Note: This article is written as a continuation of my series on insulin resistance. You will find a more thorough discussion of the data in the previous article. If you have the time, I encourage you to go through these to understand the full picture. If not, that’s okay too – this article is written to stand on its own and to offer a practical perspective on insulin resistance and the dietary decisions we can make to avoid this pathophysiologic pathway.
As the body becomes insulin resistant, it loses the ability to properly regulate energy. This state of metabolic dysfunction poses multiple dangers to the body.
For example, chronically high levels of glucose cause damage to arterial walls, leading to inflamed, leaky arteries. Additionally, high levels of circulating fat result in dyslipidemia (i.e. high triglycerides, low HDL, and high LDL). Combine these two (high blood glucose and circulating fat) and you have a system primed for atherosclerosis.
A second example is the excessive accumulation of fat in adipose tissue that ultimately is labeled as obesity. Today we are facing a significant problem related to this dysfunction that is insulin resistance and the unregulated build-up of fat, with an estimated half of the U.S. population suffering from insulin resistance, along with a third being obese and over two-thirds battling excess weight. When the body loses its ability to manage energy levels, as is the case with insulin resistance, the body is primed to pack on pounds.
The body needs energy levels to be tightly regulated so that it can prevent damage (mostly due to elevated blood sugar and lipids), but additionally to be able to fuel all the cells in the body so that they can function properly. Insulin resistance is energy-dysregulation, and for a biological being that needs energy to perform every function, it is easy to see how this can lead to disastrous consequences.
Tackling the burden of chronic disease means tackling insulin resistance. With this article I plan on doing just that, and by doing so hope to help the half of our population that is currently affected and the many more that are on the same path.
In this article, we will begin with the model that I derived in the previous articles in this series. Once we quickly review the model with the information you need to know to understand it, we will then dive into the decisions you can make to ensure that you don’t go down the dangerous road to insulin resistance, or otherwise, get off it quickly if you are already headed in that direction.
Jumping straight into things, here’s the Reprogrammed overarching model of insulin resistance:
click to open image:
In this model of insulin resistance, chronically high levels of insulin in conjunction with high levels of circulating fat causes insulin resistance. When we consume a western diet, consisting of processed, high-carbohydrate meals, and additionally consume excess calories from fat, our bodies are forced into a fat-storage mode (via the secretion of insulin) while extra calories get piled on top. This “fat storage mode” means two things: first, obviously, fat is being stored away, but additionally, and maybe even more importantly, fat oxidation (i.e. burning of fat) gets halted.
Why fat storage mode: simply, insulin is the body’s primary fat storage hormone. If insulin is elevated, energy gets stored. Furthermore, fat can only be burned when insulin levels are low (for more on insulin, see Understanding Insulin).
Fat-storage mode, brought on by excessive stimulation of insulin:
- Constant fat storage
- Halted fat burning
When this process occurs over an extended period of time, normal fat deposits (i.e. adipose tissue) start to fill up. Once these fat-storage depots reach a certain capacity, which will vary depending on the individual, that adipose tissue is going to stop accepting more fat deposits. This means that more fat will end up in the bloodstream where it can then go on to cause problems, including insulin resistance.
The two main takeaways that you need to know are this:
- Insulin resistance is a problem of excess, irregular insulin stimulation. When we consume highly processed, high carbohydrate diets, our body is put in a chronic fat storage mode.
- Insulin resistance is a problem of excess circulating fat. When our body is put in fat storage mode for too long, fat starts to accumulate and overflow into circulation. Once there it can go on to cause insulin resistance throughout the body.
This problem is caused by consuming too many processed carbohydrates, which continuously stimulates insulin, which continuously puts the body in fat storage mode.
This problem is amplified by the addition of fat to this diet. Once the body is put into fat storage mode, any excess calories consumed get stored away. These extra calories can come from any macronutrient, but the problem is worst when those excess calories are from fat, as fat is the most calorically dense.
Dietary Advice
Because insulin resistance is a problem of excess insulin stimulation in conjunction with excess circulating fat, to solve the problem we have to deal with these initial causes. Therefore, to prevent or reverse insulin resistance we must:
- minimize the secretion of insulin
- minimize the accumulation of fat
Solving these problems is where the big debates come in. For example, some people argue that fat is a problem of consuming excess calories (primarily from excess fat), and therefore to fix the problem we should consume more carbohydrate and less fat. On the other hand, some people argue that excess fat is a problem of excess carbohydrate, as this is the macronutrient that most easily stimulates insulin, and therefore puts the body in fat-storage mode.
As always, I am only interested in the data, and what the data clearly shows is that there is validity to both sides of the argument. It has been well established that either a diet high in fat and low in carbohydrate (LCHF), or a diet high in carbohydrate and low in fat (HCLF) can reverse insulin resistance and even Type II Diabetes (see references 1-4).
