Diabetes 102

Just adding, if you weren't already aware of it, Marty - there is a discussion of your work on another forum (the one Loose Cannon hates   ):

http://www.diabetes.co.uk/forum/threads/insulin-load-index-most-ketogenic-foods.75704/

Thanks Indy 51 for the welcome. Hi from the other side of Australia.

Yeah, I came across the insulin index concept from Jason Fung's lectures and went searching for some more info.

Hey Eddie. OK. I’m gonna bite.

> You have stated on your blog your wife struggled for years with her diabetes. Thankfully she now has it under control and turned her life around. People would love to know how this was achieved. I will stick my neck our here and say, I bet she followed medical professionals advice and run a carb up and shoot up regime. I'll go further, I bet her good control was achieved with a drastic reduction in carbs and replaced the lost calories with high quality natural fats.

There have been a number of phases in our diabetes journey. I’ve touched on it briefly in this article - https://optimisingnutrition.wordpress.com/2015/03/22/best_diet/ - but I will respond with a bit more detail below.

When we got married and started to plan to have a baby (same time in my wife’s head!) we found a doctor (general practitioner) who was also a diabetes guru. My wife’s sister put us in contact (sister is a GP / hospital director and her brother is an anaesthetist, sister in law is a radiologist who trained under Troy Stapleton - so there’s no lack of medical professionals who SHOULD know all about diet for diabetes). Anyway, this doctor introduced us to the idea of carb counting and being able to refine the insulin sensitivity factor to enable us to accurately calculate the insulin dose to correct the blood sugars. Up until that point she didn’t really do blood sugars that often because no one had told her what to do with the numbers anyway!

We went through a couple of successful pregnancies (see self-indulgent photos then and now at https://optimisingnutrition.wordpress.com/2015/04/02/carbs-protein-type-1s-and-canaries/) with me refining the insulin sensitivity factor every week or so to optimise control. I think her BG in pregnancy was just under 7 which we thought was pretty amazing! As you can see from the photos there was still a good chunk of insulin and carbs going down. Our doctor promotes the Mediteranean Diet and warns us to avoid saturated fat.

Meanwhile my Dad finds he’s got some obesity related hormonal issues and goes down the rabbit hole trying to straighten himself out and avoid some nasty prostate related operations. He got onto Paleo and I started listening to Robb Wolf podcasts. Eventually I found Jimmy Moore and Dave Aspray and Able James and Sam Feltham (UK!) and spent a while pile of time with my head in that headspace. We ate pretty healthy but I was still a lot bigger than I would like to be and Moni’s HbA1cs were mid 7s which is pretty good by most peoples’ standards but it still meant she couldn’t get through a day without a nap and teaching was a daunting though.

Mid last year we went to the Low Carb Down Under seminar in Brisbane where I met Lisa Scherger, Troy Stapleton and Steve Phinney. Troy mentioned the TYPEONEGRIT Facebook group (Bernstein disciples) that we joined just before Christmas and saw all these type 1s living with flat line blood sugars and HbA1cs less than 6. I suppose at that point Moni saw what could be achieved with discipline. Once you believe it’s worth the effort you can put in more effort.

In January I stumbled across Jason Fung’s stuff and churned through that on my Christmas holidays. I developed the optimal foods list for diabetics (based on carbs, protein, fibre and nutrient density – see https://optimisingnutrition.wordpress.com/2015/03/22/cheat-sheets/) which we posted to our fridge to inspire our shopping trips.

I’ve also been working through a similar process for meals to identify nutrient dense diabetic friendly meals. As part of that I calculated the insulin load for each meal which is helping her more accurately dose her insulin. This is still a work in progress, but I hope that we’ll be able to use this system to select more optimal meals which have the required insulin (based on carbs, protein and fibre) pre-calculated. If I’m going to this effort for my family I figured it would be fun to share the journey with others and stated a blog.

What has been super cool for me personally is that since I started to implement this process I have lost about 9kg and stabilised my blood sugars and achieved more consistent ketosis. I found that if you’re trying to achieve ketosis based according to the blood ketone metre you need to really fine tune your diet. The insulin index data has been a very useful guide for me. If you listen to Jimmy Moore you’ll hear him banging on about cutting carbs AND moderating protein – the insulin index puts this into an actionable formula.

So that’s the story. Not really mainstream medical influenced at all. In fact I’m often appalled at our Diabetes Queensland Facebook page that posts recipes that are high carb and seems to accept high blood sugars as inevitable and not worth fighting.

