly insulinogenic and energy dense.

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
corn-starch	-20	99%	91	381	1.31
rice puffs	-17	93%	90	383	1.13
instant oatmeal	-19	70%	68	353	1.06
fudge filled cookies	-19	47%	63	533	1.06
girl scout cookies	-19	51%	66	520	1.06
Grahams Crackers	-17	73%	77	424	1.05
choc chip cookies	-18	55%	69	498	1.04
cheesecake	-19	49%	63	506	1.04
white flour	-15	92%	82	367	1.04
white rice	-15	95%	84	365	1.02
water biscuits	-17	73%	70	384	1.01
rice flour	-15	92%	82	366	1.00
wheat flour	-14	91%	81	363	0.96
ice cream cones	-13	88%	89	402	0.94
pound cake (fat free)	-14	93%	64	283	0.90
Cookies	-15	76%	69	348	0.90
cornmeal	-13	89%	81	370	0.90
fruitcake	-16	71%	60	324	0.88
white flour	-12	92%	82	366	0.88
English muffins	-16	83%	51	245	0.87

other 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.

post updated May 2017

references

^{^[1]} http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/

^{^[2]} https://www.credit-suisse.com/us/en/articles/articles/news-and-expertise/2013/09/en/is-sugar-turning-the-economy-sour.html

articles, athletes, carbohydrates, nutrient density

nutrient dense insulinogenic foods for bodybuilding

July 11, 2016 Marty Kendall 46 Comments

As well as identifying nutrient dense diabetic friendly foods, we can use the food insulin index to highlight more insulinogenic nutrient dense higher energy density foods for use by athletes or people wanting gain weight.

This article highlights more insulinogenic nutrient dense foods that could be used by metabolically healthy people to strategically “carb up” before events, to intentionally trigger insulin spikes (e.g. Carb Back-Loading, Alt Shift Diet or the targeted ketogenic diet) or to maximise growth for people who are underweight while still maintaining high levels of nutrition.

insulin load, a refresher

Many people with diabetes will try to reduce the insulin load of their diet to normalise blood glucose levels. It’s the non-fibre carbohydrates, and to a lesser extent protein, that drive insulin and blood glucose, particularly for someone who is insulin resistant.

Managing the insulin load of your diet is an effective way to get off the blood glucose roller coaster and stabilise blood glucose levels. We can calculate the insulin load of our diet based on the carbohydrates, fibre and protein using the formula shown below.

We can also calculate the percentage of insulinogenic calories to identify the foods that will affect our blood glucose levels the least, or the most.

but why would you want to spike your glucose levels?

Much of the nutrition and diabetes world is focused on helping people who are struggling with insulin resistance and trying to normalise blood glucose. However, there are others who are blessed to be metabolically healthy who may want to strategically refill their glycogen tanks or raise their insulin levels.

Some follow a targeted ketogenic diet and strategically replenish glucose around workouts by eating higher carbohydrate foods.
Some bodybuilders use a cyclical ketogenic diet where they deplete glucose and then replenish glucose periodically.
Some fat adapted endurance athletes will look to ‘carb up’ before an event so that they have both glucose and fat based fuel sources (a.k.a. train low, race high).

Others find success with dietary approaches such as the AltShift Diet, Carb Back-Loading which alternating periods of extreme high and low carb dietary approaches (not always with the most nutritious high carb foods).

the mission…

Dr Tommy Wood approached me to design a high insulin load and a low insulin load diet regimen that he could try for a month of each to see how his body responded. The constraint was that both the high and low insulin load foods would have to be nutrient dense whole foods so as to be a fair comparison of the effect of insulin load.

The foods listed below represent the top 10% of the USDA food database prioritised for higher insulin load, higher nutrient density and higher energy density. In terms of macronutrients they come out at 36% protein, 15% fat and 44% net carbohydrates.

While these foods might not be ideal for someone with diabetes they actually look like a pretty healthy list of foods compared to the “food like products” that you’d find in the isles of the supermarket.

This chart shows the nutrients provided by the top 10% of the foods using this ranking compared to the average of all foods in the USDA foods database.

