00:00:00
What can you tell me about this? Well, if you look at the science, it's enhancing cognition. We've seen a 50%
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improvement in how individuals were able to read and absorb information of better decision-m and also we did a study and
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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
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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
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office. So, let's dig deeper. Dr. Andrew Cutnick is a research scientist who's worked on over 100
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studies on metabolic health, diabetes, and the keto diet. And through his findings, he's helping
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people prevent chronic diseases, improve cognition, and optimize performance. 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
00:00:52
supposed to eat, but I still became obese. You weighed about 255 lbs. Yep. And I had no idea how damaging that
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actually was to my body. And I think the vast majority of people also don't, but over 20% of children have obesity.
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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
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always healthy. And it's not by accident. And it wasn't soon after that I ended up getting diagnosed with a
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chronic irreversible disease that obesity puts you at risk for. And that immediately turned into a journey to
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understand how to be healthy. And I came across this diet a little over a decade ago called the ketogenic diet. So then I
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went into the science of this diet and found positive impacts on things like diabetes, obesity, Alzheimer's, serious
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mental illness, chronic diseases. And I was like, "Oh wow." Cuz a lot of people don't realize that many of these are not
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just preventable but also reversible. And you did the longest study ever done of its kind on the impact of the
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ketogenic diet on a patient that had type 1 diabetes. Yes. Let me let me tell you all about it.
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I see messages all the time in the comments section that some of you didn't realize you didn't subscribe. So, if you
00:01:59
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
00:02:05
that anybody that watches this show frequently can do to help us here to keep everything going in this show in the trajectory it's on. So please do
00:02:12
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
00:02:18
and you're on this journey with us and I appreciate you for that. So yeah, thank you
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Dr. Andrew Kutnik. If you had to try and sort of summarize and encapsulate what you spent the last couple of decades of
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your life focused on and really trying to accomplish, prove, understand from the highest level. What exactly is that?
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The core of my mission, Stephen, is really to empower individuals to take control of their own health. It's
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empowering them with science, you know, bridging science to actual action. You know, science is very complex. It's very
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hard to break it down, but having been in, you know, research for the last 15 years and having lived with
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multiple chronic diseases, uh, one of which I reversed and one of which I is irreversible. Um, I I my mission is to
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empower patients with the same tools and strategies I had access to. uh so they can take control to maximize their
00:03:11
health and performance. For the average person who may not be as knowledgeable about health and fitness, what are the areas of health that you've spent the last 15 years researching and
00:03:23
trying to understand? I would call it, you know, Stephen like metabolism in a broad terms. Now I would
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say you know to break that down further for people to understand that metabolism is trying to understand how the body
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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
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glucose levels which I'm sure many have heard of to insulin responses to all this different nuance. A lot of that
00:03:54
comes down to nutrition but it also is things like exercise. Exercise such a powerful impact on metabolism,
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incredibly important for overall health. But from a personal perspective, this journey has been very honestly selfish
00:04:06
for me. I wanted to understand how to get the best performance, the best for health for myself. And I very quickly
00:04:12
realized that uh you know some of the most powerful strategies out there were actually not necessarily the ones that
00:04:20
were being told to me when I went to the doctor's office because I went through some some pretty dramatic moments uh
00:04:25
early on in my my journey with with trying to overcome some of these these challenges.
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So take me back to the start of your story in the earliest context that's relevant to understand
00:04:36
why you became the person you became. I mean, I've got some photos here from your from your childhood which are
00:04:43
Yeah. very very telling. And you know, some of our listeners might be listening on audio alone, so they might not be able to see these these visuals on the
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screen. So, if you could describe some of these these pictures for me when Yeah.
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Um it brings back some powerful memories of uh the challenges with obesity for me.
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Um you know the the picture on the right is just a picture with on a a family adventure um where we went to the we go I go fishing with my dad a lot. You know I'm very heavy at the time. I was, you
00:05:21
know, uh, obese and, um, and the picture on the right here, this really gets me because, um, you know, I did, you did everything I was told, right? I exercised all the time. I ate what I I
00:05:32
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
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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
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America right now is obese. Okay, that means 7 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
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more fat tissue on your body, insulin levels rise almost double immediately before you even have symptoms of obesity or uh tissue damage or organ damage or
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anything along those lines. We know that that almost immediately reduces insulin sensitivity. So how well insulin, this
00:06:22
very powerful fat storage hormone, is able to actually bring nutrients from the blood into tissues. That goes down
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around 34 to 35% uh and early stages of obesity. And just to summarize for a muggle like
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me, insulin is basically the uber which takes things out of your blood and puts them where they need to be. It's essentially like a thermostat for blood glucose. That's how most people know it. So as blood glucose levels
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rise, it works as a thermostat to let's say release cool air to bring it back down. In this case, releases insulin to
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bring blood glucose back into range. As blood glucose drops, insulin is stopped.
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It stops releasing insulin out of these cells called the beta cells. And ultimately, what your body is trying to do is keep the, you know, one teaspoon
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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
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can be life-threatening. in this very very tight range and it build it builds a number of mechanisms to ultimately
00:07:19
make sure and ensure that you don't go outside of that range. But imagine losing the one molecule that directly
00:07:26
controls it. You're wearing two devices I believe on you at the moment. So you've got this
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Yeah. What is the device on your arm? It's an insulin pump. Yeah. So Stephen, your body produces insulin.
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Most people who are probably listening to this, they their body probably also produces insulin unless they have type 1
00:07:43
diabetes. And so when my body no longer produces this molecule anymore, there's got to be a way to get it. It sits on my
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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 and a way of getting that
00:08:02
same type of of insulin. And you have a CGM as well. Yeah. So on my stomach here, so on my
00:08:09
stomach here is a CGM, which is a continuous glucose monitor. CGM is a way of tracking sugar levels or
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glucose levels. And both of those devices link to your phone, which is in front of you. Um, and I'll throw that up on the screen so
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people can see, yes, what that what that kind of looks like. So on this device, you have
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a green line that is glucose levels. Okay, my blood sugar says that it's 109 right now. Which means that the
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interstitial signal of glucose is interstitial meaning within not in the blood but in the tissues. Yeah. So the amount of glucose right
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outside the blood around the tissues and that signal is an indication of the amount of glucose in the blood. That's the green line. Okay, it says that I'm 109 right now. So average blood sugar
00:08:59
levels using milligrams per deciliter is 70 to 120. That's considered normal. Below that is blue lines almost like looks like squares and triangles. Those
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are illustrations of insulin being administered but they're not perfect devices. Despite them being premier and
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you know the most advanced technology on the market, there are significant limitations to them. Um, I have actually
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I saw a clip of yours that I was watching earlier that said you think having high blood sugar over a long time
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is the biggest cause of long-term health problems. When you're focused on improving your
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overall health, you have to find out what matters most, right? So, what what's the hierarchy uh uh in the
00:09:43
health, you know, 1 2 3 4 5? What matters most on that? And we can look at that by looking at risk factors uh for
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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
00:09:57
the number one cause of death in people with diabetes. And when you look at what are the strongest predictors of
00:10:02
developing some form of cardiovascular disease, a measure called HBA1C comes up at the
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top. HBA1C is a average measurement of your blood glucose over a two to three month period of time. And that is incredibly powerful at predicting future
00:10:22
risk for let's say diseases of the eye, diseases of the kidney or even cardiovascular disease. And so when I
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think about how do we tackle uh improving health or in in particularly in these these common much more common diseases, glucose control sits at the very top of
00:10:42
that pyramid. And if unregulated, it's equivalent to 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
00:10:55
in the car. Like your engine doesn't work, or you don't have an a chassis or an axis, but yet you're you're focused
00:11:01
on rims or a sound system. And so the number one factor, particularly in diseases like diabetes, that matters
00:11:07
most is HBA1C. So does that just mean that we should be eating less sugar? So if we wanted to control the most powerful risk factor in diabetes,
00:11:21
we would need to understand how to regulate it. Right? So then let's look at the science of this. Well, the
00:11:26
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
00:11:39
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
00:11:51
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
00:12:04
life-saving for people. There's a a you know there's something called a ketogenic diet if someone's heard this
00:12:10
before. It's a diet that dramatically reduces the amount of carbohydrates in the food. And the dramatic reduction in
00:12:16
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 19 or 1796 by a gentleman named a
00:12:30
physician called John Row. He published a report on two cases of diabetes malitis using basically a carbohydrate
00:12:37
replete or reduced diet to resolve the disease. But we know that some of the most premier diabetists meaning people
00:12:44
who study diabetes or treat people with diabetes were utilizing these strategies
00:12:49
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
00:13:02
in overall health is is certainly not new. It's actually only recently that we're rediscovering century old wisdom
00:13:08
of what nutrition can do for overall health uh due to the emergence of an explosion in science that has really
00:13:16
drove a ton of public interest into this kind of unique dietary strategy. So the ketogenic diet then um it's a
00:13:22
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
00:13:28
ketogenic state three or four times a year and I use the little keto reader just to check my blood ketone levels.
