Insulin load index / most ketogenic foods

[LucySW]

@LucySW Insulin resistance isn't a function of where the insulin comes from, rather the reaction of the bold to it. In an exogenous form, we are injecting typically 50-100% more insulin than we would need from the pancreas, so there's nothing stopping insulin resistance from occurring.

Yes precisely. The point being that we are adding insulin into the system. Which won't push insulin resistance in the right direction. So how to prevent IR?

And yes, it's visibly true that losing weight, exercising, and reducing carb load all lower IR. But relying on fat to keep hunger at bay and sustain weight raises IR. And I don't want any more IR than I have to have. And I can lose some more weight, but I don't want to.

Skinny - actually now decidedly thin - reasonably fit, LCHF-ing person.

 

[martykendall]

@Spiker
HIgh fat one side,high carbs the other.
I'd rather sit in the middle of the boat, maybe not so rocky !
(Actually it annoys me that there is this two camp mentality. If you don't eat very high fat then you must eat very low fat. I assure you that the French cheese I eat is normally full fat; but I also eat French portion sizes)

Same here!

So how do we defined the middle of the boat? What is the optimal glocuse / insulin load / carbs + protein?

How would you define too much?

How would you define too little?

How would you determine optimal for a particular point?

What is a reasonable starting point for someone and how would they refine toward optimal for them?

 

[tim2000s]

Yes precisely. The point being that we are adding insulin into the system. Which won't push insulin resistance in the right direction. So how to prevent IR?

And yes, it's visibly true that losing weight, exercising, and reducing carb load all lower IR. But relying on fat to keep hunger at bay and sustain weight raises IR. And I don't want any more IR than I have to have. And I can lose some more weight, but I don't want to.

Skinny - actually now decidedly thin - reasonably fit, LCHF-ing person.

I think we are trying to simplify IR too much. Does relying on the lipid metabolism really increase insulin resistance or is it actually the glucose metabolism that does this?

I ask because there is next to no structural evidence to support this discussion. I personally have seen that increasing fat and protein consumption whilst reducing carbs had a dramatic effect on my body fat percentage (25% to sub-10%), whilst also exercising. In this time my insulin sensitivity increased.

What we also know is that higher fat content meals seem to slow the absorption of carbs and the glucogenic effects of protein in diabetics. In the absence of amylin, does this mean we actually see something approaching normal absorption and have to effectively create an additional phase two insulin response with exogenous insulin that normally wouldn't be seen? This could be seen to be IR as well.

Speaking anecdotally, I would expect IR to be cumulative related to some form of curve that would steadily increase if IR was purely insulin or fat consumption related. My experience over the last fifteen years is that as my weight (and likely body fat level) increased and decreased the amount of insulin I required changed in steps, almost as though there were thresholds at different weight and body fat percentages, which is counter to my expectations. (I'd also add that I know I was eating way too much and it fitted the NHS healthy plate mostly rather than an lc plate)

 

[LucySW]

I think we are trying to simplify IR too much.

Yes I totally agree with that. It's not helpful. That's why it's great to follow the three of you discussing this - you and Spiker and Phoenix - and now Marty.

 

[Spiker]

So how do we defined the middle of the boat? What is the optimal glocuse / insulin load / carbs + protein?

"That would be an empirical matter", as my colleague Father Jack Hackett used to say, before he left his promising career as a metabolic scientist, to join the priesthood. (After the unfortunate lab incident with the distilled alcohol and the three young interns.)

My point was not so much to state where the middle of the boat is, as to warn of the dangers of everyone running to one side. The boat has been listing sharply in the direction of high carbs and low fat for too long, the engines are sputtering, we're making little headway, and some observers think we appear to be going round in circles. ;-)

 

[Spiker]

Good point @LucySW about IR.

What do we know with confidence about it? Not much.

Maybe we know two mechanisms that worsen IR and a few mechanisms that improve it. Certainly we don't have the whole picture. And there are certain to be some overlaps and some differences in how it affects T2 vs T1. (Some researchers now make a bold claim that T1 and T2 are on a continuous spectrum but I think that's overly bold.)

 

[zand]

Thanks Zand.

I have some other thoughts on weight loss, rather than just reducing the insulin index at

https://optimisingnutrition.wordpress.com/2015/03/22/weight-loss/

https://optimisingnutrition.wordpress.com/2015/03/28/optimal-foods-for-weight-loss/

https://optimisingnutrition.wordpress.com/?p=1756

This approach emphasises reducing calorie density and increasing nutrient density rather than just reducing carbs / insulin load.

I would be interested in your thoughts.

