Tag Archives: low carb diet

the carbohydrate-insulin hypothesis vs the adipose centric model of diabetes and obesity

I recently shared Dr Ted Naiman’s latest “insulinographic” that attempts to explain the adipose centric theory of diabetesity.

It created some great discussion as well as some confusion, so I thought it would be worth an article to unpack the critical insights about how insulin really works in our body and what we can do to reduce body fat and avoid diabetes.

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The first clarification is that this isn’t a meme or a graph.  It’s more an infographic that attempts to explain how insulin is anti-catabolic and works like a dam to hold back the flood of stored energy in our body.

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The dam analogy builds on the line of thought initially detailed in the Does insulin resistance really cause obesity? article.

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Basal vs bolus insulin

I have spent a lot of time analysing the insulin index data which helps us to quantify our short-term insulin response to food.

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This is helpful for people with diabetes (like my wife Monica) to choose foods that keep their blood sugars stable as well as help them more accurately calculate their insulin dose by accounting for carbohydrates, fibre, protein and fructose.

However, with all the focus on carbs, fat and protein, I fear we may have neglected the most important thing that influences our insulin response to the food we eat.

Majoring in the minors

Before we switched to a lower carb dietary approach, my wife Monica was taking about 50 units of insulin per day to manage her Type 1 diabetes.  ABout half of that was for food (bolus) and half was her background insulin (basal).

These days, Monica takes about half the insulin that she used to.  However, now about 80% of her daily insulin dose is basal insulin while only 20% of her insulin is taken to manage her blood sugars levels around meals.

basal insulin

bolus insulin (for food)

total daily insulin

Higher carb diet

25 units

25 units

50 units

Low carb diet

20 units

5 units

25 units

Monica’s basal insulin demand has reduced a little due to some weight loss and improved insulin sensitivity.

The most interesting observation is that the vast majority of the insulin required by someone on a low carb diet is not related to the carbohydrates or even the protein in the food they eat. 

While carbs and protein raise insulin in the short term, the fat on our body and the fat in our diet have the most significant influence on our insulin levels.

The grey area in the chart below shows the insulin released across the day by someone with a functioning pancreas.  The pink line shows how someone with Type 1 diabetes tries to mimic this with an insulin pump.

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A lower carb diet is a no-brainer for someone with diabetes to help them stabilise their blood sugars and appetite.[1]  However, we get to a point of diminishing returns when we only focus on the carbohydrate and protein in our diet while ignoring the fat in our diet and the fat on our body.

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Elevated fasting (or basal) insulin is the elephant in the room for many people on a low carb or keto diet.  Many people on a low carb or ketogenic stabilise their blood sugars and improve HbA1cs, but are still obese with high fasting insulin levels.

The harsh reality is that replacing the carbs and protein in your diet with fat will not reverse your hyperinsulinemia unless it also reduces the amount of fat stored on your body!

But what is going on?

But what can we do?

That’s where Ted Naiman’s “insulinographic” comes in.

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Many people think that elevated insulin is the cause of obesity.  But, I’m coming to realise that most of the time it’s actually the other way around.

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It is actually obesity (or at least being overfat relative to our Personal Fat Threshold) that causes hyperinsulinemia.

Insulin is anti-catabolic

We typically think of insulin as an anabolic hormone that forces amino acids into muscles and glucose into our cells.  But it can actually be more useful to think of insulin’s anti-catabolic properties.[2] [3] [4] [5] [6] [7]

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Rather than just building our muscles and fat stores or forcing glucose into the cells, insulin also works to keep fat and muscle in storage.

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Insulin prevents entropy (or chaos) and ensures that we don’t melt into a puddle like Olaf the Snowman.

Someone with Type 1 diabetes does not have enough insulin to prevent catabolism.  Their protein, fat and glucose stores in their body get released into their bloodstream in an uncontrolled manner and result in high glucose, high free fatty acids and high BHB ketones.

The good news though is that if your pancreas is working, you will produce insulin when you’re not eating to enable you to regulate the amount of fuel being released from storage into your bloodstream.  

Healthy fasting insulin levels in hunter-gatherers range between 3 – 6 mIU/mL.[8]  In western populations, the average fasting insulin level is about 8.6 mIU/mL.[9]  People with insulin resistance or diabetes have much higher levels of fasting insulin.

Insulin is the hormonal signal that raises the dam wall to slow the flow from stored energy via our liver while the energy in our bloodstream is being used up.

The more fat you have to hold back in storage, the higher your insulin levels need to be.

This helps us to understand why many people low carbers who are obese have high fasting insulin levels.  Even though they may be eating minimal amounts of carbs and protein in an effort to keep their insulin levels low, their body is keeping insulin high in an effort to hold their energy in storage until the energy in their bloodstream is used up.

To help elaborate on this I have fleshed out what various scenarios would look like in terms of body fat, insulin levels and energy in the blood (i.e. glucose, ketones and free fatty acids) in the table below.

note: TOFI = thin on the outside, fat on the inside and PFT = personal fat threshold

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I can make you fat

Dr Jason Fung points out that people using exogenous (injected) insulin to manage their diabetes can develop obesity and insulin resistance because of their medications.

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Dr Robert Lustig also explains how someone injected with a little bit of extra insulin at each meal will store more fat and not be able to mobilise their body fat (lipolysis).

To some extent, this is what happens when someone with diabetes injects insulin to cover a crappy nutrient-poor insulinogenic diet.  With large doses of exogenous insulin to cover a high carb processed diet they never quite get the insulin dosing right.  They end up overdosing with insulin and having to eat more to rescue themselves from low blood sugars.  The great thing about a low carb more less processed foods for these people is that it helps stabilise blood sugar and insulin doses which is easier to manage with smaller doses of insulin.

To go back to our “dam” analogy, excessive exogenous insulin for someone who already has hyperinsulinemia is like building our dam wall higher than it needs to be.  The higher dam wall will hold back more energy in storage than it needs to and less of the energy we eat will be released into the bloodstream.

We feel hungrier because the excessive exogenous (injected) insulin is not allowing energy to be released into circulation.

We will end up eating more, and this excess energy will be stored more easily.  We will become more and more resistant to the insulin we are injecting as our fat stores become fuller, and we need more insulin to hold our fat in storage.

The solution here is a low carb diet to help stabilise blood sugars and hunger driven by excessive swings in insulin and blood sugar.

The fatal flaw in the insulin-centric view of obesity

Where this insulin-centric view of diabetes and obesity fails is that it doesn’t translate to someone who is not taking exogenous injected insulin or drugs that stimulate insulin release from their pancreas.  

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Our bodies optimise for efficiency.  Unless you have an insulinoma (a tumour on your pancreas), your pancreas will not secrete more insulin than it needs to.   

Our pancreas will not build the dam wall higher than it needs to be to hold back the energy coming into our system!