00:13:35
What is the what for anyone that's unfamiliar with the ke ketogenic diet? I I'm a bit of an advocate for it. So I'm
00:13:41
fairly familiar but I that's also taught me how unfamiliar people are with it because I talk to my friends about it
00:13:46
and there's a lot of misconceptions. Yeah. If you're on a ketogenic diet, what are you eating?
00:13:51
So typically what when someone visualizes a ketogenic diet, I think there's a lot of misinformation. and they think it's just steak and bacon.
00:13:57
Um, and I guess for some people it might be that, but it's actually uh if we're talking about a well- formulated
00:14:03
ketogenic diet, we're talking about green leafy vegetables, things that we typically associate with health. You
00:14:08
know, salads, uh, broccoli, asparagus, cauliflower, these kind of uh, nutrient-dense green leafy vegetables
00:14:16
that are high in fiber and phytonutrients. Then you also have protein as a component of that. that can come from
00:14:22
meat that can come from fish in the form of salmon, eggs, uh cheeses, a little bit comes along for the ride and things like nuts. And then you also have the rest of the diet which is made up of
00:14:33
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. And what are you removing then? Sugary starchy carbohydrates. So you're
00:14:44
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
00:14:56
diet is because these foods rapidly elevate blood sugar levels. And the rapid elevation in blood sugar also
00:15:02
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
00:15:16
fat to ketone bodies because ketone bodies fat can't actually longchain 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
00:15:28
from your own fat tissue can't readily cross the bloodb brain barrier. And we know that glucose is a fuel for the
00:15:34
brain. But what happens if you fast or you don't consume a lot of carbohydrates and you have low insulin levels and you
00:15:41
can't con transport the fat which is now your primary fuel source on a ketogenic diet because you reduce glucose or
00:15:48
carbohydrates in the diet which causes a reduction in glucose. The reduction in glucose lowers insulin. The reduction in
00:15:55
insulin causes fat to be rapidly broken down and now becomes your primary fuel source. And so there's an evolutionary basis for this, right? Because once upon a time we might have gone long periods of time
00:16:07
without eating something. And so our body turns inwards and starts using our fat stores as a mechanism to to to fuel
00:16:14
our body and that's why it produces ketones. Basically the evolution of this diet was believed to be a cyclical
00:16:22
meaning on and off pattern in human history because if we were to go through bouts of abundance in food, we probably consume it as much as we can in one moment and then we're seeking the next
00:16:35
meal and seeking the next meal. What happens in that in between time? If you're 100% reliant on having food 24/7
00:16:42
like we do in our current food environment, you would never survive evolutionarily
00:16:47
beyond a few days. With the ability to switch from a carbohydrate-based metabolism over to a
00:16:54
fat-based metabolism, we store months and months and months of fat energy in the event that we don't have nutrient. So it's a one of the most powerful survival mechanisms we have to survive
00:17:06
uh moments of famine. But we also have known since bib times of biblical text that fasting has therapeutic potential. You know most potently in and the
00:17:19
ability to what would be described as attenuate seizures. You know convulsion like behavior was described when you
00:17:26
just completely eliminate food. actually a common strategy in many religious practices because of its quote unquote
00:17:32
healing properties. Well, now we actually know that fasting induces a state of ketosis and we know that
00:17:37
ketosis is actually shown to in many of these cases have a therapeutic impact in many of these environments like a
00:17:45
seizure like seizures. We've known since the 1920 one out of the Mayo Clinic that ketogenic diets not only mimic the
00:17:53
physiology of fasting but also attenuate the seizures in children with epilepsy.
00:17:59
And that work has subsequently gone on to John Hopkins and other research institutes to show that this is a very
00:18:05
verified strategy for not just epilepsy but it has been used for obesity, type 1
00:18:10
diabetes, type two diabetes for for centuries at this point. Um, and it all starts with the reduction of
00:18:16
carbohydrates in the diet. One of the things that's been most beneficial to me, but also I know Joe Rogan has talked about this before is as
00:18:22
a sort of a podcaster that spends a lot of time talking, you notice high variance in your ability to think,
00:18:28
articulate yourself for long periods of time based on my blood ketone levels and my
00:18:35
my sort my diet broadly um but specifically the amount of ketones that are in my blood.
00:18:43
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
00:18:56
carb diet? 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
00:19:09
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
00:19:22
sugar levels, someone can Google if they're they're so interested to look up the term high blood sugar hyperlycemia
00:19:30
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
00:19:41
shakiness. These are all symptoms of a lot of what you're describing, right? Which is change in your your your
00:19:47
ability to concentrate, your energy levels. It's a very very clear that glucose levels are linked to that. We also know that the chain ju just to be clear. So is that when I'm at the high or the low in the glucose?
00:19:59
So if I you know if you if you ate one of these right now what are these oranges? Tangerines.
00:20:04
Oranges. Yep. Um if you ate one of these right now, your blood glucose levels are going to
00:20:09
go up presumably. Yes. Because these oranges are composed of bound sugar molecules together. So
00:20:17
most fruit has a structural component to it which is why you see an it it has like a has is has mass to it right it's not just a liquid and then that structural component binds together as a
00:20:30
part of it sugar that's bound together they call them polysaccharides and those polysaccharides when you consume them
00:20:37
your gut actually takes those breaks them down into individual glucose molecules to then be absorbed into the bloodstream that's when the insulin is released,
00:20:47
that's when the insulin takes that glucose and stores it into tissues like the muscle and the liver uh for future
00:20:54
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
00:21:05
that accompanies with a high insulin load, right? So the more of the oranges, the more insulin that you would need.
00:21:11
And you know, despite many of these foods being considered very healthy, those with
00:21:17
metabolic disease or metabolic dysfunction may not may have a be more vulnerable to even what would typically
00:21:24
be considered healthy foods. Um, and type 1 diabetes is a is a powerful example of that.
00:21:29
So, you said you'd you'd open to eating one of these. We've got your blood glucose and insulin levels, which we're going to put on screen for people that
00:21:35
are watching. And it'll be interesting to see how quickly we see that orange, which is considered a health food by
00:21:42
many people, have an impact on your glucose and insulin levels. So, yeah. So, so what I'm I'm going to
00:21:47
do is normally I would I would never do this, but I I think it's very important for people to understand,
00:21:53
especially those at home who either have a chronic disease, which is most Americans at this point, or kids who
00:21:58
have 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
00:22:12
it's a fruit highly recommended by almost every organization USDA f or USDA American Diabetes Association and beyond
00:22:19
the amount of or is three oranges. Three oranges is probably going to make up around h 70 to 90 grams of
00:22:27
carbohydrates. For me, my energy needs is around calculated it around 3,000 calories per day. Now, the activity I'm consuming, if I were to
00:22:40
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
00:22:52
than this at le 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
00:23:07
and type 1 diabetes if you consume will be a near equivalent to around a fifth the
00:23:14
amount of carbohydrates that I would consume per day if I was on a standard diet. The the ketogenic diet they typically
00:23:20
say that to stay within it you need to be below is it roughly 50 grams of carbohydrates a day? And it's roughly
00:23:26
because 50 grams of carbohydrates per day is a rough number that we suspect most people
00:23:34
will be able to get carbohydrates low enough to where insulin would be sufficiently low to produce ketone bodies. Okay.
