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Dr. Andrew Koutnik on glucose control and chronic disease

How glucose spikes drive disease risk well before obesity arrives; Koutnik on HbA1c as the strongest predictor, and the case for ketogenic eating in diabetes.

Steven BartletthostDr. Andrew Koutnikguest
Sep 8, 20251h 31mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 2:25

    Intro

    1. SB

      What can you tell me about this?

    2. AK

      Well, if you look at the science, it's enhancing cognition. We've seen a 50% improvement in how individuals were able to read and absorb information and have better decision-making. And also, we did a study and showed that it delayed the progression of metastatic cancer. And I've actually taken this a number of times, because having been in research for the last 15 years and having lived with multiple chronic diseases, one of which I reversed, some of the most powerful strategies like this were not being told to me when I went to the doctor's office. So let's dig deeper.

    3. NA

      Dr. Andrew Kutnick is a research scientist who's worked on over 100 studies on metabolic health, diabetes, and the keto diet. And through his findings, he's helping people prevent chronic diseases, improve cognition, and optimize performance.

    4. AK

      I went through some pretty dramatic moments in my childhood. You know, I did everything I was told, right? I exercised all the time, I ate what I was supposed to eat, but I still became obese.

    5. SB

      You weighed about 255 pounds?

    6. AK

      Yeah. And I had no idea how damaging that actually was to my body, and I think the vast majority of people also don't. But over 20% of children have obesity. That's quadrupled over the last 30 years, and a big part of that is when it comes to food, what looks healthy isn't always healthy, and it's not by accident. And it wasn't soon after that I ended up getting diagnosed with a chronic irreversible disease that obesity puts you at risk for, and that immediately turned it into a journey to understand how to be healthy. And I came across this diet a little over a decade ago called the ketogenic diet. So then I went into the science of this diet and found positive impacts on things like diabetes, obesity, Alzheimer's, serious mental illness, chronic diseases, and I was like, "Oh, wow." 'Cause a lot of people don't realize that many of these are not just preventable, but also reversible.

    7. SB

      And you did the longest study ever done of its type on the impact of the ketogenic diet on a patient that had type 1 diabetes.

    8. AK

      Yes. Let me, let me tell you all about it.

    9. SB

      I see messages all the time in the comments section that some of you didn't realize you didn't subscribe, so if you could do me a favor and double-check if you're a subscriber to this channel, that would be tremendously appreciated. It's the simple, it's the free thing that anybody that watches this show frequently can do to help us here to keep everything going in this show and the trajectory it's on, so please do double-check if you've subscribed, and, uh, thank you so much, because in a strange way, you are- you're part of our history, and you're on this journey with us, and I appreciate you for that. So yeah, thank you.

  2. 2:25 – 3:18

    What's Your Mission?

    1. SB

      Dr. Andrew Kutnick, if you had to try and sort of summarize and encapsulate what you've spent the last couple of decades of your life focused on and really trying to accomplish, prove, understand from the highest level, what exactly is that?

    2. AK

      The core of my mission, Stephen, is really to empower individuals to take control over their own health. It's empowering them with science, y- you know, bridging science to actual action. And, you know, science is very complex, it's very hard to break it down, but having been in, you know, research for the last 15 years and having lived with multiple chronic diseases, uh, one of which I reversed and one of which I- is irreversible, um, I- I- my mission is to empower patients with the same tools and strategies that I had access to, uh, so they can take control to maximize their health and performance.

    3. SB

      For the average person who may not be as knowledgeable about

  3. 3:18 – 9:24

    What Areas of Health Have You Spent the Last 15 Years Researching?

    1. SB

      health and fitness, what are the areas of health that you've spent the last 15 years researching and trying to understand?

    2. AK

      I would call it, you know, Stephen, like, metabolism, in, in a broad terms. Now, I would say, you know, to break that down further for people to understand that, metabolism is trying to understand how the body metabolizes or utilizes things like nutrients or food. So you have oranges here. What's, what's in that food? How, when you ingest it, will your body respond to it? Both from, you know, glucose levels, which I'm sure many have heard of, to insulin responses, to all this different nuance. A lot of that comes down to nutrition, but it also is things like exercise. Exercise has such a powerful impact on metabolism. Incredibly important for overall health. But from a personal perspective, this journey's been very honestly selfish for me. I wanted to understand how to get the best performance, the best for health for myself, and I very quickly realized that, uh, you know, some of the most powerful strategies out there were actually not necessarily the ones that were being told to me when I went to the doctor's office, because I went through some, some pretty dramatic moments, uh, early on in my, my journey with, with trying to overcome some of these, these challenges.

    3. SB

      So take me back to the, the start of your story and the earliest context that's relevant to understand why you became the person you became.

    4. AK

      Yeah.

    5. SB

      I mean, I've got some photos here from your, from your childhood which are-

    6. AK

      (laughs) Yeah.

    7. SB

      ... very, very telling. And, you know, some of our listeners might be listening on-

    8. AK

      Yeah.

    9. SB

      ... audio alone, so they might not be able to see these, these visuals on the screen.

    10. AK

      Yeah.

    11. SB

      So if you could describe some of these, these pictures for me.

    12. AK

      When... Yeah, it... Um, it brings back some powerful memories of, uh, the challenges with obesity for me. Um, you know, the, the picture on the right is just (laughs) you know, a, a picture with, on a, a family adventure, um, where we went to the- we'd go- I'd go fishing with my dad a lot. You know, I'm, uh, very heavy at the time. I was, you know, uh, obese and, um, uh, and the picture on the right here, th- this really gets me, because, um, you know, I d- you did everything I was told, right? I exercised all the time, I ate what I wa- I was supposed to eat or what my doctor recommended, what the fitness magazines recommended, but I was just constantly challenged with gaining more and more fat tissue, and I had no idea how damaging that actually was to my body, and, and I think the vast majority of people also don't. Um, over 68% of America right now is obese, okay? That means, you know, seven out of 10 people walking around the street in the United States of America have obesity, and we know that the second you start building more and more...... fat tissue, uh, on your body, insulin levels rise, almost double immediately, before you even have symptoms of obesity or, uh, tissue damage or organ damage or anything along those lines. We know that almost immediately reduces insulin sensitivity, so how well insulin, this very powerful fat storage hormone, is able to actually bring nutrients from the blood into tissues. That goes down around 34 to 35%, uh, in early stages of obesity.

    13. SB

      And just to summarize for-

    14. AK

      Yeah.

    15. SB

      ... s- a muggle like me, insulin is basically the Uber which takes things out of your blood and puts them where they need to be?

    16. AK

      It's essentially like a thermostat for blood glucose. That's how most people know it. So as blood glucose levels rise, it works as a thermostat to, let's say, release cool air to bring it back down. In this case, releases insulin to bring blood glucose back into range. As blood glucose drops, insulin is stopped, it stops releasing insulin out of these cells called the beta cells. And ultimately what your body's trying to do is keep the, you know, one teaspoon of sugar that's in your blood that is critical for your life, if it goes up, it can cause damage, if it goes low, it can be life-threatening, in this very, very tight range. And it built, uh, builds a number of mechanisms to ultimately make sure and ensure that you don't go outside of that range. But imagine losing the one molecule that directly controls it.

    17. SB

      You're wearing two devices, I believe, on you at the moment? So you've got this...

    18. AK

      Yeah.

    19. SB

      What is the device on your arm?

    20. AK

      It's an insulin pump.

    21. SB

      Yeah.

    22. AK

      So Stephen, your body produces insulin. Most people who are probably listening to this, they, their body probably also produces insulin, unless they have type 1 diabetes. And so when my body no longer produces this molecule anymore, there's gotta be a way to get it. It sits on my arm 24/7 because it's a way of essentially packaging a pancreas that I don't have anymore and putting it on my arm. And, and as, and a way of getting that same type of, of insulin.

    23. SB

      And you have a CGM as well.

    24. AK

      Yeah. So on my stomach here, so on my stomach here is a CGM.

    25. SB

      Which is a continuous glucose monitor.

    26. AK

      A CGM is a way of tracking sugar levels or glucose levels.

    27. SB

      And both of those devices link to your phone, which is in front of you. Um, I'll throw that up on the screen so people can see-

    28. AK

      Yes.

    29. SB

      ... what that, what that kind of looks like.

    30. AK

      So on this device, you have a green line that is glucose levels, okay? My blood sugar says that it's 109 right now, which means that the interstitial signal of glucose is-

  4. 9:24 – 13:20

    High Blood Sugar Is the Biggest Cause of Long-Term Health Problems

    1. AK

    2. SB

      Um, I've actually, I saw you, a clip of yours that I was watching earlier that said you think having high blood sugar over a long time is the biggest cause of long-term health problems.

