The Diabetes Doctor: 80% Of Adults Are Heading For Chronic Disease! Keto’s Shocking Effect On Your Brain!

0:00 What can you tell me about this? Well, if you look at the science, it's enhancing cognition. We've seen a fifteen percent improvement in how individuals were able to read and absorb information of better decision making. And also we did a study and showed that it delayed the progression. Of metastatic cancer. And I've actually taken this a number of times because having been in research for the last fifteen years and having lived with multiple chronic diseases, one of which I reversed, some of the most powerful strategies like this were not being told to me when I went to the doctor's office. So let's dig deeper. Doctor Andrew Kutenick is a research scientist who's worked on over one hundred studies on metabolic health, diabetes, and the keto diet. And through his findings, he's helping people prevent chronic diseases, improve cognition, and optimize performance. I went through some pretty dramatic moments in my childhood. You know, I did everything I was told, right? I exercised all the time, I ate what I was supposed to eat, but I still became obese. You weighed about two hundred and fifty five pounds? And I had no idea how damaging that actually was to my body. And I think the vast majority of people also don't, but over twenty percent of children have obesity. That's quadrupled over the last thirty years. And a big part of that is when it comes to food, what looks healthy isn't.

1:12 Always healthy. And it's not by accident. And it wasn't soon after that I ended up getting diagnosed with a chronic irreversible disease that L B C D puts you at risk for and That immediately turned into a journey to understand how to be healthy. And I came across this diet a little over a decade ago called the ketogenic diet. So then I went into the science of this diet and found positive impacts on things like diabetes, obesity, Alzheimer's, serious mental illness, chronic diseases, and I was like, Oh wow. Cause a lot of people don't realize that many of these are Not just preventable, but also reversible. And you did the longest study ever done of its type on the impact of the ketogenic diet on a patient that had type one diabetes. Yes. Let me let me tell you all about it. Just give me thirty seconds of your time.

1:56 Two things I wanted to say. The first thing is a huge thank you for listening and tuning into the show week after week. It means the world to all of us, and this really is a dream that we absolutely never had and couldn't have imagined getting to this place. But secondly, it's a dream where we feel like we're only just getting started. And if you enjoy what we do here, please join the twenty four percent of people that listen to this podcast regularly and follow us on this app. Here's a promise I'm gonna make to you. I'm gonna do everything in my power to make this show as good as I can now and into the future. We're gonna deliver the guest that you want me to speak to, and we're gonna continue to keep doing all of the things you love about this show. Thank you.

2:34 Uh Dr Andrew Kootnik. If you had to try and sort of summarise and encapsulate what you spent the last couple of decades of your life focused on and really trying to accomplish prove, understand from the highest level.

2:51 What exactly is that? the core of my mission, Steven, is really to empower individuals to take control of their own health. It's empowering them with science, you know, bridging science to actual action. And you know, science is very complex. It's very hard to break it down, but having been in you know research for the last fifteen years and having lived with

3:10 multiple chronic diseases, uh, one of which I reverse and one of which I is irreversible. Um, I uh my mission is to empower patients with the same tools and strategies that I had access to. uh so they can take control to maximize their health. And performance. For the average person who may not be as

3:30 knowledgeable about health and fitness. What are the areas of health that you've spent the last fifteen years researching and trying to understand? I would call it, you know, Steven, like metabolism in in uh broad terms. Now I would say, you know, to break that down further Metabolism is trying to understand how the body metabolizes or utilizes things like

3:51 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, uh glucose levels, which I'm sure many have heard of, to insulin responses to all this different nuance, a lot of that comes down to nutrition, but it also is things like exercise. Exercise such a powerful impact on metabolism, incredibly important for overall health.

4:16 But From a personal perspective, this journey's been very honestly selfish for me. I wanted to understand how to get the best performance, the best for health for myself. And I very quickly that uh you know, some of the most powerful strategies out there were actually Not necessarily the ones that we're being told. to me when I went to the doctor's office because I went through some some pretty dramatic moments uh early on in my my journey with

4:40 Well, Trying to overcome some of these. These challenges. So take me back to the the start of your story in the earliest context, that's relevant to understand Why you became the person you became, I I'm I've got some photos here from your from your childhood which are

4:55 Ha. 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 screen. If you could describe some of these these pictures for me. When Yeah it

5:09 Um It brings back some powerful memories of uh the challenges with obesity for me. Um You know, the the picture on the right is just a picture with uh

5:27 A family adventure, um where we went to the we'd go I go fishing with my dad a lot. You know, I'm a very heavy at the time. I was you know, uh obese and Um

5:37 And the picture on the right here, th 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 was I was supposed to eat or what my doctor recommended, what the fitness magazines recommended, but I was just constantly challenged with gaining more and more fat tissue, and I had no idea. How damaging that actually was to my body. And I think the vast majority of people also don't. Um

6:02 Over sixty eight percent of America right now is obese. Okay. That means in seven out of ten people walking around the street of the United States of America. Have obesity. And we know that the second you start building more and more

6:17 fat tissue uh on your body. Insulin levels rise almost double immediately. Before you even have symptoms of obesity or uh tissue damage or organ damage. Or anything along those lines. We know that that almost immediately reduces

6:31 Insulin sensitivity. Well insulin, this very powerful fat storage hormone, is able to actually bring nutrients from the blood. into tissues. That goes down around thirty four to thirty five percent uh in early stages of obesity. And just to summarize for a Muggle like me, insulin is basically the Uber.

6:50 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 rise. It works as a thermostat to let's say Release coair to bring it back down. In this case releases insulin.

7:06 to bring blood glucose back into range. As blood glucose drops, insulin Is stopped. It stops releasing insulin out of these cells called the beta cells. And ultimately what your body's trying to do is keep the you know, one teaspoon of sugar that's in your blood that is critical for your life. If it goes up, it can cause damage. If it goes low, it can be life threatening in this very, very tight range. And it built builds a number of mechanisms to ultimately make sure and ensure that you don't go outside of that range. But imagine losing the one molecule that directly controls it.

7:40 You're wearing Two devices, I believe, on you at the moment. So you've got this. What is The device in your own it's an insulin pump. Yeah. So

7:49 Steven, your body produces insulin. Most people who are probably listening to this they their body probably also produces insulin unless they have type one diabetes. And so when my body no longer produces this molecule anymore, there's gotta be a way to Get it. It sits on my arm twenty four seven because it's a way of

8:07 Essentially packaging a pancreas. Yeah. I don't have any more. And putting it on my arm. And and a way of getting that same type of of

8:17 And you have a CGM as well. Yeah, so on my stomach here, so On my stomach here is a CGM. Which is a continuous glucose monitor.

8:26 CGM is a way of tracking sugar levels or 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 people can see what that what that kind of looks like. So on this device You have A green line that is glucose levels. Okay. My blood sugar says that it's a hundred and nine right now, which means that The interstitial

8:49 signal of glucose. Is Interstitial meaning within Not in the blood, but in the tissues. Yeah, so the amount of glucose right outside the blood, around the tissues.

9:03 And That signal. is an indication of the amount of glucose in the blood. Yeah. That's the green line.

9:09 Okay, it says that I'm a hundred nine right now. So average blood sugar levels using milligrams per deciliter. is seventy to one hundred and twenty. That's considered Normal? Below that Is

9:20 Blue. lines almost like looks like squares and triangles. Those are illustrations of insulin being administered, but they're not perfect devices, despite them being premier and it you know the most advanced technology on the market. There are significant limitations to them. Um I have actually I saw you a clip of yours that I was watching earlier that said

9:41 You think having high blood sugar over a long time is the biggest cause of long term health problems? When you're focused on improving your overall health. You have to find out what matters most, right? So what what's the hierarchy Uh uh in the health.

9:57 You know, one, two, three, four, five. What matters most on that? And we can look at that by looking at risk factors. uh for future disease. Well the number one cause of death in United States and across many parts of the world is cardiovascular disease. was also the number one cause of death. And people with diabetes. And when you look at what are the strongest predictors of developing some form of cardiovascular disease,

10:20 A measure called HBA one C comes up at the top. H B A one C is a average measurement of your blood glucose over a two to three month period of time. And that is incredibly powerful.

10:33 Uh predicting future risk for let's say diseases of the eye, diseases of the kidney, or even cardiovascular disease. And so when I think about How do we tackle

10:45 Uh improving health or in Oh. It's particularly in these these common Much more common diseases. Glucose control sits at the very top of that pyramid.

