The Sugar Doctor: The Simple Diet That Prevents 80% of Disease!

0:00What can you tell me about this?

0:02>> Well, if you look at the science, it's

0:03enhancing cognition. We've seen a 50%

0:06improvement in how individuals were able

0:08to read and absorb information of better

0:10decision-m and also we did a study and

0:12showed that it delayed the progression

0:15of metastatic cancer. And I've actually

0:17taken this a number of times because

0:19having been in research for the last 15

0:21years and having lived with multiple

0:23chronic diseases, one of which I

0:25reversed. Some of the most powerful

0:26strategies like this were not being told

0:28to me when I went to the doctor's

0:29office. So, let's dig deeper.

0:31>> Dr. Andrew Cutnick is a research

0:33scientist who's worked on over 100

0:35studies on metabolic health, diabetes,

0:37and the keto diet.

0:39>> And through his findings, he's helping

0:40people prevent chronic diseases, improve

0:43cognition, and optimize performance. I

0:45went through some pretty dramatic

0:47moments in my childhood. You know, I did

0:48everything I was told, right? I

0:50exercised all the time. I ate what I was

0:52supposed to eat, but I still became

0:53obese.

0:54>> You weighed about 255 lbs.

0:56>> Yep. And I had no idea how damaging that

1:00actually was to my body. And I think the

1:02vast majority of people also don't, but

1:04over 20% of children have obesity.

1:06That's quadrupled over the last 30

1:08years. And a big part of that is when it

1:10comes to food, what looks healthy isn't

1:12always healthy. And it's not by

1:13accident. And it wasn't soon after that

1:16I ended up getting diagnosed with a

1:17chronic irreversible disease that

1:18obesity puts you at risk for. And that

1:21immediately turned into a journey to

1:23understand how to be healthy. And I came

1:25across this diet a little over a decade

1:27ago called the ketogenic diet. So then I

1:29went into the science of this diet and

1:31found positive impacts on things like

1:33diabetes, obesity, Alzheimer's, serious

1:35mental illness, chronic diseases. And I

1:37was like, "Oh wow." Cuz a lot of people

1:38don't realize that many of these are not

1:41just preventable but also reversible.

1:43And you did the longest study ever done

1:45of its kind on the impact of the

1:47ketogenic diet on a patient that had

1:49type 1 diabetes.

1:50>> Yes. Let me let me tell you all about

1:52it.

1:54>> I see messages all the time in the

1:56comments section that some of you didn't

1:57realize you didn't subscribe. So, if you

1:59could do me a favor and double check if

2:01you're a subscriber to this channel,

2:02that would be tremendously appreciated.

2:03It's the simple, it's the free thing

2:05that anybody that watches this show

2:07frequently can do to help us here to

2:08keep everything going in this show in

2:10the trajectory it's on. So please do

2:12double check if you've subscribed and uh

2:14thank you so much because in a strange

2:15way you are you're part of our history

2:18and you're on this journey with us and I

2:19appreciate you for that. So yeah, thank

2:21you

2:25Dr. Andrew Kutnik. If you had to try and

2:28sort of summarize and encapsulate what

2:30you spent the last couple of decades of

2:31your life focused on and really trying

2:33to accomplish, prove, understand from

2:36the highest level. What exactly is that?

2:40The core of my mission, Stephen, is

2:42really to empower individuals to take

2:44control of their own health. It's

2:46empowering them with science, you know,

2:48bridging science to actual action. You

2:49know, science is very complex. It's very

2:51hard to break it down, but having been

2:53in, you know, research for the last 15

2:55years and having lived with

2:58multiple chronic diseases, uh, one of

3:00which I reversed and one of which I is

3:01irreversible. Um, I I my mission is to

3:05empower patients with the same tools and

3:07strategies I had access to. uh so they

3:10can take control to maximize their

3:11health and performance.

3:13>> For the average person who may not be as

3:17knowledgeable about health and fitness,

3:19what are the areas of health that you've

3:21spent the last 15 years researching and

3:23trying to understand?

3:24>> I would call it, you know, Stephen like

3:26metabolism in a broad terms. Now I would

3:29say you know to break that down further

3:31for people to understand that metabolism

3:33is trying to understand how the body

3:35metabolizes or utilizes things like

3:38nutrients or food. So you have oranges

3:40here. What's what's in that food? How

3:43when you ingest it will your body

3:45respond to it? Both from you know

3:48glucose levels which I'm sure many have

3:49heard of to insulin responses to all

3:52this different nuance. A lot of that

3:54comes down to nutrition but it also is

3:57things like exercise. Exercise such a

3:58powerful impact on metabolism,

4:00incredibly important for overall health.

4:03But from a personal perspective, this

4:05journey has been very honestly selfish

4:06for me. I wanted to understand how to

4:08get the best performance, the best for

4:10health for myself. And I very quickly

4:12realized that uh you know some of the

4:16most powerful strategies out there were

4:17actually not necessarily the ones that

4:20were being told to me when I went to the

4:22doctor's office because I went through

4:23some some pretty dramatic moments uh

4:25early on in my my journey with with

4:27trying to overcome some of these these

4:29challenges.

4:30>> So take me back to the start of your

4:32story in the earliest context that's

4:34relevant to understand

4:36why you became the person you became. I

4:38mean, I've got some photos here from

4:40your from your childhood which are

4:43>> Yeah.

4:43>> very very telling. And you know, some of

4:45our listeners might be listening on

4:46audio alone, so they might not be able

4:47to see these these visuals on the

4:49screen.

4:50>> So, if you could describe some of these

4:52these pictures for me

4:54>> when Yeah.

5:02Um

5:04it brings back some powerful memories of

5:06uh the challenges with obesity for me.

5:09Um you know the the picture on the right

5:11is just a picture with on a a family

5:14adventure um where we went to the we go

5:17I go fishing with my dad a lot. You know

5:19I'm very heavy at the time. I was, you

5:21know, uh, obese and, um, and the picture

5:25on the right here, this really gets me

5:26because, um, you know, I did, you did

5:29everything I was told, right? I

5:30exercised all the time. I ate what I I

5:32was supposed to eat or what my doctor

5:34recommended, what the fitness magazines

5:35recommended, but I was just constantly

5:37challenged with gaining more and more

5:40fat tissue. And I had no idea how

5:44damaging that actually was to my body.

5:46And, and I think the vast majority of

5:47people also don't. Um, over 68% of

5:51America right now is obese. Okay, that

5:54means 7 out of 10 people walking around

5:56the street in the United States of

5:57America have obesity. And we know that

6:01the second you start building more and

6:04more fat tissue on your body, insulin

6:07levels rise almost double immediately

6:09before you even have symptoms of obesity

6:11or uh tissue damage or organ damage or

6:15anything along those lines. We know that

6:16that almost immediately reduces insulin

6:18sensitivity. So how well insulin, this

6:22very powerful fat storage hormone, is

6:24able to actually bring nutrients from

6:26the blood into tissues. That goes down

6:28around 34 to 35% uh and early stages of

6:31obesity.

6:32>> And just to summarize for a muggle like

6:34me, insulin is basically the uber which

6:37takes things out of your blood and puts

6:39them where they need to be.

6:40>> It's essentially like a thermostat for

6:42blood glucose. That's how most people

6:44know it. So as blood glucose levels

6:46rise, it works as a thermostat to let's

6:49say release cool air to bring it back

6:51down. In this case, releases insulin to

6:53bring blood glucose back into range. As

6:55blood glucose drops, insulin is stopped.

6:58It stops releasing insulin out of these

7:00cells called the beta cells. And

7:01ultimately, what your body is trying to

7:03do is keep the, you know, one teaspoon

7:06of sugar that's in your blood that is

7:08critical for your life. If it goes up,

7:11it can cause damage. If it goes low, it

7:12can be life-threatening. in this very

7:14very tight range and it build it builds

7:17a number of mechanisms to ultimately

7:19make sure and ensure that you don't go

7:21outside of that range. But imagine

7:23losing the one molecule that directly

7:26controls it.

7:27>> You're wearing two devices I believe on

7:29you at the moment. So you've got this

7:31>> Yeah.

7:32>> What is the device on your arm?

7:34>> It's an insulin pump.

7:35>> Yeah.

7:35>> So Stephen, your body produces insulin.

7:38Most people who are probably listening

7:39to this, they their body probably also

7:41produces insulin unless they have type 1

7:43diabetes. And so when my body no longer

7:46produces this molecule anymore, there's

7:48got to be a way to get it. It sits on my

7:51arm 24/7 because it's a way of

7:54essentially packaging a pancreas that I

7:57don't have anymore and putting it on my

7:59arm and and and a way of getting that

8:02same type of of insulin.

8:04>> And you have a CGM as well.

8:06>> Yeah. So on my stomach here, so on my

8:09stomach here is a CGM,

8:11>> which is a continuous glucose monitor.

8:13>> CGM is a way of tracking sugar levels or

8:16glucose levels.

8:17>> And both of those devices link to your

8:19phone, which is in front of you. Um, and

8:21I'll throw that up on the screen so

8:22people can see,

8:23>> yes,

8:23>> what that what that kind of looks like.

8:25>> So on this device, you have

8:28a green line that is glucose levels.

8:31Okay, my blood sugar says that it's 109

8:33right now. Which means that the

8:35interstitial

8:36signal of glucose is

8:40>> interstitial meaning within not in the

8:43blood but in the tissues.

8:44>> Yeah. So the amount of glucose right

8:47outside the blood around the tissues and

8:50that signal is an indication of the

8:53amount of glucose in the blood. That's

8:55the green line. Okay, it says that I'm

8:57109 right now. So average blood sugar

8:59levels using milligrams per deciliter is

9:0170 to 120. That's considered normal.

9:05Below that is blue lines almost like

9:09looks like squares and triangles. Those

9:11are illustrations of insulin being

9:14administered but they're not perfect

9:16devices. Despite them being premier and

9:19you know the most advanced technology on

9:21the market, there are significant

9:22limitations to them. Um, I have actually

9:25I saw a clip of yours that I was

9:26watching earlier that said you think

9:28having high blood sugar over a long time

9:31is the biggest cause of long-term health

9:33problems.

9:34>> When you're focused on improving your

9:37overall health, you have to find out

9:39what matters most, right? So, what

9:41what's the hierarchy uh uh in the

9:43health, you know, 1 2 3 4 5? What

9:46matters most on that? And we can look at

9:47that by looking at risk factors uh for

9:50future disease. Well, the number one

9:51cause of death in the United States and

9:53across many parts of the world is

9:55cardiovascular disease. Well, it's also

9:57the number one cause of death in people

9:59with diabetes. And when you look at what

10:01are the strongest predictors of

10:02developing some form of cardiovascular

10:04disease,

10:07a measure called HBA1C comes up at the

10:09top. HBA1C is a average measurement of

10:14your blood glucose over a two to three

10:16month period of time. And that is

10:18incredibly powerful at predicting future

10:22risk for let's say diseases of the eye,

10:25diseases of the kidney or even

10:27cardiovascular disease. And so when I

10:29think about how do we tackle uh

10:32improving health or in in particularly

10:35in these these common much more common

10:38diseases,

10:40glucose control sits at the very top of

10:42that pyramid. And if unregulated, it's

10:46equivalent to analogy I often use, which

10:49is you're you're driving a car and

10:51you're focused on what type of rims you

10:53have, but you don't even have an engine

10:55in the car. Like your engine doesn't

10:56work, or you don't have an a chassis or

10:59an axis, but yet you're you're focused

11:01on rims or a sound system. And so the

11:04number one factor, particularly in

11:05diseases like diabetes, that matters

11:07most is HBA1C.

