Insulin load index / most ketogenic foods

[Spiker]

I'm with @Pasha, grams of carbs per ounce of foodstuff makes my brain hurt. It's one of Dr Bernstein's foibles, doing that.

 

[Robbity]

I'm with @Pasha, grams of carbs per ounce of foodstuff makes my brain hurt. It's one of Dr Bernstein's foibles, doing that.

I can only imagine that it may be intended to avoid confusion between the actual food weight and the carbs value associated with it? But I often have enough problems anyway with comparing metric and imperial without mixing the two - though whisper: I have to admit I do sometimes use both units when weighing out ingredients for baking...

Robbity

 

[Pasha]

I can only imagine that it may be intended to avoid confusion between the actual food weight and the carbs value associated with it? But I often have enough problems anyway with comparing metric and imperial without mixing the two - though whisper: I have to admit I do sometimes use both units when weighing out ingredients for baking...

Robbity

Obviously you have never had the pleasure of a visit from the " ISO" inspectors.

 

[LucySW]

Amazing! Don't fancy dock leaves though.

 

[Heathenlass]

Amazing! Don't fancy dock leaves though.

They are actually really nice Quite peppery in flavour .

Signy

 

[phoenix]

That's the $64,000 question and could be the beginning of a whole new dosing regime!

As a starting point, one approach would be, if you know how much you would inject for the same weight of white bread, multiply that by the percentage insulin load"

don't know if you read Kirsty Bells thesis (I've just skimmed it)
She gives details of how they calculated the FII ratio for her trial .There is also an example of the workbook given to the participants with pictures of foods and FII

At the conclusion of the workshop the FID counters had their individualised ICR converted to an insulin: FID ratio (IFR), to allow the calculation of insulin doses. The IFR was calculated by scaling the usual ICR by a factor of 1.7 (1.7 = 100 divided by 59 = FII of 1000 kJ of glucose divided by grams of carbohydrate in 1000 kJ of glucose). For example, an ICR of 1 unit: 10 g carbohydrate became an IFR of 1 unit: 17 FID. In this way, the IFR automatically adjusted for differences in insulin sensitivity among subjects.

so if I've got it right for a person with a ICR of 1u to 10g carb.

White bread 16g carb @ 1u for 10g = 1.6u
White bread 26 FID @ 1u for 17FID = 1.5 u
130g chicken 0g carbs @1u for 10g = 0u
130g chicken FID 20 @ 1u for 17FID= 1.2u
2 poached eggs 1g carb @ 1u for 10g = 0.1u
2 poached eggs 14FID @ 1 u for 17 FID = 0.8 u


The 12 week study of 'sub optimally controlled' pump users didn't find any difference in results for HbA1c, average glucose and time in target . It did show an almost significant reduction in hypos and is discussed (but as not significant it could be chance)
Two confounders are important .Both groups had similar instruction/ education but of course the carb counting group weren't naïve about carb counting (no pump user is)
The insulin ratio was based upon the existing carb ratio (as described above)

the insulin dose to food ratio in the FII counters was simply extrapolated from their existing ICR, rather than determined through titration according to normal practice

I'm not so sure about the calculations used in the blog mentioned in the original post. What I've seen before in this presentation http://www.nutrientdataconf.org/pastconf/ndbc35/4-2_sampson.pdf and the section where it is discussed in the thesis suggests a certain variability (I haven't really spent that much time on that bit of the thesis though) That's variability between foods in different types of foods but sometimes within groups of seemingly similar foods and certainly foods with the same macro nutrient composition . There may be no probably no simple algorithm The presentation suggests that they were able to use different algorithms for different types of foods with reasonable success. They've apparently imputed FII for 407 foods but I don't think that there is any published list outside of the one in the workbook from the thesis.

The first published research using the FII to predict insulin response (normal subjects) is here: http://ajcn.nutrition.org/content/90/4/986.full#T1
The next one used carb counting/dosing for a high carb meal using this as a control , then compared carb counting and FI dosing for a test meal with a similar food insulin index to the control meal but far fewer carbs.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177729/?report=reader

 

[Heathenlass]

Total Available Glucose, a method for calculating insulin doses that uses protein and fat in the calculation as well as just carbs.

@Heathenlass, got more?

Yep, sorry, I missed your tag no pun intended

TAG basically calculates for everything you eat, not just carbs. It looks at what the TOTAL available glucose of a food is is due due to gluconeogenesis. For example, for protein I would bolus as if it was carbs minus 50% , and fat as 10% carb value.

The % can vary from person to person, but IMHO not enough to make a discernible difference. It can give you much tighter control of your insulin doses and BG .

There are TAG food values in the following ( rather long!) document, in Section 4 :
https://healthonline.washington.edu/document/health_online/pdf/CarbCountingClassALL3_05.pdf

Signy

 

[Spiker]

@phoenix you may well be right that we will never find a single algorithm or formula for correct dosing.

It's reminded me that for years I adjusted by bolus dose based on the total calories in the meal. Sometimes it went wrong but most of the time it was about right. An early form of TAG perhaps? Not really, just the typical situation of a T1 being kicked out into the world with no suggestion whatsoever as to how I was supposed to "adjust" my doses.

