Carbs and the GI - "total" insulin loading

The amount of insulin released is dependent on the food so even up to 2 hours the insulin responses between equal amounts of carbs are very different.

There has been some work on this and as with the GI foods have been ranked as to the amount of insulin they stimulate the body to release. It is not just carbs that elicit insulin, protein also does.Some protein foods stimulate the release of more insulin than some carb containing foods.(when this insulin for protein is released the liver normally releases some glucose to compensate. This is why I and some other T1s may need to inject some insulin for some protein foods, or meals with no carbs)
The Wiki article is quite good and has the table of foods that have been tested.
http://en.wikipedia.org/wiki/Insulin_index
The original research is here:
http://www.ajcn.org/content/66/5/1264.full.pdf

.Some people have suggested that an insulin index would be very useful and could even form a better basis for insulin dosing than counting carbs.
In her book The New Glucose revolution New York: Marlowe and Company, 2003, pages 57-58, Professor Brand-Miller points out that in most cases the glycemic index effectively predicts the insulin index. But she then goes on to say that there are some dairy foods and some high energy foods (ie high fat/high carbs) that have a low GI but a high insulin index, and that there are (as pointed out above) foods with no carbs that create high insulin responses.

Probably because of Brand Millers beliefs that the GI is all that is needed, there wasn't any more research on the insulin index until 2009.
In 2009 they published a small study using mixed meals. Basically subjects ate various meals containing the same amount of calories and the researchers looked to see if the predicted insulin response according to the insulin index occurred in mixed meals.
The results confirmed that both the insulin index and the glycemic load correlated with insulin response, the carbohydrate content was" not a significant predictor of the average response"
A meal containing grain bread, peanut butter and milk and 37.2 g carbs elicited the same insulin response as a meal of pasta and lentils containing 63.3g of carb. A meal of cookies and ice cream with 44.4 g carbs elicited less insulin than a meal of beef and potatoes with 39.8g carbs .(remember each meal contains the same amount of calories)

The graphs make it clear that at 2 hours the insulin levels are returning towards the starting point and that any continued release over the next hour wouldn't add much more to the area under the curve. (unless the body suddenly produced another insulin spike and I think that's unlikely)
It's a tiny study with not many subjects so it would need to be confirmed with many more (expensive)
http://www.ajcn.org/content/90/4/986.long
Since then there have been a couple of similar small studies like this but I'm sure that's enough to go on :lol:

Just to add it's one of my reasons that I have concerns over some lower carb diets: if they are still producing similar insulin responses, the persons body may still need to be producing high amounts of insulin.

phoenix said:

The Wiki article is quite good and has the table of foods that have been tested.
http://en.wikipedia.org/wiki/Insulin_index

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Phoenix, found this really interesting, but there are two things I'm struggling with; clarification would be appreciated!

1) The table shows that 2 different food sources could provoke the same glucose response in the blood with very different insulin responses. I'm trying to figure out which is worse for the same glucose response; the higher or lower insulin response. Is the lower one better because the Pancreas is working less hard and doesn't NEED the same response to restore the glucose level to "norm", or is it worse because with less insulin produced the BG level WON'T return to "norm" so quickly?

2) The table shows a comparitively high glucose response to dairy products like cheese and eggs. I must admit I thought cheese had a virtually zero effect on BGs, which is why many of us eat loads. Same for eggs. In fact, it shows cheese with the same glucose raising properties as some cereals. Can this be so? And can brown pasta really raise BG more than white? I always thought it was the other way round. Am I misinterpreting something here?

Yours, confused Sheep :crazy:

Read this article Grazer and it will confuse you even more. :lol: It is quite a long read but does have the advantages of graphs.

"Eggs, beef, fish, lentils, cheese , cake and donuts induced as much insulin secretion as did some carb rich foods. (Beef was equal to brown rice and fish was equal to grain bread).

The insulin demand generated by 1000kj portion of common foods.
http://www.ajcn.org/content/66/5/1264.full.pdf

Thanks; looks like a very similar set of charts. I can sort-of understand or accept the insulin response part, mainly because I've never looked into that. But cheese producing the same or more glucose level than white pasta? And brown pasta producing MORE glucose response than white? Don't get it.