10:57 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 in the car. Like your engine doesn't work, or you don't have an a a chassis or an axis, but yet your your focus on rims or a sound system. And so the number one factor, particularly in diseases like diabetes, that matters most

11:21 is HPA one C. 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

11:34 We would need to understand how to regulate it, right? So then let's look at the science of this. Well, the science says that. Carbohydrates. Food is the most potent factor in regulating Elevations in glucose.

11:49 at every single meal of the day. Well, most people are eating three to four plus meals every single day. And so the very first logical thing to look at It's food. Because what you're consuming has the most potent impact on glucose control. And glucose control has the most potent impact

12:05 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 life saving for people. There's a a a

12:20 You know, there's something called a ketogenic diet. If someone's heard this before, it's a diet that dramatically reduces the amount of carbohydrates in the food. And the dramatic reduction in carbohydrates in the food was used to save lives. of patients with type one and type two diabetes since there was the first report ever known, to my knowledge, is in nineteen or seventeen ninety-six. by a gentleman named a physician called John Rollo.

12:45 He published a report on two cases of diabetes myelitis using basically a carbohydrate replete or reduce diet. to resolve the disease, but we know that some of the most premier Diabetologist, meaning people who study diabetes or treat people with diabetes. For utilizing these strategies. For over a hundred years, before we then discovered in nineteen twenty one.

13:07 that this diet could also help neurological disorders like seizures and beyond. And so the the phenomenon of nutrition playing a role in overall health is is certainly not new. It's actually Only recently that we're rediscovering century old wisdom of what nutrition can do for overall health, uh, due to the emergence of an explosion in science. that has really drove a ton of public interest into this kind of unique dietary strategy. So the ketogenic diet then? Um it's a diet that I'm familiar with because it's a diet that I

13:38 Cycle in and out of throughout the year. Probably I'm in a ketogenic state three or four times a year. And I use the little Keto reader, just to check my blood ketone levels. W what is the what d for anyone that's unfamiliar with the ketogenic diet, I I I'm a bit of an advocate for it, so I'm fairly familiar, but I I that's also taught me how unfamiliar people are with it because I can talk to my friends about it and there's a lot of misconceptions. Yeah. If you're in a ketogenic diet, what are you eating? So

14:05 Typically what when someone visualizes a ketogenic diet, I think there's a lot of misinformation. They think it's just steak and bacon. Um and I guess for some people it might be that. But it's actually uh if we're talking about a well-formulated ketogenic diet, we're talking about green leafy vegetables, things that we uh typically associate with health, you know, salads. uh broccoli, asparagus, cauliflower, these kind of uh nutrient dense green leafy vegetables that are high in fiber and phytonutrients.

14:32 Then You also have protein as a component of that. That can come from meat, that can come from fish in the form of salmon. eggs, uh, cheeses, a little bit comes uh along for the ride and things like nuts. And then you also have the rest of the diet which is made up of fat, and this can come a lot of times from

14:49 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 you're you know You're not having bagels, you're not having donuts. Um

15:03 White rice Pastas, these type of foods. The reason they're not a part of this diet is because These foods rapidly elevate blood sugar levels.

15:13 And a rapid elevation in blood sugar also spikes insulin. Insulin Shuts down Fat breakdown. And the ability to Take that fat.

15:24 To the liver. The liver built this amazing mechanism to be able to convert fat. Keetum bodies. Because ketone bodies Fat can't actually long chain fatty acids, which is the primary form of fat that you consume.

15:39 in the food you eat and also the type that's broken down from your own fat tissue. Can't readily cross the blood brain barrier. And we know that glucose is a fuel for the brain, but what happens if you fast or you don't consume a lot of carbohydrates and you have low insulin levels? And you can't

15:55 Mm. transport the fat, which is now your primary fuel source on a ketogenic diet, because you reduce Glucose. Which cause a reduction in glucose. The reduction in glucose lowers insulin.

16:07 The reduction in 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 without

16:20 eating something. And so our body turns inwards and starts using our fat stores as a mechanism to to to fuel our body. And that's why it produces ketones. Basically the evolution of this diet was believed to be acyclical meaning uh on and off pattern in human history. Because If we were to

16:41 Go through. Yeah. we probably consume it as much as we can in one moment and then we're seeking the next meal. and seeking next meal. What happens in that in between time? If you're one hundred percent reliant on having food twenty-four seven like we do in our current food environment.

16:57 You would never survive evolutionarily. Beyond a few days. With the ability to switch from a carbohydrate based metabolism over to a fat based metabolism, we store months and months and months. Of fat energy in the event that we don't have nutrients. So it's a one of the most powerful survival mechanisms we have.

17:17 to survive uh Moments of famine. But we also known since b times of biblical text that fasting has therapeutic potential, you know, most potently in And the ability to

17:33 what would be described as attenuate seizures, you know, convulsion like behavior was described when you just completely eliminate food. It's actually a common strategy in many religious practices. because of its quote unquote healing properties. Well now we actually know that Fasting induces a state of ketosis. We know that ketosis is actually shown to, in many of these cases, have a therapeutic impact in many of these. environments like

17:58 a seizure like seizures we've known since nineteen twenty one out of the Mayo Clinic that Ketogenic diets. Not only mimic the physiology of fasting But also attenuate.

18:10 The seizures In children with epilepsy. And that work has subsequently gone on to John Hopkins and other research institutes to show that this is a very verified strategy for not just Epilepsy, but it has been used for obesity, type one diabetes, type two diabetes for for centuries at this point. Um and it all starts with the reduction of 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 a sort of a podcaster that spends a lot of time talking, you notice high variance in your ability to think, articulate yourself. For long periods of time based on

18:45 My Blood key turn levels and my Might so Uh my diet broadly. Um But specifically the amount of

18:52 Key terms that are in my Blood. Why is that? Why is it that I feel like I'm more effective in communication.

19:01 And thinking. when I'm on the ketogenic diet or taking exogenous ketones versus when I'm having a normal Western high higher carb diet. A lot of people would know why this is if they had the same tools.

19:16 and insight that type one diabetes gives. Because when you're consuming that diet What is often happening is near constant elevations

19:26 and dips, elevations and dips, highs and lows and blood sugar levels. that we know are ascribed to changes in energy levels. So we know that high blood sugar levels. Uh i someone can Google if they're they're so interested to look of the term high blood sugar hyperglycemia. or low blood sugar or hypoglycemia.

19:46 And just type in symptoms and you'll see a laundry list of things like fatigue, irritability, lack of concentration, a shakiness. These are all symptoms of a lot of what you're describing, right? Which was changing your your your ability to concentrate your energy levels. It's a very very clear that glucose levels are linked to that. We also know that the change to be clear, so is that when I'm at the high or the low In the glucose. If I You know, if you if you ate one of these right now. Yep. Oranges? Tangerines? Oranges. Yep.

20:18 Um if you ate one of these right now. You Blood glucose levels are gonna go up, presumably. Yes, because These oranges are composed of

20:28 bound sugar molecules together. So most fruit has a structural component to it. Which is why you see it in it's it it has like a has is has mass to it, right? It's not just liquid. And then that structural component binds together as a part of it sugar that's bound together, they call them polysaccharides. And those polysaccharides when you

20:49 Consume them. Your gut Actues those breaks them down into individual glucose molecules. to then be absorbed into the bloodstream.

20:59 That's when the insulin's released. That's when insulin takes that glucose and stores it into tissues like the muscle and the liver. Uh for future glucose needs. Uh and so yes, we would presume that with this high or oranges or even most fruits Pastas, rices, what all elevate blood sugar levels. But

21:18 than that a companies with a high insulin level. Right. So the more the oranges, the more insulin that you would need. And You know, despite many of these foods be considered very healthy, those with

21:30 metabolic disease or metabolic dysfunction. may not maybe have a be more vulnerable to even what would typically be considered healthy foods. Um and type one diabetes is a is a powerful example of that. So you said you'd You'd be open to eating one of these. We've got your blood glucose and insulin levels, which we're gonna put on screen for people that are watching. And it'll be interesting to see how quickly we see that.

21:53 Orange, which is considered a health food by many people, have an impact on your glucose and insulin levels. So yeah, so I so what I'm I'm gonna do is normally I would I would never do this. But I I think it's very important for people understand Especially those at home who either have a chronic disease, which is most Americans at this point, or kids who have a uh a disease like diabetes, what the impact really could be. So let's say Ornders are considered a

22:21 Superfood, uh by the American Diabetes Association. So it's a fruit highly recommended by almost every organization, USDA, F or USDA, American Diabetes Association. MBM. The amount of orange is three oranges. Three hundred is probably gonna make up.