Irrespective of insulin levels, you cannot store energy we do not eat.   

At the risk of doing your head in, we can look at the function of insulin as anabolic (building) and anti-catabolic (preventing breakdown) and get to the same conclusion:

  • Anabolic  – Although dietary fat doesn’t raise insulin much in the short term, you will always have enough basal insulin on board to store the fat you eat on your body (note: this is the anabolic.
  • Anti-catabolic – Your pancreas will always produce enough insulin to slow the flow of energy out of the stores on your body while you use up the energy from the food coming in from your mouth.

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Our fasting insulin is proportional to the amount of fat stuffed away in storage which is directly proportional to the amount of food that we have eaten.  

We cannot really blame obesity on insulin resistance.  It is our insulin sensitivity that enables our fat cells to grow.  Once we become insulin resistant, we actually find it harder to store excess energy in our adipose tissue.  

How to keep your basal insulin low

There a number of things that help us lower our dam wall, including:

  • exercise,
  • fasting,
  • a low energy diet, or
  • a high nutrient density diet.

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Exercise

Exercise, particularly resistance excercise or HIIT, is a great way to build insulin sensitivity and helps us to burn off fat and sugar without the need for insulin.[13]  People with Type 1 diabetes find they need to reduce their insulin dose when they are active and increase their basal by about 25% when they don’t exercise.

Fasting

Not eating for a period of time is a great way to reduce your insulin.

Once you use up the glycogen in your liver, your body turns to the fat stores and lowers insulin levels to allow more stored body fat to flow over the dam into the system.

However, for some people, the problem with fasting is that it’s easy to overdo the refeed.

When I was fasting regularly to try to lose some extra fat, I found I would permit myself to eat more than I would otherwise have eaten.  And the foods that I chose to eat were often less nutrient dense and more energy dense dense than usual.

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In spite of the saint-like deprivation for days, I found I didn’t lose much weight over the long-term.  In the end, I seemed to eat back my deficit.  My wife Monica would say ‘I don’t think this fasting thing is working for you!  Why don’t you try eating a little less each day?’

I have talked about using your bathroom scale or blood sugar readings to refine the frequency and quantity of your feeding to make sure you are moving towards your goal.  Unfortunately, just like tracking calories, these approaches to fine tuning your food intake require self-discipline and deprivation which is not fun.

Even better than tracking blood glucose or your weight, another way to manage your fasting/feeding frequency and food intake would be to measure your blood insulin level to ensure it was going down to new lows before you ate, and then ensure that when you refeed that you didn’t drive insulin too high with too much food.

Unfortunately, there is no home test for insulin yet, so our blood glucose metre and the bathroom scale are the best we can do for now.

Many believe that they will keep insulin levels low if they focus on higher fat foods when they refeed.  However, it is possible to drive higher levels of insulin with a high-fat intake in only a short amount of time.

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A relevant example of this is Jimmy Moore’s recent high protein experiment where he reduced his fasting insulin from 14.2 to a very respectable 8.8 mIU/mL in five days on a high protein energy restricted diet.[14] [15] [16]

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Afterwards, he finished the fast on Sunday (8 April as per the date on the Instagram image below) he proceeded to boost his fasting insulin to 18 mIU/mL after a day of high fat refeeding before the laboratory was open to measure his post-experiment labs on Monday.  This post refeed insulin was actually higher than his 14.2 mIU/mL insulin before the experiment began.

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This also aligns with the study results shown below where participants lowered their insulin and triglycerides more higher protein lower carb diet.[17]

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Similarly, this twelve month randomised control low carb study found that people had better outcomes in terms of weight, body fat, insulin, HOMA-IR, HDL, hunger and emotional eating with higher levels protein.

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It will be interesting to see how Jimmy’s upcoming high-fat bio hack goes.  I hypothesise that Jimmy’s short-term insulin level may be lower after meals, but his longer-term fasting insulin will be higher on the high-fat approach.

Once we account for the Thermic Effect of Food (TEF), there is actually more available energy in the high-fat approach as shown in the calculations below.

high protein (3:1) 80% fat
fat (g) 90 168
protein (g) 270 95
fat (cal) 810 1512
protein (cal) 1080 378
energy consumed (cal) 1890 1890
TEF (cal) 405 265
available energy (cal) 1485 1625
short-term insulin higher lower
long-term (fasting) insulin lower higher

With less energy actually available to the body in the high protein scenario, the pancreas will produce less insulin to allow more energy to be released from storage compared to the high-fat scenario.

Low energy diet

As noted in Ted’s insulinographic, a low energy density diet is another way to keep your basal insulin levels down.

You can achieve this by focusing on foods with a lower energy density which will make it harder to overeat.  This will ensure your body fat stores are used.  With less fat to hold back in storage, your insulin levels will decrease.

This is why we see some people who make the switch to a whole foods plant-based diet reduce their insulin requirements and reverse their diabetes.   As long as they stick to whole foods, they will not be able to ingest enough energy to maintain their weight, so their insulin comes down.  However, this does not hold for processed vegan junk food which can still be energy dense, highly processed, hyperpalatable and easy to overconsume.

What about trying to eat less food?

Another option is to try to simply eat less food.  While this can be helpful, it shouldn’t be the only technique used as simply restricting the intake of nutrient-poor junk food is a recipe for nutrient cravings and rebound binge eating.

Nutrient-dense diet

Maximising nutrient density is my favourite hack because it addresses the following factors:

  • Adequate protein. If you eat foods that contain the vitamins, minerals and essential fatty acids you need you will obtain plenty of protein which, on a calorie for calorie basis, is the most satiating macronutrient.   There is a lot of confusion around protein, but the reality is, if you are eating foods that contain adequate levels of vitamins, minerals and essential fatty acids you will be getting plenty of protein.  Conversely, actively avoiding protein may lead to nutrient deficiencies.  Whether you approach this in terms of higher nutrient densitym, targeting the most satiating macronutrients or the foods that will naturally provide you with greater satiety you arrive at pretty much the same point.

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  • Energy density. A nutrient-dense diet typically has plenty of whole foods that have lower levels of refined carbs and processed fats which have a lower energy density and hence are hard to overeat.
  • Minimally processed. Quantifying nutrient density is a foolproof way to ensure that the food contains the micronutrients you need rather than hyperpalatable flavourings and colours from Frankenfoods that are designed to look like they are good for you (but they’re not).  These minimally processed foods are also satiating without being hyperpalatable so are self-limiting.
  • Prevents cravings. Good nutrition, avoiding diabetes, weight control and lower insulin levels seems to boil down to getting the nutrients you need without too much energy.  Focusing on nutrient-dense foods also gives the best chance of avoiding nutrient cravings that will unnecessarily drive your appetite.