    3. AK

      When you're focused on improving your overall health, you have to find out what matters most, right? So what, what's the hierarchy, uh, uh, in the health, you know, one, two, three, four, five? What matters most on that? And we can look at that by looking at risk factors, uh, for future disease. Well, the number one cause of death in the United States and across many parts of the world is cardiovascular disease. Well, it's also the number one cause of death in people with diabetes. And when you look at what are the strongest predictors of developing some form of cardiovascular disease, a measure called HbA1C comes up at the top. HbA1C is a, an average measurement of your blood glucose over a two to three-month period of time, and that is incredibly powerful at predicting future risk for, let's say, diseases of the eye, diseases of the kidney, or even cardiovascular disease. And so when I think about how do we tackle, uh, improving health or in, in, as particularly in these, these common, much more common diseases, glucose control sits at the very top of that pyramid. And if unregulated, it's equivalent to an analogy I often use which is you're, you're driving a car and you're focused on what type of rims you have, but you don't even have an engine in the car. Like your engine doesn't work. Or you don't have an, uh, a chassis or an axis, but yet you're, you're focused on rims or a sound system. And so the number one factor, particularly in diseases like diabetes, that matters most is HbA1C.

    4. SB

      So does that just mean that we should be eating less sugar?

    5. AK

      So if we wanted to control the most powerful risk factor in diabetes, we would need to understand how to regulate it, right? So then let's look at the science of this. Well, the science says that carbohydrates, food is the most potent factor in regulating elevations in glucose at every single meal of the day. Well, most people are eating three to four plus meals every single day. And so the very first logical thing to look at is food, because what you're consuming has the most potent impact on glucose control, and glucose control has the most potent impact on your health not only today, but in the future. And so focusing on, on nutrition makes sense. But this isn't like a new phenomenon. We've known that nutrition could be potentially lifesaving for people. There's a, uh, uh, you know, there's something called a ketogenic diet, if someone's heard this before. It's a diet that dramatically reduces the amount of carbohydrates in the food, and the dramatic reduction in carbohydrates in the food was used to save lives.... of patients with type 1 and type 2 diabetes since there was the first report ever known, to my knowledge, is in nine- or 1796, by a gentleman named, a physician called John Rallow. He published a report on two cases of diabetes mellitus using basically a carbohydrate-replete or reduced diet to resolve the disease. But we know that some of the most premier diabetologists, meaning people who study diabetes or treat people with diabetes, were utilizing these strategies for over a hundred years, before we then discovered in 1921 that this diet could also help neurological disorders like seizures and beyond. And so the, the phenomenon of nutrition playing a role in overall health is, is certainly not new. It's actually only recently that we're rediscovering century-old wisdom of what nutrition can do for overall health, uh, due to the emergence of a explosion in science that has really drove a ton of public interest into this kinda unique dietary strategy.

  5. 13:20 – 18:17

    The Keto Diet

    1. AK

    2. SB

      So the ketogenic diet, then, um, it's a diet that I'm familiar with, because it's a diet that I cycle in and out of throughout the year. Probably I'm in a ketogenic state three or four times a year.

    3. AK

      Yeah.

    4. SB

      And I use the little keto reader just to check-

    5. AK

      Yeah, yeah.

    6. SB

      ... my blood ketone levels. What is th- what d- for anyone that's unfamiliar with the keto- ketogenic diet, I, I, I'm a bit of an advocate for it, so I'm fairly familiar. But I, I, that's also taught me how unfamiliar people are with it-

    7. AK

      Yeah.

    8. SB

      ... because I don't talk to my friends about it, and there's a lot of misconceptions.

    9. AK

      Yeah.

    10. SB

      If you're on a ketogenic diet, what are you eating?

    11. AK

      So typically w- when someone visualizes a ketogenic diet, I think there's a lot of misinformation, they think it's just steak and bacon. Um, and I guess for some people it might be that. But it's actually, uh, if we're talking about a well-formulated ketogenic diet, we're talking about green leafy vegetables, things that we typically associate with health. You know, salads, uh, broccoli, asparagus, cauliflower, these kind of, uh, nutrient-dense, green leafy vegetables, uh, that are high in fiber and phytonutrients. Then you also have protein as a component of that. That can come from meat, that can come from fish in the form of salmon, eggs, uh, cheeses, a little bit comes, uh, along for the ride in things like nuts. And then you also have the rest of the diet, which is made up of fat, and this can come a lot of times from, um, various plant forms. This can come, you know, from like olive oil, avocado oil.

    12. SB

      And what are you removing then?

    13. AK

      Sugary, starchy carbohydrates. So you're, you're, you know, you're not having bagels, you're not having donuts. Um, white rice, pastas, these type of foods, the reason they're not a part of this diet is because these foods rapidly elevate blood sugar levels, and the rapid elevation in blood sugar also spikes insulin. Insulin shuts down fat breakdown and the ability to take that fat to the liver. The liver built this amazing mechanism to be able to convert fat to ketone bodies. Because ketone bodies, fat can't actually, long-chain fatty acids, which is the primary form of fat that you consume in the food you eat, and also the type that's broken down from your own fat tissue, can't readily cross the blood-brain barrier. And we know that glucose is a fuel for the brain, but what happens if you fast or you don't consume a lot of carbohydrates and you have low insulin levels and you can't con- transport the fat, which is now your primary fuel source on a ketogenic diet, because you reduce glucose or carbohydrates in the diet, which causes a reduction in glucose? The reduction in glucose lowers insulin, and the reduction in insulin causes fat to be rapidly broken down, and now becomes your primary fuel source.

    14. SB

      And so there's an evolutionary basis for this, right? 'Cause once upon a time, we might have gone long periods of time without eating something, and so our body turns inwards and starts using our fat stores as a mechanism to, to, to fuel our body, and that's why it produces ketones.

    15. AK

      Basically, the evolution of this diet was believed to be a cyclical, s- meaning a on-and-off pattern in human history. Because if we were to go through bouts of abundance in food, we'd probably consume it as much as we can in one moment, and then we're seeking the next meal, and seeking the next meal. What happens in that in-between time? If you're 100% reliant on having food 24/7 like we do in our current food environment, you would never survive evolutionarily beyond a few days. With the ability to switch from a carbohydrate-based metabolism over to a fat-based metabolism, we store months and months and months of fat energy in the event that we don't have nutrients. So it's, uh, one of the most powerful survival mechanisms we have to survive, uh, moments of famine. But we also have known since bibl- times of biblical text that fasting has therapeutic potential. You know, most potently in, in the ability to what would be described as attenuate seizures, you know, convulsion-like behavior was described when you just completely eliminate food. It's actually a common strategy in many religious practices because of its, quote-unquote, "healing" properties. Well, now we actually know that fasting induces a state of ketosis, and we know that ketosis is actually shown to, in many of these cases, have a therapeutic impact in many of these environments, like a seizure, like seizures. We've known since 1921 out of the Mayo Clinic that ketogenic diets not only mimic the physiology of fasting, but also attenuate the seizures in children with epilepsy. And that work has subsequently gone on to Johns Hopkins and other research institutes to show that this is a very verified strategy for not just epilepsy, but it has been used for obesity, type 1 diabetes, type 2 diabetes for, for centuries at this point, um, and it all starts with the reduction of carbohydrates in

  6. 18:17 – 21:29

    Regulating Elevations in Blood Glucose

    1. AK

      the diet.

    2. SB

      One of the things that's been most beneficial to me, but also I know Joe Rogan has talked about this before, is as a-

    3. AK

      Yeah.

    4. SB

      ... sort of a podcaster that spends a lot of time talking, you notice high variance in your ability to think, articulate yourself-

    5. AK

      Yeah.

    6. SB

      ... for long periods of time based on my blood ketone levels and-

    7. AK

      Mm-hmm, yeah.

    8. SB

      ... my, my so- uh, my diet broadly, um, but specifically the amount of...... ketones that are in my blood. W- why is that? Why is it that I feel like I'm more effective in communication and thinking when I'm on the ketogenic diet or taking exogenous ketones versus when I'm having a normal, Western, high- higher carb diet?

    9. AK

      A lot of people would know why this is if they had the same tools and insight that type 1 diabetes gives. Because when you're consuming that diet, what is often happening is near constant elevations and dips, elevations and dips, highs and lows in blood sugar levels that we know are ascribed to changes in energy levels. So we know that high blood sugar levels, uh, uh, uh, someone can Google if they're, uh, they're so interested to look up the term high blood sugar, hyperglycemia, or low blood sugar, or hypoglycemia, and just type in symptoms. And you'll see a laundry list of things like fatigue, irritability, lack of concentration, uh, shakiness. These are all symptoms of a lot of what you're describing, right? Which is change in your, your, your ability to concentrate, your energy levels. It's a very, very clear that glucose levels are linked to that. We also know that the ch-

    10. SB

      Ju- just to be clear, so is that when I'm at the high or the low in the glucose? If I, you know, if you, if you ate one of these right now-

    11. AK

      Yeah.

    12. SB

      ... what are these, oranges? What, tangerines?

    13. AK

      Oranges, yep.

    14. SB

      Um, if you ate one of these right now, your blood glucose levels are gonna go up, presumably?