22:38 Around Uh seventy to ninety grams of carbohydrates. For me, my Energy needs it around calculated it, around three thousand calories per day. If I were to

22:53 It the Amount of carbohydrates recommended. Per day which is around fifty five percent. by let's say the USDA guidelines. that I would

23:02 Need to consume at least Or more than this, uh at le if I split up all my calories over four meals. And so This is An opportunity to see

23:16 What this will actually do to blood sugar levels. Um type one I Bs if you consume will be a near equivalent to a brown. A fifty amount of carbohydrates that I would

23:28 consume per day if I was on a standard diet. The the ketogenic type it they typically say that To stay within it, you need to be below Is it roughly fifty grams of carbohydrates a day? Fifty grams of carbohydrates per day is a

23:44 Rough number that we suspect most people will be able to get carbohydrates low enough to where insulin would be sufficiently low to produce ketone bodies. Okay. Yeah. So there's variance depending on your insulin sens sensitivity and insulin response and I guess body weight is also gonna be a factor. Big factor, major factor because

24:01 Anytime you're talking about things like Uh Glucose insulin is 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 know. I know I I I eat berries and raspberries and stuff like that. 'Cause people tell me there's like polyphenols in blue bla blaze. Cohesive with the QA diet. Because they're higher in fiber, so

24:22 Like you know, half of Well, you're consuming not half, but a large portion of its fiber. So It's more about the net carbohydrates. Th it's the the glycemic metabolic impact of the food so If the fiber is non digestible, which in fruit it isn't.

24:37 Then it shouldn't. doesn't count, right? So higher fiber content, most of the vegetables on a ketogenic diet are higher. Fiber, you know. Because you know, it's the it's the total carbohydrate to fiber ratio, so the net carbohydrates that really matter because that's the amount of that's the metabolic real metabolic impact of food. Yeah. A lot of fo a lot of ketos friendly foods they like. net carbs at one gram or something, then you look at it and you go, fucking it says twenty. So oh a hundred percent. So I I've tested two different foods that are

25:07 Keto friendly on the label. Same as that calories, same as that Fat, protein. Even fiber. Um And they can produce completely different responses. I mean the food environment nowadays, you essentially need almost a PhD in nutrition or biochemistry to walk into a grocery store.

25:22 And be able to understand what the hell's on the label. It's in it it is I and I don't want to sit here and say like oh they they don't know. Like No, They they know. I mean there's a companies who have tons of resources. Food scientists glue.

25:36 And they're putting zero sugar on the label. Friendly uh As a trick because it's associated with health benefits, right? There's all these studies on ketogenic diets that can uh they can show to improve health. And so they want to have that on their label. But what is 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 same exact metabolic effect as sugar. So maltitol, maltodextrin. Um

26:02 All these different ingredients that are gonna uh cause glucose to go up rapidly, they'll just swap it. And now you can put on your label zero sugar. If you've been in a ketogenic diet since you were Diagnosed with diabetes. Have you cycled in and out of it yourself? And if so, what have you noticed in terms of when you are in that diet and when you're not? So

26:21 I actually came across this diet A little over a decade ago. Almost Every blood meter that was taking this before C Gm'd her present, I had to just break my blood, you know, six to ten times a day to see what my blood sugars were, I was finding that I was very rarely outside of the normal range.

26:36 And I was also finding that I wasn't feeling these extreme highs and lows anymore. when I transitioned to a ketogenic diet, almost immediately, my insulin requirements dropped substantially, uh, around forty, a little over forty percent. So the

26:52 drop dramatically, but I didn't have continuous glucose monarch. I didn't have this instant feedback of like, what is my blood sugar doing? I just know I needed a a heck of a lot less insulin. And so What happened was I went into my doctor's office at the time. He happened to be

27:08 The American Diabetes Association president. at the time. He's like, I've Never seen a blood sugar level. in the normal range with someone with type one diabetes before.

27:19 He said, W what are you doing? From that point forward, that's when for me it like transitions even into like a lifelong journey. of like wow, you know, obviously nutrition had a huge impact on me losing weight when I had obesity. Now it was directly regulating this very powerful disease where

27:38 Upon diagnosis Nearly All patience. are gonna have high invariable glucose levels for the rest of their life. 99% of patients will never see normal metabolic control again for their life. A hundred percent of them are expected to get insulin resistance.

27:53 And within Three years? We s Neuroanatomical changes within the brain of children who are diagnosed. What does that mean?

28:03 When we look at MRI scans of the brain. We see that children with high and variable glucose levels with this disease with type one diabetes. They have shifts. in the type of white and gray matter. The the sections of the brain that are associated with normal brain development and childhood.

28:21 They're not developing the same way. We and we see this within three years, and it's directly linked. We also know That we see signs of the early signals of athlosclerotic progression in children within four years. Athlosclerotic pr progression, what's that? So

28:42 one of the primary causes of death in individuals across the world is cardiovascular disease. And How do we get that? Well You have changes in your blood vessel and how it functions is the first and earliest signal. a future what will ultimately be plaque or this kind of blockages within the blood vessel, which ultimately cause things like heart attacks or strokes.

29:04 Well In type one diabetes, we see that children who have high in variable glucose levels, again, ninety nine percent of patients are expected To just live this way for the rest of your life if they follow standard of care.

29:17 They're gonna see Changes in how their blood vessels literally functionally and structurally change. Their blood vessels will now shift from being This very compliant uh almost like a a smooth wave to That blood vessel now becomes very rigid. It starts to build collagen.

29:36 and more and more collagen around it becomes stiffer and stiffer. It's almost like taking a hose. And turning on a hose and pinching the hose. When you pinch the hose. as you g as it become 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

29:53 Clear signal, one of the most powerful signals that the blood vessel is starting to change before you see plaque, before you see blockages, I mean decades prior. These are all happening in childhood, by the way. You know, 10 to you know 10 to 14 year olds with diagnosed with type one diabetes. We see that the blood vessel isn't able to respond to what they call sheer stress, Steven. So that means

30:15 Let's say you go for a run, uh this morning, Steven, and your blood pressure initially increases Because as your heart rate increases, the speed of the blood increases, the amount of pressure on the vascular wall increases. That the a phenomenon when the blood moves fast

30:32 Through blood vessels. And It causes stress against the blood vessels. That's not a bad thing. It's actually a signal for the blood vessel to release something called nitric oxide. Nitric oxide.

30:43 is a potent called vaso dilator. It causes the blood vessels to open up. And this is how your body responds normally to stress. Okay, you go for an exercise, vasodilation, or you vasal constriction, then vasodilation. Um Or you know, and these are normal responses the body has. Well, what happens in type one diabetes very early on. Is that

31:05 The ability to produce nitric oxide is diminished. You're not able to respond to high stress loads. So not only are the blood vessels becoming stiffer. But now the blood vessels aren't able to even respond as well to the stress. And so as you're looking at this and you're looking over time, You see. These early signals

31:24 Of athloscerotic progression you also see very early on. That it was once expected that all patients with type one I Bs would have eye damage, some form of eye damage called retinopathy. Where you start to lose vision, eventually you can go blind within 20 years of diagnosis. So most people are diagnosed in 10 to 14 years of age, which means by 30.

31:45 You're gonna see a lot of patients who Of altered eye function and or some who are blind. Now that has extended out over time, but we know that all patients

31:58 With this disease. because of high and variable glucose levels. are expected One

32:07 Complication. And their lifetime. If they follow standard of care advice today, even with the best technologies out there. There is no pharmaceutical intervention, there is no technology that normalizes this disease. And the effects of these high invariable glucose levels and insulin resistance that accompanies it. Is cumulative.

32:28 Dose dependent and not completely reversible. Which means that Once you're diagnosed The clock starts ticking. Just like smoking, the more you do.

32:38 The earlier you do it. The earlier the impact and the more lost life you probably will get. And there's the study done. With three hundred and twenty-six participants that found that the keto diet can increase glycemic control of patients with diabetes. That was in the Precision Nutrition publication. When it says it can increase glycemic control

32:59 What does that mean? So Is that what we were talking about there? Yes. So if you when you do a diet known as the ketogenic diet, you're reducing carbohydrates.

33:10 Well When carbohydrates are consumed, they elevate Glucose levels. Well If you dramatically reduce the amount of carbohydrates consumed, you're not having those same type of glucose elevations and fluctuations. Because you're not consuming the most potent

33:25 Glucose elevating factor. in our life, which is carbohydrates. And so When they talk about improvements in glycemic control It is the measure of

33:36 Twenty four 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

33:49 Encourage people to restrict carbohydrates. In their diet. But you know because Carbohydrates and sugar have been somewhat, I guess, demonized because uh you never really hear many good things about sugar. Um so so what is your what is your goal here? What is the advice to the listener? Is it to restrict the their carbohydrates?