11:10>> So does that just mean that we should be

11:11eating less sugar?

11:14So if we wanted to control the most

11:16powerful risk factor in diabetes,

11:21we would need to understand how to

11:23regulate it. Right? So then let's look

11:25at the science of this. Well, the

11:26science says that carbohydrates,

11:30food is the most potent factor in

11:33regulating elevations in glucose at

11:36every single meal of the day. Well, most

11:38people are eating three to four plus

11:39meals every single day. And so the very

11:42first logical thing to look at is food

11:45because what you're consuming has the

11:47most potent impact on glucose control

11:49and glucose control has the most potent

11:51impact on your health not only today but

11:55in the future. And so focusing on on

11:58nutrition makes sense. But this isn't

12:01like a new phenomenon. We've known that

12:03nutrition could be potentially

12:04life-saving for people. There's a a you

12:07know there's something called a

12:08ketogenic diet if someone's heard this

12:10before. It's a diet that dramatically

12:12reduces the amount of carbohydrates in

12:13the food. And the dramatic reduction in

12:16carbohydrates in the food was used to

12:18save lives of patients with type 1 and

12:22type 2 diabetes since there was the

12:24first report ever known to my knowledge

12:26is in 19 or 1796 by a gentleman named a

12:30physician called John Row. He published

12:32a report on two cases of diabetes

12:34malitis using basically a carbohydrate

12:37replete or reduced diet to resolve the

12:40disease. But we know that some of the

12:41most premier diabetists meaning people

12:44who study diabetes or treat people with

12:46diabetes were utilizing these strategies

12:49for over a hundred years before we then

12:52discovered in 1921 that this diet could

12:55also help neurological disorders like

12:57seizures and beyond. And so the the

13:00phenomenon of nutrition playing a role

13:02in overall health is is certainly not

13:04new. It's actually only recently that

13:06we're rediscovering century old wisdom

13:08of what nutrition can do for overall

13:10health uh due to the emergence of an

13:13explosion in science that has really

13:16drove a ton of public interest into this

13:18kind of unique dietary strategy.

13:20>> So the ketogenic diet then um it's a

13:22diet that I'm familiar with because it's

13:24a diet that I cycle in and out of

13:26throughout the year. probably I'm in a

13:28ketogenic state three or four times a

13:29year and I use the little keto reader

13:32just to check my blood ketone levels.

13:35What is the what for anyone that's

13:36unfamiliar with the ke ketogenic diet? I

13:38I'm a bit of an advocate for it. So I'm

13:41fairly familiar but I that's also taught

13:43me how unfamiliar people are with it

13:44because I talk to my friends about it

13:46and there's a lot of misconceptions.

13:47>> Yeah.

13:48>> If you're on a ketogenic diet, what are

13:49you eating?

13:51>> So typically what when someone

13:53visualizes a ketogenic diet, I think

13:54there's a lot of misinformation. and

13:55they think it's just steak and bacon.

13:57Um, and I guess for some people it might

13:59be that, but it's actually uh if we're

14:02talking about a well- formulated

14:03ketogenic diet, we're talking about

14:05green leafy vegetables, things that we

14:06typically associate with health. You

14:08know, salads, uh, broccoli, asparagus,

14:11cauliflower, these kind of uh,

14:13nutrient-dense green leafy vegetables

14:16that are high in fiber and

14:17phytonutrients.

14:19Then you also have protein as a

14:20component of that. that can come from

14:22meat that can come from fish in the form

14:24of salmon, eggs, uh cheeses, a little

14:27bit comes along for the ride and things

14:29like nuts. And then you also have the

14:32rest of the diet which is made up of

14:33fat. And this can come a lot of times

14:35from um various plant forms. This can

14:38come, you know, from like olive oil,

14:40avocado oil.

14:41>> And what are you removing then?

14:43>> Sugary starchy carbohydrates. So you're

14:44you're you know you're not having

14:46bagels, you're not having donuts, um

14:50white rice, pastas, these type of foods.

14:54The reason they're not a part of this

14:56diet is because these foods rapidly

14:59elevate blood sugar levels. And the

15:01rapid elevation in blood sugar also

15:02spikes insulin. Insulin shuts down fat

15:06breakdown and the ability to take that

15:09fat to the liver. The liver built this

15:13amazing mechanism to be able to convert

15:16fat to ketone bodies because ketone

15:19bodies fat can't actually longchain

15:22fatty acids which is the primary form of

15:24fat that you consume in the food you eat

15:27and also the type that's broken down

15:28from your own fat tissue can't readily

15:31cross the bloodb brain barrier. And we

15:33know that glucose is a fuel for the

15:34brain. But what happens if you fast or

15:37you don't consume a lot of carbohydrates

15:38and you have low insulin levels and you

15:41can't con transport the fat which is now

15:44your primary fuel source on a ketogenic

15:45diet because you reduce glucose or

15:48carbohydrates in the diet which causes a

15:50reduction in glucose. The reduction in

15:52glucose lowers insulin. The reduction in

15:55insulin causes fat to be rapidly broken

15:59down and now becomes your primary fuel

16:01source.

16:02>> And so there's an evolutionary basis for

16:03this, right? Because once upon a time we

16:05might have gone long periods of time

16:07without eating something. And so our

16:09body turns inwards and starts using our

16:11fat stores as a mechanism to to to fuel

16:14our body and that's why it produces

16:15ketones. Basically the evolution of this

16:19diet was believed to be a cyclical

16:22meaning on and off pattern in human

16:25history because if we were to go through

16:30bouts of abundance in food, we probably

16:32consume it as much as we can in one

16:34moment and then we're seeking the next

16:35meal and seeking the next meal. What

16:37happens in that in between time? If

16:38you're 100% reliant on having food 24/7

16:42like we do in our current food

16:43environment, you would never survive

16:45evolutionarily

16:47beyond a few days.

16:50With the ability to switch from a

16:52carbohydrate-based metabolism over to a

16:54fat-based metabolism, we store months

16:56and months and months of fat energy in

17:00the event that we don't have nutrient.

17:01So it's a one of the most powerful

17:02survival mechanisms we have to survive

17:06uh moments of famine. But we also have

17:10known since bib times of biblical text

17:13that fasting has therapeutic potential.

17:16You know most potently in and the

17:19ability to what would be described as

17:21attenuate seizures. You know convulsion

17:23like behavior was described when you

17:26just completely eliminate food. actually

17:27a common strategy in many religious

17:29practices because of its quote unquote

17:32healing properties. Well, now we

17:33actually know that fasting induces a

17:36state of ketosis and we know that

17:37ketosis is actually shown to in many of

17:40these cases have a therapeutic impact in

17:42many of these environments like a

17:45seizure like seizures. We've known since

17:47the 1920 one out of the Mayo Clinic that

17:50ketogenic diets not only mimic the

17:53physiology of fasting but also attenuate

17:57the seizures in children with epilepsy.

17:59And that work has subsequently gone on

18:01to John Hopkins and other research

18:03institutes to show that this is a very

18:05verified strategy for not just epilepsy

18:09but it has been used for obesity, type 1

18:10diabetes, type two diabetes for for

18:12centuries at this point. Um, and it all

18:15starts with the reduction of

18:16carbohydrates in the diet.

18:18>> One of the things that's been most

18:19beneficial to me, but also I know Joe

18:21Rogan has talked about this before is as

18:22a sort of a podcaster that spends a lot

18:24of time talking, you notice high

18:26variance in your ability to think,

18:28articulate yourself

18:29>> for long periods of time based on my

18:32blood ketone levels and my

18:35>> my sort my diet broadly um but

18:37specifically the amount of ketones that

18:39are in my blood.

18:43Why is that? Why is it that I feel like

18:45I'm more effective in communication and

18:48thinking when I'm on the ketogenic diet

18:50or taking exogenous ketones versus when

18:53I'm having a normal western high higher

18:56carb diet? A lot of people

18:59would know why this is if they had the

19:01same tools and insight that type 1

19:04diabetes gives. Because when you're

19:06consuming that diet, what is often

19:09happening is near constant elevations

19:13and dips, elevations and dips, highs and

19:16lows in blood sugar levels that we know

19:18are ascribed to changes in energy

19:20levels. So, we know that high blood

19:22sugar levels, someone can Google if

19:25they're they're so interested to look up

19:27the term high blood sugar hyperlycemia

19:30or low blood sugar or hypoglycemia and

19:33just type in symptoms and you'll see a

19:35laundry list of things like fatigue,

19:38irritability, lack of concentration, uh

19:41shakiness. These are all symptoms of a

19:44lot of what you're describing, right?

19:45Which is change in your your your

19:47ability to concentrate, your energy

19:49levels. It's a very very clear that

19:52glucose levels are linked to that. We

19:54also know that the chain

19:55>> ju just to be clear. So is that when I'm

19:57at the high or the low in the glucose?

19:59So if I you know if you if you ate one

20:01of these right now

20:02>> what are these oranges? Tangerines.

20:04>> Oranges. Yep.

20:05>> Um if you ate one of these right now,

20:07your blood glucose levels are going to

20:09go up presumably.

20:11>> Yes. Because these oranges are composed

20:14of bound sugar molecules together. So

20:17most fruit has a structural component to

20:20it which is why you see an it it has

20:23like a has is has mass to it right it's

20:26not just a liquid and then that

20:28structural component binds together as a

20:30part of it sugar that's bound together

20:32they call them polysaccharides and those

20:34polysaccharides when you consume them

20:37your gut actually takes those breaks

20:41them down into individual glucose

20:42molecules

20:44to then be absorbed into the bloodstream

20:46that's when the insulin is released,

20:47that's when the insulin takes that

20:48glucose and stores it into tissues like

20:50the muscle and the liver uh for future

20:54glucose needs. Uh and so yes, we would

20:56presume that with this high or oranges

21:00or even most fruits, pastas, rices would

21:02all elevate blood sugar levels, but then

21:05that accompanies with a high insulin

21:06load, right? So the more of the oranges,

21:08the more insulin that you would need.

21:11And you know, despite many of these

21:13foods being considered very healthy,

21:15those with

21:17metabolic disease or metabolic

21:19dysfunction may not may have a be more

21:22vulnerable to even what would typically

21:24be considered healthy foods. Um, and

21:26type 1 diabetes is a is a powerful

21:28example of that.

21:29>> So, you said you'd you'd open to eating

21:31one of these. We've got your blood

21:32glucose and insulin levels, which we're

21:34going to put on screen for people that

21:35are watching. And it'll be interesting

21:37to see how quickly we see that orange,

21:40which is considered a health food by

21:42many people, have an impact on your

21:43glucose and insulin levels.

21:45>> So, yeah. So, so what I'm I'm going to

21:47do is normally I would I would never do

21:49this, but I I think it's very important

21:51for people to understand,

21:53especially those at home who either have

21:54a chronic disease, which is most

21:56Americans at this point, or kids who

21:58have a disease like diabetes, what the

22:00impact really could be. So let's say

22:06oranges are considered a superfood uh by

22:10the American Diabetes Association. So

22:12it's a fruit highly recommended by

22:13almost every organization USDA f or USDA

22:17American Diabetes Association and beyond

22:19the amount of or is three oranges.