    15. AK

      Yes, because these oranges are composed of bound sugar molecules together. So most fruit has a structural component to it, which is why you see, uh, an- it's, it, it has like a, has, is, has mass to it, right? Uh, it's not just a liquid. And then that structural component binds together as a part of it sugar that's bound together. They call them polysaccharides. And those polysaccharides, when you consume them, your gut actually takes those, breaks them down into individual glucose molecules to then be absorbed into the bloodstream. That's when the insulin's released. That's when insulin takes that glucose and stores it into tissues like the muscle and the liver, uh, for future glucose needs. Uh, and so yes, we would presume that with this, high, or oranges, or even most fruits, pastas, rices, would all elevate blood sugar levels. But then that accompanies with a high insulin load, right? So the more of the oranges, the more insulin that you would need. And, you know, despite many of these foods we consider very healthy, those with metabolic disease or metabolic dysfunction may not, may have a, be more vulnerable to even what would typically be considered healthy foods. Um, and type 1 diabetes is a, is a powerful example of that.

  7. 21:29 – 25:56

    Food Patterns Through Evolution

    1. AK

    2. SB

      So you said you'd, you're open to eating one of these. We've got your-

    3. AK

      Yeah.

    4. SB

      ... blood glucose and insulin levels, which we're gonna put on screen for people-

    5. AK

      Yeah.

    6. SB

      ... that are watching, and it'll be interesting to see how-

    7. AK

      Yeah.

    8. SB

      ... quickly we see that orange, which is considered a health food by many people, have an impact on your glucose and insulin levels.

    9. AK

      So yeah, so I, so what I'm, I'm gonna do is ... Normally I would, I would never do this. (laughs)

    10. SB

      (laughs)

    11. AK

      Um, but I, I think it's very important for people to understand, especially those at home who either have a chronic disease, which is most Americans at this point, or kids who have a, uh, a disease like diabetes, what the impact really could be. So let's say ... Oranges are considered a superfood, uh, by the American Diabetes Association. So it's a fruit, highly recommended by almost every organization in the USDA, A- or USDA, American Diabetes Association and beyond. The amount of orange, it's three oranges. Three oranges is probably gonna make up around, eh, 70 to 90 grams of carbohydrates. For me, my energy needs is around, calculated at around 3,000 calories per day. Now the activity I'm consuming, if I were to eat the amount of carbohydrates recommended per day, which is around 55% by, let's say, the USDA guidelines, that I would need to consume at least or more than this at the lea- if I split up all my calories over four meals. And so this is an opportunity to see what this will actually do to blood sugar levels and type 1 diabetes. If you consume what would be a near equivalent to around a fifth the amount of carbohydrates that I would consume per day if I was on a standard diet.

    12. SB

      The, the ketogenic diet, it, they typically say that to stay within it, you need to be below f- is it roughly 50 grams of carbohydrates a day?

    13. AK

      It, and it's roughly, because 50 grams of carbohydrates per day is a rough number that we suspect most people will be able to get carbohydrates low enough to where insulin would be sufficiently low to produce ketone bodies.

    14. SB

      Okay.

    15. AK

      Yeah.

    16. SB

      So there's variance depending on your insulin sens- sensitivity and-

    17. AK

      Yep.

    18. SB

      ... insulin response, and I guess body weight as well is gonna be a factor.

    19. AK

      Big factor. Major factor, because any time you're talking about things like, uh, glucose, insulin, there's always very individualized responses to each individual person.

    20. SB

      I don't really, I don't, I try and stay away from fruit these days. I don't know why it is. I mean, I, I have berries and raspberries and stuff-

    21. AK

      Yeah.

    22. SB

      ... like that and ... 'Cause people tell me there's, like, polyphenols in blue- black- blackberries.

    23. AK

      But those are totally con- uh, co- cohesive with a ketogenic diet.

    24. SB

      Yeah.

    25. AK

      Because they're higher in fiber, so, like, you know, half of what you're consuming, not half, but a large portion of it's fiber. So it's more about the net carbohydrates. The, it's the, the glycemic metabolic impact of the food. So if the fiber's non-digestible, which in fruit it isn't, then it shouldn't, doesn't count, right? So higher fiber content, most of the vegetables on a ketogenic diet are higher fiber.

    26. SB

      Mm-hmm.

    27. AK

      You know, because, you know, it's the, it's the total carbohydrate to fiber ratio, so the net carbohydrates that really matter. Because that's the amount of, that's the metabolic, real metabolic impact of the food.

    28. SB

      Okay.

    29. AK

      Yeah.

    30. SB

      A lot of f- a lot of keto-friendly foods say, like, net carbs one gram or something, but you look at it and you go, "Fucking ..." It says 20 or ...

  8. 25:56 – 33:32

    What Do You Notice When You're in Keto vs. Not in Keto?

    1. SB

      If you've been in a ketogenic diet since you were diagnosed with diabetes, have you cycled in and out of it yourself? And if so, what have you noticed in terms of when you are in that diet and when you're not?

    2. AK

      So I actually came across this diet a little over a decade ago. What I found is that almost every blood meter that I was taking ... This is before CGMs were present. I had to just prick my blood, you know, six to 10 times a day to see what my blood sugars were. I was finding that I was very rarely outside of the normal range, and I was also finding that I wasn't f- feeling these extreme highs and lows anymore. When I transitioned to a ketogenic diet, almost immediately my insulin requirements dropped substantially, uh, around 40, a little over 40%. So the, uh, the amount of insulin I needed to take dropped dramatically, but I didn't have continuous glucose monitor. I didn't have this instant feedback of, like, "What is my blood sugar doing?" I just know I needed a, a heck of a lot less insulin. And so what happened was I went into my doctor's office at the time, he happened to be the American Diabetes Association president at the time, he's like, "I've never seen a blood sugar level in the normal range with someone with type one diabetes before." He said, "Wh- what are you doing?" From that point forward, that's when (laughs) for me, it like transitioned, Steven, into like a, a lifelong journey of like, wow, you know? Obviously nutrition had a huge impact on me losing weight when I had obesity. Now it was directly regulating this very powerful disease where upon diagnosis, nearly all patients are gonna have high and variable glucose levels for the rest of their life. 99% of patients will never see normal metabolic control again for their life. 100% of them are expected to get insulin resistance, and within three years we see neuroanatomical changes within the brain of children who are diagnosed.

    3. SB

      What does that mean?

    4. AK

      So it means that when we look at MRI scans of the brain, we see that children with high and variable glucose levels with this disease, with type one diabetes, they have shifts in the type of white and gray matter. The, the sections of the brain that are associated with normal brain development in childhood, they're not developing the same way. We, and we see this within three years, and it's directly linked to the poor glucose control. We also know that we see signs of the early signals of atherosclerotic progression in children within four years.

    5. SB

      Atherosclerotic pro- progression. What's that?

    6. AK

      So one of the primary causes of death in individuals across the world is cardiovascular disease. And how do we get that? Well, you have changes in your blood vessel and how it functions is the first and earliest signal of future, what'll ultimately be plaque or this kind of blockages within the blood vessel which ultimately cause things like heart attacks or strokes. Well, in type one diabetes, we see that children who have high and variable glucose levels, again, 99% of patients are expected to just live this way for the rest of their life if they follow standard of care, if they follow the doctor's orders. They're gonna see changes in how their blood vessels literally functionally and structurally change. Their blood vessels will now shift from being this very compliant, uh, almost like a, a smooth wave to that blood vessel now becomes very rigid. It starts to build collagen and, uh, more and more collagen around it, becomes stiffer and stiffer. It's almost like taking a hose and turning on a hose and pinching the hose. When you pinch the hose, as you g- it, uh, becomes stiffer, and as you shrink the size of the blood vessel, it goes faster. And so we can measure that by the speed of the blood in the body. Another clear signal and one of the most powerful signals that the blood vessel is starting to change before you see plaque, before you see blockages, I mean, decades prior, these are all happening in childhood, by the way. You know, 10 to, you know, 10 to 14-year-olds with, diagnosed with type one diabetes, we see that the blood vessel isn't able to respond to what they call sheer stress, Steven. So that means, let's say you go for a run, uh, this morning, Steven, and your blood pressure initially increases because as your heart rate increases, the speed of the blood increases, the amount of pressure on the vascular wall increases. That, the, the phenomenon when the blood moves fast through blood vessels, it, it causes stress against the blood vessels. That's not a bad thing. It's actually a signal for the blood vessel to release something called nitric oxide. Nitric oxide is a potent, called vasodilator. It causes the blood vessels to open up, and this is how your body responds normally to stress, okay? You go for an exercise, vasodilation or y- vasoconstriction then vasodilation. Um, or, you know, and these are normal responses the body has. Well, what happens in type one diabetes very early on is that the ability to produce nitric oxide is diminished. You're not able to respond to high stress loads. So not only are the blood vessels becoming stiffer-... but now the blood vessels aren't able to even respond as well to the stress. And so, as you're looking at this and you're looking over time, you see these early signals of atherosclerotic progression. You also see very early on that it was once expected that all patients with type 1 diabetes would have eye damage, some form of eye damage called retinopathy, where you start to lose vision, eventually can go blind within 20 years of diagnosis, so most people are diagnosed in 10 to 14 years of age. Which means by 30 to 34 years of age, you're gonna see a lot of patients who have altered eye function and/or some who are blind. Now, that has extended out over time, but we know that all patients with this disease, because of high and variable glucose levels, are expected to get at least one complication in their lifetime if they follow standard of care advice today, even with the best technologies out there. There is no pharmaceutical intervention, there is no technology that normalizes this disease. And the effects of these high and variable glucose levels and insulin resistance that accompanies it is cumulative, dose dependent, and not completely reversible, which means that once you're diagnosed, the clock starts ticking. It ... Just like smoking, the more you do, the earlier you do it, the earlier the impact and the more lost life you probably will get.