34:08 To be very conscious of what they're consuming because nutrition has a em powerful potent impact on overall health. And for those patients who have chronic disease, which is unfortunately the overwhelming majority of us. Yes. Carbohydrates can be a very Restricting carbohydrates can have a powerful therapeutic effect.

34:29 on diseases like type two diabetes. The American Diabetes Association in their 2019 consensus report described type two diabetes as the most evidence based nutritional strategy. We know that it can have potential positive impacts on things like uh Alzheimer's disease. There are studies that have looked at this. We also know that for carbohydrate restriction, which was and I like to term this therapeutic car hydrate restriction because it's the therapeutic outcome of a carbohydrate.

34:58 reduction. Um And That's really the goal of this is Can you improve your overall health? Many people will just do this simply to improve you know, to lose weight, to feel like you say, to feel more cognitively alert.

35:11 But in my case where you're along further along the metabolic spectrum with diseases like diabetes It has a even more uh potent impact on how you feel, even more potent impact on your overall health. Um and but unfortunately about ninety three percent of Americans have some form of metabolic derangement. uh as cited by multiple studies of multiple research groups.

35:32 You did a ten year study. on the impact of the ketogenic diet. On a patient that had type one diabetes. I think this is this is Most certainly the longest study ever done of its type. Where you took one individual.

35:46 And over ten years you I guess controlled their diet? So we had access to The ability to monitor uh A unique patient who

35:58 had type one diabetes. And they were diagnosed and had followed the American Diabetes Association diet, a healthy diet for Six years. and then switch over in twenty thirteen to a ketogenic diet. Upon the initiation of the diet in post, they had DEXA scans, they controlled their calorie intake, their body composition.

36:18 They weren't taking any additional medications. And we were able to monitor the impact over a ten year period. While controlling all those variables, and why that's so important is Because one of the common concerns of a ketogenic diet Is

36:33 the hypothetical risk it can increase cardiovascular disease. And the reason that They think that it can increase cardiovascular disease, or it's hypothesized that it will, is because of the elevation in LDL. that often accompanies an increase in saturated fat in the diet. Now saturated fat comes from things like animal proteins. Uh it's in coconuts as well.

36:53 What we found is that despite A near doubling. And L DL cholesterol. On this diet.

37:01 which again should be associated with worsening cardiovascular health. We did an advanced cardiovascular assessment. in in this patient and found that Despite doubling LDL. They had maintained completely normal glycemic control. Which again based on all the data, says the number one risk factor.

37:18 they reduce their insulin load over forty percent. And Their cardiovascular health. Was not only Better.

37:27 Then the average patient of similar age and sex. with type one diabetes. It was better in almost every single category than people even with Out.

37:39 Type one diabetes. Despite the doubling of LDL cholesterol. It illustrated that. Over a ten year period it would maintain not only No sign of cardiovascular disease.

37:51 But remarkable cardiovascular health en fact. We actually followed on. That study with the largest Ever analysis of the impact of nutrition, particularly carbohydrates, in over forty six thousand patients. with type one diabetes

38:07 We showed that in over seventy percent of all reports of very low carbohydrate ketogenic diets. The patients were completely able to normalize their glucose control, normalize the most potent risk factor for. disease of type one diabetes. And it's just This is a sort of

38:25 Uh a spectrum. Of I'll put that on the screen for people to see. the different sort of stages and categorizations of being normal, pre diabetic and diabetic, right? Correct, yes. So normal is is anything less than five point seven percent HBA1 C.

38:40 Pre diabetic is that five point seven number up to six point four. And then diabetic is anywhere between six point five 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 sugar levels have uh risen quite dramatically. Yeah. So what you see initially is as uh probably only the first

39:02 Phase of this, right? So Started at an average around hundreds milligrams per deciliter on average. And

39:10 Once the food is then consumed because once you consume the food, it takes some time to break down into glucose. That glucose Then goes in the blood, and then the blood and moves glucose into this compartment around the cells, which is called the interstitial fluid. And now we're starting to see the direct impact

39:28 of just consuming probably a fifth of the amount of carbohydrates I should consume from a Superfood. Um this, you know, oranges are considered both a citrus and a fruit, and this is considered like a superfood by the American Diabetes Association. Uh In the context of diabetes. So when the glucose spike is high. So you've just eaten some oranges, the spike is going up. Yeah.

39:49 W w what does someone feel? And then what do they feel when it's then crashes down and goes below because it started at about a hundred. So I imagine that it's gonna go up to whatever it goes up to. And then it's not gonna drop back down to a hundred. It's gonna drop below One hundred typically. In a in a normal.

40:07 um non diabetic person, right? So hundreds right around the uh normal. So What you'd hope would happen is that you're gonna s go up Just a little bit. Insulin's gonna respond quickly and they're gonna come back down to normal if you have

40:19 Total. healthy metabolic function. Again, the vast majority of us do not. But In this case. what's gonna what would be predicted to happen is that

40:29 as blood sugar elevates and insulin responds. It's gonna go as high as the amount of glucose that's present in the food. Okay, but at the same time the my pod is also which is holding my insulin. is immediately trying to respond. It's immediately trying to say, okay, oh no, we need to bring this and keep this into a normal range. Um, and so it's trying to release insulin. And so you can see on the screen that there's this massive uptick in the blue line, which is uh the initial response in insulin immediately to the elevation in glucose.

41:00 This is exactly what happens in normal physiology, yet no one can measure it. But you can see it here. So how would I feel when the glucose spike is high? Uh do I feel energetic, do I feel focused, or do I feel tired? My personal experience here, Steven, is that as blood sugar becomes very high, I I become My focus reduces, my I become fatigued. Uh I can also

41:22 quote to my wife, become irritable. And Yeah, I but you can even uh look this up, you know, you can look up what are the symptoms of hyperglycemia. What are the symptoms of

41:34 elevated glucose levels above the normal range, which is normal seventy to one hundred and twenty. That's when you can start to see uh very clearly that the evidence over time has shown a a very clear impact on not only how you feel physically, but also your mental health status as well. Oh, I've just looked up the symptoms here and it says um the common immediate symptoms of having a high glucose spike is you feel

41:57 Thirsty, dry mouth. Um, frequent urination, headache, brain fog, fatigue. Sluggishness, blurry vision. Um And then once you go down and you crash.

42:09 where your glucose really drops below the normal range, what do you feel then? Typically. So a lot of how I like to describe this is almost like imagine you're outside and sunny outside. Yeah. And you're having a great day, great conversation with other friends. And then all of a sudden, very rapidly

42:26 Clouds come over, Tom. Everyone kinda dissipates and it starts to rain. It's almost like i it it's it's we know that glucose levels have a direct impact on the neurobiology of the brain, meaning how the brain functions, how it operates. And

42:44 Particular at very high glucose levels, you know, typically above a hundred and eighty milligrams per deciliter, you start to see signals of inflammation. signals of stress, like oxidative stress in the body of people have heard of th that before. And that can start to cause damage on tissues and cause a stress response. But the problem here, Stephen, is that most patients Are living there. Twenty four seven.

43:05 I was looking at some of the symptoms here and it says. the short term crash that you get after a spike. Um after a rapid rise. Is Bit of an insulin overshoot.

43:15 So it's reactive hypoglycemia, which is the sugar crash, and then you might feel in that crash jittery or shaky. Hungry, often craving cobs. And sugar again. Irritable, anxious, weak or lightheaded. I stayed up until three AM the night I first tried Replit and it blew my mind. Replit, our sponsor of this podcast, are one of the most powerful AI platforms I've come across. They allow you to turn any idea you have into real working apps in minutes. Using plain English. Just describe what you want to create and Replit's AI agents will create it for you. And you don't need any coding experience to get started. I asked Replitz AI Agent to create a brand new to-do list for me based on exactly how I wanted my perfect to-do list to be, and it built it for me in minutes.

44:00 And I didn't need to know how to code to create it. That is now the to-do list that I'm using. Super cheap, super fast, and completely personalized to exactly what I wanted it to do. And now I'm an investor in the company as well as then being a brand sponsor. And Replic connects to payment systems like Stripe or services like OpenAI. And has a built-in database and user authentication system. If you're a founder or a freelancer or anyone who's been searching for someone who can code, you can build your next app with Replit. Head to Replit.com and use code Steven to get fifty percent off your first month of Replit's core plan. You did a study in twenty twenty five, I believe, on the Impact of the Ketogenic diet on physical performance?

