How does insulin function in the body and what is its role with blood glucose?

Insulin acts like a thermostat for blood glucose, releasing when glucose levels rise to bring them back down into a tight, critical range (70-120 mg/dL). It helps transport nutrients from the blood into tissues like muscles and the liver. If glucose levels go too high it can cause damage, and if too low, it can be life-threatening.

What is HBA1C and why is it important for health?

HBA1C is an average measurement of your blood glucose levels over a two to three-month period. It's incredibly powerful at predicting future risk for diseases of the eye, kidney, and cardiovascular disease, making glucose control via HBA1C a top priority for improving overall health.

What types of foods are part of a well-formulated ketogenic diet?

A well-formulated ketogenic diet includes green leafy vegetables like salads, broccoli, asparagus, and cauliflower, which are high in fiber and phytonutrients. Protein sources include meat, fish (like salmon), eggs, and some cheeses, while fats come from sources like olive oil and avocado oil.

How does type 1 diabetes affect brain development and cardiovascular health in children?

In children with type 1 diabetes and poorly controlled glucose, MRI scans show shifts in white and gray matter within three years, disrupting normal brain development. Additionally, early signs of atherosclerotic progression (hardening and narrowing of blood vessels) are seen within four years, increasing risk for future heart attacks or strokes.

How do high and low blood sugar levels affect our physical and mental state?

High blood sugar (hyperglycemia) can lead to symptoms like fatigue, irritability, lack of concentration, shakiness, thirst, headache, and brain fog. Conversely, low blood sugar (hypoglycemia) from a sugar crash can cause jitteriness, shakiness, intense carb cravings, irritability, anxiety, weakness, and lightheadedness. Both extremes negatively impact cognitive and physical function.

Can exogenous ketones improve brain function and cognitive decline?

Yes, studies have shown that exogenous ketones can increase the stability of brain networks and attenuate the decline in cognition associated with advanced age and Alzheimer's disease. They provide an alternative fuel source to glucose, potentially protecting the aging brain and showing promise in psychiatry for serious mental illness.

Does the ketogenic diet lead to a loss of muscle mass?

Studies, including military research, show that the ketogenic diet does not lead to a deterioration of muscle mass and can even allow for muscle building, even under caloric restriction. Initial weight loss on the diet is often due to a reduction in water weight, not muscle loss, due to its natriuretic effect.

Why does the ketogenic diet reduce hunger and suppress appetite?

The ketogenic diet promotes sustained fuel influx with stabilized glucose and insulin levels, avoiding the constant swings that drive hunger. Additionally, it typically excludes highly processed foods designed to be hyper-palatable (combining carbs with salt or fat) which artificially stimulate pleasure responses and overconsumption.

What common 'healthy' foods should people avoid for better glucose control?

People should avoid liquid calories such as sodas, orange juice, and fruit smoothies due to rapid glucose and insulin spikes. Other surprising foods to limit include white bread, bagels, white rice, potatoes (in any form), pastas, refined cereals, and dried fruit, as they typically cause pronounced glucose responses.

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

The Diary Of A CEO

People & Blogs3 min read92 min video

Sep 8, 2025|1,726,931 views|45,263|2,903

The Diary Of A CEO steven bartlett steve bartlett podcast the diary of a CEO podcast life lessons CEO

Save to Pod

Key Moments

TL;DR

The ketogenic diet and exogenous ketones offer profound health benefits, impacting disease prevention, cognition, and performance.

Key Insights

High and variable glucose levels are a primary driver of chronic disease and impact brain health.

The ketogenic diet, by reducing carbohydrates, stabilizes glucose and insulin, offering therapeutic benefits for conditions like diabetes and obesity.

Exogenous ketones provide rapid metabolic benefits, potentially enhancing cognition, physical performance, and delaying cognitive decline.

While traditional sports nutrition emphasizes high carbohydrates for performance, ketogenic adaptation can lead to exceptional fat oxidation even at high intensities.

Processed foods and liquid calories, due to their hyper-palatability and rapid absorption, contribute to overconsumption and metabolic dysfunction.

Individual responses to dietary changes vary, highlighting the importance of personal experimentation beyond average study outcomes.