    7. SB

      And there's a study done with 326 participants that found that the keto diet can increase glycemic control of patients with diabetes. That was in the Precision Nutrition publication. When it says it can increase glycemic control, what does that mean?

    8. AK

      So-

    9. SB

      Is that what we were talking about there with-

    10. AK

      Yes. So if you ... When you do a diet known as a ketogenic diet, you're reducing carbohydrates. Well, when carbohydrates are consumed, they elevate glucose levels. Well, if you dramatically reduce the amount of carbohydrates consumed, you're not having those same type of glucose elevations and fluctuations because you're not consuming the most potent glucose-elevating factor in our life, which is carbohydrates. And so when they talk about improvements in glycemic control, it is the measure of 24-hour over multiple day levels of glucose in the circulation, and how well is that being controlled within a normal, healthy range.

    11. SB

      And

  9. 33:32 – 35:19

    Should We Be Restricting Carbs?

    1. SB

      so is your goal then to encourage people to restrict carbohydrates-

    2. AK

      Hmm.

    3. SB

      ... in their diet? But, you know, because carbohydrates and sugar have been somewhat, I guess, demonized because, uh, you never really hear many good things about sugar.

    4. AK

      (laughs)

    5. SB

      Um, so, so what is-

    6. AK

      Yeah.

    7. SB

      ... your, what is your goal here? What is the advice to the listener? Is it to restrict their, their carbohydrates?

    8. AK

      To be very conscious of what they're consuming because nutrition has a empowerful (laughs) potent impact on overall health. And for those patients who have chronic disease, which is unfortunately the overwhelming majority of us, yes. Carbohydrates can be a very, uh ... Restricting carbohydrates can have a powerful therapeutic effect on diseases like type two diabetes. The American Diabetes Association in their 2019 consensus report described type two diabetes as the most evidence-based nutritional strategy. We know that it can have potential positive impacts on things like, uh, Alzheimer's disease. There are studies that have looked at this. We also know that for-

    9. SB

      Carbohydrate restriction we're talking about here?

    10. AK

      Yes. Yep. So, and I like to term this therapeutic carbohydrate restriction because it's the therapeutic outcome of a carbohydrate reduction. Um, and that's really the goal of this is can you improve your overall health? Many people will just do this simply to improve, you know, to lose weight, to feel, like you say, to feel more cognitively alert. But in my case where you're along, further along the metabolic spectrum with diseases like diabetes, it has a even more, uh, potent impact on how you feel, even more potent impact on your overall health. Um, and but unfortunately about 93% of Americans have some form of metabolic derangement, uh, as cited by multiple studies and multiple research groups.

    11. SB

      You

  10. 35:19 – 38:39

    10-Year Study on the Impact of the Keto Diet

    1. SB

      did a 10-year study on the impact of the ketogenic diet on a patient that had type one diabetes. I think this is, this is most certainly the longest study ever done of its type where you took one individual and over 10 years you, I guess, controlled their diet?

    2. AK

      So we had access to the ability to monitor, uh, a unique patient who had type one diabetes, and they were diagnosed and had followed the American Diabetes Association diet, a healthy diet, for six years and then switched over in 2013 to a ketogenic diet. Upon the initiation of the diet and post, they had DEXA scans. They controlled their calorie intake, their body composition. They weren't taking any additional medications. And we were able to monitor the impact over a 10-year period while controlling all those variables. And why that's so important is because one of the common concerns of a ketogenic diet is th- the hypothetical risk it can increase cardiovascular disease. And the reason that they think that it can increase cardiovascular disease, or it's hypothesized that it will, is because of the elevation in LDL that often accompanies an increase in saturated fat in a diet. Now, saturated fat comes from things like animal proteins. Uh, it's in coconuts as well. What we found is that despite a near doubling in LDL cholesterol on this diet, which again should be associated with worsening cardiovascular health, we did an advanced cardiovascular assessment in, in this patient and found that despite doubling LDL, they had maintained completely normal glycemic control, which again-... based on all the data, says the number one risk factor. They reduced their insulin load over 40%. And their cardiovascular health was not only better than the average patient of similar age and sex with type 1 diabetes, it was better in almost every single category than people even without type 1 diabetes, despite the doubling of LDL cholesterol. It illustrated that over a 10-year period, it maintained not only no sign of cardiovascular disease, but remarkable cardiovascular health. And in fact, we actually followed on that study with the largest ever analysis of the impact of nutrition, particularly carbohydrates, in over 46,000 patients with type 1 diabetes. We showed that in over 70% of all reports of very low carbohydrate ketogenic diets, that patients were completely able to normalize their glucose control, normalize the most potent risk factor for the disease of type 1 diabetes.

    3. SB

      And is this ... This is a sort of a spectrum of ... I'll put that on the screen for people to see, the different sort of stages and categorizations of being normal, prediabetic and diabetic, right?

    4. AK

      Correct, yeah. So normal is, is anything less than 5.7% HbA1c. Prediabetic is that 5.7 number up to 6.4. And then diabetic is anywhere between 6.5 all the way up into essentially, uh, there's no cap on how high that number can go.

  11. 38:39 – 43:13

    Your Blood Sugar Levels Have Risen

    1. AK

    2. SB

      I, I mean, I noticed your, your blood su- sugar levels have, uh, risen quite dramatically.

    3. AK

      Yes.

    4. SB

      Rising to the-

    5. AK

      So what you see initially is, is, uh, probably only the first phase of this, right? So started at an average of around 100 milligrams per deciliter on average, and once the food is then consumed, 'cause once you consume the food, it takes some time to break down into glucose. That glucose then goes in the blood and then the blood then moves glucose into this compartment around the cells, what's called the interstitial fluid, and now we're starting to see the direct impact of just consuming probably a fifth of the amount of carbohydrates I should consume from a superfood. Um, this, you know, oranges are considered both a citrus and a fruit, and it's considered like a superfood by the American Diabetes Association, uh, in the context of diabetes.

    6. SB

      So when the glucose spike is high, so you've just eaten some oranges, the spike is going up-

    7. AK

      Yeah.

    8. SB

      Wh- wh- what does someone feel? And then what do they feel when it's then crashes down and goes below? Because it started at about 100-

    9. AK

      Yeah.

    10. SB

      ... so I imagine that it's gonna go up to whatever it goes up to-

    11. AK

      Yeah.

    12. SB

      ... and then it's not gonna drop back down to 100. It's gonna drop below 100 typically in a, in a normal, um, nondiabetic person, right?

    13. AK

      So 100's right around the, uh, normal, so what you'd hope would happen is that you're gonna s- go up just a little bit, insulin's gonna respond quickly, and then you're gonna come back down to normal if you have total healthy metabolic function. Again, the vast majority of us do not. But in this case, what's gonna, what would be predicted to happen is that as blood sugar elevates and insulin responds, it's gonna go as high as the amount of glucose that's present in the food, okay? But at the same time, the, my pod is also, which is holding my insulin, is immediately trying to respond. It's immediately trying to say, "Okay, oh, no, we need to bring this and keep this into a normal range," um, and so it's trying to release insulin. And so you can see on the screen that there's this massive uptick in the blue line, which is, uh, the initial response in insulin immediately to the elevation in glucose. This is exactly what happens in normal physiology, yet no one can measure it. But you can see it here.

    14. SB

      So how would I feel when the glucose spike is high? Uh, do I feel energetic, do I feel focused, or do I feel tired?

    15. AK

      My personal experience here, Steven, is that as blood sugar becomes very high, I, I become ... my focus reduces, my ... I become fatigued. Uh, I can also, according to my wife, become irritable.

    16. SB

      Mm-hmm.

    17. AK

      Um, and, uh, you, but you can even, uh, look this up. You know, you can look up, what are the symptoms of hyperglycemia? What are the symptoms of elevated glucose levels above the normal range, which is normal is 70 to 120? That's when you can start to see, uh, very clearly that the evidence over time has shown a, a very clear impact on not only how you feel physically, but also your mental health status as well.

    18. SB

      Oh, I've just looked up the symptoms here and it says, um, the common immediate symptoms of having a high glucose spike is you feel thirsty, dry mouth, um, frequent urination, headache, brain fog, fatigue, sluggishness, blurry vision. Um, and then once you go down and you crash, where your glucose really drops below the normal range, what do you feel then typically?

    19. AK

      So a lot of how I like to describe this is almost like imagine you're outside and it's sunny outside, and you're having a great day, great conversation with other friends, and then all of a sudden, very rapidly, clouds come over top. Everyone kinda dissipates and it starts to rain. It's almost like it, it, it, it, it's we know that glucose levels have a direct impact on the neurobiology of the brain, meaning how the brain functions, how it operates, and particularly at very high glucose levels, you know, typically above 180 milligrams per deciliter, you start to see signals of inflammation, signals of stress, like oxidative stress in the body, if people have heard of tho- that before. And that can start to cause damage on tissues and cause a stress response, but the problem here, Steven, is that most patients are living there 24/7.

