Can’t Lose Weight?

Can’t Concentrate?

Can’t Resist Sugar?

Could SYNDROME X Be Your Problem?

THE INSULIN FACTOR
ANTONY J. HAYNES

Dedication

For Bharti and Ben

Contents

Cover

Title Page

Dedication

Introduction

Part One What is Insulin Resistance?

Chapter 1 Tell Me About Insulin Resistance

Chapter 2 Are Refined Carbs and Sugar the Bad Guys?

Chapter 3 What’s My Risk of Insulin Resistance?

Part Two Let’s Take a Look at Diet

Chapter 4 How Your Digestion Affects Insulin

Chapter 5 Carbs and Proteins – Your Key to Reverse Insulin Resistance

Chapter 6 What’s So Essential About Essential Fats?

Chapter 7 Antioxidants: Your Defence Against Excess Insulin

Chapter 8 Key Nutrients to Reverse Insulin Resistance

Part Three Could Your Lifestyle Be Contributing to Insulin Resistance?

Chapter 9 Is Stress Affecting You More Than You Think?

Chapter 10 Are You Exercising Enough?

Chapter 11 Is It In My Genes?

Part Four The Insulin Factor Plan

Chapter 12 Your Plan to Reverse Insulin Resistance

Chapter 13 The Insulin Factor Diet Plan

Chapter 14 What Supplements Should Take and When?

Final Word

Resources

Glossary of Key Words and Terms

References

Bibliography

Index

Copyright

About the publisher

Introduction

Why should I read this book?

Do you always struggle with your weight despite watching what you eat?

Do you store most of your body fat around your middle?

Do you always crave sugary or starchy foods?

Do you have a poor memory or concentration and get ‘fuzzy’ brain, especially after eating?

Do you regularly feel tired or lethargic even if you’ve had a good night’s sleep?

Do you have high blood pressure or high cholesterol?

Do you have a history of heart disease or diabetes in your family?

If your answer is ‘yes’ to one, two or more of these questions you may well have an imbalance of a hormone in your body called insulin. And you are not alone: as many as four out of every five people have some degree of what is known as Insulin Resistance. Most of us aren’t even aware of it and, generally speaking, it is only the 22 to 25 per cent of the population who have full-blown Insulin Resistance who are more likely to get a proper diagnosis.

A staggering 80 per cent of the population have some degree of Insulin Resistance, 22 to 25 per cent of which have full-blown Insulin Resistance

What is Insulin Resistance?

Insulin Resistance, also known as Syndrome X and the Metabolic Syndrome, is a condition that occurs when, for a variety of reasons, your body makes too much insulin.

Insulin is a powerful hormone secreted by the pancreas in order to control the way the body stores and uses carbohydrates in the body. Under normal conditions, insulin is produced within moments of blood glucose levels increasing, which occurs after we eat something. In simple terms, its purpose is to enable the muscles and other tissues to take up the glucose they require for activity and to keep blood sugar levels to an acceptable level by storing any excess glucose for future use. However, for a variety of reasons – which of course we’ll look at in detail – this mechanism can become faulty, with the result that some tissues become resistant to the effects of insulin and the pancreas has to produce more insulin to get the blood glucose level down. This has many important implications for your metabolism and your general health – in essence, it makes you overweight and tired, and it dramatically increases your risk, first of heart disease and then of type II diabetes. If left untreated, Insulin Resistance will often lead to type II diabetes.

Insulin Resistance is also known as Syndrome X and the Metabolic Syndrome.

The good news is that whatever degree of Insulin Resistance you may have, you can completely reverse it by following the Insulin Factor Plan. This means that you will:

Lose weight safely and permanently

Feel energetic and alert

Stop feeling tired or dizzy before or after meals

Improve your memory and concentration

Stop craving sugary and starchy foods

Stop digestive problems causing bloating, pain, constipation, etc.

Slow down your body’s ageing process – look younger for longer!

Lower cholesterol and high blood pressure

Improve fertility and, if you are a woman, reduce your chance of developing PCOS (Polycystic Ovary Syndrome)

Lower your risk of getting heart disease and cancer

Alleviate inflammatory diseases such as arthritis and gout

Never get type II diabetes

In short, you’ll feel healthy, energetic and ready for anything – it will dramatically improve your quality of life!

How do I get started?

The Insulin Factor Plan is not a one-solution-fits-all programme because there are a range of imbalances that together or individually cause Insulin Resistance, and there are also different degrees of Insulin Resistance. With the help of questionnaires throughout the book you will be able to identify what degree of Insulin Resistance you have and which imbalances are causing it. Once you have pinpointed your imbalances – some of you will only have one or two, while others may need to address them all – you can turn to the end of the book and find out how to put together your personal plan of action. Generally speaking, you will need to make changes to your diet, take particular nutritional supplements and look at your lifestyle. The Insulin Factor Plan will help you with all three. You will of course need to commit yourself to making these changes, but the fact that you have this book and are already reading it is a very positive first step. Whilst Insulin Resistance doesn’t happen overnight, it can take only a few weeks before you notice an improvement in your symptoms. However, do also be patient since it will take an average of six months to permanently rebalance your insulin levels. Also, the more weight you need to lose the longer you will need to allow.

Medical conditions

Balancing insulin and glucose and eating a healthy diet is something that everybody would benefit from, so the Insulin Factor Plan should complement any medical treatment you are receiving. However, you should always check with your doctor before embarking on any dietary or lifestyle changes, particularly if you are taking any medication. This is because the improved diet and lifestyle may alter your dosage needs.

To help keep your motivation high, keep returning to the list above of all the health benefits that will be yours when you have balanced your insulin levels. Write them down or photocopy them and pin them up on your fridge or stick them in the front of your diary – wherever you will see them. Know that if you follow the Insulin Factor Plan you will not only turn your back on all the health problems but you will, in their place, enjoy all the benefits. Good luck, and enjoy!

Part One What is Insulin Resistance?

1 Tell Me About Insulin Resistance
What is insulin?

Although we’ve been talking about Insulin Resistance you shouldn’t think that insulin is really the bad guy in all of this. Although it is a dangerous hormone when it is produced in excessive amounts, as in the case of Insulin Resistance, it is actually vital for the body to function normally and to control how the body uses and stores glucose. Glucose is what gives your muscles and other organs the energy to function. Too little insulin is also just as dangerous, if not fatal, as seen in people who have type I diabetes: they can’t produce insulin so they need to regularly inject themselves with this hormone. Without these injections their blood sugar level would be too high which has serious and indeed fatal consequences. So, as with many things in life, it is a question of balance: too much or too little insulin in the body are just as dangerous for your health.

Too much insulin can make you overweight and tired, and increase your risk of heart disease and diabetes; too little insulin means high blood sugar levels which damages your internal organs.

What exactly does insulin do?

