Dr. Andrew Koutnik on glucose control and chronic disease

HbA1c, which reflects average blood glucose over 2–3 months, strongly predicts diabetic eye, kidney, and cardiovascular complications. In both the general population and people with diabetes, chronically elevated HbA1c is tightly linked to heart disease—the leading cause of death. Kutnick argues that focusing on glucose control sits at the top of the health “hierarchy,” and that many people obsess over secondary factors while ignoring this metabolic “engine.”

Because carbohydrates are the most potent driver of blood glucose spikes at every meal, reducing them dramatically stabilizes glucose and insulin. Kutnick cites a consensus statement that therapeutic carbohydrate restriction is the most evidence-based nutritional strategy for type 2 diabetes, and describes data from over 46,000 people with type 1 diabetes showing that >70% of very-low-carb eaters achieved normal HbA1c. His 10‑year case study showed perfect glycemic control, a 40% drop in insulin needs, and no cardiovascular damage despite higher LDL.

A proper keto diet emphasizes green leafy vegetables, high-fiber low‑sugar plant foods, adequate protein (meat, fish, eggs, dairy, nuts), and healthy fats (olive oil, avocado oil). Kutnick notes clinical work showing no loss of muscle and even muscle gain on keto with resistance training, including in calorie-restricted military populations. His own performance study found no decline in high-intensity running after four weeks of keto adaptation, and record-high fat oxidation at intensities previously assumed to be carbohydrate‑dependent.

Repeated glucose spikes and crashes (hyper- and hypoglycemia) are linked to fatigue, irritability, brain fog, poor concentration, anxiety, and physical symptoms like shakiness and blurry vision. Kutnick notes that most people on high-carb diets experience near-constant swings. In contrast, both ketogenic diets and exogenous ketones provide steadier fuel, associated with clearer thinking and more consistent performance. He highlights a 2020 MRI study showing ketones increased brain network stability by 87% compared with glucose.

Compounds such as 1,3‑butanediol raise blood ketone levels within minutes and were studied in a DARPA $10M program. Kutnick explains they lower blood glucose, modulate inflammation (e.g., via NLRP3 inflammasome), and change gene expression to boost antioxidant defenses. Research has shown improved physical performance, delayed cognitive decline in at‑risk older adults, slowed progression of metastatic cancer in animals, reduced cancer-induced wasting (cachexia) with preserved muscle, and decreased muscle protein breakdown in human physiology studies.