Researcher Koutnik Says Keto Matches High-Carb Endurance Performance

研究员Koutnik称生酮饮食耐力表现媲美高碳水饮食 研究科学家Andrew Koutnik表示，采取为期四周的生酮饮食可以在逆转代谢疾病细胞标志物的同时，保持高强度冲刺能力。 Andrew Koutnik博士探讨了血糖波动和胰岛素抵抗如何成为慢性疾病、认知能力下降和代谢功能障碍的主要诱因。结合15年以上的科学研究以及自身管理1型糖尿病的经历，他阐述了生酮饮食、碳水化合物限制和外源性酮体如何稳定血糖、改善思维清晰度并维持体能表现。他指出了现代超加工食品、液体热量以及驱动过度进食的食品工业工程的潜在隐患，同时提倡通过每日锻炼和全食物营养来实现长期健康。 做好血糖控制并降低HbA1c是预防心血管疾病、肾损伤和糖尿病并发症最关键的单一指标。 (9:24) 超过68%的美国成年人患有肥胖症，这会在出现明显症状之前导致基础胰岛素水平几乎翻倍，胰岛素敏感性下降约35%。 (3:18) 生酮饮食杜绝了易消化的碳水化合物，从而维持低胰岛素水平以触发脂肪分解，并使肝脏能够生成酮体作为大脑的替代燃料。 (13:20) 人类在碳水化合物和脂肪代谢之间转换的能力是一种进化生存机制，使身体在饥荒期间能够利用维持数月的储存脂肪。 (16:19) 血糖急剧飙升和骤降会直接损害执行认知功能，引发脑雾、疲劳、易怒和发抖。 (18:18)

Metabolic researcher Dr. Andrew Koutnik argues that blood glucose and insulin control are the primary determinants of chronic disease prevention, asserting that therapeutic carbohydrate restriction and ketogenic adaptation offer powerful, non-pharmacological interventions for metabolic, cognitive, and physical health. The Crisis of Glucose Volatility and Metabolism (9:24) Population data cited by Dr. Koutnik indicates that over 68% of American adults suffer from obesity, more than 50% have prediabetes, and roughly 93% exhibit measurable metabolic derangement. Accumulating excess adipose tissue nearly doubles baseline insulin levels and impairs insulin sensitivity by 34% to 35% long before clinical diagnosis. Koutnik describes insulin as a biological thermostat defending the single circulating teaspoon of blood glucose; when blood glucose chronically exceeds 180 mg/dL, systemic inflammation and oxidative stress escalate. Therapeutic Carbohydrate Restriction in Diabetes (33:32) Managing carbohydrate intake serves as the primary lever for regulating HbA1c, the foremost predictor of cardiovascular disease, retinopathy, and kidney damage. Grounded in practices dating back to John Rollo in 1796 and endorsed in the American Diabetes Association's 2019 consensus report for type 2 diabetes, carbohydrate restriction directly counters glycemic rollercoasters. A well-formulated ketogenic diet replaces starches and sugars with low-carbohydrate vegetables, quality proteins, and healthy fats, limiting total daily carbohydrates to roughly 50 grams to stimulate liver ketogenesis. Ketone Physiology, Neurological Health, and Disease (55:25) Because the brain cannot directly utilize long-chain fatty acids, ketone bodies supply a stable alternative fuel that prevents the cognitive fatigue, brain fog, and irritability induced by glycemic spikes and crashes. A cited 2020 neuroimaging trial recorded an 87% increase in functional brain network stability following ketone consumption compared to glucose. Furthermore, clinical trials show exogenous ketones—such as compounds explored in DARPA’s $10 million Metabolic Optimization program—suppress the NLRP3 inflammasome, reduce self-reported appetite by roughly 20%, and mitigate muscle wasting during cancer cachexia. Keto-Adaptation in Athletic Endurance and Muscle Preservation (44:21) Dr. Koutnik challenges conventional sports nutrition dogma, arguing that prior studies demonstrating a 2% decline in athletic output failed to accommodate the mandatory four-week keto-adaptation window. In a 2025 controlled trial evaluating athletes performing repeated 800-meter sprints, fully adapted participants showed no deterioration in high-intensity performance while demonstrating record-breaking fat oxidation rates at exercise intensities above 85% VO2 max. Commercial Food Processing and Deceptive Dietary Traps (67:04) Modern ultra-processed foods combine refined carbohydrates, industrial fats, and sodium to engineer hyper-palatable formulations that override physiological satiety and induce continuous 'food noise.' Koutnik warns against deceptive marketing where products claim 'zero sugar' yet contain high-glycemic substitutes like maltodextrin or maltitol that trigger blood sugar surges. Additionally, eliminating liquid calories and avoiding blended whole foods are emphasized, as stripping a food's physical fiber matrix accelerates nutrient absorption, flattens natural GLP-1 satiety signaling, and induces acute glucose spikes. While Dr. Koutnik underscores the profound metabolic benefits of carbohydrate restriction, he emphasizes that scientific literature presents group averages that obscure substantial individual variation. Unresolved questions remain regarding the long-term clinical significance of elevated LDL cholesterol observed in certain individuals consuming higher saturated fats, as well as the precise therapeutic boundaries of ketone-based protocols in metabolic psychiatry and oncology.

代谢研究科学家 Andrew Koutnik 博士结合其 15 年的代谢科学研究与自身罹患 1 型糖尿病的经历指出，持续高血糖与剧烈的葡萄糖波动是引发慢性疾病和认知受损的关键诱因；通过践行治疗性碳水化合物限制与生酮代谢，个体能够重建代谢灵活性，从而稳定血糖、减轻系统性炎症并优化大脑与运动表现。 全民代谢危机与血糖波动的系统性损伤 (9:24) Koutnik 博士指出，当前大众健康正面临严峻的代谢失调危机。流行病学数据显示，美国超过 68% 的成年人患有肥胖症，逾 50% 患有糖尿病前期，且高达 93% 的人群存在不同程度的代谢功能障碍。在机体积累过多脂肪组织的初期阶段，基础胰岛素水平几乎立即翻倍，而胰岛素敏感度则骤降约 34% 至 35%。人体的正常空腹血糖区间为 70 至 120 mg/dL，整个循环系统依赖严密调控仅维持约一茶匙的微量葡萄糖。医学文献公认，反映 2 至 3 个月平均血糖水平的糖化血红蛋白（HbA1c）是预测心血管疾病、肾功能衰竭及视网膜病变的最强指标。 高碳水饮食造成的反复血糖激增与骤降，直接导致嗜睡、脑雾、注意力涣散和易怒等神经认知障碍。若血糖读数持续突破 180 mg/dL，组织将遭受严重的氧化应激和系统性炎症。临床影像与生理研究表明，罹患 1 型糖尿病的儿童在确诊仅 3 年内，大脑磁共振成像（MRI）便可观察到白质与灰质发育异常；4 年内血管壁弹性减退并丧失一氧化氮合成能力，导致血管硬化并显著加速动脉粥样硬化与失明进程。 治疗性碳水限制与生酮饮食的临床逆转 (13:20) 利用碳水化合物限制来逆转代谢疾病拥有百余年历史依据：从 1796 年 John Rollo 首次发表低碳饮食缓解糖尿病的医学案例，到 1921 年梅奥诊所（Mayo Clinic）为模拟禁食抗癫痫效果而创立高脂生酮饮食。标准生酮饮食的核心并非单纯摄入高脂肉类，而是由高纤维深色蔬菜、优质蛋白质与健康脂肪构成，严格限制精制糖与高淀粉食物，使每日净碳水化合物（总碳水减去膳食纤维）降至 50 克以下，从而抑制胰岛素分泌，促使肝脏分解脂肪产生酮体供能。 美国糖尿病协会（ADA）2019 年共识报告明确指出，低碳水饮食模式是降低 2 型糖尿病患者血糖水平最具循证支持的营养策略。Koutnik 博士分享其个人在转向生酮饮食后，日常胰岛素注射量减少逾 40%，且血糖长年维持在非糖尿病健康区间。一项由其主导的 10 年期个案追踪显示，尽管高饱和脂肪导致受试者的低密度脂蛋白胆固醇（LDL）几乎翻倍，但全面心血管检测证实其动脉血管完全健康，心血管指标显著优于同龄非糖尿病人群。此外，一项针对 46,000 多名 1 型糖尿病患者的大规模分析表明，超过 70% 遵循非常低碳生酮饮食的患者成功实现了血糖正常化。 生酮适应重构运动机能与外源性酮体价值 (44:21) 传统运动营养学长期认为在高强度运动（超过 85% VO2 max）下机体几乎完全依赖碳水化合物氧化。Koutnik 博士反驳称，既往宣称生酮降低运动耐力的试验大多只持续 1 至 3 周，忽略了机体细胞能量通路重构至少需要 4 周的“生酮适应期”（keto-adaptation）。其 2025 年开展的严格对照试验显示，受试运动员在完成 4 周适应期后，在六组 800 米高强度冲刺测试中运动表现完全没有下降，并打破了科学文献记载的高强度负荷下最高脂肪氧化速率纪录。同时，生酮初期的急剧减重本质上是胰岛素下降引发肾脏排钠排水的利尿效应，并不涉及肌肉组织的实质损耗。 针对特殊高压环境或无法严格控制膳食的人群，外源性酮分子（如源自 1960 年代 MIT 研究并受 DARPA 资助的 1,3-丁二醇）提供了无需长期饮食限制即可提升血酮的途径。摄入外源性酮体能够直接结合 GPR109A 受体并阻断 NLRP3 炎症小体，启动表观遗传信号以增强机体抗氧化防御。临床研究证实，外源性酮体摄入可使大脑功能网络稳定性较葡萄糖提高 87%，延缓阿尔茨海默病高危患者的认知衰退；在晚期转移性肿瘤模型中，酮体还能有效抑制肿瘤扩散并减轻恶病质导致的进行性肌肉消耗。 超加工食品陷阱与可落地的生活方式重置 (67:04) 现代商业超加工食品普遍采用糖、脂肪与钠的精密配比，制造高度适口性以劫持大脑的多巴胺奖赏回路，产生持续的“食物噪音”（food noise）并破坏天然饱腹感中枢。食品工业往往还利用监管漏洞，在标榜“零糖”或“生酮友好”的产品中添加麦芽糊精或麦芽糖醇等高升糖成分。即便是橙子等常被视为健康的水果，单次食用三颗也会摄入 70 至 90 克碳水化合物并引发剧烈血糖飙升。若将水果打成果汁、冰沙或将淀粉食物捣成泥状，其天然物理纤维矩阵被彻底瓦解，糖分吸收速度大幅加快，导致胰岛素与肠道饱腹激素（如 GLP-1）的生理调节发生紊乱。 为构建长久代谢健康，Koutnik 博士强调首要任务是彻底剔除果汁、含糖饮料等“液体卡路里”，并大幅减少加工麦片、精制白米面等快速消化碳水。其个人确立的健康三大基石为营养、规律运动与深度睡眠：包括每周 6 天的高强度抗阻训练与柔术搏击以提升外周胰岛素敏感度，结合每日 2 至 3 次围绕体能训练安排的进食窗口，严禁临睡前大量进食以保护睡眠结构，从而确保全天 22 至 23 小时均处于极其稳定、可预测的代谢水平中。 Koutnik 博士强调，医学文献公布的趋势线多基于群体平均统计，掩盖了不同个体在代谢适应性与基因背景上的显著差异。尽管低碳生酮机制在稳定血糖、保护血管内皮与提升大脑功能稳定性上展现出强有力的数据支持，但针对高饱和脂肪摄入伴随的 LDL 胆固醇显著升高现象，其在不同亚群中的长期心血管净效应仍需持续观察。个体在采纳低碳干预策略时，应以持续葡萄糖监测与综合生化指标为客观依据，根据自身生理反馈进行动态调整。

## Background 本期节目由知名商业播客频道《The Diary Of A CEO》（主持人 Steven Bartlett）于 2025 年 9 月 8 日在 YouTube 平台发布。视频简介指出，深耕代谢健康 15 年并主导了史上最长生酮饮食人体研究的 Andrew Koutnik 博士，揭示了超加工食品对大脑和代谢的无形破坏，以及如何通过生酮饮食与外源性酮体等策略预防阿尔茨海默病、心血管疾病和糖尿病，重塑燃脂与身体机能。 ## TL;DR 节目围绕血糖控制作为健康核心基石展开，深入剖析了高碳水超加工食品如何引发血糖剧烈波动、胰岛素抵抗以及心血管与大脑的慢性损伤。Dr. Andrew Koutnik 结合自己逆转肥胖与终身管理 1 型糖尿病的临床及自我实验数据，论证了严格控制碳水的生酮饮食在平稳血糖、降低胰岛素负荷及保护血管内皮上的决定性作用。访谈打破了“生酮摧毁运动机能和肌肉”的传统观念，展示了充分适应后在极限运动中刷新纪录的脂肪氧化能力，并剖析了外源性酮体在提升 87% 大脑网络稳定性、抗炎与延缓恶病质方面的机制。最后，嘉宾提醒大众警惕果汁、麦片等隐形升糖食品，倡导通过天然全食物、阻力训练和代谢自觉重获健康掌控权。 ## Atmosphere & style 对谈在严谨的硬核科学探讨与真诚的个人生命叙事之间自然流转，Dr. Koutnik 回顾童年肥胖挫败感与确诊 1 型糖尿病时的坦率，为晦涩的内分泌生理机制注入了强烈的情感张力。节目通过佩戴动态血糖仪（CGM）现场吃橙子实测、实时展现体内激素应对过山车的互动，营造出极具说服力与探索欲的实验氛围。主持人 Steven Bartlett 与嘉宾同龄且同为代谢优化实践者，彼此交流充满默契与共鸣，在层层揭露食品工业操纵味觉的警醒之中，最终升华到对生命本质与意识边界的理性敬畏，带给受众极强的启发感与自我掌控力量。 ## Bulletin - [35:19](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2119s) 针对 1 型糖尿病患者开展的 10 年随访个案与 4.6 万人大规模分析显示，严格的极低碳生酮饮食可使外源性胰岛素需求减少超 40%，并帮助超 70% 的患者实现血糖控制完全正常化，同时未伴随动脉斑块等心血管病理累积。 - [50:28](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3028s) 交叉对照临床研究推翻了“断碳摧毁运动机能”的传统观念，受试者在经过 4 周充分的生酮代谢适应后，高强度冲刺跑表现未出现衰退，并在 85% VO2 max 极限负荷下刷新了学术文献中记载的运动最高脂肪氧化率纪录。 - [56:27](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3387s) 神经影像学研究证实，外源性酮体供能可使全脑网络稳定性相比葡萄糖提升 87%，且外源性酮体通过阻断 NLRP3 炎症小体及表观遗传激活抗氧化通路，在延缓认知衰退和遏制癌症恶病质骨骼肌流失方面展现出明确临床潜力。 - [01:08:32](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4112s) 现代食品工业设计的超加工食品劫持了多巴胺奖赏回路，而破除物理纤维屏障的果汁与果昔等液态热量会引发暴洪式血糖峰值，推动了当代超过 90% 成年人代谢指标受损的系统性公共健康危机。 ## Key takeaways - [09:34](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=574s) 血糖控制与糖化血红蛋白 (HbA1c) 处于代谢健康金字塔的顶峰，HbA1c 是预测心血管疾病、视网膜病变和肾病风险最强力的单一生物标志物。 - [11:10](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=670s) 极低碳水化合物饮食具有深厚的医学传承，早在 1796 年即被用于糖尿病缓解，1920 年代被梅奥诊所确立为模拟禁食以治疗儿童癫痫的有效临床手段。 - [06:32](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=392s) 正常人体血液循环中仅需约一茶匙（4-5 克）葡萄糖维系生命，摄入过多碳水化合物会大幅推高胰岛素分泌，从而在生化层面彻底锁死体内的脂肪分解通道。 - [19:52](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1192s) 即便是被普遍视为健康的水果（如柑橘）或淀粉类主食，其多糖成分在肠道快速水解后也会激起剧烈血糖波动与高胰岛素负荷，对于代谢受损者构成严重的生理压力。 - [29:38](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1778s) 长期高血糖对血管壁具有不可逆的累积性破坏，早在青少年确诊 1 型糖尿病数年内，血管便会丧失一氧化氮介导的血流切应力舒张反应，导致血管管壁纤维化并提前硬化。 - [35:19](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2119s) 低碳生酮饮食虽常引发 LDL 胆固醇上升，但 10 年临床个案与前沿心血管深度检测表明，在血糖与胰岛素维持优异的前提下，LDL 升高并未带来任何动脉粥样硬化病变，挑战了单一胆固醇致病论。 - [40:09](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2409s) 高碳饮食所诱发的是“血糖骤升—胰岛素过冲—反应性低血糖（糖崩）”恶性过山车，这是现代人反复经历脑雾、疲惫、易怒以及病理性饥饿感的生化底层逻辑。 - [44:21](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2661s) 以往认为生酮饮食损害高强度体能的学术结论，核心缺陷在于干预周期过短（不足 3 周），而人体完成由糖供能切换为脂肪与酮体高效氧化需要至少 4 周的充分适应期。 - [52:09](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3129s) 外源性酮体不仅能快速跨越血脑屏障为神经系统供能，更是一种强大的信号分子，可直接靶向结合 GPR109A 受体以抑制 NLRP3 炎症小体，发挥系统性抗炎与组织保护作用。 - [56:27](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3387s) 代谢精神病学研究揭示，精神疾病与大脑底层能量供应异常高度关联，酮体驱动不仅显著强化脑网络稳定性，还为难治性神经及心理疾病提供了饮食与分子层面的干预路径。 - [58:39](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3519s) 生酮饮食与外源性酮体具有显著的肌肉抗分解保护效应，即便在严格的热量赤字下依然可以保留甚至构建瘦体重；初期体重的大幅下降主要源于促尿钠排泄效应带来的水分排出。 - [01:04:48](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3888s) 超加工食品将糖、盐、精炼脂肪精准配比以制造超强适口性，不仅劫持食欲中枢催生持续的“食物噪音”，还会破坏体内天然 GLP-1 等肠促胰岛素的正常分泌节律。 - [01:08:32](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4112s) 绝对杜绝液态热量（含糖苏打水、鲜榨果汁与果昔冰沙）是代谢管理的首要原则，人为粉碎植物的物理纤维结构会让浓缩果糖与葡萄糖以漫灌态势涌入血液，引发激素剧震。 - [01:20:41](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4841s) 许多打着“健康”标签的食品（如精制谷物麦片、果干及白米饭）升糖效应极具欺骗性；全美超过 90% 的成年人存在代谢异常指标，严控碳水是逆转这一流行病的关键策略。 - [01:23:44](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=5024s) 科研文献中的统计平均值往往掩盖了极端个体应答者与无应答者的巨大鸿沟，每个人都应跳出教条，通过严谨的个人自我实验寻找契合自身基因与代谢机能的最优饮食结构。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=0s) 科学突破：外源性酮体与研究前瞻 在节目的开篇片段中，主持人 Steven Bartlett 与 Andrew Koutnik 博士就一项引人注目的科学发现展开对话。Koutnik 博士指出，现有的严谨科学证据表明外源性酮体在认知增强方面具有显著效果：在受试者身上，他们观察到个体阅读与吸收信息的能力提升了 50%，决策水平也更为出色。更为关键的是，他们所开展的一项研究证实，这一干预手段能够有效延缓转移性癌症的进展。Koutnik 博士坦言自己多次使用过这种物质。过去 15 年来，他深耕代谢科学研究，自身也曾饱受多种慢性疾病的折磨（其中一种他成功逆转）。但他痛心地发现，当普通患者踏进诊室时，医生几乎从不提及这些真正强大且前沿的健康策略。 Steven 随后介绍了 Andrew Koutnik 博士的学术背景与权威地位：他是一位在代谢健康、糖尿病以及生酮饮食领域发表过 100 多篇研究论文的顶尖科研人员。他的研究致力于帮助公众预防慢性病、提升脑力并优化身体机能。Koutnik 博士回顾自己的成长经历时提到，他在童年时期经历过诸多沉重的困境——即便严格遵循所有人教导的健康法则，按部就班地疯狂锻炼、严守饮食指南，体重仍一路飙升至 255 磅（约 116 公斤），陷入重度肥胖。 - **认知增强数据**：研究观察到受试者在信息吸收与阅读理解能力上实现了高达 50% 的显著提升。 - **疾病干预**：实验证实其对延缓转移性癌症进展具备切实效果。 - **儿童肥胖危机**：在过去 30 年中，儿童肥胖率翻了两番（翻了 4 倍），目前超过 20% 的儿童患有肥胖症。 - **饮食陷阱与里程碑研究**：超市里许多看似健康的食品实则极具破坏性，且这种设计并非偶然；Koutnik 博士主导了针对 1 型糖尿病患者采用生酮饮食的长达 10 年的个案跟踪研究，这也是该领域历史上持续时间最长的一项研究。 ```mermaid flowchart TD accTitle: 代谢干预与健康机能影响链路 accDescr: 展示生酮与外源性酮体干预对认知、代谢疾病及癌症等多方面产生的作用机制与路径。 subgraph Intervention["核心干预手段"] Keto["生酮饮食 (Ketogenic Diet)"] ExoK["外源性酮体 (Exogenous Ketones)"] end subgraph Brain["神经与认知系统"] Cognition["认知表现提升 50%<br/>信息吸收与决策优化"] end subgraph Disease["疾病管理与逆转"] Cancer["延缓转移性癌症恶化"] Metabolic["改善 1 型/2 型糖尿病<br/>逆转肥胖与胰岛素抵抗"] end Keto --> Brain Keto --> Metabolic ExoK --> Brain ExoK --> Cancer ``` --- ### [02:25](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=145s) 终身使命：将复杂科学转化为患者自主掌控的工具 当 Steven 询问 Koutnik 博士过去数十年的科研生涯到底在探寻什么、最宏大的目标是什么时，Koutnik 博士给出了一个坚定而真诚的答案：他的核心使命是“赋能每个人，让他们重新掌控自己的健康”（"empower individuals to take control of their own health"）。科学研究本身错综复杂，学术术语晦涩难懂，很难直接落地为日常生活中的行动准则。在过去 15 年的科研历程中，他不仅是一位身处实验室的科学家，更是一个与多种慢性病共存的患者——他成功逆转了其中一种慢性病，但另一种则是终身无法逆转的。 正因切身体会过传统医疗体系在生活方式和代谢干预上的巨大盲区，他深知患者在诊室里往往得不到最有价值的工具。