00:23:39
Yeah. So there's variance depending on your insulin sensitivity and insulin response and I guess body weight as well is going
00:23:45
to be a factor. big factor, major factor because anytime you're talking about things like uh glucose, insulin is
00:23:52
always very individualized responses to each individual person. I don't really I don't I try and stay away from fruit these days. I don't
00:23:58
know. I I berries and raspberries and stuff like that and cuz people tell me there's like polyphenols and black
00:24:04
blackberries, but those are totally uh co cohesive with the ketogenic diet because they're higher in fiber. So like
00:24:09
you know half of where you're consuming, not half, but a large portion of it fiber. So it's more about the net
00:24:15
carbohydrates. It's the the glycemic metabolic impact of the food. So if the fiber is non-digestible, which in fruit it isn't, then it shouldn't it doesn't count, right? So higher fiber
00:24:27
content. Most of the vegetables on a ketogenic diet are higher fiber, you know, because you know it's the it's the total
00:24:34
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 food.
00:24:40
Yeah. A lot of a lot of keto friendly foods say like net carbs or one gram or something, but you look at it and you go
00:24:46
[ __ ] it says 20. It's total [ __ ] man. Is it? So, oh, 100%. Um, so I I've tested two
00:24:52
different foods that are keto friendly on the label. Same as calories, same as like fat, protein, even fiber. Um, and
00:25:02
they can produce completely different responses. I mean, the food environment nowadays, you essentially need almost a PhD in nutrition or biochemistry to walk
00:25:08
into a grocery store and be able to understand what the hell's on the label. It's it is and I I don't want to sit
00:25:14
here and say like, oh, they they don't know. Like, no, they they know. I mean, there's are companies who have tons of
00:25:20
resources, food scientists galore, and they're putting zero sugar on the label and keto friendly a as a trick because it's associated with health benefits, right? There's all these studies on
00:25:31
ketogenic diets that can they can show to improve health. And so they want to have that on their label. But what is
00:25:36
often happening if you look on the back of the label, there's about a hundred different ingredients they can swap sugar for for something that has the
00:25:42
same exact metabolic effect as sugar. So malitol, maltodextrin, um all these different ingredients that are going to cause glucose to go up rapidly, they'll just swap it and now
00:25:54
you can put on your label zero sugar. Have you been in a ketogenic diet since you were diagnosed with diabetes? Have
00:26:00
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
00:26:05
when you're not? 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
00:26:17
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
00:26:24
I was also finding that I wasn't feeling these extreme highs and lows anymore when I transitioned to a ketogenic diet
00:26:31
almost immediately. My insulin requirements dropped substantially uh around 40 a little over 40%. So the uh
00:26:39
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
00:26:46
is my blood sugar doing? I just know I needed a heck of a lot less insulin. And so what happened was I went into my
00:26:53
doctor's office at the time. He happened to be the American Diabetes Association president at the time. He's like, "I've
00:27:00
never seen a blood sugar level in the normal range with someone with type 1 diabetes before." He said, "What are you
00:27:07
doing?" From that point forward, that's when for me it like transitions even into like a lifelong journey of like,
00:27:15
"Wow, you know, obviously nutrition had a huge impact on me losing weight when I had obesity. Now it was directly
00:27:21
regulating this very powerful disease where upon diagnosis nearly all patients are going to have high invariable glucose levels for the rest of their life. 99% of patients will never see
00:27:34
normal metabolic control again for their life. 100% of them are expected to get insulin resistance. And within 3 years
00:27:43
we see neuroanatomical changes within the brain of children who are diagnosed. What does that mean? So it means that when we look at MRI scans of the brain, we see that children
00:27:54
with high and variable glucose levels with this disease with type 1 diabetes, they have shifts in the type of white
00:28:01
and gray matter. The sections of the brain that are associated with normal brain development and childhood, they're
00:28:08
not developing the same way. We and we see this within 3 years and it's directly linked to the poor glucose
00:28:15
control. We also know that we see signs of the early signals of aththeroscerotic
00:28:22
progression in children within four years. Atheroscerotic progression, what's that?
00:28:27
So, one of the primary causes of death in individuals across the world is cardiovascular disease. And how do we
00:28:34
get that? Well, you have changes in your blood vessel and how it functions is the first and
00:28:41
earliest signal of future what will ultimately be plaque or this kind of blockages within the blood vessel which
00:28:48
ultimately cause things like heart attacks or strokes. Well, in type 1 diabetes, we see that children who have
00:28:54
high invariable glucose levels, again, 99% of patients are expected to just live this way for the rest of their
00:28:59
life. If they follow standard of care, if they follow the doctor's orders, they're going to see changes in how
00:29:06
their blood vessels literally functionally and structurally change. Their blood vessels will now shift from
00:29:13
being this very compliant uh almost like a a smooth wave to that blood vessel now
00:29:19
becomes very rigid. It starts to build collagen at more and more collagen around it becomes stiffer and stiffer.
00:29:26
It's almost like taking a hose and turning on a hose and pinching the hose. When you pinch the hose, as you become
00:29:34
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
00:29:41
and one of the most powerful signals that the blood vessel is starting to change before you see plaque, before you
00:29:46
see blockages, I mean decades prior. These are all happening in childhood by the way. You know, 10 to, you know, 10
00:29:52
to 14 year olds diagnosed with type 1 diabetes. we see that the blood vessel isn't able to respond to what they call
00:30:00
sheer stress Stephen. So that means let's say you go for a run uh this morning Stephen and your blood pressure
00:30:06
initially increases because as your heart rate increases the speed of the blood increases the amount of pressure
00:30:13
on the vascular wall increases that a 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
00:30:25
for the blood vessel to release something called nitric oxide. Nitric oxide is a potent called vaso diilator.
00:30:34
It causes the blood vessels to open up and this is how your body responds normally to stress. Okay, you go for an
00:30:40
exercise vasoddilation or vaso constriction then vaso dilation um or you know and these are normal responses the body has. Well, what happens in type 1 diabetes very early on is that the
00:30:52
ability to produce nitric oxide is diminished. You're not able to respond to high stress load. So, not only are
00:30:58
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
00:31:11
signals of athoscorotic progression. 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
00:31:24
you start to lose vision eventually can go blind within 20 years of diagnosis. So most people are diagnosed in 10 to 14
00:31:30
years of age which means by 30 to 34 years of age you're going to see a lot of patients who have altered eye function andor some who are blind. Now
00:31:41
that has extended out over time, but we know that all patients with this disease
00:31:47
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.