Also included in the tables below are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score score (MCA) that combines all these factors.

vegetables

food	ND	insulin load (g/100g)	calories/100g	MCA
watercress	19	2	11	1.2
seaweed (wakame)	13	11	45	1.0
shiitake mushrooms	5	72	296	0.9
spinach	17	4	23	0.9
brown mushrooms	11	5	22	0.7
asparagus	15	3	22	0.7
chard	14	3	19	0.7
seaweed (kelp)	9	10	43	0.7
yeast extract spread	8	27	185	0.6
white mushroom	11	5	22	0.6
spirulina	10	6	26	0.6
mung beans	9	4	19	0.6
Chinese cabbage	12	2	12	0.5
celery flakes	4	42	319	0.5
portabella mushrooms	11	5	29	0.5
broccoli	11	5	35	0.4
parsley	12	5	36	0.4
lettuce	12	2	15	0.4
radicchio	8	4	23	0.4
shiitake mushroom	9	7	39	0.4
peas	7	7	42	0.4
dandelion greens	9	7	45	0.3
endive	15	1	17	0.3
okra	10	3	22	0.3
pumpkin	6	4	20	0.3
bamboo shoots	8	5	27	0.3
beet greens	12	2	22	0.3
snap beans	8	3	15	0.3
zucchini	11	2	17	0.3

animal products

food	ND	insulin load (g/100g)	calories/100g	MCA
ham (lean only)	11	17	113	0.7
veal liver	9	26	192	0.7
beef liver	9	25	175	0.7
lamb liver	11	20	168	0.7
lamb kidney	11	15	112	0.6
chicken breast	8	22	148	0.5
pork liver	7	23	165	0.5
chicken liver	9	20	172	0.5
pork chop	7	23	172	0.5
veal	6	24	151	0.5
beef kidney	8	20	157	0.5
lean beef	7	23	149	0.5
leg ham	7	22	165	0.5
turkey liver	8	21	189	0.5
pork shoulder	6	22	162	0.4
ground beef	6	20	144	0.4
sirloin steak	6	24	177	0.4
ground pork	6	25	185	0.4

seafood

food	ND	insulin load (g/100g)	calories/100g	MCA
cod	14	48	290	1.5
crab	15	14	83	1.1
lobster	14	15	89	1.1
crayfish	12	13	82	0.9
shrimp	11	19	119	0.9
pollock	11	18	111	0.8
octopus	9	28	164	0.8
halibut	11	17	111	0.8
fish roe	13	18	143	0.8
haddock	10	19	116	0.8
white fish	10	18	108	0.8
clam	9	25	142	0.8
scallop	8	22	111	0.7
rockfish	10	17	109	0.7
salmon	11	20	156	0.7
whiting	9	18	116	0.7
perch	10	14	96	0.7
oyster	11	14	102	0.7
flounder	11	12	86	0.6
anchovy	9	22	210	0.6
trout	10	18	168	0.6
caviar	10	23	264	0.6
sturgeon	10	16	135	0.5
tuna	6	23	184	0.3
orange roughy	4	17	105	0.3
sardine	7	19	208	0.3

legumes

food	ND	insulin load (g/100g)	calories/100g	MCA
cowpeas	2	68	336	0.8
black beans	2	63	341	0.6
soybeans	3	49	446	0.6
pinto beans	1	64	347	0.6
kidney beans	1	63	337	0.6
broad beans	2	54	341	0.5
peas	0	57	352	0.4

grains

food	ND	insulin load (g/100g)	calories/100g	MCA
oat bran	6	65	246	0.7
baker’s yeast	10	16	105	0.5
baking powder	2	45	97	0.4
wheat bran	8	34	216	0.4
rye flour	0	58	325	0.4
quinoa	1	22	120	0.1

dairy

food	ND	insulin load (g/100g)	calories/100g	MCA
whey powder	10	82	339	1.6
cream cheese (low fat)	12	19	105	1.0
cottage cheese (low fat)	6	14	72	0.5
parmesan cheese	3	35	420	0.4
cottage cheese (low fat)	7	13	81	0.4
cheddar (non-fat)	6	20	173	0.3
mozzarella	4	26	304	0.3
kefir	6	7	41	0.3
gruyere cheese	3	23	413	0.3
low fat milk	6	8	56	0.2
Greek yogurt (low fat)	5	11	73	0.2
Swiss cheese	3	22	393	0.2
gouda cheese	3	21	356	0.2
cheddar cheese	3	20	410	0.2
egg yolk	6	12	275	0.2
edam cheese	3	21	357	0.1

other dietary approaches

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.

articles, insulin index, weight loss

insulin load… the greatest thing since carb counting?