Insulin is one of many hormones in the body, and is also a protein. It is made in and secreted from cells in the pancreas called the Islets of Langerhans, named after the German pathologist who discovered them. The pancreas is one of the most important organs involved in digesting food and storing the nutrients in what you eat in your body’s cells. To give you an idea of proportion, about 98 per cent of the cells of the pancreas are devoted to digestion, with the Islets of Langerhans cells accounting for the remaining 2 per cent. The cells in the Islets of Langerhans that produce insulin are called beta cells, or B-cells. There are also alpha cells, or A-cells, which produce glucagon, a hormone that raises blood glucose levels.

Insulin and carbohydrates

Insulin’s main function is storing glucose from the bloodstream into cells. This first involves converting glucose released into the bloodstream from the digestion of foods into glycogen. The body only has a limited capacity to store glycogen – the primary stores of glycogen in the body are the liver and muscles – so all other glucose is then stored as fat, known as adipose tissue. People who have Insulin Resistance typically store this fat around their middles. Either way, insulin lowers the concentration of glucose in the blood.

Insulin and proteins

Insulin doesn’t just determine what happens to the carbohydrates that we eat, it also plays an important part in the way that proteins are metabolized. During the digestive process, many proteins are broken down into amino acids, which are then transported into the bloodstream. Insulin promotes the transport of amino acids into the liver and muscle cells. In this way it is involved in storing proteins away in the body, just as it does carbohydrates. It also inhibits the breakdown of protein in muscle for fuel. This is because if insulin is present, the body concludes that there is adequate glucose available and there is no need to break down muscle proteins for energy.

Insulin and fats

Similarly, insulin also has command over how fats are handled in the body. It inhibits the release of fats from fat tissue. This means that insulin prevents the use of your fat for energy in a similar way to how it prevents your body breaking down proteins. Insulin also promotes the production of fatty acids in the liver, which increases the amount of fats (bad cholesterol and triglycerides) circulating in the bloodstream – a potential risk for heart disease when present in excess.

Essentially, what all this means is that insulin prevents the body from overly using itself up and breaking down structural proteins and fats, especially if you do not eat enough food. Obviously this worked well when we were hunter-gatherers, as it meant the body did not begin breaking down its reserves at the first sign of hunger. These days, few of us go hungry for any length of time, so insulin’s supreme ability to store glucose at fat for future use is not nearly so important. Indeed, the modern diet that encourages high insulin levels means that the body stores more glucose as fat and we are at greater risk of becoming overweight and obese.

How much insulin your body releases depends on what you eat

Under normal conditions, insulin is produced moments after we eat something, so insulin levels will always be higher after we eat than before. As our blood glucose levels increase, the pancreas secretes insulin into the blood and insulin then performs the storage roles described above. The rate at which the blood glucose level increases is primarily determined by the amount of carbohydrate you eat. The volume of amino acids (proteins) you eat also has an effect on insulin production but much less than carbohydrates. If you eat a portion of carbohydrates, for example, this raises your blood glucose far than if you ate the same amount of protein, resulting in more insulin being released to store the glucose away. Once the glucose and amino acids are stored away, levels of insulin reduce accordingly. In this way, insulin levels vary throughout the day depending on the food we eat.

Carbohydrates raise blood sugar more than proteins. This means that your body produces more insulin when you eat carbohydrates than protein.

Insulin Resistance

If the body is continuously exposed to high levels of insulin, the insulin receptor cells in the liver, adipose (fat) tissue and muscle start to become inefficient. The way insulin binds to the receptors in the liver, fat and muscle tissues becomes partially blunted. In essence, this means some tissues in the body become resistant to the effects of insulin so that insulin is not able to carry out its normal role. The body recognises that there is too much glucose in the bloodstream so the pancreas produces even more insulin to try and compensate. When your body is consistently producing high levels of insulin it is a sure indication that you are resistant to insulin, hence the term ‘Insulin Resistance’. The pancreas will ultimately become exhausted and unable to produce the insulin needed to maintain optimal glucose levels and this is when you become diabetic.

The harm Insulin Resistance does

We already touched on this in the introduction but it is worth looking at the knock-on health effects of Insulin Resistance in detail.

You may wonder why it is vital for the body to keep down glucose levels in the bloodstream. As much as we need glucose to function, glucose at too high a level leads to oxidation and this causes tissue damage. This is what happens in poorly controlled diabetes, which can lead to peripheral neuropathy, renal conditions and cataracts. Since high blood glucose is so damaging to your health, your body will do everything it can to maintain normal glucose levels. The only means the body has to do this is with insulin. As you will see, the list of health conditions associated with Insulin Resistance is long and unpleasant:

Lay Description | Technical Term
Heart disease | Coronary Heart Disease (CHD)
Obesity | Body Mass Index (BMI) of 30 or over
Breast cancer | Breast Cancer
High blood insulin levels | Hyperinsulinaemia
High blood cholesterol levels | Hypercholesterolaemia
High blood pressure | Hypertension
Adult-onset diabetes | NIDDM (non-insulin-dependent diabetes mellitus)
Blood sugar problems | Dysglycaemia
Polycystic ovary syndrome | PCOS
Gout | Hyperuricaemia
Arthritis | Osteoarthritis
High blood fat levels | Hypertriglyceridaemia or hyperlipidaemia
Low good cholesterol | Low HDL
Impaired GlucoseTolerance | Impaired Glucose Tolerance
Low blood glucose | Hypoglycemia
Fuzzy head after eating carbs | Carbohydrate Sensitivity

What causes Insulin Resistance?

While your genes (see chapter 11) can be a contributory cause of Insulin Resistance – there is a higher risk of Insulin Resistance amongst people of South Asian origin – generally speaking there are numerous controllable factors that cause or exacerbate Insulin Resistance. The most significant one is related to body weight, or more specifically body over-fatness, especially around the middle. This is compounded by a sedentary lifestyle and the resulting lack of muscle tissue, by ageing, stress, high blood pressure and by excess consumption of refined carbohydrates, over-processed food, saturated fat and processed vegetable fat. Interestingly, digestive health also plays an important role. Obviously, with the exception of genetic factors and ageing, many of these factors are under our control and we can take positive action. You can look at how these factors are playing a part in your health in chapter 3, with the Insulin Resistance questionnaire.

Contributory factors in Insulin Resistance

High intake of sugar and refined carbohydrates

Sedentary lifestyle

Being overweight or obese (BMI over 30)

Excess body fat around the middle (abdominal obesity)

Stress

High blood pressure

A lack of vital nutrients

Genetic factors

Increased inflammation in the body

A diet high in saturated fat

A diet high in processed vegetable fat

Insulin Resistance results from the body’s protective mechanism to prevent high blood glucose. Insulin Resistance is an extremely common problem that can cause disease and limit life span. There are many things that raise blood glucose (e.g. refined carbohydrates, sugar stress) but just one that lowers it: insulin. Insulin Resistance is reversible if you make changes to your diet and lifestyle.

Summary of key points

The food you eat directly affects your insulin levels

Insulin profoundly affects carbohydrate, protein and fat metabolism

High levels of insulin are dangerous and contribute to heart disease

Diet and lifestyle are the main causes of Insulin Resistance; there is no single genetic cause of Insulin Resistance.