22:22Three oranges is probably going to make

22:24up around h 70 to 90 grams of

22:27carbohydrates. For me, my energy needs

22:31is around calculated it around 3,000

22:33calories per day. Now, the activity I'm

22:35consuming,

22:37if I were to

22:40eat the amount of carbohydrates

22:42recommended per day, which is around 55%

22:45by, let's say, the USDA guidelines, that

22:48I would need to consume at least or more

22:52than this at le if I split up all my

22:55calories over four meals. And so,

22:59This is

23:01an opportunity to see what this will

23:04actually do to blood sugar levels

23:07and

23:09type 1 diabetes if you consume will be a

23:11near equivalent to around a fifth the

23:14amount of carbohydrates that I would

23:15consume per day if I was on a standard

23:17diet.

23:18>> The the ketogenic diet they typically

23:20say that to stay within it you need to

23:22be below is it roughly 50 grams of

23:24carbohydrates a day? And it's roughly

23:26because 50 grams of carbohydrates per

23:29day is a

23:31rough number that we suspect most people

23:34will be able to get carbohydrates low

23:36enough to where insulin would be

23:37sufficiently low to produce ketone

23:39bodies.

23:39>> Okay.

23:39>> Yeah.

23:40>> So there's variance depending on your

23:42insulin sensitivity and insulin response

23:44and I guess body weight as well is going

23:45to be a factor. big factor, major factor

23:47because anytime you're talking about

23:49things like uh glucose, insulin is

23:52always very individualized responses to

23:54each individual person.

23:55>> I don't really I don't I try and stay

23:56away from fruit these days. I don't

23:58know. I I berries and raspberries and

24:00stuff like that and cuz people tell me

24:02there's like polyphenols and black

24:04blackberries,

24:04>> but those are totally uh co cohesive

24:06with the ketogenic diet

24:07>> because they're higher in fiber. So like

24:09you know half of where you're consuming,

24:11not half, but a large portion of it

24:13fiber. So it's more about the net

24:15carbohydrates. It's the the glycemic

24:18metabolic impact of the food. So

24:21>> if the fiber is non-digestible, which in

24:23fruit it isn't, then it shouldn't it

24:25doesn't count, right? So higher fiber

24:27content. Most of the vegetables on a

24:28ketogenic diet are higher fiber, you

24:31know,

24:32>> because you know it's the it's the total

24:34carbohydrate to fiber ratio. So the net

24:35carbohydrates that really matter because

24:37that's the amount of that's the

24:38metabolic real metabolic impact of food.

24:40Yeah. A lot of a lot of keto friendly

24:42foods say like net carbs or one gram or

24:45something, but you look at it and you go

24:46[ __ ] it says 20.

24:47>> It's total [ __ ] man. Is it?

24:48>> So, oh, 100%. Um, so I I've tested two

24:52different foods that are keto friendly

24:55on the label. Same as calories, same as

24:56like fat, protein, even fiber. Um, and

25:02they can produce completely different

25:03responses. I mean, the food environment

25:04nowadays, you essentially need almost a

25:06PhD in nutrition or biochemistry to walk

25:08into a grocery store and be able to

25:10understand what the hell's on the label.

25:11It's it is and I I don't want to sit

25:14here and say like, oh, they they don't

25:15know. Like, no, they they know. I mean,

25:18there's are companies who have tons of

25:20resources, food scientists galore, and

25:23they're putting zero sugar on the label

25:26and keto friendly a as a trick because

25:29it's associated with health benefits,

25:30right? There's all these studies on

25:31ketogenic diets that can they can show

25:33to improve health. And so they want to

25:34have that on their label. But what is

25:36often happening if you look on the back

25:38of the label, there's about a hundred

25:39different ingredients they can swap

25:40sugar for for something that has the

25:42same exact metabolic effect as sugar. So

25:45malitol, maltodextrin,

25:48um all these different ingredients that

25:50are going to cause glucose to go up

25:51rapidly, they'll just swap it and now

25:54you can put on your label zero sugar.

25:56Have you been in a ketogenic diet since

25:57you were diagnosed with diabetes? Have

26:00you cycled in and out of it yourself?

26:02And if so, what have you noticed in

26:04terms of when you are in that diet and

26:05when you're not? So, I actually came

26:08across this diet a little over a decade

26:10ago. What I found is that almost every

26:14blood meter that I was taking, this is

26:15before CGMs were present, I had to just

26:17prick my blood, you know, six to 10

26:19times a day to see what my blood sugars

26:20were. I was finding that I was very

26:22rarely outside of the normal range. And

26:24I was also finding that I wasn't feeling

26:27these extreme highs and lows anymore

26:29when I transitioned to a ketogenic diet

26:31almost immediately. My insulin

26:33requirements dropped substantially uh

26:35around 40 a little over 40%. So the uh

26:39the amount of insulin I needed to take

26:41dropped dramatically, but I didn't have

26:43continuous glucose monitor. I didn't

26:44have this instant feedback of like what

26:46is my blood sugar doing? I just know I

26:48needed a heck of a lot less insulin. And

26:50so what happened was I went into my

26:53doctor's office at the time. He happened

26:54to be the American Diabetes Association

26:57president at the time. He's like, "I've

27:00never seen a blood sugar level in the

27:03normal range with someone with type 1

27:05diabetes before." He said, "What are you

27:07doing?" From that point forward, that's

27:10when for me it like transitions even

27:12into like a lifelong journey of like,

27:15"Wow, you know, obviously nutrition had

27:16a huge impact on me losing weight when I

27:18had obesity. Now it was directly

27:21regulating this very powerful disease

27:24where upon diagnosis nearly all patients

27:29are going to have high invariable

27:30glucose levels for the rest of their

27:32life. 99% of patients will never see

27:34normal metabolic control again for their

27:36life. 100% of them are expected to get

27:39insulin resistance. And within 3 years

27:43we see neuroanatomical changes within

27:46the brain of children who are diagnosed.

27:48What does that mean?

27:49>> So it means that when we look at MRI

27:52scans of the brain, we see that children

27:54with high and variable glucose levels

27:56with this disease with type 1 diabetes,

27:58they have shifts in the type of white

28:01and gray matter. The sections of the

28:03brain that are associated with normal

28:06brain development and childhood, they're

28:08not developing the same way. We and we

28:11see this within 3 years and it's

28:12directly linked to the poor glucose

28:15control. We also know that we see signs

28:19of the early signals of aththeroscerotic

28:22progression in children within four

28:24years.

28:24>> Atheroscerotic progression, what's that?

28:27>> So,

28:29one of the primary causes of death in

28:30individuals across the world is

28:31cardiovascular disease. And how do we

28:34get that? Well,

28:37you have changes in your blood vessel

28:39and how it functions is the first and

28:41earliest signal of future what will

28:44ultimately be plaque or this kind of

28:46blockages within the blood vessel which

28:48ultimately cause things like heart

28:49attacks or strokes. Well, in type 1

28:52diabetes, we see that children who have

28:54high invariable glucose levels, again,

28:5599% of patients are expected to just

28:58live this way for the rest of their

28:59life. If they follow standard of care,

29:01if they follow the doctor's orders,

29:04they're going to see changes in how

29:06their blood vessels literally

29:09functionally and structurally change.

29:11Their blood vessels will now shift from

29:13being this very compliant uh almost like

29:16a a smooth wave to that blood vessel now

29:19becomes very rigid. It starts to build

29:22collagen at more and more collagen

29:24around it becomes stiffer and stiffer.

29:26It's almost like taking a hose and

29:29turning on a hose and pinching the hose.

29:31When you pinch the hose, as you become

29:34stiffer and as you shrink the size of

29:35the blood vessel, it goes faster. And so

29:37we can measure that by the speed of the

29:38blood in the body. Another clear signal

29:41and one of the most powerful signals

29:43that the blood vessel is starting to

29:44change before you see plaque, before you

29:46see blockages, I mean decades prior.

29:49These are all happening in childhood by

29:50the way. You know, 10 to, you know, 10

29:52to 14 year olds diagnosed with type 1

29:54diabetes. we see that the blood vessel

29:57isn't able to respond to what they call

30:00sheer stress Stephen. So that means

30:02let's say you go for a run uh this

30:04morning Stephen and your blood pressure

30:06initially increases because as your

30:09heart rate increases the speed of the

30:11blood increases the amount of pressure

30:13on the vascular wall increases that a

30:17phenomenon when the blood moves fast

30:18through blood vessels it it causes

30:22stress against the blood vessels. That's

30:23not a bad thing. It's actually a signal

30:25for the blood vessel to release

30:26something called nitric oxide. Nitric

30:29oxide is a potent called vaso diilator.

30:34It causes the blood vessels to open up

30:36and this is how your body responds

30:38normally to stress. Okay, you go for an

30:40exercise vasoddilation or vaso

30:42constriction then vaso dilation um or

30:45you know and these are normal responses

30:47the body has. Well, what happens in type

30:491 diabetes very early on is that the

30:52ability to produce nitric oxide is

30:54diminished. You're not able to respond

30:57to high stress load. So, not only are

30:58the blood vessels becoming stiffer, but

31:01now the blood vessels aren't able to

31:03even respond as well to the stress. And

31:06so, as you're looking at this and you're

31:07looking over time, you see these early

31:11signals of athoscorotic progression.

31:13also see very early on that it was once

31:16expected that all patients with type 1

31:19diabetes would have eye damage some form

31:21of eye damage called retinopathy where

31:24you start to lose vision eventually can

31:25go blind within 20 years of diagnosis.

31:28So most people are diagnosed in 10 to 14

31:30years of age which means by 30 to 34

31:33years of age you're going to see a lot

31:35of patients who have altered eye

31:38function andor some who are blind. Now

31:41that has extended out over time, but we

31:42know that all patients with this disease

31:47because of high and variable glucose

31:48levels are expected to get at least one

31:54complication in their lifetime if they

31:57follow standard of care advice today.

31:59Even with the best technologies out

32:01there, there is no pharmaceutical

32:03intervention. There is no technology

32:05that normalizes this disease. And the

32:08effects of these high invariable glucose

32:09levels and insulin resistance that

32:11accompanies it

32:13is cumulative

32:15dose dependent and not completely

32:17reversible. Which means that once you're

32:20diagnosed, the clock starts ticking. It

32:23just like smoking. The more you do, the

32:25earlier you do it, the earlier the

32:27impact and the more lost life you

32:29probably will get. And there was a study

32:31done with 326 participants that found

32:34that the keto diet can increase glycemic

32:36control of patients with diabetes. That

32:39was in the precision nutrition

32:40publication. When it says it can

32:43increase glycemic control, what does

32:46that mean?

32:49>> So is that what we were talking about

32:50there with

32:51>> Yes. So if you when you do a diet known

32:54as a ketogenic diet, you're reducing

32:56carbohydrates. Well, when carbohydrates

32:59are consumed, they elevate glucose

33:01levels. Well, if you dramatically reduce

33:03the amount of carbohydrates consumed,

33:05you're not having those same type of

33:07glucose elevations and fluctuations

33:10because you're not consuming the most

33:11potent glucose elevating factor in our

33:14life, which is carbohydrates. And so

33:17when they talk about improvements in

33:19glycemic control, it is the measure of

33:2224-hour over multiple day levels of

33:25glucose in the circulation. And how well

33:28is that being controlled within a normal

33:30healthy range?

