Oh cool, okay, I'm glad I mentioned it then! I generally assume it’s too specific for people unless they mention already having diagnosed issues with insulin so I try to avoid giving people the massive brain dump below unasked, haha. Caveat here that I’m terrible at tracking my sources because I’ve been sporadically reading up on this stuff for so long now so I’m very much thinking about what I’ve read over the years and googling for things that look useful in the vein of my osmosis’d knowledge, and I'm also neither medical or science inclined so there's very probably plenty of other and better sources out there. But hopefully it’s still a useful overview for you to start from.
So one of the first things I was taught after I was diagnosed was the glycemic index. If you’re not familiar with that, it’s worth going straight to the source which is a team in my home city who have a big database of glycemic values. A lot of it is fairly common sense stuff ie. sugar and refined carbs digest faster so your blood sugar spikes and minimal processing of ingredients or adding fat and protein will usually lower those spikes, but sometimes GI values can be unexpected so it’s worth getting familiar with if you aren’t. There’s a billion books out there about GI, some of which I’ve found useful but nothing has ever really said anything I didn’t already know straight from the research team's website. I haven't needed to really use the website much in years though so if you still have questions or would like me to browse some of the more recently published books to make some recs, just say the word.
I was also initially advised not only that big spikes can worsen resistance but also to eat six small meals a day to help keep blood sugar spikes down even further as if I was already diabetic, but that seems to be less and less the advice these days. Now I see more people either claiming or investigating that eating less frequently is better for insulin resistance because the less insulin we have constantly circling, the easier it is for that resistance to sort of calm down or at least not progress. MedDiet + skipping breakfast (actual paper also linked from the article), is interesting food for thought given the emerging claims that intermittent fasting might improve insulin resistance (or it might not! It might make things worse! It might screw with hormones which might influence insulin or vice versa! I’ve seen plenty of disagreement there and little serious data yet.) Grazing vs. Two Meals for Insulin Resistance is not academic but also a good summary of stuff I’ve heard from varying quarters. I've also seen some suggestions I can't source right now that loading more calories into breakfast than anywhere else is good for insulin resistance, and that if you do skip a meal it should be dinner.
I personally don’t find GI alone useful, even in the context of knowing to eat more plant foods and such. It certainly contributes to positive results for me, but the many dieticians who have advised me to eat ‘a low GI diet’ and gave me little further advice proved… frustrating, shall we say. And people who are really strict about this end up cutting out for instance certain fruit and vegetables while freely being able to eat pizza, so it’s definitely just an additional info point and not a useful overall eating pattern to my mind. Good building block though.
After lots of trial and error and reading and failed interactions with the medical professionals, I’ve mostly settled in on the Mediterranean Diet as the focus of what I look at now. In part because I’d agree with recessional that it seems to have the biggest evidence based consensus that it’s helpful and certainly that it’s also unlikely to do me unexpected harm, in as much as anything seems to have consensus. And in part because of seeing stuff like this: Effects of MedDiet on need for drugs in newly diagnosed type 2 patients - can’t find a free full source for something like this, but the abstract has a good example of the kind of comparison stats that now feel like old news to me when comparing a high (healthy) fat MedDiet vs. low fat diet on insulin/sugar What’s behind Mediterranean diet and lower cardiovascular risk - full paper linked at the bottom; this is cardio focused but I find the insulin component interesting and the timeframe mentioned for some of the people followed is encouraging, plus it’s super recent. If you do dig further into MedDiet at all, you’ll find an overwhelming amount of cardio focus but often with secondary usefulness for insulin and other health issues. Dietary Polyphenols, Mediterranean diet, Prediabetes, and Type 2 Diabetes MedDiet may lower risk of developing metabolic syndrome
If you’re not familiar with the actual definition of the Mediterranean Diet, Mayo Clinic has a decent basics guide. If you’re reading Pollan and such then most of this isn’t going to be ground breaking to you, it’s just a slightly more specific version of eating minimally processed and mostly plants. In terms of evaluating research, the specifics of the diet can vary a lot from study to study even though they all list ‘Mediterranean Diet’ as if it means just one thing - I’ve found this a useful literature review to get some basic ranges of things. Diet in the Prevention and Control of Obesity, Insulin Res. And Type 2 is also interesting, and though it doesn’t mention MedDiet the various recommended percents and ratios in the diet are basically the same though MedDiet is perhaps more specifically lower with saturated fat. So there’s more than one way to skin this particular cat for sure.