44:42 You know, if a ketogenic diet has all these therapeutic potentials, you know, going back for over Two centuries. What is Truly the impact of it on performance. That's one of the primary reasons where at least someone were to walk into a a clinical setting and say, Well, yeah, you can do this, but

44:59 I've heard it's going to decrease my performance. Physical performance. Physical performance. And so we were very, very interested in this because we thought, okay. Yeah. You know, when we look at why carbohydrates are currently being recommended as sports nutrition, is because since nineteen twenty one they've been shown to improve performance. And how they showed that in nineteen twenty one was that physicians out of Harvard and um and Boston actually watch Boston marathoners. half of which he would come wouldn't even finish the race.

45:29 Slurred words. They would uh have like almost pale skin. Shakey. weren't able to articulate their words or some wouldn't finish at all. And what they were finding was that these when they tested the blood of these individuals, that they were finding that glucose levels were low. Basically they reached

45:45 What they call hypoglycemia. It's a medical term described. Very low blood sugar levels. And The next year they provided carbohydrates. And these marathoners and the Boston marathon.

45:57 And all of them improved their performance. And so since nineteen twenty w or n not nineteen twenty five, actually, we've known that carbohydrates can improve performance. But We What has happened though over time is that in nineteen sixties. We There was a measurement technique called the Birdstrom method where you actually did a muscle biopsy

46:17 Pulled out. muscle tissue and found that oh wow, there's actually glucose stored in the muscle. So it must be really important for physical performance. If the muscle which is used to contract and move the body during physical performance that if glucose is in that tissue, it must be essential for performance. And then after they discovered that, there was all these associations between low

46:38 glucose levels in the muscle called glycogen, low glycogen, and fatigue. Then after that, the in the nineteen eighties they were able to look at the amount of sugar, carbohydrates, and fat that the body was burning.

46:56 And what they found at that stage is that Oh wow, it looks like The am the amount that people are able to sustain intense exercise Is

47:07 Proportional to how many carbohydrates that are burning. And then there was a few modeling studies, Steven, that then looked at okay, what's the relationship between Let's say uh

47:21 The intensity of exercise And what type of fuel you use, whether it be fat. or carbohydrates. And they found that They modeled it.

47:31 Okay, and said okay, well at lower intensities you must Um almost all fat and at very high intensities you must burn carbs. And there was a number of studies in two thousand seventeen to twenty twenty.

47:44 three different studies that looked at the ketogenic diet over a five day to three week period. And they saw that in those studies that there was a decline in performance Buy around Two percent.

47:57 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 obviously the ketogenic diet must impair performance. And there's all this evidence since nineteen twenty one that the amount of carbohydrates Glycogen. How much carbs you're you're consuming is essential performance. But here's the kicker. Is that

48:19 One major confounder of all this is that we've known for quite a long period of time that the adaptation to a ketogenic diet Is not one week. It's not two weeks. Not even three. It's

48:31 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 burning Using key tones. So the body's ability to

48:47 oxidation or the amount of carbohydrates it's burning for fuel because you're giving your body less of it. the amount of fat that's being utilized for fuel goes up dramatically. And then you produce way more ketone bodies and ketones are now being used. As knowing a a Body uh

49:03 Tissue. Substrate meaning energy for the muscle, but also for the brain. And so it's this transition over, but When people were looking at these studies, they were just looking at

49:15 Some of the metrics of what Happens when you your body transforms When you reduce carbohydrates. Okay. So what we wanted to do is say, okay, if there's all these health promoting benefits of a ketogenic diet, that sounds great. But

49:30 All these studies and sports dogma would say that's gonna impair performance. Okay. So let's test that. Let's actually put athletes On a ketogenic diet. Four four weeks.

49:43 We're gonna control not only their calories, we're gonna control their body composition, we're gonna control their activity level. We're gonna control all these key confounders that many of these prior studies Never controlled. So that we could truly test.

49:58 the diet induced, so the macronutrient, meaning the shift from carbs to fat. effect on performance. But we're gonna do it in the same person. So now we're gonna control their genetics. We're gonna control their environment.

50:12 Once we did that, Stephen, We tested What most people think is a you know a very glucose dependent form of exercise. We asked them to do six by eight hundred meter sprints. They were on a high carb diet.

50:26 And then they switch to a low carb diet. Now what happened is all randomized uh and controlled. When they switched over. They had No deterioration in performance. At four weeks.

50:39 At the four week mark. In a Form of exercises that we would expect. would be extremely glucose dependent, extremely carbohydrate dependent. But before four weeks was there an impairment in that performance. So what we were interested in, Steven, is Studying

50:55 at the end. Okay. So we didn't look intermediately. We exclusively look at the end time point because the the question was Well it if Is there a difference once you stick to this diet? Because if you you go on this diet, ideally you're you're sticking with it over time. And so If it is true that you require carbohydrates, we then also measured how many carbohydrates in fat they were.

51:19 Burning. During Exercise. And it was over what we call eighty-five percent of their VO2 max, which means eighty-five percent of their total maximum oxygen consumption during exercise. That is when we would expect

51:36 Омостно фабі оксидіз ор тобі берн. And almost exclusively carbohydrates. Well we found That these athletes recorded the highest levels. of fat burning during exercise.

51:50 Every report in the literature. Athletes. Ketogenic diet.

51:56 That when these diets adapted to the diet for sufficiently long They had record levels of fat oxidation. Even At very high intensity levels. Which means that fat was able to provide

52:11 Nutrients and fuel. At very very intense form of exercise when we would expect only carbohydrates would be relevant. And utilizable. So many of my friends

52:24 um that are insurance athletes or that are involved in things like cycling talk about exogenous ketones. Um, I'm a co co owner of a company that produces exogenous ketones, that's my disclaimer. I've got the product here. What can you tell me about products like this, exogenous ketone products?

52:42 Exogenous meaning ex externally supplemented, I guess. Right. So with a ketogenic diet, you produce them, your liver produces them for you with um Exogenous you're consuming these. Well Why would you consume them? Why not just do a ketogenic diet? Well, we know that A ketogenite diet. Takes time to adapt. We just talked about that with physical performance, that we see that you know up to four weeks to see the full effect on performance or more.

53:12 Well What happens if you're let's say a war fighter or someone who's going out into the field or immediately wants to flip into this state? You can't do that. Unless There was a molecule that you could consume that could rapidly elevate ketone bodies in circulation.

53:28 Within minutes. Insert. Exogenous ketone bodies. We have known Since The nineteen sixties.

53:38 That the product in there was studied by MIT uh in the aerospace department called one three B Tane dial. It that it was able to Ketone bodies. In circulation. There was a study in 2016 called the Metabolic Optimization, it was a$10 million program from DARPA.

53:58 DARPA is an advanced research organization from the United States government where they fund very high risk high reward programs. And one of which was the the the use and testing of ketone bodies. And so that uh molecule that they tested was um utilized the same molecules in there and they kind of uh tweak some of the formulations a bit. And they showed that and we know that this is the same for this molecule as well, that when you consume them at rapidly

54:25 changes metabolism. Almost uh not identical to what happens with the ketogenic type, but it has at almost direct impact it has a bud glucose lowering effect. It directly binds to receptors like the Um They call GPR one oh nine A.

54:42 Or uh Or some other key receptors that directly uh impact inflammation. So it directly blocks something called N L R P three inflammosome, which is a molecule that leads to increases in inflammation. We also know that it changes the way that our genes

54:59 are used in the body called epigenetic. signalling. And so the con uh consumption of ketone bodies can actually change the molecules on our genes and and how those molecules are ultimately manifested.

55:14 That increases Or antioxidant. capacity, meaning our ability to block oxidative stress in the body. We We see all these powerful effects, these rapid shifts of metabolism within the body.

55:27 And his twenty sixteen study showed that just Orally consuming these molecules. could rapidly shift metabolism, but that it was also linked to an improvement in physical performance. But if you look beyond that and just like Uh. These these kind of

55:41 studies'cause we looked at them in athletes, we looked at them in healthy individuals. And then also in military settings. But we've also there's studies looking at this in patients at risk for cognitive decline, so patients at risk for Alzheimer's disease. They've shown that in a six month study administering exogenous uh ketone bodies was able to attenuate the decline. in uh cognition that we know happens with advanced age. And just to be clear though, you're saying it reduces the decline. It doesn't

56:07 Correct. Cure Alzheimer's or fix Alzheimer's. It just Delays. Accurate. Yes. It's it's We know that as individuals age.

