Diabetes Diet

The Food Insulin Index Trumps Carb Counting

The new food insulin index can work much better than carbohydrate counting, which for years has been considered to be the gold standard for improving glycemic control. For those of us who have diabetes, this index is also a more comprehensive guide to blood sugar control than the glycemic index.

For years the limitation of the food insulin index (also known as just the insulin index) was the few foods tested. The original 1997 study, which in 2003 I reviewed in detail for the first time in the article “Insulin Index”on my personal website, tested only 38 foods.

We had to wait until 2011 for the index to grow to about 120 foods in “Prediction of postprandial glycemia and insulinemia in lean, young, healthy adults.” I reviewed that study here at “Manage Your Blood Sugar Better with the Insulin Index.”

Now, a much more extensive study of the food insulin index is available, and it is further expanded to include 26 more tested foods. The study, titled “Clinical Application of the Food Insulin Index to Diabetes Mellitus,” is Kirstine Bell’s Ph.D. dissertation from Australia’s University of Sydney. The entire 282-page dissertation plus a dozen appendices is free online.

These are the foods most recently tested for their food insulin index:

insulin index chart

It’s no coincidence that Kirstine Bell’s Ph.D. comes from the University of Sydney. That’s where Professor Jennie Brand-Miller was Bell’s supervisor has led much of the world’s research of both the insulin and glycemic indexes for more than two decades.

Carb Counting Doesn’t Help

One of the most significant findings to come out of Bell’s work is that carbohydrate counting simply doesn’t work well enough. She led a systematic review and meta-analysis of the “Efficacy of carbohydrate counting in type 1 diabetes.” The study found “no significant improvement in A1C with carbohydrate counting over general dietary advice and/or usual care.”

Earlier studies show that using the glycemic index does help us improve our A1C levels. I know it too from my own experience of using the GI for years. But that index shows us only the blood sugar effect of carbohydrates. The GI ignores the effects of the other two macronutrients, protein and fat.

Effects of Protein and Fat on Blood Sugar

Bell’s work helps us fine-tune our understanding of the effects of protein in particular. When our bodies don’t produce enough insulin, protein can raise our blood sugar level. “In the absence of sufficient exogenous insulin in people with type 1 diabetes,” she writes, “it has been shown that protein can raise the blood glucose level.”

On the other hand, when we eat fat along with carbohydrate, this “results in lower blood glucose levels and significantly higher insulin levels compared with those following carbohydrate ingestion alone.”

Compared with about 2,500 foods tested for their glycemic index, those tested for their food insulin index are few indeed. But, Bell writes that “The tested foods included the top 100 sources of energy in the American diet, representing 10 food categories.”

Applying the Insulin Index to People with Type 1 and Type 2 Diabetes

High levels of insulin in our blood after eating “is not the response to a single nutrient (carbohydrate) but rather the sum total effect of metabolic interactions among different nutrients within foods,” Bell writes. Consequently, her dissertation includes randomized study of people with type 1 and type 2 diabetes:

A study of 26 adults with type 1 diabetes who use insulin pumps compared traditional carb counting with using the insulin index. In this 12-week study blood sugar levels were similar, but those in the insulin index group tended to have a lower risk of hypoglycemia.

The first real-world study of 10 adults with type 2 diabetes consumed either a high insulin index or a low insulin index diet. The results showed an impressive 41 percent reduction in the predicted insulin demand.

Like the glycemic index, we can’t accurately calculate a food’s insulin index based on the nutrients it has. This makes the complete database of 147 foods tested for their food insulin index currently the best guide we have to managing our blood sugar.

This article is based on an earlier version of my article published by HealthCentral.

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24 Comments

  • Reply Susanne May 23, 2016 at 12:27 pm

    Hello!
    I left by half mistake cheese off my bread. Something vety odd thing happened, my blood sugar leveys almost crush as l am type 2 diabetic. I don’t use much other dairy products. I became curious about what’s causing this. After looking for answers in internet, I found your articles etc. and a very important word: insulin index, and more importantly an explonation for what the values are for protein. I would like to know the 5-10 most avoidable food items to have relatively low GI and GL but high FII values. I told a near friend with type 2 diabetes about this and he was very interested to try to be without cheese for a week. He’s been now two days without cheese and phoned me that he didn’ have to take any insulin for the night as until now. I would like to know, why insulin index is not more discussed nationally nor internationally nor told to diabetics as the amount of type 2 diabetes is increasing around the world.