    20. SB

      I was looking at some of the symptoms here and it says the short term crash that you get after a spike, um, after a rapid rise is a bit of an insulin overshoot. So it's reactive hyperglycemia, which is the sugar crash, and then you might feel, in that crash, jittery or shaky, hungry, often craving carbs.... and sugar again, irritable, anxious,

  12. 43:13 – 44:21

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    1. SB

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  13. 44:21 – 52:09

    The Keto Diet and Physical Performance

    1. SB

      You did a study in 2025, I believe, on the impact of the ketogenic diet on physical performance?

    2. AK

      You know, if the ketogenic diet has all these therapeutic potentials, you know, going back for over two centuries, what is truly the impact of it on performance? Because that's one of the primary reasons where if someone were to walk into a, a clinical setting and say, "Well, yeah, you can do this, but I've heard it's gonna decrease my performance."

    3. SB

      Physical performance.

    4. AK

      Physical performance. And so we were very, very interested in this because we thought, okay, it... You know, when we look at why carbohydrates are currently being recommended as sports nutrition is because since 1921, they've been shown to improve performance. And how they showed that in 1921 was that physicians out of Harvard and, um, in Boston actually watched Boston marathoners, half of which who would c- wouldn't even finish the race, slurred words. They would, uh, have, like, almost pale skin, shaky, weren't able to articulate their words, or some wouldn't finish at all. And what they were finding was that these... when they tested the blood of these individuals, that they were finding that glucose levels were low. Basically, they reached what they call hypoglycemia. It's a medical term to describe very low blood sugar levels. And then next year, they provided carbohydrates and these marathoners in the Boston Marathon, and all of them improved their performance. And so since 1920- or n- not 1925, actually, we've known that carbohydrates can improve performance. But we- what has happened though over time is that in 1960s, we... there was a measurement technique called the Bergstrom method where you actually did a muscle biopsy and pulled out muscle tissue and found that, oh, wow, there's actually glucose stored in the muscle. So it must be really important for physical performance if the muscle which is used to contract and move the body during physical performance, that if glucose is in that tissue, it must be essential for performance. And then after they discovered that, there was all these associations between low glucose levels in the muscle, called glycogen, low glycogen, and fatigue. Then after that, the... in the 1980s, they were able to look at the amount of sugar or carbohydrates and fat that the body was burning during exercise. And what they found at that stage is that, oh, wow, it looks like the a- the amount that people are able to sustain intense exercise is proportional to how many carbohydrates they're burning. And then there was a few modeling studies, Steven, that then looked at, okay, what's the relationship between, let's say, uh, the intensity of exercise and what type of fuel you use, whether it be fat or carbohydrates. And they found that... Uh, they modeled it, okay, and said, "Okay, well, at lower intensities, you must burn almost all fat. And at very high intensities, you must burn carbs." And there was a number of studies in 2017 to 2020, three different studies that looked at the ketogenic diet over a five-day to three-week period, and they saw that, in those studies, that there was a decline in performance by around 2%.

    5. SB

      If you were in the ketogenic diet, if you were on the ketogenic diet.

    6. AK

      Correct. Compared to a high carb diet.

    7. SB

      Yeah.

    8. AK

      And so what did that tell these researchers? Well, they said, "Okay, well, obviously the ketogenic diet must impair performance." And there's all this evidence since 1921s that the amount of carbohydrates, glycogen, how much carbs you're, you're consuming, is essential for performance. But here's the kicker, is that one major confounder of all of this is that we've known for quite a long period of time that the adaptation to a ketogenic diet is not one week, it's not two weeks, not even three, it's four weeks or more.

    9. SB

      And when you say adaptation, you mean your body's transition to being in a, a state where it's efficient at burning using ketones?

    10. AK

      So the body's ability to lower its glucose oxidation or the amount of carbohydrates it's burning for fuel, because you're giving your body less of it, the amount of fat that's being utilized for fuel goes up dramatically, and then you produce way more ketone bodies, and ketones are now being used as not only a, a body, uh, tissue substrate, meaning energy for the muscle, but also for the brain. And so it's this transition over. But when people were looking at these studies, they were just looking at some of the metrics of what happens when you, your body transforms when you reduce carbohydrates.

    11. SB

      Okay.

    12. AK

      So what we wanted to do is say, okay, if there's all these health-promoting benefits of a ketogenic diet, that sounds great-... but all these studies and sports dogma would say that it's gonna impair performance. Okay. So, let's test that. Let's actually put athletes on a ketogenic diet for four weeks. We are gonna control not only their calories, we're gonna control their body composition, we're gonna control their activity level. We're gonna control all these key confounders that many of these prior studies never controlled, so that we could truly test the diet-induced, so the macronutrient, meaning the shift from carbs to fat, effect on performance. But we're gonna do it in the same person, so now we're gonna control their genetics, we're gonna control their environment. Once we did that, Steven, we tested what most people think is a, you know, a very glucose-dependent form of exercise. We asked them to do six-by-800-meter sprints. They were on a high-carb diet, and then they switched to a low-carb diet. Now, what happened, this was all randomized, uh, and controlled. When they switched over, they had no deterioration in performance.

    13. SB

      At four weeks?

    14. AK

      At the four-week mark, in a form of exercise that we would expect would be extremely glucose-dependent, extremely carbohydrate-dependent.

    15. SB

      But before four weeks, was there an impairment in their performance?

    16. AK

      So, what we were interested in, Steven, is studying at the end.

    17. SB

      Okay.

    18. AK

      So we didn't look intermediately. We exclusively look at the end timepoint because the, the question was, well, i- if, is there a difference once you stick to this diet? Because if you, you go on this diet, ideally you're, you're sticking with it over time. And so, if it is true that you require carbohydrates, we then also measured how many carbohydrates and fat they were burning during exercise, and it was over what we call 85% of their VO2 max, which means 85% of their total maximum oxygen consumption during exercise. That is when we would expect almost no fat to be oxidized or to be burned, and almost exclusively carbohydrates. Well, we found that these athletes recorded the highest levels of fat burning during exercise ever reported in the literature, illustrating that when these athletes-

    19. SB

      The ketogenic?

    20. AK

      Ketogenic diet. That when these diets adapted to the diet for sufficiently long, they had record levels of fat oxidation even at very high intensity levels, which means that fat was able to provide nutrients and fuel at very, very intense form of exercise when we would expect only carbohydrates would be relevant and utilizable.

  14. 52:09 – 56:27

    Exogenous Ketones

    1. SB

      So many of my friends, um, that are endurance athletes or that are involved in things like cycling talk about exogenous ketones. Um, I'm a c- co-owner of a company that produces exogenous ketones. That's my disclaimer. I've got the product here. What can you tell me about products like this, exogenous ketone products, exogenous meaning ex- externally supplemented, I guess?

    2. AK

      Right. So with a ketogenic diet, you produce them. Your liver produces them for you. With, um, exogenous, you're consuming these. Well, why would you consume them? Why not just do a ketogenic diet? Well, we know that a ketogenic diet takes time to adapt. We just talked about that with physical performance, that we see the, you know, up to four weeks to see the full effect on, on performance, or more. Well, what happens if you're, let's say, a war fighter or someone who's going out into the field or immediately wants to flip into this state? You can't do that unless there was a molecule that you could consume that could rapidly elevate ketone bodies in circulation within minutes. Insert exogenous ketone bodies. We have known since the 1960s that the product in there was studied by MIT, uh, in the aerospace department called 1,3-butanediol, it, that it was able to be consumed and rapidly elevate ketone bodies in circulation. There was a study in 2016 called the Metabolic Optimization, it's a $10 million program from DARPA-

    3. SB

      DARPA being the?

    4. AK

      DARPA is an advanced research organization from the United States government where they fund very high-risk, high-reward programs, and one of which was the, uh, the, uh, the use and testing of ketone bodies. And so that, uh, molecule that they tested was, um, utilized the same molecule that's in there and they kind of, uh, tweaked some of the formulations a bit, and they showed that... and we know that this is the same for this molecule as well, that when you consume them, it rapidly changes metabolism, almost, uh, not identical to what happens with the ketogenic diet, but it has a almost direct impact. It has a blood glucose-lowering effect. It directly binds to receptors like the, um, they call GPR109A or, uh, or some other key receptors that directly, uh, impact inflammation. So, it directly blocks something called NORp3 inflammasome, which is a molecule that leads to increases in inflammation. We also know that it changes the way that our genes are used in the body, called epigenetic signaling. And so the con- uh, consumption of ketone bodies can actually change the molecules on our genes and, and how those molecules are ultimately manifested, and that increases our antioxidant capacity, meaning our ability to block oxidative stress in the body. We, we see all these powerful effects, these s- rapid shifts in metabolism within the body, and this 2016 study showed that just, uh, orally consuming these molecules-... could rapidly shift metabolism, but it was also linked to an improvement of physical performance. But if you look beyond that and just like, uh, these, these kind of studies w- 'cause we looked at them in athletes, we looked at them in healthy individuals, and then also in military settings. But we've also ... There's studies looking at this in patients at risk for cognitive decline, so patients at risk for Alzheimer's disease. They've shown that in a six-month study, administering exogenous, uh, ketone bodies was able to attenuate the decline in, uh, cognition that we know happens with advanced age.

