Ted Naiman, M.D., a former vegetarian who received medical training at the Seventh-Day Adventist Loma Linda University, discusses the most important metrics for tracking your health and disease risk, diabetes, obesity, heart disease, and exercise.
Naiman says he considers waist:height ratio the most important test, followed by, in order of utility and importance: fasting glucose, triglyceride to HDL ratio, and fasting insulin.
Waist-to-height ratio is a free test of your insulin level. You can do it at home. All you need is a tape measure. For the past few months, I've measured my waist almost every day. The smaller your waist relative to your height, the lower your insulin level and greater your insulin sensitivity.
Fasting glucose can also be obtained at home with a glucometer. You can purchase a home-use glucometer for less than $50.
Triglyceride:HDL ratio is a blood measure of insulin level and sensitivity. You will need to get a blood test for this. In the Phoenix valley, you can get blood tests from Healthwaves very inexpensively. A complete lipid panel is only $25. Similar services are available in other cities. Naiman suggests getting your triglycerides as low as possible and your HDL as high as possible.
If you simply won't accept anything other than a direct test of your insulin level, you can order a fasting serum insulin test.
If you have a small waist, normal glucose, low triglycerides, and high HDL, you don't need to test your serum insulin.
When I measured my waist girth in September 2014, when I was eating a vegan plant-based diet according to appetite, it was 33.5":
By 2016, I realized that I wasn't going to get lean eating a low-fat whole foods plant based diet to satisfaction, which was generally about 2500 kcal per day and 15-20% of energy from fat. I had tried restricting to 10% fat, but I was hungry constantly and would eat even more total calories, closer to 3000. I resolved to restrict my food intake to 2100-2200 kcal per day lose the fat I didn't want. I kept my plant protein intake high (100+ grams per day) because it helped reduce my appetite. By late November, 2016, my waist girth had reduced to about 31.5 inches when I took this photo:
However, I didn't think I was going to ever get my waist down below 31" as it had been when I was in high school, because I often had bloating from intestinal gas due to my high fiber intake, and I couldn't comfortably restrict my food intake to any greater degree for long enough to make a leaner condition sustainable.
Then I got the results from my Nov 25, 2016 blood test:
My globulin was below the normal range, suggesting possible dietary protein malabsorption or deficiency, despite eating at least 100 g of plant protein daily. My phosphorus was below normal range, suggesting I was not getting adequate phosphorous from the whole foods vegan diet; I hypothesized this was due to the high levels of phytate in the grains and beans I was eating daily. Total cholesterol was 154, but my triglycerides (78) were higher than my HDL (60). I had 30% more triglycerides than HDL.
Although I had been having cravings for animal protein for several months prior to this test, I was trying to satisfy myself by eating large amounts of legumes, tofu, tempeh, and plant-based meat analogues. I stuck with the vegan diet until March 2017, when I decided I needed to follow my highly evolved sensory guidance, not an ideology. I then began eating some meat, and cutting out grains and beans, but still ate a lot of fruit, especially dates, and potatoes. Since I was still eating a lot of fiber, sugars and starches, I still had significant bloating.
In May of 2017 I started restricting carbohydrate to less than 100 g/d, but otherwise ate as much as I needed to feel satisfied.
As months passed, I found I preferred how I felt and functioned when I ate no more than 50 g carbohydrate per day. This practically eliminated abdominal bloating.
For a some weeks, I did not monitor my caloric intake on a daily basis, because I wanted to regulate my food intake using only my senses of appetite, taste and satisfaction along with my mental and physical performance. I ate as much as necessary to feel energized and satisfied. My sparse Cronometer records show I ate as little as 2100 kcal on some days, as much as 2800 kcal on other days, the lower intakes occurring on more sedentary days and the higher intakes on more active days.
On June 2, 2017 I found my waist was below 31," near 30.75" for the first time since I was in high school:
Since then my waist has reduced to and remained stable at 30.5 – 30.625" on most mornings, and has occasionally dipped below that, while my total body muscle mass has steadily increased. My diet is high in protein (25-30% energy), fat (60-65%), and cholesterol (1400 mg or more daily), and low in carbohydrate (generally not more than 50 g per day, and less than 10% of total energy intake).
Meanwhile, on June 22, 2017 I had another blood test. My triglycerides remained at 78, but my HDL increased to 110. Now I have 40% more HDL than triglycerides. My globulin recovered to the normal range, my phosphorus almost recovered to the normal range.
From July 2017 forward, I have been eating according to appetite, and my Cronometer records show my kcalorie intake has either been either equal to or greater than my calculated expenditure on the vast majority of days. Through September I was averaging about 2700 kcal, which is estimated to be about 350 kcal above my daily requirement for weight maintenance. From July until the end of September I continued to lose body fat and gain muscle. I took these photos of my waist at the end of the day on September 5, 2017:
Compare these two to the photo above from November 2016. I am leaner and carry more muscle mass now on an ad libitum VLCHFHP animal-based diet than I was then on a high protein, high carbohydrate plant-based diet with calorie-restriction.
If Naiman is correct – and I think he is – this indicates that my chronic insulin level was significantly higher when I ate a plant-based diet, than it is now.