Fat raises insulin too, it just takes longer

Most of the time we focus on carbs (and to a lesser extent protein) as being the culprit when it comes to raising insulin levels.   But does this hold true when we look at the big picture?

The insulin index data suggests that higher fat foods have a lower insulin response.  But is this simply because the insulin index testing only measured the insulin response over three hours?

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The chart below on the left shows that insulin rises more slowly for a high-fat meal compared to glucose or a mixed meal.[18]  However, it still rises and looks like it will keep on going for a while after the 120-minute measurement.

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If we were able to test the insulin response over 24 hours, I think we would see that insulin response is actually more closely related to the available energy in our food rather than a specific nutrient.

Is our long-term insulin response simply related to the amount of energy in our food and hence the amount of energy needs to be held back in storage by the liver?

Is it only because carbs and protein have a higher oxidative priority than fat that we see a greater short-term spike in insulin (i.e. the body needs to act more quickly with a sharper insulin response to hold back energy from carbs in storage compared to fat or protein)?

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The adipose centric model of diabesity

The insulin-centric view of obesity, diabetes and insulin resistance focuses on reducing insulin by switching carbs out for fat to control our (short term) insulin response to food.

Meanwhile, the adipose-centric view of diabetes is a little bit more sophisticated and complete as it also considers the long-term insulin response to the food we consume.

Someone who is lean and insulin sensitive will have healthy levels of adipose tissue that can quickly swell to take on more energy and then release it.  If you are insulin sensitive like these guys, you store precious energy very efficiently when it is available.

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But our fat stores can only take in so much energy before they become full.  There is a limit to how high you can build your dam wall.

When your fat cells become stuffed and can’t take on more energy, they are said to be “insulin resistant”.  At this point, any excess energy spills out into the bloodstream as elevated glucose, free fatty acids or ketones.  Excess energy is also pumped into our vital organs, and we develop fatty liver, fatty pancreas, heart disease and the other complications of western civilisation.

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To be clear, it’s not being obese that causes diabetes. Instead, it’s a matter of being overfat relative to your Personal Fat Threshold.  Some people are “blessed” to be able to store a lot more energy in their fat stores before they become insulin resistant and diabetic, while others find that can only store a little bit of energy in their adipose stores before it overflows and ends up being stored in their vital organs and bloodstream.

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Disease progression and reversal

Listed below is the progression from health to disease, with hyperinsulinemia building progressively throughout.

  1. Insulin-sensitive healthy fat levels that are able to easily absorb and release any excess energy for later use.
  2. Expansion and filling of insulin-sensitive adipose tissue with sustained energy excess.
  3. Fat cells become full and exceed your Personal Fat Threshold (largely influenced by genetics).
  4. Fat cells become full and “insulin resistant” relative to other parts of the body.
  5. Excess energy builds up as visceral fat in vital organs and spills over into the bloodstream (aka diabetes).
  6. Excessive swings in blood sugar and insulin cause a dysregulated appetite driving further overeating.
  7. Complications of western disease due to (i.e. obesity, diabetes, heart disease, Parkinsons, Alzheimers, dementia etc).

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To reverse these steps and reduce insulin to normal levels we need to follow to:

  1. Stabilise blood sugars and insulin swings by reducing processed carbohydrates to help improve appetite control and eliminate the need for exogenous insulin.
  2. Focus on more nutrient dense, less energy dense foods to improve satiety and induce an energy deficit.
  3. A sustained energy deficit causes a reduction in visceral fat which improves the function of the heart, liver, pancreas and brain.
  4. Reduced pressure on the adipose fat allows to below the Personal Fat Threshold allows incoming energy to be buffered in fat stores without overflow into the bloodstream (i.e. reversal of diabetes).
  5. Fat loss further reverses insulin levels and blood sugars to achieve optimal levels for longevity and performance.

So what’s the solution?

So, if insulin and carbs aren’t to blame for our obesity and diabetes then what can we do?

Is it back to just eat less, exercise more?

Well sort of, but not exactly.

There are a number of practical steps that we can take to avoid diabesity including:

  • Minimise cheap hyper-palatable processed food that overrides our satiety signals and tricks our taste buds.
  • Invest in quality food and learn to cook at home from fresh whole ingredients.
  • Monitor your nutrient intake by logging your food using Cronometer.
  • Eat your meals mindfully with other people rather than in front of a screen alone.
  • Don’t use food as a source of comfort.
  • Sleep and rest enough so you don’t need to use energy dense food as a pick me up.
  • Be active and build as much lean muscle as you can in order to efficiently burn the carbs and fat you consume.
  • Focus on nutrient-dense foods that are minimally processed that will minimize cravings. If you focus on maximising the good stuff in your diet, you will not have to worry as much about avoiding the processed food that are full of sugars, flavourings and seed oils.
  • Moderate carbs if you need to stabilise blood sugar and insulin swings which can help stabilise appetite. Diabetes and longevity expert, Dr Peter Attia, recommends that we eat foods that will keep our blood sugar low (i.e. less than 90 mg/dL) and with a relatively tight standard deviation of less than 10 mg/dL.[19] [20]
  • Don’t demonise macronutrients, but instead prioritise nutrient-dense whole foods.

If all of the above still don’t get you to where you want to be then you may need to track your intake for a while and titrate down your calorie intake to recalibrate your version satiety.   The good news is that many people find when focusing on maximising the nutrient density of their diet managing the quantity of food isn’t such a big deal.

 

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792004/

[2] https://www.ncbi.nlm.nih.gov/pubmed/16705065

[3] https://www.ncbi.nlm.nih.gov/pubmed/3298320

[4] https://www.t-nation.com/diet-fat-loss/insulin-advantage

[5] https://www.ncbi.nlm.nih.gov/pubmed/16705065

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804253/

[7] https://academic.oup.com/bja/article/85/1/69/263650

[8] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[9] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[10] https://www.ncbi.nlm.nih.gov/pubmed/7972417

[11] http://www.diabetesincontrol.com/insulin-as-a-satiety-signal-in-postprandial-period/

[12] https://weightology.net/insulin-an-undeserved-bad-reputation/

[13] https://www.ncbi.nlm.nih.gov/pubmed/9435517

[14] http://www.ketohackingmd.com/8-7-day-high-protein-hack-experiment-results-part-1/

[15] http://www.ketohackingmd.com/9-7-day-high-protein-hack-experiment-results-part-2/

[16] http://www.ketohackingmd.com/10-7-day-high-protein-hack-experiment-results-part-3/

[17] https://www.ncbi.nlm.nih.gov/pubmed/15817850

[18] https://chrismasterjohnphd.com/2017/07/26/insulin-really-response-carbohydrate-just-gauge-energy-status-mwm-2-23/

[19] https://peterattiamd.com/2016-update/

[20] https://www.youtube.com/watch?v=vDFxdkck354

 

balancing diet and diabetes medications

  • High blood glucose levels (glucose toxicity) and high insulin levels (hyperinsulinemia) are both bad news for your health.
  • The highest priority in the treatment of diabetes should be to reduce foods that require large amounts of insulin.
  • Over reliance on medications can lead to ‘learned helplessness’, meaning that people do not use a dietary intervention to what is primary a dietary disease.
  • Periods of fasting and intense exercise also improve insulin sensitivity.
  • A lower insulin load diet and improved insulin sensitivity will enable you to reduce and possibly eliminate medications.

when do you need insulin?