2 Are Refined Carbs and Sugar the Bad Guys?

They’re sweet, they’re comforting, they give you an instant feelgood high – small wonder that so many of us keep on turning to refined carbohydrates and sugar. We’re also surrounded by food products containing these instantly gratifying substances – fizzy drinks, chocolate bars, bagels, pasta, ice cream, sweets to suck, chew or swallow – and because the ‘fix’ we get from them is sweet and addictive, we are tempted time and time again.

We have been refining foods for centuries, as far back as the ancient Pharaohs who also observed the dangers of excess carbohydrates, but never as intensively since the middle of the 20th century. Too busy, too tired, too dissatisfied or too depressed, we are easily seduced by the promise of a quick sugar or carb high. So, you may not want to hear it but carbohydrates and sugars really are the bad guys, especially when it comes to Insulin Resistance and all of its knock-on effects. Understandably, it is a message that most people don’t want to hear. We are consuming more sugar in our diets today than ever before: in the UK the average person consumes 1201b of sugar a year, while in the USA the average person eats a staggering 1951b. This equates to people in the UK eating nothing except sugar every fifth day and in the US every fourth!

Captain Cleave on sugar

As early as the 1930s a Royal Naval doctor, Captain Thomas Latimer Cleave, identified the dangers of refined carbohydrates and sugar. He observed the correlation between rising incidences of heart and bowel disorders, obesity, diabetes, varicose veins, dental decay, haemorrhoids and related diseases with the under-consumption of dietary fibre and over-consumption of refined carbohydrates. Sailing around the world between different countries and communities, he observed that there was a close correlation between the degree to which a society’s diet was refined with cereals, rice and sugar plants, and the incidences of these diseases. For instance, tribal communities eating a traditional wholefood diet were free from these diseases, whereas tribal communities who had adopted a more refined diet were not. He continued to study the effects of refined foods on health, eventually publishing The Saccharine Disease in 1974.

The sugar-body fat connection

The single most significant cause of being overweight is eating too many refined carbohydrates, for example white bread, bagels, white pasta, white rice, biscuits, cakes, sweets, chocolate. It is virtually impossible to be obese on a natural food diet. It is very easy to overeat refined carbohydrates because they are a denser form of calories: an apple contains the same amount of calories as a single teaspoon of sugar. You could quite easily eat 10 teaspoons of sugar in a fizzy drink but you’d be hard pushed to eat 10 apples in one sitting! The best way to prevent being overweight is to avoid refined carbohydrates. The ultimate refined carbohydrate is white sugar.

The key difference between natural foods and refined sugars is that natural foods contain fibre, vitamins, minerals and other nutrients, whereas sugar and refined carbohydrates do not. This is why sugar and refined carbohydrates are often referred to as empty calories. What is more, sugar and refined carbohydrates also deplete nutrients in the body when they are metabolized. For example, every time you eat white sugar, you deplete your zinc and chromium levels as your body needs zinc and chromium in order to make insulin.

Although fat consumption and exercise play a part in weight control, they are not as important as you may think. It is quite possible to lose weight by reducing refined carbohydrates and not making any changes to your fat consumption and exercise routine. However, the Insulin Factor Plan does still recommend moderate exercise and emphasizes the need for good quality fats.

Sugar and diabetes

There is also a strong link between sugar and diabetes. This is because refined carbohydrates encourage the body to produce high levels of insulin, which ultimately exhausts the pancreas so it is unable to make enough insulin to control blood glucose, leading to diabetes.

Sugar and heart disease

Not only does sugar increase your risk of diabetes, but it also increases your risk of heart disease. Interestingly, sugar will actually start affecting the health of your cardiovascular system long before you ever get diabetes. This is because high levels of insulin, normally caused by a diet high in refined carbohydrates, exist for many years before you develop diabetes, and excess insulin is one of the most powerful causes of furred arteries, high cholesterol and blood fats, (triglycerides) and high blood pressure (see chapter 1). Insulin is as responsible for elevated bad cholesterol and blood fats as dietary fat. As you know, there is a strong link between high cholesterol and blood fats, and heart attacks and strokes.

Sugar and tooth decay

Of course, it will come as no surprise that sugar is also the main culprit when it comes to tooth decay.

Digestive problems

Refined carbohydrates are also behind many digestive problems, because they feed unwanted bacteria in the gut. The refined carbohydrates line the wall of the gut and enable bacteria to thrive and survive rather than pass on through. These bacteria contribute to a range of conditions from excess flatulence, appendicitis, inflammation of the gallbladder and poor digestion of fats, abdominal bloating, offensive smelling stools, and even cystitis and interstitial cystitis.

The hostile bacteria cause inflammation in the gut provoking the immune system to produce molecules called cytokines. This is a normal self-defence mechanism. However, an excess of these immune defence molecules causes problems in the same way excess insulin causes problems. They can escape the gut and get into the bloodstream and disrupt the binding of insulin to its receptor cells. Research shows that these cytokines are a significant contributory factor to Insulin Resistance.

This is why the health of your digestive system is an important part of the Insulin Factor Plan.

Surprisingly, the health of your digestive system plays an important part in reversing Insulin Resistance.

But if you are completely appalled at the idea of not being able to eat sugar again, don’t panic! Firstly, it’s more a question of cutting down on foods that contain refined carbohydrates, and secondly it really isn’t as difficult as you think, particularly as there are supplements you can take to stop your cravings – most of my clients who are hooked on sugary things are surprised how easy it can be to give them up.

Summary of key points

Refined carbohydrates including sugar really ARE the bad guys when it comes to your health, particularly regarding Insulin Resistance.

Sugar has been identified as a main cause of weight problems, heart disease, high cholesterol, diabetes, tooth decay and even digestive problems.

To restore your health, it is more a question of cutting down on refined carbohydrates, not necessarily cutting them out completely. In any case, there are supplements to stop your cravings, so it is not just a question of your will power!

3 What’s My Risk of Insulin Resistance?

In this chapter you can find out about your own risk of Insulin Resistance. The first thing you have to do is to work out your Body Mass Index (BMI) and then you can go on to further assess your risk of Insulin Resistance by answering a five-part questionnaire. We’ll also have a brief look at interpreting the results of a proper Insulin Resistance blood test, in case you want to do this, as it will give you a clearer indication of what degree of Insulin Resistance you have. We’ll also look in a little more detail at the major causes of Insulin Resistance in relation to your questionnaire results and which sections you should focus on in your Insulin Factor Plan.

Body Mass Index (BMI)

Although you do not have to be overweight to be insulin resistant, being overweight and having a high proportion of body fat are significant risk factors for Insulin Resistance and heart disease. For this reason, it is helpful to work out your Body Mass Index, or BMI. There are two groups of people for whom a BMI reading is not always helpful or accurate, namely:

Athletes and those of a muscular build: it may overestimate body fat.

Older persons and others who have lost muscle mass: it may underestimate body fat.

Generally speaking, though, your BMI is a reliable indicator of your total body fat.

Work out your BMI by using the BMI table (see Resources). If you need help with assessing your BMI number, please talk to your doctor, who can work it out for you.