THE CRITICAL ROLE OF METABOLISM AND GLUCOSE CONTROL

Dr. Andrew Koutnik emphasizes that understanding metabolism—how our body utilizes nutrients—is key to health. The primary goal is stabilizing blood glucose and insulin levels, as high and variable glucose (measured by HbA1c) is the paramount risk factor for cardiovascular disease, eye disease, kidney disease, and neurological issues. Unregulated glucose is akin to driving a car without an engine; other health efforts become secondary. His personal journey with obesity and a chronic disease diagnosis fueled his deep dive into metabolic health.

THE KETOGENIC DIET: A THERAPEUTIC APPROACH

The ketogenic diet, characterized by a significant reduction in carbohydrates, has a long history of therapeutic use, dating back to the 18th century for diabetes and the 1920s for neurological disorders like epilepsy. By drastically lowering carbohydrate intake, the diet forces the body to switch to fat as its primary fuel source, producing ketone bodies. This metabolic shift helps stabilize blood sugar and insulin, offering potential for weight loss, improved diabetes management, and cognitive benefits. Nutrient-dense, low-carbohydrate foods like leafy greens and healthy fats form the basis of a well-formulated ketogenic diet.

EXOGENOUS KETONES: RAPID METABOLIC ADVANTAGES

For those seeking immediate metabolic benefits without the adaptation period of a ketogenic diet, exogenous ketones offer a rapid solution. These supplements can quickly elevate blood ketone levels, providing an alternative fuel source for the brain and body. Studies suggest they can enhance cognitive function, improve physical performance, and even attenuate cognitive decline associated with aging. They also play a role in reducing inflammation and influencing gene expression, potentially offering therapeutic applications in areas like serious mental illness and even delaying cancer progression.

PERFORMANCE OPTIMIZATION ON A KETOGENIC DIET

Contrary to the long-held belief that carbohydrates are essential for peak physical performance, research indicates that a well-adapted ketogenic diet can support even high-intensity exercise. After a sufficient adaptation period (around four weeks), athletes on a ketogenic diet have demonstrated unprecedented levels of fat oxidation during intense exercise. This suggests that the body can efficiently utilize ketones and fats for fuel, even at high exertion levels, challenging the traditional sports nutrition dogma centered around carbohydrate loading.

NAVIGATING THE MODERN FOOD ENVIRONMENT

The current food landscape, dominated by hyper-processed items, presents significant challenges to metabolic health. Foods engineered for extreme palatability, often combining carbohydrates, salt, and fat, trigger powerful dopamine responses that drive overconsumption and a feeling of never being full. Liquid calories, such as sodas and fruit juices, are particularly detrimental as they offer little nutritional value, rapidly spike glucose and insulin, and can paradoxically increase hunger. Understanding the 'net carb' concept, focusing on whole foods, and being mindful of hidden sugars in processed items are crucial for making informed dietary choices.

PERSONALIZED HEALTH AND THE IMPORTANCE OF EXPERIMENTATION

Dr. Koutnik stresses that individual responses to dietary interventions can vary significantly. While studies provide valuable average outcomes, direct personal experimentation is vital to understand what works best for one's own body. For individuals with chronic conditions like type 1 diabetes, the ketogenic diet has demonstrably improved quality of life, reduced insulin requirements, and normalized glucose control, challenging expected prognoses. This personalized approach, combined with foundational health pillars of nutrition, exercise, and sleep, empowers individuals to take control of their health journey.

Mentioned in This Episode

●Supplements

●Products

●Software & Apps

●Tools

●Organizations

●Books

●Studies Cited

●Concepts

●People Referenced

Optimizing Health Through Diet & Lifestyle

Practical takeaways from this episode

Do This

Be conscious of the food you consume daily, treating it like medicine.

Focus on whole foods and nutrient-dense green leafy vegetables.

Reduce carbohydrates, especially if you have a metabolic disorder, to stabilize glucose and insulin.

Ensure sufficient protein intake, particularly if building muscle.

Exercise hard and with resistance regularly (e.g., weightlifting, Brazilian Jiu-Jitsu).

Include aerobic exercise consistently for cardiovascular health.

Prioritize good quality sleep as a pillar of health.

Consider trying different dietary strategies, including ketogenic, to find what works best for your body.

Avoid This

Don't consume liquid calories like soda, orange juice, or fruit smoothies due to rapid glucose spikes and lack of nutrients.

Avoid highly processed foods, especially those combining carbohydrates with salt or fat, which drive overconsumption.