    • Reply David Mendosa May 23, 2016 at 1:29 pm

      Yes, Susanne, the insulin index is important and not written about much. But I wrote the first article about it and continue to write about it:

      Insulin Index
      http://www.mendosa.com/insulin_index.htm
      Jul 8, 2014 – The research on the insulin index of foods is intriguing but limited. Only 16 peer-reviewed articles in MEDLINE even mention the term “insulin …

      The Insulin Index Is Better for Managing Your Blood Sugar
      http://www.mendosa.com/blog/?p=3624
      Aug 15, 2015 – The Insulin Index is better for managing your blood sugar that the Glycemic Index. It is more recent than the Glycemic Index, which dates from …

      The Food Insulin Index Trumps Carb Counting
      http://www.mendosa.com/blog/?p=3667
      Oct 19, 2015 – The new food insulin index can work much better than carbohydrate counting, which for years has been considered to be the gold standard for …

      The Insulin Index
      http://www.mendosa.com/blog/?p=58
      May 3, 2006 – Lots of people are wondering whatever happened to the insulin index. I wondered too, so I asked Susanna Holt. Dr. Holt developed the insulin …

  • Reply Jackie K January 7, 2016 at 8:29 pm

    P – I used to bake or microwave sweet potatoes chips myself They are very yummy but too much work sometimes. Now I buy Simply Nature brand (Distributed by Aldi Inc) with simply ingredients of sweet potatoes, oil, and sea salt. There are other sweet potato chip brands, just make sure you read the label and watch out fat, sugar and carb content. This is probably an indulgence or big no-no to some folks whose diet consists extreme low-carb, but I found myself not sleeping well if I don’t eat something at night. But that something is very very tricky to find. Again, each body is different. and I don’t eat it every night either.
    I am yet to try green apple or vinegar.

  • Reply p January 7, 2016 at 6:38 pm

    Jackie which chips did you find that were healthy?

  • Reply Jackie K January 7, 2016 at 2:57 pm

    I thought the insulin index (before this list and article came out) finally helped explain why some meats spike my post meal glucose level and cause me gain weight, such as pork and beef, and even fatty fish. I always believed that carb is not the only thing that spikes sugar glucose level. The low numbers on pork and beef sausage surprise me the most and are contrary to my personal experience. On the contrary, sweet potatoes (yam) has been quite alright for me. In fact, recently I have had hard time having tight sleep after 4am but last night after eating 20 healthy version of sweet potato chips I slept through the night like a baby and morning testing was normal. When everything else fails, I could always take comfort from the fact that everyone’s body is different. try to learn and try different things but sometimes the effectiveness does hinge on each individual body. BTW, David, Chana Dal works for me, my post meal reading was 120 after my 1st consumption of the turkey chili and it will be my stable food in my pantry so thank you!

  • Reply aruna December 14, 2015 at 4:19 am

    So we should not eat rice or chappatiis

  • Reply p November 2, 2015 at 5:52 pm

    Hi David, Thanks for the quick response!
    Your diet is very similar to my diet, and I’ll check out the chana dal. I do enjoy probiotics in kimchi and saurkraut and greek yogurts. I crave good fats, am normal weight and produce little insulin, (genetic). I am debating on whether I’m getting enough fiber. And difficult knowing I have a high calcium score asymptomatic CAD) to juggle.
    Thanks again and keep up the great work!

  • Reply p November 2, 2015 at 5:31 pm

    Hi David, I’d love it if you would give us an example of your diet. I LOVE eggs and dairy and picture a VLC primarily those. I’m currently 50gm TOTAL carbs. Do you get count total carbs (including fiber?).
    PS I’ve read all your posts!

    • Reply David Mendosa November 2, 2015 at 5:37 pm

      I count total carbs, Patricia. And here is my current diet:

      The question that people ask me the most often when they learn that since 2007 I have been following a very low-carb diet to manage my diabetes and my weight, is “What can you possibly find that you really like to eat?”

      That’s a good question, but one for which I have an equally good answer: “I eat so much healthy and delicious food that I have a hard time stopping myself.”

      In my continuing quest for these fine foods, I eat some old standbys, but have also discovered many foods that aren’t common in this country yet. I still keep discovering great additions to my diet and keep on writing about these foods here.

      Essentially, my diet is to eat no more than about 50 or 60 grams of total (not net) carbohydrate per day. My typical meals keep changing. But lately this is what I generally eat when I am at home:

      Breakfast: A low-carb protein shake with almond milk. Maybe one or two poached or hard-boiled eggs. I often eat a little kimchi (from Korea) too or sauerkraut (from Germany) too. They are both probiotic foods.

      Lunch: A large salad consisting of organic greens (often spinach, arugula, dandelion greens, bok choy, and/or kale), green peppers, broccoli, green onions especially including the green part, radishes, tofu (from Japan), and/or cucumber. Sometimes the salad will also have natto (from Japan), a small avocado, a little hard cheese, a little summer squash, or a few pitted green olives. I sometimes add a sprinkling of chia seeds (from Peru). For salad dressing I use organic apple cider vinegar and organic extra virgin olive oil.

