Insulin

Well, I fucked up.

Last year when I was eating low carb, I was doing it all wrong.  I think I was scared of all macronutrients except protein, and instead of following a diet plan that was ketogenic – allowing for the production of ketones to provide fuel to the body – I was following some random Atkins-esque plan.  I was losing weight (at first) so it seemed like the right thing to do, but when my weight loss stopped and my labs looked terrible and I started feeling tired and bored with my meat-and-vegetable diet I gave up.  I now realize that my focus was misguided.  I was targeting carbohydrates (keeping them low) when I should have been targeting insulin.

Thanks to my brilliant commenters I now realize that diet was actually fairly insulinogenic, and with all that insulin it’s impossible to use body fat for fuel.  I lost 15-20 pounds eating that way, which probably represented a reduction in my previous Peat-inspired insulin level of 27.9 two years ago.  I wonder if this is why people stall on low-carb diets…they manage to reduce their insulin level enough with their meat-and-veggies-only diet, but because the meat is actually insulinogenic the weight stops at the point that the insulin stops dropping.  So Atkins had it right up to a point…and for some people that’s enough.  Their insulin isn’t so chronically high, or their body isn’t so quick to toss insulin all over the place, and just cutting the carbs is enough to drop insulin low enough that their body can release stored fat for fuel.  I’m not one of those people.

For years I’ve had to be very careful of what I eat because everything seems to make me desperately hungry.  Coffee, rice, gigantic salads containing many ounces of skinless chicken – always with the ravenous hunger 1-2 hours later. 10 years ago I could eat a “low carb diet” of meat, eggs, and veggies and never feel hungry.  Now my blood sugar is much less stable than that, probably because insulin resistance has advanced and therefore insulin output has increased. When I was eating meat/eggs/veggies for 6-8 months last year I would have what seemed like a giant breakfast of steak and eggs – seriously, like 800-1000 calories, and I would be hungry 2 hours later.  I figured I was just broken and kept eating more and more to make the hunger go away.

When I originally started with Nourish Balance Thrive I met with their diet specialist, Julie, and she recommended a paleo diet that was 60-65% fat.  I think for most people that would probably work well.  I eliminated all starch and sugar from my diet and figured I was probably in the ballpark as long as I was eating fatty meats.  I really should have Cronometered it, because looking back I was probably getting only about 50% of my calories from fat…and that was not enough.  So I was putting myself in a state where I had no carbohydrates for quick energy and no ketones due to high insulin.  It’s really no wonder I stayed hungry, weight loss stopped, and I got tired. It seems the goal shouldn’t be low blood sugar – it should be low insulin, as discussed by Dr. Fung in Christopher Kelly’s podcast and Woo all over her blog (though, ironically the latter considers the former to be a menace who must be stopped).

So I’ve been learning over the last couple of days about insulin – how to lower it, how to keep it low, and how to fuel the body while doing that.  My goals, of course, are to lose body fat and improve metabolic markers (reduce blood sugar, cholesterol, triglycerides, blood pressure) while not starving and being irritable all the time.  I came across the Optimising Nutrition blog discussing an “insulin index” – much more useful to me than a “glycemic index” since my goal is shifting from low blood sugar to low insulin.  Contrary to my previous belief, carbohydrate density and insulin demand are not perfectly correlated.

The author states:

“The chart below [see it here] shows the relationship between the glycemic load and insulin index from the testing undertaken in healthy people.  Reducing the glycemic load does not guarantee a low insulin response, particularly when it comes to high protein foods.”

This graph, which is based on the data in this thesis: Clinical Application of the Food Insulin Index to Diabetes Mellitus (Kirstine Bell, September 2014 indicates that raisins create about as much insulin as cheddar cheese.

I know, right?

Click here and scroll down for a chart of Least Insulinogenic Foods along with their Food Insulin Index.  Suddenly my seemingly-random and incredibly-annoying hunger makes so much sense.   I was eating too much meat, and my insulin was too high.