00:31:59
Even with the best technologies out there, there is no pharmaceutical intervention. There is no technology
00:32:05
that normalizes this disease. And the effects of these high invariable glucose levels and insulin resistance that
00:32:11
accompanies it is cumulative dose dependent and not completely reversible. Which means that once you're diagnosed, the clock starts ticking. It
00:32:23
just like smoking. The more you do, the earlier you do it, the earlier the impact and the more lost life you
00:32:29
probably will get. And there was a study done with 326 participants that found that the keto diet can increase glycemic
00:32:36
control of patients with diabetes. That was in the precision nutrition publication. When it says it can
00:32:43
increase glycemic control, what does that mean? So is that what we were talking about there with Yes. So if you when you do a diet known
00:32:54
as a ketogenic diet, you're reducing carbohydrates. Well, when carbohydrates are consumed, they elevate glucose
00:33:01
levels. Well, if you dramatically reduce the amount of carbohydrates consumed, you're not having those same type of
00:33:07
glucose elevations and fluctuations because you're not consuming the most potent glucose elevating factor in our
00:33:14
life, which is carbohydrates. And so when they talk about improvements in glycemic control, it is the measure of
00:33:22
24-hour over multiple day levels of glucose in the circulation. And how well is that being controlled within a normal healthy range? And so is your goal then to
00:33:36
encourage people to restrict carbohydrates in their diet? But you know because carbohydrates and sugar have been somewhat I guess demonized because you never really hear many good things about
00:33:47
sugar. Um so so what is what is your goal here? What is the advice to the listener? Is it to restrict their their
00:33:52
carbohydrates? To be very conscious of what they're consuming because nutrition has a powerful potent impact on overall health. And for those patients who have
00:34:04
chronic disease, which is unfortunately the overwhelming majority of us, yes, carbohydrates can be a very restricting carbohydrates can have a powerful therapeutic effect on diseases like type
00:34:18
2 diabetes. The American Diabetes Association in their 2019 consensus report described type 2 diabetes as the
00:34:25
most evidence-based nutritional strategy. We know that it can have potential positive impacts on things
00:34:32
like uh Alzheimer's disease. There are studies that have looked at this. We also know that for carbohydrate restriction we
00:34:38
Yep. So, and I like to term this therapeutic carbohydrate restriction because it's the therapeutic outcome of
00:34:44
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
00:34:56
say, to feel more cognitively alert. But in my case where you're along further along the metabolic spectrum with
00:35:01
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
00:35:14
metabolic derangement, uh, as cited by multiple studies and multiple research groups. You did a 10-year study on the
00:35:21
impact of the ketogenic diet on a patient that had type 1 diabetes. I think this is this is most certainly the longest study ever done of its type where you took one individual and over
00:35:33
10 years you I guess controlled their diet. So, we had access to the ability to monitor uh a unique patient who had type 1 diabetes and they
00:35:48
were diagnosed and had followed the American Diabetes Association diet, a healthy diet for 6 years and then
00:35:55
switched over in 2013 to a ketogenic diet. Upon the initiation of the diet and post, they had DEXA scans. They
00:36:02
controlled their calorie intake, their body composition. they weren't taking any additional medications and we were
00:36:08
able to monitor the impact over a 10-year period while controlling all those variables.
00:36:14
And why that's so important is because one of the common concerns of a ketogenic diet is the hypothetical risk
00:36:22
it can increase cardiovascular disease. And the reason that they think that it can increase
00:36:27
cardiovascular disease or it's hypothesized that it will is because of the elevation in LDL that often
00:36:32
accompanies an increase in saturated fat in the diet. Now saturated fat comes from things like animal proteins, uh
00:36:38
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
00:36:51
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
00:37:04
is the number one risk factor. They reduced their insulin load over 40%. And their cardiovascular health was not
00:37:13
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
00:37:25
type 1 diabetes. despite the doubling of LDL cholesterol, it illustrated that over a 10-ear period, it maintained not only no sign
00:37:36
of cardiovascular disease, but remarkable cardiovascular health. And and in fact, we actually followed on
00:37:43
that study with the largest ever analysis of the impact of nutrition, particularly carbohydrates, in over 46,000 patients with type 1 diabetes. We
00:37:54
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
00:38:07
for disease of type 1 diabetes. 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
00:38:19
normal, pre-diabetic, and diabetic. Right. Correct. Yes. So normal is anything less than 5.7% HBA1C. Pre-diabetic is that
00:38:28
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. I I mean I noticed your your blood sugar
00:38:41
levels have uh risen quite dramatically to that. So what you see initially is is
00:38:48
probably only the first phase of this, right? So started at an average of around 100 milligs per deciliter on
00:38:55
average. And once the food is then consumed cuz once you consume the food it takes some time to break down into glucose that glucose then goes into the blood and then the blood then moves
00:39:08
glucose into this compartment around the cells which called the interstitial fluid. And now we're starting to see the
00:39:14
direct impact of just consuming probably a fifth of the amount of carbohydrates I should consume from a superfood. Um this
00:39:22
you know oranges are considered both a citrus in a fruit and this is considered like a superfood by the American Diabetes Association uh in the context
00:39:29
of diabetes. So when the glucose spike is high, so you've just eaten some oranges, the
00:39:34
spike is going up. Yeah. What does someone feel and then what do they feel when it's then crashes down
00:39:41
and goes below? Because it started at about 100. So I imagine that it's going to go up to whatever it goes up to and
00:39:48
then it's not going to drop back down to 100. It's going to drop below 100 typically in a in a normal um
00:39:54
non-diabetic person, right? So 100's right around the uh normal. So what you'd hope would happen is that you're going to go up just a little bit, insulin's going to respond quickly, and
00:40:05
you're going to come back down to normal. if you have total healthy metabolic function. Again, the vast majority of us do not. But in this case,
00:40:13
what's going to what would be predicted to happen is that as blood sugar elevates and insulin responds,
00:40:21
it's going to go as high as the amount of glucose that's present in the food. Okay? But at the same time, the my pod
00:40:28
is also which is holding my insulin is immediately trying to respond. it's immediately trying to say, "Okay, oh no,
00:40:33
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
00:40:39
on the screen that there's this massive uptick in the blue line, which is the initial response in insulin immediately to the elevation in glucose. This is exactly what happens in normal
00:40:49
physiology. Yet no one can measure it, but you can see it here. So how would I feel when the glucose
00:40:54
spike is high? Do I feel energetic? Do I feel focused? Or do I feel tired? My personal experience here Stephen is that
00:41:01
as blood sugar becomes very high I become my focus reduces my I become fatigued. Uh I can also according to my wife become irritable. Um and but you
00:41:13
can even look this up you know you can look up what are the symptoms of hypoglycemia what are the symptoms of
00:41:21
elevated glucose levels above the normal range which is normal 70 to 120. That's
00:41:26
when you can start to see uh very clearly that the evidence over time has shown a a very clear impact on not only
00:41:33
how you feel physically but also your mental health status as well. Oh, I've just looked up the symptoms here and it
00:41:39
says um the common immediate symptoms of having a high glucose spike is you feel
00:41:44
thirsty, dry mouth, um frequent urination, headache, brain fog, fatigue, sluggishness, blurry vision. Um,
00:41:53
and then once you go down and you crash or your glucose really drops below the normal range, what do you feel then?
00:42:00
Typically, 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
00:42:07
a great day, great conversation with other friends, and then all of a sudden, very rapidly, clouds come over top.
00:42:15
Everyone kind of dissipates and it starts to rain. It's almost like it's it's we know that glucose levels have a
00:42:23
direct impact on the neurobiology of the brain. Meaning how the brain functions,
00:42:28
how it operates, and particularly at very high glucose levels, you know, typically above 180 milligs per
00:42:35
deciliter, you start to see signals of inflammation, signals of stress, like oxidative stress in the body if people
00:42:42
have heard of that before. And that can start to cause damage on tissues and cause a stress response. But the problem
00:42:47
here, Stephen, is that most patients are living there 24/7. I was looking at some of the symptoms
00:42:53
here, and it says the short-term crash you get after a spike, um, after a rapid rise
00:42:59
is a bit of an insulin overshoot. So, it's reactive hypoglycemia, which is the sugar crash. And then you might feel in that crash jittery or shaky, hungry, often craving carbs and sugar again,
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Replet's core plan. You did a study in 2025, I believe, on the impact of the ketogenic diet on physical performance. you know, if the ketogenic diet has all these therapeutic potentials, you know,
00:44:32
going back for over two centuries, what is truly the impact of it on performance? Because that's one of the primary reasons where someone were to walk into a a clinical setting and say, "Well, yeah, you can do this, but I've
00:44:46
heard it's going to decrease my performance." Physical performance. Physical performance. And so we were very very interested in this because we
00:44:52
thought okay it 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
00:45:03
improve performance and how they showed that in 1921 was that physicians out of Harvard and um and Boston actually
00:45:11
watched Boston marathoners half of which who would come wouldn't even finish the race slurred words they would uh have
00:45:18
like almost pale skin, shaky, weren't able to articulate their words or some wouldn't finish at all. And what they
00:45:25
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
00:45:32
what they call hypoglycemia. It's a medical term to describe very low blood sugar levels. And
00:45:40
then next year they provided carbohydrates and these marathoners in the Boston Marathon and all of them
00:45:45
improve their performance. And so since 192 or 1925 actually we've known that carbohydrates can improve performance.