One thing I like about Troy Stapleton is that he’s also a big Mark Sisson / paleo / ancestral framework fan. I think that bringing in the nutritional density aspect into the insulin load concept is pretty exciting because you can just point people to the most nutritious diabetic friendly meals based on the data without people having to believe in LCHF or paleo or some other framework that requires a level of blind faith and often gets debated because of that fact(see https://optimisingnutrition.wordpress.com/2015/03/22/the-most-nutritious-diabetic-friendly-meals/).

And talking speaking of Lisa Sherger, if you look at what she’s doing to optimise her son’s insulin doses at the moment you’ll see it’s not just run of the mill (see http://diabeticalien.blogspot.com.au/2015/04/preventing-protein-spike.html). Using the insulin index theory detailed in my paper she’s blousing for carbs (minus fibre) 40 minutes before the meal and then dosing for the protein one hour after to match the rise in blood sugar that she sees on the CGM. Is this a lot of extra work? Yes! Is it worth it? Maybe, if you want amazing blood sugars that are better than the majority of the mainstream population. Is it for everyone? Probably not, but some people want to go to that extra effort.

For the people that want to put in the extra effort to get the extra results I would like to use my knowledge and experience (God knows I’ve spent enough time reading books and listening to endless podcasts) to develop the tools that can help people optimise their nutrition and manage their insulin using the best tools possible.

Cheers

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

The more I look at your blog, Marty - the more impressed I am with the amount of work and thought you've put into this. Your wife is one lucky lady having a hubby who cares so much about her health

I'll bet you were stoked to get such positive feedback from Dr Fung, Ivor Cummings and Franziska Spritzler (sssshhh, don't tell anyone but Eddie has a huge crush on her )

Hi Marty

Thanks for coming back with such a detailed and open reply. I can see you are extremely passionate in what you are doing, and your system has worked for you and your wife. I am sure it could work for others. I think we could trade arguments re. the insulin index for a long time. You have made your position extremely clear. I applaud anyone that gets off their butt and puts a great deal of effort into trying to help others. I am also extremely passionate about helping diabetics, and non diabetics who struggle to gain control of their weight. I think if I tell you my story, you will see where I am coming from.

My Grandmother was a type two diabetic, it killed her. My Father was a type two diabetic, it killed him. When my father died he was riddled with diabetic complications, two previous heart attacks and many years blighted. Two weeks before he died I was diagnosed a type two diabetic. I only saw him once after that, and at the meeting I asked him about his blood glucose control. At this stage he had been on insulin for years and around ten different medications, all related to poor diabetes control and complications.

Even after only two weeks of diagnosis I knew what safe BG numbers were, and asked him about his. He told me he liked to keep BG numbers to ten, he had be told by his medical professionals ten was a good number. He had complied fully with his Doctor and the prescribed high carb low fat diet. I call this diet, the diet of slow death. That diet pretty much was prescribed to me. I was given a book by my diabetes trained nurse sponsored by Takeda, the largest insulin outfit in Japan. That informed me I could eat the same diet as a non diabetic, and to eat lots of starchy carbs, including rice, potatoes, bread and pasta etc.

I had self diagnosed before getting the official verdict from my medics. I had never had a weight problem in my life, but around a year before diagnosis I gained around 50 lbs in weight within a short period, constant thirst, poor eyesight and always tired, all the bog standard symptoms. I went out on a Saturday, purchased a BG meter and tested, that weekend and using the ten test strips supplied, average BG 26mmol/L. So, off to the medics, diagnosis confirmed and HbA1c 12, prescribed two metformin and see you in three months time. That sort of support is typical in the UK for most, the treatment for diabetes, especially type two’s is pitiful, almost beyond description.

So, I joined a diabetes forum diabetes.co.uk, and I got very lucky. Back in those day it had less than 2000 members, but just as I joined a guy called Fergus Craig also joined. He is a type one diabetic, he was running marathons at 45, and competing in 100 mile bike races. He was holding long time HbA1c in the mid fours, great lipid panel and was a Bernstein disciple. At this stage and by cutting out sugar and Coca Cola etc, but not the starchy carbs, I was averaging 15 on the BG meter, and never better than 12, grim numbers. I decided to give the low carb (30 carbs per day) higher natural fat diet a try, within five days I was averaging fasting BG numbers between 4 and 5. Two hours after a meal never higher than 7. Second HbA1c test three months later mid fives, diabetes reversed. My Doctor was very interested in the reversal, and asked me was I being treated elsewhere. The appointment was going well, until I mentioned the most dreaded words a medic can ever hear, ‘low carb diet’. The tone of the meeting changed, and I heard the words so many others have heard, if works for you etc. end of meeting.