My BMI No.:

Date:

Interpreting your result

If your BMI puts you in the overweight or obese bracket, you need to start thinking about losing weight. People who are overweight have a greater chance of developing conditions that are caused at least in part by Insulin Resistance: high blood pressure, high blood fats and cholesterol, diabetes, heart disease, strokes and certain cancers. Even a small weight loss (just 10 per cent of your current weight) will help to lower your insulin and consequent risk of developing those diseases. You don’t and shouldn’t try to lose weight overnight, as crash dieting actually increases Insulin Resistance. Instead you should follow the Insulin Factor Plan as recommended in chapter 12 which will help you to lose weight steadily and permanently.

Underweight: | less than 18.5
Normal weight: | 18.5–24.9
Overweight: | 25–29.9
Obese: | more than 30

Insulin Resistance questionnaire

Now that you have calculated your BMI, you are ready to complete the Insulin Resistance questionnaire. The questionnaire is not meant to be the definitive and most accurate method of assessing Insulin Resistance, although it certainly is a good guide.

Whilst you may have already made up your mind that you have Insulin Resistance, the following questions should give you clarification. Importantly, most ‘yes’ answers – other than those in the family history section – can be addressed successfully with the Insulin Factor Plan. Even if you only have a low risk of Insulin Resistance, the questionnaire will show you which aspects of your diet and lifestyle you need to keep an eye on. It is also useful for you to return to and see what progress you have made.

The Insulin Resistance questionnaire is made up of five parts:

1 Family and Health History

2 Signs and Symptoms

3 Dietary Factors

4 Lifestyle and Exercise

5 Lab Test Results (not essential, but explanations are given so you can understand your results).

Part one – family and health history
Scoring this part of the questionnaire

This is simple. You need to answer ‘yes’ or ‘no’ to each question, with the exception of the age question. Each ‘yes’ answer is awarded a single point. In the age question, you score more the older you are, with a maximum of 3 and a minimum of 0.

Do you have now or have you ever had in the past:

1 A family history of diabetes (type II), heart disease or stroke?

2 A family history of obesity or high cholesterol?

3 Type II diabetes (non-insulin dependent, adult-onset)?

4 High blood pressure (Hypertension)?

5 High blood sugar (Hyperglycemia)?

6 Low blood sugar (Hypoglycemia)?

7 Polycystic Ovary Syndrome (PCOS)?

8 Gout or arthritis?

9 Kidney stones?

10 A BMI of 30 or over?

11 Take the birth control pill (now, or for more than a year in the past)?

12 Exercise less than one hour a week?

13 Are you of South Asian, African, Polynesian, or Mexican origin?

14 Crash dieted to lose weight quickly?

15 What is your age? (60+ = 3, 50–59 = 2, 30–49 = 1, under 30 = 0)

Score out of 17 (women) =

Score out of 16 (men) =

Part two – signs and symptoms
Scoring this part of the questionnaire

Again, ‘yes’ answers score one point, but please note that if your BMI is equal to or over 33 then you score one point four times for the weight-related questions.

Do you have now or have you ever had in the past:

1 Is your BMI 33 or more?

2 Is your BMI 30 or more?

3 Is your BMI 27 or more?

4 Is your BMI 24 or more?

5 Difficulty losing weight despite exercise and/or a calorie-controlled diet?

6 An addiction to carbohydrates/sweets?

7 Inexplicable fatigue, tiredness, lack of energy?

8 Headaches, nausea or fatigue that is alleviated by eating?

9 A feeling of always being thirsty?

10 Need to eat every 3 hours or less?

11 Irritable after 4 hours without food?

12 Sleepy or fuzzy headed particularly after carbohydrate meals?

13 Suffer from afternoon fatigue?

14 Indigestion after meals?

15 Acne?

16 Physically unfit?

17 Hirsutism (excess facial hair or on the thighs)? (Women only)

18 Dry, flaky skin?

19 An earlobe crease in each ear?

20 Postural hypotension (your blood pressure drops when you stand up)?

21 Arcus senilis in your eyes? (This is a marking in the coloured part of the eye, the iris, where there is a white circle within the circumference, usually at the top of the iris under the eyelid (11 to 1 o’clock), but sometimes in the lower part too (4–8 o’clock), and sometimes around the whole iris)

Score out of 21 (women) =

Score out of 20 (men) =

Part three – Diet
Scoring this part of the questionnaire

Each ‘yes’ answer scores one point. Please note that if you smoke more than 15 cigarettes a day, then you score one point three times for the smoking-related questions. The same principle applies to the alcohol, water intake and vegetable intake questions.

Do you now or have you ever in the past:

1 Eat refined carbohydrates (e.g. white bread, white rice, sugar)?

2 Eat hidden sugars in foods or drinks?

3 Regularly eat large meals?

4 Smoke more than 15 cigarettes a day?

5 Smoke more than 8 cigarettes a day?

6 Smoke cigarettes every day or more than 10 a week?

7 Drink caffeinated drinks (with or without sugar) (e.g. coffee or cola drinks)?

8 Drink more than four cups of tea a day (with or without sugar)?

9 Drink more than 2 units/glasses of alcohol a day?

10 Drink more than 4 units/glasses of alcohol a day?

11 Eat fried food more than once a week?

12 Eat barbecued food more than once a month?

13 Eat processed foods regularly, including microwave or oven meals?

14 Eat protein foods (e.g. fish, white meats, eggs, meats) less than 3 times a week?

15 Are you a vegan (no meat or dairy products)?

16 Drink more than two glasses of fruit or vegetable juice a day?

17 Seldom eat oily fish, nuts and seeds? (see chapter 6)

18 Eat less than one portion of fresh vegetables a day?

19 Eat less than two portions of fresh vegetables a day?

20 Eat two meals a day or less?

21 Eat just one meal a day?

22 Drink less than three glasses of water a day?

23 Drink less than five glasses of water a day?

24 Drink less than eight glasses of water a day?

Score out of 24 =

Part four – lifestyle and exercise
Scoring this part of the questionnaire

Each ‘yes’ answer scores one point, except where indicated with regard to frequency of exercise. Exercise in this context means anything in which you are physically moving for at least 20 minutes at a time, be it aerobic, stretching or resistance work.

Are you now or have you ever in the past:

1 Regularly stressed or anxious?

2 A poor sleeper?

3 Always chasing appointments or deadlines?

4 Unable to relax without feeling guilty?

5 A person who has a persistent need for achievement?

6 Easily angered?

7 A sedentary person (e.g. office worker)?

8 A person who does anaerobic (e.g. weights only) and no aerobic exercise?

9 A person who exercises 3–4 times a week (score 1)?

10 A person who exercises 1–2 times a week (score 2)?

11 A person who exercises less than once a week (score 3)?

12 A very competitive person?

13 Irritable and impatient?

Score out of 16 =

Part five – Blood test results
Scoring this part of the questionnaire

Read through this section and answer any questions for which you have blood test results. Skip this section if you have not had a blood test done.

Do you currently have any of the following?