00:45:52
But we what has happened though over time is that in 1960s we there was a measurement technique called the Birdstrom method where you actually did a muscle biopsy pulled out
00:46:05
muscle tissue and found that oh wow there's actually glucose stored in the muscle. So it must be really important
00:46:10
for physical performance. If the muscle which is used to contract and move the body during physical performance that if
00:46:17
glucose is in that tissue, it must be essential for performance. And then after they discovered that there was all
00:46:23
these associations between low glucose levels in the muscle called glycogen, low glycogen and fatigue. Then after
00:46:31
that the in the 1980s they were able to look at the amount of sugar, carbohydrates and fat that the body was burning during exercise. And what they found at that stage is that oh
00:46:45
wow it looks like the the amount that people are able to sustain intense exercise is proportional to how many carbohydrates they're burning.
00:46:59
And then there was a few modeling studies Stephen that then looked at okay what's the relationship between
00:47:06
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 they modeled it okay
00:47:18
and said okay well at lower intensities you must burn almost all fat and at very
00:47:23
high intensities you must burn carbs and there was a number of studies in 2017 to
00:47:30
2020, three different studies that looked at the ketogenic diet over a 5day to 3 week period. And they saw that in those studies that there was a decline
00:47:40
in performance by around 2%. If you were in the ketogenic diet, if you were on the ketogenic diet, correct? Compared to a high carb diet. Yeah. And so what did that tell these researchers? Well, it said, "Okay, well
00:47:52
obviously the ketogenic diet must impair performance." And there's all this evidence since 1921s that the amount of carbohydrates, glycogen, how much carbs
00:48:00
you're you're consuming is essential performance. But here's the kicker is that one major confounder of all this is that we've known for quite a long period of time that the adaptation to a ketogenic
00:48:12
diet is not one week, it's not two weeks, not even three, it's four weeks or more. And when you say adaptation, you mean your body's transition to being in a a state where it's efficient at
00:48:26
burning using ketones. 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
00:48:39
less of it. The amount of fat that's being utilized for fuel goes up dramatically. And then you produce way
00:48:45
more ketone bodies. And ketones are now being used as not only a a body uh tissue substrate meaning energy for the
00:48:53
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
00:49:06
body transforms when you reduce carbohydrates. Okay. So what we wanted to do is say,
00:49:11
okay, if there's all these healthpromoting benefits of a ketogenic diet, that sounds great, but all these
00:49:18
studies and sports dogma would say that's going to impair performance. Okay, so let's test that. Let's actually
00:49:24
put athletes on a ketogenic diet for 4 weeks. We are going to control not only their calories, we're going to control their body composition, we're going to control their activity level. We're
00:49:38
going to control all these key confounders that many of these prior studies never controlled so that we
00:49:44
could truly test the diet induced so the macronutrient meaning the shift from carbs to fat effect on performance but we're going to do it in the same person.
00:49:55
So now we're going to control their genetics. We're going to control their environment. Once we did that, Stephen,
00:50:01
we tested what most people think is a, you know, a very glucose dependent form of exercise. We asked them to do 6 by 800 meter sprints. They were on a high carb diet and then they switched to a
00:50:13
low carb diet. Now, what happened this is all randomized uh and controlled. When they switched over,
00:50:20
they had no deterioration in performance at four weeks. at the four-week mark in
00:50:28
a form of exercise that we would expect would be extremely glucose dependent, extremely carbohydrate dependent. But before 4 weeks, was there an impairment in their performance?
00:50:39
So what we were interested in, Stephen, is studying at the end. So we didn't look intermediately. We exclusively look
00:50:46
at the end time point because the the question was, well, 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
00:50:59
if it is true that you require carbohydrates, we then also measured how many carbohydrates and fat they were
00:51:06
burning during exercise. And it was over what we call 85% of their V2 max, which means 85% of their total maximum oxygen consumption during
00:51:18
exercise. That is when we would expect almost no fat to be oxidized or to be burned and almost exclusively carbohydrates. Well,
00:51:30
we found that these athletes recorded the highest levels of fat burning during exercise ever reported in the literature, illustrating that when these athletes, the ketogenic
00:51:42
ketogenic diet that when these diets adapted to the diet for sufficiently long, they had record levels of fat
00:51:51
oxidation even at very high intensity levels. which means that fat was able to provide nutrients and fuel at very very intense forms of exercise when we would
00:52:03
expect only carbohydrates would be relevant and utilizable. So many of my friends um that are endurance athletes or that are involved
00:52:15
in things like cycling talk about exogenous ketones. Um I'm a co-owner of a company that produces exogenous
00:52:21
ketones. That's my disclaimer. I've got the product here. What can you tell me about products like this? Exogenous
00:52:28
ketone products. Exogenous meaning externally supplemented, I guess, right? So, with a ketogenic diet, you
00:52:34
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
00:52:47
ketogenic diet takes time to adapt. We just talked about that with physical performance
00:52:52
that we see that you know up to four weeks to see the full effect on on performance or more. Well, what happens
00:53:00
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
00:53:06
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.
00:53:17
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 13butane dial. It that it was
00:53:32
able to be consumed and rapidly elevate ketone bodies in circulation. There was a study in 2016 called the metabolic optimization $10 million program from DARPA. DARPA being the
00:53:45
DARPA is an advanced research organization from the United States government where they fund very high risk high reward programs and one of
00:53:52
which was the the 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
00:54:04
formulations a bit and they showed that and we know that this is the same for this molecule as well that when you
00:54:10
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
00:54:22
directly binds to receptors like the um they call GPR 109A or uh or some other key receptors that directly uh impact inflammation. So it directly blocks something called NLRP3 inflammosome
00:54:38
which is a molecule that leads to increases in inflammation. We also know that it changes the way that our genes
00:54:46
are used in the body called epigenetic signaling. And so the uh consumption of ketone bodies can actually change the molecules on our genes and and how those
00:54:58
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
00:55:10
powerful effects, these rapid shifts in metabolism within the body. And this 2016 study showed that just orally
00:55:17
consuming these molecules could rapidly shift metabolism, but that it was also linked to an improvement in physical
00:55:22
performance. But if you look beyond that and just like uh these these kind of studies because we looked at them in athletes, we looked at them in healthy individuals and then also in military
00:55:33
settings. But we've also there's studies looking at this in patients at risk for cognitive decline. So patients at risk
00:55:38
for Alzheimer's disease. They've shown that in a six-month study administering exogenous uh ketone bodies was able to
00:55:45
attenuate the decline in uh cognition that we know happens with advanced age. And just to be clear there, you're saying it reduces the decline. It doesn't correct cure Alzheimer's or fix Alzheimer's. It
00:55:57
just delays. Accurate. Yes. It's it's we know that as individuals age, you're on a precipitous or or steady decline in in brain
00:56:09
function. Um, and so the goal is to to offset or to stop the decline. You know, that's our goal. We want to maintain normal uh brain function and our ability to think clearly and to understand
00:56:23
things clearly like reading and and doing problems and solving problems. There have also been this emergence of
00:56:29
studies in the world of psychiatry. I think there's around 11 ongoing active clinical trials looking at the impact and interaction of ketonebased therapies and brain health uh particularly serious
00:56:42
mental illness. One in four adults in the United States actually over one in four adults in the United States has
00:56:47
serious mental illness. In fact, I believe over the numbers are over 20% of of adults are taking some type of psycho
00:56:55
uh altering medication. At its core, we see all these relationships between underlying metabolism being a key factor contributing to mental health
00:57:07
status. and the application of the this unique diet which we know increases ketone bodies which appear to have
00:57:13
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
00:57:25
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
00:57:38
effects um in people of all sorts of different conditions uh or disorders. On one of the studies that I read about the administration of exogenous ketones
00:57:49