Still a confused Sheep! :***:

Obviously still much work to be done in this field. {There you go Grazer}I don't think there are likely to be any definitive answers anytime soon.

I very oftten fear that most of our strategies for coping with the disease are merely differnt ways of losing weight or reducing food intake. I am sure metformin's greatest contribution to reducing bgs is its weight reducing properties..

I wonder if it will ever be possible to recommend any sort of diet for diabetics based on this research even when it is developed..
It all sounds too complicated and too restrictive even without considering variations between individual responses.

Well, that's because things are a bit more complicated than the simple model would suggest.

What makes things worse is GI (e.g. brown pasta vs white pasta) becomes completely useless for predicting the effect of meals (i.e. other food with white pasta vs food with brown pasta).
[Coulsten AM et al: Effects of dietary carbohydrate on plasma glucose, insulin and gastric inhibitory polypeptide responses to test meals in subjects with non-insulin-dependent diabetes mellitus. American Journal of Clinical Nutrition, 1984]

I am sure metformin's greatest contribution to reducing bgs is its weight reducing properties.

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It also reduces endogenous glucose production, which is 2-3x that of a healthy person.

1) The table shows that 2 different food sources could provoke the same glucose response in the blood with very different insulin responses. I'm trying to figure out which is worse for the same glucose response; the higher or lower insulin response. Is the lower one better because the Pancreas is working less hard and doesn't NEED the same response to restore the glucose level to "norm", or is it worse because with less insulin produced the BG level WON'T return to "norm" so quickly?

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I don't think anyone knows
This is what Brand Miller said in her 2003 book

At the present time, we don't know how to interpret this type of response (low glycemia, high insulinemia) for long-term health. It may be a good outcome because the rise in insulin has contributed to the low level of glycemia. On the other hand, it may be not-so-good, because the increased demand for insulin contributes to beta-cell "exhaustion" and the development of type 2 diabetes

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I haven't explored it in any depth. Here are 2 things I found this afternoon
There is a study that looked at the analysed insulin load of the women in the Nurses health study. The insulin load had no effect on the fasting glucose levels (not surprisingly since the insulin produced should keep the glucose levels under control) Those with a diet that was assumed to have a higher insulin load and were also obese had lower HDL. Those that ate diets with a higher insulin load had higher triglycerides .
I think though its quite a speculative study ( so far as I can see they used an algorithm to estimate insulin loads of various foods and they checked some for accuracy)
The abstract is here http://www.ajcn.org/content/94/1/182.short
and a power point presentation here http://www.nutrientdataconf.org/PastCon ... ampson.pdf
Another study found that there was no relationship between the estimated insulin load of the diet and colorectal cancer.

2) The table shows a comparitively high glucose response to dairy products like cheese and eggs. I must admit I thought cheese had a virtually zero effect on BGs, which is why many of us eat loads. Same for eggs. In fact, it shows cheese with the same glucose raising properties as some cereals. Can this be so? And can brown pasta really raise BG more than white? I always thought it was the other way round. Am I misinterpreting something here

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Pasta : If you just check pasta/spaghetti on the GI index you'll find that there's quite a range of GIs for pasta and wholemeal appears at the lower end and at the higher end. (though none are in the highest category unless overcooked)
Insulin
Having to calculate insulin shows me that eggs and cheese do effect my levels . I don't often eat 'no' carb meals, the one exception is an English breakfast when travelling to and from the UK. I have to guesstimate and usually use about the same dose as my normal porridge/berry breakfast. On occasions I've had to do a correction dose later. There are T1s that use a system called TAG (total available glucose) where they include a factor for carbs, another for protein and a small one for fat...to me that seems far too complicated. Most of my meals have similar proportions of protein/fat/carbs so I'm sure that I already include these elements when I calculate the dose.
Looking this up today though I've found a study where they carb counted a high carb meal to calculate peoples bolus requirements and later gave them a mixed meal (half the carb of the first meal +protein and fat). They used carb counting to dose on on occasion and the insulin index on another. They got far better postprandial results using the insulin index to calculate the dose .http://care.diabetesjournals.org/conten ... /2146.full

Thanks Phoenix - I think! :***:
Getting there, but I might need to do some post-cheese testing!