Last year I was tracking my blood sugars.  I was concerned with what I saw.

Based on my average sugars of about 6.2mmol/L my HbA1c would have been about 5.5%.  I wasn’t happy because I knew it was still well away from ideal. [1]  I knew that improving my blood sugars was likely the key to losing the weight that I had been struggling with.

In an odd sort of way I was jealous of my wife who has type 1 diabetes.  She could manipulate her blood glucose levels manually with her insulin pump, but I wasn’t sure what to do to bring my blood glucose levels down to more healthy levels.

Given that doctors will typically not give insulin until your HbA1c is greater than 7.0% [2] there was no way a doctor was going to prescribe me with insulin.  My doctor told me to lose some weight to combat the developing signs of fatty liver in my blood tests.

In January 2015 I found Jason’s Fung’s videos [3] and kicked myself in the butt.  Intermittent fasting seemed to do the trick to break the insulin resistance even though I had been following a lower carb paleo approach for a while.  I was able to get my blood sugars back down to an average of 5.4mmol/L to give me an estimated HbA1c of about 4.8% and in the process of actively trying to manage my blood glucose levels I lost ten kilograms.

Fasting and improving insulin sensitivity

Dr Jason Fung [4] has recently increased the focus on fasting and dietary intervention and discourages an over-reliance on insulin to manage diabetes.

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Jason says that focussing on medicating the symptoms of diabetes rather than addressing the root cause of insulin resistance can lead to a ‘learned helplessness’ where people do not pursue a dietary solution to what is largely a dietary problem.

Addressing diabetes by giving insulin to address the symptom of high blood glucose levels is like giving an alcoholic alcohol to relieve the symptoms of their alcohol withdrawal. 

Meanwhile, Dr Richard Bernstein says that most of his type 2 diabetics need to remain on small doses of insulin in addition to minimising carbohydrate in order to achieve ‘normal blood sugars’.[5]

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In this video Dr Bernstein however notes a number of negative consequences of taking exogenous insulin including:

  • inconvenience,
  • it can make you fat if you eat a lot of carbohydrate, and
  • it can cause hypoglycaemia (i.e. low blood glucose levels).

the balance between diet and medication

So how do we find the optimal balance between an over-reliance on exogenous insulin and medication while still achieving normal blood sugars?

Dr Ted Naiman of BurnFatNotSugar.com says that when he sees a new diabetic patient he checks their fasting insulin and C-peptide levels to understand whether they are still producing insulin or if their pancreas is already burned out.

If you don’t have access to these tests another option is to test your ketones and blood glucose levels to establish the ratio of glucose to ketones, which can also help you estimate your insulin levels (see the glucose : ketone index).

High insulin and high blood glucose means that you are insulin resistant (i.e. hyperinsulinemia).

Low insulin and high blood glucose means that you are insulin deficient and your pancreas is not producing enough insulin (i.e. type 1.5 diabetes, LADA).

Dr Naiman (pictured below – he practices what he preaches!) says he “avoids insulin like the plague” if at all possible, preferring to focus on diet, fasting and exercise.

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Ted says that if you are still producing insulin but have high blood glucose levels the urgent need is to reduce the insulin load of the diet, start an exercise routine to improve insulin sensitivity, and ideally commence intermittent fasting ASAP!  If you continue to consume a diet with a high insulin load you risk burning out the beta cells of your pancreas at which point you will require insulin.

Ted has produced an excellent summary of intermittent fasting and the various ways to put it into practice that you can download here.  For more detail you also can check out Brad Pilon’s Eat Stop Eat or Jason Fung’s series on the topic.

the dangers of glucose toxicity

As discussed in the Diabetes 102 article there are a range of well-established risk factors for high blood sugars including accelerated brain shrinkage, cancer, obesity, heart disease and stroke.

This article from Jenny Ruhl’s Blood Sugar 101 lists a number of other complications related to high blood sugars including nerve damage, beta cell destruction, heart disease, diabetic retinopathy, and kidney disease.

Just in case you weren’t already aware… elevated blood glucose levels are very bad news!

If you want to be healthy, feel good, look good and live a long life, then your number one priority should be to do whatever it takes to achieve excellent blood sugars.

the dangers of insulin toxicity

I was interested to hear Professor Tim Noakes tell Robb Wolf in episode 273 of the Paleo Solution Podcast

You really want to keep your control through diet and minimal medication and never use insulin.

What I take this to mean is not that insulin is forbidden for people who need it, but rather that you should do whatever you can to not get to the point that you need to be injecting insulin to control your blood glucose levels.

Dr Fung points to the ACCORD Study[6] along with the ADVANCE, VADT and ORIGIN studies which showed worse outcomes for people with type 1 diabetes who targeted a lower HbA1c of 6.0% rather than a more typical 7.5%.

The figure below from the ACCORD study shows the reduction in HbA1c with intensive therapy (i.e. more insulin) to “successfully” reduce blood sugar levels.  What they found however was that the people in the intensive therapy group were 22% more likely to die (i.e. all-cause mortality) in spite of having ‘better’ blood glucose levels!

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This may sound contradictory, because at the same time we know that reduced HbA1c levels actually lead to better health outcomes in the general population.  So what’s the difference?  Why are these studies suggesting that trying to normalise blood glucose levels are dangerous?  Is there something about people with diabetes that makes it unhealthy for them to have lower blood sugars?

There is plenty of debate on what these studies really mean, [7] [8] [9] however Dr Fung says it is the use of medication in the absence of dietary intervention that is making the difference.  Simply applying more insulin or other medications without addressing the diet is not only illogical it’s very dangerous!

This aligns with the data shown below[10] which shows that reducing HbA1c is highly beneficial when it comes to heart attack and stroke risk, however doing it through the use of antidiabetic medication does not help.

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Ivor Cummings does a great job on his blog of highlighting a wide range of studies that demonstrate that insulin resistance is by far the dominant risk factor for heart disease. [11] [12] [13] [14] [15]  All we do when we medicate a high carbohydrate diet with insulin is to exacerbate the insulin resistance.

So is insulin all bad?  Not necessarily.  Insulin is important for a range of bodily functions including growth.  However, high levels of insulin to cover high levels of dietary carbohydrate is a recipe for metabolic disaster.