他将自己的探索形容为一段“极其自私”的旅程：最初，他只是想为了自己活下去，寻找能带给自己最佳体能表现与健康水平的极致手段。而当他发现这些真正起效的非药物策略往往被传统医疗边缘化后，他立志搭建起前沿科学与个体行动之间的桥梁，将自己亲测有效的认知和工具毫无保留地交付给大众。 --- ### [03:18](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=198s) 破译代谢密码：营养、运动与医疗盲区 针对大众常常感到模糊的“代谢”（Metabolism）概念，Koutnik 博士做出了清晰通俗的界定。代谢在广义上就是探索人体如何处理、转化和利用摄入的营养素与食物。他指着演播室桌上的橘子举例道：食物中究竟含有什么成分？当你把它们吃进肚子后，身体会产生怎样的应答？这种应答绝不仅是大家常听说的血糖波动，还包括深层的胰岛素释放动力学以及错综复杂的激素调节级联反应。 在代谢的调控版图中，除了至关重要的日常营养摄入，运动同样具有无与伦比的代谢重塑能力，对整体机能维系不可或缺。Koutnik 博士感慨，现代人往往低估了食物对体内环境的剧烈冲击。他在年少时期饱受健康折磨时，曾完全信赖权威——医生怎么开药、健美杂志怎么推荐、公共卫生指南怎么规定，他就怎么吃、怎么练。然而这种盲信换来的却是身体指标的全面崩塌，这促使他彻底跳出传统教条，将毕生精力投入到代谢生理学的底层逻辑探索中。 --- ### [04:30](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=270s) 肥胖的隐形创伤：脂肪堆积与胰岛素抵抗的连锁反应 看着 Steven 调出的童年旧照，Koutnik 博士的情绪明显产生了波动，那些被肥胖阴影笼罩的痛苦记忆再次被唤醒。其中一张照片是他与父亲一起去钓鱼的家庭出游照，画面中的他身躯庞大，体脂极高；另一张照片更是深深刺痛了他，因为那时他每天都拼尽全力运动，严格计算并吃着“健康推荐”的食物，但体内的脂肪组织却像失控一样疯长。彼时的他对脂肪在体内引发的深层生化破坏一无所知，而他指出，当今社会的绝大多数人也同样蒙在鼓里。 目前全美已有超过 68% 的成年人处于超重或肥胖状态，这意味着走在街上的每 10 个人里就有 7 个存在肥胖问题。Koutnik 博士从细胞生理学层面揭示了这种危机的隐蔽性：一旦体内脂肪组织开始超额蓄积，在人体尚未表现出任何外在器官损伤或明显的临床症状之前，体内的空腹胰岛素水平几乎就会立刻翻倍。紧接着，人体的胰岛素敏感性便会剧烈滑坡约 34% 至 35%。胰岛素本质上是一种极其强大的“脂肪储存激素”，当组织细胞对其产生抵抗，整个营养转运系统就会陷入病态循环。 - **超重肥胖率**：美国成年人中有超过 68%（约 70%）的人患有肥胖或超重。 - **激素水平骤变**：脂肪刚开始超标蓄积时，甚至在器官出现病理改变前，血液中的胰岛素水平就会暴增接近 100%（翻倍）。 - **敏感性断崖式下跌**：在肥胖形成的早期阶段，机体的胰岛素敏感性即已降低约 34% 至 35%。 --- ### [06:32](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=392s) 人体恒温器：胰岛素与一茶匙血糖的生命平衡 为了让非专业听众理解这一复杂系统，Steven 打了个比方：“胰岛素就像是网约车 Uber，把血液里的乘客运送到它们该去的地方。”Koutnik 博士对此给出了更精准的隐喻：胰岛素其实是维持人体血糖稳态的“恒温器”。当餐后血糖上升时，胰岛素就像恒温器启动冷气一样，由胰岛 Beta 细胞紧急分泌，促使多余糖分进入细胞，将血糖压回安全区间；而当血糖回落，Beta 细胞便停止分泌胰岛素。 Koutnik 博士强调了一个令人震撼的人体生理事实：在健康成年人的整整几升循环血液中，维持生命正常运转所必需的葡萄糖总量其实仅仅只有“一茶匙”（大约 4-5 克）。这微量的一茶匙糖构成了生死攸关的平衡木——稍微超标就会日积月累地腐蚀微血管和内脏器官，引发不可逆损伤；而一旦过低，则会迅速诱发低血糖休克，直接危及生命。为此，人体演化出了极其严密的调控回路来守卫这一极其狭窄的生理窗口。然而，一旦掌控这套系统的核心分子（胰岛素）彻底失联，人体就会直面灾难。 --- ### [07:27](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=447s) 行走的“人造胰腺”：双设备监测与现代技术的局限 作为一名 1 型糖尿病患者，Koutnik 博士向观众展示了他身上全天候佩戴的两台维持生命的电子设备。他的手臂上贴着一个 24 小时运转的连续胰岛素泵（Insulin Pump）。因为他的自身免疫系统早已摧毁了体内的胰岛细胞，身体彻底丧失了分泌胰岛素的能力，这个外挂装置本质上就是一台“打包在手臂上的机械胰腺”，时刻根据需求向体内微量泵入人造胰岛素。 与此同时，他的腹部佩戴着另一个圆形感应装置——连续血糖监测仪（CGM）。两个传感器实时无线联动到他面前的手机屏幕上。Koutnik 博士向现场展示了即时读数： - 屏幕上有一条绿色曲线代表组织间液葡萄糖浓度，当时读数为 109 mg/dL（毫克/分升）。他解释道，传感器测量的虽然是组织间液（Interstitial Fluid，即组织细胞间隙的液体），但它高度精准地映射了血管内的真实血糖水平。医学上公认的正常血糖波动区间在 70 至 120 mg/dL 之间。 - 在绿色曲线下方，排列着方形与三角形组成的蓝色标识，记录着胰岛素泵执行微量注射的动态节点。 尽管这两台仪器代表了当今全球民用医疗科技的最高水准，Koutnik 博士依然直言不讳地指出：“它们绝非完美，依然存在极其显著的局限性。”即便借助最先进的闭环算法，外源输入的机械调控也永远无法完全复刻天然生物胰腺那种以秒为单位的灵敏感应与精妙平衡。这一残酷现实，正是驱使他从饮食根源寻找终极解法、深入探寻长期高血糖与慢性病底层因果链条的根本动力。 ### [09:34](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=574s) 血糖控制是健康金字塔的顶峰 当人们试图改善整体健康时，必须理清健康的优先级——在各项指标中究竟什么排在第一位。审视未来疾病的风险因素可以发现，无论在全美还是全球大部分地区，心血管疾病始终是头号死因；而在糖尿病人群中，心血管疾病同样高居致死率榜首。在预测心血管疾病发病可能性的所有生物标志物中，糖化血红蛋白（HbA1c）位列首位。HbA1c 反映的是过去两到三个月内血液中葡萄糖的平均浓度，它对未来是否会发生视网膜病变、肾脏疾病以及心血管疾病具有极其强大的预测能力。 因此在攻克这些最常见的慢性疾病时，血糖控制始终处于健康金字塔的最高顶峰。Dr. Andrew Koutnik 形象地比喻道：如果不控制好血糖，就如同开着一辆没有发动机、连底盘和车轴都没有的汽车，车主却还在纠结应该换什么样的轮毂或者音响系统。如果最核心的引擎根本运转不了，关注那些外在的细枝末节毫无意义。而在糖尿病等严重影响代谢的疾病中，这个决定生死存亡的“引擎”就是 HbA1c。 - **核心健康指标**：HbA1c 反映过去 2-3 个月的平均血糖水平，是预测心血管疾病、视网膜病变和肾脏疾病最强力的单一指标。 - **生动比喻**：忽视血糖控制而只关注其他养生细节，等同于“车子没有发动机和底盘，却在挑选轮毂与音响”。 --- ### [11:10](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=670s) 碳水化合物的作用与生酮饮食的历史传承 面对“控制血糖是否就意味着少吃糖”的疑问，Dr. Andrew Koutnik 从科学机理层面做出了解析。科学证据明确表明，在日常饮食中，碳水化合物是每餐饭后促使血糖飙升的最强驱动因素。鉴于绝大多数人一天要吃三到四餐甚至更多，调整食物结构自然成为最合乎逻辑的第一步。食物深刻决定了血糖起伏，而血糖的稳定性又决定了当下与未来的长期健康。 然而，通过营养干预逆转疾病并非现代人的发明。早在两百多年前，医学界就已发现大幅减少食物中的碳水化合物能够挽救患者生命。已知最早的临床报告记录于 1796 年，医生约翰·罗洛（John Rollo）发表了两例通过低碳水饮食缓解糖尿病（Diabetes Mellitus）病情的案例。在随后的一个多世纪里，顶尖的糖尿病治疗专家们一直采用低碳策略。直到 1921 年，科学家进一步发现这种饮食方案还能有效改善癫痫等神经系统疾病。公众今天看似狂热追逐的生酮趋势，本质上是现代科学在重新验证并挖掘数个世纪前的医学智慧。 - **1796 年**：医生约翰·罗洛（John Rollo）首次发表报告，使用低碳水化合物饮食治疗并缓解了两例糖尿病。 - **1921 年**：医学界发现极低碳水化合物饮食能有效控制癫痫发作等神经系统疾病。 --- ### [13:20](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=800s) 什么是真正合理的生酮饮食及其生理机制 许多人对生酮饮食存在极大误解，往往以为它就是无节制地大吃牛排和培根。Dr. Andrew Koutnik 澄清，一套配比科学合理的生酮饮食（Well-formulated Ketogenic Diet）其实包含了大量与传统健康理念相符的食材： 1. **富含膳食纤维与植物营养素的绿叶蔬菜**：如羽衣甘蓝、沙拉菜、西兰花、芦笋、花椰菜等高营养密度的蔬菜。 2. **优质蛋白质**：来源于肉类、三文鱼等深海鱼类、鸡蛋、奶酪以及少量的坚果。 3. **健康脂肪**：主要来自橄榄油、牛油果油等植物类优质油脂。 这种饮食从餐盘中彻底剔除的是高糖、高淀粉的精制碳水化合物，包括贝果、甜甜圈、白米饭和意面等。剔除它们的核心原因在于：高碳水食物会使血糖急速飙升，从而刺激胰岛素大量分泌；而高浓度的胰岛素会直接阻断体内脂肪的分解，让脂肪无法输送到肝脏。由于长链脂肪酸无法直接穿透血脑屏障，当人体通过限制碳水化合物摄入使血糖下降、胰岛素水平降低时，肝脏便会启动一套精密的生化转化机制，把分解出的脂肪转化为能够穿透血脑屏障为大脑供能的酮体。 ```mermaid flowchart TD accTitle: 生酮状态的代谢转化路径 accDescr: 展示限制碳水化合物后如何引发低胰岛素水平、脂肪分解以及肝脏产生酮体供脑使用的生化过程 subgraph INTAKE["饮食干预"] A["剔除高糖/高淀粉碳水化合物"] end subgraph HORMONAL["激素与血糖反应"] B["血糖水平降低且趋于平稳"] C["胰岛素分泌大幅下降"] end subgraph METABOLISM["脂肪代谢与产酮"] D["解除脂肪分解抑制<br/>脂肪组织释放游离脂肪酸"] E["肝脏启动生酮通路<br/>转化为酮体 (Ketone Bodies)"] F["酮体穿透血脑屏障<br/>成为大脑与身体的核心燃料"] end A --> B B --> C C --> D D --> E E --> F ``` --- ### [16:02](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=962s) 进化的生存智慧与断食治疗的历史 人类机体产生酮体的能力深深植根于进化机制。远古时期的人类不可能生活在当今这种食物全天候唾手可得的环境中，而是经历着食物极度匮乏与偶尔丰沛交替的周期性循环。如果在两餐之间缺乏食物时人类只能依赖碳水化合物代谢，那么人类在野外挨不过几天就会因能量枯竭而灭绝。正是这种在碳水化合物代谢与脂肪代谢之间自如切换的“代谢灵活性”，让体内储存的几个月脂肪储备能够转化为源源不断的能量，成为人类抵御饥荒的最强生存武器。 从古至今，完全断食一直被赋予“治愈”的意义，甚至在各类古老宗教典籍中都有通过禁食缓解惊厥抽搐等疾病的记录。现代医学证实，完全断食会诱发身体进入深度酮症状态。1921 年梅奥诊所（Mayo Clinic）发现生酮饮食可以在不忍饥挨饿的情况下模拟断食的生理状态，成功抑制儿童癫痫的发作。此后约翰斯·霍普金斯大学等权威机构进行了大量后续研究，进一步证实生酮不仅对神经系统紊乱有效，在肥胖症、1 型糖尿病及 2 型糖尿病的代谢管理中同样拥有数百年反复验证的医学价值。 - **进化生存法则**：人类体内储存的脂肪能量可供维持数月生存，生酮机制是人类祖先度过长期饥荒的核心生理屏障。 - **临床传承**：从古籍中的断食疗法，到 1920 年代梅奥诊所用生酮饮食模拟断食治疗小儿癫痫，再到约翰斯·霍普金斯大学的机制研究，形成了完整的科研证据链。 --- ### [18:18](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1098s) 为什么生酮状态能带来极高的专注力与大脑清晰度 主持人 Steven Bartlett 谈及自己的切身体会：作为一名需要长时间持续高强度对话的播客主持人，他和著名播客主乔·罗根（Joe Rogan）都有同样的体验——思维敏锐度与语言表达的流畅度，会随着血液中酮体水平的波动而产生极其显著的变化。在生酮状态或摄入外源性酮体（Exogenous Ketones）时，头脑会异常清醒专注，而一旦回到高碳水为主的西方传统饮食，这种持久的思维敏捷性便大打折扣。 Dr. Andrew Koutnik 指出，普通人如果像 1 型糖尿病患者那样拥有实时监测血糖的工具和视角，就能立刻看透背后的原因。在常规高碳水饮食下，人体血糖经历的是无休止的“剧烈飙升与断崖下跌”。高血糖（Hyperglycemia）和低血糖（Hypoglycemia）的典型临床症状在网上一查便知：严重的疲劳迟钝、易怒烦躁、注意力无法集中、身体发抖等。正是这种像过山车般的血糖震荡，直接破坏了大脑的能量稳定供给，引发精神状态与精力的剧烈起伏；而生酮状态提供的稳定供能，彻底摆脱了这种代谢过山车的负面干扰。 ### [19:52](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1192s) 水果并非人人皆宜：多糖、胰岛素负担与代谢脆弱性 在日常认知中，新鲜水果几乎是“健康饮食”的代名词，然而对于人体的代谢系统而言，其生化本质却复杂得多。当被问及吃下一个橙子或橘子后体内究竟会发生什么时，安德鲁·库特尼克博士（Dr. Andrew Koutnik）解释道，水果并非单纯的糖水混合物，它具有实体质量与纤维骨架，其中的糖分是以大分子多糖（polysaccharides）的形式结合在一起的。当人们咀嚼吞咽后，肠道系统必须将这些复合糖链逐级水解、拆解为单个葡萄糖分子，随后吸收入血。血液中血糖水平的急剧上升，会立刻触发胰腺分泌胰岛素，把葡萄糖运送到骨骼肌和肝脏等组织中储存，以备日后能量所需。 这意味着，哪怕是公认健康的天然水果，抑或是米饭、意面等优质碳水化合物，都会带来显著的血糖波动，并伴随着巨大的“胰岛素负荷”。摄入的橙子越多，身体为了维持血糖稳态所需的胰岛素剂量就越惊人。库特尼克博士特别强调，尽管公众普遍将这类食物奉为圭臬，但对于已经存在代谢障碍或代谢功能受损的人群（例如 1 型糖尿病患者）而言，他们的身体根本无法承受这种代谢负荷，哪怕面对常规意义上的“健康食品”，也会表现出极高的生理脆弱性。 ```mermaid flowchart TD accTitle: 碳水化合物消化与血糖负荷代谢通路 accDescr: 展示了从摄入富含多糖的水果到肠道水解、血糖升高、胰岛素分泌及不同人群代谢差异的生化过程。 subgraph Digestion["消化吸收阶段"] A["摄入多糖食物 (如橙子/米面)"] --> B["肠道酶解拆分为单个葡萄糖分子"] B --> C["葡萄糖迅速吸收入血"] end subgraph Response["代谢调节与储存"] C --> D["触发高胰岛素分泌负荷"] D --> E["将葡萄糖转运至肌肉与肝脏储存"] end subgraph Divergence["健康差异与后果"] E --> F["健康代谢人群: 维持相对稳态"] E --> G["代谢功能受损/1型糖尿病: 血糖剧烈波动、器官受损"] end ``` --- ### [21:29](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1289s) 现场实测挑战：吃下三个“超级食物”橙子 为了向观众直观展示碳水化合物对人体的真实冲击，库特尼克博士在录制现场破天荒地接受了一项挑战——当场吃下三个橙子。他坦言自己平时绝不会这么做，但为了让那些罹患慢性病的普通人以及患有糖尿病的患儿家庭看清真相，这场现场实测至关重要。讽刺的是，柑橘类水果甚至被美国糖尿病协会（ADA）和美国农业部（USDA）等权威机构列为极力推荐的“超级食物”。 在具体数据层面上，三个普通大小的橙子大约含有 70 到 90 克净碳水化合物。库特尼克博士依据自身的体能活动水平计算，自己每日大约需要消耗 3000 大卡的热量；如果按照 USDA 膳食指南建议的 55% 能量来自碳水化合物来执行，平摊在每天的四餐中，他每餐所需摄入的碳水甚至会显著超过这三个橙子的量。通过在镜头前佩戴的连续血糖监测设备，这顿相当于普通标准膳食单餐碳水用量（约占其全天推荐量五分之一）的“健康水果餐”，将成为检验人体血糖与胰岛素应激的活生生标本。 - **三个橙子的碳水含量**：约 70–90 克碳水化合物。 - **每日热量与官方指南**：按 3000 大卡日消耗计算，若遵循 USDA 推荐的 55% 碳水供能比，单餐所需碳水摄入远超 3 个橙子。 - **实验目的**：揭示被官方机构认证的“超级食物”如何在短时间内直接拉高血糖水平并迫使机体大量追加胰岛素。 --- ### [23:18](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1398s) 碳水阈值、浆果优势与食品工业的“净碳水”骗局 对话随即切入生酮饮食（Ketogenic Diet）的摄入红线。医学界通常将每天 50 克碳水化合物视为进入生酮状态的大致安全阈值，之所以设定在这个数字，是因为它能确保绝大多数人的体内胰岛素降到足够低的基线水平，从而促使肝脏启动脂肪酸氧化并产生酮体。当然，这个临界值因人而异，具体取决于个体的体重、肌肉量以及原本的胰岛素敏感度。谈到水果选择时，主持人斯蒂芬·巴特利特提到自己平时尽量远离水果，但会吃一些黑莓、覆盆子等浆果。库特尼克博士指出，高纤维、富含多酚的浆果确实完全契合生酮饮食，因为起决定性作用的是“净碳水化合物”（总碳水减去不可消化的膳食纤维），这才是真正对身体产生血糖与代谢冲击的有效成分。 紧接着，两人对当下超市货架上的“低碳概念商品”展开了尖锐的批判。巴特利特愤慨地指出，很多标榜“净碳水仅 1 克”的所谓生酮友好零食，翻开成分表一看总碳水居然高达 20 克，简直是“彻头彻尾的胡扯”。库特尼克博士对此百分之百认同，并指出这正是食品工业蓄意操纵的把戏： - **成分表造假与替代套路**：食品巨头雇佣顶尖食品科学家，利用法规漏洞将砂糖替换为麦芽糖醇（Maltitol）、麦芽糊精（Maltodextrin）等具有完全相同代谢危害、能让血糖暴涨的原料，转头却在包装正面印上大号加粗的“零添加糖（Zero Sugar）”和“生酮友好（Keto Friendly）”。 - **认知门槛异化**：现代普通人去一趟杂货店采购，几乎需要拥有生物化学或营养学博士学位才能看穿成分标签背后的猫腻。 - **同标不同质**：两款标注同样热量、脂肪、蛋白质甚至纤维含量的“生酮食品”，进入体内后诱发的真实代谢反应可能天差地别。 --- ### [25:56](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1556s) 十年生酮历程：让权威医生震惊的医学奇迹 谈及自身经历，库特尼克博士回顾了自己在确诊 1 型糖尿病后十余年间探索生酮饮食的心路历程。当时连续血糖监测仪（CGM）尚未普及，他不得不每天用采血针扎破手指 6 到 10 次来监测血糖走势。当他彻底转向生酮饮食后，奇迹发生了：他的血糖指标几乎全天候稳定在正常生理区间内，彻底摆脱了此前忽高忽低的剧烈过山车反应；更令人震惊的是，他每日的外源胰岛素需求量骤降了 40% 以上。 这一结果甚至颠覆了当时美国顶级内分泌专家的认知。当库特尼克前往诊所复查时，他的主治医生——恰好兼任时任美国糖尿病协会（ADA）主席——看着检测单惊呼道："我这辈子从未在任何一个 1 型糖尿病患者身上，看到过完全处于正常范围内的血糖水平！你到底做了什么？" 这一刻促使库特尼克下定决心将余生奉献给代谢健康研究。在此之前，改良营养帮他摆脱了肥胖，而如今，这一饮食策略更成为了抗击绝症的核心武器。 - **胰岛素用量断崖式下降**：转型生酮饮食后，外源性胰岛素需求立刻减少超过 40%。 - **终结血糖过山车**：告别严重的低血糖昏厥与高血糖眩晕风险，血糖常年锚定在非糖尿病人群的健康基线。 - **打破医学教条**：令时任 ADA 主席公开承认临床罕见，证实了严控碳水在自身免疫性糖尿病管理中的决定性力量。 --- ### [27:48](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1668s) 常规疗法的盲区：高血糖正在暗中摧毁患儿的大脑与血管 库特尼克博士进而揭露了当前 1 型糖尿病标准医疗护理模式（Standard of Care）背后的残酷现实。在现行医疗指南的指导下，几乎所有患者都被告知可以照常摄入碳水化合物、只需注射相应剂量的胰岛素即可。然而临床统计表明： 1. **99% 的患者终其一生都无法恢复正常的代谢控制**，必须终身忍受高波动性血糖的折磨； 2. **100% 的患者预计最终都会并发严重的胰岛素抵抗**。 这种慢性高血糖状态对年幼患者的机体摧残尤为触目惊心： - **大脑结构性萎缩与发育畸变**：脑部核磁共振（MRI）扫描显示，确诊后短短 **3 年之内**，血糖控制不佳的患儿大脑白质与灰质分布就发生了显著病理改变。负责儿童大脑正常认知与神经发育的核心脑区生长轨迹发生异化，这种脑解剖学损伤与长期较差的血糖控制直接挂钩。 - **动脉粥样硬化与血管硬化病变**：心血管疾病是全球人类的头号杀手，而其最早期的病理萌芽在患儿确诊后仅仅 **4 年之内** 就会暴露无遗。原本健康、富有弹性、能像平滑波浪般舒缩的健康血管，由于长期高血糖浸润，血管壁周围开始沉积越来越多的胶原蛋白，导致管壁迅速纤维化、彻底失去弹性并陷入病理性僵硬（arterial stiffness）。 库特尼克博士用了一个生动的比喻来形容这种血管硬化过程：就像拿着一根通水的水管，当你用力捏紧并收缩管径时，水流在管内的喷射冲力与流速就会骤然飙升。通过测定脉搏波传导速度，医生可以清晰监测到这些原本年轻的孩子，其血管是如何在遵循所谓“标准医嘱”的过程中一步步硬化并迈向心脑血管堵塞的深渊。 ### [29:38](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1778s) 血管损伤的早期信号：切应力、一氧化氮与并发症的倒计时 在斑块形成或血管真正发生堵塞的数十年之前，血管功能就已经开始出现病变，而这些变化往往早在童年时期就已悄然发生。对于那些在 10 到 14 岁被确诊为 1 型糖尿病的青少年来说，他们的血管极早就丧失了对所谓“切应力”（Shear Stress）做出正常响应的能力。当人开始跑步运动时，心率攀升，血流速度加快，对血管壁产生的压力随之增加。在健康状态下，这种血流冲击产生的切应力并非坏事，它是身体释放一氧化氮（Nitric Oxide）的关键生理信号。一氧化氮是一种强效血管舒张剂，能促使血管扩张以应对血流压力。然而在 1 型糖尿病患者体内，早期合成一氧化氮的能力便显著受损，血管不仅逐渐硬化，还失去了随负荷扩张的代偿机制，这成为了动脉粥样硬化进展的最早预警信号。 长期处于高血糖和剧烈血糖波动的状态，会带来不可逆的器质性病变。过去临床上普遍认为，几乎所有 1 型糖尿病患者在确诊后 20 年内都会出现某种程度的视网膜病变（Retinopathy），导致视力受损甚至失明。这意味着一个在 10 至 14 岁发病的孩子，到了 30 至 34 岁正值壮年时，就可能面临视力退化甚至失明的残酷现实。即便随着现代医学的发展这一时间线有所拉长，但如果仅仅遵循现行的标准治疗建议，患者在一生中几乎必然会遭遇至少一种严重并发症。没有任何一种现有的药物或技术能够彻底逆转这一疾病。高血糖及其伴随的胰岛素抵抗对身体的伤害是“累积性的、剂量依赖性的，且无法完全逆转的”。一旦确诊，生命的倒计时便已开启，正如吸烟一样，暴露的时间越早、越久，失去的寿命和健康的代价就越惨重。 ```mermaid flowchart TD accTitle: 正常与糖尿病状态下的血管切应力响应对比 accDescr: 对比健康血管与糖尿病受损血管在血流切应力刺激下不同的生理反应路径。 subgraph Normal["正常生理响应"] A1["运动 / 心率上升"] --> B1["血流加速并产生切应力"] B1 --> C1["血管内皮释放一氧化氮 (NO)"] C1 --> D1["血管舒张，顺畅适应负荷"] end subgraph Diabetic["1 型糖尿病病理改变"] A2["长期高血糖 / 血糖波动"] --> B2["一氧化氮合成能力受损"] B2 --> C2["血管弹性下降、硬化"] C2 --> D2["微血管病变 / 视网膜病变等并发症"] end ``` - **儿童与青少年期病变**：许多在 10–14 岁确诊 1 型糖尿病的患者，血管内皮功能障碍在诊断初期即已出现，早于肉眼可见的血管斑块数十年。 - **不可逆的累积伤害**：血糖波动对血管内皮的破坏具有剂量累积效应，单纯依靠现有的胰岛素泵或监测设备，仍无法消除并发症隐患。 --- ### [32:51](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1971s) 治疗性碳水化合物限制与全美代谢危机 当提到一项发表在营养学期刊上、包含 326 名参与者并证实生酮饮食能显著提升糖尿病患者“血糖控制能力”的研究时，其核心机制其实非常直观。所谓血糖控制，是指评估患者在 24 小时乃至数天周期内，循环系统中的血糖浓度维持在健康正常范围内的稳定程度。在日常生活中，饮食中摄入的碳水化合物是升血糖作用最强的物质。通过极大地减少碳水化合物摄入，直接切断了引发血糖大幅飙升和剧烈波动的诱因，血糖水平自然能够维持在平稳区间。 面对主持人的提问——是否所有人都要像妖魔化糖分一样去严格限制碳水，专业建议是保持高度的“膳食自觉”。针对已经患有慢性代谢疾病的庞大人群，限制碳水化合物具有极强的临床干预价值，这一策略更准确地应被称为“治疗性碳水化合物限制”（Therapeutic Carbohydrate Restriction）。美国糖尿病协会（ADA）在 2019 年的共识报告中，已将极低碳水化合物饮食列为控制 2 型糖尿病证据最充分的营养干预策略之一，且该策略在改善阿尔茨海默病等神经退行性疾病方面也展现出巨大潜力。绝大多数人采取低碳水或生酮饮食可能只是为了减重或获得更清晰的大脑状态，但对于代谢受损者而言，它的治疗意义更为深远。多项权威研究揭示，目前约有 93% 的美国人在代谢层面上处于不健康或异常状态，代谢机能紊乱已成为一种极度普遍的现代流行病。 - **核心定义**：血糖控制（Glycemic Control）指的是全天候将循环系统内的葡萄糖水平精确平稳地限制在正常生理区间内。 - **权威指南背书**：美国糖尿病协会（ADA）2019 年共识明确指出，限制碳水化合物是改善 2 型糖尿病最有实证依据的营养学手段。 - **代谢健康现状**：多项流行病学数据表明，高达 93% 的美国成年人存在至少一项代谢异常指标。 --- ### [35:19](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2119s) 破除胆固醇迷思：长达十年的生酮个案与四万六千人研究 关于生酮饮食，医学界长期存在一个核心担忧：高饱和脂肪（源自动物蛋白、椰子油等）的摄入往往会导致低密度脂蛋白胆固醇（LDL-C）上升，从而在理论上增加心血管疾病的风险。为了验证这种假说，一项长达 10 年的前瞻性个案研究得以展开。该研究严密追踪了一位 1 型糖尿病患者：该患者确诊后曾严格遵循了 6 年美国糖尿病协会推荐的标准健康饮食，随后在 2013 年转为生酮饮食。在接下来的整整 10 年里，研究人员通过连续的骨密度与身体成分扫描（DEXA）、严格的热量与营养控制，并在患者不依赖其他额外药物的情况下，长期监测其心血管与代谢指标。 检测结果极具颠覆性：尽管该患者在转为生酮饮食后，体内的 LDL 胆固醇水平几乎翻倍——在传统医学观点中这代表着心血管风险的急剧恶化——但先进的心血管深度评估却显示，其血管壁没有任何心血管疾病的病变迹象。相反，患者的血糖控制完全正常化，每日外源胰岛素需求量骤降超过 40%，其整体心血管健康指标不仅远优于同年龄、同性别的 1 型糖尿病患者，甚至在几乎所有检测维度上都优于没有糖尿病的普通健康人。这一发现有力地挑战了单纯以 LDL 数值作为心血管风险唯一决定因素的传统教条。