NEW 100-Year Study Proved We’re Wrong About Carbs!

Carbohydrates have the most potent impact on glucose levels at every meal of every day. Even foods like oranges, bananas, things that are considered superfoods have very potent impacts on glucose. But not just glucose levels, also affecting insulin. Many guidelines even today still believe that you need at least 130 g of carbohydrates. And we know that all this is now untrue. Dr. Andrew Knick is back. His newly published study will change the way you think about carbohydrates, fat loss, and insulin forever. We've actually done a number of randomized control trials as well as synthesized over a 100 years of data looking at whether people actually need these high amounts of carbohydrates that have been recommended since frankly the 1960s and '70s. And we have found that a lot of this guidance has been misled.

So would you say that if somebody were to quit or lower the carbohydrates that could fix insulin resistance, even fatty liver disease? So yes, we know that diseases like obesity and diabetes can be not just prevented but reversed. So there is clear evidence that at the very first meal when you choose a low carbohydrate meal, glucose levels immediately change. Insulin levels immediately change. We see the elevation of things called ketone bodies. Now this is all within the first 24 hours, rapid changes. But within the next 7 days, this lowered insulin level starts to cause a cascade of changes. One of the most common consequences of going on a ketogenic diet is losing weight.

Dr. Knutnick, there is a big question right now in the health world. Do we need carbohydrates for energy, for fat loss, and for performance? And if anyone can answer this, it's you. Because you are unique. You have been born with or spent your whole life with type 1 diabetes, which means that your body doesn't produce insulin, so the foods that you eat affects you even more, especially carbs. So my first question, how has this shaped the way that you think about food, insulin, and performance?

Having type 1 diabetes means that at every meal you have to calculate the amount of calories, the amount of carbs particularly, uh, but also proteins and fats because they all have different impacts on glucose in the body. And with type 1 diabetes, you now have to replace the insulin your body no longer produces. But we also have to calculate the exact amount of insulin for every meal. And so we have to become really experts rather quickly at what we're consuming and how much insulin our body will need. And so we quickly can become judges of insulin sensitivity, insulin resistance, and how things like exercise can rapidly change how potent any amount of insulin is at each meal. And so it gives you a real-world, robust perspective on how various factors in life, particularly food, which has the most potent impact on glucose, impacts our glucose, impacts our metabolism because you become the gatekeeper for the most potent hormone of all metabolism, and you control it completely.

So when it comes to those foods that you mentioned, what do you think in your experience, because you've lived with this for most of your life, what's the worst types of foods that's affecting your blood sugar and therefore your insulin? Well, it's not really controversial to say that. We know that when we look at the diet and it's, it's the most evidence-based impact across even lifestyle, uh, and and other factors is carbohydrates. We know that carbohydrates, uh, have a place in certain contexts, but in environments like, let's say, type 1 diabetes, which is what I live with on a regular basis, carbohydrates have the most potent impact on glucose levels at every meal of every day and actually are the most potent lifestyle factor we know of in affecting glucose levels. But not just glucose levels, also affecting insulin. Something that most people are completely unaware of how high those levels can get before they start seeing changes in how they feel and the changes in their body that happen over time when insulin becomes higher and higher, uh, for prolonged periods.

So what are the types of foods? So specifically like orange juice, cakes, bagels, pasta, oatmeal, all of the above, apples, fruits. Does fruits affect you? Yes, they do. And this is where I think a lot of people become, uh, uh, upset when I talk about, uh, even foods that are categorically not notoriously, but generally seen as very, very healthy, is in the context of type 1 diabetes. You see the glucose footprint of every single, uh, uh, gram of carbohydrate that you consume, every single calorie that you consume. Um, and even foods like oranges, bananas, things that are considered superfoods by, uh, organizations like the American Diabetes Association, have very potent impacts on glucose. Uh, and we know that because typically one of the most common types of foods that are recommended to people with diabetes if their blood sugar ever becomes too dangerously low, which is sometimes does occur when people overdose on insulin, is oranges, is fruits because we know how rapidly and how potently it can elevate glucose levels. So yes, fruits have a very, very potent and rapid impact on glucose levels.

Now, we think of fruits as typically healthy, but that's predominantly because of all the other components of fruit. Typically, they have some form of fiber, phytonutrients, um, and various other components in fruit that we we see as healthy. But when you look at it from the lens of someone living with diabetes or maybe on the precipice of diabetes, uh, foods like oranges and bananas rapidly spike glucose levels and also insulin and can often lead patients who are managing or or on the precipice of getting these conditions to be on a roller coaster ride, uh, at at those meals. So absolutely, even fruits can have potent impacts on on glucose levels, but it really depends on the type of fruit and it also depends on the type of carbohydrate, cuz not all are created equal. Absolutely. I'm glad that you said that, cuz I think people, they do think that fruit is healthy and it's natural. It's got fiber. There's a debate around if we do need fiber, but that's not a topic for this conversation. Um, but there are certain foods that people think I should be eating, should not be eating, but some healthy foods we should be kind of staying away from. Bananas, even apples in excess, all these different things.