One thing I do find though is that if I’m mostly cooking from scratch with 5-7+ servings of fruit/vege is that my fat and protein ratios are easily way too low for MedDiet. I can’t put my finger on specific sources right now but I know I’ve read (and my personal experience backs) that going to lower carb/higher fat and protein within the typical ranges of the MedDiet may be better for insulin resistance. I personally aim for around 45% carbohydrates which is the bottom of most ranges and certainly going below typical ranges with something like keto might worsen insulin resistance - proper study also linked from the bottom of this one. I personally wonder if, in this vein, eating less frequently improves resistance because less insulin means less stress on the system and if the usefulness of the MedDiet more specifically is all this nuts and oils and legumes keep the fat and protein ratios higher than just broadly eating plant based or whole foods, but I can’t put my finger on useful sources for that or remember if that’s just me hypothesising or actually having read that somewhere at some point. I personally get decent fat and protein ratios by mostly getting my carbs from fruit and vege and treating wholegrains the same way I treat meat ie. not having them every meal and ideally max 1-2 servings a day. But I also don’t eat gluten or dairy or as many legumes as I’d like for IBS type reasons so my macro ratios may easily not be anyone else’s macro ratios and more grains might be just fine for other people (especially if not aiming for the lower carb ranges), plus the studies certainly seem to assume people eat more of them than I do. If you're interested in this bit I do know I've seen TedTalks and the like lately more in the vein of how I eat re: grains and protein, if nothing else, but that's not necessarily the sort of sources you're looking for.
You’ll also see lots of ‘MedDiet is good because it’s low in red meat’ claims around if you look, but that may not be necessary for health as long as your meat is well chosen. Not worrying as much about that component of the MedDiet might also be useful for insulin by helping to keep overall carbs and GI down.
People have often waxed poetic about high quantities of olive oil and polyphenols with the MedDiet, but this also fascinates me on the oil benefits front: Good Fats vs Bad Fats: Comparison of Fatty Acids in the Promotion of Insulin Resistance, Inflammation and Obesity. Total anecdata here, but I went on a coconut oil kick a few years ago for a bit largely to replace dairy in certain deserts and surprise weight drops started happening. I didn’t get more blood tests at that time to confirm it, but historically my weight only shifts down when I’m making a sustained and higher than usual improvement to my insulin resistance. I’m sure many fad followers would argue that makes the coconut oil a magic bullet food or something, but I wonder if something like this might better explain it - along with more definitely how oil in everything would have been lowering the glycemic index of my desserts, and displacing carbs in my overall calories.
In terms of specifically obesity and does it drive insulin resistance or does resistance cause obesity and all that fun stuff, I’m mostly still at sea. I feel like opinion changes on causes and risks more often than anything else I read, and a more science inclined person than me could probably sift through all that better but I’ve mostly given up. It definitely seems bad for us, even if only from a likely to progress to diabetes standpoint. Or possibly resistance starts because something else is wrong (beyond just a high GI diet) that we don't understand. I do know there’s plenty of higher weight people without insulin resistance, and lower weight people with hidden insulin resistance. I have personally continued to gain weight on the above diet, mostly because I am a fallible human with too many health problems to juggle and I can’t strictly adhere to the above eating suggestions all the time. When I can do it 90% of the time for an extended stretch, weight comes off without me doing anything else to shift it. But even eating like that some of the time with occasional bouts of being really good about it has reduced my insulin resistance from borderline prediabetic to only barely resistant, while my weight has still doubled since my resistance was first diagnosed. So I'm inclined to think it's definitely not as simple as or all about losing weight.
One other thing I would mention is metformin. This is super recent and fascinating, given most things don’t work long term for weight loss. It’s also a magic bullet for weight + insulin resistance in my personal experience. I could eat or exercise as much or as little and as well or as badly as I wanted and still drop weight and improve my test results, but I couldn’t tolerate the side effects on my digestion (which is sensitive at the best of times, though) so it made me really sick in other ways. So if you do have or develop insulin resistance and metformin is suggested to you, there’s definite pros and cons. But I think I remember you talking about gut issues before so you might want to be really careful with it. The slow release version seems to help a lot of people avoid side effects, but my gut is still a special snowflake on that version of it so I gave up.