Rather than relying on insulin, Dr Fung recommends a low insulin load diet combined with periods of fasting to improve insulin sensitivity and reduce insulin and blood sugar levels.  Dr Fung told me that people need to “reduce both blood glucose and insulin to reduce glucotoxicity and insulin toxicity.”  He says a HbA1c of less than “6.0% is defined as normal, although the lower you get, the better. However, this only applies if you are using diet rather than medications.” [16]

two sides of the same coin?

Both Dr Fung and Dr Bernstein focus primarily on non-medical interventions which include:

  1. A low carbohydrate / low glucose load / low insulinogenic diet. I suggest you focus on foods from this list and meals from here to bring your blood sugars under control.
  2. Exercise will improve your insulin sensitivity and help to remove excess glucose from your system. High intensity short duration exercise is ideal along with regular movement through the day.  Rather than forcing yourself to exercise out of guilt you may find once you balance your blood sugars with diet rather than medication you have more energy and want to move more.
  3. Fasting is a great way to restore insulin sensitivity and reduce blood glucose levels naturally. It might be considered by some to be extreme, however it’s the most aggressive and effective approach to move the metabolic needle in the right direction.  And it’s not that hard, particularly if you’ve got a lot of weight to lose and you’re looking down the barrel of major health complications.

Bob Briggs does a great job of putting this into simple terms that are easy to understand and apply.

refining insulin levels for type 1 diabetics

For someone with type 1 diabetes balancing dietary insulin load with exogenous insulin is an ongoing process of fine tuning.

Getting the basal insulin dose is important, particularly if you’re following a reduced carbohydrate approach, as it can represent up to 80% of the daily insulin dose.  Unless you’re fasting you are unlikely to have a higher basal : bolus ratio than this.  Covering too much of your food with basal insulin can be dangerous if you need to skip or delay a meal for any reason (e.g. sleeping in on the weekend).

The scatter plot of blood glucose readings below shows my wife Monica’s blood glucose readings.  We use this data to review and refine her basal insulin rates (80% of her insulin dose) every couple of weeks.

image010

While we are still on a journey, her blood glucose levels are the best they’ve been in her adult life and we’ve seen massive improvements since switching to a more nutrient dense low insulin load diet.

If her blood sugars drift up in a particular period of the day she will increase the basal rate on her pump in the two hours leading up to the point where the blood glucose levels are high.  Conversely, if there are a cluster of hypos (lows) at a particular point in time she will drop back the basal insulin leading up to that time.  Ideally we try to keep the high / low bars on the top chart on the red line, but not below it.

Her basal rates (shown below) are lower over night with a higher dose in the morning to cover the ‘dawn phenomenon’ which is the body’s way of supplying glucagon and adrenaline in preparation for the day ahead.

image012

We’ve experimented with reducing basal insulin rates and running higher blood glucose levels to avoid lows and to reduce the overall insulin load.  However this hasn’t really worked as Moni just doesn’t feel good with higher blood glucose levels.

It’s a delicate balancing act between blood glucose levels and insulin load.  Your mileage may vary.  You’ll need to refine things based on how you feel and with what you are comfortable with.

It’s also a good idea to look at the data over a longer period to make sure you’re not just reacting to recent events.  Diet, hormones, stress, sickness and exhaustion all influence blood sugars and insulin requirements.

Knee jerk reactions to recent events can throw everything out of whack.  We’ve found it better to make small refinements rather than large changes.

Some female diabetics also refine their basal rates around their monthly cycle as insulin resistance typically increases by around 15% in the four days leading up to their period.  It’s worth tracking this and being ready to adjust insulin dosage.

the law of small numbers

The most important thing to know is that managing the insulin load of your diet is the most important thing you can do to improve blood glucose control.  If you have a high degree of variability in your blood glucose from hour to hour due to a highly insulinogenic diet you’ll never be able to bring blood glucose levels down without risking going too low.

Most endocrinologists will recommend against targeting optimal blood glucose levels due to the risk of hypoglycaemia (low glucose levels).  However reducing the insulin load of the diet will mean that the amplitude of the blood glucose swings are smaller, which will enable you to bring the overall average blood glucose level down using the basal insulin and smaller food bolus and correcting insulin doses.

Bernstein talks about the ‘law of small numbers’.  If you are consuming a high carbohydrate diet then you will need ‘industrial doses’ of insulin and there is no way to calculate the insulin dose perfectly, so the errors compound and the resulting blood sugar swings are out of control.  It’s the severe blood glucose swings that make you feel really bad, even more so than high or the low blood sugars alone.

adjusting insulin doses for type 2 diabetics

For the most part the observations from people with type 1 diabetes also apply to those with type 2 diabetes.  A type 2 diabetic can balance their dietary insulin load with the insulin produced by their own pancreas supplemented with insulin sensitising drugs such as Metformin or injected insulin.

The first priority when transitioning to a low carbohydrate diet is to avoid driving your blood sugars low with too much medication.   Rather than going low all the time it’s better to reduce your medications to a point where higher blood glucose levels will remind you that you need to manage blood glucose by controlling your diet.

If your medications are too high you will likely end up having to eat extra food to treat low blood glucose levels all the time.  So not only do you have more insulin than you want (which will stop you using stored body fat for energy) you have to eat more than you need because of excess medication (which will also get stored as fat).

It’s hard to give an exact target blood sugar range, however the following guidelines may be useful:

  1. Blood glucose levels less than 4.0mmol/L (73mg/dL) are typically considered low (unless you are young and / or have high ketone levels). If you are seeing these blood glucose levels you should decrease your diabetes medications.
  2. Post meal blood sugars should be less than 6.7mmol/L (120mg/dL). If you’re seeing higher blood glucose levels than this after meals then you shouldn’t eat what you just ate again.
  3. A fasting blood sugar of less than 5.0mmol/L (90mg/dL) and an average blood sugar of less than 5.4mmol/L (100mg/dL) is ideal.

Once you reduce your dietary insulin load (i.e. by reducing carbohydrates, moderating your protein and maximising high fibre foods) you will not require as much medication and may need to reduce your medications to prevent hypos (low blood sugars).

If your dietary insulin load reduces further you will be able to reduce, and possibly eliminate, your diabetes medications as your own pancreas is able to keep up with your decreased insulin requirements.

If you are able to further reduce your insulin load your blood sugars will come closer to normal levels.  With reduced insulin you will be able to use your body fat stores for fuel and ideally lose weight.

Depending on your goals and level of dedication (or OCD), you might get to a point where injecting small amounts of insulin is no longer worth the hassle.  This is something that you should work through with your doctor who prescribed the insulin and / or medications.