So for the last 3-4 days I’ve been following these charts and eating things that are much less insulinogenic.  The steps I’ve taken:

  • Eliminated all dense forms of carbohydrate again (rice, sugar in all forms, etc) limiting carbohydrate intake to just vegetables
  • Drastically reduced meat intake to probably 4 ounces per day
  • Eliminated egg whites
  • Added high fat dairy including cream cheese, sour cream and mozzarella cheese (no milk), as well as olives, homemade low-PUFA mayonnaise, and raw macadamia nuts

The results so far: hunger has dropped about 80% and when it’s there it’s not the gnawing painful type. Irritability and fatigue are gone, unless I accidentally eat too much protein.  I learned today that egg yolks (not just the whites) contain a certain amount of protein and 3 of them – even without the whites – is really too much.  I’m still working out the details, but Cronometer tells me that even a seemingly high ratio of fat to protein+carb is not high enough to avoid the irritability and hunger that suggest too much insulin was generated.  For example, this morning breakfast was 3 egg yolks cooked in coconut oil with half of an avocado.  Here’s the macronutrient breakdown of this meal:

fat

So this meal had a ratio of about 2.6/1 fat to carb+protein.  About 90 minutes later I had that familiar hunger/irritability.  So I’ll be looking for more of a 3/1 or 4/1 ratio which translates to about 75-80% of calories from fat.  I ate a couple ounces of macadamia nuts and felt much better.

Further experiments to follow.

I feel really happy.  My mood has improved 100% since giving up the carbs again, and it happened on day 1.  This is probably related to discontinuing the eating of foods that cause endotoxin.  I hope I’m on the right track now.

A side note – taking the Metformin is going well.  My hot flashes went away a few days after I started taking it.  Things are looking up.

What Now?

I don’t know.

I started taking Metformin a week ago, and this time around I don’t feel terrible.  I do feel like there’s been some change in sodium balance or something – I feel like I’m retaining water or something and the scale is up a couple of pounds.  I’ve regained almost all of the weight I lost a year ago.  Again my clothes don’t fit and I feel fat.

Exercise has been a bust.  I haven’t been able to commit to using my lunch hour for working out.  It required giving up the only down time I have some days, and it was making me hungrier (if that’s possible).  I’m sure there’s a way to incorporate exercise but right now I just feel overwhelmed.  I started meditating and stopped that too.  I also started a gratitude journal…and stopped it.  I am having trouble feeling rested and my energy is really inconsistent.  Some days I can do it.  Other days – like, all of last week – I feel like I can’t. Last week I was experimenting with eating low carb during the day and then eating rice or sweet potatoes with dinner.  I guess not a good plan.  All of the hunger of a carb-rich diet and none of the energy.

Suggestions have been made to do a ketogenic diet for a week and then do intermittent fasting after that.  Yeah, maybe.  When I was doing low carb last year I was eating too much meat….so maybe it wasn’t ketogenic.  Maybe I should try a fat-tastic diet.  I did this once before without success but I might be up for trying it again.  Peat friends, I already know what you’re going to say.  I really do.  My answer to you is this: My labs suck either way, and my perpetual hunger has got to be stopped.  So it’s a maybe.

Edited to add – Hey, I just had a profound insight about my marriage.  When you really love someone you don’t abandon them.  All the negotiation, confusion, upset…it’s all just drama.  He’s just not that into me.  I never thought I’d have to say that about my husband, but there it is.  If he was, he’d do what it takes to stick around.  Ok then.

Metformin, Part 2

I have become discouraged, and I started taking Metformin, again.

I started exercising last week – some high intensity interval training (HIIT) or just walking as well as some basic resistance training (squats and planks, mostly).  My hunger increased.  I can’t leave for work now without packing half of the refrigerator in my bag, just to get through the day without becoming desperately hungry.  I calculated what I’m eating and when left to my intuition and one rule (Eat Real Food) I eat about 2700 calories a day, about 50% fat, 25% protein, 25% carbs.  It’s a lot of flippin food, but otherwise I feel like I’m starving.  I’m unable to keep my blood sugar stable while eating carbs unless I just eat a ton of them, and if I do that my triglycerides are 500.  I can’t tolerate too much fiber because of the endotoxin (serotonin?) problem, so a diet of low glycemic carbohydrates (beans, brown rice) is out.  And somehow in the middle of this I’ve managed to gain weight in the last week.   Bah.

I just have too much going on now.  I can’t manage it all anymore.  I can’t have marital difficulties, a socially demanding 6 year old, 1.5 jobs, and also be dealing with blood sugar swings all the time.  Plus, my former relaxation time – my lunch break – is now being used for exercise.

I give up.  Bring on the drugs.