56:17 You're on a precipitous or or steady decline. in in brain function. Um And

56:25 So the goal is to s 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 things clearly like reading and and doing problems and solving problems. There have also been these emergence of studies And the world of psychiatry. I think there's around eleven.

56:46 ongoing active clinical trials looking at the impact and interaction of ketone based therapies. And brainhouse. uh particularly serious mental illness. one in four adults in the United States, actually over one in four adults in the United States has serious mental illness. In fact, I believe over the numbers are over twenty percent of of adults are taking some type of

57:07 psycho uh altering uh medication. At its core, we see all these relationships between underlying metabolism being a key factor contributing to mental health status and the application of the this unique diet. Which we know increases ketone bodies, which appear to have direct impact on the brain.

57:28 Now seems to be linked. to improved serious mental illness. And it'll be interesting to see where the that evolves, but it's just a fascinating world to imagine that nutrition, not a medication. not a technology, but the the simply going to the grocery store and swapping the things you choose in there.

57:47 Can lead to these powerful Powerful therapeutic effects. um and people of all sorts of different conditions. uh or disorders. On one of the studies that I read about

57:59 The Administration of exogenous ketones. and the impact it has on brain network stability was from two thousand and twenty, where they investigated if brain network stability responds to Two major brain fuels, either glucose or ketones. And participants came to the laboratory on two occasions and drank exogenous ketones. Or

58:17 Glucose. And after cons consuming these drinks, they underwent an MRA scan. Strikingly, the study showed that ketones increased the stability of brain networks. In contrast, glucose decreased the stability of the network. The network stability was eighty seven percent greater after ketone consumption, than stability measured after glucose consumption. And in that study which is on PubMed, the last line of the abstract says dietary interventions resulting in ketone utilization increase available energy and thus

58:45 Maybe 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 in a very aggressive form of metacetic cancer. And what we saw in and my work in graduate school was that

59:02 when applying disxogenous ketones that it delayed the progression. of the metastatic cancer. But it also When looking at body weight. reduce the rapid decline in body weight we sometimes see with cancer, a ch a phenomenon called caquexia.

59:19 Which is a way A term to describe the w rapid wasting. A body tissue. And it is no more aggressive than the context of cancer, particularly metastatic cancer is where it's most common.

59:32 And when we saw the lack of decline And 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 um

59:46 and muscle mass. So it also appeared and there's been a number of what they call clinical physiology studies. So studies That actually directly manipulate human beings. with molecules and tests, you know, like muscle tissues and how they function

1:00:03 We see that Exogenous Keatson administration can't be a dramatically reduce the amount of muscle breakdown. uh or uh breakdown of muscle tissue. Uh

1:00:14 Essentially. Illustrating it may be a powerful mechanism in promoting healthy muscle mass as well. In terms of being in a key to check that one of the things I'm always quite concerned about is Am I still able to gain muscle mass?

1:00:28 If I'm in a ketogenic diet because I Yeah. I've I've when I go into a ketogenic diet and I stop having carbohydrates, I tend to lose weight rapidly and shred. Yeah, it's the fat falls off. And I get Okay.

1:00:41 Very lean, but Yeah. Psss more skinny. You smiled though, because uh maybe you you like to be uh 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.

1:00:58 And build it. Yes, and build it. So they've shown that as well. So Jeff Volk out of Ohio State University is done a number of studies in this area, um, looking at individuals who were actually on a Uh. uh reduced intake diets. They're reducing less calories, so they had less energy in the diet, and then they were also doing the ketogenic diet. It was actually a military study. And they show that they were able to maintain uh muscle mass just as much as if someone

1:01:23 was on a high carb diet um while Under A Caloric restriction or another way of describing that as like a semi starv starving starvation state.

1:01:34 Impact. negative impact that we see with these diets on muscle mass. However, to your per to your personal example, one of the first things that happens when you go onto a ketogenic diet is there's a uh Um naturatic effect or natures effect. But basically you reduce

1:01:49 the amount of sodium uh in the body so you s you you p 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 on a ketogenic diet, which for many people is great because if they're trying to do it to lose weight That's like immediate reinforcement, but it's sometimes it's water weight. Well, water is in both the fat and the muscle. So it's it's not necessarily that you're losing any muscle mass per se, but it just might be in a phenomenal or less water weight. And in some context, that might be beneficial, right? If you're in a sport where you have a

1:02:20 power to weight ratio, but you're able to maintain the same power. At a lower weight. Simply by shifting water, that's great. Um, as long as you're able to function equivalently. Is there anything I do need to be thinking about in terms of my diet?

1:02:34 to make sure I'm still gaining weight just to I guess to keep Keep my protein levels. Hi. So the most important thing related to your diet when it comes to trying to build muscle mass is to exercise hard. And

1:02:47 with resistance exercise. Ah, that's the most important thing when it comes to your diet. To enhance that effect. Protein is one of the the most powerful nutrients you can consume to augment that response. Another is to ensure you're having sufficient

1:03:03 calories, right? So you're in a caloric deficit. So you said that you know you tend to eat less calories because you're probably not as hungry. Um, well yes, that's one of the most powerful ways to lose not only fat, but also muscle, is to just not eat food. Or I think that's it. Because I my I lose my appetite when I when I'm in the ketogenic Oh yeah. I also lose my appetite a little bit when I take these um exogenous ketones like ketone IQ. Yeah.

1:03:26 Uh, and I've I've seen some of the studies that show that there's roughly twenty percent decrease in um appetite. when you take exogenous ketones according to one particular study that I read. But when I when I'm in the ketogenic diet, I it's like food is I get hungry. But then I start eating and

1:03:44 I stopped very quickly. Yeah. And it's really bizarre. Like I was I was in Cape Town for ten days or two weeks writing my book. And that's 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, I'm amazing. I start eating it. I have like five or six bites and I'm done. And only when I'm in the ketogenic diet.

1:04:02 There's something going on in my body which just doesn't Just doesn't Wanna Bingy like I sometimes think two things to talk about. One is the type of food you're consuming on a ketogenic diet, and the other is what is happening in your body. in your metabolism on the diet. So

1:04:19 There's a a book called Always Hungry by a uh physician, uh and our cronologist named David Ludwig, and he's kind of coined this carbohydrate insulin model. And um you know, it's semi somewhat controversial, but the r the reality is that uh there's There's some important notes in it, one related to hunger, which is if you're able to have a fuel source on a ketogenic diet that's sustained over time. So you don't have the up and downs of glucose and up and downs of insulin, so these constant swings. Whereas on a Kitojant That you have the sustained

1:04:48 level fuel influx, right? So you have this Nutrient availability in the blood. So glucose levels are much more stabilized, insulin is much more stabilized, and you don't have those fluctuations particular in those specific molecules. That might be one potential reason. But the other potential reason is that when you're on a ketogenic diet, you

1:05:05 Consume. The type of foods that drive hunger. So again, we talked about in the grocery store, the seventy percent of the grocery store and particularly in the center of the grocery store. that is highly processed, where they combine carbohydrates with with salt or fat or some combination there in that makes it highly palatable or very, very

1:05:25 tasty, you know, increase the dopamine response, this positive reinforcement response of the food. Um That drives people to to seek more of that pleasure response. And as a result, they want to consume more. So everyone has probably felt this example where you're in a restaurant. you eating enough food to where you feel physically full, you're like, oh I'm totally full, like I ugh.

1:05:46 I don't want any four. More food. Someone walks by. With your favorite dessert. And you're like oh. Mm.

1:05:54 I could eat that. You're literally physically full. But yet You want to consume more food. This

1:06:03 is a is a uh a phenomenon that has been the struggle of of in America and the the rest of the world, essentially now, um, where the food environment often drives people to overconsume. And it's not by accident. These are like Well conductive strategies in the food industry to

1:06:22 lead to these positive pleasure responses. I have to put this with bread in the restaurant, you know, they give you bread first. Yeah, it's a good it's a it's solid strategy, Steven, to cause you to want to consume start to finish. Not only the bread. Get a big meal. And follow on with dessert.

1:06:40 You know, it 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 You you combine this mixture of new uh m molecules in the food that you consume it you get oh this tastes great. Crinkles. The same exact thing where

1:06:58 You combine these different components and it forces you this like, Oh, this tastes great. I need more. And you never feel full. One of the most common tricks. that the the food industry utilizes In these environments. Is that They

1:07:14 One thing they certainly are aware of this, right? And so when you consume these type of foods together They They know they can see more of it, but sometimes people aren't even aware of it. And a best example of this Go look at the back of the

1:07:28 Most of the bacon. on the grocery store aisle. Go look at the back of most peanut butters, almond butters, nut butters in the grocery store. Most of them. Have added Salt?