33:32>> And so is your goal then to

33:36encourage people to restrict

33:37carbohydrates

33:39>> in their diet? But you know because

33:41carbohydrates and sugar have been

33:43somewhat I guess demonized because you

33:45never really hear many good things about

33:47sugar.

33:48>> Um so so what is what is your goal here?

33:49What is the advice to the listener? Is

33:51it to restrict their their

33:52carbohydrates?

33:55>> To be very conscious of what they're

33:57consuming because nutrition has a

33:59powerful potent impact on overall

34:01health. And for those patients who have

34:04chronic disease, which is unfortunately

34:07the overwhelming majority of us, yes,

34:10carbohydrates can be a very restricting

34:13carbohydrates can have a powerful

34:14therapeutic effect on diseases like type

34:182 diabetes. The American Diabetes

34:19Association in their 2019 consensus

34:21report described type 2 diabetes as the

34:25most evidence-based nutritional

34:26strategy. We know that it can have

34:30potential positive impacts on things

34:32like uh Alzheimer's disease. There are

34:34studies that have looked at this. We

34:35also know that for

34:36>> carbohydrate restriction we

34:38>> Yep. So, and I like to term this

34:39therapeutic carbohydrate restriction

34:41because it's the therapeutic outcome of

34:44a carbohydrate reduction. Um and that's

34:48really the goal of this is can you

34:50improve your overall health. Many people

34:52will just do this simply to improve, you

34:54know, to lose weight, to feel, like you

34:56say, to feel more cognitively alert. But

34:58in my case where you're along further

35:00along the metabolic spectrum with

35:01diseases like diabetes, it has a even

35:04more uh potent impact on how you feel,

35:08even more potent impact on your overall

35:09health. Um, and but unfortunately about

35:1293% of Americans have some form of

35:14metabolic derangement, uh, as cited by

35:17multiple studies and multiple research

35:18groups. You did a 10-year study on the

35:21impact of the ketogenic diet on a

35:25patient that had type 1 diabetes. I

35:27think this is this is most certainly the

35:28longest study ever done of its type

35:31where you took one individual and over

35:3310 years you I guess controlled their

35:36diet. So, we had access to

35:41the ability to monitor uh a unique

35:44patient who had type 1 diabetes and they

35:48were diagnosed and had followed the

35:50American Diabetes Association diet, a

35:52healthy diet for 6 years and then

35:55switched over in 2013 to a ketogenic

35:57diet. Upon the initiation of the diet

35:59and post, they had DEXA scans. They

36:02controlled their calorie intake, their

36:03body composition. they weren't taking

36:05any additional medications and we were

36:08able to monitor the impact over a

36:1010-year period

36:12while controlling all those variables.

36:14And why that's so important is because

36:17one of the common concerns of a

36:18ketogenic diet is the hypothetical risk

36:22it can increase cardiovascular disease.

36:24And the reason that

36:26they think that it can increase

36:27cardiovascular disease or it's

36:28hypothesized that it will is because of

36:30the elevation in LDL that often

36:32accompanies an increase in saturated fat

36:34in the diet. Now saturated fat comes

36:36from things like animal proteins, uh

36:38it's in coconuts as well. What we found

36:41is that despite a near doubling in LDL

36:45cholesterol on this diet, which again

36:49should be associated with worsening

36:50cardiovascular health, we did an

36:51advanced cardiovascular assessment in in

36:54this patient and found that despite

36:57doubling LDL, they had maintained

36:59completely normal glycemic control,

37:01which again based on all the data says

37:04is the number one risk factor. They

37:05reduced their insulin load over 40%.

37:08And their cardiovascular health was not

37:13only better than the average patient of

37:17similar age and sex with type 1

37:19diabetes, it was better in almost every

37:22single category than people even without

37:25type 1 diabetes.

37:28despite the doubling of LDL cholesterol,

37:31it illustrated that over a 10-ear

37:33period, it maintained not only no sign

37:36of cardiovascular disease, but

37:38remarkable cardiovascular health. And

37:40and in fact, we actually followed on

37:43that study with the largest ever

37:46analysis of the impact of nutrition,

37:49particularly carbohydrates, in over

37:5046,000 patients with type 1 diabetes. We

37:54showed that in over 70% of all reports

37:57of very low carbohydrate ketogenic diets

37:59that patients were completely able to

38:02normalize their glucose control,

38:04normalize the most potent risk factor

38:07for disease of type 1 diabetes.

38:10>> And is this this is a sort of a spectrum

38:14of I'll put that on the screen for

38:16people to see the different sort of

38:17stages and categorizations of being

38:19normal, pre-diabetic, and diabetic.

38:21Right.

38:21>> Correct. Yes. So normal is anything less

38:24than 5.7% HBA1C. Pre-diabetic is that

38:285.7 number up to 6.4. And then diabetic

38:32is anywhere between 6.5 all the way up

38:34into essentially uh there's no cap on

38:37how high that number can go. I

38:39>> I mean I noticed your your blood sugar

38:41levels have uh risen quite dramatically

38:44to

38:44>> that. So what you see initially is is

38:48probably only the first phase of this,

38:50right? So started at an average of

38:52around 100 milligs per deciliter on

38:55average. And once the food is then

38:59consumed cuz once you consume the food

39:01it takes some time to break down into

39:03glucose that glucose then goes into the

39:06blood and then the blood then moves

39:08glucose into this compartment around the

39:10cells which called the interstitial

39:12fluid. And now we're starting to see the

39:14direct impact of just consuming probably

39:16a fifth of the amount of carbohydrates I

39:19should consume from a superfood. Um this

39:22you know oranges are considered both a

39:23citrus in a fruit and this is considered

39:25like a superfood by the American

39:26Diabetes Association uh in the context

39:29of diabetes.

39:30>> So when the glucose spike is high, so

39:33you've just eaten some oranges, the

39:34spike is going up.

39:36>> Yeah.

39:37What does someone feel and then what do

39:39they feel when it's then crashes down

39:41and goes below? Because it started at

39:43about 100. So I imagine that it's going

39:46to go up to whatever it goes up to and

39:48then it's not going to drop back down to

39:49100. It's going to drop below 100

39:52typically in a in a normal um

39:54non-diabetic person, right?

39:56>> So 100's right around the uh normal. So

40:00what you'd hope would happen is that

40:01you're going to go up just a little bit,

40:03insulin's going to respond quickly, and

40:05you're going to come back down to

40:06normal. if you have total healthy

40:08metabolic function. Again, the vast

40:09majority of us do not. But in this case,

40:13what's going to what would be predicted

40:15to happen is that as blood sugar

40:17elevates and insulin responds,

40:21it's going to go as high as the amount

40:23of glucose that's present in the food.

40:24Okay? But at the same time, the my pod

40:28is also which is holding my insulin is

40:30immediately trying to respond. it's

40:32immediately trying to say, "Okay, oh no,

40:33we need to bring this and keep this into

40:34a normal range." Um, and so it's trying

40:37to release insulin. And so you can see

40:39on the screen that there's this massive

40:41uptick in the blue line, which is the

40:44initial response in insulin immediately

40:45to the elevation in glucose. This is

40:48exactly what happens in normal

40:49physiology. Yet no one can measure it,

40:51but you can see it here.

40:52>> So how would I feel when the glucose

40:54spike is high? Do I feel energetic? Do I

40:57feel focused? Or do I feel tired? My

40:59personal experience here Stephen is that

41:01as blood sugar becomes very high I

41:03become my focus reduces my I become

41:07fatigued. Uh I can also according to my

41:09wife become irritable. Um and but you

41:13can even look this up you know you can

41:15look up what are the symptoms of

41:17hypoglycemia what are the symptoms of

41:21elevated glucose levels above the normal

41:23range which is normal 70 to 120. That's

41:26when you can start to see uh very

41:28clearly that the evidence over time has

41:30shown a a very clear impact on not only

41:33how you feel physically but also your

41:35mental health status as well. Oh, I've

41:37just looked up the symptoms here and it

41:39says um the common immediate symptoms of

41:41having a high glucose spike is you feel

41:44thirsty, dry mouth, um frequent

41:46urination, headache, brain fog, fatigue,

41:49sluggishness, blurry vision. Um,

41:53and then once you go down and you crash

41:56or your glucose really drops below the

41:57normal range, what do you feel then?

42:00Typically,

42:00>> so a lot of how I like to describe this

42:02is almost like imagine you're outside

42:05and it's sunny outside and you're having

42:07a great day, great conversation with

42:09other friends, and then all of a sudden,

42:11very rapidly, clouds come over top.

42:15Everyone kind of dissipates and it

42:17starts to rain. It's almost like it's

42:20it's we know that glucose levels have a

42:23direct impact on the neurobiology of the

42:26brain. Meaning how the brain functions,

42:28how it operates, and particularly at

42:31very high glucose levels, you know,

42:33typically above 180 milligs per

42:35deciliter, you start to see signals of

42:37inflammation, signals of stress, like

42:40oxidative stress in the body if people

42:42have heard of that before. And that can

42:44start to cause damage on tissues and

42:46cause a stress response. But the problem

42:47here, Stephen, is that most patients are

42:50living there 24/7.

42:52>> I was looking at some of the symptoms

42:53here, and it says the short-term crash

42:55you get after a spike, um, after a rapid

42:57rise

42:59is a bit of an insulin overshoot. So,

43:02it's reactive hypoglycemia, which is the

43:05sugar crash. And then you might feel in

43:07that crash jittery or shaky, hungry,

43:09often craving carbs and sugar again,

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44:19Replet's core plan. You did a study in

44:222025, I believe, on the impact of the

44:26ketogenic diet on physical performance.

44:29you know, if the ketogenic diet has all

44:30these therapeutic potentials, you know,

44:32going back for over two centuries, what

44:35is truly the impact of it on

44:39performance? Because that's one of the

44:40primary reasons where someone were to

44:42walk into a a clinical setting and say,

44:44"Well, yeah, you can do this, but I've

44:46heard it's going to decrease my

44:47performance."

44:48>> Physical performance.

44:49>> Physical performance. And so we were

44:50very very interested in this because we

44:52thought okay

44:54it it

44:56you know when we look at why

44:58carbohydrates are currently being

44:59recommended as sports nutrition is

45:01because since 1921 they've been shown to

45:03improve performance and how they showed

45:05that in 1921 was that physicians out of

45:08Harvard and um and Boston actually

45:11watched Boston marathoners half of which

45:13who would come wouldn't even finish the

45:15race slurred words they would uh have

45:18like almost pale skin, shaky, weren't

45:21able to articulate their words or some

45:23wouldn't finish at all. And what they

45:25were finding was that these when they

45:26tested the blood of these individuals

45:28that they were finding that glucose

45:29levels were low. Basically, they reached

45:32what they call hypoglycemia. It's a

45:34medical term to describe very low blood

45:37sugar levels. And

45:40then next year they provided

45:41carbohydrates and these marathoners in

45:43the Boston Marathon and all of them

45:45improve their performance. And so since

45:47192 or 1925 actually we've known that

45:50carbohydrates can improve performance.

45:52But we what has happened though over

45:55time is that in 1960s

45:57we there was a measurement technique

45:59called the Birdstrom method where you

46:01actually did a muscle biopsy pulled out

46:05muscle tissue and found that oh wow

46:06there's actually glucose stored in the

46:08muscle. So it must be really important

46:10for physical performance. If the muscle

46:12which is used to contract and move the

46:15body during physical performance that if

46:17glucose is in that tissue, it must be

46:19essential for performance. And then

46:21after they discovered that there was all

46:23these associations between low glucose

46:26levels in the muscle called glycogen,

46:28low glycogen and fatigue. Then after

46:31that the in the 1980s they were able to

46:35look at the amount of

46:38sugar, carbohydrates and fat that the

46:40body was burning during exercise. And

46:43what they found at that stage is that oh

46:45wow it looks like the the amount that

46:48people are able to sustain intense

46:52exercise is proportional to how many

46:56carbohydrates they're burning.