在此基础上，研究团队进一步开展了涉及超过 46,000 名 1 型糖尿病患者的大规模分析，结果表明，在采用极低碳水化合物生酮饮食的记录中，有超过 70% 的患者成功将血糖控制恢复至完全正常水平，彻底逆转了这一最具破坏性的致病风险。 | 临床分类指标 | 糖化血红蛋白 (HbA1c) 判定标准 | |:--- |:--- | | **正常代谢 (Normal)** | **< 5.7%** | | **糖尿病前期 (Pre-diabetic)** | **5.7% – 6.4%** | | **糖尿病 (Diabetic)** | **≥ 6.5%（上不封顶）** | - **十年个案关键数据**： - LDL 胆固醇：指标接近翻倍，但血管造影与高级心血管评估显示动脉完全健康、无斑块累积。 - 胰岛素负荷：每日外源性胰岛素使用量减少达 40% 以上。 - 综合心血管状态：超越同龄非糖尿病健康对照组。 - **大样本临床证据**：在针对 4.6 万余名患者的大型营养分析中，极低碳水化合物生酮饮食帮助超过 70% 的病例实现了血糖控制的彻底正常化。 --- ### [38:39](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2319s) 现场实测：所谓的“超级食物”如何引发血糖骤升 在节目录制现场，实时血糖监测仪器清晰地记录下了嘉宾血液中葡萄糖的剧烈变化。此前他的基线空腹血糖平稳地维持在约 100 mg/dL（这是正常生理范围的临界水平）。但在摄入了少量橙子后，血糖曲线开始急剧拉升。这一现象生动地展现了营养学中的误区：橙子虽然被广泛誉为柑橘类水果典范，甚至在某些糖尿病膳食建议中被奉为“超级食物”，但即使只摄入了推荐摄入量五分之一的碳水化合物，也会对血糖造成强烈的冲击。 从食物被摄入、在消化道中分解为葡萄糖进入血液循环，再渗透到细胞间质液（Interstitial Fluid）中被连续血糖监测仪探针感知，整个过程呈现出明显的时滞性与上升脉冲。当这一峰值骤然升起时，人体会经历快速的代谢负荷；而对于代谢完全健康的人群来说，理想的生理反应是胰岛素迅速分泌，使血糖在轻微升高后平缓回落至正常水平。然而，当大量摄入快速吸收的碳水化合物时，随之而来的往往是胰岛素过量分泌导致的血糖骤降（Reactive Hypoglycemia），不仅会跌落到原本的 100 mg/dL 基线以下，还会引发疲惫、脑雾与强烈的饥饿感。现场的动态变化直观证明了：即便来自天然的水果糖分，也足以掀起剧烈的代谢波澜。 ### [40:09](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2409s) 血糖峰值、胰岛素应激与身心崩溃的恶性循环 在展示的实时监测图表上，可以清晰地看到进食后的生理反应过程。Dr. Andrew Koutnik 解释道，随着食物中的碳水化合物转化为葡萄糖涌入血液，血糖水平迅速蹿升，而他佩戴的胰岛素泵（Omnipod）便会立刻进入应急状态，迅速注入胰岛素以试图将血糖拉回正常范围（通常为 70 至 120 mg/dL）。屏幕上蓝色的胰岛素激增曲线，正是普通健康人群在进食后体内自然发生的生理机制，只是绝大多数人无法肉眼监测到这一剧烈波动。 ```mermaid flowchart TD accTitle: 高碳水饮食引发的血糖与胰岛素过山车 accDescr: 展示从摄入葡萄糖到血糖飙升、胰岛素过度分泌，最终导致反应性低血糖和渴望碳水的完整恶性循环机制。 subgraph Phase1["第一阶段：血糖峰值与高糖应激"] A["摄入高碳水食物"] --> B["血糖急速飙升（>180 mg/dL）"] B --> C["高血糖症状：口渴、脑雾、疲惫、视物模糊、易怒"] C --> D["触发全身氧化应激与神经组织炎症"] end subgraph Phase2["第二阶段：胰岛素过冲与崩溃"] B --> E["胰岛素暴增（胰腺过度分泌）"] E --> F["反应性低血糖（血糖骤降 / Sugar Crash）"] F --> G["低血糖症状：发抖、心慌、极度饥饿、焦虑虚弱"] G --> H["迫切渴望摄入糖分与碳水化合物"] H -.->|"重新进食"| A end ``` 当被问及处于血糖峰值时人体究竟会有何感受时，Dr. Koutnik 坦言，就他个人而言，极高的血糖会让他注意力急剧涣散、陷入深度疲劳，甚至据他妻子观察还会变得异常烦躁易怒。Steven 现场查阅医学资料后补充，高血糖典型的即刻症状包括极度口渴、口干、尿频、头痛、脑雾、全身乏力、动作迟缓以及视力模糊。 Dr. Koutnik 用了一个生动的隐喻来描绘这种状态：就像原本置身于晴空万里、阳光明媚的户外，正与朋友愉快交谈，突然之间乌云压顶、狂风骤雨袭来，人群四散奔逃。当血糖超过 180 mg/dL 时，它会直接冲击大脑神经生物学功能，诱发全身氧化应激与组织炎性损伤。更为可怕的是，现代社会中大量人群一天 24 小时、一周 7 天都身处这种高血糖应激状态之中。 随着胰岛素过度分泌以应对飙升的血糖，往往会发生“胰岛素过冲”（Insulin overshoot），导致血糖在急剧攀升后经历悬崖式骤降，诱发反应性低血糖（Reactive Hypoglycemia），即通俗所说的“糖崩”（Sugar Crash）。在此阶段，人会感到身体发抖发颤、心慌心悸、虚弱无力，并产生强烈的食欲，极度渴望再次摄入精制碳水和糖，从而陷入难以自拔的恶性循环。 ### [43:13](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2593s) 赞助商插播：Replit AI 在进入运动表现的研究前，节目插播了赞助商 Replit 的广告。Steven Bartlett 讲述了自己首次使用 Replit 时的震撼体验，他甚至为此熬夜研究到凌晨 3 点。Replit 是一款强大的 AI 平台，允许用户仅凭日常自然语言在几分钟内构建出真实可运行的应用程序。Steven 分享道，他曾通过让 AI 智能体根据自己的个人习惯定制了一款待办事项清单（To-do list），未写一行代码就完成了全套开发，该应用至今仍是他日常工作的主力工具。 - 零编程基础：直接用日常自然语言描述需求，由 AI 自动化编写并部署。 - 全栈整合：支持无缝对接 Stripe 支付体系、OpenAI 服务，且内置数据库与用户身份验证功能。 - 专属优惠：访问 replet.com 输入专属兑换码“STEVEN”，可享首月 Core 方案五折优惠（50% off）。 ### [44:21](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2661s) 生酮饮食与运动表现：颠覆百年“碳水神话”的历史溯源 关于生酮饮食在医学上的诸多益处虽已有上百年的记录，但在临床与健身领域中，阻碍人们尝试的最大绊脚石往往是根深蒂固的传统观念——“限制碳水会直接摧毁运动机能”。为了探究真相，Dr. Koutnik 梳理了运动营养学百年来围绕碳水化合物建立的科学脉络： - **1921–1925 年（波士顿马拉松研究）**：哈佛大学及波士顿的医生观察到，半数未完赛的马拉松选手面色苍白、言语不清、身体颤抖甚至直接昏迷。验血证实他们陷入了极其严重的“低血糖症”（Hypoglycemia）。次年，研究团队在比赛期间为选手补充碳水化合物，全员运动表现均显著提升，由此正式确立了碳水提升运动表现的理论基石。 - **1960 年代（Bergström 肌肉活检技术）**：研究人员利用 Bergström 穿刺针从活体肌肉中提取样本，惊喜地发现肌纤维内大量储存着葡萄糖（肌糖原，Glycogen）。科学家由此推导：既然运动做功的肌肉组织内储有糖原，那么糖原消耗殆尽（Low Glycogen）必然是导致运动疲劳的根本元凶。 - **1980 年代（能量底物代谢测定）**：测定高强度运动中机体燃烧糖分与脂肪比例的技术诞生，数据显示运动员维持高强度运动的能力似乎与其碳水化合物的氧化速率完全成正比。 - **2017–2020 年（早先生酮短期研究的误区）**：数项探究生酮饮食对耐力表现影响的经典研究设定了 5 天至 3 周的干预周期，最终无一例外得出“生酮饮食会导致高强度耐力表现下降约 2%”的结论，促使学术界一度盖棺定论。 Dr. Koutnik 一针见血地指出，早先这些研究存在一个致命的混杂因素——**适应期严重不足**。机体从依赖葡萄糖氧化转变为高效利用酮体和脂肪供能的“生酮适应”（Keto-adaptation），根本无法在一周、两周甚至三周内完成，生理学上完整的代谢重塑至少需要 4 周或更长时间。那些研究仅仅记录了代谢过渡期身体遭遇的不良反应，而非生酮完全适应后的真实机能。 ### [49:09](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2949s) 4周生酮适应：高强度无氧冲刺表现未现衰退 针对以往研究周期太短、变量失控的弊端，Dr. Koutnik 团队开展了一项控制极度严苛的交叉对照研究。为了彻底消除过往文献中未被控制的变量干扰，他们对受试运动员的卡路里摄入、身体成分（肌肉与体脂）、每日运动量乃至生活环境进行了全面标准化监控。由于研究采取自身交叉对照设计，受试者分别在不同时期执行高碳水饮食与严格生酮饮食，因而选手的基因体质差异也被完全消除。 研究团队直接选择了传统运动生理学公认极度依赖无氧糖酵解供能的高强度爆发项目：**6 组 800 米全力冲刺跑（6 x 800m sprints）**。受试运动员在严谨的随机化流程下，完成了从高碳水化合物饮食向严格生酮饮食的转换。 经过足足 4 周的充分生酮代谢适应后，测试结果颠覆了长期以来的运动生理学教条：在长达 4 周的生酮饮食后，运动员在极度依赖糖酵解的高强度冲刺跑中，**运动表现完全没有发生任何衰退**。这有力证明了经过充分的生理适应，机体在大幅上调脂肪酸氧化与酮体供能的同时，完全能够维持高强度的竞技运动表现。 ### [50:28](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3028s) 高强度运动下的极端脂肪氧化突破 当讨论生酮适应时，史蒂文·巴特利特（Steven Bartlett）好奇运动员在适应生酮饮食的前四周内，体能表现是否会遭遇滑坡。安德鲁·库特尼克博士（Dr. Andrew Koutnik）解释称，他们的研究重心专门聚焦在适应期结束后的最终节点，因为如果一个人选择践行生酮饮食，核心在于长期坚持后的生理质变。传统运动生理学一直认为，高强度爆发力运动极度依赖葡萄糖与碳水化合物供能；然而，当研究团队在受试者达到 85% 以上的最大摄氧量（VO2 max）这一极限强度下测量底物消耗时，结果彻底颠覆了既往认知。 通常情况下，在达到 85% VO2 max 的高负荷状态下，人体几乎不会氧化或燃烧脂肪，能量供应理应几乎百分之百来自碳水化合物。但测量数据表明，这些彻底适应生酮饮食的运动员展现出了科学文献中“有史以来记录到的最高水平运动脂肪燃烧率”。这一发现有力地证实，只要给予机体充足的时间进行生酮适应，即便在最剧烈、原本被认为必须依赖碳水化合物的极限运动中，脂肪依然能够充当极其强劲的高效燃料。 - **极限强度下的供能突破**：在超过 85% VO2 max 的高强度运动中，适应生酮的运动员刷新了文献记载的脂肪氧化峰值纪录，推翻了“高强度运动只能烧糖”的传统教条。 --- ### [52:09](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3129s) 外源性酮体的发展渊源与多维生理机制 史蒂文提起身边许多耐力运动员与自行车手都在热烈讨论“外源性酮体”（Exogenous Ketones），同时坦诚做出利益声明：自己作为一家外源性酮体公司的联合创始人，桌上正摆着这款产品。他提问，既然生酮饮食能让肝脏自主产生内源性酮体，为什么还需要外源性补充？库特尼克博士指出，生酮饮食需要数周的严苛适应期，而对于战地士兵或急需瞬间进入高能代谢状态的人群，等待四周并不现实。这就需要一种能在口服后数分钟内迅速推升血液循环中酮体浓度的分子，也就是外源性酮体。 外源性酮体的研究可追溯至 20 世纪 60 年代麻省理工学院（MIT）航空航天部门对 1,3-丁二醇（1,3-butanediol）的探索。2016 年，美国国防高级研究计划局（DARPA）更是豪掷 1000 万美元设立“代谢优化计划”，深入测试此类分子。外源性酮体进入人体后，能引发一系列极其迅速且强效的代谢调控： ```mermaid flowchart TD accTitle: 外源性酮体的生理代谢机制与通路 accDescr: 展示摄入外源性酮体后在体内激活的抗炎、降糖、表观遗传与神经保护通路 A["摄入外源性酮体<br/>(如 1,3-丁二醇衍生物)"] --> B["数分钟内血酮飙升"] subgraph Pathways ["核心生理与分子作用通路"] B --> C["迅速降低血糖水平"] B --> D["结合 GPR109A 受体<br/>抑制 NLRP3 炎症小体"] B --> E["表观遗传修饰<br/>增强内源抗氧化能力"] end subgraph Outcomes ["机能收益"] C --> F["平稳代谢与能量输出"] D --> G["系统性抗炎与组织修复"] E --> H["阻断氧化应激与损伤"] end ``` 这种分子在降低血糖的同时，能直接结合机体的 GPR109A 等受体，强力阻断导致全身炎症级联反应的关键分子——NLRP3 炎症小体；它还能作为表观遗传信号分子，改变基因表面的分子修饰，显著激活人体的抗氧化防御能力以抵御氧化应激。在针对阿尔茨海默病高危人群的一项为期 6 个月的临床试验中，外源性酮体成功延缓了认知能力的衰退。面对史蒂文的严谨追问，库特尼克确认，外源性酮体并非“彻底治愈”阿尔茨海默病，而是通过在衰老进程中截断或延缓脑功能的断崖式下滑，维持清晰的思维、阅读与解题能力。 - **军工级研发背景**：DARPA 斥资 1000 万美元资助代谢优化计划，旨在通过口服酮体让士兵在极端环境下瞬间切换代谢引擎并提升运动表现。 - **抗炎与表观遗传**：酮体不仅是能源分子，更是信号分子，能靶向阻断 NLRP3 炎症小体，并通过表观遗传途径激活内源性抗氧化基因。 - **延缓认知衰退**：在 6 个月的临床干预中，外源性酮体有效减缓了阿尔茨海默病风险患者的脑力衰退速度。 --- ### [56:27](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3387s) 脑网络稳定性与代谢精神病学的前沿突破 话题转向脑健康与精神医学，库特尼克博士指出，目前约有 11 项活跃的临床试验正聚焦于酮类疗法对严重精神疾病的干预效果。在当下的美国，超过四分之一的成年人患有严重心理或精神疾病，20% 以上的人在长期服用精神类药物。越来越多的科学证据表明，底层代谢紊乱正是精神疾病的核心诱因之一，而通过在超市调整购物篮中的食材来重构体内代谢，其展现出的治疗潜力丝毫不亚于药物和尖端医疗技术。 史蒂文随之援引了一篇发表于 2020 年的重磅神经科学研究：科研人员借助功能性磁共振成像（fMRI），测试了大脑在葡萄糖与外源性酮体这两种主要燃料驱动下的“脑网络稳定性”（Brain Network Stability）。扫描结果极其惊人：摄入外源性酮体后，大脑网络的稳定性比摄入葡萄糖后整整高出 87%，而葡萄糖反而降低了神经网络的稳态。论文摘要明确指出：“能够促进酮体利用的饮食干预措施增加了脑部可用能量，因此在保护大脑免受衰老损伤方面展现出巨大潜力。” - **代谢精神病学崛起**：研究发现基础代谢异常与精神健康高度相关，生酮饮食通过调节脑代谢为严重精神疾病提供了非药物治疗途径。 - **87% 的脑稳定性提升**：2020 年的神经影像学研究证实，相较于葡萄糖，外源性酮体使全脑网络稳定性骤增 87%，有效改善大脑能量匮乏状态。 --- ### [58:39](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3519s) 癌症恶病质中的肌肉保全与生酮增肌真相 库特尼克分享了自己在读博期间针对恶性转移性癌症的课题研究。在面对极为凶险的转移性肿瘤时，使用外源性酮体不仅延缓了癌细胞的扩散转移进程，更创造了另一个医学奇迹：显著遏制了癌症恶病质（Cachexia）引发的体重暴跌。恶病质是一种因疾病导致全身身体组织急剧消耗的重度消耗状态，在晚期癌症中最为致命。库特尼克通过成分分析发现，酮体阻断体重下滑的核心，在于其奇迹般地保全了骨骼肌质量。多项人体临床生理学研究进一步证实，外源性酮体能够显著抑制肌肉蛋白的分解代谢，是维护肌肉健康维度的强大生理保护剂。 听到这里，史蒂文道出了许多健身爱好者的顾虑：“如果我采用生酮饮食，还能增加肌肉量吗？”他笑着坦言，每当自己断绝碳水进入生酮状态，脂肪便飞速褪去，整个人变得极度精瘦、肌肉线条分明（Shredded），但他同时也担忧自己会变得过于瘦弱。库特尼克相视一笑，随即彻底打消了他的顾虑：生酮饮食绝不会引起肌肉萎缩，大量的严谨科研已证明生酮状态下不仅能维持肌肉，而且完全能够增肌。俄亥俄州立大学的杰夫·沃尔克（Jeff Volek）教授曾在军方资助的研究中证实，即使受试者处于严格的热量缺口饮食（Calorie Deficit）状态下，配合生酮饮食依然能够保持甚至构建高质量的肌肉组织。 - **逆转恶病质肌肉萎缩**：在晚期转移性癌症模型中，外源性酮体通过直接抑制肌组织分解代谢，强效阻止了恶病质引发的肌肉流失。 - **生酮增肌完全可行**：杰夫·沃尔克等学者的研究证明，在生酮饮食乃至热量受限状态下，机体依然具备保留并合成瘦体重的生理能力。 ### [01:01:06](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3666s) 生酮饮食对肌肉量与体内水分的影响 安德鲁·库特尼克博士（Dr. Andrew Koutnik）指出，相关研究已经表明，在热量受限（caloric restriction）或类似于半饥饿状态（semi-starvation state）下，采取生酮饮食的人能够像摄入高碳水化合物饮食的人一样维持肌肉量。换句话说，生酮饮食对肌肉量并没有负面影响。然而，针对史蒂文·巴特利特（Steven Bartlett）的切身经历，刚进入生酮饮食状态时，身体首先经历的是一种促尿钠排泄效应（natriuretic effect），也就是钠离子被排出体外。 随着钠排泄出来，身体所储存的水分也会减少。这就是为什么人们在最初进入生酮饮食时，体重会出现戏剧性的迅速下降。对于很多想要减肥的人来说，这种立竿见影的数字变化是一个极大的正面反馈；然而，减掉的很大一部分其实只是水重（water weight）。水同时存在于脂肪和肌肉组织当中，因此初期体重的下降并不意味着肌肉流失，而仅仅是体液含量的改变。在某些需要控制“功重比”（power-to-weight ratio）的竞技运动中，只要运动员能在更低的体重下保持同等力量输出，这种排水效应反而是非常有利的。 - 研究证实：在热量赤字状态下，生酮饮食与高碳饮食在维持瘦肌肉组织方面的效果相当。 - 初期体重骤降机制：生酮饮食具有利钠/促尿钠排泄特性，伴随水分流失而非真正的骨骼肌流失。 - 运动优势：对力量体重比有严格要求的运动项目而言，无损力量前提下的脱水减重往往是一大优势。 --- ### [01:02:27](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3747s) 生酮状态下的食欲抑制与“暴饮暴食”刹车机制 面对史蒂文关于增肌期如何保证体重增长的疑问，库特尼克博士强调，增肌的核心基石始终是刻苦的阻力训练（resistance exercise），饮食只是在此基础上放大效果。在营养层面，足量摄入蛋白质是增强肌肉合成最强有力的手段，其次是保证充足的总热量。如果处于热量赤字状态，人体不仅会减掉脂肪，往往也不可避免地会损失部分肌肉。 史蒂文坦言自己在生酮饮食期间极易陷入热量不足，因为他的食欲大幅衰退。服用 Ketone-IQ 等外源性酮体（exogenous ketones）时也会出现类似现象，有研究表明外源性酮体能使食欲下降约 20%。史蒂文分享了自己在开普敦闭关写书两周时的真实案例：私人厨师精心制作了令人垂涎的生酮美食，尽管他感觉很饿，但仅仅吃了五六口后饱腹感就骤然降临，完全吃不下了。这种身体机制让他彻底告别了以往常见的暴饮暴食。 ```mermaid flowchart TD accTitle: 生酮饮食调节食欲的双重机制 accDescr: 展示生酮饮食通过稳定代谢能量与规避加工食品双向降低食欲的逻辑图 subgraph Metabolic["代谢层面机制"] A["稳定且持续的能量供应"] --> B["规避血糖与胰岛素过山车"] B --> C["持续饱腹，消除异常饥饿"] end subgraph FoodChoice["食物选择机制"] D["杜绝超加工食品"] --> E["阻断高糖/高盐/高脂协同刺激"] E --> F["切断多巴胺驱动的超额进食循环"] end C & F --> G["自然恢复食欲调控，消除'食物噪音'"] ``` 库特尼克博士从两个维度解释了这一食欲骤降的现象： 1. **代谢与激素层面**：内分泌学家大卫·卢德维格（Dr. David Ludwig）在其著作《Always Hungry?》中提出了著名的碳水化合物-胰岛素模型（Carbohydrate-Insulin Model）。在高碳水饮食下，血糖和胰岛素频繁剧烈波动，引发突发性饥饿；而在生酮饮食下，血液中营养素供应平缓稳定，血糖与胰岛素维持低位平衡，杜绝了低血糖诱发的急性食欲失控。 2. **食物类型层面**：生酮饮食排除了驱动食欲暴走的超加工食品（ultra-processed foods）。 --- ### [01:04:48](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3888s) 食品工业的味觉陷阱与“食物噪音” 现代食品工业精心设计了超市中心货架上 70% 的高度加工食品。通过将精制碳水化合物与盐、脂肪按精确比例组合，制造出极高适口性（hyper-palatability）的食物。这种复合风味会触发大脑中强烈的多巴胺赏赐反应（dopamine response）。即使一个人在餐厅已经吃得胃部物理膨胀、自认为“饱到完全吃不下”，但当服务员推来精美的甜点车时，大脑依然会发出“我还能再吃一块”的信号。这种生理饱腹与神经奖赏之间的脱节，正是导致全球肥胖流行的核心驱动力。 史蒂文联想到西餐厅总在正餐前免费供应餐包，库特尼克博士确认这正是诱导消费者从头到尾超额摄入的商业策略。同样的手法被广泛运用于多力多滋（Doritos）、品客薯片（Pringles）等零食中，通过分子层面的巧妙搭配让人“根本停不下来”。更隐蔽的是，即使在普通消费者认为健康的食品中，如超市售卖的培根（bacon）、花生酱、杏仁酱等各类坚果酱（nut butters）的配料表里，几乎都额外添加了盐和糖。这些添加量甚至没有甜到让你尝出来，但足以在大脑神经层面唤醒快感中枢，让人深陷无法摆脱的“食物噪音”（food noise）和持续想吃的冲动中。 - 餐厅餐包策略：利用快速吸收的碳水化合物刺激食欲中枢，促使顾客追加大份主菜和甜点。 - 隐形添加糖与盐：日常食品如培根和坚果黄油普遍添加微量糖与盐，旨在无形中强化大脑对该食物的依恋度。 - “食物噪音”定义：大脑持续不断、难以抑制的进食冲动与对食物的心理渴望，源于食物设计对多巴胺通路的劫持。 --- ### [01:08:32](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4112s) 液态热量的陷阱与食物物理结构的破坏 针对现代人如何打破这种过度进食的恶性循环，库特尼克博士给出的首要且不容商量的法则就是：**绝对不要摄入液态热量（liquid calories）**。苏打水、可乐（Coke）等含糖饮料没有任何营养成分，却含有极高热量，会导致血糖和胰岛素直接爆表，其骤起骤落的波动随后会诱发更强烈的饥饿感。 史蒂文提到许多人推崇的果汁（如鲜榨橙汁）和水果冰沙（fruit smoothies）。库特尼克博士直言许多人误以为果冰沙很健康，但这其实是一个巨大的误区。完整的水果本身富含营养物质和膳食纤维，但一旦将其打碎、榨汁或搅拌成冰沙，就会彻底破坏植物原有的物理结构。 库特尼克博士打了个生动的比方：原本固体食物在消化道内像细水长流的水管，一点一点释放营养；而打碎成果汁、冰沙或将土豆做成土豆泥后，原本需要身体花费时间逐步分解消化的物理屏障被瞬间抹平，直接把微弱水流变成了“大水漫灌”，使糖分以极高的速率瞬间涌入血液，引起激烈的激素紊乱。 ### [01:10:14](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4214s) 超加工食品、GLP-1 激素与超生理剂量的受体激动剂 Dr. Andrew Koutnik 深入剖析了超加工食品是如何从生理机制上彻底破坏人体的激素平衡的。当精制与加工食物以极快的速度涌入消化系统时，肠道吸收营养物质的速率被骤然拉高，直接导致体内如 GLP-1（胰高血糖素样肽-1）等关键肠促胰岛素的分泌节律完全紊乱，正常的胰岛素应答机制也随之崩溃。针对 Steven 提到的“GLP-1 是饱腹感/饥饿激素”，Koutnik 进一步澄清：GLP-1 确实与食欲密切相关，它在进食后由肠道释放，向大脑传递饱腹信号以调节进食冲动。 如今 GLP-1 之所以家喻户晓，完全是因为 Ozempic（司美格鲁肽/Semaglutide）、Wegovy 以及 Tirzepatide（替尔泊肽）等 GLP-1 受体激动剂类减肥药物的爆火。然而 Koutnik 尖锐地指出，这些药物并不是将体内的 GLP-1 水平恢复到生理正常状态，而是将其强行推高至“超生理剂量”（super-physiologic levels）——这是一种在自然人体状态下永远不可能观察到或达到的极端水平，以此来强行关闭大脑对食物的渴望。 ```mermaid flowchart TD accTitle: 加工食品与GLP-1受体激动剂的作用路径对比 accDescr: 对比超加工食品导致代谢紊乱与药物推高GLP-1至超生理水平的机制 subgraph ULTRA_PROCESSED["超加工食品入侵路径"] A["高吸收率加工营养物质"] --> B["营养物质瞬间涌入血液"] B --> C["天然GLP-1节律紊乱"] B --> D["胰岛素过度暴激"] C & D --> E["代谢失调与持续饥饿"] end subgraph GLP1_DRUGS["GLP-1 受体激动剂干预"] F["Ozempic / Wegovy / Tirzepatide"] --> G["超生理剂量受体激活"] G --> H["远超自然峰值的激素信号"] H --> I["强行截断大脑饥饿中枢冲动"] end ``` ### [01:11:09](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4269s) 赞助支持：Ketone-IQ 与 Stan Store 商业平台 Steven 在插播中分享了他个人对 Ketone-IQ 倾注数百万元投资并成为联合创始人的真实经历。他在播客中反复谈及自己长期坚持极低碳水、极低糖饮食以促进内源性酮体生成，从而获得极佳专注力、体能耐力与稳定情绪的故事。不久后，Ketone-IQ 的外源性酮体小样出现在了他伦敦总部的办公桌上。亲身体验后，Steven 惊叹于这小瓶饮剂对自己语言表达敏捷度、工作专注力、健身表现以及消除午后机能崩溃（crash）的立竿见影效果，因此决定直接投资成为合伙人。 随后，Steven 介绍了另一家由他联合创办的数字平台 Stan Store，用15秒时间向听众传授轻量化创业哲学。他强调人生中成功的人往往没有完美的预设方案，而是专注于迈出第一步、保持痴迷并持之以恒。Stan Store 旨在让创作者、教练和创业者在两分钟内免去复杂技术壁垒，直接上线属于自己的数字产品、咨询服务或会员社群，将个人专业知识高效转化为商业收入。 ### [01:13:05](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4385s) 面向大众的核心生活建议：饮食、运动与代谢重置 回到访谈，Steven 向 Dr. Koutnik 抛出一个直击本质的问题：如果有机会向五百万人传授如何活得更好、表现更佳并抵御现代不良食品环境，首要建议是什么？Koutnik 直截了当地指出，第一法则就是“对每天摄入体内的每一口食物保持高度警觉与自觉意识”。食物对身体产生的影响绝不亚于甚至远超现代药物。建立健康体质的根基在于坚决摄入天然全食物（whole foods）、彻底戒除高糖饮料等液体卡路里。 对于存在代谢障碍（例如像 Koutnik 本人一样的 1 型糖尿病患者或胰岛素抵抗人群），严格限制碳水化合物是目前已知能稳定血糖、降低胰岛素并逆转肥胖与 2 型糖尿病的最强效干预手段之一；前沿医学研究甚至表明，低碳生酮饮食有促使重度精神疾病进入长期缓解期的潜力。