Because both ends of the macronutrient spectrum can successfully solve our problem, it leads me to think that the macronutrient debate isn’t what is most important. What is important is sticking to a diet that solves the primary problem at hand: high levels of insulin. Therefore I am going to build my dietary recommendations by focusing on what is really important, keeping insulin levels low.
Building a healthy diet by focusing on insulin minimization
To reverse and prevent insulin resistance it is essential that insulin secretion is kept in check.
Remember, insulin secretion leads to fat storage, so if we can minimize the secretion of insulin, then logically we wouldn’t have a fat storage problem. Additionally, we know that a significant piece of the insulin resistance problem is, well, insulin, and therefore minimizing the amount of insulin in the system would logically be a good place to start.
So, how do we minimize the secretion of insulin?
This is a fairly straightforward answer: we avoid the need for insulin secretion by keeping blood sugar low, which is accomplished by minimizing the consumption of carbohydrate.
This is why a high-fat low-carbohydrate diet works wonders to counteract insulin resistance. If we take the carbohydrate out of the system (and ensure that excess protein is not consumed, as excess protein will be converted to glucose inside the body) then we minimize insulin secretion.
Low carb = low insulin = fat burning & minimized fat storage
Does this mean that going low-carb is the only way to solve the problem?
No, and we must be careful not to get carried away, because even though diets low in carbohydrate tend to be beneficial for the problem of insulin resistance and excess fat accumulation, this does not necessarily mean that a diet higher in carbohydrate will cause the excessive secretion of insulin and fat gain.
Remember, a high-carbohydrate diet can solve the same problem – it’s just that the reasons are quite different.
The secret to a successful higher carbohydrate diet is the large quantity of nutrient-rich plant foods. When ample amounts of plants are consumed, the body receives an abundance of resources that it needs to maintain healthy cellular functioning. This includes the strong functioning of the insulin receptor, thus helping to solve the insulin resistance problem.
The second reason a high-carb low-fat diet works is because, when it is based entirely on plant foods, it is very difficult to overeat. It would take a lot of work to consume too many calories on a diet that consists entirely of plant foods, and therefore excess fat accumulation is much less likely to be a problem.
However, both of these benefits of a low-fat, plant-based diet can be overthrown if these foods continue to excessively stimulate insulin. Generally speaking, whole plant foods tend to elicit a low-to-moderate release of insulin. High-fiber plants (think the green and leafy kind) hardly stimulate insulin at all, and many fruits and vegetables elicit a low, regular insulin response which can be perfectly healthy.
Unfortunately, this gets a little bit trickier when we start discussing plant foods that contain more starch or fructose, as this is when variability comes in. When some individuals consume high fructose or starchy foods, even if they come from whole plants, this can be enough to cause large insulin responses, thus sending them right back to the problem.
These foods are not a problem for everyone, as people with a healthy metabolism (insulin-sensitive individuals) and who additionally have the proper (epi)genome, respond perfectly fine to these starchy foods. However, when it comes to discussing the reversal of insulin resistance, we have to be especially careful to minimize the release of insulin and stimulation of fat storage mode, so excess starch or fructose may hinder progress.
Building a Diet fit for you
Now that I have established how both a low-carb and high-carb diet can work to solve the insulin resistance problem, we can dive into the bigger picture.
Let’s review a couple of the common themes for what makes these successful diets:
- Eating lots of plant foods supports a well-functioning body, and plants tend to only slightly stimulate insulin while delivering lower doses of energy
- Eating fat keeps insulin levels low and the body well-satiated
A diet that consists of ample amounts of whole plant-foods, and additionally ample amounts of natural, high-quality fats, keeps insulin levels low and puts the body in a state where it can burn fat. This diet also keeps the body satiated and delivers ample amounts of nutrients.
This is contrasted with a diet consisting of processed carbohydrate which stimulates insulin, putting the body in fat storage mode. Remember, fat storage mode not only causes the accumulation of excess fat, but also prevents the burning of any fat, and this causes insulin resistance.
This means that processed food is out and any real, whole foods are in.
There it is – all you really need to know. If you want to prevent or reverse insulin resistance, cut out the junk food and replace it with real, whole foods. I told you it was simple.
One More Problem: Individual Variability
Well okay, there is still one problem – that problem of individual variability. See, thus far, I have really only discussed these diets under the context of what works for the population. Unfortunately, when we zoom into the context of an individual, the picture becomes a little bit more complicated.
For example, some people thrive on a whole foods plant-based diet (WFPB). They enjoy eating fruits and vegetables to their heart’s desire, while they watch the pounds simply melt off. For people like this, a WFPB diet is wonderful. They get to enjoy the delicious tastes and varieties that come with all the plant foods out there and enjoy all the incredible health benefits at the same time.