May 2, 2016 Marty Kendall 58 Comments

In previous articles I have outlined the idea of the insulin load ^[1] ^[2]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^{^[3]} and glucogenic amino acids (protein)^{^[4]} ^{^[5]} 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.

Patricia Berry Moore

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.

THANK YOU!

Patricia had seen my presentation on the food insulin index, applied the theory, and it worked!

Patricia said:

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.” Thanks dear… I think.

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 use the app Lose it! which helps me track macros. So it’s pretty easy to keep a running total of my insulin load too.

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 carbohydrate. 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.

Mike Alward

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.

Mike says:

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.

I just got several folks to calculate their insulin load, and their heads almost exploded when I introduced them to GKI.

You can see in the chart below how Mike’s ketones have increased as he has reduced the insulin load of his diet.

The chart below shows how Mike’s glucose : ketone index (an approximation of insulin levels) has decreased as he lowered 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^{^[6]} 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 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 reduced 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 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 less 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 macro nutrients in terms of carbohydrates, protein and fat as per the 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 macro nutrient 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 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. You pancreas is constantly producing basal insulin to manage the flow of energy out of your liver and to remove excess energy from your blood stream.

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 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.

summary

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 reduce 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.

The foods lists in the table below have been optimised to suit different levels of insulin resistance and tailored to your weight loss goals.

approach	average glucose		waist : height
approach	(mg/dL)	(mmol/L)	waist : height
therapeutic ketosis	> 140	> 7.8
diabetes and nutritional ketosis	108 to 140	6.0 to 7.8
weight loss (insulin resistant)	100 to 108	5.4 to 6.0	> 0.5
weight loss (insulin sensitive)	< 97	< 5.4	> 0.5
bulking	< 97	< 5.4	< 0.5
nutrient dense maintenance	< 97	< 5.4	< 0.5

post last updated: April 2017

references

^{^[1]} https://optimisingnutrition.com/2015/03/23/most-ketogenic-diet-foods/

^{^[2]} https://optimisingnutrition.com/2015/03/22/ketosis-the-cure-for-diabetes/

^{^[3]} https://en.wikipedia.org/wiki/Dietary_fiber

^{^[4]} https://optimisingnutrition.com/2015/07/06/insulin-index-v2/

^{^[5]} https://en.wikipedia.org/wiki/Glucogenic_amino_acid

^{^[6]} https://www.myfitnesspal.com/

athletes, blood sugar, diabetes, fibre, insulin index, weight loss

the latest food insulin index data

March 30, 2015 Marty Kendall 33 Comments

Understanding the factors that our requirement for insulin is critical to good managing and avoiding diabetes and maintaining good metabolic health.

Living with someone who has Type 1 Diabetes for fifteen years I’ve gained an intimate understanding of how different foods will take your blood glucose levels on a wild ride.

In this article, I will share my insights from the latest food insulin index data and how we can apply it to optimise our insulin and blood glucose response to the food we eat.

How to get off the blood glucose roller coaster

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

High blood glucose levels make her feel “yucky”. 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 exhausted. If you have diabetes, you are likely familiar with this feeling.

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

When we decided we wanted to have kids, we found a great doctor who helped us to understand how to match insulin with carbs, but moderating the input of carbohydrate that necessitates insulin was never mentioned by physicians, endocrinologists or diabetes educators.

We eventually stumbled across low carb, and she was above to significantly improve her blood glucose control.

The latest food insulin index data

Then 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 the University of Sydney which seemed to provide more insight into our insulin response to food.

I hoped that by gaining a better understanding how different foods affect our requirement for insulin, I might be able to further refine our food choices to further reduce the amplitude of Monica’s blood glucose swings.

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 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. This was 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.

Considering how significant this information could be for people trying to manage their insulin levels (e.g. people with diabetes, “low carbers” or “ketonians”) I was surprised that there hadn’t been much 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, mainly because only a small number of foods been tested.

After some searching, 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. I plotted the relationship between carbohydrates and the food insulin index data.