1 High fasting insulin

2 High fasting triglycerides

3 High triglycerides after a meal

4 Decreased HDL (good) cholesterol

5 Elevated LDL (bad) cholesterol

6 Elevated total cholesterol

7 Elevated systolic blood pressure (your first figure is over 139)

8 Elevated diastolic blood pressure (your second figure is over 89)

9 Elevated fibrinogen

10 Elevated PAI-1 (plasminogen activator inhibitor-1)

11 High uric acid (or gout)

12 Low Serum or Salivary DHEA (DHEA may have an inverse relationship with Cortisol and insulin)

13 Elevated testosterone in women (acute hyperinsulinemia increases testosterone blood levels and suppresses SHBG synthesis) (women only)

14 Low levels of sex hormone binding globulin (SHBG) (women only)

15 Decreased testosterone (serum or saliva test) (men only)

Score out of 14 (women) =

Score out of 13 (men) =

If you have answered ‘yes’ to any of the questions above, other than insulin itself, you should consider a fasting glucose and insulin test to rule out Insulin Resistance and diabetes. Also, make sure you discuss ‘positive’ results with your doctor. (See Resources for laboratory information.)

Your scores

Section five of the questionnaire determines whether you have Insulin Resistance or not, and to what degree. However, the sections one to four of the questionnaire help to quantify your risk and will show you which aspects of the Insulin Factor Plan you need to follow. The higher your score in the first four sections, the more advisable it is to have an Insulin Resistance test.

Use the chart below to note your scores and total them up.

Total scores

1 Family and Health History | /17(F)
| /16 (M)
2 Signs and Symptoms | /21 (F)
| /20 (M)
3 Diet | /24
4 Lifestyle and Exercise | /16
5 Blood Test Results | /14(F)
| /13 (M)
| _______
Total | /92 (F)
| /89 (M)

Interpreting the questionnaire

Whilst your total score is perhaps the most important indicator of overall risk for Insulin Resistance, the individual parts also have relevance. Both are categorized according to risk in the table below.

The Insulin Resistance questionnaire indicates the degree of Insulin Resistance you may have. The following text clarifies your risk of Insulin Resistance, and will help you plan your dietary and lifestyle changes.

1 Family and Health History: As only two elements in this section can change (weight and age), this is a relatively fixed score. This sets the scene for your risk, but does not determine it.

2 Signs and Symptoms: If you scored highly on this part of the questionnaire, together with a moderate risk total score or more, it suggests that you could be at a moderately advanced stage of Insulin Resistance, particularly if you are overweight. You need to follow all parts of the Insulin Factor Plan.

If you score highly on this section but only score a low risk on all other parts of the questionnaire, then consider taking the Adrenal Stress Profile saliva test and study chapter 9 on stress. You will also need to follow the dietary plan in chapter 13, and the Adrenal Support Supplement Programme.

3 Dietary Factors: If you scored highly on this part but not on the others, this puts you at risk of being in the early stages of Insulin Resistance, and increases your risk of developing it in due course. Eating refined carbohydrates represents the single biggest risk factor for developing Insulin Resistance. This risk is more pronounced if you score highly in part 4, Lifestyle and Exercise. You need to concentrate on the dietary plan in chapter 13, and follow the Insulin Resistance Supplement Plan One.

4 Lifestyle and Exercise: If you score highly in this section only then is there a need to start becoming more physically active. Even if you are not overweight you could well be in the early stages of Insulin Resistance. Inactivity is a profoundly important risk factor for Insulin Resistance, especially if you’ve scored highly in part 3 of the questionnaire, Dietary Factors. You need to read chapter 10 and find out the most suitable exercise for you.

5 Blood Test Results: These give ‘hard’ evidence of your current degree of Insulin Resistance, which is examined in more detail here. It is unlikely that a high score in this part would not be matched by high scores in other parts of the questionnaire. Don’t worry if your test results score highly: it doesn’t mean you can’t change them, far from it. In fact, the blood tests are an excellent way to monitor your improvements when you implement the Insulin Factor Plan.

Improving your situation

Your total questionnaire score, for either four or five parts, represents your baseline score, which will improve when you begin to implement the Insulin Factor Plan. Please redo parts 2 to 4 or 2 to 5 inclusive (not part 1, unless you have lost weight and are a year older) one month after you begin any changes in diet, nutrition and exercise to see the reduction in your scores. This is a good way of monitoring how you are doing, and will hopefully encourage you to keep going. If your score does not go down at all, please review chapter 12, which provides you with the model of how to reverse Insulin Resistance, and double check that you have gone through the action steps and check lists. If, within another month, there is still no change, it would be best to go and see a qualified nutritionist (see Resources).

There are many other questionnaires in this book but the Insulin Resistance questionnaire is the most important. Keeping your results of the questionnaires in mind, let’s now take a look at the six major causes of Insulin Resistance and how your questionnaire results tie in with them.

The six major causes of Insulin Resistance

There are six major causes of Insulin Resistance and your results from the questionnaires will show you how much of a contributor each one is to you.

1 General diet: eating too many refined carbohydrates and over-processed foods (this includes low nutrient levels and an imbalance in dietary fats – see chapters 5–8)

Measured by the Diet Questionnaire

2 Sedentary lifestyle: lack of physical activity and exercise, and lack of muscle (see chapter 10)

Measured by Exercise and Lifestyle Questionnaire

3 Weight: being overweight and/or having an elevated BMI (see this chapter)

Measured by BMI calculation, observation and body composition measurements

4 Stress: abnormal stress hormones (cortisol and DHEA) have a negative effect on Insulin Resistance (see chapter 9)

Measured by Stress Questionnaire and adrenal hormone saliva test

5 Lack of nutrients: chromium, magnesium, essential fats, other nutrients (trace minerals, minerals, vitamins) including antioxidants (see chapters 6, 7 and 8)

Measured by Diet and Signs and Symptoms Questionnaires and blood tests

6 Genetic influence: a family history of diabetes, heart disease and obesity and being of South Asian, African, Polynesian or Mexican origin (see chapter 11)

Measured by Family and Health History Questionnaire

The Insulin Connection

Age and insulin

Whatever your ethnic origin, your risk of Insulin Resistance increases as you get older. If you remain active, take gentle exercise to reduce loss of muscle mass, reduce the amount of calories you eat but increase the quality of your nutrient intake (as we age we become less efficient at digesting food), your age will not work against you and you will also find that you age more slowly.

However, it is also true that Insulin Resistance is becoming increasingly common in younger and younger people and a person’s chronological age is a less obvious risk factor than it once was. In actual fact, people who develop Insulin Resistance as early as the late teens and early twenties have a prematurely aged metabolism – i.e. they have the metabolism you’d expect to see in someone at least twice their age. Don’t worry if this sounds like you. Not only will the Insulin Factor Plan put your insulin and glucose levels back on track but it will also help you take years off your body’s biological age – the best kind of side-effect!

See Resources for help interpreting your Insulin Resistance Blood Test.

If you have done a blood test and know what degree of Insulin Resistance you have, turn to the Resources. However, without a blood test you can still get a good idea about what degree of Insulin Resistance you have, and take the appropriate action as outlined below. Your questionnaire scores will reflect a low, moderate or high risk of Insulin Resistance, which correlate with the different stages of Insulin Resistance that would be determined by the blood test.