Cheers

Marty Kendall

Well I'm sorry it took me so long to read the links. They make sense to me, however for the moment I will continue with cutting carbs only and not calories. As a failed dieter of 25 years or more I spent much of that time counting calories, so much so that I slowed my metabolism right down. I know that the links show a sensible attitude to weight and carbs and calories, but I am scared of getting back into the frame of mind that I need to starve myself to lose weight. My focus for now is having <30g carbs daily and some days this takes me to 1800+ calories. I am losing weight more quickly now than I did on <1000 calories daily (low fat) diet.

I appreciate your time and effort in giving me the links and I will re read them if/when I get stuck with weight loss again. Thank you.

 

[phoenix]

. I've only read this through once but it throws quite a lot of interesting thoughts into the mix . The first one in particular is interesting because it points out that insulin resistance in T1 is different to in type 2.

insulin is not delivered at the portal vein therefore :
"In type 1 diabetes, absent pancreatic insulin secretion is the opposite phenotype to the endogenous hyperinsulinaemia characteristic of most conditions characterised by insulin resistance. As type 1 diabetes is characterised by higher peripheral insulin concentrations and lower portal concentrations, it follows that contrasting hepatic and peripheral lipid handling might be predicted"
ie we are less likely to develop fatty livers but we may end up with higher amounts of lipids stored in muscles, (including the heart) and also around and in the blood vessels.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671104/?report=reader

also:
http://care.diabetesjournals.org/content/30/3/707.full
In a post hoc analysis of weight gain and metabolic syndrome in the DCCT

Higher insulin resistance at baseline in the DCCT (as estimated by eGDR) was associated with increased subsequent risk of both micro- and macrovascular complications. Insulin dose and the presence of IDF-defined metabolic syndrome were poor predictors by comparison. Although intensive treatment was associated with a higher subsequent prevalence of metabolic syndrome, the benefits of improved glycemia appear to outweigh the risks related to development of the metabolic syndrome.
(eGDR means estimated glucose disposal rate a formula using AIC ,hip to waist ratio and HT which stands for hypertension but I can't see what measurement they used there )

 

[LucySW]

Thanks Phoenix.

 

[Spiker]

@martykendall as you are interested in exercise in non diabetics, have you looked at the Phinney & Volek books, and have you looked at the work of Prof Tim Noakes?

 

[martykendall]

@martykendall as you are interested in exercise in non diabetics, have you looked at the Phinney & Volek books, and have you looked at the work of Prof Tim Noakes?

Definitely. Noakes, Phinney and Volek are legends!

There's an interesting spectrum of knowledge regarding optimal nutrition from diabetic to optimal athletic performance, and they all sort of tie together.

I'm not sure if you've seen my 2c worth in the blog at in this article - https://optimisingnutrition.wordpress.com/2015/03/22/for-athletes-and-the-metabolically-healthy/

 

[martykendall]

"That would be an empirical matter", as my colleague Father Jack Hackett used to say, before he left his promising career as a metabolic scientist, to join the priesthood. (After the unfortunate lab incident with the distilled alcohol and the three young interns.)

My point was not so much to state where the middle of the boat is, as to warn of the dangers of everyone running to one side. The boat has been listing sharply in the direction of high carbs and low fat for too long, the engines are sputtering, we're making little headway, and some observers think we appear to be going round in circles. ;-)

I would still like to know your thoughts on how to steer the boat forward using empirical data. What levels would you use (protein, carbs, calories, total glucose, calories, HbA1c, insulin, blood sugar) and what would be your optimal targets to trim the sails?

 

[tim2000s]

I would still like to know your thoughts on how to steer the boat forward using empirical data. What levels would you use (protein, carbs, calories, total glucose, calories, HbA1c, insulin, blood sugar) and what would be your optimal targets to trim the sails?

I think we still lack a lot of the empirical data to generate the levels.

The likes of Trudi Deakin recommend 80/15/5 ( I think it was) fat/protein/carbs. I myself am eating 45/45/10. But then we fall into the questions that tie all these together. What are the optimum levels of F/P/C as part of calorie intake? What is optimum calorifically? Before we even ask this question, bg level and hba1c target levels need to be broached.

From my perspective, I would suggest that regularly tested bg levels should be such that the hba1c shows in the "normal" range of 4.5%-6%. This should mean a non-spiking, non-hypoing bg range of 4-7mmol/l.

If that is the target then how do we get there? Fuel and insulin have to be optimised to reach these targets. Either as a non-diabetic/pre-diabetic by changing diet or as a diabetic by managing diet and insulin.

While we focus on an LC approach there are a lot of active t1s that focus on a low fat approach and have seen massive insulin sensitivity as a result. The key thing they don't eat is processed foods and refined carbs.

Similarly, the LC approach has a key aspect in that most of the foods that are used are whole foods and non-processed.

I am starting to wonder whether this is a more important aspect of diet than specifically LC or LF.