第二大不可替代的基石是坚持高频规律运动：缺乏运动虽不一定是导致肥胖的唯一原发诱因，但体力活动在代谢重塑、细胞活力与整体机能维系上具有不可动摇的底线价值。 - **食物即药物**：日常饮食对内分泌与代谢的重塑能力在许多场景下强于药剂干预。 - **杜绝液体热量**：拒绝含糖饮料与精制液体卡路里是稳定基础代谢的第一步。 - **碳水限制的力量**：对代谢综合征人群而言，控碳不仅是减重，更是阻断慢性病恶化的有效临床路径。 ### [01:14:24](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4464s) 从肥胖者到肌肉专家：Dr. Koutnik 的全周自律训练实验 当 Steven 打趣称赞 Koutnik 结实的肌肉围度并询问是否与对抗 1 型糖尿病相关时，Koutnik 坦言自己年轻时也曾深受肥胖困扰。正是那段体重超标的经历，促使他终其一生痴迷于如何变得“更大、更强、更快”以及如何最大化优化代谢与运动表现。这演变成了一场围绕自己身体展开的长达数十年的自我实验——利用不同形式的阻抗训练探索它们对骨骼肌摄取糖分、胰岛素敏感度以及整体代谢健康的微观调控。 在谈到具体的训练方案时，Koutnik 透露他几乎坚持每天训练： - **阻抗力量训练**：每周安排 6 天，每次进行 30 到 60 分钟高强度的器械或自由重量力量训练。 - **巴西柔术（BJJ）**：每周通常骑自行车前往柔术馆进行 5 次训练。柔术具备极高强度的间歇特征（通常是持续 5 分钟的极限搏抗，随后伴随 1 到 2 分钟间歇），是对无氧爆发力与心肺耐力的严酷考验。 - **功能性有氧调节**：当柔术或举重训练量不足时，他会补充跑步、骑行，或使用双摇阻力风阻车（Airdyne bike）。风阻车能同时调动上下肢全力输出，既能高效拉升心肺负荷，又极少带来肌肉组织的机械性撕裂损伤，是心血管维护的极佳利器。 ### [01:16:17](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4577s) 摆脱饥饿的束缚：享受 22 小时的血糖平稳与进食自律 Koutnik 分享了自己的作息与进食习惯。转变为生酮饮食后，他早晨醒来大脑甚至完全不会出现关于“觅食”的念头。他与 Steven 都有相同的共鸣：生酮状态不仅抚平了血糖和胰岛素的剧烈波幅，更直接消除了常人时刻伴随的虚假饥饿感。Koutnik 坦言，比起进食过程带来的短暂愉悦，他更加热爱一天中那 22 到 23 个小时身体处于平稳、纯净状态的生活质量（lived quality of life）——没有血糖过山车式的剧烈震荡，没有高胰岛素引发的困倦，也没有任何不可预测的代谢不适。 在实际执行中，Koutnik 通常每天进食 2 到 3 餐，进食时机多安排在力量训练或柔术前后，偶尔在睡前补充蛋白质，但他会刻意避免临睡前进食以防破坏深层睡眠质量。他的原则十分务实：只有身体发出真正饥饿信号时才进食，并且确保摄入足够的高质量蛋白质以支撑每日高负荷训练造成的肌肉组织修复需求。 ### [01:17:57](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4677s) 健康的三大支柱与隐匿的升糖刺客 Koutnik 总结道，健康并没有神乎其神的秘诀，量身定制的营养结构、高频体能训练以及优质深层睡眠构成了生命健康的“三大核心支柱”。如果这三项基础没有夯实，在其他任何旁门左道上花费的心思与金钱都纯属徒劳。 访谈最后，Steven 将话题引向常人最容易忽视的“隐匿升糖炸弹”，并结合自己的成长经历发出感慨：他在成长过程中一直坚信纯果汁是极致健康的饮品，童年时甚至痛饮 Sunny Delight（果味饮料）以为自己在为身体注入丰沛的维生素。如今戴上连续血糖监测（CGM）深入了解生理代谢后，他为当年的无知感到后怕；即便理解父母抚养孩子的不易，但每当在公共场合看到家长给幼儿递上一大杯鲜榨橙汁时，他的脑海中都会瞬间浮现出那杯看似天然的水果原汁在孩子稚嫩的血管中激起惊人血糖海啸与胰岛素峰值的画面。 ### [01:19:08](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4748s) 糖瘾的形成与加工食品的血糖陷阱 当谈到儿童面对高糖饮食的反应时，安德鲁·考特尼克博士（Dr. Andrew Koutnik）分享了为人父母的切身体会。他家里有两个孩子，分别只有三岁和六岁。他发现每当孩子们尝到那些高糖、高度可口的美食时，整个人就变得“不依不饶地想要再吃”，普通的天然食物立刻变得索然无味。这种现象极为生动地折射出当代成年人每天面对的生理挑战：许多人在不知不觉中陷入这种饮食循环，完全没有意识到高糖食物对自身新陈代谢、饥饿感调控以及未来长期健康造成的深远破坏。 斯蒂芬·巴特利特（Steven Bartlett）追问，在通过连续血糖监测仪（CGM）和胰岛素检测设备进行的大量自我实验中，除了之前谈到的“液体热量（如含糖饮料）”之外，还有哪些食物会引发极其剧烈或出人意料的血糖波动。考特尼克博士指出，市面上存在太多让人防不胜防的食物，很难单一归咎于某种特定产品。尤其是各种高度加工食品，当人们选择吃工业加工食品时，实际上是在盲目信任食品公司添加的配料能够契合人体的新陈代谢。而现实情况往往相反，这种良性代谢反应“不仅无法保证，而且大多数时候都是奢望”。 ### [01:20:41](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4841s) 颠覆常识的“健康食品”：从白米饭、精制麦片到果干 斯蒂芬列举了一份日常食物清单向考特尼克博士求证，其中包括含糖饮料、白面包、百吉饼和白米饭。斯蒂芬坦言白米饭的上榜让他极为震惊，因为他从小一直把米饭当作健康食品。考特尼克博士证实了这一点：白米饭、任何形式的土豆（土豆泥、烤土豆，尤其是炸薯条）以及意大利面，都会引发极强的血糖和胰岛素反应；虽然红薯的升糖反应相对温和一些，但依然非常显著。 更具杀伤力的是精制谷物麦片。考特尼克博士直言，大多数市售麦片对血糖和胰岛素的冲击力“远比前面提到的那些食物恶劣得多”。即便是那些打着“有益心脏健康”标签的麦片，只要吃下一小碗，他的血糖就会“瞬间冲破天花板”。斯蒂芬还提到了另一个极具迷惑性的“健康食品”——果干。脱水制作过程不仅去除了水分，还极度浓缩了糖分，使糖分被人体更快吸收，造成比新鲜水果严重得多的血糖飙升。考特尼克博士表示，除非自己在低血糖危急关头需要紧急救命，否则平时绝不碰任何果干。 针对临床与学术界常有的“不必人人自危、许多人对碳水代谢良好”的声音，考特尼克博士给出了沉重的人口健康数据进行反驳： - **糖尿病前期**：全美超过半数（50%+）的成年人患有糖尿病前期（Pre-diabetes）。 - **代谢受损**：超过90%的人口在各项生物标记物上显示出不同程度的代谢健康受损。 - **肥胖率**：肥胖人口占比极高（超过68%超重或肥胖）。 - **儿童健康危机**：约20%的儿童已经出现肥胖或糖尿病前期的症状。 现代人把健康的饮食和运动称作“良药”，但考特尼克博士强调，这些原本只是人类身体设计所必须履行的日常基准；正是因为缺失了这些基石，身体在维持正常机能时才会彻底崩溃。 ```mermaid flowchart TD accTitle: 高升糖食物对代谢健康恶化的推动链路 accDescr: 展示高升糖食品如何导致代谢受损并形成恶性健康危机 subgraph Foods["高升糖与加工食品"] A["精制加工谷物<br/>(麦片/白面包/米饭)"] B["浓缩糖类<br/>(果干/含糖饮料)"] C["块茎类与淀粉<br/>(炸薯条/土豆泥/意面)"] end subgraph Internal["生理代谢机制"] D["剧烈血糖尖峰与高胰岛素"] E["饱腹感失控与持续渴求"] end subgraph Crisis["全民代谢健康危机"] F["超90%人群代谢指标异常"] G["半数以上患糖尿病前期"] H["儿童肥胖率与前驱病达20%"] end A --> D B --> D C --> D D --> E E --> D D --> F F --> G G --> H ``` ### [01:23:44](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=5024s) 每个人都该尝试生酮饮食吗？个体差异与“平均值”陷阱 斯蒂芬提出核心疑问：“每个人都应该尝试生酮饮食吗？”考特尼克博士并未给出非黑即白的结论，而是从科学方法论和个体差异的角度深入剖析。他指出，如果不亲自尝试，你永远无法确知某项干预对自己究竟是有益还是无效。现代科学研究通常习惯于呈现柱状图或平均趋势线，但大众往往忽略了：那条代表“平均效果”的线是由许多各不相同的个体数据汇聚而成的。 如果在某项临床研究中，你刚好是位于数据顶端或底部的“离群值（Outlier）”——也就是所谓的极端应答者或无应答者——盲从基于平均值制定的建议就会出现偏差。例如，在针对外源性酮体稳定脑功能的实验中，某些受试者的大脑网络稳定性可能获得了100%的惊人提升，而另一些人可能只有20%的改善，二者平均后得出的数字并不能完全代表每个独立个体的潜力。 ```mermaid flowchart LR accTitle: 科研统计平均值与个体差异对比 accDescr: 展示临床研究中平均数掩盖极端应答者与无应答者的逻辑 subgraph Research["科研报告常见呈现"] R1["群体测试数据"] --> R2["平均值趋势线/柱状图"] end subgraph Individual["个体真实代谢表现"] R1 --> I1["超强应答者<br/>(如脑稳定性提升100%)"] R1 --> I2["中度应答者<br/>(落在平均区间)"] R1 --> I3["无/负应答者<br/>(代谢无明显变化)"] end R2 -.->|"掩盖真相"| Individual ``` 考特尼克博士分享了自己过往的经历：他人生中先后尝试过15到20种截然不同的饮食策略。作为一名患有1型糖尿病且曾受肥胖困扰的科研学者，他最终发现生酮饮食是唯一能让自己的血糖不再剧烈波动、极度降低胰岛素使用量并显著提高生活质量的手段。如果不严格控制代谢，1型糖尿病几乎必然导致并发症并缩短10到20年的预期寿命。 - **SOCOM 特战研究特例**：考特尼克博士提到在为美国特种作战司令部（SOCOM）使用 Ketone-IQ 外源性酮体产品的低氧极端环境研究中，几乎所有受试者的血氧饱和度（$SpO_2$）和心率都出现了一致性改善，但他明确指出这种“全员响应”的现象在科学实验中是极其罕见的。 ### [01:27:08](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=5228s) 终极拷问：模拟世界之外究竟存在什么？ 节目录制接近尾声，斯蒂芬抛出了每期节目的标志性闭幕传统：上一位匿名嘉宾给考特尼克博士留下了一个颇具哲学与科幻色彩的深奥问题——“在模拟世界（The Simulation）之外，究竟存在着什么？” 面对这个突如其来的难题，考特尼克博士思索良久后坦言，这完全取决于个人对人类存在的哲学认知。他认为人类对世界的一切感知都受到大脑容量和生理机制的绝对局限；无论是理解现实还是用“模拟世界”这个词汇去构想宇宙，本身都受困于人类大脑的诠释能力。 斯蒂芬再次追问他心目中的答案，考特尼克博士给出他的回应：“超越意识的运作能力（Our ability to operate beyond consciousness）”。他认为模拟之外存在的不是通常意义上的意识，而是一种能够突破当下意识维度限制的某种状态。随后两人相视而笑，考特尼克直呼这个问题简直“把人难倒了”，斯蒂芬则顺势追问在这一切表象之外，他是否相信神或某种造物主的存在。 ### [01:28:57](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=5337s) 致敬与总结：将个人困境转化为推动代谢科学前沿的力量 当被问及模拟世界之外究竟存在什么终极答案时，安德鲁·库特尼克博士（Dr. Andrew Koutnik）坦诚表示，人类或许永远无法给出精确的解答；承认自己的“不知道”，反而是对未知世界最理性的敬畏。对话由此转向总结与致谢，主持人史蒂文·巴特利特（Steven Bartlett）对库特尼克博士所作出的学术贡献表达了深切的敬意。史蒂文特别提到，该领域的诸多专业人士——包括桌上所放置的外源酮品牌（Ketone-IQ）创始人迈克尔（Michael Brandt）——都一致将库特尼克博士尊为生酮代谢、血糖控制及胰岛素调节领域的“黄金科研标杆”与思想领袖。 更令史蒂文赞叹的是，库特尼克博士如今仅有 34 岁（两人同龄），却已对全球健康领域产生了如此深远且根本性的推动。库特尼克年少时确诊 1 型糖尿病的经历固然是一场人生悲剧，但他却将这场严峻的健康危机，转化成了照亮无数人前行道路的宏大事业。因为他的严谨研究，成千上万面临慢性病困扰、渴望改善身体机能与代谢健康的人得以重新认识自己的身体。史蒂文真诚呼吁他务必坚持当前的科研探索与大众科普，因为这项工作在当今慢性病肆虐的社会环境下极其迫切且不可替代。面对这番由衷赞许，库特尼克博士致谢并表示能够来到节目分享是自己的荣幸。 - **业界声誉**：被酮体补剂领域专家及先锋研发者誉为酮类、血糖及胰岛素科学研究的“黄金标准”（gold standard）。 - **学术成就与年龄对比**：年仅 34 岁便在代谢健康领域确立了核心学术地位，深刻重塑了人们对生酮饮食、运动表现与疾病管理的认知。 - **因祸得福的科研驱动力**：从年轻时确诊 1 型糖尿病的个人健康创伤出发，通过十余年严苛的自我实验与临床研究，为全球大众提供了预防慢性病与优化身体机能的科学方案。 --- ### [01:30:11](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=5411s) 节目结语：DOAC Inner Circle 专属社区招募 在访谈落幕之际，史蒂文面向观众宣布了一项全新的独家计划——正式推出《CEO日记》（The Diary Of A CEO）的专属私人社群“DOAC Inner Circle”。史蒂文表示，团队在节目录制背后积累了海量从未公开过的珍贵内容，为了让最忠实的听众能够更深入地探索节目背后的世界，他决定向首批 10,000 名用户敞开大门。 加入该社群的成员将获得多项前所未有的特权：查阅史蒂文在录音时 iPad 上的专属采访提纲（briefs）、观看从未公开发布的精彩片段与幕后花絮、收听被雪藏的整期深度访谈，并拥有与史蒂文直接互动的渠道。社群成员甚至可以直接参与节目的内容共创，决定未来访谈的嘉宾人选与探讨主题。这一专属通道限额 10,000 人，观众可通过视频下方的专属链接或访问官方网址（doaccircle.com）申请加入。 ## Notable quotes > [00:00](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=0s) 在受试者身上，他们观察到个体阅读与吸收信息的能力提升了 50%，决策水平也更为出色。 — Dr. Andrew Koutnik > [02:25](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=145s) 赋能每个人，让他们重新掌控自己的健康 — Dr. Andrew Koutnik > [09:34](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=574s) 如果不控制好血糖，就如同开着一辆没有发动机、连底盘和车轴都没有的汽车，车主却还在纠结应该换什么样的轮毂或者音响系统。 — Dr. Andrew Koutnik > [25:56](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=1556s) 我这辈子从未在任何一个 1 型糖尿病患者身上，看到过完全处于正常范围内的血糖水平！你到底做了什么？ — 时任美国糖尿病协会（ADA）主席 > [40:09](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=2409s) 就像原本置身于晴空万里、阳光明媚的户外，正与朋友愉快交谈，突然之间乌云压顶、狂风骤雨袭来，人群四散奔逃。 — Dr. Andrew Koutnik > [56:27](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=3387s) 能够促进酮体利用的饮食干预措施增加了脑部可用能量，因此在保护大脑免受衰老损伤方面展现出巨大潜力。 — Steven Bartlett > [01:13:05](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4385s) 对每天摄入体内的每一口食物保持高度警觉与自觉意识 — Dr. Andrew Koutnik > [01:16:17](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=4577s) 比起进食过程带来的短暂愉悦，他更加热爱一天中那 22 到 23 个小时身体处于平稳、纯净状态的生活质量 — Dr. Andrew Koutnik > [01:27:08](https://www.youtube.com/watch?v=QXUNnXHXeVQ&t=5228s) 超越意识的运作能力 — Dr. Andrew Koutnik ## Mentioned Andrew Koutnik, Steven Bartlett, John Rollo, David Ludwig, Jeff Volek, Michael Brandt, The Diary Of A CEO, Mayo Clinic, Johns Hopkins University, Harvard University, MIT, Ohio State University, DARPA, SOCOM, ADA, USDA, Replit, Stan Store, Ketone-IQ, Omnipod, Ozempic, Wegovy, Tirzepatide, Doritos, Pringles, Sunny Delight, Always Hungry? ## Video description Dr. Andrew Koutnik led the longest-ever human study on the ketogenic diet and spent 15+ years studying metabolism, now Dr Andrew Koutnik reveals what the science says about fat loss, depression, diabetes, and disease. Dr. Koutnik is a leading research scientist specialising in metabolic health, human performance, and Type 1 diabetes management. He has contributed to over 100 scientific publications and, in 2024, co-authored a landmark 10-year case report on the ketogenic diet and diabetes. He explains: ◼️Why ultra-processed foods are silently destroying your brain and metabolism ◼️How 70% of grocery store food is designed to keep you sick ◼️How this one diet could prevent Alzheimer’s, heart disease, and diabetes ◼️How keto and fasting can reset your body better than any workout ◼️The hidden reason you can’t burn fat and how to fix it fast 00:00 Intro 02:25 What's Your Mission? 03:18 What Areas of Health Have You Spent the Last 15 Years Researching? 09:24 High Blood Sugar Is the Biggest Cause of Long-Term Health Problems 13:20 The Keto Diet 18:17 Regulating Elevations in Blood Glucose 21:29 Food Patterns Through Evolution 25:56 What Do You Notice When You're in Keto vs. Not in Keto? 33:32 Should We Be Restricting Carbs? 35:19 10-Year Study on the Impact of the Keto Diet 38:39 Your Blood Sugar Levels Have Risen 43:13 Ads 44:21 The Keto Diet and Physical Performance 52:09 Exogenous Ketones 56:27 Exogenous Ketones for Mental Health 58:39 Exogenous Ketones Helping With Cancer Body Weight Increase 01:00:08 Keto Diet and Gaining Muscle 01:03:19 Not Feeling Hungry on the Keto Diet 01:06:22 The Food Industry Engineers Food to Make You More Hungry 01:11:08 Ads 01:13:05 How Can Our Audience Live a Better Life Practically? 01:18:24 What Is Something Surprising About Glucose? 01:23:44 Should Everybody Try the Keto Diet? 01:27:08 What's on the Other Side of the Simulation? Follow Dr Andrew: X - https://bit.ly/3VHSGv3 Instagram - https://bit.ly/3HWF4sT The Diary Of A CEO: ⬛Join DOAC circle here - https://doaccircle.com/ ⬛Buy The Diary Of A CEO book here - https://smarturl.it/DOACbook ⬛The 1% Diary is back - limited time only: https://bit.ly/3YFbJbt ⬛The Diary Of A CEO Conversation Cards (Second Edition): https://g2ul0.app.link/f31dsUttKKb ⬛Get email updates - https://bit.ly/diary-of-a-ceo-yt ⬛Follow Steven - https://g2ul0.app.link/gnGqL4IsKKb Independent Fact Checker: https://bit.ly/3VAPGkb Sponsors: Replit - http://replit.com with code STEVEN KetoneIQ - Visit https://ketone.com/STEVEN for 30% off your subscription order Stan Store - Visit https://stevenbartlett.stan.store for your 14-Day free trial [Source](https://www.youtube.com/watch?v=QXUNnXHXeVQ)

[0:00] Dr. Andrew Koutnik: 在受试者身上，他们观察到个体阅读与吸收信息的能力提升了 50%，决策水平也更为出色。 [2:25] Dr. Andrew Koutnik: 赋能每个人，让他们重新掌控自己的健康 [9:34] Dr. Andrew Koutnik: 如果不控制好血糖，就如同开着一辆没有发动机、连底盘和车轴都没有的汽车，车主却还在纠结应该换什么样的轮毂或者音响系统。 [25:56] 时任美国糖尿病协会（ADA）主席: 我这辈子从未在任何一个 1 型糖尿病患者身上，看到过完全处于正常范围内的血糖水平！你到底做了什么？ [40:09] Dr. Andrew Koutnik: 就像原本置身于晴空万里、阳光明媚的户外，正与朋友愉快交谈，突然之间乌云压顶、狂风骤雨袭来，人群四散奔逃。 [56:27] Steven Bartlett: 能够促进酮体利用的饮食干预措施增加了脑部可用能量，因此在保护大脑免受衰老损伤方面展现出巨大潜力。 [73:05] Dr. Andrew Koutnik: 对每天摄入体内的每一口食物保持高度警觉与自觉意识 [76:17] Dr. Andrew Koutnik: 比起进食过程带来的短暂愉悦，他更加热爱一天中那 22 到 23 个小时身体处于平稳、纯净状态的生活质量 [87:08] Dr. Andrew Koutnik: 超越意识的运作能力

[23:18] Dr. Andrew Koutnik: essentially need almost a PhD in nutrition or biochemistry to walk into a grocery store and be able to understand what the hell's on the label. [26:08] Doctor (ADA President): I've never seen a blood sugar level in the normal range with someone with Type 1 diabetes before. [26:08] Dr. Andrew Koutnik: The more you do, the earlier you do it, the earlier the impact and the more lost life you probably will get. [38:39] Dr. Andrew Koutnik: It's almost like imagine you're outside and it's sunny outside and you're having a great day... and then all of a sudden, very rapidly, clouds come over top... and it starts to rain. [52:09] Dr. Andrew Koutnik: It directly blocks something called NLRP3 inflammasome, which is a molecule that leads to increases in inflammation. We also know that it changes the way that our genes are used in the body called epigenetic signaling. [55:25] Steven Bartlett: The network stability was 87% greater after ketone consumption than stability measured after glucose consumption. [76:17] Dr. Andrew Koutnik: I enjoy the 23 hours or 22 hours of my day where I have the stability, not the moments in time where I'm introducing uncertainty and variability.