 

references

[1] https://optimisingnutrition.wordpress.com/2015/03/22/diabetes-102/

[2] http://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/type-2-diabetes-and-insulin/

[3] https://optimisingnutrition.wordpress.com/2015/03/22/diabetes-102/

[4] https://intensivedietarymanagement.com/

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

[6] http://www.nejm.org/doi/full/10.1056/NEJMoa0802743#t=articleTop

[7] http://phlauntdiabetesupdates.blogspot.com/2012/10/new-page-why-lowering-a1c-below-60-is.html

[8] http://diatribe.org/issues/10/learning-curve

[9] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518370/

[10] http://www.cardiab.com/content/12/1/164

[11] http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2004.01371.x/epdf

[12] http://www.thefatemperor.com/blog/2015/5/5/hilarious-apob-now-being-used-as-predictor-of-insulin-resistance-cholesterol-lchf

[13] http://www.thefatemperor.com/blog/2015/4/30/insulin-resistance-the-primary-cause-of-coronary-artery-disease-bar-none-lchf

[14] http://jaha.ahajournals.org/content/4/4/e001524.full.pdf+html

[15] http://www.thefatemperor.com/blog/2015/5/3/cholesterol-lchf-whats-the-only-thing-that-matters-for-repeat-heart-attacks

[16] https://intensivedietarymanagement.com/lchf-for-type-1-diabetes/

why is good blood glucose control so important?

When my wife Monica was diagnosed with type 1 diabetes at ten she was advised to eat at least 130g of carbohydrates with every meal.

The insulin dose was kept fixed to cover this fixed amount of carbohydrates.  If she went low she had to eat more carbs to bring her blood glucose back up.

Welcome to the everyday blood sugar roller coaster that takes over your life when you have diabetes!

1-150131150046303

It wasn’t till after we were married in 2002 and started thinking about having kids that she found a doctor with an interest in diabetes who told her that she could tailor her insulin dose to what she wanted to eat.

Up until this time even the visits to the endocrinologist were to get more scripts for insulin and thyroid medication.  No useful advice was provided about how to manage diabetes.

It’s amazing that the concept of carbohydrate counting was new and shiny in 2003 when Richard Bernstein developed the concepts back in 1970s!

Today, the standard of care for diabetes seems to have incorporated Bernstein’s carbohydrate counting, however the nutritionists and diabetes associations still advises that diabetics should not have to deprive themselves of any food in the pursuit of health.  And like everyone else, they should eat a diet full of “healthy whole grains”.

It wasn’t until we discovered Paleo and then low carb through family members and social media that she found that she could improve blood sugar control through diet.

More recently by refining our diet to prioritise low insulin load, high fibre and high nutrient density foods I’m pleased to say that she has been able to find another level of improved blood sugar control, increased energy and reduced depression and anxiety that so often comes with blood sugar dis-regulation.

Real-Food-Pyramid1 (1)

It is still not easy and we are still learning, however she is now able to enjoy working as a supply teacher rather than just getting through the morning and needing to sleep during the afternoon before picking up the kids from school.

Her big regret is that she did not discover this earlier, which would have saved her from spending decades living in a fog with limited energy.

The chart below shows the difference diet can make in the management of blood glucose, particularly for a type 1 diabetic (notice that these plots are only two months apart!).  People who find success with this dietary approach find a substantial improvement in quality of life and their state of well being that makes it well worth the effort.

image017

Below is a recent post on the TYPEONEGRIT Facebook group from a mother of a type 1 diabetic child describing their interaction with her health care team.  It’s still not simple to go against the main stream dietary advice.

We had our team meeting today to discuss LCHF…  they are so terrified of this, even though we have great BG readings, behaviour improvements and learning improvements (noted by us, family, friends and his school) which they didn’t even acknowledge.

The nutritionist is concerned that he won’t be getting the micronutrients that only come from grains and the higher carb vegetables (grains are fortified), then her concern was the B vitamins 1, 3 and 6. 

Then the concern about Iron (what?! have you seen the meat and spinach listed?). Then it was calcium and magnesium (clearly they don’t have a clue about LCHF).

They said they are afraid this diet may cause future developmental harm. We said your diet WILL cause future harm and way more than developmental. Back and forth and on it went. We addressed their concerns with peer reviewed research, and respect to their limited knowledge.

We will be an open book and comply because I want them to learn that T1D care can be so much better than it has been up to now, and pave the way for the next families that wishes to do LCHF.

They will check for vitamins and minerals at his 3 month blood work (again special for our case, which we have to pay for).

The good news here is that after running an intense battery of tests they decided to use this child as Canada’s first case study in LCHF paediatrics for the management of type 1 diabetes.

This post inspired me to run some numbers on a range of diets to see whether there was any issue with the nutritional content of higher fat diets.   It turns out that diets with higher levels of fat can be very nutritious while the grain based diet that everyone is recommended does very poorly, particularly when you take the insulin of these higher carbohydrate diets into account (see the Diet Wars… Which One is  Optimal article for more details).

It breaks my heart to see diabetics living with a highly diminished quality when there is the potential to greatly reduce the impact of diabetes by more informed food choices.

For people with diabetes and their carers diet is important and maybe a matter of life and death, or at least a decision that will greatly affect their quality and length of life.

can you eat too much fat on a ketogenic diet?

Eating a low carb, high fibre, moderate protein diet will often naturally lead to elimination of processed high carb foods, increased satiety and reduced energy intake.  Reducing insulin will then allow stored body fat to be used for fuel.

However if someone was trying to lose weight I would not recommend emphasising dietary fat once they were fat adapted in order to allow energy to be supplied from body fat.

Ketones can rise to high levels in fasting as we burn our own body fat (endogenous ketosis), but chasing this state with exogenous ketones or heaps of processed fat can lead to a high energy state (endogenous ketosis) which can drive insulin resistance and fat storage.

image24

Some people aiming for ketosis to lose weight can overdo the fat calories and not achieve the weight loss.  If your aim is weight loss it’s better to be in calorie deficit and be burning stored body fat, than to have high blood ketones produced by MCT oil and butter.

While counting calories may be beneficial for some people to retrain their appetite initially, a better long term approach may be to try some form of intermittent fasting to reset insulin sensitivity and reduce overall calorie intake.  You can use your blood sugar or your weight to help guide your fasting frequency.

If your body fat and blood sugars are under control then go ahead and indulge in supplemental MCT oil or some extra butter in your coffee for the mental buzz, but keep in mind that, while ketosis will lead to increased satiety for most people, calories matter in the long run.

In the end I think you should be consuming the most nutrient dense foods that will keep your blood sugars at normal healthy levels.   The food lists in the table below to suit your blood sugar levels and body weight goals.

approach

average glucose

waist : height

(mg/dL)

(mmol/L)

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 May 2017

 

.

fibre… net carbs or total carbs?