At that stage, I should have been very happy and got on with the rest of my life, I should have walked away from diabetes.co,uk. But I was so incensed at the medical profession and realised how easy type two diabetes could be reversed, I joined the few  low carb Hezbollah members at the forum, and started spreading the word. Everyone would want to know how to reverse type two and get healthy again yes. No, a small group of what I call low carb antis and a BDA dietitian, challenged me on almost every post. I was a dead man walking, scurvy, osteoporosis, cancer, and cognitive disorder was waiting for me down the road. Fortunately some did follow my sermons from the mount, they have stayed as friends for seven years. The only diabetes medication used is Metformin, a long time proved to be safe drug, most use no diabetes medication at all. All holding non diabetic BG numbers and all showing no diabetic complications whatsoever.

To cut a long story short re. the diabetes.co.uk forum, I call the forum of flog. It’s primary role is to make money, by selling products and services to diabetics, (and not so long ago was wanting to link with big pharma), decided to ban countless low carbers, even world renown Doctor, type two diabetic and low carb expert Jay Wortman, was banned by the forum. This was done despite the fact, almost all the success stories at the flog, involved a low carb higher fat diet.

What should I have done, walked away and think I gave it a go to help others, I don’t need the grief, or stay and fight. I stayed to fight the spreaders of misinformation and big pharma and junk food liers, whose greed and corruption, leads to the early painful deaths of countless diabetics around the world. Take on the NHS, DUK, BDA, recommended dietary lunacy promoted to diabetics.

So Marty, that’s my story. I am happy to trade posts with you on the insulin index, and any other subjects, but maybe we have reached a stalemate on that issue. You have stated your case for the insulin index extremely well, and provided a huge amount of data to back your claims.  I have said previously why? and mentioned re-inventing a perfectly good wheel. I am a great believer in the saying “if it ain’t broke don’t try to fix it” The Bernstein type low carb high fat approach has worked perfectly for a very long time, thousands maybe millions have found it their salvation, the great beauty of the method is it’s total simplicity. I have also said before, I believe in simplicity, especially when talking to newbies and long term poorly controlled diabetics.

Let’s shake hands on this one, and work together for the benefit of all diabetics around the world. We speak the truth, with no hidden agenda, we fight for love, there can never ever be a better cause, we are on the side of right, and will never be beaten. I am sure all the members look forward to reading more of your posts, I certainly do. I hope I have not offended you, and as Mo said yesterday, diplomacy is not one of my strengths.

Kind regards Eddie

Health warning. I got lucky with the very fast reduction in BG and did not suffer any eye damage. The best advice is to spend weeks or even months slowly reducing BG numbers if very high at the start of a low carb diet. A very swift change from very high numbers to non diabetic, can result in permanent eye damage.

> The more I look at your blog, Marty - the more impressed I am with the amount of work and thought you've put into this. Your wife is one lucky lady having a hubby who cares so much about her health.

Thanks Indy.  It's not an easy journey and not always plain sailing.  Type 1 with thyroid issues sux and it's not always easy.  The low carb journey has definitely helped though.

It's also partly my vanity.  I've been dabbling in diet stuff for a while and I think a better understanding of the insulin effect of foods has helped move my health forward.  

It's also become a bit of a passion over the past few months.  I like to have a project.  As Eddie said it makes you angry to see so many people suffering under bad advice, lack of knowledge and commercial interests who can make so much money from people being sick!

And thanks Indy51 for highlighting the discussion over at the 'other' forum. I've been learning a heap from Spiker and Tim2000s in this discussion. http://www.diabetes.co.uk/forum/threads/insulin-load-index-most-ketogenic-foods.75704/

Thanks Eddie for your response and sharing your story.

These forums and Facebook groups as such a great way to learn.  They can really help people when the mainstream medical establishment is giving such garbage advice.  
I have learned a pile and its fun to be part of communities where you can share and learn

> The Bernstein type low carb high fat approach has worked perfectly for a very long time, thousands maybe millions have found it their salvation, the great beauty of the method is it’s total simplicity.

I hate to be nit-picky, but I actually think Bernstein is low carb, high protein.  For some reason I’m fascinated with the question of how to find the optimal balance of protein for someone who is low carb.  How do you balance health without incurring excessive insulin / glucose from the glucogenic effect of food?  Bernstein touches on this but I think some more discussion might be warranted to help people for whom standard low carb isn’t working for.  

I also acknowledge that the formula is a bit klunky and scary, but my hope is to create some simple lists of foods (https://optimisingnutrition.wordpress.com/2015/03/22/cheat-sheets/) and meals ( https://optimisingnutrition.wordpress.com/2015/03/22/recipes/) that can be useful without getting into the theory.