I've also tried to keep this succinct, but, well, it's long and heavily sprinkled with personal opinion. If there's anything you want me to elaborate on or doesn't make sense though, just ask. I am happy to talk about this stuff till the cows come home!
no subject
So one of the first things I was taught after I was diagnosed was the glycemic index. If you’re not familiar with that, it’s worth going straight to the source which is a team in my home city who have a big database of glycemic values. A lot of it is fairly common sense stuff ie. sugar and refined carbs digest faster so your blood sugar spikes and minimal processing of ingredients or adding fat and protein will usually lower those spikes, but sometimes GI values can be unexpected so it’s worth getting familiar with if you aren’t. There’s a billion books out there about GI, some of which I’ve found useful but nothing has ever really said anything I didn’t already know straight from the research team's website. I haven't needed to really use the website much in years though so if you still have questions or would like me to browse some of the more recently published books to make some recs, just say the word.
I was also initially advised not only that big spikes can worsen resistance but also to eat six small meals a day to help keep blood sugar spikes down even further as if I was already diabetic, but that seems to be less and less the advice these days. Now I see more people either claiming or investigating that eating less frequently is better for insulin resistance because the less insulin we have constantly circling, the easier it is for that resistance to sort of calm down or at least not progress. MedDiet + skipping breakfast (actual paper also linked from the article), is interesting food for thought given the emerging claims that intermittent fasting might improve insulin resistance (or it might not! It might make things worse! It might screw with hormones which might influence insulin or vice versa! I’ve seen plenty of disagreement there and little serious data yet.) Grazing vs. Two Meals for Insulin Resistance is not academic but also a good summary of stuff I’ve heard from varying quarters. I've also seen some suggestions I can't source right now that loading more calories into breakfast than anywhere else is good for insulin resistance, and that if you do skip a meal it should be dinner.
I personally don’t find GI alone useful, even in the context of knowing to eat more plant foods and such. It certainly contributes to positive results for me, but the many dieticians who have advised me to eat ‘a low GI diet’ and gave me little further advice proved… frustrating, shall we say. And people who are really strict about this end up cutting out for instance certain fruit and vegetables while freely being able to eat pizza, so it’s definitely just an additional info point and not a useful overall eating pattern to my mind. Good building block though.
After lots of trial and error and reading and failed interactions with the medical professionals, I’ve mostly settled in on the Mediterranean Diet as the focus of what I look at now. In part because I’d agree with recessional that it seems to have the biggest evidence based consensus that it’s helpful and certainly that it’s also unlikely to do me unexpected harm, in as much as anything seems to have consensus. And in part because of seeing stuff like this:
Effects of MedDiet on need for drugs in newly diagnosed type 2 patients - can’t find a free full source for something like this, but the abstract has a good example of the kind of comparison stats that now feel like old news to me when comparing a high (healthy) fat MedDiet vs. low fat diet on insulin/sugar
What’s behind Mediterranean diet and lower cardiovascular risk - full paper linked at the bottom; this is cardio focused but I find the insulin component interesting and the timeframe mentioned for some of the people followed is encouraging, plus it’s super recent. If you do dig further into MedDiet at all, you’ll find an overwhelming amount of cardio focus but often with secondary usefulness for insulin and other health issues.
Dietary Polyphenols, Mediterranean diet, Prediabetes, and Type 2 Diabetes
MedDiet may lower risk of developing metabolic syndrome
If you’re not familiar with the actual definition of the Mediterranean Diet, Mayo Clinic has a decent basics guide. If you’re reading Pollan and such then most of this isn’t going to be ground breaking to you, it’s just a slightly more specific version of eating minimally processed and mostly plants. In terms of evaluating research, the specifics of the diet can vary a lot from study to study even though they all list ‘Mediterranean Diet’ as if it means just one thing - I’ve found this a useful literature review to get some basic ranges of things. Diet in the Prevention and Control of Obesity, Insulin Res. And Type 2 is also interesting, and though it doesn’t mention MedDiet the various recommended percents and ratios in the diet are basically the same though MedDiet is perhaps more specifically lower with saturated fat. So there’s more than one way to skin this particular cat for sure.