Again, empirical data is hard to come by and what may be required is to supply proponents of all diet types with cgm of some kind and ask them to keep a week of diet and exercise data along with the records. If you can do this among a large enough sample size of enough of a variety of people, you may have a better picture from which to draw observational conclusions.

 

[martykendall]

I think we still lack a lot of the empirical data to generate the levels.

The likes of Trudi Deakin recommend 80/15/5 ( I think it was) fat/protein/carbs. I myself am eating 45/45/10. But then we fall into the questions that tie all these together. What are the optimum levels of F/P/C as part of calorie intake? What is optimum calorifically? Before we even ask this question, bg level and hba1c target levels need to be broached.

From my perspective, I would suggest that regularly tested bg levels should be such that the hba1c shows in the "normal" range of 4.5%-6%. This should mean a non-spiking, non-hypoing bg range of 4-7mmol/l.

If that is the target then how do we get there? Fuel and insulin have to be optimised to reach these targets. Either as a non-diabetic/pre-diabetic by changing diet or as a diabetic by managing diet and insulin.

While we focus on an LC approach there are a lot of active t1s that focus on a low fat approach and have seen massive insulin sensitivity as a result. The key thing they don't eat is processed foods and refined carbs.

Similarly, the LC approach has a key aspect in that most of the foods that are used are whole foods and non-processed.

I am starting to wonder whether this is a more important aspect of diet than specifically LC or LF.

Again, empirical data is hard to come by and what may be required is to supply proponents of all diet types with cgm of some kind and ask them to keep a week of diet and exercise data along with the records. If you can do this among a large enough sample size of enough of a variety of people, you may have a better picture from which to draw observational conclusions.

Good thoughts @tim2000s.

I think the priority is to wind back the glucose load (from carbs and protein) to try to approximate normal / optimal blood sugars.

A couple of things that I don't see talked about enough is that that non-starchy veggies contain vitamins and minerals and carbs. Protein contains amino acids that we need for health. So I think there are dangers in pushing too low on the glucose load from carbs and protein. You would only want to go as low as you needed to to get excellent blood sugars / HbA1c.

Most people think that LCHF is the default, but forget that you can also decrease the glucose load of your diet by focussing on high fibre veggies with a bit of protein and fat. For lots of people this might be a more sustainable healthy long term approach.

 

[tim2000s]

Good thoughts @tim2000s.
Most people think that LCHF is the default, but forget that you can also decrease the glucose load of your diet by focussing on high fibre veggies with a bit of protein and fat. For lots of people this might be a more sustainable healthy long term approach.

Have you seen the 80/10/10 diet where 80 is carbs from fruit, veg, pulses etc?

 

[martykendall]

Have you seen the 80/10/10 diet where 80 is carbs from fruit, veg, pulses etc?

See https://optimisingnutrition.wordpress.com/2015/03/22/best_diet/

I would suggest most people should lean towards a high veggies paleo type approach with some meat.

Unless you're really metabolically challenged you might want to ramp up the fat and then compensate for nutrients with organ meats.

I think the vegetarian approach works well because it increases fibre and nutrients, but you need some animal products for vitamin D and B12 which are important.

I think a diabetic eating high fruit is delusional!

 

[Spiker]

Most people think that LCHF is the default

Not outside of our very small world they don't. Let's not make the mistake of confusing our immediate peer group for a majority opinion. LCHF is very much a minority view still. Increasing maybe but still minority.

I don't think anyone is proposing pushing protein below the levels of RDA and structural demand.

Since you are pushing for a personal view I would say eat the minimum of glucogenic micronutrients (carbs and protein) that you can handle, for optimum health. My personal opinion is this will lead to improved lifespan and quality of life for all humans, but particularly for diabetics. Personal opinion.

 

[Spiker]

I also agree we should all get those nutrients from unprocessed whole foods rather than industrial processed foods. And that we should all practice some kind of fasting from time to time. This is a backdoor Paleo manifesto, though I don't come at it from a Paleo argument per se.

 

[martykendall]

I would say eat the minimum of glucogenic micronutrients (carbs and protein) that you can handle, for optimum health. My personal opinion is this will lead to improved lifespan and quality of life for all humans, but particularly for diabetics. Personal opinion.

Definitely.

I think there is more to be done to give people the tools to help people reduce their glucogenic load from carbs and protein to a point where they obtain optimal blood sugars while not swinging too far to the other side of the boat where they miss out on the nutrition that can be obtained from protein and vegetables which contain some carbs.

 

[martykendall]

Not outside of our very small world they don't. Let's not make the mistake of confusing our immediate peer group for a majority opinion. LCHF is very much a minority view still. Increasing maybe but still minority.

There are some followers of Ron Rosedale who say that you can get your glucose needs from glycerol from fat. I don't think starvation ketosis is a viable long term lifestyle for optimal health (unless you're trying to slow cancer growth or something extreme like that).