Low Risk – Stage 1

You are insulin sensitive, and insulin levels fluctuate depending on food and drink intake, but you have normal fasting insulin and glucose levels. This does not mean you are free of symptoms, since you can put on weight if you eat too much, but this is not a dramatic or rapid process. You can also get symptoms of low blood sugar after eating a sugary meal like a big baked potato, because your insulin works well and is stimulated in large amounts by the high-sugar potato and consequently stores glucose into liver, muscle and fat cells rapidly, resulting in ‘post-prandial hypoglycaemia’. At this stage your blood test results would all be normal.

Action: Follow the Insulin Factor Diet Plan and Insulin Resistance Supplement Plan One

Moderate Risk – Stage 2

Your fasting insulin is still normal, as is your glucose. However, you can gain body fat more easily in this stage, and your fasting triglycerides (blood fats) would be elevated and the good cholesterol (HDL) low.

Action: Follow the Insulin Factor Diet Plan and Insulin Resistance Supplement Plan Two

High Risk – Stage 3

Your fasting insulin is elevated, as it is after eating, the triglycerides (blood fats) are high too and the HDL is low, and, generally, you are overweight, especially around your middle.

Action: Follow the Insulin Factor Diet Plan and Insulin Resistance Supplement Plan Three

High Risk-Stage 4

Your scenario is the same as for stage 3 above, except that your fasting blood glucose is a little too high.

Action: Follow the Insulin Factor Diet Plan and Insulin Resistance Supplement Plan Three

Stage 5

At this stage you would technically be diabetic because your blood glucose would be too high.

Action: Follow the Insulin Factor Diet Plan and follow doctor’s drug prescription. Supplements may be appropriate but should be recommended by a qualified nutritionist working with your doctor.

So, now you know your risk of Insulin Resistance. However, before you get going with the Insulin Factor Plan you need to take a closer look at the diet and lifestyle influences that will really make a difference to the speed at which you reverse Insulin Resistance. These are the two main areas of change that you will form part of your Insulin Factor Plan and getting to grips with them will make it much easier for you to succeed.

Summary of key points

A high Body Mass Index (BMI) is a significant, independent risk factor for Insulin Resistance.

The six major causes of Insulin Resistance are: 1 Eating too many refined carbohydrates and over-processed foods 2 Sedentary lifestyle 3 Being overweight 4 Stress 5 Lack of nutrients 6 Genetic influence.

Age is not a specific risk factor, but an associated one for Insulin Resistance.

Insulin Resistance in younger people indicates an accelerated biological age.

There are degrees of Insulin Resistance and these help to distinguish appropriate dietary and exercise recommendations.

Part Two Let’s Take a Look at Diet

4 How Your Digestion Affects Insulin

Digestive problems are a hidden cause of Insulin Resistance. This is mainly because as much as 70 per cent of the body’s immune system is located within the gut, and if your gut immunity is taxed the gut is flooded with cytokines – if you remember these are immune messengers – and in large quantities these blunt receptors for insulin in your body. This means insulin becomes less effective at storing glucose away so the body produces more insulin to compensate. For example, this is why, if you have a food intolerance, you can have difficulty in losing weight: your immune system is battling with a perceived threat and, in producing cytokines to fight it, interrupts the usual efficient function of insulin.

It’s not just food intolerances that cause an immune reaction in the gut: yeasts such as candida albicans, unfriendly bacteria, parasites and maldigestion trigger cytokine activity as well. Poor diet is a major culprit since not only does it not provide adequate nutrients for optimal immune function but it creates an environment within the gut that favours and feeds unwanted bugs.

The other thing that causes or exacerbates the likelihood of both gut problems is stress. Stress directly weakens immunity within the gut, thereby leading to an inability to distinguish friend from foe (i.e. overreacting to an everyday food) and prevent the colonization of unwanted bugs.

Digestive problems are extremely common as the typical Western diet is high in refined foods and we lead high-stress lifestyles.

Gut Health Questionnaire

Answer ‘yes’ or ‘no’ to the following questions. Each ‘yes’ answer is awarded a single point. Your total score will help you determine the likelihood of your digestive system contributing to Insulin Resistance.

Do you regularly (every few days) have:

1 Indigestion or heartburn?

2 Bloating after meals?

3 Nausea?

4 Excess flatulence?

5 Abdominal pain?

6 Cramps?

7 Irregular bowels?

8 Diarrhoea?

9 Constipation (less than one motion per day)?

10 Haemorrhoids (piles)?

11 Known or suspected food intolerances?

12 Antibiotics?

13 Anti-pain medications (e.g. aspirin or ibuprofen)?

14 Yeast or candida overgrowth?

15 Parasite or gut bacterial infections?

16 Food poisoning?

17 More than 14 units of alcohol per week?

Score out of 17 =

If you have any one of these regularly then your digestive health needs attention. If you’ve scored more than 5 then it almost certainly means it is compromising your Insulin Resistance, and warrants immediate action. If you have a pattern of any of these symptoms after eating specific foods then this suggests you have a food intolerance and this could be affecting your insulin sensitivity. It would be worth your while eliminating the suspected culprit food for a trial period of four weeks to see if your symptoms improve.

To address any digestive problems start the Insulin Factor Diet Plan and the Gut Supplement Plan rather than the Insulin Resistance Supplement Plan. It may take a number of weeks to reduce your questionnaire score, and only when you have reduced the score to 4 or less, and the symptoms are less regular, should you start following any of the Insulin Resistance Supplement Plans.

Summary of key points

70 per cent of your immune system is located in the gut.

Gut problems almost always involve the immune system.

Immune system reactivity produces cytokines.

Gut cytokines travel to the bloodstream and blunts the action of insulin.

Food intolerances play an important role in the production of cytokines in the gut.

Invariably, if you have Insulin Resistance and gut problems too, you need to address the latter first.

5 Carbs and Proteins – Your Key to Reverse Insulin Resistance
The Insulin Connection

Mixed messages

With all this discussion about refined sugars and carbohydrates you may be wondering if you should still be eating them, particularly as we are bombarded on a daily basis with conflicting opinions and information on what we should and should not be eating. First we are told that ‘fat is bad’, then it’s carbohydrates. What are we to do – not eat either? And how can we do that when we’ve been told that too much protein isn’t good for us either? It’s hardly surprising there are a lot of confused people.

What the headlines – and often the articles themselves – fail to explain is that there are good and bad fats, good and bad carbs, and good and bad proteins, all of which should ideally be eaten in balance with each other for optimum health. They also make an assumption that we are all the same, which is evidently not the case as each of us requires a different balance of nutrients to achieve good health. Take twins for example: they can have up to a twenty-fold difference in needs for some nutrients.¹ Imagine how different it could be between people who are not related!

To help you start to get to grips with some useful nutritional facts, this chapter looks at carbohydrates and fibre, the Glycemic Index, and then proteins. Lastly you’ll find out what proportions of carbs and protein you should eat to reverse Insulin Resistance.

There are two questionnaires to help you figure out what kind of carbs and proteins you are eating. The carbohydrate questionnaire is the first.