    5. SB

      And just to be clear there, you're saying it reduces the decline. It doesn't-

    6. AK

      Correct.

    7. SB

      ... cure Alzheimer's or fix Alzheimer's or anything.

    8. AK

      Correct.

    9. SB

      It just delays?

    10. AK

      Accurate, yes. It's, it's ... We know that as individuals age, you're on a precipitous or, or steady decline in, in brain function, um, and so the goal is to s- to offset or to stop the decline, you know. That's our goal. We wanna maintain normal, uh, brain function and our ability to think clearly and to understand things clearly like reading and, and doing problems and solving problems.

  15. 56:27 – 58:39

    Exogenous Ketones for Mental Health

    1. AK

      There have also been these emergence of studies in the world of psychiatry. I think there's around 11 ongoing active clinical trials looking at the impact and interaction of ketone-based therapies and brain health, uh, particularly serious mental illness. One in four adults in the United States, uh, actually over one in four adults in the United States has serious mental illness. In fact, I believe over ... The numbers are over 20% of, of adults are taking some type of psycho, uh, altering, uh, medication. At its core, we see all of these relationships between underlying metabolism being a key factor contributing to mental health status, and the application of the, this unique diet, which we know increases ketone bodies which appear to have direct impacts on the brain, now seems to be linked to improved serious mental illness. And it'll be interesting to see where the, that evolves. But it's just a fascinating world to imagine that nutrition, not a medication, not a technology, but the, the simply going to the grocery store and swapping the things you choose in there can lead to these powerful, powerful therapeutic effects, um, in people of all sorts of different conditions, uh, or disorders.

    2. SB

      Um, one of the studies that I read about the administration of exogenous ketones and the impact it has on brain network stability was from 2020 when they investigated if brain network stability responds to two major brain fuels, either glucose or ketones, and participants came to the laboratory on two occasions and drank exogenous ketones or glucose, and after cons- consuming these drinks, they underwent an MRI scan. Strikingly, the study showed that ketones increased the stability of brain networks. In contrast, glucose decreased the stability of the network. The network stability was 87% greater after ketone consumption than stability measured after glucose consumption. And in that study, which is on PubMed, the last line of the abstract says, "Dietary interventions resulting in ketone utilization increase available energy and thus may show potential in protecting the aging of the brain," which is super interesting.

    3. AK

      So

  16. 58:39 – 1:00:08

    Exogenous Ketones Helping With Cancer Body Weight Increase

    1. AK

      we did a study, uh, looking at cancer and applying exogenous ketones in a very aggressive form of metastatic cancer, and what we saw in, in my work in graduate school was that when applying just exogenous ketones that it delayed the progression of the metastatic cancer. But it also, when looking at body weight, reduced the rapid decline in body weight we sometimes see with cancer, a ch- a phenomenon called cachexia, which is a way, uh, a term to describe the wa- rapid wasting of body tissue with disease, and it is no more aggressive than the context of cancer, particularly metastatic cancers where it's most common. And when we saw the lack of decline in body weight, I then looked at where the body weight was coming from, and it was clear that the lack of body weight decline was because of the preservation of, in muscle mass. So it also appeared, and there's been a number of what they call clinical physiology studies, so studies that actually directly manipulate human beings with molecules and tests, you know, like muscle tissues and how they function, we see that exogenous ketone administration can dramatically reduce the amount of muscle breakdown, uh, or, uh, breakdown of muscle tissue, uh, essentially illustrating it may be a powerful mechanism in promoting healthy muscle mass as well.

  17. 1:00:08 – 1:03:19

    Keto Diet and Gaining Muscle

    1. AK

    2. SB

      In terms of being in a ketogenic diet, one of the things I'm always quite concerned about is am I still able to gain muscle mass if I'm in a ketogenic diet because I-

    3. AK

      Mm-hmm, yeah.

    4. SB

      ... I've, I've s- ... When I go into a ketogenic diet and I stop having carbohydrates, I tend to lose weight rapidly and shred.

    5. AK

      Yeah.

    6. SB

      Right? So the fats falls off and I get, uh, uh, very lean, but-

    7. AK

      Yeah.

    8. SB

      S- more skinny.

    9. AK

      You smiled though because, uh, maybe you, you like to be, uh, more shredded. Um, so a phenomenon with the ketogenic diet is so w- there's no deterioration in muscle mass with a ketogenic diet. There have been plenty of studies that have shown that you're able to maintain muscle mass, uh-

    10. SB

      And build it?

    11. AK

      Yes, and build it. So they've shown that as well. So Jeff Volek out of Ohio State University has done a number of studies in this area, um, looking at individuals who were actually on a, uh, uh, reduced intake diet, so they're reducing less calories so they had less energy in the diet and then they were also doing the ketogenic diet. It was actually a military study, and they showed that they were able to maintain, uh, muscle mass just as much as if someone was on a high carb diet, um, while under a caloric restriction, or another way of describing that is like a semi-starve- starving, starvation state.So there's no impact, negative impact that we see with these diets on muscle mass. However, to your per- your personal example, one of the first things that happens when you go on a ketogenic diet is there's a, uh, a natriuretic or natriuresis effect, where basically you reduce the amount of sodium, uh, in the body. So you s- you, you pi- you piss it out basically, and, um, you, so you hold less water weight, and that's one of the first things. That's why people see this rapid shift in body weight initially when they're, you know, on a ketogenic diet, which for many people is great because if they're trying to do it to lose weight, that's like immediate reinforcement. But sometimes it's water weight. Well, water is in both the fat and the muscle, so it's, it's not necessarily that you're losing any muscle mass per se, but it just might be in a phenomena or less water weight. And in some context that might be beneficial, right? If you're in a sport where you have a power-to-weight ratio but you're able to maintain the same power at a lower weight simply by shifting (laughs) water, that's great, um, as long as you're able to function equivalently.

    12. SB

      Is there anything I do need to be thinking about in terms of my diet to make sure I'm still gaining weight just to, I guess, to keep, like, to keep my protein levels high?

    13. AK

      So the most important thing related to your diet when it comes to trying to build muscle mass is to exercise hard and with resistance exercise. Uh, that's the most important thing. When it comes to your diet, to enhance that effect, protein is one of the, the most powerful nutrients you can consume to augment that response. Another is to ensure you're having enou- uh, sufficient calories, right? So if you're in a caloric deficit, so you said that, you know, you tend to eat less calories because you're probably not as hungry, um, well, yes, that's one of the most powerful ways to lose not only fat but also muscle is to just not eat food or-

    14. SB

      I think that's it.

    15. AK

      (laughs)

    16. SB

      Because I, my, I lose my appetite when I, when I'm in the ketogenic diet.

    17. AK

      Yeah.

    18. SB

      I also lose my appetite a little bit when I take these, um, exogenous ketones like Ketone IQ.

    19. AK

      Yeah.

    20. SB

      Uh, and I've, I've seen some of the studies that show that there's a r- roughly 20% decrease in, um, appetite

  18. 1:03:19 – 1:06:22

    Not Feeling Hungry on the Keto Diet

    1. SB

      when you take exogenous ketones according to one particular study that I read. But when I, when I'm in the ketogenic diet, I, it's like food is ... I get hungry, but then I start eating, and I stop very quickly.

    2. AK

      Yeah.

    3. SB

      And it's really bizarre. Like I was, I was in Cape Town for 10 days or two weeks writing my book, and so I had the chef there, and the chef cooks me my food and makes this amazing food, and I'm so hungry. I look at it. I'm like, "Oh, amazing." I start eating it. I have like five or six bites, and I'm done. And only when I'm in the ketogenic diet, there's something going on in my body which just doesn't, just doesn't wanna binge eat like I sometimes did.

    4. AK

      So there's two things to talk about. One is the type of foods you're consuming on a ketogenic diet, and the other is what is happening in your body and your metabolism on the diet. So there's a, a book called Always Hungry by a physician, uh, endocrinologist named David Ludwig, and he's kind of coined this carbohydrate-insulin model. And, um, it, you know, it's semi- somewhat controversial, but the r- reality is that, uh, there's, there's some important notes in it, one related to hunger, which is if you're able to have a fuel source on a ketogenic diet that's sustained over time, so you don't have the up and downs of glucose and up and downs of insulin, so these constant swings, whereas on a ketogenic diet you have this sustained level of fuel influx, right? So you have this nutrient availability in the blood, so glucose levels are much more stabilized. Insulin is much more stabilized, and you don't have those fluctuations, parti- in those specific molecules. That might be one potential reason, but the other potential reason is that when you're on a ketogenic diet, you tend to not consume the type of foods that drive hunger. So again, we talked about in the grocery store, the 70% of the grocery store and particularly in the center of the grocery store, that is highly processed where they combine carbohydrates with, with salt or fat or some combination therein that makes it highly palatable or very, very tasty, you know, increase the dopamine response, this positive reinforcement response of the food. Um, that drives people to, to seek more of that pleasure response, and as a result they wanna consume more. So everyone has probably felt this example where you're in a restaurant, you've eaten enough food to where you feel physically full. You're like, "Oh, I'm totally full." Like, "Uh, ugh, I don't wanna eat any more, more food." Someone walks by with your favorite dessert and you're like, "Oh, uh, well, hmm, I could eat that." You're literally physically full, but yet you want to consume more food. This is a, is a, uh, a phenomenon that has been the struggle of, of, i- in America and the, uh, rest of the world essentially now, um, where the food environment often drives people to overconsume, and it's not by accident. These are like w- well-conducted strategies in the food industry to lead to these positive pleasure responses to-

    5. SB

      I think about this with bread in the restaurant. You know, they give you bread first typically.