At the same time, the glucogenic effect of protein is just tinkering at the edges of low carb and most people will likely to great on the standard approach!  

Thanks for the welcome to the forum.  I love the discussions.  

Cheers

Marty

Cheers Marty, I've been following your discussions with Spiker & Tim, very interesting stuff. I guess we're all looking for the Holy Grail of diabetes control and insulin management which I'm doubtful we will ever achieve as I still feel there are too many variables. However, I still find the current system of carb counting along to be best guess and trial & error. Keep us updated with your findings please.

mo1905 wrote:Cheers Marty, I've been following your discussions with Spiker & Tim, very interesting stuff. I guess we're all looking for the Holy Grail of diabetes control and insulin management which I'm doubtful we will ever achieve as I still feel there are too many variables. However, I still find the current system of carb counting along to be best guess and trial & error. Keep us updated with your findings please.

Thanks Mo. Spiker is stretching my brain... which is great. So much to learn from people who have been living with diabetes and researching it!

It would be nice to move the needle a little bit more on the nutrition component of diabetes. There are enough variables and other things to worry about with the condition that's for sure!

Just received my email newsletter from Low Carb Downunder and was chuffed to see that @martykendall is presenting at two of their upcoming events in Melbourne and Brisbane:

http://www.lowcarbdownunder.com.au/events/the-evidence-for-low-carb-nutrition/

Low Carb Downunder usually post videos of their lectures on Youtube, so hopefully we'll get to see Marty's presentation eventually

Thanks for this Indy, I was really interested in what Marty had to say.

Thanks for the info Indy. I remember Marty when he came over here, a very interesting if short debate. He clearly won't be adding me to his Christmas card list, but he has put in a huge amount of work and a very bright fella. A couple of points interest me. The insulin index has been around for at least twenty years, but has never taken off and I can't remember Dr. Richard Bernstein every pushing it. The $64,000 question, why has the index never become popular and accepted as a step forward for most diabetics?

I've read some of Marty's stuff about the insulin index and, maybe it's just me being a bit thick, but I haven't been able to grasp the point of it. All very technical and clever looking, but it doesn't seem, fundamentally to say anything more than steer clear of the carbs and be aware that, ultimately, protein can end up as sugars, so will have some insulin requirement. Perhaps there is a relevance to the scientifically minded T1.
I'd be very pleased to hear an explanation.
Sally

Sally wrote:I've read some of Marty's stuff about the insulin index and, maybe it's just me being a bit thick, but I haven't been able to grasp the point of it.  All very technical and clever looking, but it doesn't seem, fundamentally to say anything more than steer clear of the carbs and be aware that, ultimately, protein can end up as sugars, so will have some insulin requirement.  Perhaps there is a relevance to the scientifically minded T1.
I'd be very pleased to hear an explanation.
Sally

"but I haven't been able to grasp the point of it" "I'd be very pleased to hear an explanation"

Same goes for me. When you consider how hard it has been to get some half way honest info on food packaging (although still highly misleading) what chance of getting insulin index information on a packet of Hobnobs or a loaf of bread. For me the insulin index is an interesting diversion, some fun for techno geeks, but in the real world, a bit of a gimmick.  

Well when I read it I saw it as an extra tool for T1s to make sure they got their bolus right and also as maybe helpful for me when I was trying to get into ketosis.

Then I discovered my 'drink cream diet' and decided that was the easy way to ketosis, so I gave up looking into it further. I still found it interesting though.

Eddie wrote:Thanks for the info Indy. I remember Marty when he came over here, a very interesting if short debate. He clearly won't be adding me to his Christmas card list, but he has put in a huge amount of work and a very bright fella. A couple of points interest me. The insulin index has been around for at least twenty years, but has never taken off and I can't remember Dr. Richard Bernstein every pushing it. The $64,000 question, why has the index never become popular and accepted as a step forward for most diabetics?

As I understand it, the research has only recently (2014?) been completed. A PHD student of Jennie Brand-Miller's at Sydney Uni extended the GI/GL research they'd done to include the insulin index of food. So until now there hasn't been a comprehensive food database. Now there is and Marty has gone to the trouble of documenting it beyond the student's thesis and getting it to a wider audience.

If Jason Fung and others more knowledgeable than I think his work has merit, I'm not going to argue.

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

The work was carried out to help Marty's Type 1 wife, so yes, I think it probably is more applicable to Type 1s wanting extra good control (which of course won't be every Type 1). But if you believe Jason Fung's arguments about keeping insulin low for Type 2's, then there would appear to be some benefit for us also. Again, not everyone will care to take the diet to that level, but their choice and it's another tool in the toolbox for those who want to use it.