and the impact it has on brain network stability was from 2020 where they investigated if brain network stability
00:57:55
responds to two major brain fuels either glucose or ketones. And participants came to the laboratory on two occasions
00:58:01
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
00:58:13
contrast, glucose decreased the stability of the network. The network stability was 87% greater after ketone
00:58:19
consumption than stability measured after glucose consumption. And in that study which is on PubMed, the last line
00:58:25
of the abstract says, "Dietary interventions resulting in ketone utilization increase available energy
00:58:31
and thus may show potential in protecting the aging of the brain which is super interesting. So we did a study uh looking at cancer and applying exogenous ketones and a
00:58:43
very aggressive form of metastatic cancer. And what we saw in in my work in graduate school is that when applying
00:58:49
disogenous ketones that it delayed the progression of the metastatic cancer, but it also when looking at body weight reduced the
00:59:01
rapid decline in body weight we sometimes see with cancer. A phenomenon called cexia which is a way a term to
00:59:08
describe the wa rapid wasting of body tissue with disease. And it is no more aggressive than the context of cancer particularly metastatic cancer is where it's most common and when we saw the
00:59:21
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
00:59:34
muscle mass. So it also appeared and there's been a number of what they call clinical physiology studies. those
00:59:40
studies that actually directly manipulate human beings with molecules and tests, you know, like muscle tissues and how they function. We see that
00:59:52
exogenous ketone administration can dramatically reduce the amount of muscle breakdown uh or breakdown of muscle tissue. Uh essentially illustrating it
01:00:03
may be a powerful mechanism in promoting healthy muscle mass as well. In terms of
01:00:09
being in a ketogenic diet, one of the things I'm always quite concerned about is am I still able to gain muscle mass
01:00:15
if I'm in a ketogenic diet? Because I Yeah, I when I go into a ketogenic diet and I stop having carbohydrates, I tend
01:00:22
to lose weight rapidly and shred. Yeah. The fats falls off and I get very lean but yeah, more skinny. You smiled though because maybe you like
01:00:34
to be more shredded. Um, so a phenomenon with the ketogenic diet. So there's no deterioration in muscle mass with the ketogenic diet. There have been plenty of studies that have shown that you're able to maintain muscle mass
01:00:45
and build it. Yes. And build it. So they've shown that as well. So Jeff Volic out of Ohio State University has done a number of studies
01:00:51
in this area. Um, looking at individuals who were actually on a reduced intake diet. So they're reducing less calories. So they had less energy in the diet. And then they were also
01:01:03
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
01:01:09
someone was on a high carb diet um while under a caloric restriction or another way of describing that is like a semi starving starvation state. So there's no
01:01:21
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 onto a ketogenic diet is there's a
01:01:32
naturatic effect or natures effect, but basically you reduce the amount of sodium in the body. So, you you you p
01:01:39
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
01:01:49
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
01:01:55
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
01:02:00
just might be in a phenomena less water weight. And in some context, that might be beneficial. Right? If you're in a sport where you have a
01:02:07
power toweight ratio, but you're able to maintain the same power at a lower weight simply by shifting water, that's
01:02:15
great. Um, as long as you're able to function equivalently. Is there anything I do need to be thinking about in terms
01:02:20
of my diet to make sure I'm still gaining weight just to I guess to keep to keep my protein levels high?
01:02:27
So, the most important thing related to your diet when it comes to trying to build muscle mass is to exercise hard
01:02:33
and with resistance exercise. Uh that's the most important thing when it comes to your diet to enhance that effect.
01:02:40
Protein is one of the the most powerful nutrients you can consume to augment that response. Another is to ensure
01:02:47
you're having uh sufficient calories. Right? So if you're in a caloric deficit, so you said that you
01:02:53
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
01:03:00
also muscle is to just not eat food or I think that's it because I I lose my appetite when I when I'm in the ketogenic diet. I also lose my appetite a little bit when I take these um exogenous ketones
01:03:11
like Ketone IQ. Yeah. And I've seen some of the studies that show that there's roughly 20% decrease in
01:03:18
um appetite when you take exogenous ketones according to one particular study that I
01:03:23
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
01:03:31
stop very quickly. Yeah. And it's really bizarre. Like I was I was in Cape Town for 10 days or two
01:03:37
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 amazing. I
01:03:44
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
01:03:50
going on in my body which just doesn't just doesn't want to binge eat like I sometimes did. 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
01:04:01
is happening in your body in your metabolism on the diet. So there's a a book called Always Hungry by a physician u endocrinologist named David Lugwid and
01:04:11
he's kind of coined this carbohydrate insulin model and um you know it's semi somewhat controversial but the the reality is that there's there's some important notes in it. One related to
01:04:23
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
01:04:28
the up and downs of glucose and up and downs insulin. these constant swings. Whereas on a ketogenic diet, you have
01:04:33
this sustained level of fuel influx, right? So you have this nutrient availability in the blood. So glucose
01:04:39
levels are much more stabilized, insulin is much more stabilized, and you don't have those fluctuations particle.
01:04:46
That might be one potential reason. But the other potential reason is that when you're on a ketogenic diet, you tend to
01:04:52
not consume the type of foods that drive hunger. So again, we talked about in the
01:04:58
grocery store, the 70% of the grocery store, particularly in the center of the grocery store that is highly processed
01:05:03
where they combine carbohydrates with with salt or fat or some combination there in that makes it
01:05:09
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
01:05:21
seek more of that pleasure response and as a result, they want to consume more. So, everyone has probably felt this
01:05:26
example where you're in a restaurant, you've eaten enough food to where you feel physically full. You're like, "Oh,
01:05:31
I'm totally full. Like, I don't want to eat any more food." Someone walks by with your favorite dessert. And you're
01:05:38
like, "Oh, well, h I could eat that." You're literally physically full, but yet you want to consume more food. This is a is a a phenomenon that has been the
01:05:54
struggle of of in America and the the rest of the world essentially now um where the food environment often drives people to over consume and it's not by
01:06:04
accident. These are like well conducted strategies in the food industry to lead to these positive pleasure responses. I think about this with bread in the restaurant. You know they give you bread first.
01:06:16
Yeah. That's a good It's a solid strategy, Stephen, to cause you to want to consume start to finish not only the
01:06:23
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
01:06:34
you you combine this mixture of new uh molecules in the food that you consume it, you get, oh, this tastes great. Pringles. The same exact thing where you combine
01:06:46
these different components and it forces you this like, "Oh, this tastes great. I need more." And you never feel full. One
01:06:52
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
01:07:04
so when you consume these type of foods together, they they know they consume more of it, but sometimes people aren't
01:07:10
even aware of it. And 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
01:07:21
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
01:07:32
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
01:07:44
a huge part in why people always feel hungry in today's food environment. They're always seeking more food and they can't get off that hamster
01:07:57
wheel. They're always over consuming or always referring to this phenomenon called food noise where they always feel
01:08:03
the drive to consume foods or they never feel full. And it's and it's because of the sugar and
01:08:09
the soap. It is because the food is composed and made in such a way to be to have a flavor profile that your brain says
01:08:22
not just eat one bite, eat as much as possible because we're always seeking these pleasure responses, right? In our
01:08:29
lives, in our world, it's this is even independent of food. So, what do we do about this?
01:08:34
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
01:08:50
will drive people often to over consume them and very drive this pleasure response in the brain.
01:08:55
Liquid calories. What's a liquid calorie? So let's say you have uh a soda or a Coke. Yeah. So basically completely void of any nutrients and really high in
01:09:07
calories, spikes your glucose through the roof, insulin through the roof, and then often makes you hungrier afterwards, not less hungry by having
01:09:14
like orange juice is another great example. Smoothies, those those fruit smoothies people have.