      Dinner: This is the meal that varies more than breakfast or lunch. Sometimes it’s just a bowl of plain whole Greek yogurt, maybe with a few wild blueberries and a sprinkling of chia seeds or organic sunflower seeds. Sometimes it’s just a bowl of vegetable soup that I make, sometimes with chana dal (from India). Sometimes I just skip dinner. I no longer eat meat, poultry, fish, or seafood.

      Snacks: I don’t snack much, but when I do it’s a handful of almonds, hazelnuts (from Turkey or Oregon), macadamia nuts (from Australia), or no more than five Brazil nuts. My snack could instead be a bit of hard cheese (like Gruyere or cheddar, which have no carbohydrates), a few raw radishes, or some olives.

      Intermittent Fasting: I make sure to eat dinner at least three hours before lying down for the night. I never have anything to eat after dinner. I skip dinner entirely if my weight is up and it’s above my goal weight.

      For me this is easy, because I have never been a good cook and never baked anything. I am hungry only when I fast, and then not long or much. I never need more. That’s because as I brought my weight down into the low normal range, I don’t need as much food. I no longer need to feed all that fat!

  • Reply julie devine November 2, 2015 at 12:48 pm

    Does anyone have a copy of the food index rather than carb counting?

  • Reply p November 1, 2015 at 7:15 pm

    Don’t Type 2 diabetics want to minimize insulin elevation? Does this chart mean Type 1 may need more insulin if they eat cauliflower? I am told I make little insulin so am type 1.5 controlled with metformin and insulin.

    David these articles are great. Are you still vegan with fish? How low carb are you and are you worried about feeding your microbiome? All of this is so confusing to me….

    • Reply David Mendosa November 2, 2015 at 8:32 am

      Thank you, Patricia. I used to eat a very low-carb diet with some fish. But I stopped eating fish and became a vegetarian, not a vegan (vegans don’t eat eggs or dairy either). I am still very low-carb, less than 50g/day. You got me with your question about feeding my microbiome, unless you are talking about probiotics. I get a lot of them.

  • Reply Ron Roberson November 1, 2015 at 3:51 pm

    What does it mean? How did David control his diabetes with the carb diet?

    • Reply David Mendosa November 1, 2015 at 4:47 pm

      I didn’t control my diabetes with a carb diet. I control it with a VERY LOW-CARB diet. Quite different, Ron.

  • Reply Barbara November 1, 2015 at 7:08 am

    so are we trying for a higher or a lower Number food?

  • Reply Gary November 1, 2015 at 5:04 am

    I am also confused. What is the effect of a higher or lower food insulin index percentage? Because a sweet potato has a high percentage, may I assume that higher percentages affect out blood sugar more?

  • Reply David Nielsen October 31, 2015 at 3:58 pm

    I think I understand now- the caloric portions are equal so we are seeing the insulin load of 250 calories worth of custard (a small portion) versus 250 calories of steamed cauliflower (a pretty large portion).

    It still is mighty surprising.

  • Reply David Nielsen October 31, 2015 at 3:53 pm

    Am I reading that graph correctly when I see steamed cauliflower equal to custard and higher than chocolate milk? I realize custard and chocolate milk are complex foods with protein and fat in addition to carbohydrates, but there are a lot of carbs in those foods. Is what we are seeing here the battle between glucagon and insulin and is it that which lowers the glycemic index of carbohydrate-rich foods that are also high in fat? What are we to conclude from such a measure?

  • Reply ana October 20, 2015 at 8:38 am

    sorry for the typos and extra “easier” sentence…cat on my lap.

  • Reply ana October 20, 2015 at 8:37 am

    There is a table in the article that Dave linked us to. It isn’t the best to look at. I copied and pasted it into a word document and easier it was much easier to read the table that way.

  • Reply irene October 20, 2015 at 4:16 am

    Some surprises here. Cauliflower has a higher index than peas, or a peach.

    • Reply David Mendosa October 20, 2015 at 9:12 am

      This is indeed interesting, Irene. Especially because cauliflower is so low in carbohydrates that I list it among the “http://www.mendosa.com/freefoods.htm.” Anyway, so good to hear from you! I still think of you and wish that you hadn’t moved so far away!

  • Reply Arun October 19, 2015 at 9:20 pm

    This article does not say what insulin index we must look for….or have I missed something ?

    • Reply David Mendosa October 20, 2015 at 9:17 am

      You’re right, Arun. That level hasn’t been set, as it has been for the glycemic index of course.

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