I think it was an intellectual challenge for the engineer in Marty as well as having a very personal application to his wife's health. I don't quite get the negativity towards someone who is expanding the knowledge base. How can new insights be a bad thing?

Hi Indy

The insulin index goes back to 1997, admittedly the list of data has been expanded. As you say some of the people involved came up with GI index which Barry Groves comprehensibly shredded, as a useful tool for anyone let alone a diabetic. I am sorry I sound so negative but at the moment I cannot see the point of the insulin index. Perhaps someone can explain to me what I am missing. As we know there are so many variables, I can't understand how the insulin index can make control tighter.

I have great respect for Jason Fung, but do you know what I think, he is being very clever but honest with his presentations. He knows at the moment he cannot go full on with a recommendation for a low carb high fat diet, although he mentions it in fairly casual way, so he talks of fasting and other less controversial methods. He appears to be playing a game of slowly slowly catchy monkey, but I might be wrong. For me Richard Bernstein completely nailed BG control years ago, others seem to me to trying to re-invent the wheel. Of course science moves on, but for the foreseeable future it's LCHF it's just a question of trial and error by the individual. I expect some genius will come up with an algorithm that can work out almost all the variables, but even a mild infection can throw BG numbers all over the place. The betus is one tough gig at times but certainly interesting, especially when our limbs and eye sight are at stake.

Link to insulin index  http://ajcn.nutrition.org/content/66/5/1264.full.pdf

Hey guys.

Thanks for noticing the LCDU gig Indy. I'm excited to have the opportunity.

I spend more than enough of my time in FB groups rather than forums, but I saw this one pop up in my email notifications and thought I'd have a look.

Why hasn't the insulin index taken off? I think the more recent work by Kirstine Bell extending the testing from 38 points to more than one hundred is very powerful.

Why is it important? I live in the type 1 world where many people are already low carb but struggle to manage the glucose rise from protein. Taking fibre and protein into account gives us a more accurate way to calculate the insulin requirement for a meal compared to just carbs. It also gives us a powerful way to combine prioritise foods that will have a more gentle effect on blood sugars and keep you off the blood sugar / insulin rollercoaster.

I was also intrigued by Dr Fung's statement that many people struggle to lose weight following Atkins because of the insulinogenic effect of protein. I think the insulin index helps to explain why this would happen and what to do about it.

Where it gets very cool is if we combine the algorithm with nutrient density which enables us to quantitatively prioritise foods for different goals. If we all agree that nutrient dense foods that don't raise blood glucose too much are ideal then we can shortlist foods that meet these goals.

@martykendall - not sure if you've looked at this side of things, but one of the DCUK members has been working on expanding his BG management app to include an IOB calculation with input from members like Spiker who also gave you feedback.

If you're interested, the thread can be found at: http://www.diabetes.co.uk/forum/threads/iob-model.82743/

Good luck with your speaking gigs

martykendall wrote:Hey guys.  

Thanks for noticing the LCDU gig Indy.  I'm excited to have the opportunity.

I spend more than enough of my time in FB groups rather than forums, but I saw this one pop up in my email notifications and thought I'd have a look.

Why hasn't the insulin index taken off?  I think the more recent work by Kirstine Bell extending the testing from 38 points to more than one hundred is very powerful.

Why is it important?  I live in the type 1 world where many people are already low carb but struggle to manage the glucose rise from protein.  Taking fibre and protein into account gives us a more accurate way to calculate the insulin requirement for a meal compared to just carbs.  It also gives us a powerful way to combine prioritise foods that will have a more gentle effect on blood sugars and keep you off the blood sugar / insulin rollercoaster.  

I was also intrigued by Dr Fung's statement that many people struggle to lose weight following Atkins because of the insulinogenic effect of protein.  I think the insulin index helps to explain why this would happen and what to do about it.

Where it gets very cool is if we combine the algorithm with nutrient density which enables us to quantitatively prioritise foods for different goals.  If we all agree that nutrient dense foods that don't raise blood glucose too much are ideal then we can shortlist foods that meet these goals.  

Hi Marty glad to see you back here. I know I come across as a negative old git to you, but I am interested in the debate and I am genuinely looking to see if  the insulin index can help me.

"Why hasn't the insulin index taken off?  I think the more recent work by Kirstine Bell extending the testing from 38 points to more than one hundred is very powerful."

But the insulin index still hasn't taken off.

"I live in the type 1 world where many people are already low carb but struggle to manage the glucose rise from protein."