One thing I do find though is that if I’m mostly cooking from scratch with 5-7+ servings of fruit/vege is that my fat and protein ratios are easily way too low for MedDiet. I can’t put my finger on specific sources right now but I know I’ve read (and my personal experience backs) that going to lower carb/higher fat and protein within the typical ranges of the MedDiet may be better for insulin resistance. I personally aim for around 45% carbohydrates which is the bottom of most ranges and certainly going below typical ranges with something like keto might worsen insulin resistance - proper study also linked from the bottom of this one. I personally wonder if, in this vein, eating less frequently improves resistance because less insulin means less stress on the system and if the usefulness of the MedDiet more specifically is all this nuts and oils and legumes keep the fat and protein ratios higher than just broadly eating plant based or whole foods, but I can’t put my finger on useful sources for that or remember if that’s just me hypothesising or actually having read that somewhere at some point. I personally get decent fat and protein ratios by mostly getting my carbs from fruit and vege and treating wholegrains the same way I treat meat ie. not having them every meal and ideally max 1-2 servings a day. But I also don’t eat gluten or dairy or as many legumes as I’d like for IBS type reasons so my macro ratios may easily not be anyone else’s macro ratios and more grains might be just fine for other people (especially if not aiming for the lower carb ranges), plus the studies certainly seem to assume people eat more of them than I do. If you're interested in this bit I do know I've seen TedTalks and the like lately more in the vein of how I eat re: grains and protein, if nothing else, but that's not necessarily the sort of sources you're looking for.
You’ll also see lots of ‘MedDiet is good because it’s low in red meat’ claims around if you look, but that may not be necessary for health as long as your meat is well chosen. Not worrying as much about that component of the MedDiet might also be useful for insulin by helping to keep overall carbs and GI down.
People have often waxed poetic about high quantities of olive oil and polyphenols with the MedDiet, but this also fascinates me on the oil benefits front: Good Fats vs Bad Fats: Comparison of Fatty Acids in the Promotion of Insulin Resistance, Inflammation and Obesity. Total anecdata here, but I went on a coconut oil kick a few years ago for a bit largely to replace dairy in certain deserts and surprise weight drops started happening. I didn’t get more blood tests at that time to confirm it, but historically my weight only shifts down when I’m making a sustained and higher than usual improvement to my insulin resistance. I’m sure many fad followers would argue that makes the coconut oil a magic bullet food or something, but I wonder if something like this might better explain it - along with more definitely how oil in everything would have been lowering the glycemic index of my desserts, and displacing carbs in my overall calories.
In terms of specifically obesity and does it drive insulin resistance or does resistance cause obesity and all that fun stuff, I’m mostly still at sea. I feel like opinion changes on causes and risks more often than anything else I read, and a more science inclined person than me could probably sift through all that better but I’ve mostly given up. It definitely seems bad for us, even if only from a likely to progress to diabetes standpoint. Or possibly resistance starts because something else is wrong (beyond just a high GI diet) that we don't understand. I do know there’s plenty of higher weight people without insulin resistance, and lower weight people with hidden insulin resistance. I have personally continued to gain weight on the above diet, mostly because I am a fallible human with too many health problems to juggle and I can’t strictly adhere to the above eating suggestions all the time. When I can do it 90% of the time for an extended stretch, weight comes off without me doing anything else to shift it. But even eating like that some of the time with occasional bouts of being really good about it has reduced my insulin resistance from borderline prediabetic to only barely resistant, while my weight has still doubled since my resistance was first diagnosed. So I'm inclined to think it's definitely not as simple as or all about losing weight.
One other thing I would mention is metformin. This is super recent and fascinating, given most things don’t work long term for weight loss. It’s also a magic bullet for weight + insulin resistance in my personal experience. I could eat or exercise as much or as little and as well or as badly as I wanted and still drop weight and improve my test results, but I couldn’t tolerate the side effects on my digestion (which is sensitive at the best of times, though) so it made me really sick in other ways. So if you do have or develop insulin resistance and metformin is suggested to you, there’s definite pros and cons. But I think I remember you talking about gut issues before so you might want to be really careful with it. The slow release version seems to help a lot of people avoid side effects, but my gut is still a special snowflake on that version of it so I gave up.
I've also tried to keep this succinct, but, well, it's long and heavily sprinkled with personal opinion. If there's anything you want me to elaborate on or doesn't make sense though, just ask. I am happy to talk about this stuff till the cows come home!