 

[martykendall]

This is amazing. We know that GI and GL are unreliable and inconsistent and don't always predict what a food will do to our blood glucose. We know there's more to dose calculation than just carbs or even just carbs and protein. This data looks directly at the insulin response of foods. Starting in 2009, a lot more insulin load data is now available for more foods. This could replace TAG. It's not too much to imagine this replacing carb counting one day for diabetics.

https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/

Just a quick question, the insulin percentage that they give- is there some way of converting that into insulin units required for foods? Or is it intended as a guide of which foods we should predominantly base our diet around- so focus more on the foods with the single figure percentages, and less so on the higher percentages?

Hey. Just thought I'd say hi on this discussion. It's pretty exciting to see the response that you guys have given to the concept.

In response to this question there's two measurements. One is the percentage of insulingenic calories of a food that allows us to rank one food against another which helps if you're trying to minimise insulin. The the second is insulin load which is similar to carb counting but also considers the protein and fibre.

By choosing from the low insulin foods (see https://optimisingnutrition.wordpress.com/2015/03/22/cheat-sheets/) and the high ranking meals (see https://optimisingnutrition.wordpress.com/2015/03/22/the-most-nutritious-diabetic-friendly-meals/) I would hope that most people would be able to get away with not having to count everything, but the mechanism is there if you want to go to that length.

 

[martykendall]

Yep, sorry, I missed your tag no pun intended

TAG basically calculates for everything you eat, not just carbs. It looks at what the TOTAL available glucose of a food is is due due to gluconeogenesis. For example, for protein I would bolus as if it was carbs minus 50% , and fat as 10% carb value.

Signy

Hi Signy

My review of the data from the University of Sydney didn't show that fat has an impact on insulin. TAG also doesn't account for fibre. The original TAG book seems to be out of print. Do you know what the basis of these factors is at all? I've searched, a lot, with no luck.

Marty Kendall
https://optimisingnutrition.wordpress.com/

 

[martykendall]

That's the $64,000 question and could be the beginning of a whole new dosing regime!

As a starting point, one approach would be, if you know how much you would inject for the same weight of white bread, multiply that by the percentage insulin load"

The idea is that you would calculate and dose for the insulin load (i.e. carbs - fibre + 0.54 protein) in a similar way that you would dose for carbohydrates. See https://optimisingnutrition.wordpress.com/2015/03/22/ketosis-the-cure-for-diabetes/ for more details.

 

[martykendall]

don't know if you read Kirsty Bells thesis (I've just skimmed it)... There may be no probably no simple algorithm The presentation suggests that they were able to use different algorithms for different types of foods with reasonable success. They've apparently imputed FII for 407 foods but I don't think that there is any published list outside of the one in the workbook from the thesis

Hi Phoenix

I Excellent thesis! A good read. Really thorough work. Emailed Kristy Bell to congratulate and run a few ideas by her but didn't get a response.

I suggested that she look at using the FII data to focus on reducing the insulin load of the diet (ala low carbing) but I imagine that this wasn't what they were trying to achieve because I think it was done in the normal mainstream nutritionist paradigm.

I'm not sure what their FII algorithm is, but I managed to pull the data out of the appendix into a spreadsheet and run some correlation analysis on it to find that the insulin index correlated with carbs plus about half the protein minus the fibre. It's a pretty simple algorythm and makes sense based on experience.

Rather than relying on the foods that have been testing in real life humans or the 407 foods that it has been "imputed" for you can then simply apply this formula to all foods.

The thesis work seemed to find some efficacy using the FII over normal carb counting when using a standard high carb diet. I think where it gets exciting is to use the FII to select for foods foods that require the least insulin (ala low carb, but better!).

While I was ranking foods based on their insulin index I thought I'd try to add nutrient density into the mix and I'm pretty happy with the outcome! See https://optimisingnutrition.wordpress.com/2015/03/22/the-most-nutritious-diabetic-friendly-meals/

I'm glad people have found this interesting and I would really appreciate any feedback on how it could be refined further for wider use.

Cheers

Marty Kendall
https://optimisingnutrition.wordpress.com/

 

[Pasha]

@martykendall,

Visited your blog and enjoyed it a great deal. Thanks for posting the link.

 

[LucySW]

The idea is that you would calculate and dose for the insulin load (i.e. carbs - fibre + 0.54 protein) in a similar way that you would dose for carbohydrates. See https://optimisingnutrition.wordpress.com/2015/03/22/ketosis-the-cure-for-diabetes/ for more details.

Marty, Really enjoyed the ketosis article. And many great posts to chew over. Thank you for posting the links, and thank you Spiker for opening the discussion.

Lucy

 

[martykendall]

Marty, Really enjoyed the ketosis article. And many great posts to chew over. Thank you for posting the links, and thank you Spiker for opening the discussion.

Lucy

Thanks Lucy for the encouraging feedback. Would love to hear your feedback or suggestions as you work your way through it.