    6. AK

      (laughs) Yeah, it's a good, it's a, a solid strategy, Steven, to cause you to wanna consume start to finish,

  19. 1:06:22 – 1:11:08

    The Food Industry Engineers Food to Make You More Hungry

    1. AK

      not only the bread, get a big meal, and follow on with dessert. You know, it, it is a, is a, is a great strategy for ensuring that, but it's also the same strategy that, you know, Doritos is using where like-

    2. SB

      Mm-hmm.

    3. AK

      ... you, you combine this mixture of n- uh, molecules in the food, that you consume it and you go, "Oh, this tastes great."

    4. SB

      Pringles.

    5. AK

      Uh, uh, same exact thing where-

    6. SB

      Mm-hmm.

    7. AK

      ... you combine these different components and it forces you, this, like, "Oh, this tastes great. I need more." And you never feel full. One of the most common tricks that the, the food industry utilizes in these environments is that they, one, they, they certainly are aware of this, right? And so when you consume these type of foods together, they, they know they consume more of it, but, uh, sometimes people aren't even aware of it. And the best example of this, go look at the back of most of the bacon on the grocery store aisle. Go look at the back of most peanut butters, almond butters, nut butters in the grocery store. Most of them have added salt and added sugar-Even to levels where you don't even taste it. But go look at the label. The reason those are added is to increase the flavor profile, the positive brain response to the food, so that you consume more of it, and this is a huge part in why people f- always feel hungry in today's food environment. They're always seeking more food, and they can't get off that hamster wheel. They're always over-consuming or always referring to this phenomenon called food noise, where they always feel the drive to consume foods, or they never feel full. And-

    8. SB

      It's, and it's because of the sugar and the salt?

    9. AK

      It is because the food is composed and made in such a way to be, to have a flavor profile that your brain says, "Not just eat one bite. Eat as much as possible," because we're always seeking these pleasure responses, right? In, I- in our lives, in our world. It's, uh, this is even independent of food.

    10. SB

      So what do we do about this?

    11. AK

      (laughs) So the solution for most people in this situation is to try to focus ... Number one, don't consume liquid calories. That's like a dead giveaway bad move, because those are abundance of calories, will drive people often to over-consume them, and very, uh, drive this pleasure response in the brain that-

    12. SB

      Liquid calories. What's a liquid calorie?

    13. AK

      So let's say you have, uh, a soda-

    14. SB

      Yeah.

    15. AK

      ... or a Coke.

    16. SB

      Yeah.

    17. AK

      So basically, completely void of any, uh, nutrients and really high in calories, spikes your glucose through the roof, insulin through the roof, and then often makes you hungrier afterwards, not less hungry, by having that-

    18. SB

      Like, like orange juice.

    19. AK

      Is, another great example.

    20. SB

      Smoothies. Those, those fruit smoothies people have.

    21. AK

      Exactly. In fact, just taking fruit and then blending it up actually increases the speed by which it's absorbed, changes the hormonal response, and leads to a worse outcome for most people.

    22. SB

      Most people think a fruit smoothie is a healthy thing.

    23. AK

      Yeah, I don't know about that. Um, I would, uh, uh, I think that when you take fruit, which for most reasons isn't terrible, right? Like, it's not ... These are, uh, nutrient-dense f- foods. If people can consume them and get away from them, great. If you have a metabolic disease, you might be more vulnerable to, let's say, glucose elevations. But when you then take foods like that, it could be any foods, it could be taking potatoes and then making mashed potatoes, by simply changing or blending that food up, you are now taking a lot of the structural components that your body would take time to digest, and you're removing them. And you basically almost are like, uh, uh, uh, well, it's turning on like a small hose that's just giving out a little bit of water at a time, and is turning it on all the way. You know, you're rapidly increasing the speed of how the nutrients enter the body, and it completely changes the hormonal response of molecules like GLP-1, and, and normal levels of GLP-1 in the body are completely altered. The insulin response is also altered.

    24. SB

      And GLP-1 sig- is the hunger hormone.

    25. AK

      It's known for being related to hunger because it's released in response to food. It changes the brain's hunger drive, and most people know of it because of-

    26. SB

      Ozempic.

    27. AK

      ... Ozempic, semaglutide, Wegovy, tirzepatide, um, all these GLP-1 receptor agonists that are increasing GLP-1 levels not to normal levels. They're increasing them to super physiologic levels, mean- uh, levels that would never be observed or ever seen in normal settings of the

  20. 1:11:08 – 1:13:05

    Ads

    1. AK

      body.

    2. SB

      I've just invested millions into this and become a co-owner of the company. It's a company called Ketone IQ, and the story is quite interesting. I started talking about ketosis on this podcast and the fact that I'm l- very low carb, very, very low sugar, and my body produces ketones, which have made me incredibly focused, have improved my endurance, have improved my mood, and have made me more capable at doing what I do here. And because I was talking about it on the podcast, a couple of weeks later, these showed up on my desk in my HQ in London, these little shots. And oh my God, the impact this had on my ability to articulate myself, on my focus, on my workouts, on my mood, on stopping me crashing throughout the day was so profound that I reached out to the founders of the company, and now I'm a co-owner of this business. I highly, highly recommend you look into this. I highly recommend you look at the science behind the product. If you want to try it for yourself, visit ketone.com/stephen for 30% off your subscription order, and you'll also get a free gift with your second shipment. That's ketone.com/stephen. And I'm so honored that once again, a company I own can sponsor my podcast. Just give me 15 seconds to explain how you can build a viable business online. The people I see winning in life don't have a perfect plan. They just take the first step, and then the next, and then they keep going. They stay obsessed and they stay consistent. And Stan Store, a platform I co-own and one of our sponsors, is the best first step to help turn your knowledge into income. It only takes a couple of minutes to launch your business and start selling digital products, coaching, memberships, or communities online without any tech headaches or endless setup. Thousands of entrepreneurs, creators, and risk-takers use Stan to take control of their future, because Stan is for entrepreneurs, for those willing to put in the work and bet on themselves. If you're ready to start building, join us. Launch your business today with a free 14-day trial at stephenbartlett.stan.store.

  21. 1:13:05 – 1:18:24

    How Can Our Audience Live a Better Life Practically?

    1. SB

      So I wanna give the audience that are listening some practical ways that they can change their life to live a better life, and to navigate the food environment we live in. But just a, just generally, the advice that you would give if you had the ear of, I don't know, five million people right now-

    2. AK

      Yeah. (laughs)

    3. SB

      ... and you could say something to them to help them live better lives, to perform better, what advice would you give them?

    4. AK

      Number one is, I would say, be conscious of the food you're consuming and what you're consuming on a daily basis. The impact of food is, is equivalent to medicine. It is ...... and sometimes more powerful than medicine. So, uh, what you drink, what you eat, you know, focusing on whole foods, not consuming liquid calories, and if you're, uh, someone who could benefit uniquely from stable glu- glucose levels, lower insulin levels like someone who has, uh, some type of metabolic disorder like I do, reducing carbohydrates oftentimes can be a very powerful strategy; in fact, known to prevent and reverse things like obesity and type 2 diabetes, with emergent evidence, eh, for its potential ability to put things like serious mental illness into remission. But we'll see as more evidence comes out. Exercise on a regular basis. We know that exercise might not be the primary... the lack of exercise might not be the primary driver for why someone is or isn't obese, but we do know that physical activity promotes health. We do know that physical activity, uh, is extremely important for overall wellbeing. And so-

    5. SB

      You've got big muscles.

    6. AK

      Oh, well... (laughs)

    7. SB

      Is that somewhat linked to your, your type 1 diabetes at all? Is that, is that part of your strategy?

    8. AK

      Yeah. Look, I was obese at one point, and so I, I've, since that point, taken a very... I, I've become ob- you know, obsessed with trying to find out how to be, uh, bigger, stronger, faster, optimize my metabolic health, optimize my performance. And so it's been a lifelong kind of self-experiment in that, in that journey. But y- uh, exercise is just important in general, but it's, for me, it's about all the different experiments and, and strategies I can use with exercise, uh, with resistance exercise and beyond to kind of play around with what affects my body, what affects my insulin, how do I increase my overall metabolic health, and what I have seen is that that's directly linked to my performance.

    9. SB

      How often do you exercise?

    10. AK

      I try to exercise every single day. Um, as much as I-

    11. SB

      And, and how, and how long for, and what types of exercise?