01:09:20
Exactly. In fact, just taking fruit and then blending it up actually increases the speed by which it's absorbed changes
01:09:26
the hormonal response and leads to a worse outcome for most people. Most people think a fruit smoothie is a
01:09:31
healthy thing. Yeah, I don't know about that. Um, I would I think that when you take fruit,
01:09:38
which for most reasons isn't terrible, right? Like, it's not these are nutrient-dense foods, if people can
01:09:44
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
01:09:51
then take foods like that, it could be any foods. It could be taking potatoes and then making mashed potatoes. By
01:09:56
simply changing or blending that food up, you're now taking a lot of the structural components that your body
01:10:02
would take time to digest and you're removing them and you basically almost are like almost turning on like a small hose that's just giving a little bit of
01:10:12
water at a time and it's turning it on all the way. you know, you're rapidly increasing the speed of how the nutrients enter the body and it
01:10:19
completely changes the hormonal response of molecules like GLP-1 and and normal levels of GLP1 in the body are completely altered. The insulin response is also altered and GLP1 is the hunger hormone.
01:10:32
It's known for being related to hunger because it's released in response to food. It changes the brain's hunger
01:10:40
drive and most people know of it because of oimpic simaglletide wobi traipide um all
01:10:48
these GLP-1 receptor agonists that are increasing GOP1 levels not to normal levels they're increasing them to super
01:11:01
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stephvenbartlet.stan.store. So, I want to 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
01:13:12
environment we live in. But just to just generally the advice that you would give if you had the ear of I don't know five
01:13:17
million people right now and you could say something to them to help them live better lives, to perform better. What
01:13:23
advice would you give them? Number one is I would say be conscious of the food you're consuming and what
01:13:29
you're consuming on a daily basis. The impact of food is is equivalent to medicine. It is and sometimes more
01:13:35
powerful than medicine. So, uh what you drink, what you eat, you know, focusing on whole foods, not consuming liquid
01:13:42
calories. And if you're someone who could benefit uniquely from stable glucose levels, lower insulin levels,
01:13:48
like someone who has some type of metabolic disorder like I do, reducing carbohydrates oftentimes can be a very
01:13:54
powerful strategy. In fact, known to prevent and reverse things like obesity and type 2 diabetes with emerging
01:14:00
evidence for its potential ability to put things like serious mental illness into remission, but we'll see as more
01:14:05
evidence comes out. Exercise on a regular basis. We know that exercise might not be the primary the lack of
01:14:12
exercise might not be the primary driver for why someone is or isn't obese, but we do know that physical activity
01:14:17
promotes health. We do know that physical activity uh is extremely important for overall well-being. And so
01:14:24
you've got big muscles. Oh, well, is that somewhat linked to your your type 1 diabetes at all? Is that is that part of your strategy? You know, look, I was obese at one point. And so I I've
01:14:36
since that point taken a very I become, you know, obsessed with trying to find out how to be bigger, stronger, faster,
01:14:43
optimize my metabolic health, optimize my performance. And so it's been a lifelong kind of self-experiment in that in that journey. But yeah, exercise is
01:14:51
just important in general. But it's for me it's about all the different experiments and and strategies I can use
01:14:56
with exercise uh with resistance exercise and beyond to kind of play around with what affects my body, what
01:15:02
affects my insulin, how do I increase my overall metabolic health and what I have seen is that that's directly linked to
01:15:08
my performance. How often do you exercise? I try to exercise every single day. Um
01:15:15
as much as I How long for and what types of exercise? So what I do right now is I typically do
01:15:23
weightlifting for 30 minutes to an hour every or six days a week. Um and then I will go typically ride a bike to jiu-jitsu. So Brazilian jiu-jitsu which
01:15:34
can be uniquely almost like a mixed exercise, intense exercise where it's going to be extremely intense for like 5
01:15:40
minutes and then you have a one or two minute break. Extremely intense and then a break. Uh and I do that typically around 5 days a week. Um, I also try to
01:15:48
purposely engage in some type of aerobic exercise when I can. If I I wasn't able to do as much jiu-jitsu one day or as
01:15:55
much uh resistance exercise. I always try to add on some type of cardiovascular work, whether that be a
01:16:01
run, a bike, or these aerodyine bikes where it's just lower and upper body. I find those to be incredibly uh effective
01:16:07
and powerful tools and actually um uh just not causing damage to muscle tissue but also allowing you to improve your overall cardiovascular health. What does your diet look like?
01:16:19
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
01:16:24
switched to a ketogenic diet, not only improve my glucose and insulin, but I also found that with a ketogenic diet
01:16:31
that I don't feel hungry. So, I would wake up and I don't tend to eat food right away.
01:16:38
In fact, I enjoy when I don't eat food more so than when I do eat food often times just
01:16:43
because not because I don't enjoy the feeling of sitting down and having food. I love that. But
01:16:50
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
01:17:04
hours of my day where I have the stability, not the the moments in time where I'm introducing uncertainty and
01:17:10
variability. to dumb that down a little bit. What I'm saying is that when I when I don't eat I
01:17:16
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
01:17:23
easier. And so, do you eat once a day or twice a day or I tend to eat two to three times a day,
01:17:28
you know, sometimes right before jiu-jitsu or weightlifting jiu-jitsu, always afterwards and always before uh
01:17:35
sometimes before bed. try not to do it right before bed um because it tends to impact my sleep quality a little bit.
01:17:41
But I find that I just eat whenever I feel hungry and I try to give myself sufficient protein to be able to respond
01:17:48
to the the exercise that I'm doing. So, I've got the first one's about being intentional about your food choices. The
01:17:53
second one is about exercise. Mhm. Anything else? Well, sleep's really important. You
01:17:58
know, these are these are, you know, Stephen, this isn't like uh oh, like this is the most revolutionary advice of
01:18:05
all time, but these these core foundational components, good nutrition tailored to your specific needs, exercising as much as you can, and
01:18:15
getting good sleep are the pillars of health. If you don't have those corrected, then you're wasting your time
01:18:22
everywhere else. And 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 on that you've
01:18:35
mentioned and you're you're looking at the insulin and glucose response. Is there anything that people don't
01:18:41
understand as having a really pronounced impact on their glucose levels that they wouldn't expect? Like orange juice is
01:18:47
one of the ones that growing up I thought [ __ ] I thought this was a healthy thing. I used to I used to drink Sunny Delight thinking I was putting all
01:18:53
these amazing vitamins in my body and now I actually look back and regret it and I you know
01:18:59
not to be judgmental over any parents because parenting is very hard but sometimes I'll see parents giving their
01:19:05
children like a big glass of orange juice and in my head I just see the glucose spike that that child's about to
01:19:10
have. It's funny when you mention parenting because I have a three and a six-year-old at home and it's amazing
01:19:16
when they try one of these foods, these very sugary foods, these very tasty foods, they it's almost like they become incessant on wanting it again. You know, like
01:19:28
normal food isn't good enough anymore. Um, and I think that's a great illustration
01:19:34
of of what many of us adults are are challenged with on a daily basis, but yet many people are just unaware of the
01:19:41
impact that it's having on their metabolism, impacting it's having on their hunger, the impact that that's going to lead to on their future health.
01:19:47
And is there anything that you've spotted from your experiments with your your CGM and your insulin device that
01:19:54
people should most certainly avoid? So, you said liquid calories. Is there anything else that causes a really pronounced or unexpected glucose
01:19:59
response? Yeah, you know, there's so many honestly, Stephen, over time that it's honest, it's really hard to
01:20:06
pinpoint any singular one. A lot of the foods that are out there are often surprisingly challenging on glucose levels, on insulin levels, particularly
01:20:17
the processed foods, because what happens when you make these food products is that you're trusting the
01:20:23
food company to put ingredients in there that you're going to respond favorably to, that your metabolism will respond well to. And the truth is that that's
01:20:31
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, Stephen. I just But I've experienced it numerous times.