 

[phoenix]

@martykendall
1) There are some 2nd hand copies of the original TAG book offered for sale on Amazon.com.
2) The US forum Tu diabetes has (had) a group that discussed TAG but they are in the middle of changing their platform and I can't get onto them this morning to check.
3) Re fat:
Wolpert suggests that the FII dosing trials ,being based on the the immediate 2 hour post prandial period may be missing later rises in insulin demand. Part of this later demand may be to do with delayed gastric emptying caused by the fat. However, there is also the suggestion that increased fatty acids leads to a decrease in insulin sensitivity (so more insulin needed over a longer period)
Intro with references 5-8
+ conclusion, which even notes individual and even possible sex differences between responses to fat.
http://care.diabetesjournals.org/content/36/4/810.full
4) re fibre, there is quite a bit of evidence that fibre(especially soluble) increases insulin sensitivity The US guidelines on fibre (and even worse the UK ones) are very low. Your breakfast dish really isn't that high in fibre since the total calories for the dish is more than my BMR requirement for a whole day .I think that was meant to be 4 portions.


I've been interested in the FII and optimal insulin dosing for a long time. I will pass on the Ketogenic diet aspects of your blog though..

 

[smidge]

It's quite amazing for me reading through the list of foods and helps to explain some of the anomalies I've seen - maybe. I'm on a 1:8 ICR and I have to jab 1u for a 2egg omelette. I also know I have to jab disproportionately more for bread than any other carb. - so maybe there's a formula for these things rather than me working out the insulin and 'adding a bit on' to cover things we aren't told about!

Mind you, I reckon I'd struggle with the Maths :-(

Smidge

 

[Spiker]

The idea is that you would calculate and dose for the insulin load (i.e. carbs - fibre + 0.54 protein) in a similar way that you would dose for carbohydrates. See https://optimisingnutrition.wordpress.com/2015/03/22/ketosis-the-cure-for-diabetes/ for more details.

In the UK we wouldn't subtract fibre from the carbs as our carb information already ignores fibre.

I'm not convinced by a fixed ratio of 0.54 for protein, or any fixed ratio of protein. That assumes gluconeogenesis is constant, which it certainly isn't.

So while I would be happy to use FII based on purely empirical data, but not on any extrapolation. The formula above is more simplistic than TAG. And more likely to be wrong, in my view. I am convinced from personal experience as well as research evidence that ingested fat does decrease insulin sensitivity as well as delaying the blood glucose rise.

 

[tim2000s]

I'm also pretty certain that phase 1 insulin response to protein is not related to gluconeogenesis, rather to the amino acid uptake. As a result, the bonus roughly 0.5 x protein is actually not linked to gng at all. That occurs as a slower process 1.5+ hours after eating and really needs to be approached differently in terms of insulin use.

 

[martykendall]

@martykendall
1) There are some 2nd hand copies of the original TAG book offered for sale on Amazon.com.
2) The US forum Tu diabetes has (had) a group that discussed TAG but they are in the middle of changing their platform and I can't get onto them this morning to check.
3) Re fat:
Wolpert suggests that the FII dosing trials ,being based on the the immediate 2 hour post prandial period may be missing later rises in insulin demand. Part of this later demand may be to do with delayed gastric emptying caused by the fat. However, there is also the suggestion that increased fatty acids leads to a decrease in insulin sensitivity (so more insulin needed over a longer period)
Intro with references 5-8
+ conclusion, which even notes individual and even possible sex differences between responses to fat.
http://care.diabetesjournals.org/content/36/4/810.full
4) re fibre, there is quite a bit of evidence that fibre(especially soluble) increases insulin sensitivity The US guidelines on fibre (and even worse the UK ones) are very low.

5) Your breakfast dish really isn't that high in fibre since the total calories for the dish is more than my BMR requirement for a whole day .I think that was meant to be 4 portions.

6) I've been interested in the FII and optimal insulin dosing for a long time. I will pass on the Ketogenic diet aspects of your blog though..

Thanks Phoenix

1. Shipping to Australia becomes a bit of a killer. I've been looking lately at the glucogenic potential of proteins. Seems about 80% of amino acids in proteins can be converted to glucose. http://en.wikipedia.org/wiki/Glucogenic_amino_acid

2. The TuDiabetes discussion was very informative (and long).

3. I had a quick look at the paper. I'm not sure I understand the mechanism. It also doesn't align with my real life experience where I see the BG of type 1s not influenced by fat.

4. Does fibre increase insulin sensitivity (though some change in the gut microbiome) or is it just not digestible and hence does not raise glucose, and it just appears that it increases insulin sensitivity?

5. Yeah, the breakfast stax recipie from the Ruled.Me site is 1385 calories. For comparison purposes I have broken my meals back down to 500 calories for standardisation for comparison.

6. Ketesis is a thing at the moment. And I've been intrigued by it. Based on my blood sugar testing I'm in "light nutritional ketosis" if my blood sugars are optimal and not when I'm not. So I think everyone with their blood sugars close to optimal will have some ketones. But I'm not an advocate for most loading up on MCT oil etc to elevate ketones if the added fat is going to lead to a calorie excess and decreased nutritional content of their meals. See https://optimisingnutrition.wordpress.com/2015/03/22/ketosis-the-cure-for-diabetes/

Cheers

Marty