    12. AK

      So, what I do right now is I typically do weightlifting for 30 minutes to an hour every s- or six days a week, um, and then I will go, typically ride a bike to jujitsu. So, Brazilian jujitsu, which can be uniquely almost like a mixed exercise, intense exercise, where it's gonna be extremely intense for, like, five minutes, and then you have a one or two-minute break, extremely intense, and then a break. Uh, and I do that typically around five days a week. Um, I also try to purposely engage in some type of aerobic exercise when I can. If I, I wasn't able to do as much jujitsu one day or as much, uh, resistance exercise, I always try to add on some type of cardiovascular work, whether that be a run, a bike, or these Airdyne bikes where it's just lower and upper body. I find those to be incredibly, uh, effective and powerful tools and actually, um, uh, just not causing damage to muscle tissue, but also allowing you to improve your overall cardiovascular health.

    13. SB

      What does your diet look like?

    14. AK

      So, I tend to wake up and not think about food. That's one thing that I've also experienced, similar to you, that when I switched to a ketogenic diet, not only it improved my glucose and insulin, but I also found that with a ketogenic diet, that I don't feel hungry. So, I would wake up and I don't tend to eat food right away. In fact, I enjoy when I don't eat food more so than when I do eat food oftentimes, just because... not because I don't enjoy the feeling of sitting down and having food. I love that. But the experience and lived quality of life of not having high variable glucose levels, high insulin levels, and the uncertainty that comes with that in my daily life, I enjoy the 23 hours or 22 hours of my day where I have this stability, not the, the, the moments in time where I'm introducing uncertainty and variability. To dumb that down a little bit, what I'm saying is that when I, when I don't e- I wake up and I don't eat food, because I find that it... I'm not hungry, but I also find that it makes managing diabetes easier.

    15. SB

      And so do you eat once a day or twice a day, or how often?

    16. AK

      I tend to eat two to three times a day, you know, t- uh, sometimes right before jujitsu or, uh, weightlifting and jujitsu, always afterwards, and always before, uh, sometime before bed. Try not to do it right before bed, um, because it tends to impact my sleep quality a little bit. But I find that I just eat whenever I feel hungry and I try to give myself sufficient protein to be able to respond to the, the exercise that I'm doing.

    17. SB

      So, I've got the first one's about being intentional about your food choices. The second one is about exercise.

    18. AK

      Mm-hmm.

    19. SB

      Anything else?

    20. AK

      Well, sleep's really important. You know, these are, these are, uh, you know, Stephen, this isn't like, uh, oh, like this is the most revolutionary advice of all time, but these, these core foundational components, good nutrition tailored to your specific needs, exercising as much as you can, and getting good sleep are the pillars of health. If you don't have those corrected, then you're wasting your time everywhere else.

    21. SB

      And, uh,

  22. 1:18:24 – 1:23:44

    What Is Something Surprising About Glucose?

    1. SB

      is there anything as it relates to glucose that surprised you? Because you're someone that sees a lot of this data. I mean, you, you, you, you walk around with the, the, the two devices, one that you've mentioned, and you're, you're looking at the insulin and glucose response. Is there anything that people don't understand is having a really pronounced impact on their glucose levels that they wouldn't expect? Like, orange juice is one of the ones that growing up I thought, f- I thought this was a healthy thing.

    2. AK

      Yeah.

    3. SB

      I used to, I used to drink Sunny Delight thinking I was putting all these amazing vitamins in my body-

    4. AK

      Yeah.

    5. SB

      ... and now I actually look back and regret it. And I, you know, not to be judgmental of any parents, because-

    6. AK

      (laughs) Yeah.

    7. SB

      ... parenting is very hard, but sometimes I'll see parents giving their children like a big glass of orange juice, and in my head I just see the glucose spike that that child's about to have.

    8. AK

      It's funny when you mention parenting, 'cause I have a three and a six-year-old at home, and it's amazing when they try one of these foods, these very sugary foods, these very tasty foods, they... (laughs) It's almost like they become incessant on wanting it again. You know, like normal food isn't good enough anymore. Um, a- and I think that's a great illustration of, of what many-... of us adults are, are challenged with on a daily basis. But yet, a l- many people are just unaware of the impact that it's having on their metabolism, impact, I mean, it's having on their hunger, the impact that that's gonna lead to on their future health.

    9. SB

      And is there anything that you've spotted from your experiments with your, your CGM and your insulin device that people should most certainly avoid? So you said liquid calories. Is there anything else that causes a really pronounced or unexpected glucose response?

    10. AK

      Yeah. I- you know, there's so many, honestly, Steven, over time, that it's honest- it's really hard to pinpoint any singular one. A lot of the foods that are out there are, are often surprisingly challenging on glucose levels, on insulin levels, particularly the processed foods, because what happens when you make these food products is that you're trusting the food company to put ingredients in there that you're gonna respond favorably to, that your metabolism will respond well to, and the truth is that that's far from a guarantee, and, in many cases, maybe, uh, less likely than it is likely. And so, yeah, I don't have a singular example for you, Steven. I just ... uh, but I've experienced it numerous times.

    11. SB

      So I've got a, a small list here. Um, sugary drinks-

    12. AK

      Yeah.

    13. SB

      ... white bread and bagels, white rice. That surprised me a lot 'cause I used to think white r-

    14. AK

      Oh, really?

    15. SB

      I used ... I thought, growing up, rice was like a health food.

    16. AK

      Okay, well so, if- on that note (laughs) , white rice, potatoes, pasta-

    17. SB

      All potatoes in any form?

    18. AK

      Sweet potatoes tend to have less of a glycemic response, but it's still gonna have a, a potent glycemic response.

    19. SB

      So mashed or baked potatoes, obviously french fries, yeah.

    20. AK

      Uh, f- oh, for sure french fries. Most of, like, pasta's a big one.

    21. SB

      Cereal? Refined cereals?

    22. AK

      Most cereals are actually worse than the foods that I just described, on blood sugar and insulin, uh, by a long shot, in fact. Uh, mo- (laughs) most of the, you know, these heart-healthy cereals, um, these, these wo- I would never ... Blood sugar would just spike through the roof proportional to the amount I ate, so yeah, it, it ... I wouldn't, I wouldn't be consuming a lot of those. And I think, I think most people at this stage in the, the health and science world would also generally align with, with that, that those aren't necessarily the best foods to consume. We would think, you know, more, more of the less glycemic or less ... foods that have less of an impact on glucose levels, less of a p- impact on insulin levels. You know, one, one thing I constantly hear, especially in the research and clinical community is like, "Well, look, you know, w- not everyone needs to be concerned about that because, you know, people can respond to a lot of these foods just fine." I say, "Well, you're, you're right, except that over half of America has prediabetes, and uh, 90-plus percent have some form of measurement that indicates that their metabolic health is impaired, and over 86, 68% are obese." And now children are affected with these diseases, with obesity and prediabetes at, at around 20%. So it, it's, it's the fact that we are now less healthy than, than we've ever been, um-

    23. SB

      We don't have the foundation to support.

    24. AK

      Correct, and I think w- you know, when we think about healthy nutrition, we think about exercise, we describe them as medicine, but the reality is these are just normal aspects of things you should do every single day because that's what our bodies were made to do. And when we don't do those things, this is when health deteriorates, this is when we're challenging our body to maintain normal health. Um-

    25. SB

      One of the surprising ones for me was dried fruits, and it said, "While dr- while fruit contains natural sugars, the process of drying it concentrates those sugars. This removes the water and can make the sugar more readily available for absorption, leading to a higher glucose spike compared to fresh fruit." Typically, people think of dried fruit as being a health food-

    26. AK

      (laughs)

    27. SB

      ... as well.

    28. AK

      Yeah, I don't, I don't touch those because ... Unless I, I don't have any glucose on me and I ... my blood sugar is going down for some reason and it's da- in dangerously low levels, that's when I consume those foods. Otherwise, I would, I would not consume them just because of how quickly they raise blood sugar levels.

    29. SB

      Do you think

  23. 1:23:44 – 1:27:08

    Should Everybody Try the Keto Diet?

    1. SB

      everybody should try the ketogenic diet?

    2. AK

      Ooh, that is good question. I think ... Wow. What I would say is that you will never know the potential of its benefit or lack thereof if you don't try. Like anything in life, we are, we're left to assume what everyone else is ... Like, you might have ... We've talked about the ketogenic diet numerous times here, we talked about exogenous ketones numerous times here, but if you don't try it, you don't know how it'll work for you. In science, Steven, one of the most important things to appreciate is that we often publish bar graphs, look like this, you know, the ... a, a line, uh, that illustrates the average outcome of a group of people. But what you don't appreciate is that that line or that bar graph is made up of numerous individuals who all averaged to that number. But what if you're the person who's at the very high dot or the very bottom dot, meaning that you're the, what they call an outlier, or someone who responded negatively or positively to that, and then you just follow the average advice that that study showed? Well, "Oh, look, I tried this approach and it didn't, it didn't work for me. Uh, I'm just gonna keep trying 'cause this study said that it, I should." Well, no. You might be the person who was in that study who didn't respond, just like the person on the opposite end of the spectrum who did, who averaged out to the middle.

Episode duration: 1:31:25

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