The Carbohydrate Questionnaire
Scoring the questionnaire

Each ‘yes’ answer scores 1 point.

Do you regularly:

1 Eat sugar or hidden sugars in food or drink?

2 Eat packet foods such as breakfast cereals?

3 Eat white flour products (e.g. bread, pasta, biscuits, cakes) and/or white rice more than 5 times a week?

4 Crave sweet foods?

5 Smoke cigarettes?

6 Drink more than 2 glasses of wine or beer a night?

7 Drink more than 3 cups of tea a day?

8 Drink more than 2 cups of coffee a day?

9 Drink fizzy drinks on most days?

10 Feel dizzy or irritable after 3 hours without food?

11 Get nauseous if you go without food, especially in the morning?

12 Get the shakes if you go without food for too long?

13 Get headaches if you miss a meal?

14 Need to eat frequent meals?

15 Pee a lot during the day and night?

16 Have excessive thirst?

17 Have cold hands and feet?

18 Get tired?

19 Get anxious and stressed?

20 Work harder than most people?

21 Wake up in the night feeling hungry?

22 Are you addicted to carbohydrates/sweet foods?

Total Score = /22

Interpreting the questionnaire

A high score in this questionnaire means you consume too many refined carbohydrates and this contributes to and increases your risk of Insulin Resistance. As you make changes to your diet, you should see your score reduce. Reading this chapter will help you understand why the wrong carbs are the major cause of Insulin Resistance.

0–5
Excellent! Keep your carb balance at this level. If you scored 5 or just under, see if you can score even lower by following the Insulin Factor Plan.

6–10
This suggests you have a blood sugar problem, which is caused by your diet. To resolve this as swiftly as possible you should to follow the Insulin Factor Diet Plan and the Insulin Resistance Supplement Plan One.

11–15
Too much! This strongly indicates a blood sugar and insulin problem, and that your diet is the major culprit. You need to follow the Insulin Factor Diet Plan and the Insulin Resistance Supplement Plan that your Insulin Resistance Questionnaire indicated in chapter 3. You should also redo this questionnaire in four weeks’ time to check your progress.

16+
Much too much! There’s no doubt that your diet is a significant causative factor in your Insulin Resistance. You may benefit from doing the Insulin Resistance Blood Test. You need to follow the Insulin Factor Diet Plan and the Insulin Resistance Supplement Plan that your Insulin Resistance Questionnaire indicated in chapter 3. You also need to consider testing and balancing your adrenal hormones (see chapter 9). Use the questionnaires to monitor your progress. After four or five weeks, if there is no marked improvement despite changing your diet you should see a qualified nutritionist (see Resources).

Carbohydrate groups

Most foods actually contain a mixture of carbohydrates, proteins and fats; it’s rare for any food to contain only one of these macro-nutrients. Some foods are dominant in carbohydrates, some dominant in protein and some in fat. Carbohydrate dominant foods consist of cereals, grains, starchy vegetables and fruits. Legumes (beans and pulses) also contain predominantly carbohydrates even though they are often referred to as a protein food. Meats, fish, poultry and eggs have little or no carbohydrate content, whilst dairy products can contain the carbohydrate lactose (milk contains more than hard cheese) and soy products can contain carbohydrates, depending on the type (e.g. tofu, soy milk, tempeh). Nuts and seeds have little or no carbohydrate (the cashew nut contains the most, with 18 per cent of its weight as carbs). Non-starchy vegetables also contain some carbohydrates but in much smaller amounts than their starchy counterparts.

The most simple carbohydrates are known as simple sugars or monosaccharides. These are the fundamental building blocks of carbohydrates, just as the amino acid is the building block for proteins. When you eat a simple sugar or refined carbohydrate it requires little or no digestion and is absorbed quickly into the bloodstream. This elicits a rapid and excessive insulin response, and it is for this reason that refined carbs are so bad for you. The human body is not designed to handle REGULAR intake of refined carbohydrates with impunity.

Refined carbs and simple sugars require little or no digestion and provoke a rapid and excessive insulin response. This is why they are so bad for you.

A system has been devised to measure how rapidly different carbs affect your blood glucose. This is called the Glycemic Index, which is a measure of the amount of insulin the body needs to produce to lower the glucose levels after eating that food. The higher the GI the more insulin is produced.

The Glycemic Index and Load

The Glycemic Index (GI) is a numerical system of measuring how fast a carbohydrate triggers a rise in circulating blood sugar – the higher the number, the greater the blood sugar response. So a low GI food will cause a small rise, while a high GI food will trigger a dramatic spike. A GI of 70 or more is high, a GI of 56 to 69 inclusive is medium and a GI of 55 or less is low.

The Glycemic Load (GL) is a relatively new way to assess the impact of carbohydrate consumption. It takes the Glycemic Index into account, but gives a fuller picture than the Glycemic Index alone. A Glycemic Index score tells you only how rapidly a particular carbohydrate turns into sugar – but it doesn’t tell you how much of that carbohydrate is in a serving of a particular food (i.e. the GI is a qualitative measure, whereas the GL is a quantitative measure). You need to know both things to understand a food’s effect on blood sugar. The carbohydrate in watermelon, for example, has a high GI, but there isn’t a lot of it, so watermelon’s Glycemic Load is relatively low. A GL of 20 or more is high, a GL of 11 to 19 inclusive is medium and a GL of 10 or less is low. Foods that have a low GL almost always have a low GI. Foods with an intermediate or high GL range from very low to very high GI. There is a detailed table in the Resources section showing the GI and GL of common foods.

The Glycemic Index and obesity

You may be surprised to know that it is not just the number of calories you eat that results in weight loss or weight gain. This is because calorie counting does not take into account the Glycemic Index and the hormonal response to food. Calorie counting can be helpful but should certainly not be the sole focus for weight loss. The reason why a low GI carbohydrate diet helps weight control is because it helps you feel satisfied after a meal and it both minimizes insulin levels after consumption and maintains insulin sensitivity.

Case Study: Carol

Resisting sugar is not just a matter of will power, however. I believe it is also linked to biochemistry and habit. When Carol came to see me some years ago she was in her early thirties and had been a member of over-eaters anonymous for seven years. During this time she had not touched refined sugar and yet she still craved it. Sugar craving is sugar addiction, no matter which way you look at it. She was still addicted to sugar because she was having to use her will-power NOT to eat any. However, she still evidently had marked fluctuations in her blood glucose levels.

Based on her symptoms, a glucose tolerance test was recommended and the results were proof enough. Carol’s blood glucose levels went up too high at first, into the mildly diabetic range, and then plummeted into the hypoglycaemic range. She felt dreadful while the test was being performed – and remember this was after seven years of avoiding sugar. We did not measure her insulin and adrenal hormones at the time, but needless to say the insulin mounted a delayed response to the sugar shock and then was produced in high amounts, resulting in the sudden drop in blood glucose, at which time the adrenals would have kicked in to increase the level again. Carol was in stage 1 or stage 2 of Insulin Resistance, but was certainly not a full-blown case. There were also adrenal issues.