Looking at the foods sitting above the trend line the chart below it appears that the foods with the greatest insulin response compared to what would be predicted by carbohydrate and protein tend to be the ones that are more processed such as ice-cream, baked beans, pancakes and Jelly Beans.

On the lower side of the trend line we have less processed foods (e.g. full cream milk, navy beans, porridge and All Bran with added fibre).

Microsoft Word Document 25032015 40944 AM.bmp

Processed foods tend to contain less fibre, while carbohydrates in their original state typically contain more fibre.  Fibre is indigestible carbohydrate and hence does not raise blood sugars or require insulin.

Fibre is also important for the health of our gut and feeds the good bacteria in our digestive tract.

Could it be possible to also use fibre as a proxy for the level of processing to help refine the prediction of insulin demand by different foods?

In order to test whether fibre is useful to predict insulin demand I tested the relationship between carbohydrates plus different amounts of the fibre in the various foods.

The best correlation was achieved by removing all of the fibre.  Using net carbs gives an increased correlation compared to the carbohydrates alone (i.e. R2 = 0.435 compared to R2 = 0.482).

Microsoft Word Document 25032015 41148 AM.bmp

Considering the carbohydrates, protein and fibre in a food enables us to more accurately predict insulin demand.

This concept is known in the low carb community as “net carbs”.  If you’re trying count carbohydrates to manage insulin people are often advised to consider the total carbohydrates minus the fibre as fibre cannot be digested but is rather digested by our intestinal bacteria.

This aligns with the understanding that carbohydrates consumed with the packaging that they came with (i.e. fibre) do not have as big an effect on insulin.

This relationship might be part of the reason why many populations have maintained good health on a higher level of carbohydrate consumed in their raw natural state compared to when they come from the supermarket in boxes with barcodes.

There is some disagreement on how to deal with fibre on a restricted carbohydrate diet:

  • Some people say you should ignore fibre because “net carbs” is just a marketing ploy.
  • Some people choose to count half the fibre as carbs as a middle ground.
  • Experienced type 1 diabetics who monitor their blood sugars using continuous glucose meters will tell you that the fibre in their veggies will not raise their blood sugars however they ignore the fibre in packaged foods because it does raise their blood sugar.

My interpretation of the food insulin index data indicates that real fibre in foods is indigestible and hence does not raise blood sugar and require insulin.  However excess cooking and processing will soften this fibre and make it digestible.

It appears that the fibre in a food is a useful proxy for the level of processing and helps us to better predict the insulin demand of a food.

If you want to reduce your insulin load you can increase the amount of non-starchy veggies such as spinach, broccoli, mushrooms, Brussel sprouts and kale in your diet.

If you’re using packaged diet products then I suggest you ignore the fibre content, or maybe don’t buy them in the first place.

The major problem I see with encouraging people to consider total carbohydrates rather than net carbohydrates is that it will encourage people to avoid vegetables which not be optimal for health in the long term.  The reality is, when you take fibre into account, you can eat a lot of non-starchy vegetables without significantly impacting your net carbohydrates.

[next article…  how do you like your veggies… cooked or raw?]

[this post is part of the insulin index series]

[Like what you’re reading?  Skip to the full story here.]

how do you like your veggies… cooked or raw?

Nutrition for athletes and the metabolically healthy

  • Most people, once fat adapted, will do fine on a high fat ketogenic diet  and not need additional carbs to be able to exercise.
  • Learning to be metabolically flexible (i.e. using both fat and carbohydrates for fuel) can be a major advantage for an athlete.
  • Athletes and may benefit from increasing carbohydrates around competitions to speed recovery and replenish glycogen stores.
  • This article highlights some nutrient dense food options that contain slightly more carbohydrates to support intense exercise.

more about me

I became interested in the concept of low carbohydrate fuelling strategies when I started commuting to work on my bike.

The first problem is that I live 30km (18 miles) from work, but still chose to ride, both ways, in an effort to get fit and lose weight.

The second problem was that when I got home after riding 60km I just wanted to eat until I stopped feeling hungry.

The third problem was that when I weighed myself, in spite of the massive amounts of exercise that I was doing, the scale wasn’t moving in the direction that I wanted it to!

I had heard that athletes such as Ben Greenfield [1], Tim Olsen [2], Zach Bitter [3] and Sami Inkinen [4] were blowing away records using a restricted carbohydrate approach.  I wanted to be just like them.  Even a little bit.

low carb versus high carb for endurance

Typical preparation for endurance events involves “carbing up” with large doses of pasta before an event and precise timing of added simple carbs such as gels during the event to keep the glycogen fuel tank full.

One of the challenges for endurance athletes is staying fuelled without gut issues from constant ingestions of sugar gels and sports drinks.

The often used analogy is that being an athlete on a high carbohydrate diets is like being a fuel tanker constantly having to stop at the gas station to fill up. [5]

The advantage to using a ketogenic fuelling approach is that we train our bodies to be “metabolically flexible” and able access our body fat in addition to the stored glycogen in our liver and muscles for fuel.

The results below show how someone who is metabolically flexible will obtain a larger proportion of their fuel from their body fat meaning and become less dependent on refuelling with carbohydrates.

image008

advantages of keeping carbs low for athletes

Aside from endurance performance, there are a number of reasons that you may want to control your control your carbohydrate intake if you’re an athlete:

  1. To help you get / stay lean. Keeping your power to weight ratio high is important so you don’t have to drag excess weight around the course.
  2. To reduce diabetes risk and all the associated issues. Keeping your blood sugars close to optimal for long term health should be seen as a greater goal than short term performance.
  3. To improve overall health and longevity due by decreasing inflammation, oxidation free radical damage.
  4. To improved energy stability and reduce gastrointestinal distress.

when is a ketogenic diet not a good idea?

Robb Wolf says that while he is a big fan of the ketogenic approach combined with intermittent fasting, the people that seem to do it are not the overweight sedentary office workers who might benefit the most from it, but rather the people doing intense workouts combined with intermittent fasting and burning themselves into the ground. [7]

There can also be some advantages in having your glycogen fuel tank full for explosive power in intense exercise.  Some people choose to “train low, race high”, meaning that during a race you can keep your glycogen stores reserved for intense burst efforts such as sprinting to the finish line. [8]

Minimising carbs most of the time and adding a few more for ‘game day’ can be a good strategy to maximise performance.

how much carbohydrate do you need?

Insulin is required to grow muscle (and store fat). [9]

Body builders use a protein shake or simple carbs to spike insulin and support muscle grown (anabolism) before or after a workout. [10] [11]  Some will even inject insulin before a workout to maximise muscle growth.

Programs such as the TKD or John Kiefer’s Carb Backloading [12] or Carb Nite [13] is designed for physique competitors wanting the benefits of ketogenic diet without burning themselves into the ground or stalling in the long term.  It should be noted though that this approach is not necessarily ketogenic or optimal for long term health.