1:07:40 and added sugar. Even to levels where you don't even taste it. But go look at the label. The reason those are added. is to increase the flavor profile the positive

1:07:52 Brain response to the food. So that you consume more of it. And this is a huge part. And why people Always feel hungry.

1:08:02 in today's food environment. They're always seeking more food. And they can't get off. That hamster wheel. They're always over consuming or always referring to this phenomenon called food noise, where they always feel the drive to consume foods, or they never feel full.

1:08:21 And it's and it's because of the sugar and the salt. It is Because The food is composed And made in such a way to be to have a flavor profile.

1:08:31 That you're Brain. Says Not just eat one bite. Eat as much as possible.

1:08:39 These pleasure responses, right, in in our lives, in our world. It's i this is even independent of food. So what do we do about this? 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

1:09:00 Art. Abundance of calories. Will drive people often to overconsume them and very Uh drive this pleasure response in the brain. Liquid calories. What's a liquid calorie? So let's say you have uh a soda.

1:09:13 Or a coke. Yeah. So basically completely void of any nutrients. And Really high in calories, spice your glucose through the roof, insulin through the roof, and then often makes you hungrier afterwards, not less hungry. Like orange juice.

1:09:28 Is a another great example. Smoothies. Those those fruit smoothies people have. Exactly. In fact, just taking fruit and then blending it up actually increases the speed by which it's absorbed, changes the hormonal response, and leads to a worse outcome for most people. Most people think a fruit smoothie is a healthy thing. Yeah, I I don't know about that. Um I would I I think that when you take fruit Which for most reasons isn't terrible, right? Like it's not these are

1:09:54 Nutrient dense. Food. If people can consume them and get away from them, great. If you have a metabolic disease, you might be more vulnerable to, let's say, glucose elevations. But when you then take foods like that, it could be any foods, it could be taking potatoes and then making mashed potatoes, by simply changing or blending that food up, you are now taking a lot of the structural components that your body would take time to digest and you're removing them. And you basically almost are like uh almost turning on like a small hose that's just giving out a little bit of water at a time and is turning it on all the way. You know, you're rapidly increasing the speed of how the nutrients enter the body.

1:10:32 And it completely changes the hormonal response of molecules like GLP one and and normal levels of GLP one in the body are completely altered. The insulin response is also altered. And GLP one six is the hunger. It's known for being related to hunger because it's released in response to food. It changes.

1:10:51 The brains Hunger drive. And most people know of it because of Ozimpic, Samagide, Wagovee Tresipotite.

1:11:00 Um, all these GOP one receptor agonists that are Increas one levels not to normal levels. They're increasing them to super

1:11:14 physiologic levels, m levels that would never be observed or ever seen. in normal settings of the body. I've just invested millions into this and become a co-owner of the company. It's a company called Ketone IQ. And the story is quite interesting. I started talking about ketosis on this podcast and the fact that I'm very low carb, very, very low sugar, and my body produces ketones, which have made me incredibly focused. Have improved my endurance, have improved my mood, and have made me more capable at doing what I do here. And because I was talking about it on the podcast, a couple of weeks later, These showed up on my desk in my HQ in London, these little shots. And oh my

1:11:52 God. The impact this had on my ability to articulate myself, on my focus, on my workouts, on my mood, on stopping me crashing throughout the day was so profound that I reached out to the founders of the company, and now I'm a co-owner of this business. I highly, highly recommend you look into this. I highly recommend you look at the science behind the product. If you want to try it for yourself, visit ketone.com slash Steven for thirty percent off your subscription order. And you'll also get a free gift with your second shipment. That's ketone. Dot com slash Steven. And I'm so honored that once again a company I own can sponsor my podcast. Just give me fifteen seconds to explain how you can build a viable business online. The people I see winning in life don't have a perfect plan. They just take the first step and then the next and then they keep going.

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1:13:13 at Steven Bartlett dot stan Dot store. So I wanna give the audience that are listening some practical ways that they can change their life to live a better life and to navigate the food environment we live in. But just to Just generally the advice that you would give if you had the year of I don't know if

1:13:30 Five million people right now. And you could say something to them to help them live better lives, to perform better. What advice would you give them? Number one is I would say Be conscious of the food you're consuming and what you're consuming on a daily basis. The impact of food is is equivalent to medicine. It is And sometimes more powerful than medicine. So

1:13:50 uh what you drink, what you eat, you know, focusing on whole foods, not consuming liquid calories. And if you're uh someone who could benefit uniquely from stable uh glucose levels, lower insulin levels, like someone who has uh some type of metabolic disorder like I do, Reducing carbohydrates oftentimes can be a very powerful strategy, in fact, known to prevent and reverse things like obesity and type two diabetes. with emergent evidence for its potential ability to put things like serious mental illness into remission, but we'll see as more evidence comes out.

1:14:20 Exercise on a regular basis. We know that exercise might not be the primary the lack of exercise might not be the primary driver for why someone is or isn't obese, but we do know that physical activity promotes health. We do know that physical activity uh is extremely important for overall well being. And so big muscles. Oh well.

1:14:40 Is that somewhat linked to your Do you d type one diabetes at all? Is that is that part of your strategy? Yeah, look, I was obese at one point and so I I've since that point taken a very I I become s you know obsessed with trying to find out how to be uh bigger, stronger, faster. optimize my metabolic health, optimize my performance. And so it's been a lifelong kind of self-experiment in that in that journey.

1:15:02 But I exercise is just important in general, but it's for me it's about all the different experiments and and strategies I can use with exercise uh with resistance exercise and beyond to kind of play around with what affects my body, what affects my insulin, how do I increase my overall metabolic health.

1:15:20 And what I have seen is that that's directly linked to my performance. How often do you exercise? I try to exercise every single day. Um as much as it's how long for and what types of exercise. So what I do right now is I

1:15:35 typically do weightlifting for thirty minutes to an hour every s or six days a week. Um And then I will go typically ride a bike to jujitsu, so Brazilian Jiu Jitsu, which can be uniquely almost like a mixed exercise, intense exercise, where it's gonna be extremely intense for like five minutes and then you have a one or two minute break, extremely intense and then a break. Uh and I do that typically around five days a week.

1:15:59 Um I also try to purposely engage in some type of aerobic exercise when I can, if I I wasn't able to do as much jujitsu one day. or as much uh resistance exercise, I always try to add on some type of cardiovascular work, whether that be A run, a bike, or these airdyne bikes where it's just lower and upper body. I find those to be incredibly uh effective and powerful tools and actually

1:16:23 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?

1:16:32 So I tend to wake up And not think about food. That's one thing that I've also experienced similar to you that when I switched to a ketogenic diet, not only improved my glucose and insulin, but I also found that with a ketogenic diet that I Don't feel hungry. So I would wake up and I don't

1:16:50 tend to eat food right away. I enjoy when I don't eat food more so than when I do eat food oftentimes, just because not because I don't enjoy the The feeling of sitting down and having food. I love that. But The experience and lived

1:17:05 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 twenty three hours or twenty two hours of my day. where I have the stability, not the the moments in time where I'm introducing uncertainty and variability.

1:17:24 To dumb that down a little bit, what I'm saying is that When I when I don't e I wake up and I don't eat food because I find that it I'm not hungry, but I also find that it makes managing diabetes easier. And so do you

1:17:38 Once a day or twice a day, or I tend to eat two to three times a day, you know, t uh sometimes right before Jujitsu or uh Weightlifting jiu jitsu always afterwards and always before uh sometime before bed. Try not to do it right before bed, uh, because it tends to impact my sleep quality a little bit. But I find that I just eat whenever I feel hungry and I try to give myself sufficient protein to be able to respond to the

1:18:01 the exercise that I'm doing. So I've got the first one's about being intentional about your food choices, the second one is about exercise. Mm-hmm. Anything else? Well sleep's really important. You know, these are these are uh you know.

1:18:13 Stephen, this isn't like uh Oh, like this is the most revolutionary advice of all time. But these these core foundational components Good nutrition. Tailored to your specific needs. Exercising as much as you can.

1:18:28 And getting good sleep are the pillars of health. If you don't have those Corrected. Then you're wasting your time everywhere else. And are is there anything as it relates to Glucose.

1:18:41 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 mentioned and you're you're looking at the insulin and glucose response. Is there anything that people don't understand as having a really pronounced impact on their glucose levels that they wouldn't expect. Like orange juice is one of the ones that growing up I thought fuck, I thought this was a healthy thing. I used to I used to drink Sunny Delight thinking I was putting all these amazing vitamins in my body.