[0:00] What can you tell me about this? [0:02] >> Well, if you look at the science, it's [0:03] enhancing cognition. We've seen a 50% [0:06] improvement in how individuals were able [0:08] to read and absorb information of better [0:10] decision-m and also we did a study and [0:12] showed that it delayed the progression [0:15] of metastatic cancer. And I've actually [0:17] taken this a number of times because [0:19] having been in research for the last 15 [0:21] years and having lived with multiple [0:23] chronic diseases, one of which I [0:25] reversed. Some of the most powerful [0:26] strategies like this were not being told [0:28] to me when I went to the doctor's [0:29] office. So, let's dig deeper. [0:31] >> Dr. Andrew Cutnick is a research [0:33] scientist who's worked on over 100 [0:35] studies on metabolic health, diabetes, [0:37] and the keto diet. [0:39] >> And through his findings, he's helping [0:40] people prevent chronic diseases, improve [0:43] cognition, and optimize performance. I [0:45] went through some pretty dramatic [0:47] moments in my childhood. You know, I did [0:48] everything I was told, right? I [0:50] exercised all the time. I ate what I was [0:52] supposed to eat, but I still became [0:53] obese. [0:54] >> You weighed about 255 lbs. [0:56] >> Yep. And I had no idea how damaging that [1:00] actually was to my body. And I think the [1:02] vast majority of people also don't, but [1:04] over 20% of children have obesity. [1:06] That's quadrupled over the last 30 [1:08] years. And a big part of that is when it [1:10] comes to food, what looks healthy isn't [1:12] always healthy. And it's not by [1:13] accident. And it wasn't soon after that [1:16] I ended up getting diagnosed with a [1:17] chronic irreversible disease that [1:18] obesity puts you at risk for. And that [1:21] immediately turned into a journey to [1:23] understand how to be healthy. And I came [1:25] across this diet a little over a decade [1:27] ago called the ketogenic diet. So then I [1:29] went into the science of this diet and [1:31] found positive impacts on things like [1:33] diabetes, obesity, Alzheimer's, serious [1:35] mental illness, chronic diseases. And I [1:37] was like, "Oh wow." Cuz a lot of people [1:38] don't realize that many of these are not [1:41] just preventable but also reversible. [1:43] And you did the longest study ever done [1:45] of its kind on the impact of the [1:47] ketogenic diet on a patient that had [1:49] type 1 diabetes. [1:50] >> Yes. Let me let me tell you all about [1:52] it. [1:54] >> I see messages all the time in the [1:56] comments section that some of you didn't [1:57] realize you didn't subscribe. So, if you [1:59] could do me a favor and double check if [2:01] you're a subscriber to this channel, [2:02] that would be tremendously appreciated. [2:03] It's the simple, it's the free thing [2:05] that anybody that watches this show [2:07] frequently can do to help us here to [2:08] keep everything going in this show in [2:10] the trajectory it's on. So please do [2:12] double check if you've subscribed and uh [2:14] thank you so much because in a strange [2:15] way you are you're part of our history [2:18] and you're on this journey with us and I [2:19] appreciate you for that. So yeah, thank [2:21] you [2:25] Dr. Andrew Kutnik. If you had to try and [2:28] sort of summarize and encapsulate what [2:30] you spent the last couple of decades of [2:31] your life focused on and really trying [2:33] to accomplish, prove, understand from [2:36] the highest level. What exactly is that? [2:40] The core of my mission, Stephen, is [2:42] really to empower individuals to take [2:44] control of their own health. It's [2:46] empowering them with science, you know, [2:48] bridging science to actual action. You [2:49] know, science is very complex. It's very [2:51] hard to break it down, but having been [2:53] in, you know, research for the last 15 [2:55] years and having lived with [2:58] multiple chronic diseases, uh, one of [3:00] which I reversed and one of which I is [3:01] irreversible. Um, I I my mission is to [3:05] empower patients with the same tools and [3:07] strategies I had access to. uh so they [3:10] can take control to maximize their [3:11] health and performance. [3:13] >> For the average person who may not be as [3:17] knowledgeable about health and fitness, [3:19] what are the areas of health that you've [3:21] spent the last 15 years researching and [3:23] trying to understand? [3:24] >> I would call it, you know, Stephen like [3:26] metabolism in a broad terms. Now I would [3:29] say you know to break that down further [3:31] for people to understand that metabolism [3:33] is trying to understand how the body [3:35] metabolizes or utilizes things like [3:38] nutrients or food. So you have oranges [3:40] here. What's what's in that food? How [3:43] when you ingest it will your body [3:45] respond to it? Both from you know [3:48] glucose levels which I'm sure many have [3:49] heard of to insulin responses to all [3:52] this different nuance. A lot of that [3:54] comes down to nutrition but it also is [3:57] things like exercise. Exercise such a [3:58] powerful impact on metabolism, [4:00] incredibly important for overall health. [4:03] But from a personal perspective, this [4:05] journey has been very honestly selfish [4:06] for me. I wanted to understand how to [4:08] get the best performance, the best for [4:10] health for myself. And I very quickly [4:12] realized that uh you know some of the [4:16] most powerful strategies out there were [4:17] actually not necessarily the ones that [4:20] were being told to me when I went to the [4:22] doctor's office because I went through [4:23] some some pretty dramatic moments uh [4:25] early on in my my journey with with [4:27] trying to overcome some of these these [4:29] challenges. [4:30] >> So take me back to the start of your [4:32] story in the earliest context that's [4:34] relevant to understand [4:36] why you became the person you became. I [4:38] mean, I've got some photos here from [4:40] your from your childhood which are [4:43] >> Yeah. [4:43] >> very very telling. And you know, some of [4:45] our listeners might be listening on [4:46] audio alone, so they might not be able [4:47] to see these these visuals on the [4:49] screen. [4:50] >> So, if you could describe some of these [4:52] these pictures for me [4:54] >> when Yeah. [5:02] Um [5:04] it brings back some powerful memories of [5:06] uh the challenges with obesity for me. [5:09] Um you know the the picture on the right [5:11] is just a picture with on a a family [5:14] adventure um where we went to the we go [5:17] I go fishing with my dad a lot. You know [5:19] I'm very heavy at the time. I was, you [5:21] know, uh, obese and, um, and the picture [5:25] on the right here, this really gets me [5:26] because, um, you know, I did, you did [5:29] everything I was told, right? I [5:30] exercised all the time. I ate what I I [5:32] was supposed to eat or what my doctor [5:34] recommended, what the fitness magazines [5:35] recommended, but I was just constantly [5:37] challenged with gaining more and more [5:40] fat tissue. And I had no idea how [5:44] damaging that actually was to my body. [5:46] And, and I think the vast majority of [5:47] people also don't. Um, over 68% of [5:51] America right now is obese. Okay, that [5:54] means 7 out of 10 people walking around [5:56] the street in the United States of [5:57] America have obesity. And we know that [6:01] the second you start building more and [6:04] more fat tissue on your body, insulin [6:07] levels rise almost double immediately [6:09] before you even have symptoms of obesity [6:11] or uh tissue damage or organ damage or [6:15] anything along those lines. We know that [6:16] that almost immediately reduces insulin [6:18] sensitivity. So how well insulin, this [6:22] very powerful fat storage hormone, is [6:24] able to actually bring nutrients from [6:26] the blood into tissues. That goes down [6:28] around 34 to 35% uh and early stages of [6:31] obesity. [6:32] >> And just to summarize for a muggle like [6:34] me, insulin is basically the uber which [6:37] takes things out of your blood and puts [6:39] them where they need to be. [6:40] >> It's essentially like a thermostat for [6:42] blood glucose. That's how most people [6:44] know it. So as blood glucose levels [6:46] rise, it works as a thermostat to let's [6:49] say release cool air to bring it back [6:51] down. In this case, releases insulin to [6:53] bring blood glucose back into range. As [6:55] blood glucose drops, insulin is stopped. [6:58] It stops releasing insulin out of these [7:00] cells called the beta cells. And [7:01] ultimately, what your body is trying to [7:03] do is keep the, you know, one teaspoon [7:06] of sugar that's in your blood that is [7:08] critical for your life. If it goes up, [7:11] it can cause damage. If it goes low, it [7:12] can be life-threatening. in this very [7:14] very tight range and it build it builds [7:17] a number of mechanisms to ultimately [7:19] make sure and ensure that you don't go [7:21] outside of that range. But imagine [7:23] losing the one molecule that directly [7:26] controls it. [7:27] >> You're wearing two devices I believe on [7:29] you 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. [7:38] Most people who are probably listening [7:39] to this, they their body probably also [7:41] produces insulin unless they have type 1 [7:43] diabetes. And so when my body no longer [7:46] produces this molecule anymore, there's [7:48] got to be a way to get it. It sits on my [7:51] arm 24/7 because it's a way of [7:54] essentially packaging a pancreas that I [7:57] don't have anymore and putting it on my [7:59] arm and and and a way of getting that [8:02] same type of of insulin. [8:04] >> And you have a CGM as well. [8:06] >> Yeah. So on my stomach here, so on my [8:09] stomach here is a CGM, [8:11] >> which is a continuous glucose monitor. [8:13] >> CGM is a way of tracking sugar levels or [8:16] glucose levels. [8:17] >> And both of those devices link to your [8:19] phone, which is in front of you. Um, and [8:21] I'll throw that up on the screen so [8:22] people can see, [8:23] >> yes, [8:23] >> what that what that kind of looks like. [8:25] >> So on this device, you have [8:28] a green line that is glucose levels. [8:31] Okay, my blood sugar says that it's 109 [8:33] right now. Which means that the [8:35] interstitial [8:36] signal of glucose is [8:40] >> interstitial meaning within not in the [8:43] blood but in the tissues. [8:44] >> Yeah. So the amount of glucose right [8:47] outside the blood around the tissues and [8:50] that signal is an indication of the [8:53] amount of glucose in the blood. That's [8:55] the green line. Okay, it says that I'm [8:57] 109 right now. So average blood sugar [8:59] levels using milligrams per deciliter is [9:01] 70 to 120. That's considered normal. [9:05] Below that is blue lines almost like [9:09] looks like squares and triangles. Those [9:11] are illustrations of insulin being [9:14] administered but they're not perfect [9:16] devices. Despite them being premier and [9:19] you know the most advanced technology on [9:21] the market, there are significant [9:22] limitations to them. Um, I have actually [9:25] I saw a clip of yours that I was [9:26] watching earlier that said you think [9:28] having high blood sugar over a long time [9:31] is the biggest cause of long-term health [9:33] problems. [9:34] >> When you're focused on improving your [9:37] overall health, you have to find out [9:39] what matters most, right? So, what [9:41] what's the hierarchy uh uh in the [9:43] health, you know, 1 2 3 4 5? What [9:46] matters most on that? And we can look at [9:47] that by looking at risk factors uh for [9:50] future disease. Well, the number one [9:51] cause of death in the United States and [9:53] across many parts of the world is [9:55] cardiovascular disease. Well, it's also [9:57] the number one cause of death in people [9:59] with diabetes. And when you look at what [10:01] are the strongest predictors of [10:02] developing some form of cardiovascular [10:04] disease, [10:07] a measure called HBA1C comes up at the [10:09] top. HBA1C is a average measurement of [10:14] your blood glucose over a two to three [10:16] month period of time. And that is [10:18] incredibly powerful at predicting future [10:22] risk for let's say diseases of the eye, [10:25] diseases of the kidney or even [10:27] cardiovascular disease. And so when I [10:29] think about how do we tackle uh [10:32] improving health or in in particularly [10:35] in these these common much more common [10:38] diseases, [10:40] glucose control sits at the very top of [10:42] that pyramid. And if unregulated, it's [10:46] equivalent to analogy I often use, which [10:49] is you're you're driving a car and [10:51] you're focused on what type of rims you [10:53] have, but you don't even have an engine [10:55] in the car. Like your engine doesn't [10:56] work, or you don't have an a chassis or [10:59] an axis, but yet you're you're focused [11:01] on rims or a sound system. And so the [11:04] number one factor, particularly in [11:05] diseases like diabetes, that matters [11:07] most is HBA1C. [11:10] >> So does that just mean that we should be [11:11] eating less sugar? [11:14] So if we wanted to control the most [11:16] powerful risk factor in diabetes, [11:21] we would need to understand how to [11:23] regulate it. Right? So then let's look [11:25] at the science of this. Well, the [11:26] science says that carbohydrates, [11:30] food is the most potent factor in [11:33] regulating elevations in glucose at [11:36] every single meal of the day. Well, most [11:38] people are eating three to four plus [11:39] meals every single day. And so the very [11:42] first logical thing to look at is food [11:45] because what you're consuming has the [11:47] most potent impact on glucose control [11:49] and glucose control has the most potent [11:51] impact on your health not only today but [11:55] in the future. And so focusing on on [11:58] nutrition makes sense. But this isn't [12:01] like a new phenomenon. We've known that [12:03] nutrition could be potentially [12:04] life-saving for people. There's a a you [12:07] know there's something called a [12:08] ketogenic diet if someone's heard this [12:10] before. It's a diet that dramatically [12:12] reduces the amount of carbohydrates in [12:13] the food. And the dramatic reduction in [12:16] carbohydrates in the food was used to [12:18] save lives of patients with type 1 and [12:22] type 2 diabetes since there was the [12:24] first report ever known to my knowledge [12:26] is in 19 or 1796 by a gentleman named a [12:30] physician called John Row. He published [12:32] a report on two cases of diabetes [12:34] malitis using basically a carbohydrate [12:37] replete or reduced diet to resolve the [12:40] disease. But we know that some of the [12:41] most premier diabetists meaning people [12:44] who study diabetes or treat people with [12:46] diabetes were utilizing these strategies [12:49] for over a hundred years before we then [12:52] discovered in 1921 that this diet could [12:55] also help neurological disorders like [12:57] seizures and beyond. And so the the [13:00] phenomenon of nutrition playing a role [13:02] in overall health is is certainly not [13:04] new. It's actually only recently that [13:06] we're rediscovering century old wisdom [13:08] of what nutrition can do for overall [13:10] health uh due to the emergence of an [13:13] explosion in science that has really [13:16] drove a ton of public interest into this [13:18] kind of unique dietary strategy. [13:20] >> So the ketogenic diet then um it's a [13:22] diet that I'm familiar with because it's [13:24] a diet that I cycle in and out of [13:26] throughout the year. probably I'm in a [13:28] ketogenic state three or four times a [13:29] year and I use the little keto reader [13:32] just to check my blood ketone levels. [13:35] What is the what for anyone that's [13:36] unfamiliar with the ke ketogenic diet? I [13:38] I'm a bit of an advocate for it. So I'm [13:41] fairly familiar but I that's also taught [13:43] me how unfamiliar people are with it [13:44] because I talk to my friends about it [13:46] and there's a lot of misconceptions. [13:47] >> Yeah. [13:48] >> If you're on a ketogenic diet, what are [13:49] you eating? [13:51] >> So typically what when someone [13:53] visualizes a ketogenic diet, I think [13:54] there's a lot of misinformation. and [13:55] they think it's just steak and bacon. [13:57] Um, and I guess for some people it might [13:59] be that, but it's actually uh if we're [14:02] talking about a well- formulated [14:03] ketogenic diet, we're talking about [14:05] green leafy vegetables, things that we [14:06] typically associate with health. You [14:08] know, salads, uh, broccoli, asparagus, [14:11] cauliflower, these kind of uh, [14:13] nutrient-dense green leafy vegetables [14:16] that are high in fiber and [14:17] phytonutrients. [14:19] Then you also have protein as a [14:20] component of that. that can come from [14:22] meat that can come from fish in the form [14:24] of salmon, eggs, uh cheeses, a little [14:27] bit comes along for the ride and things [14:29] like nuts. And then you also have the [14:32] rest of the diet which is made up of [14:33] fat. And this can come a lot of times [14:35] from um various plant forms. This can [14:38] come, you know, from like olive oil, [14:40] avocado oil. [14:41] >> And what are you removing then? [14:43] >> Sugary starchy carbohydrates. So you're [14:44] you're you know you're not having [14:46] bagels, you're not having donuts, um [14:50] white rice, pastas, these type of foods. [14:54] The reason they're not a part of this [14:56] diet is because these foods rapidly [14:59] elevate blood sugar levels. And the [15:01] rapid elevation in blood sugar also [15:02] spikes insulin. Insulin shuts down fat [15:06] breakdown and the ability to take that [15:09] fat to the liver. The liver built this [15:13] amazing mechanism to be able to convert [15:16] fat to ketone bodies because ketone [15:19] bodies fat can't actually longchain [15:22] fatty acids which is the primary form of [15:24] fat that you consume in the food you eat [15:27] and also the type that's broken down [15:28] from your own fat tissue can't readily [15:31] cross the bloodb brain barrier. And we [15:33] know that glucose is a fuel for the [15:34] brain. But what happens if you fast or [15:37] you don't consume a lot of carbohydrates [15:38] and you have low insulin levels and you [15:41] can't con transport the fat which is now [15:44] your primary fuel source on a ketogenic [15:45] diet because you reduce glucose or [15:48] carbohydrates in the diet which causes a [15:50] reduction in glucose. The reduction in [15:52] glucose lowers insulin. The reduction in [15:55] insulin causes fat to be rapidly broken [15:59] down and now becomes your primary fuel [16:01] source. [16:02] >> And so there's an evolutionary basis for [16:03] this, right? Because once upon a time we [16:05] might have gone long periods of time [16:07] without eating something. And so our [16:09] body turns inwards and starts using our [16:11] fat stores as a mechanism to to to fuel [16:14] our body and that's why it produces [16:15] ketones. Basically the evolution of this [16:19] diet was believed to be a cyclical [16:22] meaning on and off pattern in human [16:25] history because if we were to go through [16:30] bouts of abundance in food, we probably [16:32] consume it as much as we can in one [16:34] moment and then we're seeking the next [16:35] meal and seeking the next meal. What [16:37] happens in that in between time? If [16:38] you're 100% reliant on having food 24/7 [16:42] like we do in our current food [16:43] environment, you would never survive [16:45] evolutionarily [16:47] beyond a few days. [16:50] With the ability to switch from a [16:52] carbohydrate-based metabolism over to a [16:54] fat-based metabolism, we store months [16:56] and months and months of fat energy in [17:00] the event that we don't have nutrient. [17:01] So it's a one of the most powerful [17:02] survival mechanisms we have to survive [17:06] uh moments of famine. But we also have [17:10] known since bib times of biblical text [17:13] that fasting has therapeutic potential. [17:16] You know most potently in and the [17:19] ability to what would be described as [17:21] attenuate seizures. You know convulsion [17:23] like behavior was described when you [17:26] just completely eliminate food. actually [17:27] a common strategy in many religious [17:29] practices because of its quote unquote [17:32] healing properties. Well, now we [17:33] actually know that fasting induces a [17:36] state of ketosis and we know that [17:37] ketosis is actually shown to in many of [17:40] these cases have a therapeutic impact in [17:42] many of these environments like a [17:45] seizure like seizures. We've known since [17:47] the 1920 one out of the Mayo Clinic that [17:50] ketogenic diets not only mimic the [17:53] physiology of fasting but also attenuate [17:57] the seizures in children with epilepsy. [17:59] And that work has subsequently gone on [18:01] to John Hopkins and other research [18:03] institutes to show that this is a very [18:05] verified strategy for not just epilepsy [18:09] but it has been used for obesity, type 1 [18:10] diabetes, type two diabetes for for [18:12] centuries at this point. Um, and it all [18:15] starts with the reduction of [18:16] carbohydrates in the diet. [18:18] >> One of the things that's been most [18:19] beneficial to me, but also I know Joe [18:21] Rogan has talked about this before is as [18:22] a sort of a podcaster that spends a lot [18:24] of time talking, you notice high [18:26] variance in your ability to think, [18:28] articulate yourself [18:29] >> for long periods of time based on my [18:32] blood ketone levels and my [18:35] >> my sort my diet broadly um but [18:37] specifically the amount of ketones that [18:39] are in my blood. [18:43] Why is that? Why is it that I feel like [18:45] I'm more effective in communication and [18:48] thinking when I'm on the ketogenic diet [18:50] or taking exogenous ketones versus when [18:53] I'm having a normal western high higher [18:56] carb diet? A lot of people [18:59] would know why this is if they had the [19:01] same tools and insight that type 1 [19:04] diabetes gives. Because when you're [19:06] consuming that diet, what is often [19:09] happening is near constant elevations [19:13] and dips, elevations and dips, highs and [19:16] lows in blood sugar levels that we know [19:18] are ascribed to changes in energy [19:20] levels. So, we know that high blood [19:22] sugar levels, someone can Google if [19:25] they're they're so interested to look up [19:27] the term high blood sugar hyperlycemia [19:30] or low blood sugar or hypoglycemia and [19:33] just type in symptoms and you'll see a [19:35] laundry list of things like fatigue, [19:38] irritability, lack of concentration, uh [19:41] shakiness. These are all symptoms of a [19:44] lot of what you're describing, right? [19:45] Which is change in your your your [19:47] ability to concentrate, your energy [19:49] levels. It's a very very clear that [19:52] glucose levels are linked to that. We [19:54] also know that the chain [19:55] >> ju just to be clear. So is that when I'm [19:57] at the high or the low in the glucose? [19:59] So if I you know if you if you ate one [20:01] of 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, [20:07] your blood glucose levels are going to [20:09] go up presumably. [20:11] >> Yes. Because these oranges are composed [20:14] of bound sugar molecules together. So [20:17] most fruit has a structural component to [20:20] it which is why you see an it it has [20:23] like a has is has mass to it right it's [20:26] not just a liquid and then that [20:28] structural component binds together as a [20:30] part of it sugar that's bound together [20:32] they call them polysaccharides and those [20:34] polysaccharides when you consume them [20:37] your gut actually takes those breaks [20:41] them down into individual glucose [20:42] molecules [20:44] to then be absorbed into the bloodstream [20:46] that's when the insulin is released, [20:47] that's when the insulin takes that [20:48] glucose and stores it into tissues like [20:50] the muscle and the liver uh for future [20:54] glucose needs. Uh and so yes, we would [20:56] presume that with this high or oranges [21:00] or even most fruits, pastas, rices would [21:02] all elevate blood sugar levels, but then [21:05] that accompanies with a high insulin [21:06] load, right? So the more of the oranges, [21:08] the more insulin that you would need. [21:11] And you know, despite many of these [21:13] foods being considered very healthy, [21:15] those with [21:17] metabolic disease or metabolic [21:19] dysfunction may not may have a be more [21:22] vulnerable to even what would typically [21:24] be considered healthy foods. Um, and [21:26] type 1 diabetes is a is a powerful [21:28] example of that. [21:29] >> So, you said you'd you'd open to eating [21:31] one of these. We've got your blood [21:32] glucose and insulin levels, which we're [21:34] going to put on screen for people that [21:35] are watching. And it'll be interesting [21:37] to see how quickly we see that orange, [21:40] which is considered a health food by [21:42] many people, have an impact on your [21:43] glucose and insulin levels. [21:45] >> So, yeah. So, so what I'm I'm going to [21:47] do is normally I would I would never do [21:49] this, but I I think it's very important [21:51] for people to understand, [21:53] especially those at home who either have [21:54] a chronic disease, which is most [21:56] Americans at this point, or kids who [21:58] have a disease like diabetes, what the [22:00] impact really could be. So let's say [22:06] oranges are considered a superfood uh by [22:10] the American Diabetes Association. So [22:12] it's a fruit highly recommended by [22:13] almost every organization USDA f or USDA [22:17] American Diabetes Association and beyond [22:19] the amount of or is three oranges. [22:22] Three oranges is probably going to make [22:24] up around h 70 to 90 grams of [22:27] carbohydrates. For me, my energy needs [22:31] is around calculated it around 3,000 [22:33] calories per day. Now, the activity I'm [22:35] consuming, [22:37] if I were to [22:40] eat the amount of carbohydrates [22:42] recommended per day, which is around 55% [22:45] by, let's say, the USDA guidelines, that [22:48] I would need to consume at least or more [22:52] than this at le if I split up all my [22:55] calories over four meals. And so, [22:59] This is [23:01] an opportunity to see what this will [23:04] actually do to blood sugar levels [23:07] and [23:09] type 1 diabetes if you consume will be a [23:11] near equivalent to around a fifth the [23:14] amount of carbohydrates that I would [23:15] consume per day if I was on a standard [23:17] diet. [23:18] >> The the ketogenic diet they typically [23:20] say that to stay within it you need to [23:22] be below is it roughly 50 grams of [23:24] carbohydrates a day? And it's roughly [23:26] because 50 grams of carbohydrates per [23:29] day is a [23:31] rough number that we suspect most people [23:34] will be able to get carbohydrates low [23:36] enough to where insulin would be [23:37] sufficiently low to produce ketone [23:39] bodies. [23:39] >> Okay. [23:39] >> Yeah. [23:40] >> So there's variance depending on your [23:42] insulin sensitivity and insulin response [23:44] and I guess body weight as well is going [23:45] to be a factor. big factor, major factor [23:47] because anytime you're talking about [23:49] things like uh glucose, insulin is [23:52] always very individualized responses to [23:54] each individual person. [23:55] >> I don't really I don't I try and stay [23:56] away from fruit these days. I don't [23:58] know. I I berries and raspberries and [24:00] stuff like that and cuz people tell me [24:02] there's like polyphenols and black [24:04] blackberries, [24:04] >> but those are totally uh co cohesive [24:06] with the ketogenic diet [24:07] >> because they're higher in fiber. So like [24:09] you know half of where you're consuming, [24:11] not half, but a large portion of it [24:13] fiber. So it's more about the net [24:15] carbohydrates. It's the the glycemic [24:18] metabolic impact of the food. So [24:21] >> if the fiber is non-digestible, which in [24:23] fruit it isn't, then it shouldn't it [24:25] doesn't count, right? So higher fiber [24:27] content. Most of the vegetables on a [24:28] ketogenic diet are higher fiber, you [24:31] know, [24:32] >> because you know it's the it's the total [24:34] carbohydrate to fiber ratio. So the net [24:35] carbohydrates that really matter because [24:37] that's the amount of that's the [24:38] metabolic real metabolic impact of food. [24:40] Yeah. A lot of a lot of keto friendly [24:42] foods say like net carbs or one gram or [24:45] something, 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 [24:52] different foods that are keto friendly [24:55] on the label. Same as calories, same as [24:56] like fat, protein, even fiber. Um, and [25:02] they can produce completely different [25:03] responses. I mean, the food environment [25:04] nowadays, you essentially need almost a [25:06] PhD in nutrition or biochemistry to walk [25:08] into a grocery store and be able to [25:10] understand what the hell's on the label. [25:11] It's it is and I I don't want to sit [25:14] here and say like, oh, they they don't [25:15] know. Like, no, they they know. I mean, [25:18] there's are companies who have tons of [25:20] resources, food scientists galore, and [25:23] they're putting zero sugar on the label [25:26] and keto friendly a as a trick because [25:29] it's associated with health benefits, [25:30] right? There's all these studies on [25:31] ketogenic diets that can they can show [25:33] to improve health. And so they want to [25:34] have that on their label. But what is [25:36] often happening if you look on the back [25:38] of the label, there's about a hundred [25:39] different ingredients they can swap [25:40] sugar for for something that has the [25:42] same exact metabolic effect as sugar. So [25:45] malitol, maltodextrin, [25:48] um all these different ingredients that [25:50] are going to cause glucose to go up [25:51] rapidly, they'll just swap it and now [25:54] you can put on your label zero sugar. [25:56] Have you been in a ketogenic diet since [25:57] you were diagnosed with diabetes? Have [26:00] you cycled in and out of it yourself? [26:02] And if so, what have you noticed in [26:04] terms of when you are in that diet and [26:05] when you're not? So, I actually came [26:08] across this diet a little over a decade [26:10] ago. What I found is that almost every [26:14] blood meter that I was taking, this is [26:15] before CGMs were present, I had to just [26:17] prick my blood, you know, six to 10 [26:19] times a day to see what my blood sugars [26:20] were. I was finding that I was very [26:22] rarely outside of the normal range. And [26:24] I was also finding that I wasn't feeling [26:27] these extreme highs and lows anymore [26:29] when I transitioned to a ketogenic diet [26:31] almost immediately. My insulin [26:33] requirements dropped substantially uh [26:35] around 40 a little over 40%. So the uh [26:39] the amount of insulin I needed to take [26:41] dropped dramatically, but I didn't have [26:43] continuous glucose monitor. I didn't [26:44] have this instant feedback of like what [26:46] is my blood sugar doing? I just know I [26:48] needed a heck of a lot less insulin. And [26:50] so what happened was I went into my [26:53] doctor's office at the time. He happened [26:54] to be the American Diabetes Association [26:57] president at the time. He's like, "I've [27:00] never seen a blood sugar level in the [27:03] normal range with someone with type 1 [27:05] diabetes before." He said, "What are you [27:07] doing?" From that point forward, that's [27:10] when for me it like transitions even [27:12] into like a lifelong journey of like, [27:15] "Wow, you know, obviously nutrition had [27:16] a huge impact on me losing weight when I [27:18] had obesity. Now it was directly [27:21] regulating this very powerful disease [27:24] where upon diagnosis nearly all patients [27:29] are going to have high invariable [27:30] glucose levels for the rest of their [27:32] life. 99% of patients will never see [27:34] normal metabolic control again for their [27:36] life. 100% of them are expected to get [27:39] insulin resistance. And within 3 years [27:43] we see neuroanatomical changes within [27:46] the brain of children who are diagnosed. [27:48] What does that mean? [27:49] >> So it means that when we look at MRI [27:52] scans of the brain, we see that children [27:54] with high and variable glucose levels [27:56] with this disease with type 1 diabetes, [27:58] they have shifts in the type of white [28:01] and gray matter. The sections of the [28:03] brain that are associated with normal [28:06] brain development and childhood, they're [28:08] not developing the same way. We and we [28:11] see this within 3 years and it's [28:12] directly linked to the poor glucose [28:15] control. We also know that we see signs [28:19] of the early signals of aththeroscerotic [28:22] progression in children within four [28:24] years. [28:24] >> Atheroscerotic progression, what's that? [28:27] >> So, [28:29] one of the primary causes of death in [28:30] individuals across the world is [28:31] cardiovascular disease. And how do we [28:34] get that? Well, [28:37] you have changes in your blood vessel [28:39] and how it functions is the first and [28:41] earliest signal of future what will [28:44] ultimately be plaque or this kind of [28:46] blockages within the blood vessel which [28:48] ultimately cause things like heart [28:49] attacks or strokes. Well, in type 1 [28:52] diabetes, we see that children who have [28:54] high invariable glucose levels, again, [28:55] 99% of patients are expected to just [28:58] live this way for the rest of their [28:59] life. If they follow standard of care, [29:01] if they follow the doctor's orders, [29:04] they're going to see changes in how [29:06] their blood vessels literally [29:09] functionally and structurally change. [29:11] Their blood vessels will now shift from [29:13] being this very compliant uh almost like [29:16] a a smooth wave to that blood vessel now [29:19] becomes very rigid. It starts to build [29:22] collagen at more and more collagen [29:24] around it becomes stiffer and stiffer. [29:26] It's almost like taking a hose and [29:29] turning on a hose and pinching the hose. [29:31] When you pinch the hose, as you become [29:34] stiffer and as you shrink the size of [29:35] the blood vessel, it goes faster. And so [29:37] we can measure that by the speed of the [29:38] blood in the body. Another clear signal [29:41] and one of the most powerful signals [29:43] that the blood vessel is starting to [29:44] change before you see plaque, before you [29:46] see blockages, I mean decades prior. [29:49] These are all happening in childhood by [29:50] the way. You know, 10 to, you know, 10 [29:52] to 14 year olds diagnosed with type 1 [29:54] diabetes. we see that the blood vessel [29:57] isn't able to respond to what they call [30:00] sheer stress Stephen. So that means [30:02] let's say you go for a run uh this [30:04] morning Stephen and your blood pressure [30:06] initially increases because as your [30:09] heart rate increases the speed of the [30:11] blood increases the amount of pressure [30:13] on the vascular wall increases that a [30:17] phenomenon when the blood moves fast [30:18] through blood vessels it it causes [30:22] stress against the blood vessels. That's [30:23] not a bad thing. It's actually a signal [30:25] for the blood vessel to release [30:26] something called nitric oxide. Nitric [30:29] oxide is a potent called vaso diilator. [30:34] It causes the blood vessels to open up [30:36] and this is how your body responds [30:38] normally to stress. Okay, you go for an [30:40] exercise vasoddilation or vaso [30:42] constriction then vaso dilation um or [30:45] you know and these are normal responses [30:47] the body has. Well, what happens in type [30:49] 1 diabetes very early on is that the [30:52] ability to produce nitric oxide is [30:54] diminished. You're not able to respond [30:57] to high stress load. So, not only are [30:58] the blood vessels becoming stiffer, but [31:01] now the blood vessels aren't able to [31:03] even respond as well to the stress. And [31:06] so, as you're looking at this and you're [31:07] looking over time, you see these early [31:11] signals of athoscorotic progression. [31:13] also see very early on that it was once [31:16] expected that all patients with type 1 [31:19] diabetes would have eye damage some form [31:21] of eye damage called retinopathy where [31:24] you start to lose vision eventually can [31:25] go blind within 20 years of diagnosis. [31:28] So most people are diagnosed in 10 to 14 [31:30] years of age which means by 30 to 34 [31:33] years of age you're going to see a lot [31:35] of patients who have altered eye [31:38] function andor some who are blind. Now [31:41] that has extended out over time, but we [31:42] know that all patients with this disease [31:47] because of high and variable glucose [31:48] levels are expected to get at least one [31:54] complication in their lifetime if they [31:57] follow standard of care advice today. [31:59] Even with the best technologies out [32:01] there, there is no pharmaceutical [32:03] intervention. There is no technology [32:05] that normalizes this disease. And the [32:08] effects of these high invariable glucose [32:09] levels and insulin resistance that [32:11] accompanies it [32:13] is cumulative [32:15] dose dependent and not completely [32:17] reversible. Which means that once you're [32:20] diagnosed, the clock starts ticking. It [32:23] just like smoking. The more you do, the [32:25] earlier you do it, the earlier the [32:27] impact and the more lost life you [32:29] probably will get. And there was a study [32:31] done with 326 participants that found [32:34] that the keto diet can increase glycemic [32:36] control of patients with diabetes. That [32:39] was in the precision nutrition [32:40] publication. When it says it can [32:43] increase glycemic control, what does [32:46] that mean? [32:49] >> So is that what we were talking about [32:50] there with [32:51] >> Yes. So if you when you do a diet known [32:54] as a ketogenic diet, you're reducing [32:56] carbohydrates. Well, when carbohydrates [32:59] are consumed, they elevate glucose [33:01] levels. Well, if you dramatically reduce [33:03] the amount of carbohydrates consumed, [33:05] you're not having those same type of [33:07] glucose elevations and fluctuations [33:10] because you're not consuming the most [33:11] potent glucose elevating factor in our [33:14] life, which is carbohydrates. And so [33:17] when they talk about improvements in [33:19] glycemic control, it is the measure of [33:22] 24-hour over multiple day levels of [33:25] glucose in the circulation. And how well [33:28] is that being controlled within a normal [33:30] healthy range? [33:32] >> And so is your goal then to [33:36] encourage people to restrict [33:37] carbohydrates [33:39] >> in their diet? But you know because [33:41] carbohydrates and sugar have been [33:43] somewhat I guess demonized because you [33:45] never really hear many good things about [33:47] sugar. [33:48] >> Um so so what is what is your goal here? [33:49] What is the advice to the listener? Is [33:51] it to restrict their their [33:52] carbohydrates? [33:55] >> To be very conscious of what they're [33:57] consuming because nutrition has a [33:59] powerful potent impact on overall [34:01] health. And for those patients who have [34:04] chronic disease, which is unfortunately [34:07] the overwhelming majority of us, yes, [34:10] carbohydrates can be a very restricting [34:13] carbohydrates can have a powerful [34:14] therapeutic effect on diseases like type [34:18] 2 diabetes. The American Diabetes [34:19] Association in their 2019 consensus [34:21] report described type 2 diabetes as the [34:25] most evidence-based nutritional [34:26] strategy. We know that it can have [34:30] potential positive impacts on things [34:32] like uh Alzheimer's disease. There are [34:34] studies that have looked at this. We [34:35] also know that for [34:36] >> carbohydrate restriction we [34:38] >> Yep. So, and I like to term this [34:39] therapeutic carbohydrate restriction [34:41] because it's the therapeutic outcome of [34:44] a carbohydrate reduction. Um and that's [34:48] really the goal of this is can you [34:50] improve your overall health. Many people [34:52] will just do this simply to improve, you [34:54] know, to lose weight, to feel, like you [34:56] say, to feel more cognitively alert. But [34:58] in my case where you're along further [35:00] along the metabolic spectrum with [35:01] diseases like diabetes, it has a even [35:04] more uh potent impact on how you feel, [35:08] even more potent impact on your overall [35:09] health. Um, and but unfortunately about [35:12] 93% of Americans have some form of [35:14] metabolic derangement, uh, as cited by [35:17] multiple studies and multiple research [35:18] groups. You did a 10-year study on the [35:21] impact of the ketogenic diet on a [35:25] patient that had type 1 diabetes. I [35:27] think this is this is most certainly the [35:28] longest study ever done of its type [35:31] where you took one individual and over [35:33] 10 years you I guess controlled their [35:36] diet. So, we had access to [35:41] the ability to monitor uh a unique [35:44] patient who had type 1 diabetes and they [35:48] were diagnosed and had followed the [35:50] American Diabetes Association diet, a [35:52] healthy diet for 6 years and then [35:55] switched over in 2013 to a ketogenic [35:57] diet. Upon the initiation of the diet [35:59] and post, they had DEXA scans. They [36:02] controlled their calorie intake, their [36:03] body composition. they weren't taking [36:05] any additional medications and we were [36:08] able to monitor the impact over a [36:10] 10-year period [36:12] while controlling all those variables. [36:14] And why that's so important is because [36:17] one of the common concerns of a [36:18] ketogenic diet is the hypothetical risk [36:22] it can increase cardiovascular disease. [36:24] And the reason that [36:26] they think that it can increase [36:27] cardiovascular disease or it's [36:28] hypothesized that it will is because of [36:30] the elevation in LDL that often [36:32] accompanies an increase in saturated fat [36:34] in the diet. Now saturated fat comes [36:36] from things like animal proteins, uh [36:38] it's in coconuts as well. What we found [36:41] is that despite a near doubling in LDL [36:45] cholesterol on this diet, which again [36:49] should be associated with worsening [36:50] cardiovascular health, we did an [36:51] advanced cardiovascular assessment in in [36:54] this patient and found that despite [36:57] doubling LDL, they had maintained [36:59] completely normal glycemic control, [37:01] which again based on all the data says [37:04] is the number one risk factor. They [37:05] reduced their insulin load over 40%. [37:08] And their cardiovascular health was not [37:13] only better than the average patient of [37:17] similar age and sex with type 1 [37:19] diabetes, it was better in almost every [37:22] single category than people even without [37:25] type 1 diabetes. [37:28] despite the doubling of LDL cholesterol, [37:31] it illustrated that over a 10-ear [37:33] period, it maintained not only no sign [37:36] of cardiovascular disease, but [37:38] remarkable cardiovascular health. And [37:40] and in fact, we actually followed on [37:43] that study with the largest ever [37:46] analysis of the impact of nutrition, [37:49] particularly carbohydrates, in over [37:50] 46,000 patients with type 1 diabetes. We [37:54] showed that in over 70% of all reports [37:57] of very low carbohydrate ketogenic diets [37:59] that patients were completely able to [38:02] normalize their glucose control, [38:04] normalize the most potent risk factor [38:07] for disease of type 1 diabetes. [38:10] >> And is this this is a sort of a spectrum [38:14] of I'll put that on the screen for [38:16] people to see the different sort of [38:17] stages and categorizations of being [38:19] normal, pre-diabetic, and diabetic. [38:21] Right. [38:21] >> Correct. Yes. So normal is anything less [38:24] than 5.7% HBA1C. Pre-diabetic is that [38:28] 5.7 number up to 6.4. And then diabetic [38:32] is anywhere between 6.5 all the way up [38:34] into essentially uh there's no cap on [38:37] how high that number can go. I [38:39] >> I mean I noticed your your blood sugar [38:41] levels have uh risen quite dramatically [38:44] to [38:44] >> that. So what you see initially is is [38:48] probably only the first phase of this, [38:50] right? So started at an average of [38:52] around 100 milligs per deciliter on [38:55] average. And once the food is then [38:59] consumed cuz once you consume the food [39:01] it takes some time to break down into [39:03] glucose that glucose then goes into the [39:06] blood and then the blood then moves [39:08] glucose into this compartment around the [39:10] cells which called the interstitial [39:12] fluid. And now we're starting to see the [39:14] direct impact of just consuming probably [39:16] a fifth of the amount of carbohydrates I [39:19] should consume from a superfood. Um this [39:22] you know oranges are considered both a [39:23] citrus in a fruit and this is considered [39:25] like a superfood by the American [39:26] Diabetes Association uh in the context [39:29] of diabetes. [39:30] >> So when the glucose spike is high, so [39:33] you've just eaten some oranges, the [39:34] spike is going up. [39:36] >> Yeah. [39:37] What does someone feel and then what do [39:39] they feel when it's then crashes down [39:41] and goes below? Because it started at [39:43] about 100. So I imagine that it's going [39:46] to go up to whatever it goes up to and [39:48] then it's not going to drop back down to [39:49] 100. It's going to drop below 100 [39:52] typically in a in a normal um [39:54] non-diabetic person, right? [39:56] >> So 100's right around the uh normal. So [40:00] what you'd hope would happen is that [40:01] you're going to go up just a little bit, [40:03] insulin's going to respond quickly, and [40:05] you're going to come back down to [40:06] normal. if you have total healthy [40:08] metabolic function. Again, the vast [40:09] majority of us do not. But in this case, [40:13] what's going to what would be predicted [40:15] to happen is that as blood sugar [40:17] elevates and insulin responds, [40:21] it's going to go as high as the amount [40:23] of glucose that's present in the food. [40:24] Okay? But at the same time, the my pod [40:28] is also which is holding my insulin is [40:30] immediately trying to respond. it's [40:32] immediately trying to say, "Okay, oh no, [40:33] we need to bring this and keep this into [40:34] a normal range." Um, and so it's trying [40:37] to release insulin. And so you can see [40:39] on the screen that there's this massive [40:41] uptick in the blue line, which is the [40:44] initial response in insulin immediately [40:45] to the elevation in glucose. This is [40:48] exactly what happens in normal [40:49] physiology. Yet no one can measure it, [40:51] but you can see it here. [40:52] >> So how would I feel when the glucose [40:54] spike is high? Do I feel energetic? Do I [40:57] feel focused? Or do I feel tired? My [40:59] personal experience here Stephen is that [41:01] as blood sugar becomes very high I [41:03] become my focus reduces my I become [41:07] fatigued. Uh I can also according to my [41:09] wife become irritable. Um and but you [41:13] can even look this up you know you can [41:15] look up what are the symptoms of [41:17] hypoglycemia what are the symptoms of [41:21] elevated glucose levels above the normal [41:23] range which is normal 70 to 120. That's [41:26] when you can start to see uh very [41:28] clearly that the evidence over time has [41:30] shown a a very clear impact on not only [41:33] how you feel physically but also your [41:35] mental health status as well. Oh, I've [41:37] just looked up the symptoms here and it [41:39] says um the common immediate symptoms of [41:41] having a high glucose spike is you feel [41:44] thirsty, dry mouth, um frequent [41:46] urination, headache, brain fog, fatigue, [41:49] sluggishness, blurry vision. Um, [41:53] and then once you go down and you crash [41:56] or your glucose really drops below the [41:57] normal range, what do you feel then? [42:00] Typically, [42:00] >> so a lot of how I like to describe this [42:02] is almost like imagine you're outside [42:05] and it's sunny outside and you're having [42:07] a great day, great conversation with [42:09] other friends, and then all of a sudden, [42:11] very rapidly, clouds come over top. [42:15] Everyone kind of dissipates and it [42:17] starts to rain. It's almost like it's [42:20] it's we know that glucose levels have a [42:23] direct impact on the neurobiology of the [42:26] brain. Meaning how the brain functions, [42:28] how it operates, and particularly at [42:31] very high glucose levels, you know, [42:33] typically above 180 milligs per [42:35] deciliter, you start to see signals of [42:37] inflammation, signals of stress, like [42:40] oxidative stress in the body if people [42:42] have heard of that before. And that can [42:44] start to cause damage on tissues and [42:46] cause a stress response. But the problem [42:47] here, Stephen, is that most patients are [42:50] living there 24/7. [42:52] >> I was looking at some of the symptoms [42:53] here, and it says the short-term crash [42:55] you get after a spike, um, after a rapid [42:57] rise [42:59] is a bit of an insulin overshoot. So, [43:02] it's reactive hypoglycemia, which is the [43:05] sugar crash. 