Ben Greenfield recommends endurance athletes aim for a lower level of carbs most of the time (say 10%) but then increase carbohydrates to around 30% from real whole foods before and / or after demanding exercise.

Cerial Killers 2: Run on Fat [14] tells the story of Sami Inkinen working with Steve Phinney to refine his diet to 70% far, 20% protein, 10% carbs to undertaken the caloric equivalent of two marathons a day for fourth days to row between San Francisco and Hawaii, proving that you don’t need many carbs at all to undertake intense exercise. [15]

Keep in mind too that if weight loss is your goal then shorter bursts of intense exercise will raise your metabolism without leaving you wanting to eat everything in sight.  Extended cardio may leave you hungry to a point that you may just eat all the calories that you just burned, then some, particularly if you’re not yet fat adapted.

can you handle it?

This all needs to be taken in the context of keeping your blood sugars close as close to optimal as you can get them.  Even if you are lean and fit it is worth periodically checking your blood sugars.

If your blood sugars are drifting up then it might be time to take evasive action and prioritise your long term health over short term sports performance.

risk level HbA1c average blood sugar
 (%)  (mmol/L)  (mg/dL)
optimal 4.5 4.6 83
excellent < 5.0 < 5.4 < 97
good < 5.4 < 6.0 < 108
danger > 6.5 > 7.8 > 140

Professor Tim Noakes has stated that he believes that no athlete needs more than 200g of carbohydrates per day. [16]  Noakes himself, the author of the Bible of carbohydrate fuelling for endurance athletes, [17] switched to a low carb diet after realising that he had become a type 2 diabetic after years of following his own high carb fuelling strategies.

Similarly, Sami Ikenin [18] became a low carb advocate after realising that his high carb diet that he was following had led him to become diabetic.  After he switched to a restricted carb approach, he improved his triathlon performance and recently rowed from California to Hawaii on a 70% fat diet to raise awareness of the dangers of sugar. [19]

what should I eat?

Previously I showed how we can use the food ranking system [20] to prioritise foods for weight loss and diabetes.  We can also use the food ranking system to prioritise nutrient dense foods with a little more carbohydrates if blood sugar control is not such a concern.

This weighting system emphasises nutrient density per gram (40% weighting), and nutrient density per calorie (15%) with a lesser weighting towards the insulinogenic properties of the food (25%).

Cost is also a consideration given that an athlete might be consuming larger amounts of food than someone trying to lose weight.  The resultant food rankings are shown below.

ND / calorie fibre / calorie ND / $ ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 30% 20% 5% 10%

Rich Froning’s favourite peanut butter [21] rates well along with a wide range of nutrient dense nuts and seeds.

Vegetables, as always do well, with spinach and mushrooms at the top of the list.  Sweet potato scrapes in at the end of the vegetables as good nutrient dense high carb option.

A number of grain based foods such as rice and oats make the cut due to their nutrient density and low cost.  There’s been plenty of debate around the topic of ‘safe starches’ [22] however I think it depends on your context.  If you’re active and keeping your blood sugars under control then things like rice, and potatoes may be useful to speed recovery around intense exercise if you feel the need.

A number of breads make it into the list due to the fact that they are a low cost source of nutrition.  However many people will avoid these due to concerns over gluten leading to a leaky gut etc.

Organ meats, as always, ranks highly.  It’s interesting to note that bacon ranks as the first non-seafood meat.

There are also more fruit choices on this approach if you’re not worried about blood sugar.

nuts, seeds and legumes

  • peanut butter
  • sunflower seeds
  • peanuts
  • brazil nuts
  • pumpkin seeds
  • pistachio nuts
  • pecans
  • cashews
  • almonds
  • pine nuts
  • macadamia nuts
  • lentils
  • kidney beans
  • mung beans
  • chick peas
  • coconut meat

vegetables and spices

  • spinach
  • mushrooms
  • chives
  • coriander
  • chard
  • turnip greens
  • rosemary
  • spirulina
  • cinnamon
  • ginger
  • broccoli
  • lentils
  • Brussel sprouts
  • Kale
  • asparagus
  • Sweet potato

dairy and egg

  • egg yolk
  • whole egg
  • cheese
  • milk

animal products

  • organ meats (liver, heart, giblets)
  • sardine
  • oyster
  • anchovy
  • cod
  • herring
  • bacon
  • oyster
  • chorizo
  • mussel
  • trout
  • salmon
  • tuna
  • beef jerky
  • turkey
  • ground beef
  • lamb

fats and oils

  • olive oil
  • coconut oil
  • butter

fruit

  • avocado
  • olives
  • raspberries
  • blackberries
  • oranges
  • banana
  • dates
  • strawberries

grains

  • tortilla
  • oats
  • white bread
  • multi grain bread
  • croissants
  • oat bran muffins
  • rice

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

daily meal plan

An example daily meal plan using the highest ranking foods is shown below.  For breakfast we have bacon with spinach and eggs, a salad with tuna for lunch, salmon and veggies for dinner with nuts for snacks.

image029

This would give us a macronutrient break down of 25% carbs, 27% protein and 48% fat.   The other advantage of eating more carbohydrates is that we can increase our fibre even higher, with this scenario giving 45g fibre per day to contribute to good gut health.

In the next article we’ll look at how we can use the food insulin index data to calculate the most ketogenic diet foods.

references

[1] http://www.bengreenfieldfitness.com/2013/05/low-carb-triathlon-training/

[2] http://www.timothyallenolson.com/2013/04/10/nutrition/

[3] http://zachbitter.com/blog/2012/10/high-carb-vs-high-fat.html

[4] http://www.samiinkinen.com/

[5] http://www.thecavewomandiva.com/?p=121

[6] http://www.ultrarunning.com/features/health-and-nutrition/the-emerging-science-on-fat-adaptation/

[7] http://blog.dansplan.com/why-dietary-fat-is-fattening-and-when-its-not/

[8] http://thatpaleoguy.com/2010/09/15/high-fat-diets-for-cyclists-part-one-of-six/

[9] https://www.t-nation.com/diet-fat-loss/insulin-advantage

[10] http://livinlavidalowcarb.com/blog/tag/ben-greenfield

[11] http://beyondtrainingbook.com/

[12] http://carbbackloading.com

[13] http://carbnite.com/

[14] http://www.cerealkillersmovie.com/

[15] http://www.fatchancerow.org/expedition/

[16] https://twitter.com/proftimnoakes/status/450136949459001344

[17] http://www.amazon.com/Lore-Running-Edition-Timothy-Noakes/dp/0873229592

[18] http://www.samiinkinen.com/

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

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

[21] http://www.mensfitnessmagazine.com.au/2012/02/the-fittest-man-on-earth/

[22] https://www.youtube.com/watch?v=XyvlWUQAkxM