Carol was not eating enough protein by any means, with none whatsoever at breakfast. In addition, her diet as a whole was relatively high in carbohydrates, though these had a relatively medium to low Glycemic Index. I addressed her lack of protein by getting her to eat high BV protein for breakfast, lunch and dinner. She continued to eat some carbohydrates as well, so it was by no means a low or no carbohydrate diet at all. When she got into the habit of eating the protein foods her craving virtually disappeared. Her will-power enabled her to implement the new programme, but it was the new programme that gave her new-found freedom from her cravings. She has a motto, which I often use myself, ‘discipline equals freedom’. The discipline to follow a programme allows you to derive the benefits from that programme.

It is not how many calories you eat, but rather the type of calories you eat that causes weight gain.

What’s the difference between simple sugars and starches?

Glucose (aka dextrose) is the best-known simple sugar. Sugars composed of two monosaccharide units are called double sugars or disaccharides, and these are found extensively in nature. Sucrose, also known as table sugar, is the best-known double sugar. When you eat sucrose, the enzyme sucrase splits it into the simple sugars glucose and fructose, which are then quickly absorbed into the body. More complex sugars, or polysaccharides, contain links of many simple sugars. Starch, for instance, contains polysaccharides, and are therefore known as complex carbohydrates. Plant starch requires much greater digestion and hence is absorbed much more slowly than less complex sugars like sucrose or glucose. As a consequence, starchy vegetables have a medium to low Glycemic Index.

Starchy vegetables

Some examples of starchy vegetables are given below:

Artichokes | Parsnip (cooked)
Beetroot | Potato
Carrots | Pumpkin
Corn | Sweet potato
Green peas | Turnip (cooked)
Leeks | Yam

Cooking transforms more complex carbs into more simple carbs. This means that the GI of raw starches is almost always lower than cooked starches.

Fibre foods

Just as starch slows down digestion, so too does fibre. Fibre makes you feel more full, which helps reduce appetite and slows the release of sugar into the bloodstream. It feeds friendly bacteria, carries toxins out of the gut, so unwanted bugs are less able to flourish.

Essentially, there are two kinds of fibre, soluble and insoluble. Soluble fibre absorbs much more water, toxins and even cholesterol than insoluble fibre, and carries them all through the colon for elimination; insoluble fibre provides bulk but can irritate the gut lining, especially when eaten in excess. For example, oat bran, which is a rich source of soluble fibre, can lower cholesterol levels whereas wheat bran, a rich source of insoluble fibre, does not.

Rich sources of soluble fibre | Rich sources of insoluble fibre
Soluble | Wheat bran
Fruits |
Vegetables |
Legumes |
Oats |
Pectin |

Legumes – which contain plenty of soluble fibre – are a particularly useful source of carbohydrate in the diet. This is because they have a low Glycemic Index and are very insulin-friendly. Unfortunately, some people may find that legumes can cause excess wind, so introduce them gradually into your diet. If, however, the problem persists it may be due to a lack of digestive enzymes and you may need to either avoid them altogether or reduce the volume of legumes eaten and instead consume more starchy vegetables.

In some countries legumes are a staple; however, in the West they are not as common – with the exception of tinned baked beans. So, instead of opting for de-natured, often sugar-loaded, baked beans why not try some of the following:

Aduki beans | Butter beans
Black beans | Chickpeas
French green beans | Mung beans
Haricot beans | Navy beans
Lentils/Split peas | Pinto beans

Grains

Starchy vegetables, legumes and grains are the three main foods groups from which we derive the bulk of our carbohydrates. Fruit is also a high carbohydrate food. Of these groups it is grains that are most often refined and processed – and it is food processing that is largely to blame for the huge increase in refined, high Glycemic Index foods. The main staple foods around the world are wheat and rice. However, there is more to grains than just the big two. Below is a list of grains and, where appropriate, the sorts of foods that are made from them. Where possible, opt for the unrefined product – wholemeal breads, whole-wheat pasta, unrefined breakfast cereals, brown rice, quinoa, millet grains and so on.

Grains | Food
Wheat (white & brown) | Bread, pasta, breakfast cereals, cakes, biscuits, couscous
Rice (white & brown) | Pasta, bread, biscuits, crackers, rice cakes
Oats | Porridge, flapjacks, biscuits
Rye | Bread, pasta, crackers (Ryvita)
Barley | Bread, pasta, cereals
Millet | Bread, pasta
Buckwheat | Pasta, noodles
Bulghur | Tabouleh
Corn* | Tortilla chips, pasta, popcorn
Quinoa | Cereals
Polenta |
*Generally, corn is processed and refined

Fruit

While fruit contains many beneficial nutrients, such as antioxidants, vitamins, minerals, fibre and water, as a food group, fruit is higher in carbohydrates and lower in protein and fat than any other. Fructose is the main carbohydrate in fruit, which is absorbed more slowly than glucose but still more quickly than complex carbs found in whole grains and legumes. For this reason you should be careful about how much fruit you eat. For the archetypal fit and lean individual, fruit will not be an issue, but the more insulin resistant you are, the more likely it is that you need to limit your fruit intake. If you have full-blown Insulin Resistance, you should only eat the lowest Glycemic Index fruits.

Higher GI fruits | Lower GI fruits
Banana | Blackberries
Dates | Blueberries
Figs | Cherries
Grapes | Grapefruit
Prunes | Raspberries
Raisins | Strawberries
Watermelon |

Limit carbohydrates, don’t avoid them

If you have Insulin Resistance you should limit all carbohydrates, but not avoid them. However, you should avoid all high Glycemic Index foods. You can eat moderate to low Glycemic Index foods, such as many of the above grains in their whole form and in small amounts, although the more insulin resistant you are the fewer you should eat. Some people consider grains to be a primary cause of the Insulin Resistance phenomenon, and recommend an avoidance of all grains, both whole and refined. However, this is not practical for most people and can also cause health problems in the longer term. Instead of cutting out carbs altogether, concentrate on cutting out refined carbs from your diet and choose instead starchy vegetables and legumes as your main source of carbohydrate and whole grains as a limited source – this cannot be emphasized enough.

Main sources of carbohydrate

Try to limit your carb intake to 40 per cent of your diet, and within this 40 per cent the following proportions:

Starchy vegetables | 35%
Legumes (beans/pulses) | 35%
Fruits | 15%
Cereals/grains | 15%

Why shouldn’t I cut out carbs altogether?

Don’t make the mistake of thinking that if low GI is good, no GI (i.e. eating no carbs at all) is better. Whatever degree of Insulin Resistance you have, it’s made worse if you eat no carbs at all. Eating a very low carb diet for more than a couple of weeks can reduce the activity of your thyroid hormones, in particular the most active thyroid hormone, T3, or tri-iodo-thyronine. A low level of T3 can lead to fatigue, weight gain and poor circulation. What’s more, a low carb diet will also cause your blood glucose to drop and, when this happens, your brain stimulates the adrenals to raise blood glucose with cortisol, resulting in high cortisol levels. Independently of eating a low carb diet, high cortisol levels will actually reduce the thyroid hormone T3 and also increase Insulin Resistance (see chapter 9

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