However, what about another individual – one that, say, hates vegetables. I know these WFPB diets can be great, but if you think I am going to take someone who has lived off of barbecue and put them on a vegan diet, you have got to be kidding. But here’s the great news – I don’t have to recommend a vegan diet, because a high-fat diet, one that includes meat and animal products, is also a great way to solve our insulin problem.
The diet that works best for you is the diet you can stick with. So if a diet that includes meat and fatty animal foods is the only diet that you will stick with, feel free to go with a higher fat diet. You can feel comfortable knowing that this diet-style has been proven to reverse insulin resistance and Type II diabetes (4).
Unfortunately there is one more factor to consider, one which may or may not be a big deal for your success. It is great to tailor to our personal preferences, but we also have to tailor to our body’s preferences.
For example, it is possible that, even though an individual enjoys eating ample amounts plant foods, their cells could be programmed to hyper-respond to starchy foods like potatoes. I have heard from plenty of people whom, even though they focus on consuming whole plant foods, still have a problem with their blood sugar and weight because they have a problem with carbohydrates. Some bodies are simply programmed (via genetics and epigenetics) to excrete high levels of insulin in response to even controlled amounts of glucose.
Therefore, if you are someone who is frustrated because you can’t seem to lose weight, it is possible that cutting out foods such as grains, potatoes, and other starchy plant foods may help solve this problem. Yes, this also includes fruits that are higher in fructose, such as bananas and apples. This would mean consuming more fat, such as more avocado, coconut oil, or grass-fed butter to get fulfill energy requirements.
But the other side of the story could be possible too. There are certain genes (e.g. FTO gene) that make it difficult, and even dangerous, for the body to process too much fat. If you know you have one of these genes, or if you have had problems with high-fat diets, then it may be the case that a high-fat diet is dangerous for you. In this case, consuming more starchy plant foods will be necessary to get enough energy.
Choosing a diet:
Choosing a diet style can be as simple as making the choice to only consume real, whole foods. If you want to make this transformation as easy as possible, simply focus on only consuming foods that you purchased in their whole, minimally-processed form. Cook these foods yourself, using only high-quality ingredients and safe cooking methods.
The other option is to pick a side of the macronutrient spectrum that seems best to you. Maybe you’re excited about a diet that excludes meat, dairy, and eggs, and just want to focus on eating tons of plants! Sounds great – you could easily start there, then alter the diet if you feel you need more fats or protein.
Or, you could decide that, since you love meat and dairy, you want to go for a high-fat diet made up of lots of animal foods. Great! Start there, and adjust as your body gives you signals on what you need.
Choosing a healthy diet does not have to be complicated. Start wherever you want to and then adjust when your body gives you cues to do so.
Of course, if you have any serious medical conditions or are at high risk for one, make sure that whatever you do is being supervised by someone trained to do so. Just make sure that whichever licensed doctor/dietician/etc. that you choose understands the science and isn’t forcing you to choose a diet based on outdated information.
Solving the Insulin Resistance Epidemic
Remember, contrary to common belief, reversing pathophysiological conditions, including insulin resistance and even Type II Diabetes, is entirely in the range of possibilities. If you currently suffer from insulin resistance or even full-fledged diabetes, you do not have to opt for a lifetime of medication and constant fuss over your energy levels.
But fixing the problem is going to take a little more work than popping pills. It is going to take a commitment to making dietary and lifestyle changes that got you here in the first place.
But still, this transition to a healthy diet and lifestyle doesn’t have to be a miserable experience. It doesn’t have to involve giving up your favorite food groups and spending large amounts of time counting calories or macros. Instead, it can simply be a matter of opting out of a diet filled with processed, poor quality foods for a diet based on real food.
I can’t promise you that simply shifting to a real foods diet is going to solve your problems, but based on the evidence, I can tell you that there is certainly a great chance that your condition will greatly improve. Moreover, if you decide to take some time and experiment with different types of real, whole food diets (e.g. LCHF vs. HCLF or vegan vs. keto), you are likely going to see some major results.
Chronic disease is rooted in physiology, which is directly tied to your diet. Cleaning up the foods you eat can be the simplest way to fix your body, and additionally to keeping a well-functioning body for many years to come.
To finish off I will leave you with some overall advice for eating real, whole foods. These are meant to be overarching guidelines and advice for a healthy diet to get you started, and not concrete rules for everyone to always follow.
Wrapping it up with some overall dietary advice:
No matter what diet you decide to embark on, there several key ideas to keep in mind:
1. Opt for whole, minimally processed foods:
- Meat and Animal Products
- When you buy your meat, make sure the only ingredient is the meat (meat with no artificial/processed chemicals). If you buy milk, make sure it is real milk (that means whole milk – nothing that has been adulterated by removing anything or putting anything extra in).