46:59And then there was a few modeling

47:02studies Stephen that then looked at okay

47:04what's the relationship between

47:06let's say uh the intensity of exercise

47:10and what type of fuel you use whether it

47:12be fat or carbohydrates

47:15and they found that they modeled it okay

47:18and said okay well at lower intensities

47:20you must burn almost all fat and at very

47:23high intensities you must burn carbs and

47:26there was a number of studies in 2017 to

47:302020, three different studies that

47:33looked at the ketogenic diet over a 5day

47:35to 3 week period. And they saw that in

47:39those studies that there was a decline

47:40in performance by around 2%.

47:44>> If you were in the ketogenic diet, if

47:46you were on the ketogenic diet,

47:47>> correct? Compared to a high carb diet.

47:49>> Yeah.

47:49>> And so what did that tell these

47:51researchers? Well, it said, "Okay, well

47:52obviously the ketogenic diet must impair

47:54performance." And there's all this

47:55evidence since 1921s that the amount of

47:57carbohydrates, glycogen, how much carbs

48:00you're you're consuming is essential

48:02performance. But here's the kicker is

48:04that

48:06one major confounder of all this is that

48:08we've known for quite a long period of

48:10time that the adaptation to a ketogenic

48:12diet is not one week, it's not two

48:16weeks, not even three, it's four weeks

48:19or more. And when you say adaptation,

48:21you mean your body's transition to being

48:23in a a state where it's efficient at

48:26burning using ketones.

48:29>> So the body's ability to

48:32lower its glucose oxidation or the

48:35amount of carbohydrates it's burning for

48:37fuel because you're giving your body

48:39less of it. The amount of fat that's

48:41being utilized for fuel goes up

48:42dramatically. And then you produce way

48:45more ketone bodies. And ketones are now

48:46being used as not only a a body uh

48:50tissue substrate meaning energy for the

48:53muscle but also for the brain. And so

48:56it's this transition over. But when

48:59people were looking at these studies

49:00they were just looking at some of the

49:03metrics of what happens when you your

49:06body transforms when you reduce

49:08carbohydrates.

49:09>> Okay. So what we wanted to do is say,

49:11okay, if there's all these

49:13healthpromoting benefits of a ketogenic

49:15diet, that sounds great, but all these

49:18studies and sports dogma would say

49:20that's going to impair performance.

49:21Okay, so let's test that. Let's actually

49:24put athletes on a ketogenic diet for 4

49:28weeks. We are going to control not only

49:32their calories, we're going to control

49:33their body composition, we're going to

49:35control their activity level. We're

49:38going to control all these key

49:39confounders that many of these prior

49:41studies never controlled so that we

49:44could truly test the diet induced so the

49:47macronutrient meaning the shift from

49:49carbs to fat effect on performance but

49:53we're going to do it in the same person.

49:55So now we're going to control their

49:56genetics. We're going to control their

49:58environment. Once we did that, Stephen,

50:01we tested what most people think is a,

50:05you know, a very glucose dependent form

50:07of exercise. We asked them to do 6 by

50:09800 meter sprints. They were on a high

50:12carb diet and then they switched to a

50:13low carb diet. Now, what happened this

50:15is all randomized uh and controlled.

50:18When they switched over,

50:20they had no deterioration in performance

50:25>> at four weeks. at the four-week mark in

50:28a form of exercise that we would expect

50:32would be extremely glucose dependent,

50:34extremely carbohydrate dependent.

50:36>> But before 4 weeks, was there an

50:38impairment in their performance?

50:39>> So what we were interested in, Stephen,

50:41is studying at the end. So we didn't

50:44look intermediately. We exclusively look

50:46at the end time point because the the

50:48question was, well, if is there a

50:51difference once you stick to this diet?

50:53Because if you you go on this diet,

50:54ideally you're you're sticking with it

50:56over time. And so

50:59if it is true that you require

51:01carbohydrates, we then also measured how

51:03many carbohydrates and fat they were

51:06burning during exercise.

51:09And it was over what we call 85% of

51:12their V2 max, which means 85% of their

51:15total maximum oxygen consumption during

51:18exercise.

51:20That is when we would expect almost no

51:23fat to be oxidized or to be burned and

51:27almost exclusively carbohydrates. Well,

51:30we found that these athletes recorded

51:33the highest levels of fat burning during

51:36exercise ever reported in the

51:38literature, illustrating that when these

51:40athletes,

51:41>> the ketogenic

51:42>> ketogenic diet that when these diets

51:45adapted to the diet for sufficiently

51:47long, they had record levels of fat

51:51oxidation even at very high intensity

51:54levels. which means that fat was able to

51:57provide nutrients and fuel at very very

52:02intense forms of exercise when we would

52:03expect only carbohydrates would be

52:05relevant and utilizable.

52:09So many of my friends um that are

52:12endurance athletes or that are involved

52:15in things like cycling talk about

52:16exogenous ketones. Um I'm a co-owner of

52:19a company that produces exogenous

52:21ketones. That's my disclaimer. I've got

52:23the product here. What can you tell me

52:26about products like this? Exogenous

52:28ketone products. Exogenous meaning

52:30externally supplemented, I guess,

52:33>> right? So, with a ketogenic diet, you

52:34produce them. Your liver produces them

52:36for you. With um exogenous, you're

52:40consuming these. Well, why would you

52:43consume them? Why not just do a

52:44ketogenic diet? Well, we know that a

52:47ketogenic diet

52:50takes time to adapt. We just talked

52:51about that with physical performance

52:52that we see that you know up to four

52:54weeks to see the full effect on on

52:56performance or more. Well, what happens

53:00if you're let's say a war fighter or

53:02someone who's going out into the field

53:04or immediately wants to flip into this

53:06state? You can't do that unless there

53:10was a molecule that you could consume

53:12that could rapidly elevate ketone bodies

53:14in circulation within minutes.

53:17Insert exogenous ketone bodies. We have

53:20known since the 1960s

53:25that the product in there was studied by

53:27MIT uh in the aerospace department

53:30called 13butane dial. It that it was

53:32able to be consumed and rapidly elevate

53:36ketone bodies in circulation. There was

53:38a study in 2016 called the metabolic

53:41optimization $10 million program from

53:43DARPA. DARPA being the

53:45>> DARPA is an advanced research

53:47organization from the United States

53:48government where they fund very high

53:49risk high reward programs and one of

53:52which was the the the use and testing of

53:55ketone bodies. And so that uh molecule

53:57that they tested was um utilized the

54:00same molecule that's in there and they

54:02kind of uh tweaked some of the

54:04formulations a bit and they showed that

54:06and we know that this is the same for

54:08this molecule as well that when you

54:10consume them it rapidly changes

54:12metabolism almost uh not identical to

54:15what happens with the ketogenic diet but

54:17it has a almost direct impact. It has a

54:20blood glucose lowering effect. it

54:22directly binds to receptors like the um

54:26they call GPR 109A or uh or some other

54:31key receptors that directly uh impact

54:33inflammation. So it directly blocks

54:35something called NLRP3 inflammosome

54:38which is a molecule that leads to

54:40increases in inflammation. We also know

54:42that it changes the way that our genes

54:46are used in the body called epigenetic

54:49signaling. And so the uh consumption of

54:52ketone bodies can actually change the

54:55molecules on our genes and and how those

54:58molecules are ultimately manifested and

55:01that increases our antioxidant capacity

55:04meaning our ability to block oxidative

55:06stress in the body. We we see all these

55:10powerful effects, these rapid shifts in

55:12metabolism within the body. And this

55:142016 study showed that just orally

55:17consuming these molecules could rapidly

55:19shift metabolism, but that it was also

55:21linked to an improvement in physical

55:22performance. But if you look beyond that

55:25and just like uh these these kind of

55:28studies because we looked at them in

55:29athletes, we looked at them in healthy

55:30individuals and then also in military

55:33settings. But we've also there's studies

55:35looking at this in patients at risk for

55:37cognitive decline. So patients at risk

55:38for Alzheimer's disease. They've shown

55:41that in a six-month study administering

55:42exogenous uh ketone bodies was able to

55:45attenuate the decline in uh cognition

55:48that we know happens with advanced age.

55:51>> And just to be clear there, you're

55:52saying it reduces the decline. It

55:53doesn't

55:54>> correct

55:55>> cure Alzheimer's or fix Alzheimer's. It

55:57just delays.

56:00>> Accurate. Yes. It's it's we know that as

56:03individuals age, you're on a precipitous

56:06or or steady decline in in brain

56:09function. Um, and so the goal is to to

56:14offset or to stop the decline. You know,

56:16that's our goal. We want to maintain

56:18normal uh brain function and our ability

56:20to think clearly and to understand

56:23things clearly like reading and and

56:24doing problems and solving problems.

56:27There have also been this emergence of

56:29studies in the world of psychiatry. I

56:32think there's around 11 ongoing active

56:35clinical trials looking at the impact

56:36and interaction of ketonebased therapies

56:39and brain health uh particularly serious

56:42mental illness. One in four adults in

56:44the United States actually over one in

56:45four adults in the United States has

56:47serious mental illness. In fact, I

56:49believe over the numbers are over 20% of

56:51of adults are taking some type of psycho

56:55uh altering medication. At its core, we

56:58see all these relationships

57:00between underlying metabolism being a

57:03key

57:05factor contributing to mental health

57:07status. and the application of the this

57:09unique diet which we know increases

57:11ketone bodies which appear to have

57:13direct impacts on the brain now seems to

57:16be linked to improved serious mental

57:19illness and it'll be interesting to see

57:21where the that evolves but it's just a

57:23fascinating world to imagine that

57:25nutrition not a medication not a

57:29technology but the the simply going to

57:31the grocery store and swapping the

57:33things you choose in there can lead to

57:35these powerful powerful therapeutic

57:38effects um in people of all sorts of

57:41different conditions uh or disorders.

57:44>> On one of the studies that I read about

57:46the administration of exogenous ketones

57:49and the impact it has on brain network

57:51stability was from 2020 where they

57:53investigated if brain network stability

57:55responds to two major brain fuels either

57:58glucose or ketones. And participants

57:59came to the laboratory on two occasions

58:01and drank exogenous ketones or glucose.

58:05And after cons consuming these drinks,

58:07they underwent an MRI scan. Strikingly,

58:09the study showed that ketones increased

58:11the stability of brain networks. In

58:13contrast, glucose decreased the

58:14stability of the network. The network

58:16stability was 87% greater after ketone

58:19consumption than stability measured

58:21after glucose consumption. And in that

58:23study which is on PubMed, the last line

58:25of the abstract says, "Dietary

58:27interventions resulting in ketone

58:29utilization increase available energy

58:31and thus may show potential in

58:34protecting the aging of the brain which

58:37is super interesting.