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Super [43:52] cheap, super fast, and completely [43:54] personalized to exactly what I wanted it [43:56] to do. And now I'm an investor in the [43:59] company as well as them being a brand [44:00] sponsor. And Replic connects to payment [44:03] systems like Stripe or services like [44:04] OpenAI and has a built-in database and [44:07] user authentication system. If you're a [44:09] founder or a freelancer or anyone who's [44:11] been searching for someone who can code, [44:13] you can build your next app with Replet. [44:15] Head to replet.com and use code Steven [44:17] to get 50% off your first month of [44:19] Replet's core plan. You did a study in [44:22] 2025, I believe, on the impact of the [44:26] ketogenic diet on physical performance. [44:29] you know, if the ketogenic diet has all [44:30] these therapeutic potentials, you know, [44:32] going back for over two centuries, what [44:35] is truly the impact of it on [44:39] performance? Because that's one of the [44:40] primary reasons where someone were to [44:42] walk into a a clinical setting and say, [44:44] "Well, yeah, you can do this, but I've [44:46] heard it's going to decrease my [44:47] performance." [44:48] >> Physical performance. [44:49] >> Physical performance. And so we were [44:50] very very interested in this because we [44:52] thought okay [44:54] it it [44:56] you know when we look at why [44:58] carbohydrates are currently being [44:59] recommended as sports nutrition is [45:01] because since 1921 they've been shown to [45:03] improve performance and how they showed [45:05] that in 1921 was that physicians out of [45:08] Harvard and um and Boston actually [45:11] watched Boston marathoners half of which [45:13] who would come wouldn't even finish the [45:15] race slurred words they would uh have [45:18] like almost pale skin, shaky, weren't [45:21] able to articulate their words or some [45:23] wouldn't finish at all. And what they [45:25] were finding was that these when they [45:26] tested the blood of these individuals [45:28] that they were finding that glucose [45:29] levels were low. Basically, they reached [45:32] what they call hypoglycemia. It's a [45:34] medical term to describe very low blood [45:37] sugar levels. And [45:40] then next year they provided [45:41] carbohydrates and these marathoners in [45:43] the Boston Marathon and all of them [45:45] improve their performance. And so since [45:47] 192 or 1925 actually we've known that [45:50] carbohydrates can improve performance. [45:52] But we what has happened though over [45:55] time is that in 1960s [45:57] we there was a measurement technique [45:59] called the Birdstrom method where you [46:01] actually did a muscle biopsy pulled out [46:05] muscle tissue and found that oh wow [46:06] there's actually glucose stored in the [46:08] muscle. So it must be really important [46:10] for physical performance. If the muscle [46:12] which is used to contract and move the [46:15] body during physical performance that if [46:17] glucose is in that tissue, it must be [46:19] essential for performance. And then [46:21] after they discovered that there was all [46:23] these associations between low glucose [46:26] levels in the muscle called glycogen, [46:28] low glycogen and fatigue. Then after [46:31] that the in the 1980s they were able to [46:35] look at the amount of [46:38] sugar, carbohydrates and fat that the [46:40] body was burning during exercise. And [46:43] what they found at that stage is that oh [46:45] wow it looks like the the amount that [46:48] people are able to sustain intense [46:52] exercise is proportional to how many [46:56] carbohydrates they're burning. [46:59] And then there was a few modeling [47:02] studies Stephen that then looked at okay [47:04] what's the relationship between [47:06] let's say uh the intensity of exercise [47:10] and what type of fuel you use whether it [47:12] be fat or carbohydrates [47:15] and they found that they modeled it okay [47:18] and said okay well at lower intensities [47:20] you must burn almost all fat and at very [47:23] high intensities you must burn carbs and [47:26] there was a number of studies in 2017 to [47:30] 2020, three different studies that [47:33] looked at the ketogenic diet over a 5day [47:35] to 3 week period. And they saw that in [47:39] those studies that there was a decline [47:40] in performance by around 2%. [47:44] >> If you were in the ketogenic diet, if [47:46] you 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 [47:51] researchers? Well, it said, "Okay, well [47:52] obviously the ketogenic diet must impair [47:54] performance." And there's all this [47:55] evidence since 1921s that the amount of [47:57] carbohydrates, glycogen, how much carbs [48:00] you're you're consuming is essential [48:02] performance. But here's the kicker is [48:04] that [48:06] one major confounder of all this is that [48:08] we've known for quite a long period of [48:10] time that the adaptation to a ketogenic [48:12] diet is not one week, it's not two [48:16] weeks, not even three, it's four weeks [48:19] or more. And when you say adaptation, [48:21] you mean your body's transition to being [48:23] in a a state where it's efficient at [48:26] burning using ketones. [48:29] >> So the body's ability to [48:32] lower its glucose oxidation or the [48:35] amount of carbohydrates it's burning for [48:37] fuel because you're giving your body [48:39] less of it. The amount of fat that's [48:41] being utilized for fuel goes up [48:42] dramatically. And then you produce way [48:45] more ketone bodies. And ketones are now [48:46] being used as not only a a body uh [48:50] tissue substrate meaning energy for the [48:53] muscle but also for the brain. And so [48:56] it's this transition over. But when [48:59] people were looking at these studies [49:00] they were just looking at some of the [49:03] metrics of what happens when you your [49:06] body transforms when you reduce [49:08] carbohydrates. [49:09] >> Okay. So what we wanted to do is say, [49:11] okay, if there's all these [49:13] healthpromoting benefits of a ketogenic [49:15] diet, that sounds great, but all these [49:18] studies and sports dogma would say [49:20] that's going to impair performance. [49:21] Okay, so let's test that. Let's actually [49:24] put athletes on a ketogenic diet for 4 [49:28] weeks. We are going to control not only [49:32] their calories, we're going to control [49:33] their body composition, we're going to [49:35] control their activity level. We're [49:38] going to control all these key [49:39] confounders that many of these prior [49:41] studies never controlled so that we [49:44] could truly test the diet induced so the [49:47] macronutrient meaning the shift from [49:49] carbs to fat effect on performance but [49:53] we're going to do it in the same person. [49:55] So now we're going to control their [49:56] genetics. We're going to control their [49:58] environment. Once we did that, Stephen, [50:01] we tested what most people think is a, [50:05] you know, a very glucose dependent form [50:07] of exercise. We asked them to do 6 by [50:09] 800 meter sprints. They were on a high [50:12] carb diet and then they switched to a [50:13] low carb diet. Now, what happened this [50:15] is all randomized uh and controlled. [50:18] When they switched over, [50:20] they had no deterioration in performance [50:25] >> at four weeks. at the four-week mark in [50:28] a form of exercise that we would expect [50:32] would be extremely glucose dependent, [50:34] extremely carbohydrate dependent. [50:36] >> But before 4 weeks, was there an [50:38] impairment in their performance? [50:39] >> So what we were interested in, Stephen, [50:41] is studying at the end. So we didn't [50:44] look intermediately. We exclusively look [50:46] at the end time point because the the [50:48] question was, well, if is there a [50:51] difference once you stick to this diet? [50:53] Because if you you go on this diet, [50:54] ideally you're you're sticking with it [50:56] over time. And so [50:59] if it is true that you require [51:01] carbohydrates, we then also measured how [51:03] many carbohydrates and fat they were [51:06] burning during exercise. [51:09] And it was over what we call 85% of [51:12] their V2 max, which means 85% of their [51:15] total maximum oxygen consumption during [51:18] exercise. [51:20] That is when we would expect almost no [51:23] fat to be oxidized or to be burned and [51:27] almost exclusively carbohydrates. Well, [51:30] we found that these athletes recorded [51:33] the highest levels of fat burning during [51:36] exercise ever reported in the [51:38] literature, illustrating that when these [51:40] athletes, [51:41] >> the ketogenic [51:42] >> ketogenic diet that when these diets [51:45] adapted to the diet for sufficiently [51:47] long, they had record levels of fat [51:51] oxidation even at very high intensity [51:54] levels. which means that fat was able to [51:57] provide nutrients and fuel at very very [52:02] intense forms of exercise when we would [52:03] expect only carbohydrates would be [52:05] relevant and utilizable. [52:09] So many of my friends um that are [52:12] endurance athletes or that are involved [52:15] in things like cycling talk about [52:16] exogenous ketones. Um I'm a co-owner of [52:19] a company that produces exogenous [52:21] ketones. That's my disclaimer. I've got [52:23] the product here. What can you tell me [52:26] about products like this? Exogenous [52:28] ketone products. Exogenous meaning [52:30] externally supplemented, I guess, [52:33] >> right? So, with a ketogenic diet, you [52:34] produce them. Your liver produces them [52:36] for you. With um exogenous, you're [52:40] consuming these. Well, why would you [52:43] consume them? Why not just do a [52:44] ketogenic diet? Well, we know that a [52:47] ketogenic diet [52:50] takes time to adapt. We just talked [52:51] about that with physical performance [52:52] that we see that you know up to four [52:54] weeks to see the full effect on on [52:56] performance or more. Well, what happens [53:00] if you're let's say a war fighter or [53:02] someone who's going out into the field [53:04] or immediately wants to flip into this [53:06] state? You can't do that unless there [53:10] was a molecule that you could consume [53:12] that could rapidly elevate ketone bodies [53:14] in circulation within minutes. [53:17] Insert exogenous ketone bodies. We have [53:20] known since the 1960s [53:25] that the product in there was studied by [53:27] MIT uh in the aerospace department [53:30] called 13butane dial. It that it was [53:32] able to be consumed and rapidly elevate [53:36] ketone bodies in circulation. There was [53:38] a study in 2016 called the metabolic [53:41] optimization $10 million program from [53:43] DARPA. DARPA being the [53:45] >> DARPA is an advanced research [53:47] organization from the United States [53:48] government where they fund very high [53:49] risk high reward programs and one of [53:52] which was the the the use and testing of [53:55] ketone bodies. And so that uh molecule [53:57] that they tested was um utilized the [54:00] same molecule that's in there and they [54:02] kind of uh tweaked some of the [54:04] formulations a bit and they showed that [54:06] and we know that this is the same for [54:08] this molecule as well that when you [54:10] consume them it rapidly changes [54:12] metabolism almost uh not identical to [54:15] what happens with the ketogenic diet but [54:17] it has a almost direct impact. It has a [54:20] blood glucose lowering effect. it [54:22] directly binds to receptors like the um [54:26] they call GPR 109A or uh or some other [54:31] key receptors that directly uh impact [54:33] inflammation. So it directly blocks [54:35] something called NLRP3 inflammosome [54:38] which is a molecule that leads to [54:40] increases in inflammation. We also know [54:42] that it changes the way that our genes [54:46] are used in the body called epigenetic [54:49] signaling. And so the uh consumption of [54:52] ketone bodies can actually change the [54:55] molecules on our genes and and how those [54:58] molecules are ultimately manifested and [55:01] that increases our antioxidant capacity [55:04] meaning our ability to block oxidative [55:06] stress in the body. We we see all these [55:10] powerful effects, these rapid shifts in [55:12] metabolism within the body. And this [55:14] 2016 study showed that just orally [55:17] consuming these molecules could rapidly [55:19] shift metabolism, but that it was also [55:21] linked to an improvement in physical [55:22] performance. But if you look beyond that [55:25] and just like uh these these kind of [55:28] studies because we looked at them in [55:29] athletes, we looked at them in healthy [55:30] individuals and then also in military [55:33] settings. But we've also there's studies [55:35] looking at this in patients at risk for [55:37] cognitive decline. So patients at risk [55:38] for Alzheimer's disease. They've shown [55:41] that in a six-month study administering [55:42] exogenous uh ketone bodies was able to [55:45] attenuate the decline in uh cognition [55:48] that we know happens with advanced age. [55:51] >> And just to be clear there, you're [55:52] saying it reduces the decline. It [55:53] doesn't [55:54] >> correct [55:55] >> cure Alzheimer's or fix Alzheimer's. It [55:57] just delays. [56:00] >> Accurate. Yes. It's it's we know that as [56:03] individuals age, you're on a precipitous [56:06] or or steady decline in in brain [56:09] function. Um, and so the goal is to to [56:14] offset or to stop the decline. You know, [56:16] that's our goal. We want to maintain [56:18] normal uh brain function and our ability [56:20] to think clearly and to understand [56:23] things clearly like reading and and [56:24] doing problems and solving problems. [56:27] There have also been this emergence of [56:29] studies in the world of psychiatry. I [56:32] think there's around 11 ongoing active [56:35] clinical trials looking at the impact [56:36] and interaction of ketonebased therapies [56:39] and brain health uh particularly serious [56:42] mental illness. One in four adults in [56:44] the United States actually over one in [56:45] four adults in the United States has [56:47] serious mental illness. In fact, I [56:49] believe over the numbers are over 20% of [56:51] of adults are taking some type of psycho [56:55] uh altering medication. At its core, we [56:58] see all these relationships [57:00] between underlying metabolism being a [57:03] key [57:05] factor contributing to mental health [57:07] status. and the application of the this [57:09] unique diet which we know increases [57:11] ketone bodies which appear to have [57:13] direct impacts on the brain now seems to [57:16] be linked to improved serious mental [57:19] illness and it'll be interesting to see [57:21] where the that evolves but it's just a [57:23] fascinating world to imagine that [57:25] nutrition not a medication not a [57:29] technology but the the simply going to [57:31] the grocery store and swapping the [57:33] things you choose in there can lead to [57:35] these powerful powerful therapeutic [57:38] effects um in people of all sorts of [57:41] different conditions uh or disorders. [57:44] >> On one of the studies that I read about [57:46] the administration of exogenous ketones [57:49] and the impact it has on brain network [57:51] stability was from 2020 where they [57:53] investigated if brain network stability [57:55] responds to two major brain fuels either [57:58] glucose or ketones. And participants [57:59] came to the laboratory on two occasions [58:01] and drank exogenous ketones or glucose. [58:05] And after cons consuming these drinks, [58:07] they underwent an MRI scan. Strikingly, [58:09] the study showed that ketones increased [58:11] the stability of brain networks. In [58:13] contrast, glucose decreased the [58:14] stability of the network. The network [58:16] stability was 87% greater after ketone [58:19] consumption than stability measured [58:21] after glucose consumption. And in that [58:23] study which is on PubMed, the last line [58:25] of the abstract says, "Dietary [58:27] interventions resulting in ketone [58:29] utilization increase available energy [58:31] and thus may show potential in [58:34] protecting the aging of the brain which [58:37] is super interesting. [58:38] >> So we did a study uh looking at cancer [58:41] and applying exogenous ketones and a [58:43] very aggressive form of metastatic [58:45] cancer. And what we saw in in my work in [58:47] graduate school is that when applying [58:49] disogenous ketones that it delayed the [58:52] progression of the metastatic cancer, [58:55] but it also [58:58] when looking at body weight reduced the [59:01] rapid decline in body weight we [59:03] sometimes see with cancer. A phenomenon [59:05] called cexia which is a way a term to [59:08] describe the wa rapid wasting of body [59:12] tissue with disease. And it is no more [59:15] aggressive than the context of cancer [59:17] particularly metastatic cancer is where [59:18] it's most common and when we saw the [59:21] lack of decline in body weight I then [59:25] looked at where the body weight was [59:26] coming from and it was clear that the [59:29] lack of body weight decline [59:31] was because of the preservation of in [59:34] muscle mass. So it also appeared and [59:36] there's been a number of what they call [59:38] clinical physiology studies. those [59:40] studies that actually directly [59:43] manipulate human beings with molecules [59:46] and tests, you know, like muscle tissues [59:48] and how they function. We see that [59:52] exogenous ketone administration can [59:56] dramatically reduce the amount of muscle [59:57] breakdown uh or breakdown of muscle [60:00] tissue. Uh essentially illustrating it [60:03] may be a powerful mechanism in promoting [60:06] healthy muscle mass as well. In terms of [60:09] being in a ketogenic diet, one of the [60:10] things I'm always quite concerned about [60:11] is am I still able to gain muscle mass [60:15] if I'm in a ketogenic diet? Because I [60:17] >> Yeah, I when I go into a ketogenic diet [60:20] and I stop having carbohydrates, I tend [60:22] to lose weight rapidly and shred. [60:24] >> Yeah. [60:24] >> The fats falls off and I get very lean [60:28] but [60:29] >> yeah, [60:30] >> more skinny. [60:31] >> You smiled though because maybe you like [60:34] to be more shredded. Um, so a phenomenon [60:37] with the ketogenic diet. So there's no [60:39] deterioration in muscle mass with the [60:41] ketogenic diet. There have been plenty [60:42] of studies that have shown that you're [60:43] able to maintain muscle mass [60:45] >> and build it. [60:46] >> Yes. And build it. So they've shown that [60:48] as well. So Jeff Volic out of Ohio State [60:50] University has done a number of studies [60:51] in this area. Um, looking at individuals [60:54] who were actually on a [60:57] reduced intake diet. So they're reducing [60:59] less calories. So they had less energy [61:01] in the diet. And then they were also [61:03] doing the ketogenic diet. It was [61:04] actually a military study and they [61:06] showed that they were able to maintain [61:08] uh muscle mass just as much as if [61:09] someone was on a high carb diet um while [61:13] under a caloric restriction or another [61:16] way of describing that is like a semi [61:17] starving starvation state. So there's no [61:21] impact negative impact that we see with [61:24] these diets on muscle mass. However, to [61:26] your per your personal example, one of [61:28] the first things that happens when you [61:29] go onto a ketogenic diet is there's a [61:32] naturatic effect or natures effect, but [61:34] basically you reduce the amount of [61:36] sodium in the body. So, you you you p [61:39] you piss it out basically and um you so [61:42] you hold less water weight and that's [61:44] one of the first things. That's why [61:45] people see this rapid shift in body [61:46] weight initially when they're you know [61:48] on a ketogenic diet, which for many [61:49] people is great because if they're [61:50] trying to do it to lose weight, that's [61:52] like immediate reinforcement. But [61:53] sometimes it's water weight. Well, water [61:55] is in both the fat and the muscle. So, [61:57] it's it's not necessarily that you're [61:59] losing any muscle mass per se, but it [62:00] just might be in a phenomena less water [62:02] weight. And in some context, that might [62:03] be beneficial. Right? If you're in a [62:05] sport where you have a [62:07] power toweight ratio, but you're able to [62:09] maintain the same power at a lower [62:12] weight simply by shifting water, that's [62:15] great. Um, as long as you're able to [62:16] function equivalently. Is there anything [62:18] I do need to be thinking about in terms [62:20] of my diet to make sure I'm still [62:22] gaining weight just to I guess to keep [62:24] to keep my protein levels high? [62:27] >> So, the most important thing related to [62:28] your diet when it comes to trying to [62:30] build muscle mass is to exercise hard [62:33] and with resistance exercise. Uh that's [62:36] the most important thing when it comes [62:37] to your diet to enhance that effect. [62:40] Protein is one of the the most powerful [62:42] nutrients you can consume to augment [62:45] that response. Another is to ensure [62:47] you're having uh sufficient [62:50] calories. Right? So if you're in a [62:52] caloric deficit, so you said that you [62:53] know you tend to eat less calories [62:54] because you're probably not as hungry. [62:56] Um well, yes, that's one of the most [62:58] powerful ways to lose not only fat but [63:00] also muscle is to just not eat food or [63:02] >> I think that's it because I I lose my [63:05] appetite when I when I'm in the [63:06] ketogenic diet. [63:08] >> I also lose my appetite a little bit [63:09] when I take these um exogenous ketones [63:11] like Ketone IQ. [63:12] >> Yeah. And I've seen some of the studies [63:14] that show that there's roughly 20% [63:16] decrease in [63:18] um appetite [63:20] when you take exogenous ketones [63:22] according to one particular study that I [63:23] read. But when I when I'm in the [63:24] ketogenic diet, I it's like food is I [63:28] get hungry but then I start eating and I [63:31] stop very quickly. [63:32] >> Yeah. [63:33] >> And it's really bizarre. Like I was I [63:35] was in Cape Town for 10 days or two [63:37] weeks writing my book. And so I had the [63:39] chef there and the chef cooks me my food [63:40] and makes this amazing food and I'm so [63:42] hungry. I look at it I'm like amazing. I [63:44] start eating it. I have like five or six [63:46] bites and I'm done. And only when I'm in [63:48] the ketogenic diet, there's something [63:50] going on in my body which just doesn't [63:52] just doesn't want to binge eat like I [63:56] sometimes did. [63:56] >> So there's two things to talk about. One [63:58] is the type of foods you're consuming on [63:59] a ketogenic diet and the other is what [64:01] is happening in your body in your [64:03] metabolism on the diet. So there's a a [64:06] book called Always Hungry by a physician [64:09] u endocrinologist named David Lugwid and [64:11] he's kind of coined this carbohydrate [64:14] insulin model and um you know it's semi [64:17] somewhat controversial but the the [64:19] reality is that there's there's some [64:21] important notes in it. One related to [64:23] hunger which is if you're able to have a [64:24] fuel source on a ketogenic diet that's [64:27] sustained over time. So you don't have [64:28] the up and downs of glucose and up and [64:30] downs insulin. these constant swings. [64:32] Whereas on a ketogenic diet, you have [64:33] this sustained level of fuel influx, [64:36] right? So you have this nutrient [64:38] availability in the blood. So glucose [64:39] levels are much more stabilized, insulin [64:40] is much more stabilized, and you don't [64:42] have those fluctuations particle. [64:46] That might be one potential reason. But [64:48] the other potential reason is that when [64:49] you're on a ketogenic diet, you tend to [64:52] not consume the type of foods that drive [64:55] hunger. So again, we talked about in the [64:58] grocery store, the 70% of the grocery [64:59] store, particularly in the center of the [65:01] grocery store that is highly processed [65:03] where they combine [65:06] carbohydrates with with salt or fat or [65:08] some combination there in that makes it [65:09] highly palatable or very very tasty, you [65:13] know, increase the dopamine response, [65:15] this positive reinforcement response of [65:17] the food. Um, that drives people to to [65:21] seek more of that pleasure response and [65:23] as a result, they want to consume more. [65:24] So, everyone has probably felt this [65:26] example where you're in a restaurant, [65:28] you've eaten enough food to where you [65:29] feel physically full. You're like, "Oh, [65:31] I'm totally full. Like, I don't want to [65:33] eat any more food." Someone walks by [65:36] with your favorite dessert. And you're [65:38] like, "Oh, well, h I could eat that." [65:42] You're literally physically full, but [65:45] yet you want to consume more food. This [65:50] is a is a a phenomenon that has been the [65:54] struggle of of in America and the the [65:57] rest of the world essentially now um [65:59] where the food environment often drives [66:01] people to over consume and it's not by [66:04] accident. These are like well conducted [66:07] strategies in the food industry to lead [66:10] to these positive pleasure responses. [66:11] >> I think about this with bread in the [66:13] restaurant. You know they give you bread [66:14] first. [66:16] >> Yeah. That's a good It's a solid [66:18] strategy, Stephen, to cause you to want [66:20] to consume start to finish not only the [66:23] bread, get a big meal, and follow on [66:26] with dessert. You know, it it is a is a [66:28] is a great strategy for ensuring that, [66:30] but it's also the same strategy that, [66:32] you know, Doritos is using where like [66:34] you you combine this mixture of new uh [66:39] molecules in the food that you consume [66:41] it, you get, oh, this tastes great. [66:42] Pringles. [66:43] >> The same exact thing where you combine [66:46] these different components and it forces [66:48] you this like, "Oh, this tastes great. I [66:50] need more." And you never feel full. One [66:52] of the most common tricks that the the [66:55] food industry utilizes in these [66:58] environments is that they one they they [67:02] certainly are aware of this, right? And [67:04] so when you consume these type of foods [67:06] together, they they know they consume [67:08] more of it, but sometimes people aren't [67:10] even aware of it. And best example of [67:13] this, go look at the back of most of the [67:16] bacon [67:17] on the grocery store aisle. Go look at [67:19] the back of most peanut butters, almond [67:21] butters, nut butters in the grocery [67:23] store. Most of them have added salt and [67:27] added sugar. Even to levels where you [67:30] don't even taste it, but go look at the [67:32] label. The reason those are added is to [67:36] increase the flavor profile, the [67:38] positive brain response to the food. so [67:41] that you consume more of it. And this is [67:44] a huge part in why people always feel [67:48] hungry in today's food environment. [67:51] They're always seeking more food [67:54] and they can't get off that hamster [67:57] wheel. They're always over consuming or [67:59] always referring to this phenomenon [68:01] called food noise where they always feel [68:03] the drive to consume foods or they never [68:06] feel full. And [68:08] >> it's and it's because of the sugar and [68:09] the soap. It is because the food is [68:14] composed and made in such a way to be to [68:16] have a flavor profile that your brain [68:20] says [68:22] not just eat one bite, eat as much as [68:24] possible because we're always seeking [68:26] these pleasure responses, right? In our [68:29] lives, in our world, it's this is even [68:30] independent of food. [68:32] >> So, what do we do about this? [68:34] So the solution for most people in this [68:37] situation is to try to focus number one [68:41] don't consume liquid calories. That's [68:43] like a dead giveaway bad move because [68:46] those are abundance of calories [68:50] will drive people often to over consume [68:52] them and very drive this pleasure [68:54] response in the brain. [68:55] >> Liquid calories. What's a liquid [68:56] calorie? [68:57] >> So let's say you have uh a soda or a [69:00] Coke. [69:01] >> Yeah. So basically completely void of [69:03] any nutrients and really high in [69:07] calories, spikes your glucose through [69:08] the roof, insulin through the roof, and [69:10] then often makes you hungrier [69:12] afterwards, not less hungry by having [69:14] >> like orange juice [69:15] >> is another great example. [69:17] >> Smoothies, those those fruit smoothies [69:19] people have. [69:20] >> Exactly. In fact, just taking fruit and [69:22] then blending it