- Consume high-quality meat from animals fed their natural diets. Grain-fed animals produce products that negatively impact health (e.g. a higher omega-6:omega-3 ratio)
- Always opt for fresh fruits and vegetables, real whole grains (not junk that is simply labeled as such), and any other form of whole plant food.
- cereal or bread may be labeled as “whole-wheat,” but this is far from a whole grain. In a whole grain you can see the grain – this isn’t the case with products made from flour (a refined food).
- Try to avoid foods that come in packages. If a food does come in a package, make sure that ALL of the ingredients are real foods, and nothing extra has been added
- Be extremely cautious when eating out. It is best to avoid it entirely, but if you must eat out take extra care to choose restaurants that really care about quality (as opposed to ones that market quality but really don’t give a damn about your health)
2. Limit the following foods as much as you can. Understand that if you embark on a journey to lose weight, improve insulin sensitivity, and improve your overall health, but continue to eat these foods regularly, you are impairing your ability to achieve good results.
- Vegetable oil (canola oil, soybean oil, cottonseed oil, etc.)
- Because of a very successful campaign that argued for the health benefits of polyunsaturated fats over saturated fats, vegetable oils are now everywhere. Unfortunately they are likely one of the most dangerous foods we consume. Limit foods that contain vegetable oil (which is almost every single processed food), and if any of these are currently in your kitchen THROW THEM OUT
- Sugar
- Consuming sugar is the easiest way to make your body store excess fat, which causes insulin resistance. Fructose is so incredibly dangerous because it can only be processed by the liver, and in doing so is turned into fat.
- How much better would our world be if sugar wasn’t in it? We seem to not be able to live without it, but it is easily one of the largest reasons for this world’s health problems. Getting sugar out of the diet is difficult because of its addictive qualities, but getting this chemical out of your life will greatly improve it.
- Forget the marketing scheme that argues for the benefits of sugar because it is natural and low-calorie: this is complete marketing b.s.
- Anything with chemical additives – consuming chemical additives are great ways to put on excess pounds and disrupt insulin functioning, which is the exact opposite of our goal.
- Processed meat – this is just high protein with added chemicals… which leads us to protein
What about protein?
What I haven’t discussed yet is protein. I leave this until the end because I like to keep it out of these macronutrient arguments. Protein really needs to be in a category of its own and should not be grouped with the other macronutrients (fats and carbohydrates) which can be traded off.
Protein deserves a category of its own because it shouldn’t be used as an energy source – it should be used only for its sole purpose as an amino acid source. Too much protein gets converted to glucose, which puts a heavy load on the liver and actually results in a spike in insulin. Consuming too much protein is just like consuming too much processed carbohydrate, which leads to insulin resistance.
Protein should generally be consumed at a moderate level, around 0.7 grams per pound of lean body mass, with room for a little bit more if it is needed for fitness goals. That puts a typical individual around 60-80 grams of protein a day, with a little more to preserve muscle mass if you are bulking up or elderly.
The sources of this protein can be dependent on the overall diet you choose. For example, if you opt for a vegan diet to reach your high-carb goals, of course that protein is going to come from consuming ample amounts of plants. On the other hand, if you consume a high-fat diet, you will get your protein from animal sources, with some additional protein from all the low-carb plants foods you will be eating Or, if you forgo choosing a “diet,” and instead take my method involving simply choosing real foods, then you can choose whatever protein sources you want!
Just make sure that you are careful to get enough protein on a low-fat diet, and make sure that you don’t consume too much protein on any other diet.
Links to supporting articles
Macronutrients, weight loss, and misplaced blame: the true effect of specific diets on insulin
Testing the Saturated Fat Hypothesis: What is Saturated Fat’s True Role in Insulin Resistance?
Stuck in a Carbohydrate Paradigm
Insulin Resistance and Macronutrient Wars; An argument to drop this argument
References
- Kahleova, H., Matoulek, M., Malinska, H., Oliyarnik, O., Kazdova, L., Neskudla, T., … Pelikanova, T. (2011). Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type2 diabetes. Diabetic Medicine, 28(5), 549–559. http://doi.org/10.1111/j.1464-5491.2010.03209.x
- McMacken, M., & Shah, S. (2017). A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of Geriatric Cardiology, 14(5), 342–354. http://doi.org/10.11909/j.issn.1671-5411.2017.05.009
- Barnard, N. D., Cohen, J., Jenkins, D. J. A., Turner-McGrievy, G., Gloede, L., Jaster, B., … Talpers, S. (2006). A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care, 29(8), 1777–83. http://doi.org/10.2337/dc06-0606.
- Hallberg, S. J., McKenzie, A. L., Williams, P. T., Bhanpuri, N. H., Peters, A. L., Campbell, W. W., … Volek, J. S. (2018). Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Therapy. http://doi.org/10.1007/s13300-018-0373-9