58:38>> So we did a study uh looking at cancer

58:41and applying exogenous ketones and a

58:43very aggressive form of metastatic

58:45cancer. And what we saw in in my work in

58:47graduate school is that when applying

58:49disogenous ketones that it delayed the

58:52progression of the metastatic cancer,

58:55but it also

58:58when looking at body weight reduced the

59:01rapid decline in body weight we

59:03sometimes see with cancer. A phenomenon

59:05called cexia which is a way a term to

59:08describe the wa rapid wasting of body

59:12tissue with disease. And it is no more

59:15aggressive than the context of cancer

59:17particularly metastatic cancer is where

59:18it's most common and when we saw the

59:21lack of decline in body weight I then

59:25looked at where the body weight was

59:26coming from and it was clear that the

59:29lack of body weight decline

59:31was because of the preservation of in

59:34muscle mass. So it also appeared and

59:36there's been a number of what they call

59:38clinical physiology studies. those

59:40studies that actually directly

59:43manipulate human beings with molecules

59:46and tests, you know, like muscle tissues

59:48and how they function. We see that

59:52exogenous ketone administration can

59:56dramatically reduce the amount of muscle

59:57breakdown uh or breakdown of muscle

1:00:00tissue. Uh essentially illustrating it

1:00:03may be a powerful mechanism in promoting

1:00:06healthy muscle mass as well. In terms of

1:00:09being in a ketogenic diet, one of the

1:00:10things I'm always quite concerned about

1:00:11is am I still able to gain muscle mass

1:00:15if I'm in a ketogenic diet? Because I

1:00:17>> Yeah, I when I go into a ketogenic diet

1:00:20and I stop having carbohydrates, I tend

1:00:22to lose weight rapidly and shred.

1:00:24>> Yeah.

1:00:24>> The fats falls off and I get very lean

1:00:28but

1:00:29>> yeah,

1:00:30>> more skinny.

1:00:31>> You smiled though because maybe you like

1:00:34to be more shredded. Um, so a phenomenon

1:00:37with the ketogenic diet. So there's no

1:00:39deterioration in muscle mass with the

1:00:41ketogenic diet. There have been plenty

1:00:42of studies that have shown that you're

1:00:43able to maintain muscle mass

1:00:45>> and build it.

1:00:46>> Yes. And build it. So they've shown that

1:00:48as well. So Jeff Volic out of Ohio State

1:00:50University has done a number of studies

1:00:51in this area. Um, looking at individuals

1:00:54who were actually on a

1:00:57reduced intake diet. So they're reducing

1:00:59less calories. So they had less energy

1:01:01in the diet. And then they were also

1:01:03doing the ketogenic diet. It was

1:01:04actually a military study and they

1:01:06showed that they were able to maintain

1:01:08uh muscle mass just as much as if

1:01:09someone was on a high carb diet um while

1:01:13under a caloric restriction or another

1:01:16way of describing that is like a semi

1:01:17starving starvation state. So there's no

1:01:21impact negative impact that we see with

1:01:24these diets on muscle mass. However, to

1:01:26your per your personal example, one of

1:01:28the first things that happens when you

1:01:29go onto a ketogenic diet is there's a

1:01:32naturatic effect or natures effect, but

1:01:34basically you reduce the amount of

1:01:36sodium in the body. So, you you you p

1:01:39you piss it out basically and um you so

1:01:42you hold less water weight and that's

1:01:44one of the first things. That's why

1:01:45people see this rapid shift in body

1:01:46weight initially when they're you know

1:01:48on a ketogenic diet, which for many

1:01:49people is great because if they're

1:01:50trying to do it to lose weight, that's

1:01:52like immediate reinforcement. But

1:01:53sometimes it's water weight. Well, water

1:01:55is in both the fat and the muscle. So,

1:01:57it's it's not necessarily that you're

1:01:59losing any muscle mass per se, but it

1:02:00just might be in a phenomena less water

1:02:02weight. And in some context, that might

1:02:03be beneficial. Right? If you're in a

1:02:05sport where you have a

1:02:07power toweight ratio, but you're able to

1:02:09maintain the same power at a lower

1:02:12weight simply by shifting water, that's

1:02:15great. Um, as long as you're able to

1:02:16function equivalently. Is there anything

1:02:18I do need to be thinking about in terms

1:02:20of my diet to make sure I'm still

1:02:22gaining weight just to I guess to keep

1:02:24to keep my protein levels high?

1:02:27>> So, the most important thing related to

1:02:28your diet when it comes to trying to

1:02:30build muscle mass is to exercise hard

1:02:33and with resistance exercise. Uh that's

1:02:36the most important thing when it comes

1:02:37to your diet to enhance that effect.

1:02:40Protein is one of the the most powerful

1:02:42nutrients you can consume to augment

1:02:45that response. Another is to ensure

1:02:47you're having uh sufficient

1:02:50calories. Right? So if you're in a

1:02:52caloric deficit, so you said that you

1:02:53know you tend to eat less calories

1:02:54because you're probably not as hungry.

1:02:56Um well, yes, that's one of the most

1:02:58powerful ways to lose not only fat but

1:03:00also muscle is to just not eat food or

1:03:02>> I think that's it because I I lose my

1:03:05appetite when I when I'm in the

1:03:06ketogenic diet.

1:03:08>> I also lose my appetite a little bit

1:03:09when I take these um exogenous ketones

1:03:11like Ketone IQ.

1:03:12>> Yeah. And I've seen some of the studies

1:03:14that show that there's roughly 20%

1:03:16decrease in

1:03:18um appetite

1:03:20when you take exogenous ketones

1:03:22according to one particular study that I

1:03:23read. But when I when I'm in the

1:03:24ketogenic diet, I it's like food is I

1:03:28get hungry but then I start eating and I

1:03:31stop very quickly.

1:03:32>> Yeah.

1:03:33>> And it's really bizarre. Like I was I

1:03:35was in Cape Town for 10 days or two

1:03:37weeks writing my book. And so I had the

1:03:39chef there and the chef cooks me my food

1:03:40and makes this amazing food and I'm so

1:03:42hungry. I look at it I'm like amazing. I

1:03:44start eating it. I have like five or six

1:03:46bites and I'm done. And only when I'm in

1:03:48the ketogenic diet, there's something

1:03:50going on in my body which just doesn't

1:03:52just doesn't want to binge eat like I

1:03:56sometimes did.

1:03:56>> So there's two things to talk about. One

1:03:58is the type of foods you're consuming on

1:03:59a ketogenic diet and the other is what

1:04:01is happening in your body in your

1:04:03metabolism on the diet. So there's a a

1:04:06book called Always Hungry by a physician

1:04:09u endocrinologist named David Lugwid and

1:04:11he's kind of coined this carbohydrate

1:04:14insulin model and um you know it's semi

1:04:17somewhat controversial but the the

1:04:19reality is that there's there's some

1:04:21important notes in it. One related to

1:04:23hunger which is if you're able to have a

1:04:24fuel source on a ketogenic diet that's

1:04:27sustained over time. So you don't have

1:04:28the up and downs of glucose and up and

1:04:30downs insulin. these constant swings.

1:04:32Whereas on a ketogenic diet, you have

1:04:33this sustained level of fuel influx,

1:04:36right? So you have this nutrient

1:04:38availability in the blood. So glucose

1:04:39levels are much more stabilized, insulin

1:04:40is much more stabilized, and you don't

1:04:42have those fluctuations particle.

1:04:46That might be one potential reason. But

1:04:48the other potential reason is that when

1:04:49you're on a ketogenic diet, you tend to

1:04:52not consume the type of foods that drive

1:04:55hunger. So again, we talked about in the

1:04:58grocery store, the 70% of the grocery

1:04:59store, particularly in the center of the

1:05:01grocery store that is highly processed

1:05:03where they combine

1:05:06carbohydrates with with salt or fat or

1:05:08some combination there in that makes it

1:05:09highly palatable or very very tasty, you

1:05:13know, increase the dopamine response,

1:05:15this positive reinforcement response of

1:05:17the food. Um, that drives people to to

1:05:21seek more of that pleasure response and

1:05:23as a result, they want to consume more.

1:05:24So, everyone has probably felt this

1:05:26example where you're in a restaurant,

1:05:28you've eaten enough food to where you

1:05:29feel physically full. You're like, "Oh,

1:05:31I'm totally full. Like, I don't want to

1:05:33eat any more food." Someone walks by

1:05:36with your favorite dessert. And you're

1:05:38like, "Oh, well, h I could eat that."

1:05:42You're literally physically full, but

1:05:45yet you want to consume more food. This

1:05:50is a is a a phenomenon that has been the

1:05:54struggle of of in America and the the

1:05:57rest of the world essentially now um

1:05:59where the food environment often drives

1:06:01people to over consume and it's not by

1:06:04accident. These are like well conducted

1:06:07strategies in the food industry to lead

1:06:10to these positive pleasure responses.

1:06:11>> I think about this with bread in the

1:06:13restaurant. You know they give you bread

1:06:14first.

1:06:16>> Yeah. That's a good It's a solid

1:06:18strategy, Stephen, to cause you to want

1:06:20to consume start to finish not only the

1:06:23bread, get a big meal, and follow on

1:06:26with dessert. You know, it it is a is a

1:06:28is a great strategy for ensuring that,

1:06:30but it's also the same strategy that,

1:06:32you know, Doritos is using where like

1:06:34you you combine this mixture of new uh

1:06:39molecules in the food that you consume

1:06:41it, you get, oh, this tastes great.

1:06:42Pringles.

1:06:43>> The same exact thing where you combine

1:06:46these different components and it forces

1:06:48you this like, "Oh, this tastes great. I

1:06:50need more." And you never feel full. One

1:06:52of the most common tricks that the the

1:06:55food industry utilizes in these

1:06:58environments is that they one they they

1:07:02certainly are aware of this, right? And

1:07:04so when you consume these type of foods

1:07:06together, they they know they consume

1:07:08more of it, but sometimes people aren't

1:07:10even aware of it. And best example of

1:07:13this, go look at the back of most of the

1:07:16bacon

1:07:17on the grocery store aisle. Go look at

1:07:19the back of most peanut butters, almond

1:07:21butters, nut butters in the grocery

1:07:23store. Most of them have added salt and

1:07:27added sugar. Even to levels where you

1:07:30don't even taste it, but go look at the

1:07:32label. The reason those are added is to

1:07:36increase the flavor profile, the

1:07:38positive brain response to the food. so

1:07:41that you consume more of it. And this is

1:07:44a huge part in why people always feel

1:07:48hungry in today's food environment.

1:07:51They're always seeking more food

1:07:54and they can't get off that hamster

1:07:57wheel. They're always over consuming or

1:07:59always referring to this phenomenon

1:08:01called food noise where they always feel

1:08:03the drive to consume foods or they never

1:08:06feel full. And

1:08:08>> it's and it's because of the sugar and

1:08:09the soap. It is because the food is

1:08:14composed and made in such a way to be to

1:08:16have a flavor profile that your brain

1:08:20says

1:08:22not just eat one bite, eat as much as

1:08:24possible because we're always seeking

1:08:26these pleasure responses, right? In our

1:08:29lives, in our world, it's this is even

1:08:30independent of food.

1:08:32>> So, what do we do about this?

1:08:34So the solution for most people in this

1:08:37situation is to try to focus number one

1:08:41don't consume liquid calories. That's

1:08:43like a dead giveaway bad move because

1:08:46those are abundance of calories

1:08:50will drive people often to over consume

1:08:52them and very drive this pleasure

1:08:54response in the brain.

1:08:55>> Liquid calories. What's a liquid

1:08:56calorie?