A well informed type one diabetic knows full well protein needs to be taken account of and adjusts insulin requirement accordingly.

"I was also intrigued by Dr Fung's statement that many people struggle to lose weight following Atkins because of the insulinogenic effect of protein.  I think the insulin index helps to explain why this would happen and what to do about it."

Us low carbers do not use and do not advocate an Atkins diet especially the induction phases. We know full well protein can covert to up to approximately 50% glucose via gluconeogenesis, hence the reason their is no such thing as an essential carbohydrate. We recommend when cutting back on carbs to replace lost calories with fat never protein.

"If we all agree that nutrient dense foods that don't raise blood glucose too much are ideal then we can shortlist foods that meet these goals."

The most nutrient dense food in term of calories is of course fat, with over twice the calories per gram as carbs and protein. It also raises insulin levels and BG the least, and of course we carry a good deal of stored energy around with us, many too much stored energy as blubber. But that's another issue.

Yesterday I was reading the breakdown between type one and two diabetics is reckoned to be 6% T1 and 94%T2 (DUK). As a type two does not have a clue how much insulin their body is producing or how insulin resistant they are, how does the insulin index help them to better control?

It seems to me whatever any diabetic T1 and T2 has in the way of information, the only way to gain good long term control is by intensive blood glucose testing and adjustment. Whatever we have in the way of data and algorithms etc. is only a very blunt tool. There are also so many variables that even the best controlled and disciplined diabetic with a pump, CGM and test strips can see numbers go all over the place with a mild infection.

The bottom line I suppose is how will the insulin index provide me with better BG control? If you can tell me that, I'll be on the insulin index promotion campaign trail like a shot.

Hey Eddie

I miss our fun old times...

Nutrient density... I'm talking about micronutrients not calorie density. Unfortunately high fat foods don't always have a great range of micronutrients like sardines, liver or spinach might. So we can combine the various goals to shortlist our food selection that will be nutritious and gentle on diabetes. See https://optimisingnutrition.wordpress.com/2015/03/22/towards-a-personalised-food-ranking-system/ and https://optimisingnutrition.wordpress.com/?p=1655

How will the insulin index help with better blood glucose control? If you're a type 1 it can help with you insulin dosing calculations (see https://optimisingnutrition.wordpress.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes/). But at the same time, rather than just using it to react to foods we can use it to chose foods that will minimise our requirement for insulin.

In the end diabetes (whether type 1 or type 2) is a condition where we cannot produce enough insulin to manage our blood glucose levels (due to decreased pancreatic function or insulin resistance). The solution to diabetes is to reduce the insulin load of your diet.

In my experience the blood glucose rollercoaster is ugly. For a type 1 eating foods that mean you need to take a large bolus of insulin that will send you crashing down and then need to eat to get out of that low is what we want to avoid. The same process is in play for a type 2 but their insulin is coming from their pancreas is producing more insulin.

To some degree we all have a limited supply of insulin and want to avoid the blood glucose / insulin roller coaster. Anyone with limited pancreatic function or insulin resistance (i.e. most of the population these days) should also be interested in not overloading their pancreas to the point that it can't produce enough insulin to keep stable blood glucose levels. This is not just about the carbs, it's protein and fibre too. Hence choosing foods that have a lower insulin demand gives them a better chance of maintaining normal glucose levels and minimising insulin (endogenous or exogenous) that leads to body fat storage etc.

"But the insulin index still hasn't taken off."

In five months this article - https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/ - has clocked 60,000 views which has exceeded my expectations. Obviously some people get it and keep sharing it around the place. I'm not aiming for world domination but it's nice to see the concept being used.

I'm surprised that the University of Sydney and Harvard who have been involved in developing this data aren't promoting the implications more. This probably relates to the fact that it turns the grain based 'balanced diet' food recommendations for diabetics and the rest of the population on its head.

Thanks for the reply Marty I'm off out for a few hours get back to you later.

martykendall wrote:Hey Eddie

I miss our fun old times...

Nutrient density...  I'm talking about micronutrients not calorie density.  Unfortunately high fat foods don't always have a great range of micronutrients like sardines, liver or spinach might.  So we can combine the various goals to shortlist our food selection that will be nutritious and gentle on diabetes.  See https://optimisingnutrition.wordpress.com/2015/03/22/towards-a-personalised-food-ranking-system/ and https://optimisingnutrition.wordpress.com/?p=1655

How will the insulin index help with better blood glucose control?  If you're a type 1 it can help with you insulin dosing calculations (see https://optimisingnutrition.wordpress.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes/).  But at the same time, rather than just using it to react to foods we can use it to chose foods that will minimise our requirement for insulin.  