Don't fall for 'zero sugar' or 'keto friendly' labels that use other ingredients (like maltitol, maltodextrin) with similar negative metabolic effects to sugar.

Avoid white bread, bagels, white rice, potatoes (mashed, baked, French fries), and most refined cereals due to their potent glycemic response.

Steer clear of dried fruit unless for emergency low blood sugar, as it causes rapid glucose spikes.

Blood Glucose Levels and Diabetes Classification

Data extracted from this episode

Category	HBA1C (%)	Description
Normal	< 5.7	Anything less than 5.7% HBA1C
Pre-diabetic	5.7 - 6.4	From 5.7% up to 6.4% HBA1C
Diabetic	6.5+	Anywhere between 6.5% and higher, with no upper cap

Ketogenic Diet Impact on Cardiovascular Health (10-year study)

Data extracted from this episode

Metric	Pre-Keto Diet (6 years)	Post-Keto Diet (10 years)	Impact
LDL Cholesterol	Normal	Near doubling	Doubled, but did not worsen cardiovascular health
Glycemic Control	Normal to high	Completely normal	Normalized, despite high LDL
Insulin Load	High	Reduced over 40%	Significantly reduced requirements
Cardiovascular Health	Average for Type 1	Better than average (even non-diabetics)	Remarkably improved, no signs of disease

Common Questions

Dr. Andrew Kutnick's mission is to empower individuals to take control of their health by bridging complex scientific knowledge into actionable strategies. Having experienced chronic diseases himself, he aims to share the tools and strategies he used to maximize health and performance.

Topics

Glucose Control Type 1 Diabetes Obesity Management Hunger Regulation Therapeutic Carbohydrate Restriction

Mentioned in this video

personDr. David Ludwig

An endocrinologist who coined the carbohydrate-insulin model, linking food choices to hunger and metabolic responses.

personDanny Miranda

Mentioned as the co-founder of the ketone product (Ketone-IQ) on the host's table, indicating his involvement in the company.

supplement1,3-Butanediol

The molecule studied by MIT in the 1960s and later by DARPA, capable of being consumed to rapidly elevate ketone bodies in circulation within minutes.

studyPrecision Nutrition publication

Cited as a source for a study involving 326 participants detailing how the keto diet can increase glycemic control in diabetic patients.

conceptNLRP3 Inflammasome

A molecule that leads to increases in inflammation, which exogenous ketones directly block.

conceptPolysaccharides

Bound sugar molecules in fruits that are broken down into individual glucose molecules in the gut for absorption into the bloodstream.

conceptEpigenetic Signaling

The process by which the consumption of ketone bodies can change molecules on our genes and how those genes are manifested, increasing antioxidant capacity.

conceptHbA1c

An average measurement of blood glucose over a two to three month period, considered a powerful predictor of future risk for various diseases, including cardiovascular, eye, and kidney diseases.

productZepbound

Another GLP-1 receptor agonist medication that is used to increase GLP-1 levels.

supplementMaltitol

A sugar alcohol used as a sugar substitute that can have the same metabolic effect as sugar, rapidly elevating glucose.

personDr. Andrew Kutnick

A research scientist who has worked on over 100 studies on metabolic health, diabetes, and the keto diet, also living with Type 1 Diabetes which he manages with a ketogenic diet.

toolInsulin Pump

A device worn by individuals with Type 1 Diabetes to continuously administer insulin, mimicking the function of a pancreas.

supplementMaltodextrin

A white starchy powder used as a food additive and sugar substitute, known to cause rapid increases in glucose levels despite 'zero sugar' labels.

organizationAmerican Diabetes Association (ADA)

An organization that in its 2019 consensus report described type 2 diabetes as the most evidence-based nutritional strategy to reverse the disease using ketogenic diets.

organizationDARPA

An advanced research organization from the United States government that funded a $10 million metabolic optimization program in 2016 to test ketone bodies.

organizationPubMed

Repository of biomedical literature where a 2020 study on exogenous ketones and brain network stability was published.

personJeff Volek

Researcher from Ohio State University who has conducted studies on the ketogenic diet's impact on muscle mass, even under caloric restriction.

bookAlways Hungry?

A book by Dr. David Ludwig that discusses the carbohydrate-insulin model of obesity and its relation to hunger and sustained fuel sources on a ketogenic diet.