1:08:57>> So let's say you have uh a soda or a

1:09:00Coke.

1:09:01>> Yeah. So basically completely void of

1:09:03any nutrients and really high in

1:09:07calories, spikes your glucose through

1:09:08the roof, insulin through the roof, and

1:09:10then often makes you hungrier

1:09:12afterwards, not less hungry by having

1:09:14>> like orange juice

1:09:15>> is another great example.

1:09:17>> Smoothies, those those fruit smoothies

1:09:19people have.

1:09:20>> Exactly. In fact, just taking fruit and

1:09:22then blending it up actually increases

1:09:23the speed by which it's absorbed changes

1:09:26the hormonal response and leads to a

1:09:28worse outcome for most people. Most

1:09:29people think a fruit smoothie is a

1:09:31healthy thing.

1:09:32>> Yeah, I don't know about that. Um, I

1:09:35would I think that when you take fruit,

1:09:38which for most reasons isn't terrible,

1:09:40right? Like, it's not these are

1:09:42nutrient-dense foods, if people can

1:09:44consume them and get away from them,

1:09:46great. If you have a metabolic disease,

1:09:47you might be more vulnerable to, let's

1:09:48say, glucose elevations. But when you

1:09:51then take foods like that, it could be

1:09:52any foods. It could be taking potatoes

1:09:54and then making mashed potatoes. By

1:09:56simply changing or blending that food

1:09:59up, you're now taking a lot of the

1:10:01structural components that your body

1:10:02would take time to digest and you're

1:10:04removing them and you basically almost

1:10:07are like almost turning on like a small

1:10:10hose that's just giving a little bit of

1:10:12water at a time and it's turning it on

1:10:14all the way. you know, you're rapidly

1:10:16increasing the speed of how the

1:10:17nutrients enter the body and it

1:10:19completely changes the hormonal response

1:10:21of molecules like GLP-1 and and normal

1:10:24levels of GLP1 in the body are

1:10:26completely altered. The insulin response

1:10:28is also altered

1:10:29>> and GLP1 is the hunger hormone.

1:10:32>> It's known for being related to hunger

1:10:34because it's released in response to

1:10:35food. It changes the brain's hunger

1:10:40drive and most people know of it because

1:10:42of

1:10:44>> oimpic simaglletide wobi traipide um all

1:10:48these GLP-1 receptor agonists that

1:10:52are

1:10:54increasing GOP1 levels not to normal

1:10:57levels they're increasing them to super

1:11:01physiologic levels mean levels that

1:11:03would never be observed or ever seen

1:11:06in normal settings of the body.

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1:13:05So, I want to give the audience that are

1:13:06listening some practical ways that they

1:13:08can change their life to live a better

1:13:10life and to navigate the food

1:13:12environment we live in. But just to just

1:13:13generally the advice that you would give

1:13:15if you had the ear of I don't know five

1:13:17million people right now and you could

1:13:19say something to them to help them live

1:13:21better lives, to perform better. What

1:13:23advice would you give them?

1:13:25>> Number one is I would say be conscious

1:13:28of the food you're consuming and what

1:13:29you're consuming on a daily basis. The

1:13:31impact of food is is equivalent to

1:13:33medicine. It is and sometimes more

1:13:35powerful than medicine. So, uh what you

1:13:38drink, what you eat, you know, focusing

1:13:40on whole foods, not consuming liquid

1:13:42calories. And if you're someone who

1:13:44could benefit uniquely from stable

1:13:46glucose levels, lower insulin levels,

1:13:48like someone who has some type of

1:13:50metabolic disorder like I do, reducing

1:13:52carbohydrates oftentimes can be a very

1:13:54powerful strategy. In fact, known to

1:13:56prevent and reverse things like obesity

1:13:58and type 2 diabetes with emerging

1:14:00evidence for its potential ability to

1:14:02put things like serious mental illness

1:14:04into remission, but we'll see as more

1:14:05evidence comes out. Exercise on a

1:14:08regular basis. We know that exercise

1:14:10might not be the primary the lack of

1:14:12exercise might not be the primary driver

1:14:13for why someone is or isn't obese, but

1:14:16we do know that physical activity

1:14:17promotes health. We do know that

1:14:19physical activity uh is extremely

1:14:22important for overall well-being. And so

1:14:24>> you've got big muscles.

1:14:25>> Oh, well,

1:14:27>> is that somewhat linked to your your

1:14:29type 1 diabetes at all? Is that is that

1:14:31part of your strategy? You know, look, I

1:14:33was obese at one point. And so I I've

1:14:36since that point taken a very I become,

1:14:39you know, obsessed with trying to find

1:14:41out how to be bigger, stronger, faster,

1:14:43optimize my metabolic health, optimize

1:14:45my performance. And so it's been a

1:14:46lifelong kind of self-experiment in that

1:14:48in that journey. But yeah, exercise is

1:14:51just important in general. But it's for

1:14:52me it's about all the different

1:14:54experiments and and strategies I can use

1:14:56with exercise uh with resistance

1:14:58exercise and beyond to kind of play

1:15:01around with what affects my body, what

1:15:02affects my insulin, how do I increase my

1:15:05overall metabolic health and what I have

1:15:07seen is that that's directly linked to

1:15:08my performance.

1:15:09>> How often do you exercise?

1:15:12>> I try to exercise every single day. Um

1:15:15as much as I

1:15:16>> How long for and what types of exercise?

1:15:18So what I do right now is I typically do

1:15:23weightlifting for 30 minutes to an hour

1:15:24every or six days a week. Um and then I

1:15:28will go typically ride a bike to

1:15:32jiu-jitsu. So Brazilian jiu-jitsu which

1:15:34can be uniquely almost like a mixed

1:15:37exercise, intense exercise where it's

1:15:38going to be extremely intense for like 5

1:15:40minutes and then you have a one or two

1:15:41minute break. Extremely intense and then

1:15:42a break. Uh and I do that typically

1:15:44around 5 days a week. Um, I also try to

1:15:48purposely engage in some type of aerobic

1:15:50exercise when I can. If I I wasn't able

1:15:52to do as much jiu-jitsu one day or as

1:15:55much uh resistance exercise. I always

1:15:57try to add on some type of

1:15:58cardiovascular work, whether that be a

1:16:01run, a bike, or these aerodyine bikes

1:16:03where it's just lower and upper body. I

1:16:05find those to be incredibly uh effective

1:16:07and powerful tools and actually um uh

1:16:11just not causing damage to muscle tissue

1:16:14but also allowing you to improve your

1:16:16overall cardiovascular health.

1:16:17>> What does your diet look like?

1:16:19>> So I tend to wake up and not think about

1:16:22food. That's one thing that I've also

1:16:23experienced similar to you that when I

1:16:24switched to a ketogenic diet, not only

1:16:26improve my glucose and insulin, but I

1:16:29also found that with a ketogenic diet

1:16:31that I

1:16:34don't feel hungry. So, I would wake up

1:16:35and I don't tend to eat food right away.

1:16:38In fact,

1:16:40I enjoy when I don't eat food more so

1:16:42than when I do eat food often times just

1:16:43because not because I don't enjoy the

1:16:45feeling of sitting down and having food.

1:16:47I love that.

1:16:48But

1:16:50the experience and lived quality of life

1:16:53of not having high variable glucose

1:16:56levels, high insulin levels, and the

1:16:58uncertainty that comes with that in my

1:16:59daily life, I enjoy the 23 hours or 22

1:17:04hours of my day where I have the

1:17:05stability, not the the moments in time

1:17:08where I'm introducing uncertainty and

1:17:10variability.

1:17:11to dumb that down a little bit. What I'm

1:17:13saying is that when I when I don't eat I

1:17:16wake up and I don't eat food because I

1:17:18find that it I'm not hungry, but I also

1:17:20find that it makes managing diabetes

1:17:23easier.

1:17:24>> And so, do you eat once a day or twice a

1:17:26day or

1:17:26>> I tend to eat two to three times a day,

1:17:28you know, sometimes right before

1:17:30jiu-jitsu or weightlifting jiu-jitsu,

1:17:33always afterwards and always before uh

1:17:35sometimes before bed. try not to do it

1:17:37right before bed um because it tends to

1:17:39impact my sleep quality a little bit.

1:17:41But I find that I just eat whenever I

1:17:44feel hungry and I try to give myself

1:17:45sufficient protein to be able to respond

1:17:48to the the exercise that I'm doing.

1:17:50>> So, I've got the first one's about being

1:17:51intentional about your food choices. The

1:17:53second one is about exercise.

1:17:55>> Mhm.

1:17:55>> Anything else?

1:17:57>> Well, sleep's really important. You

1:17:58know, these are these are, you know,

1:18:00Stephen, this isn't like uh oh, like

1:18:03this is the most revolutionary advice of

1:18:05all time, but these these core

1:18:07foundational components, good nutrition

1:18:10tailored to your specific needs,

1:18:12exercising as much as you can, and

1:18:15getting good sleep are the pillars of

1:18:17health. If you don't have those

1:18:19corrected, then you're wasting your time

1:18:22everywhere else. And is there anything

1:18:24as it relates to glucose

1:18:28that surprised you? Because you're

1:18:30someone that sees a lot of this data. I

1:18:31mean, you you you you walk around with

1:18:33the the the two devices on that you've

1:18:35mentioned and you're you're looking at

1:18:36the insulin and glucose response. Is

1:18:39there anything that people don't

1:18:41understand as having a really pronounced

1:18:44impact on their glucose levels that they

1:18:45wouldn't expect? Like orange juice is

1:18:47one of the ones that growing up I

1:18:48thought [ __ ] I thought this was a

1:18:50healthy thing. I used to I used to drink

1:18:51Sunny Delight thinking I was putting all

1:18:53these amazing vitamins in my body

1:18:55>> and now I actually look back and regret

1:18:57it and I you know

1:18:59>> not to be judgmental over any parents

1:19:00because parenting is very hard but

1:19:02sometimes I'll see parents giving their

1:19:05children like a big glass of orange

1:19:06juice and in my head I just see the

1:19:08glucose spike that that child's about to

1:19:10have. It's funny when you mention

1:19:11parenting because I have a three and a

1:19:13six-year-old at home and it's amazing

1:19:16when they try one of these foods, these

1:19:19very sugary foods, these very tasty

1:19:22foods, they

1:19:24it's almost like they become incessant

1:19:27on wanting it again. You know, like

1:19:28normal food isn't good enough anymore.

1:19:31Um,

1:19:32and I think that's a great illustration

1:19:34of of what many of us adults are are

1:19:37challenged with on a daily basis, but

1:19:38yet many people are just unaware of the

1:19:41impact that it's having on their

1:19:42metabolism, impacting it's having on

1:19:43their hunger, the impact that that's

1:19:45going to lead to on their future health.

1:19:47>> And is there anything that you've

1:19:48spotted from your experiments with your

1:19:50your CGM and your insulin device that

1:19:54people should most certainly avoid? So,

1:19:55you said liquid calories. Is there

1:19:56anything else that causes a really

1:19:58pronounced or unexpected glucose

1:19:59response? Yeah, you know, there's so

1:20:02many honestly, Stephen, over time that

1:20:04it's honest, it's really hard to

1:20:06pinpoint any singular one. A lot of the

1:20:10foods that are out there are often

1:20:12surprisingly challenging on glucose

1:20:15levels, on insulin levels, particularly

1:20:17the processed foods, because what

1:20:19happens when you make these food

1:20:21products is that you're trusting the

1:20:23food company to put ingredients in there

1:20:24that you're going to respond favorably

1:20:26to, that your metabolism will respond

1:20:27well to. And the truth is that that's

1:20:31far from a guarantee and in many cases

1:20:33maybe uh less likely than it is likely.