In the end diabetes (whether type 1 or type 2) is a condition where we cannot produce enough insulin to manage our blood glucose levels (due to decreased pancreatic function or insulin resistance).  The solution to diabetes is to reduce the insulin load of your diet.  

In my experience the blood glucose rollercoaster is ugly.  For a type 1 eating foods that mean you need to take a large bolus of insulin that will send you crashing down and then need to eat to get out of that low is what we want to avoid.  The same process is in play for a type 2 but their insulin is coming from their pancreas is producing more insulin.  

To some degree we all have a limited supply of insulin and want to avoid the blood glucose / insulin roller coaster.  Anyone with limited pancreatic function or insulin resistance (i.e. most of the population these days) should also be interested in not overloading their pancreas to the point that it can't produce enough insulin to keep stable blood glucose levels.  This is not just about the carbs, it's protein and fibre too.  Hence choosing foods that have a lower insulin demand gives them a better chance of maintaining normal glucose levels and minimising insulin (endogenous or exogenous) that leads to body fat storage etc.

"But the insulin index still hasn't taken off."  

In five months this article - https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/ - has clocked 60,000 views which has exceeded my expectations.  Obviously some people get it and keep sharing it around the place.  I'm not aiming for world domination but it's nice to see the concept being used.  

I'm surprised that the University of Sydney and Harvard who have been involved in developing this data aren't promoting the implications more.  This probably relates to the fact that it turns the grain based 'balanced diet' food recommendations for diabetics and the rest of the population on its head.  

“Nutrient density... I'm talking about micronutrients not calorie density. Unfortunately high fat foods don't always have a great range of micronutrients like sardines, liver or spinach might. So we can combine the various goals to shortlist our food selection that will be nutritious and gentle on diabetes. See https://optimisingnutrition.wordpress.com/2015/03/22/towards-a-personalised-food-ranking-system/ and https://optimisingnutrition.wordpress.com/?p=1655”

I can assure you that we all know the most nutrient rich foods, for optimum health and what is gentle on our diabetes. Man only has need for meat and fat, but not many of us want to live on barely cooked meat, offal and fat. Check out the Bellevue Hospital study Vilhjalmur Stefansson. That being said a diet of 30 to 50 well chosen carbs, together with a range of natural fats and proteins supplies all the nutrients we need to stay in control of our diabetes and stay healthy, active and satiated.

“How will the insulin index help with better blood glucose control? If you're a type 1 it can help with you insulin dosing calculations (see https://optimisingnutrition.wordpress.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes/). But at the same time, rather than just using it to react to foods we can use it to chose foods that will minimise our requirement for insulin.”

A low carb higher fat diet also reduces insulin to the minimum, Bernstein calls it the power of small numbers, the less the carbs the less the insulin equals greater control and insulin predictability, less margin for error and absolute minimum insulin requirements.

“In the end diabetes (whether type 1 or type 2) is a condition where we cannot produce enough insulin to manage our blood glucose levels (due to decreased pancreatic function or insulin resistance). The solution to diabetes is to reduce the insulin load of your diet.”

That is manifestly not the case for the majority of diabetics, most overweight type two’s, that’s around 80% of type two's, are awash with insulin at diagnosis, Dr. Jason Fung knows this too well, hence he states over and over again the last thing a type two needs is injected insulin. Bernstein wrote about this over ten years ago and our low carb crew have been saying this years before Jason Fung. BTW an insulin injecting type two diabetic has up to three times the mortality rate (dose dependent) as a non insulin using type two, there are various reason for this, but are scientifically proven.

"In my experience the blood glucose rollercoaster is ugly. For a type 1 eating foods that mean you need to take a large bolus of insulin that will send you crashing down and then need to eat to get out of that low is what we want to avoid. The same process is in play for a type 2 but their insulin is coming from their pancreas is producing more insulin."

No well controlled low carbing T1 diabetic has high and lows. They do not need a large amounts of bolus insulin or large amounts of basal insulin to hold constant safe BG numbers. The same applies to T2’s whether on injected insulin or not.

"To some degree we all have a limited supply of insulin and want to avoid the blood glucose / insulin roller coaster. Anyone with limited pancreatic function or insulin resistance (i.e. most of the population these days) should also be interested in not overloading their pancreas to the point that it can't produce enough insulin to keep stable blood glucose levels. This is not just about the carbs, it's protein and fibre too. Hence choosing foods that have a lower insulin demand gives them a better chance of maintaining normal glucose levels and minimising insulin (endogenous or exogenous) that leads to body fat storage etc.

But the insulin index still hasn't taken off.