Bernstein has a theory, in simple terms bulk generates carbs?

His theory works on the lines, you eat a max of carbs per meal, 6g breaks, dinner and tea 12g's of carbs...

Now if you have a salad, there's quite a few ways of making this up to comply with a max of 12g of carbs.. And dependant on what you make it up with, you could have a single cup of salad or 2, 3 or 4 cups of salad.. But Bernstein says, that you should have no more than 2 cups of salad.. As if you have more than this the bulk acts like carbs turning a 12g into 24g of carbs etc... Same with protein, he limits this both due to it ability to break down into glucose (if I remember rightly is 50%) and also it bulks out a meal above his recommendation of allowable bulk!

As a T1, I've got to at times make an allowance of insulin for protein/fat meal.. How much will depend on whether I have or how much carbs with it..

The amount if protein turned into carbohydrate will depend on the bodies requirement.. if you are on a relatively low carb diet then you should probably account for around 25%+ of protein to convert to glucose. When I low carb'd I tended to cover this with background as the conversion is not always the same or at the same rate..

I think if your eating 80/100g+ of carb a day (like I do currently) then from my experience I don't really need to account for the protein.. so although it might be having an effect its reasonably negligible.

This is a great thread. I love the Brand Miller stuff, but I'm not sure just how useful it is to T2 diabetics. Measuring First-Phase Insulin Response in metabolically healthy people, has little to do with Second-Phase Insulin Response in a T2 diabetic - which definitely does depend on the amount of carbohydrate in a meal.

First-Phase Insulin response is what happens when you first start to eat and is your metabolism's rough guestimate of the amount of insulin required to deal with a meal.

Second-Phase Insulin response is what happens if you BG is still elevated after the First-Phase response, as your pancreas dumps out a (hopefully smaller) amount of insulin to try and mop-up the excess glucose.

1. All of the subjects of the test were metabolically normal people, so what I think that we are talking about here is "First-Phase Insulin Response" - since their BG probably returned to near fasting levels within the 120 minute period
2. As I understand it First-Phase Insulin is dumped as soon as you start to chew (and I have heard it suggested that simply thinking about eating is enough to instigate it.)
3. Since your Pancreas can't know in a priori what the content of your meal is, then the amount of insulin dumped is based on the carbohydrate content of recent meals.
4. Since I presume that most of the subjects of this study were eating "balanced" meals as their regular diet, it is possible that their pancreas' dumped enough insulin to deal with the amount of carbohydrate that they usually ate, rather than that in the meal that they actually consumed.
5. I'd therefore be interested to see what happened to my insulin levels, now that my metabolic machinery is set up to process less than 10g of carb a meal. We talked the other day about how people eating a large quantity of carbs after eating a ketonic diet had paticularly poor insulin responses, this is probably the reason why.

I'd love to see her extend the study to include those of us with broken insulin responses:

1. First-phase insulin responses depend on stored insulin. For those of us with chronic insulin resistance, our pancreas is often too busy with second-phase insulin response to manufacture the insulin needed to do this, meaning that many T2 diabetics have a diminished first-phase response.
2. Even if we don't, first-phase insulin isn't usually enough to deal with our elevated BG levels (which is why we are often still bumping around the 7 mark 2 hours after a meal), making second-phase insulin (the stuff that tries to get our BG down to about 5mmol/l) much more critical.

Measuring insulin response is only half the story, you also need to account for other hormonal responses and especially glucagon (a hormone that regulates insulin production). I understand that although the consumption of dairy products stimulare a large insulin response, it also stimulate an equally large glucagon response which mitigates the effect of the insulin.

She alludes to this in the 2009 paper:

addition of fat to a carbohydrate-rich meal reduces postprandial glycemia but not the insulin response (9, 10). Several insulinotropic factors are known to potentiate the stimulatory effect of glucose and mediate postprandial insulin secretion. These factors include specific amino acids and fatty acids and gastrointestinal hormones such as gastric inhibitory polypeptide, glucagon-like peptide 1, glucagon, and cholecystokinin

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The bottom line is that I'm more interested in controlling my BG than worrying about First-Phase Insulin response, over which I have relatively little control.