1:19:08 Yeah. And now I actually look back and regret it. And I You know. Not to be judgmental over any parents because parenting is very hard. But sometimes I'll see parents giving their Children like a big glass of orange juice. And in my head, I just see the glucose fight that that child's about to have. It's funny when you mention parenting, because I have a three and a six year old at home.

1:19:27 And It's amazing when they try one of these foods, these very Sugary foods, these very tasty foods, they It's almost like they become incessant.

1:19:40 I'm wanting it again. You know, like normal food. Isn't good enough anymore. Um And I think that's a great illustration of of what many of us adults are are challenged with on a daily basis. But yet

1:19:52 Many people are just unaware of the impact that it's having on their metabolism, impacting that it's having on their hunger, the impact that that's gonna lead to on their future health. And is there anything that you've spotted from your experiments with your your CGM and your insulin device? that people should most certainly avoid. So you said liquid calories. Is there anything else that causes a really pronounced or unexpected glucose response? Yeah. Honestly, Steven, over time that it's honest it's really hard to pinpoint.

1:20:20 Any singular one. A lot of the foods that are out there are are often surprisingly challenging on glucose levels, on insulin levels, particularly the processed foods, because what happens when you make these food products is that you're trusting the food company to put ingredients in it that you're gonna respond favorably to, that your metabolism will respond well to. And the truth is that that's far from a guarantee and in in many cases maybe uh less likely than it is likely.

1:20:49 And so yeah, I don't have a single example for you, Steven. I just uh but I've experienced it numerous times. So I've got a a small list here. Um sugary drinks, white bread and bagels. White rice, that's surprised me a lot'cause I used to think white rice Oh, really? I s I thought growing up rice was like a health food. Okay, well so on that note.

1:21:07 Yeah. White rice. Potatoes. All potatoes. In any form.

1:21:13 Sweet potatoes tend to have less of a glycemic response, but it's still gonna have a a potent glycemic response. So mashed or baked potatoes, obviously French fries. Yeah. F for sure French fries. Most of like pasta is a big one. Cereal? Refined cereals? Most cereals are actually worse than the foods I just described on blood sugar and insulin. uh by a long shot. In fact, uh m most of the you know, these heart healthy cereals

1:21:40 Um These these w I would never blood sugar would just spike through the roof. So yeah, it it I wouldn't I wouldn't be consuming a lot of those and I think I think most people at this stage in the the health and science world would also generally align with with that, that those aren't necessarily the best food to consume. We would think, you know,

1:22:02 More more of the less glycemic or less the foods that have less of an impact on glucose levels, less of a p impact on insulin levels. You know, one one thing I constantly hear, especially in the research and clinical community, is like Well

1:22:17 Look, you know Not everyone needs to be concerned about that. Because You know. People can respond to a lot of these foods just fine. I say you're you're right.

1:22:26 Except that over Half of America has pre diabetes. And a ninety plus percent have some form of measurement that

1:22:36 indicates that their metabolic health is impaired. And Over eighty six. Sixty eight percent. Are obese.

1:22:44 And now children are affected with these diseases. with obesity and pre-diabetes at around twenty percent. So it it's It's the fact that we are now less healthy than than we've ever been.

1:22:59 And we don't have the foundation to support. Correct. w you know, when we think about healthy nutrition, we think about exercise We describe them as medicine, but the reality is these are just normal aspects of things you should do every single day because that's what our bodies were made to do. And when we don't do those things, this is when health deteriorates. This is when we're challenging our body to maintain normal health. One of the surprising ones for me was dried fruits.

1:23:25 And it said, While dr while fruit contains natural sugars, the process of drying it concentrates those sugars. This removes the water and can make the sugar more readily available for absorption, leading to a higher glucose spite compared to fresh fruit. Typically people think of dried fruit as being a health food. Yeah, I don't I don't touch those because unless I I don't have any glucose on me and I my blood sugar is going down for some reason and it's d dangerously low levels.

1:23:50 that's when I consume those foods. Otherwise I would I would not consume them just because of how quickly they raise blood sugar levels. Trevor Burrus Do you think everybody should try the ketogenic diet? Ooh, that is a good question. I think Wow.

1:24:07 What I would say Is that You will never know. The potential of its benefit. Or

1:24:15 Lack thereof if you don't try. Like anything in life, we're we're left to assume what everyone else is like you might have we've talked about the ketogenic diet numerous times here. We talked about exogenous ketones numerous times here. But If you don't try it, you don't know how it'll work for you. In science, Steven, one of the most important things to appreciate is that we often publish

1:24:40 Bar graphs. Look like this, you know. the uh a line uh that illustrates the average outcome of a group of people. But what you don't appreciate is that that line or that bar graph

1:24:55 Is made up of numerous individuals. Who all average to that number. But what if you're the person who's at the very high dot or the very bottom dot, meaning that You're the what they call an outlier or someone who responded negatively or positively to that. And then you just follow the average advice.

1:25:14 That that study showed. Well Oh look, I tried this approach and it didn't it didn't work for me. Uh, I'm just gonna keep trying'cause the study said that it I should. Well now.

1:25:24 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 metal. So in the in that study that talked about the impact of exogenous ketones on brain stability. Someone might have had a hundred percent improvement in brain stability, and someone might have had twenty percent improvement or whatever, and that they've averaged it out.

1:25:46 um across a bigger group of people. So if you are that person that had a hundred percent gain in brain stability, it's a pretty unbelievable tool for you to understand. Based on your body. Exactly. And and that's that's always the case uh in science. I mean there are s and the sometimes we look at this as responders and non responders. Um, but actually in the study where we gave um Uh the product from

1:26:09 A tremendo and Q and IQ. In the the SOCOM study, we actually saw that nearly all of them saw an increase in SPO two. Nearly all of them saw an increase in heart rate, but that's rare. That is rare. S BO2. Ah, so uh the amount of oxygen in the blood. So the the measure that would indicate whether someone Yeah.

1:26:29 In these low oxygen environments. had to more blood or less more oxygen or less oxygen. Ultimately it's it's important to try. I I I think it's a I would always say yes, you should try because Or any nutrition strategy because

1:26:43 You should tr try different ones. I've probably tried over ten plus different diets. I mean, honestly, maybe like fifteen or twenty at this point in my life. I've just come to find that the ketogenic diet for all the reasons we described and because I have type one I Bs and I had ob or have type 1 IB, but had obesity. Find that a ketogenic diet is remarkably powerful at helping me live. uh dramatically improved quality of life, not have the increased risk for the high invariable glucose levels, high insulin levels that lead to a a near guarantee of complications and 10 to twenty years of lost life expectancy. That's why I do it. 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 a really tough question.

1:27:28 So it's a very strange question as well, but I I'm gonna ask you anyway. Yeah. The question is What is outside? the simulation. I think it depends.

1:27:48 On your philosophy. On how Our existence. Yeah. With the limitations.

1:27:59 of understanding that Our awareness of our world is completely limited and To our Our brain's capacity. And

1:28:10 our interpretation and then explanation of the world in the term of a simulation or lack you know, however you want to frame it. I believe It is is always going to be limited by our brain's ability to understand and articulate that. So what do you think is outside the simulation?

1:28:33 Consciousness. You think consciousness is outside the simulation? I think that our ability to have Not consciousness, Stephen, but

1:28:44 our ability to Operate beyond Consciousness. Got me on that one, man. That was a that was a tough question. Yeah, it is a tough question. That's a

1:28:58 D do you think there is Do you think there is a God? Beyond beyond this all this stuff that we see, yeah. I'm gonna give you the most real honest answer possible. Yeah.

1:29:10 I don't think we ever can actually answer that question accurately. So your your answer therefore is you don't know. I don't know. And I don't think I'll ever know. Yeah. Okay. Thank you.

1:29:21 Thank you so much for doing the work that you do. Really appreciate it, because you know, so many of my friends in this field and even Michael, the founder of the the Kewn product on my on my uh Table here. Talk about you as being the sort of gold standard of uh research science and

1:29:35 um thought leadership on the subject of ketones and more broadly on the subject of um 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 profound way. And you're only just getting started at thirty four years old, which is remarkable. We're basically the same age. And uh you've had such a tremendous 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 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 so many people that will better understand themselves and their their illnesses, but also their performance and um everything correlated related to that because of you. So please keep keep doing the research you're doing and spreading the word in the way you're spreading it 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. Steve, it was an honor. Appreciate it, sir.

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