As you can see, the relationship between carbohydrates and insulin is not straightforward. Some high protein and low-fat foods are sitting quite high up on the vertical axis while there are some high fibre foods with a lower insulin response than you might expect. However, once we account for the effect of protein, fibre and fructose we get are able to more accurately predict our body’s response insulin response to food. The foods in the bottom left corner of this chart are the least insulinogenic (or insulinemic).

If you want to dig into this data a bit more, you can check out the interactive Tableau version here.

As detailed in the most ketogenic diet foods article, this improved ability to quantify our insulin response to food enables us to identify foods that require less insulin and reduce the amplitude of our blood sugar swings in response to food. This understanding could also prove invaluable for who need a therapeutic ketogenic dietary approach as an adjunct to cancer treatment, epilepsy or dementia.

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.

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.

While living with Type 1 will never be fun, the journey towards normal blood glucose levels has been more than worth it, with Moni’s energy levels improving to the point she can go back to work and look forward to a long, healthy and happy life.

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 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.

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.

optimal foods for different goals

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.

the Nutrient Optimiser

Building on the ability to quantify insulin load, nutrient density and energy density, more recently I have been developing a novel tool. The Nutrient Optimiser reviews your food log diet and helps you to initially 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.

Once your glucose levels are normalised the Nutrient Optimiser focusses on your micro nutrient fingerprint to identify foods that will fill in your micro nutrient deficiencies with real food.

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. Alternatively, the Nutrient Optimiser can help you if you were looking to increase your insulin levels for bulking or identify higher energy density foods for athletes.

It’s early days for the Nutrient Optimiser, but the initial results are very promising.

Post last updated July 2017

blood sugar, diabetes, insulin index, ketosis

the 100 most ketogenic diet foods

March 23, 2015 Marty Kendall 166 Comments

Ketosis occurs when there is a lack of glucose, our insulin levels drop, and our body switches to fat for fuel.

Managing our insulin response to the food we eat is critical to ensuring that we are able to burn fat.

The food insulin index data indicates that our insulin response to food is best predicted, not just by carbohydrate, but also the protein and fibre content of our food.

This improved understanding can help us prioritise foods with a lower insulin load that will help us improve our blood glucose control.

But before we get to the list of the most ketogenic foods, let’s look at the research and the theory that enables us to identify foods that will cause the least insulin response.

Food insulin index

The food insulin index score of various foods was determined by feeding 1000kJ (or 239 kcal) of various foods to non-diabetic participants and measuring their insulin response over three hours. This was 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.

More food insulin index data

Digging a bit further I came across a recent PhD thesis from the University Of Sydney titled Clinical Application of the Food Insulin Index to Diabetes Mellitus (Kirstine Bell, September 2014) which contained a more extensive list of foods that had been tested in the original study.

With this additional data perhaps we can make more sense of the various factors that affect insulin, the master regulating hormone of our metabolism?

In the chart below I have plotted the carbohydrates versus the insulin response of foods for more than one hundred foods. Although insulin is loosely correlated with the carbohydrate content of our food, we can see that high protein foods such as steak, tuna and fish still require a significant amount of insulin.

I ran some analysis on the data and found that we secrete about half as much insulin in response to protein compared to carbohydrate. And we get the best correlation when we assume that indigestible fibre does not raise insulin. Interestingly, fructose only requires about a quarter of the insulin as carbohydrate.

Once we account for protein and fibre, we get a much better prediction of the insulin response to food compared carbohydrate alone. People wanting to follow a low carb or ketogenic diet will want to eat foods that lie towards the bottom left of this chart.

[Check out this cool interactive visualisation of all the FII test data here.]

Using this understanding, we can calculate insulin load of our food using the following formula:

insulin load = total carbohydrate – fibre + 0.56 x protein – 0.725 x fructose

We can also estimate the proportion of the energy in our food that requires insulin to metabolise (i.e. “the percentage of insulinogenic calories”).

If you have the macronutrient details of food or a meal you can calculate the percentage of insulinogenic calories using this calculator created by Dr Ted Naiman.

possible applications

Insulin is not bad at normal levels, but we are understanding more and more that excess insulin (e.g. hyperinsulinemia, insulin resistance, Type 2 diabetes) is highly problematic, perhaps as much or more than high blood glucose levels.

Understanding how to calculate our insulin response to food could enable us to better manage our diet to avoid elevated blood glucose and hyperinsulinemia.