01:20:41
So I've got a a small list here. Um sugary drinks, white bread and bagels, white rice. That surprised me a lot cuz
01:20:48
I used to think white rice Oh, really? I I thought growing up rice was like a health food. Okay. Well, so on that note,
01:20:55
white rice, potatoes, potatoes in any form. Sweet potatoes tend to have less of a
01:21:01
glycemic response, but it's still going to have a a potent glycemic response. So, mashed or baked potatoes, obviously,
01:21:06
French fries. Yeah, for sure. French fries. Most of like pasta is a big one. Cereal, refined cereals, most cereals are actually worse than the
01:21:18
foods I just described on blood sugar and insulin by a long shot. In fact, uh mo most of the you know these hearthealthy cereals um
01:21:29
these these would I would never blood sugar would just spike through the roof portion of the amount I ate. So yeah, it
01:21:34
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
01:21:41
and science world would also generally align with with that that those aren't necessarily the best foods to consume.
01:21:47
we would think, you know, more more of the less glycemic or less the foods that have less of an impact on glucose levels, less of a impact on insulin levels. You know, one one thing I
01:21:59
constantly hear, especially in the research and clinical community is like, well, look, you know, not everyone needs
01:22:06
to be concerned about that because, you know, people can respond to a lot of these foods just fine. And I say,
01:22:12
"You're you're right." Except that over half of America has pre-diabetes and 90 plus% have some form of measurement that indicates that their
01:22:23
metabolic health is impaired and over 86 68% are obese and now children are affected with these diseases with obesity and pre-diabetes and around 20%.
01:22:38
So it it's it's the fact that we are now less healthy than than we've ever been.
01:22:46
Um we don't have the foundation to support. Correct. And I think you know when we
01:22:51
think about healthy nutrition, we think about exercise. We describe them as medicine, but the
01:22:56
reality is these are just normal aspects of things you should do every single day because that's what our bodies were made
01:23:01
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
01:23:08
health. One of the surprising ones for me was dried fruit. And it said while while fruit contains natural sugars, the
01:23:14
process of drying it concentrates those sugars. This removes the water and can make the sugar more readily available
01:23:19
for absorption, leading to a higher glucose spike compared to fresh fruit. Typically, people think of dried fruit
01:23:25
as being a health food as well. Yeah. I don't I don't touch those because unless I I don't have any
01:23:31
glucose on me and I my blood sugar is going down for some reason and I stay in dangerously low levels, that's when I
01:23:37
consume those foods. Otherwise, I would I would not consume them just because of how quickly they raise blood sugar
01:23:43
levels. Do you think everybody should try the ketogenic diet? Ooh, that is a good question. I think
01:23:51
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
01:24:05
anything in life, we are we're left to assume what everyone else is like. You might have we've talked about the
01:24:11
ketogenic diet numerous times here. We talked about exogenous ketones numerous times here.
01:24:16
But if you don't try it, you don't know how it'll work for you. In science, Stephen, one of the most important
01:24:23
things to appreciate is that we often publish bar graphs look like this. You know, the a line uh that illustrates the average outcome of a group of people.
01:24:36
But what you don't appreciate is that that line or that bar graph is made up of numerous individuals who all average to that number. But what if you're the
01:24:49
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
01:24:55
responded negatively or positively to that and then you just follow the average advice that that study showed.
01:25:03
Well, oh, look, I tried this approach and it didn't it didn't work for me. Uh, I'm just going to keep trying cuz this
01:25:08
study said that 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
01:25:20
metal. So when in that study that talked about the impact of exogenous ketones on brain stability, someone might have had 100%
01:25:27
improvement in brain stability and someone might have had 20% improvement or whatever and they've averaged it out
01:25:33
um across a bigger group of people. So if you you are that person that had a 100% gain in brain stability, it's a
01:25:39
pretty unbelievable tool for you to understand based on your body. Exactly. And and that's that's always the case in science. I mean there are and there sometimes we look at this as
01:25:50
responders and non-responders. Um but actually in the study where we gave um uh the product from ketone IQ in the the
01:25:59
SOCOM study, we actually saw that nearly all of them saw an increase in SPO2. nearly all themselves an increase in
01:26:05
heart rate but that's rare that is rare sp2 ah so uh the amount of oxygen in the
01:26:11
blood so the the measure that would indicate whether someone uh in these low oxygen environments had
01:26:18
more blood or less more oxygen or less oxygen ultimately it's it's important to try I
01:26:24
I think it's I would always say yes you should try because or any nutrition strategy because you should try
01:26:31
different ones I've probably tried over plus different diets only honestly maybe like 15 or 20 at this point in my life.
01:26:36
I've just come to find that the ketogenic diet for all the reasons we described and because I have type 1
01:26:41
diabetes and I had obese or have type 1 diabetes but had obesity find that a ketogenic diet is remarkably powerful at helping me live a dramatically improved quality of life.
01:26:54
not have the increased risk for the high invariable glucose levels, high insulin levels that lead to a a near guarantee
01:27:01
of complications and 10 to 20 years of lost life and expectancy. That's why I do it.
01:27:07
I have a closing tradition on this podcast where the next guest leaves a question for the next guest not knowing who they're leaving it for. And this is
01:27:13
a really tough question. So, it's a very strange question as well, but I'm going to ask you it anyway.
01:27:18
Yeah. The question is what is outside the simulation? I think it depends on your philosophy on how our existence
01:27:41
is with the limitations of understanding that our awareness of our world is completely limited to our our brain's capacity and
01:27:57
our interpretation and then explanation of the world and the term of a simulation or lack, you know, however you want to frame it, I believe is is
01:28:07
always going to be limited by our brain's ability to understand and articulate that. So, what do you think is outside the
01:28:13
simulation? Consciousness. You think consciousness is outside the simulation? I think that
01:28:27
our ability to have not consciousness, Stephen, but our ability to operate beyond consciousness.
01:28:39
Got me on that one, man. That was a that tough question. Yeah, it is a tough question. That's that's that's a it's a burner right
01:28:46
there. I don't know. Do do you think there is do you think there is a god beyond beyond this all this stuff that we see here? I'm going to give you the most real honest answer possible.
01:28:57
Yeah. I don't think we ever can actually answer that question accurately. So your your answer therefore is you
01:29:03
don't know. I don't know and I don't think I'll ever know. Yeah. Okay. Thank you. Thank you so much for doing
01:29:09
the work that you do. really appreciate that because you know so many of my friends in this field and even Michael the founder of the the ketone product on
01:29:15
my on my uh table here talk about you as being the sort of gold standard of research science and um thought leadership on the subject of ketones and more broadly on the subject of um
01:29:27
glucose and all of the adjacent subjects like insulin. So you've really pushed the field forward and the thinking forward in this space in a really
01:29:33
profound way and you're only just getting started at 34 years old which is remarkable. we're basically the same age and uh you've had such a tremendous
01:29:40
impact on the field of health and that's born out of the story that you told at the start through your own complications. So although it was it's
01:29:46
such a tragic thing to be have such a diagnosis at such a young age, what's come from that is a beautiful thing for
01:29:51
so many people um that will better understand themselves and their their illnesses but also their performance and
01:29:57
um everything correlate related to that because of you. So please keep doing the research you're doing and spreading the word in the way you're spreading it
01:30:03
because it's much much needed work and it's it's important work. So, thank you so much and thank you for giving me your time today,
01:30:08
Stephen. That was an honor. Appreciate it, sir. Make sure you keep what I'm about to say to yourself. I'm inviting 10,000 of you
01:30:15
to come even deeper into the diary of a CEO. Welcome to my inner circle. This is
01:30:20
a brand new private community that I'm launching to the world. We have so many incredible things that happen that you
01:30:25
are never shown. We have the briefs that are on my iPad when I'm recording the conversation. We have clips we've never
01:30:31
released. We have behindthe-scenes conversations with the guests and also the episodes that we've never ever
01:30:37
released and so much more. In the circle, you'll have direct access to me. You can tell us what you want this show to be, who you want us to interview, and the types of conversations you would love us to have. But remember, for now,
01:30:49
we're only inviting the first 10,000 people that join before it closes. So, if you want to join our private closed
01:30:55
community, head to the link in the description below or go to daccircle.com. I will speak to you then. [Music]
01:31:12
Heat. Heat.