Good and helpful reply. Being specific, I guess my concern is still that the AUC on eating cheese, I.e the effect on BG, was significant. Also with eggs. Understand the insulin response, but the bottom line suggestion seems to be that cheese and eggs, for example, (I dont have a fixation with them!) raises BG. Or have I still got it wrong?

Grazer said:

Good and helpful reply. Being specific, I guess my concern is still that the AUC on eating cheese, I.e the effect on BG, was significant. Also with eggs. Understand the insulin response, but the bottom line suggestion seems to be that cheese and eggs, for example, (I dont have a fixation with them!) raises BG. Or have I still got it wrong?

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Yes you have it wrong.

The carbohydrate content of the food is what raises your BG.

If you eat a low-carb piece of food - an egg say, and your pancreas dumps out a large amount of insulin because it thinks you might have eaten a chocolate hob-nob by mistake, it will reduce your BG levels rather than raising it.

It's more of a concern for Taubes/Atkins type dieters, who think that raised insulin levels promote fat storage. However Taubes is very clear that he is talking about chronically raised insulin levels in people with metabolic syndrome and / or T2 diabetes. He accepts that all food spikes your insulin to some degree.

Since you are a skinny runt of a goat who could do with putting a bit more weight on, it shouldn't be of much concern to you.

Grazer said:

Good and helpful reply. Being specific, I guess my concern is still that the AUC on eating cheese, I.e the effect on BG, was significant. Also with eggs. Understand the insulin response, but the bottom line suggestion seems to be that cheese and eggs, for example, (I dont have a fixation with them!) raises BG. Or have I still got it wrong?

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In addition, in the 2009 paper she shows that while the carb content of the meal does not influence the insulin response, the fat content of the meal has a strong influence (in reducing the insulin response):
http://www.ajcn.org/content/90/4/986/F2.expansion.html

Since on a low-carb diet you are replacing carbohydrates with fat, you will still be reducing your insulin levels. Extrapolating her line, and eating much more than 30g of fat per meal, I should be getting somewhere near zero insulin response to my diet.

This is great stuff isn't it?

So is she saying that carbs are irrelevant if there is loads of fat? Like fried bread for example.

......you just wouldn't let it lie, would you...........

:lol: :lol: :lol:

wiflib

Jeannemum said:

So is she saying that carbs are irrelevant if there is loads of fat? Like fried bread for example.

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It depends what your intention is:
If you want to minimize your BG to eating bread then combining it with some nice fat should help knock the edge off the spike.

However, from the Gospel according to Taubes, eating carbs and fat at the same time is the worst thing that you can do. The carbs will elevate your insulin causing the fat to be stored as body fat, rather than oxidised for energy.

I love fried bread too. For 40 years I didn't eat it cos it was fried. Now I can't eat it cos it's bread.

Grazer said:

Good and helpful reply. Being specific, I guess my concern is still that the AUC on eating cheese, I.e the effect on BG, was significant. Also with eggs. Understand the insulin response, but the bottom line suggestion seems to be that cheese and eggs, for example, (I dont have a fixation with them!) raises BG. Or have I still got it wrong?

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Actually Malc, I don't understand that bit. Cheese and Eggs have a GI of essentially zero because they contain only insignificant amounts of carbohydrate. I don't understand why they get Glucose Scores at all.

I guess it's because 58% of protein is metabolized as glucose.

borofergie said:

Jeannemum said:

So is she saying that carbs are irrelevant if there is loads of fat? Like fried bread for example.

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It depends what your intention is:
If you want to minimize your BG to eating bread then combining it with some nice fat should help knock the edge off the spike.

However, from the Gospel according to Taubes, eating carbs and fat at the same time is the worst thing that you can do. The carbs will elevate your insulin causing the fat to be stored as body fat, rather than oxidised for energy.

I love fried bread too. For 40 years I didn't eat it cos it was fried. Now I can't eat it cos it's bread.

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Believe me, I have no intention of putting the two together again. The fry up is delicious as it is. I am ultra low carbing right now, hence my purple stick.