1:20:36And so yeah, I don't have a singular

1:20:38example for you, Stephen. I just But

1:20:40I've experienced it numerous times.

1:20:41>> So I've got a a small list here. Um

1:20:44sugary drinks, white bread and bagels,

1:20:46white rice. That surprised me a lot cuz

1:20:48I used to think white rice Oh, really? I

1:20:49I thought growing up rice was like a

1:20:51health food.

1:20:52>> Okay. Well, so on that note,

1:20:55white rice, potatoes,

1:20:58potatoes in any form.

1:20:59>> Sweet potatoes tend to have less of a

1:21:01glycemic response, but it's still going

1:21:03to have a a potent glycemic response.

1:21:05>> So, mashed or baked potatoes, obviously,

1:21:06French fries. Yeah,

1:21:08>> for sure. French fries. Most of like

1:21:10pasta is a big one.

1:21:12>> Cereal,

1:21:14refined cereals,

1:21:15>> most cereals are actually worse than the

1:21:18foods I just described on blood sugar

1:21:20and insulin by a long shot. In fact, uh

1:21:24mo most of the you know these

1:21:25hearthealthy cereals um

1:21:29these these would I would never blood

1:21:31sugar would just spike through the roof

1:21:33portion of the amount I ate. So yeah, it

1:21:34it I wouldn't I wouldn't be consuming a

1:21:36lot of those. And I think I think most

1:21:39people at this stage in the the health

1:21:41and science world would also generally

1:21:44align with with that that those aren't

1:21:46necessarily the best foods to consume.

1:21:47we would think, you know, more more of

1:21:51the less glycemic or less the foods that

1:21:54have less of an impact on glucose

1:21:55levels, less of a impact on insulin

1:21:57levels. You know, one one thing I

1:21:59constantly hear, especially in the

1:22:01research and clinical community is like,

1:22:03well, look, you know, not everyone needs

1:22:06to be concerned about that because, you

1:22:09know, people can respond to a lot of

1:22:11these foods just fine. And I say,

1:22:12"You're you're right." Except that over

1:22:15half of America has pre-diabetes

1:22:18and 90 plus% have some form of

1:22:21measurement that indicates that their

1:22:23metabolic health is impaired and over 86

1:22:2868% are obese and now children are

1:22:32affected with these diseases with

1:22:34obesity and pre-diabetes and around 20%.

1:22:38So it it's it's the fact that we are now

1:22:42less healthy than than we've ever been.

1:22:46Um

1:22:46>> we don't have the foundation to support.

1:22:49>> Correct. And I think you know when we

1:22:51think about healthy nutrition, we think

1:22:53about exercise.

1:22:54We describe them as medicine, but the

1:22:56reality is these are just normal aspects

1:22:58of things you should do every single day

1:23:00because that's what our bodies were made

1:23:01to do. And when we don't do those

1:23:03things, this is when health

1:23:04deteriorates. This is when we're

1:23:06challenging our body to maintain normal

1:23:08health.

1:23:09>> One of the surprising ones for me was

1:23:10dried fruit. And it said while while

1:23:13fruit contains natural sugars, the

1:23:14process of drying it concentrates those

1:23:16sugars. This removes the water and can

1:23:18make the sugar more readily available

1:23:19for absorption, leading to a higher

1:23:21glucose spike compared to fresh fruit.

1:23:23Typically, people think of dried fruit

1:23:25as being a health food as well.

1:23:27>> Yeah. I don't I don't touch those

1:23:29because unless I I don't have any

1:23:31glucose on me and I my blood sugar is

1:23:33going down for some reason and I stay in

1:23:35dangerously low levels, that's when I

1:23:37consume those foods. Otherwise, I would

1:23:39I would not consume them just because of

1:23:41how quickly they raise blood sugar

1:23:43levels.

1:23:43>> Do you think everybody should try the

1:23:45ketogenic diet?

1:23:47>> Ooh, that is a good question. I think

1:23:51Wow.

1:23:54What I would say is that you will never

1:23:59know the potential of its benefit or

1:24:02lack thereof if you don't try. Like

1:24:05anything in life, we are we're left to

1:24:08assume what everyone else is like. You

1:24:10might have we've talked about the

1:24:11ketogenic diet numerous times here. We

1:24:12talked about exogenous ketones numerous

1:24:14times here.

1:24:16But if you don't try it, you don't know

1:24:18how it'll work for you. In science,

1:24:21Stephen, one of the most important

1:24:23things to appreciate is that we often

1:24:25publish bar graphs look like this. You

1:24:29know, the a line uh that illustrates the

1:24:33average outcome of a group of people.

1:24:36But what you don't appreciate is that

1:24:39that line or that bar graph is made up

1:24:43of numerous individuals who all average

1:24:47to that number. But what if you're the

1:24:49person who's at the very high dot or the

1:24:51very bottom dot, meaning that you're the

1:24:53what they call an outlier or someone who

1:24:55responded negatively or positively to

1:24:57that and then you just follow the

1:25:00average advice that that study showed.

1:25:03Well, oh, look, I tried this approach

1:25:05and it didn't it didn't work for me. Uh,

1:25:07I'm just going to keep trying cuz this

1:25:08study said that I should. Well, no. you

1:25:12might be the person who was in that

1:25:14study who didn't respond just like the

1:25:16person on the opposite end of the

1:25:17spectrum who did who averaged out to the

1:25:20metal.

1:25:21>> So when in that study that talked about

1:25:23the impact of exogenous ketones on brain

1:25:25stability, someone might have had 100%

1:25:27improvement in brain stability and

1:25:29someone might have had 20% improvement

1:25:31or whatever and they've averaged it out

1:25:33um across a bigger group of people. So

1:25:35if you you are that person that had a

1:25:37100% gain in brain stability, it's a

1:25:39pretty unbelievable tool for you to

1:25:41understand based on your body.

1:25:44>> Exactly. And and that's that's always

1:25:46the case in science. I mean there are

1:25:48and there sometimes we look at this as

1:25:50responders and non-responders. Um but

1:25:52actually in the study where we gave um

1:25:54uh the product from ketone IQ in the the

1:25:59SOCOM study, we actually saw that nearly

1:26:01all of them saw an increase in SPO2.

1:26:03nearly all themselves an increase in

1:26:05heart rate but that's rare that is rare

1:26:08>> sp2

1:26:09>> ah so uh the amount of oxygen in the

1:26:11blood so the the measure that would

1:26:13indicate whether someone

1:26:15>> uh in these low oxygen environments had

1:26:18more blood or less more oxygen or less

1:26:20oxygen

1:26:22>> ultimately it's it's important to try I

1:26:24I think it's I would always say yes you

1:26:26should try because or any nutrition

1:26:29strategy because you should try

1:26:31different ones I've probably tried over

1:26:33plus different diets only honestly maybe

1:26:34like 15 or 20 at this point in my life.

1:26:36I've just come to find that the

1:26:38ketogenic diet for all the reasons we

1:26:40described and because I have type 1

1:26:41diabetes and I had obese or have type 1

1:26:45diabetes but had obesity

1:26:47find that a ketogenic diet is remarkably

1:26:49powerful at helping me live a

1:26:52dramatically improved quality of life.

1:26:54not have the increased risk for the high

1:26:56invariable glucose levels, high insulin

1:26:58levels that lead to a a near guarantee

1:27:01of complications and 10 to 20 years of

1:27:04lost life and expectancy. That's why I

1:27:06do it.

1:27:07>> I have a closing tradition on this

1:27:09podcast where the next guest leaves a

1:27:10question for the next guest not knowing

1:27:12who they're leaving it for. And this is

1:27:13a really tough question.

1:27:15>> So, it's a very strange question as

1:27:17well, but I'm going to ask you it

1:27:18anyway.

1:27:18>> Yeah. The question is

1:27:23what is outside the simulation?

1:27:32I think it depends on your philosophy

1:27:37on how our existence

1:27:41is

1:27:44with the limitations

1:27:46of understanding that our awareness of

1:27:50our world is completely limited to our

1:27:53our brain's capacity and

1:27:57our interpretation and then explanation

1:28:00of the world and the term of a

1:28:02simulation or lack, you know, however

1:28:04you want to frame it, I believe is is

1:28:07always going to be limited by our

1:28:09brain's ability to understand and

1:28:11articulate that.

1:28:11>> So, what do you think is outside the

1:28:13simulation?

1:28:20>> Consciousness.

1:28:22>> You think consciousness is outside the

1:28:24simulation? I think that

1:28:27our ability to have not consciousness,

1:28:30Stephen, but our ability to

1:28:34operate beyond

1:28:36consciousness.

1:28:39>> Got me on that one, man. That was a that

1:28:41>> tough question.

1:28:42>> Yeah, it is a tough question. That's

1:28:43that's that's a it's a burner right

1:28:46there. I don't know. Do do you think

1:28:48there is do you think there is a god

1:28:51>> beyond beyond this all this stuff that

1:28:53we see here?

1:28:54>> I'm going to give you the most real

1:28:55honest answer possible.

1:28:57>> Yeah.

1:28:57>> I don't think we ever can actually

1:28:59answer that question accurately.

1:29:01>> So your your answer therefore is you

1:29:03don't know.

1:29:03>> I don't know and I don't think I'll ever

1:29:05know.

1:29:05>> Yeah. Okay.

1:29:08Thank you. Thank you so much for doing

1:29:09the work that you do. really appreciate

1:29:10that because you know so many of my

1:29:11friends in this field and even Michael

1:29:14the founder of the the ketone product on

1:29:15my on my uh table here talk about you as

1:29:19being the sort of gold standard of

1:29:21research science and um thought

1:29:23leadership on the subject of ketones and

1:29:25more broadly on the subject of um

1:29:27glucose and all of the adjacent subjects

1:29:29like insulin. So you've really pushed

1:29:31the field forward and the thinking

1:29:32forward in this space in a really

1:29:33profound way and you're only just

1:29:34getting started at 34 years old which is

1:29:36remarkable. we're basically the same age

1:29:38and uh you've had such a tremendous

1:29:40impact on the field of health and that's

1:29:42born out of the story that you told at

1:29:43the start through your own

1:29:44complications. So although it was it's

1:29:46such a tragic thing to be have such a

1:29:47diagnosis at such a young age, what's

1:29:49come from that is a beautiful thing for

1:29:51so many people um that will better

1:29:53understand themselves and their their

1:29:55illnesses but also their performance and

1:29:57um everything correlate related to that

1:29:59because of you. So please keep doing the

1:30:01research you're doing and spreading the

1:30:02word in the way you're spreading it

1:30:03because it's much much needed work and

1:30:05it's it's important work. So, thank you

1:30:06so much and thank you for giving me your

1:30:08time today,

1:30:08>> Stephen. That was an honor. Appreciate

1:30:10it, sir.

1:30:11>> Make sure you keep what I'm about to say

1:30:12to yourself. I'm inviting 10,000 of you

1:30:15to come even deeper into the diary of a

1:30:17CEO. Welcome to my inner circle. This is

1:30:20a brand new private community that I'm

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1:30:42You can tell us what you want this show

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1:31:00I will speak to you then.

1:31:04[Music]

1:31:12Heat. Heat.