In five months this article - https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/ - has clocked 60,000 views which has exceeded my expectations. Obviously some people get it and keep sharing it around the place. I'm not aiming for world domination but it's nice to see the concept being used. m surprised that the University of Sydney and Harvard who have been involved in developing this data aren't promoting the implications more. This probably relates to the fact that it turns the grain based 'balanced diet' food recommendations for diabetics and the rest of the population on its head."

With respect page views does not mean “the concept being used” I have had over 700 hundred readers read a blog post in a couple of days, that sort of post often goes onto thousands of reads, but tells me nothing regarding how many people are using my recommendations.

I have still to see any information regarding the insulin index that will improve my control of blood glucose. If that applied only to me, it would mean nothing. But I am what I call the bog standard diabetic and what applies to me, applies to the vast majority of diabetics. Of course what works for almost all diabetics are the methods promoted by Dr. Richard Bernstein many years ago, and I suspect will continue to work for a very long time.

I believe the insulin index is an interesting subject and worthy of discussion, as is resistant starch and a hundred  other concepts, but at the end of the day the benefits to the majority of diabetics is minimal. With all due respect you have studied the insulin index in great depth, you should be able to convince me of the benefits. Maybe I am as thick as a plank, but far more clever people than me explained how low carb works in around two minutes. Years after learning of the insulin index, I clearly still don’t get it.

I have much more I could say on this, and if you are up for it let's give it the whole nine yards. I am sure we can keep the debate friendly, and hopefully interesting and informative to ourselves and the other members.

With respect Eddie

It’s been interesting to read Marty’s recent posts on this thread and also to read Eddie’s replies. I would suspect that neither Marty, nor Eddie, would disagree that all types of diabetics should be very wary of carbs and that they should not be afraid of fats, which can be safely used to make up for lost carbs. These are the fundamentals and, for most, they are simple to follow, without any need to refer to lists, charts, apps or whatever and, for large numbers of diabetics, they do the job.

Marty appears to be trying to take it a stage further. His main point, as I see it, is that the foods which are permitted on a LCHF diet are not all equal. Proteins end up as sugars eventually, indigestible fibres can stimulate insulin production and some LCHF foods are more nutritious than others. Marty is trying to draw all this together and come up with LCHF diabetic super-foods.

Whether Marty’s super-food index will change the lives and health of any or many diabetics remains to be seen. Is it all so subtle that the vagaries of blood sugar levels will obscure any benefits, or will the index be another useful tool in taking control?

In our house, we are cutting down a little on protein. A couple less meat meals a week, replaced with veggie. This is, perhaps, our nod to the insulin index, but we are in the fortunate position (my husband is T2) that a broad brush will do for us and simply avoiding the obvious and oft listed carbs and sugar sources has maintained non-diabetic numbers.

Sally

Sally wrote:It’s been interesting to read Marty’s recent posts on this thread and also to read Eddie’s replies.    I would suspect that neither Marty, nor Eddie, would disagree that all types of diabetics should be very wary of carbs and that they should not be afraid of fats, which can be safely used to make up for lost carbs.  These are the fundamentals and, for most, they are simple to follow, without any need to refer to lists, charts, apps or whatever and, for large numbers of diabetics, they do the job.  

Marty appears to be trying to take it a stage further.  His main point, as I see it, is that the foods which are permitted on a LCHF diet are not all equal.  Proteins end up as sugars eventually, indigestible fibres can stimulate insulin production and some LCHF foods are more nutritious than others.  Marty is trying to draw all this together and come up with LCHF diabetic super-foods.  

Whether Marty’s super-food index will change the lives and health of any or many diabetics remains to be seen.  Is it all so subtle that the vagaries of blood sugar levels will obscure any benefits, or will the index be another useful tool in taking control?

In our house, we are cutting down a little on protein.  A couple less meat meals a week, replaced with veggie.  This is, perhaps, our nod to the insulin index, but we are in the fortunate position (my husband is T2) that a broad brush will do for us and simply avoiding the obvious and oft listed carbs and sugar sources has maintained non-diabetic numbers.

Sally

Can't argue with anything you have said Sally, but whatever information we receive, whatever index's and charts we follow, it all boils down to the same thing for safe blood glucose readings and good diabetes control. First we eat to our meters then we check out the most nutrient dense foods we can tolerate or want to eat, very easily done. So very simple, but the human race are past masters at complicating a very simple concept, that not only works, but could be explained to a six year old bright kid. "would you eat the food I gave you if it made you ill" obviously they would say no! Kids are very bright in my experience, so often they see straight to the very bare essence of the situation.