The biggest challenge for someone with Type 1 Diabetes (like my wife) occurs when you require a large dose of insulin to address a high blood glucose level that is caused by eating non-fibre carbohydrates and large amounts of protein. It’s much easier to manage your blood glucose levels when the insulin load of your diet is lower (i.e. less non-fibre carbohydrates and moderate protein).

A more accurate understanding of insulin load can also help people with diabetes more accurately calculate their insulin dose or people trying to manage conditions like cancer or epilepsy through a therapeutic ketogenic diet.

For the rest of us who are somewhere on the insulin resistance scale, being able to calculate the insulin load of our diet will enable us to enable our pancreas to keep with our diet and maintain normal blood glucose levels.

The most ketogenic foods

Listed below are the most ketogenic foods. I have included some other parameters that may be of interest:

energy density – foods that contain high levels of fibre and water have a low energy density (i.e. calories per 100g) and will tend to make us full with fewer calories.
percentage of insulinogenic calories – this is the proportion of the energy in the food that will require insulin to metabolise.
insulin load – foods such as non-starchy vegetables have a higher percentage of insulinogenic calories, but because of their low energy density will have a very low insulin load per 100g of food, meaning that you will need to eat a lot of that particular food for it to affect your blood glucose or insulin significantly.
net carbohydrates – these are the digestible carbohydrates that will affect your blood glucose levels and insulin that remain after you account for the indigestible fibre.

The amount you need to prioritise each of these parameters depends on a range of considerations including your blood glucose control and your weight loss goals. Along with the insulin response to different foods, nutrient density and energy density are other important parameters we can use to optimise our food choices.

The chart below shows the nutrients provided by the most ketogenic foods in comparison to the USDA foods database. We can see that there are quite some nutrients that are less available in the most ketogenic foods compared to the average of the foods that commonly available. While it is valuable to manage the insulin load of our diet, it is also important to maximise the nutrient density of our food as much as we can while still maintaining excellent blood glucose levels.

different foods for different goals

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 add to your list for your next shopping expedition.

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.

I have sorted the foods below by insulin load which will be useful if you are looking for foods to help you manage the insulin load of your diet. If you’re interested, the most ketogenic foods article has these foods sorted by their proportion of insulinogenic calories.

Focusing on foods with a low percentage of insulinogenic calories will be useful if you are aiming for a high fat therapeutic ketogenic diet. Focusing on foods with a low insulin load may be more useful if you want to lose weight and use some of your body fat for fuel.

The most ketogenic diet foods

eggs

Eggs are a staple for low carbers, ketogenic dieters and diabetics. Not only are they nutritious they are also low in carbohydrates.

food	% insulinogenic	insulin load (g/100g)	calories/100g
egg yolk	18%	12	275
whole egg	30%	10	143
egg white	74%	9	52

The egg white is higher in protein and hence more insulinogenic. At the same time the energy density (calories/100g) of the egg white is lower, and hence the insulin load per 100g for the egg white is lower.

dairy

Some people believe that red meat and dairy are uniquely insulinogenic. However, my reading of the food insulin index data is that there is nothing special about these foods that aren’t explained by their carbohydrate, protein and fibre content.

Dairy foods typically have a high energy density. This is great if you’re a growing baby, an athlete trying to replenish energy or a bodybuilder trying to spike insulin for hypertrophy. High palatability and high energy density are not a good combination if you’re trying to lose weight.

cheese

food	% insulinogenic	net carbs/100g	insulin load (g/100g)	calories/100g
cream cheese	10%	4	8	348
cottage cheese	38%	3	9	93
ricotta cheese	25%	3	11	174
feta cheese	22%	4	14	265
Limburger cheese	18%	0	15	327
Camembert cheese	20%	0	15	299
brie cheese	19%	0	16	334
Muenster cheese	20%	1	18	368
blue cheese	20%	2	18	354
mozzarella	23%	2	18	318
Monterey	20%	1	19	373
cheddar cheese	20%	1	20	403
Colby	20%	3	20	394
Edam cheese	22%	1	20	356
Gouda cheese	23%	2	20	356
provolone	24%	2	21	350
Gruyère cheese	21%	0	22	412
goat cheese	22%	2	25	451
Swiss cheese	26%	5	25	379
parmesan cheese	30%	3	31	411

milk and cream

Milk has a higher proportion of insulin calories compared to cheese. Butter and cream have a lower insulin load and proportion of insulinogenic calories.