up actually increases [69:23] the speed by which it's absorbed changes [69:26] the hormonal response and leads to a [69:28] worse outcome for most people. Most [69:29] people think a fruit smoothie is a [69:31] healthy thing. [69:32] >> Yeah, I don't know about that. Um, I [69:35] would I think that when you take fruit, [69:38] which for most reasons isn't terrible, [69:40] right? Like, it's not these are [69:42] nutrient-dense foods, if people can [69:44] consume them and get away from them, [69:46] great. If you have a metabolic disease, [69:47] you might be more vulnerable to, let's [69:48] say, glucose elevations. But when you [69:51] then take foods like that, it could be [69:52] any foods. It could be taking potatoes [69:54] and then making mashed potatoes. By [69:56] simply changing or blending that food [69:59] up, you're now taking a lot of the [70:01] structural components that your body [70:02] would take time to digest and you're [70:04] removing them and you basically almost [70:07] are like almost turning on like a small [70:10] hose that's just giving a little bit of [70:12] water at a time and it's turning it on [70:14] all the way. you know, you're rapidly [70:16] increasing the speed of how the [70:17] nutrients enter the body and it [70:19] completely changes the hormonal response [70:21] of molecules like GLP-1 and and normal [70:24] levels of GLP1 in the body are [70:26] completely altered. The insulin response [70:28] is also altered [70:29] >> and GLP1 is the hunger hormone. [70:32] >> It's known for being related to hunger [70:34] because it's released in response to [70:35] food. It changes the brain's hunger [70:40] drive and most people know of it because [70:42] of [70:44] >> oimpic simaglletide wobi traipide um all [70:48] these GLP-1 receptor agonists that [70:52] are [70:54] increasing GOP1 levels not to normal [70:57] levels they're increasing them to super [71:01] physiologic levels mean levels that [71:03] would never be observed or ever seen [71:06] in normal settings of the body. [71:09] >> I've just invested millions into this [71:11] and become a co-owner of the company. [71:13] It's a company called Ketone IQ. And the [71:16] story is quite interesting. I started [71:18] talking about ketosis on this podcast [71:19] and the fact that I'm very low carb, [71:21] very, very low sugar, and my body [71:23] produces ketones, which have made me [71:24] incredibly focused, have improved my [71:26] endurance, have improved my mood, and [71:28] have made me more capable at doing what [71:30] I do here. And because I was talking [71:31] about it on the podcast, a couple of [71:33] weeks later, these showed up on my desk [71:35] in my HQ in London, these little shots. [71:38] And oh my god, the impact this had on my [71:42] ability to articulate myself, on my [71:44] focus, on my workouts, on my mood, on [71:47] stopping me crashing throughout the day [71:49] was so profound that I reached out to [71:51] the founders of the company, and now I'm [71:53] a co-owner of this business. I highly, [71:56] highly recommend you look into this. I [71:57] highly recommend you look at the science [71:58] behind the product. If you want to try [72:00] it for yourself, visit [72:01] ketone.com/stephven [72:03] for 30% off your subscription order. And [72:05] you'll also get a free gift with your [72:07] second shipment. That's [72:08] ketone.com/stephven. [72:12] And I'm so honored that once again, a [72:13] company I own can sponsor my podcast. [72:16] Just give me 15 seconds to explain how [72:18] you can build a viable business online. [72:20] The people I see winning in life don't [72:21] have a perfect plan. They just take the [72:23] first step and then the next and then [72:24] they keep going. They stay obsessed and [72:26] they stay consistent. And Standtore, a [72:29] platform I co-own and one of our [72:30] sponsors, is the best first step to help [72:33] turn your knowledge into income. It only [72:35] takes a couple of minutes to launch your [72:37] business and start selling digital [72:38] products, coaching, memberships, or [72:40] communities online without any tech [72:42] headaches or endless setup. Thousands of [72:45] entrepreneurs, creators, and risktakers [72:47] use Stan to take control of their future [72:49] because Stan is for entrepreneurs, for [72:51] those willing to put in the work and bet [72:53] on themselves. If you're ready to start [72:56] building, join us. Launch your business [72:58] today with a free 14-day trial at [73:01] stephvenbartlet.stan.store. [73:05] So, I want to give the audience that are [73:06] listening some practical ways that they [73:08] can change their life to live a better [73:10] life and to navigate the food [73:12] environment we live in. But just to just [73:13] generally the advice that you would give [73:15] if you had the ear of I don't know five [73:17] million people right now and you could [73:19] say something to them to help them live [73:21] better lives, to perform better. What [73:23] advice would you give them? [73:25] >> Number one is I would say be conscious [73:28] of the food you're consuming and what [73:29] you're consuming on a daily basis. The [73:31] impact of food is is equivalent to [73:33] medicine. It is and sometimes more [73:35] powerful than medicine. So, uh what you [73:38] drink, what you eat, you know, focusing [73:40] on whole foods, not consuming liquid [73:42] calories. And if you're someone who [73:44] could benefit uniquely from stable [73:46] glucose levels, lower insulin levels, [73:48] like someone who has some type of [73:50] metabolic disorder like I do, reducing [73:52] carbohydrates oftentimes can be a very [73:54] powerful strategy. In fact, known to [73:56] prevent and reverse things like obesity [73:58] and type 2 diabetes with emerging [74:00] evidence for its potential ability to [74:02] put things like serious mental illness [74:04] into remission, but we'll see as more [74:05] evidence comes out. Exercise on a [74:08] regular basis. We know that exercise [74:10] might not be the primary the lack of [74:12] exercise might not be the primary driver [74:13] for why someone is or isn't obese, but [74:16] we do know that physical activity [74:17] promotes health. We do know that [74:19] physical activity uh is extremely [74:22] important for overall well-being. And so [74:24] >> you've got big muscles. [74:25] >> Oh, well, [74:27] >> is that somewhat linked to your your [74:29] type 1 diabetes at all? Is that is that [74:31] part of your strategy? You know, look, I [74:33] was obese at one point. And so I I've [74:36] since that point taken a very I become, [74:39] you know, obsessed with trying to find [74:41] out how to be bigger, stronger, faster, [74:43] optimize my metabolic health, optimize [74:45] my performance. And so it's been a [74:46] lifelong kind of self-experiment in that [74:48] in that journey. But yeah, exercise is [74:51] just important in general. But it's for [74:52] me it's about all the different [74:54] experiments and and strategies I can use [74:56] with exercise uh with resistance [74:58] exercise and beyond to kind of play [75:01] around with what affects my body, what [75:02] affects my insulin, how do I increase my [75:05] overall metabolic health and what I have [75:07] seen is that that's directly linked to [75:08] my performance. [75:09] >> How often do you exercise? [75:12] >> I try to exercise every single day. Um [75:15] as much as I [75:16] >> How long for and what types of exercise? [75:18] So what I do right now is I typically do [75:23] weightlifting for 30 minutes to an hour [75:24] every or six days a week. Um and then I [75:28] will go typically ride a bike to [75:32] jiu-jitsu. So Brazilian jiu-jitsu which [75:34] can be uniquely almost like a mixed [75:37] exercise, intense exercise where it's [75:38] going to be extremely intense for like 5 [75:40] minutes and then you have a one or two [75:41] minute break. Extremely intense and then [75:42] a break. Uh and I do that typically [75:44] around 5 days a week. Um, I also try to [75:48] purposely engage in some type of aerobic [75:50] exercise when I can. If I I wasn't able [75:52] to do as much jiu-jitsu one day or as [75:55] much uh resistance exercise. I always [75:57] try to add on some type of [75:58] cardiovascular work, whether that be a [76:01] run, a bike, or these aerodyine bikes [76:03] where it's just lower and upper body. I [76:05] find those to be incredibly uh effective [76:07] and powerful tools and actually um uh [76:11] just not causing damage to muscle tissue [76:14] but also allowing you to improve your [76:16] overall cardiovascular health. [76:17] >> What does your diet look like? [76:19] >> So I tend to wake up and not think about [76:22] food. That's one thing that I've also [76:23] experienced similar to you that when I [76:24] switched to a ketogenic diet, not only [76:26] improve my glucose and insulin, but I [76:29] also found that with a ketogenic diet [76:31] that I [76:34] don't feel hungry. So, I would wake up [76:35] and I don't tend to eat food right away. [76:38] In fact, [76:40] I enjoy when I don't eat food more so [76:42] than when I do eat food often times just [76:43] because not because I don't enjoy the [76:45] feeling of sitting down and having food. [76:47] I love that. [76:48] But [76:50] the experience and lived quality of life [76:53] of not having high variable glucose [76:56] levels, high insulin levels, and the [76:58] uncertainty that comes with that in my [76:59] daily life, I enjoy the 23 hours or 22 [77:04] hours of my day where I have the [77:05] stability, not the the moments in time [77:08] where I'm introducing uncertainty and [77:10] variability. [77:11] to dumb that down a little bit. What I'm [77:13] saying is that when I when I don't eat I [77:16] wake up and I don't eat food because I [77:18] find that it I'm not hungry, but I also [77:20] find that it makes managing diabetes [77:23] easier. [77:24] >> And so, do you eat once a day or twice a [77:26] day or [77:26] >> I tend to eat two to three times a day, [77:28] you know, sometimes right before [77:30] jiu-jitsu or weightlifting jiu-jitsu, [77:33] always afterwards and always before uh [77:35] sometimes before bed. try not to do it [77:37] right before bed um because it tends to [77:39] impact my sleep quality a little bit. [77:41] But I find that I just eat whenever I [77:44] feel hungry and I try to give myself [77:45] sufficient protein to be able to respond [77:48] to the the exercise that I'm doing. [77:50] >> So, I've got the first one's about being [77:51] intentional about your food choices. The [77:53] second one is about exercise. [77:55] >> Mhm. [77:55] >> Anything else? [77:57] >> Well, sleep's really important. You [77:58] know, these are these are, you know, [78:00] Stephen, this isn't like uh oh, like [78:03] this is the most revolutionary advice of [78:05] all time, but these these core [78:07] foundational components, good nutrition [78:10] tailored to your specific needs, [78:12] exercising as much as you can, and [78:15] getting good sleep are the pillars of [78:17] health. If you don't have those [78:19] corrected, then you're wasting your time [78:22] everywhere else. And is there anything [78:24] as it relates to glucose [78:28] that surprised you? Because you're [78:30] someone that sees a lot of this data. I [78:31] mean, you you you you walk around with [78:33] the the the two devices on that you've [78:35] mentioned and you're you're looking at [78:36] the insulin and glucose response. Is [78:39] there anything that people don't [78:41] understand as having a really pronounced [78:44] impact on their glucose levels that they [78:45] wouldn't expect? Like orange juice is [78:47] one of the ones that growing up I [78:48] thought [ __ ] I thought this was a [78:50] healthy thing. I used to I used to drink [78:51] Sunny Delight thinking I was putting all [78:53] these amazing vitamins in my body [78:55] >> and now I actually look back and regret [78:57] it and I you know [78:59] >> not to be judgmental over any parents [79:00] because parenting is very hard but [79:02] sometimes I'll see parents giving their [79:05] children like a big glass of orange [79:06] juice and in my head I just see the [79:08] glucose spike that that child's about to [79:10] have. It's funny when you mention [79:11] parenting because I have a three and a [79:13] six-year-old at home and it's amazing [79:16] when they try one of these foods, these [79:19] very sugary foods, these very tasty [79:22] foods, they [79:24] it's almost like they become incessant [79:27] on wanting it again. You know, like [79:28] normal food isn't good enough anymore. [79:31] Um, [79:32] and I think that's a great illustration [79:34] of of what many of us adults are are [79:37] challenged with on a daily basis, but [79:38] yet many people are just unaware of the [79:41] impact that it's having on their [79:42] metabolism, impacting it's having on [79:43] their hunger, the impact that that's [79:45] going to lead to on their future health. [79:47] >> And is there anything that you've [79:48] spotted from your experiments with your [79:50] your CGM and your insulin device that [79:54] people should most certainly avoid? So, [79:55] you said liquid calories. Is there [79:56] anything else that causes a really [79:58] pronounced or unexpected glucose [79:59] response? Yeah, you know, there's so [80:02] many honestly, Stephen, over time that [80:04] it's honest, it's really hard to [80:06] pinpoint any singular one. A lot of the [80:10] foods that are out there are often [80:12] surprisingly challenging on glucose [80:15] levels, on insulin levels, particularly [80:17] the processed foods, because what [80:19] happens when you make these food [80:21] products is that you're trusting the [80:23] food company to put ingredients in there [80:24] that you're going to respond favorably [80:26] to, that your metabolism will respond [80:27] well to. And the truth is that that's [80:31] far from a guarantee and in many cases [80:33] maybe uh less likely than it is likely. [80:36] And so yeah, I don't have a singular [80:38] example for you, Stephen. I just But [80:40] I've experienced it numerous times. [80:41] >> So I've got a a small list here. Um [80:44] sugary drinks, white bread and bagels, [80:46] white rice. That surprised me a lot cuz [80:48] I used to think white rice Oh, really? I [80:49] I thought growing up rice was like a [80:51] health food. [80:52] >> Okay. Well, so on that note, [80:55] white rice, potatoes, [80:58] potatoes in any form. [80:59] >> Sweet potatoes tend to have less of a [81:01] glycemic response, but it's still going [81:03] to have a a potent glycemic response. [81:05] >> So, mashed or baked potatoes, obviously, [81:06] French fries. Yeah, [81:08] >> for sure. French fries. Most of like [81:10] pasta is a big one. [81:12] >> Cereal, [81:14] refined cereals, [81:15] >> most cereals are actually worse than the [81:18] foods I just described on blood sugar [81:20] and insulin by a long shot. In fact, uh [81:24] mo most of the you know these [81:25] hearthealthy cereals um [81:29] these these would I would never blood [81:31] sugar would just spike through the roof [81:33] portion of the amount I ate. So yeah, it [81:34] it I wouldn't I wouldn't be consuming a [81:36] lot of those. And I think I think most [81:39] people at this stage in the the health [81:41] and science world would also generally [81:44] align with with that that those aren't [81:46] necessarily the best foods to consume. [81:47] we would think, you know, more more of [81:51] the less glycemic or less the foods that [81:54] have less of an impact on glucose [81:55] levels, less of a impact on insulin [81:57] levels. You know, one one thing I [81:59] constantly hear, especially in the [82:01] research and clinical community is like, [82:03] well, look, you know, not everyone needs [82:06] to be concerned about that because, you [82:09] know, people can respond to a lot of [82:11] these foods just fine. And I say, [82:12] "You're you're right." Except that over [82:15] half of America has pre-diabetes [82:18] and 90 plus% have some form of [82:21] measurement that indicates that their [82:23] metabolic health is impaired and over 86 [82:28] 68% are obese and now children are [82:32] affected with these diseases with [82:34] obesity and pre-diabetes and around 20%. [82:38] So it it's it's the fact that we are now [82:42] less healthy than than we've ever been. [82:46] Um [82:46] >> we don't have the foundation to support. [82:49] >> Correct. And I think you know when we [82:51] think about healthy nutrition, we think [82:53] about exercise. [82:54] We describe them as medicine, but the [82:56] reality is these are just normal aspects [82:58] of things you should do every single day [83:00] because that's what our bodies were made [83:01] to do. And when we don't do those [83:03] things, this is when health [83:04] deteriorates. This is when we're [83:06] challenging our body to maintain normal [83:08] health. [83:09] >> One of the surprising ones for me was [83:10] dried fruit. And it said while while [83:13] fruit contains natural sugars, the [83:14] process of drying it concentrates those [83:16] sugars. This removes the water and can [83:18] make the sugar more readily available [83:19] for absorption, leading to a higher [83:21] glucose spike compared to fresh fruit. [83:23] Typically, people think of dried fruit [83:25] as being a health food as well. [83:27] >> Yeah. I don't I don't touch those [83:29] because unless I I don't have any [83:31] glucose on me and I my blood sugar is [83:33] going down for some reason and I stay in [83:35] dangerously low levels, that's when I [83:37] consume those foods. Otherwise, I would [83:39] I would not consume them just because of [83:41] how quickly they raise blood sugar [83:43] levels. [83:43] >> Do you think everybody should try the [83:45] ketogenic diet? [83:47] >> Ooh, that is a good question. I think [83:51] Wow. [83:54] What I would say is that you will never [83:59] know the potential of its benefit or [84:02] lack thereof if you don't try. Like [84:05] anything in life, we are we're left to [84:08] assume what everyone else is like. You [84:10] might have we've talked about the [84:11] ketogenic diet numerous times here. We [84:12] talked about exogenous ketones numerous [84:14] times here. [84:16] But if you don't try it, you don't know [84:18] how it'll work for you. In science, [84:21] Stephen, one of the most important [84:23] things to appreciate is that we often [84:25] publish bar graphs look like this. You [84:29] know, the a line uh that illustrates the [84:33] average outcome of a group of people. [84:36] But what you don't appreciate is that [84:39] that line or that bar graph is made up [84:43] of numerous individuals who all average [84:47] to that number. But what if you're the [84:49] person who's at the very high dot or the [84:51] very bottom dot, meaning that you're the [84:53] what they call an outlier or someone who [84:55] responded negatively or positively to [84:57] that and then you just follow the [85:00] average advice that that study showed. [85:03] Well, oh, look, I tried this approach [85:05] and it didn't it didn't work for me. Uh, [85:07] I'm just going to keep trying cuz this [85:08] study said that I should. Well, no. you [85:12] might be the person who was in that [85:14] study who didn't respond just like the [85:16] person on the opposite end of the [85:17] spectrum who did who averaged out to the [85:20] metal. [85:21] >> So when in that study that talked about [85:23] the impact of exogenous ketones on brain [85:25] stability, someone might have had 100% [85:27] improvement in brain stability and [85:29] someone might have had 20% improvement [85:31] or whatever and they've averaged it out [85:33] um across a bigger group of people. So [85:35] if you you are that person that had a [85:37] 100% gain in brain stability, it's a [85:39] pretty unbelievable tool for you to [85:41] understand based on your body. [85:44] >> Exactly. And and that's that's always [85:46] the case in science. I mean there are [85:48] and there sometimes we look at this as [85:50] responders and non-responders. Um but [85:52] actually in the study where we gave um [85:54] uh the product from ketone IQ in the the [85:59] SOCOM study, we actually saw that nearly [86:01] all of them saw an increase in SPO2. [86:03] nearly all themselves an increase in [86:05] heart rate but that's rare that is rare [86:08] >> sp2 [86:09] >> ah so uh the amount of oxygen in the [86:11] blood so the the measure that would [86:13] indicate whether someone [86:15] >> uh in these low oxygen environments had [86:18] more blood or less more oxygen or less [86:20] oxygen [86:22] >> ultimately it's it's important to try I [86:24] I think it's I would always say yes you [86:26] should try because or any nutrition [86:29] strategy because you should try [86:31] different ones I've probably tried over [86:33] plus different diets only honestly maybe [86:34] like 15 or 20 at this point in my life. [86:36] I've just come to find that the [86:38] ketogenic diet for all the reasons we [86:40] described and because I have type 1 [86:41] diabetes and I had obese or have type 1 [86:45] diabetes but had obesity [86:47] find that a ketogenic diet is remarkably [86:49] powerful at helping me live a [86:52] dramatically improved quality of life. [86:54] not have the increased risk for the high [86:56] invariable glucose levels, high insulin [86:58] levels that lead to a a near guarantee [87:01] of complications and 10 to 20 years of [87:04] lost life and expectancy. That's why I [87:06] do it. [87:07] >> I have a closing tradition on this [87:09] podcast where the next guest leaves a [87:10] question for the next guest not knowing [87:12] who they're leaving it for. And this is [87:13] a really tough question. [87:15] >> So, it's a very strange question as [87:17] well, but I'm going to ask you it [87:18] anyway. [87:18] >> Yeah. The question is [87:23] what is outside the simulation? [87:32] I think it depends on your philosophy [87:37] on how our existence [87:41] is [87:44] with the limitations [87:46] of understanding that our awareness of [87:50] our world is completely limited to our [87:53] our brain's capacity and [87:57] our interpretation and then explanation [88:00] of the world and the term of a [88:02] simulation or lack, you know, however [88:04] you want to frame it, I believe is is [88:07] always going to be limited by our [88:09] brain's ability to understand and [88:11] articulate that. [88:11] >> So, what do you think is outside the [88:13] simulation? [88:20] >> Consciousness. [88:22] >> You think consciousness is outside the [88:24] simulation? I think that [88:27] our ability to have not consciousness, [88:30] Stephen, but our ability to [88:34] operate beyond [88:36] consciousness. [88:39] >> Got me on that one, man. That was a that [88:41] >> tough question. [88:42] >> Yeah, it is a tough question. That's [88:43] that's that's a it's a burner right [88:46] there. I don't know. Do do you think [88:48] there is do you think there is a god [88:51] >> beyond beyond this all this stuff that [88:53] we see here? [88:54] >> I'm going to give you the most real [88:55] honest answer possible. [88:57] >> Yeah. [88:57] >> I don't think we ever can actually [88:59] answer that question accurately. [89:01] >> So your your answer therefore is you [89:03] don't know. [89:03] >> I don't know and I don't think I'll ever [89:05] know. [89:05] >> Yeah. Okay. [89:08] Thank you. Thank you so much for doing [89:09] the work that you do. really appreciate [89:10] that because you know so many of my [89:11] friends in this field and even Michael [89:14] the founder of the the ketone product on [89:15] my on my uh table here talk about you as [89:19] being the sort of gold standard of [89:21] research science and um thought [89:23] leadership on the subject of ketones and [89:25] more broadly on the subject of um [89:27] glucose and all of the adjacent subjects [89:29] like insulin. So you've really pushed [89:31] the field forward and the thinking [89:32] forward in this space in a really [89:33] profound way and you're only just [89:34] getting started at 34 years old which is [89:36] remarkable. we're basically the same age [89:38] and uh you've had such a tremendous [89:40] impact on the field of health and that's [89:42] born out of the story that you told at [89:43] the start through your own [89:44] complications. So although it was it's [89:46] such a tragic thing to be have such a [89:47] diagnosis at such a young age, what's [89:49] come from that is a beautiful thing for [89:51] so many people um that will better [89:53] understand themselves and their their [89:55] illnesses but also their performance and [89:57] um everything correlate related to that [89:59] because of you. So please keep doing the [90:01] research you're doing and spreading the [90:02] word in the way you're spreading it [90:03] because it's much much needed work and [90:05] it's it's important work. So, thank you [90:06] so much and thank you for giving me your [90:08] time today, [90:08] >> Stephen. That was an honor. Appreciate [90:10] it, sir. [90:11] >> Make sure you keep what I'm about to say [90:12] to yourself. I'm inviting 10,000 of you [90:15] to come even deeper into the diary of a [90:17] CEO. Welcome to my inner circle. This is [90:20] a brand new private community that I'm [90:22] launching to the world. We have so many [90:24] incredible things that happen that you [90:25] are never shown. We have the briefs that [90:28] are on my iPad when I'm recording the [90:29] conversation. We have clips we've never [90:31] released. We have behindthe-scenes [90:33] conversations with the guests and also [90:34] the episodes that we've never ever [90:37] released and so much more. In the [90:40] circle, you'll have direct access to me. [90:42] You can tell us what you want this show [90:43] to be, who you want us to interview, and [90:45] the types of conversations you would [90:47] love us to have. But remember, for now, [90:49] we're only inviting the first 10,000 [90:51] people that join before it closes. So, [90:53] if you want to join our private closed [90:55] community, head to the link in the [90:56] description below or go to [90:57] daccircle.com. [91:00] I will speak to you then. [91:04] [Music] [91:12] Heat. Heat.