food	% insulinogenic	net carbs/100g	insulin load (g/100g)	calories/100g
butter	0%	0	1	734
cream	5%	4	5	431
goat milk	40%	4	7	69
full cream milk	44%	5	7	65
low-fat milk	58%	5	7	50
human milk	43%	7	8	71
reduced fat milk	59%	5	8	51

yoghurt

Full fat plain Greek yoghurt has the lowest percentage of insulinogenic calories while the sweetened and low-fat options are extremely insulinogenic.

food	% insulinogenic	net carbs/100g	insulin load (g/100g)	calories/100g
Greek Yoghurt	27%	6	9	130
plain low-fat yoghurt	69%	7	11	63
skim milk yoghurt	86%	8	12	55
Low-fat fruit yoghurt	93%	19	22	95

fruit

It’s interesting to note that there are only a handful of fruits with a low percentage of insulinogenic calories (i.e. olives and avocados). However, some fruits like oranges have a lower insulin load because of their low energy density and therefore may not spike your blood sugar as much as dates or raisins which have a high proportion of insulinogenic calories as well as a high insulin load. If in doubt, get a blood glucose metre and compare how much your favourite foods raise your blood glucose levels.

food	% insulinogenic	insulin load (g/100g)	calories/100g
olives	3%	1	145
avocado	8%	3	160
blackberries	27%	3	43
raspberries	30%	4	52
strawberries	49%	4	32
apples	50%	7	52
gooseberries	52%	6	44
passionfruit	52%	14	97
apples	54%	7	48
pears	54%	7	50
boysenberries	54%	8	50
kiwifruit	55%	9	61
carambola	56%	5	31
blueberries	56%	9	57
blueberries	58%	14	88
watermelon	60%	5	30
jackfruit	61%	16	95
cherries	61%	9	50
mango	63%	11	60
pears	64%	7	42
cranberries	65%	8	46

vegetables

There aren’t many dietary approaches that don’t advise you to eat more vegetables. It’s also hard to overeat non-starchy veggies because they have a very low-calorie density and are high in fibre. Again, due to the low energy density, the net carbohydrates are low in a lot of the non-starchy veggies and hence won’t significantly raise your blood glucose levels.

food	% insulinogenic	insulin load (g/100g)	calories/100g
alfalfa	19%	1	23
chicory greens	23%	2	23
endive	23%	1	17
escarole	24%	1	19
coriander	30%	2	23
beet greens	35%	2	22
banana pepper	36%	3	27
mustard greens	36%	3	27
collards	37%	4	33
jalapeno peppers	37%	3	27
sauerkraut	39%	2	19
pickles	39%	1	12
cucumber	39%	1	12
zucchini	40%	2	17
red peppers	40%	3	31
chayote	40%	3	24
edamame	41%	13	121
radishes	43%	2	16
turnip greens	44%	4	29
summer squash	45%	2	19
arugula	45%	3	25
carrots	47%	5	37
parsley	48%	5	36
chives	48%	4	30
spinach	49%	4	23
artichokes	49%	7	47
soybeans (sprouted)	49%	12	81
Brussel sprouts	50%	6	42
lettuce	50%	2	15
asparagus	50%	3	22
celery	50%	3	18
bamboo shoots	50%	2	11
okra	50%	3	22
cauliflower	50%	4	25
broccoli	50%	5	35
turnips	51%	3	21
chard	51%	3	19
celery flakes	53%	42	319
dandelion greens	54%	7	45
Chinese cabbage	54%	2	12
red cabbage	55%	5	29
portabella mushrooms	55%	5	29
rhubarb	55%	3	21
cabbage	55%	4	23
shiitake mushroom	58%	7	39
snap beans	58%	3	15
yeast extract spread	59%	27	185
kale	60%	5	28
bamboo shoots	60%	5	27
turnips	61%	4	22
carrots	61%	4	23
potatoes	64%	26	158

nuts and seeds

Most nuts and seeds have a low percentage of insulinogenic calories though they have a higher energy density are possible to overeat.

food	% insulinogenic	insulin load (g/100g)	calories/100g
macadamia nuts	6%	12	718
pecans	6%	12	691
coconut cream	8%	7	330
coconut milk	8%	5	230
brazil nuts	9%	16	659
coconut meat	10%	9	354
sesame seeds	10%	17	631
hazelnuts	10%	17	629
pine nuts	11%	21	673
flax seed	11%	16	534
walnuts	13%	22	619
sunflower seeds	15%	22	546
almonds	15%	25	607
almond butter	16%	26	614
butternuts	17%	28	612
pumpkin seeds	19%	29	559
sesame butter	21%	33	586
pistachio nuts	22%	34	569
cashews	26%	40	580
coconut	34%	39	443
gingko nuts	52%	15	111
coconut water	66%	3	19

seafood

Seafood is a great source of essential fatty acids which are heard to find in plant based foods.

food	% insulinogenic	insulin load (g/100g)	calories/100g
mackerel	14%	10	305
cisco	29%	13	177
caviar	33%	23	264
herring	36%	19	217
sardine	37%	19	208
anchovy	44%	22	210
trout	45%	18	168
fish roe	47%	18	143
sturgeon	49%	16	135
salmon	52%	20	156
tuna	52%	23	184
flounder	57%	12	86
oyster	59%	14	102
perch	62%	14	96
rockfish	66%	17	109
whiting	66%	18	116
halibut	66%	17	111
crayfish	67%	13	82
shrimp	69%	19	119
pollock	69%	18	111
white fish	70%	18	108
orange roughy	70%	17	105
haddock	71%	19	116
cod	71%	48	290
octopus	71%	28	164
lobster	71%	15	89
crab	71%	14	83
clam	73%	25	142
scallop	77%	22	111

animal products

food	% insulinogenic	insulin load (g/100g)	calories/100g
bacon	11%	11	417
bologna	11%	9	310
sweetbread	12%	9	318
liver sausage	13%	10	331
pepperoni	13%	16	504
blood sausage	14%	13	379
kielbasa	15%	12	325
knackwurst	16%	12	307
liver pate	16%	13	319
bratwurst	16%	13	333
frankfurter	17%	12	290
chorizo	17%	19	455
pork ribs	18%	16	361
beef sausage	18%	15	332
duck	18%	15	337
salami	18%	17	378
meatballs	19%	14	286
lamb rib	19%	17	361
turkey bacon	19%	11	226
pork sausage	20%	16	325
headcheese	20%	8	157
turkey	20%	21	414
beef brains	22%	8	151
pork sausage	25%	13	217
bologna	26%	11	172
T-bone steak	26%	19	294
lamb brains	27%	10	154

the Nutrient Optimiser

Once your glucose levels are normalised the Nutrient Optimiser focusses on your micro nutrient fingerprint to identify foods that will fill in your micro nutrient deficiencies with real food.

It’s early days for the Nutrient Optimiser, but the initial results are very promising.

Post last updated July 2017

the importance of monitoring blood glucose levels

optimal ketone levels

the relationship between ketones and glucose

it works until it doesn’t

what is insulin resistance anyway?

be a nutrient chaser

ask the experts

are you really insulin resistant?

oral glucose tolerance test

kraft test

oral protein tolerance test

optimal dietary approach survey

can I take my insulin levels to zero?

so just tell me what to eat!

references

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context matters

disclaimers

insulin is not the bad guy

different degrees of the ketogenic diet

ketogenic ratio

ratio of fat to protein

protein grammes per kilogramme of lean body weight

gluconeogenesis

carbohydrate counting

protein, insulin load and nutrient density

what is ketosis?

insulin load versus nutrient density

macronutrient splits

nutrient density

choosing the right approach for you

more numbers

what about mTOR?

how much protein?

insulin load

summary

references

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optimal foods for diabetes and nutritional ketosis

optimal foods for weight loss

finding the optimal balance between the extremes

vegetables

seafood

animal products

dairy and egg

other dietary approaches

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what’s so bad about sugar anyway?

drinks

sweets

fruits and fruit juices

cereals and baked products

other approaches

references

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insulin load, a refresher

but why would you want to spike your glucose levels?

the mission…

vegetables

animal products

seafood

legumes

grains

dairy

other dietary approaches

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show me the data!

Patricia Berry Moore

a little closer to home

Mike Alward