You also had a very interesting experience that you, you did a TED talk about the ketogenic diet, and so many people have fixed their life doing low carb ketogenic. You helped somebody reverse their diabetes and lose over 100 pounds. In that moment, how did that make you feel? Yeah, it's that was a, a kind of career-changing moment for me because, uh, doing the TED talk, I, I got to speak on my personal journey managing my disease and about nutrition and just a nutritional strategy that has been utilized for frankly over 200 years for the prevention and reversal, uh, not just the management, but the prevention and reversal of diseases like diabetes, uh, as well as obesity. And I was speaking about this, uh, diet known as the ketogenic diet. And I received a message, uh, after that talk was published and, um, and it was someone who was able to find my email address, emailed me and communicated and said, "Hey, you know, I don't, I don't know if you remember me, but I was sitting in that audience and I heard what you said and I had, they had at the time type two diabetes, not even type 1 diabetes, but type two diabetes. Uh, and I changed the way I ate after what you said. I looked up resources on how to do it the right way. And now I've lost over 100 pounds and I completely reversed my disease. And I feel like I have my life back for the first time." And I read that message and, you know, Reena, at that time I was a graduate student. I was still a student. I was still, I wasn't, I wasn't, you know, I didn't complete my PhD at that point. And I never realized how powerful those messages could be to help people with these chronic diseases who they think they can't reverse. Often times they're taught to just manage these conditions. They don't realize that one, they're preventable and two, uh, that they can actually be reversed. And hearing from that patient really made me sit back and realize, wow, there is an opportunity to help so many people by just talking about not only the research that we do on these topics and how powerful nutrition is sometimes more than traditional pharmaceuticals and and other technologies that have come on the market, but how powerfully you can actually shift someone's life, uh, and their quality of life. And I had lived that myself, uh, having, uh, transformed my diet, uh, to combat obesity and ultimately to manage my type 1 diabetes. But to hear from someone else doing it, I realized, man, if I could do that to one person, imagine the opportunity to get out and speak and help hundreds, maybe thousands of people, uh, gain that empowerment in their own life and ultimately trek the what is sometimes a difficult journey to health. Uh, and that's really the goal that we're all trying to get to. Absolutely. That is monumental. I think it gives so much people hope that if I have type 2 diabetes, or in your case type 1 diabetes, if I'm overweight, if I have elevated insulin, I can do something about it. I don't have to take pills. I don't have to listen to what my doctor is telling me if they're telling me the wrong advice. And that's how this episode is going to help because you just published a new study with respect to carbohydrates. Let's turn our attention to carbohydrates. Let's first understand with carbohydrates, we're told that we need them for energy, for fat loss, for performance. Do you think that's misleading?

I think it is misleading because for so long we have believed that carbohydrates are essential to let's say perform physical activity. Uh, for a long time, many guidelines even today still believe that you need at least 130 grams of carbohydrates to fuel your brain. And we know that all this is now untrue. We've actually known since the 1960s that the brain can function just fine, uh, on zero grams of carbohydrates for for periods of time. Uh, in fact, and frankly forever. Um, we know that, uh, we, the only essential nutrients that we need are amino acids and, uh, free fatty acids. It doesn't mean that you don't need other or you won't benefit from other nutrients, but those are the only essential nutrients. And so backing up for a second, when we think about, uh, the things like the diet, things like, uh, the impact or its requirement for so long, not just the general person, uh, is recommended to have high amounts of carbohydrates just to quote unquote survive, which is untrue. We don't, we don't need them to survive, as many in your audience knows. But even athletes, uh, where this has been pushed to extreme levels, uh, some athletes are are being told that they should consume, if they are a high, high volume athlete, upwards of over a thousand grams of carbohydrates per day. Uh, upwards of 60 to 90 grams per hour during exercise with the belief that it is essential for them to perform optimally. And we've actually done a number of randomized control trials as well as synthesized over a hundred years of data looking at whether people actually need these high amounts of carbohydrates that have been recommended since frankly the 1960s and '70s. And we have found that a lot of this guidance has has been misled or misguiding people and not without consequence. We've actually seen that there are some major consequences to these recommendations, even in the people we believe were most immune to metabolic derangement, athletes.

So you mentioned the study that you've just, so it's a review of of over a hundred years of of over 160 studies, you could probably like say better than me, but maybe tell us exactly what you looked at and a bit more detail around that so people can understand what that means for them. They're not athletes, but if we look at athletes, that can definitely correlate to people in our everyday lives. Correct. So, I, I have to tell a story about this because we didn't begin by, uh, synthesizing over 100 years of data and looking at over 600 research articles, which is what's what's being published. But it actually started with, um, years and years back, finding that the ketogenic diet was able to, uh, not just, uh, treat, but sometimes prevent and reverse multiple diseases. We were looking at neurological diseases, where we're looking at things like metastatic cancer and its impact on on lowering cancer burden and actually protecting muscle tissue during cancer. There were so many different things that we were looking at, thinking, "Wow, nutrition, simply going to the grocery store and making a different choice about what you were going to buy in there could have this powerful medicinal effects." But yet, so many of the healthiest people in society, athletes, were being told to do the exact opposite of this therapeutic strategy, but to consume abundance of carbohydrates and sometimes absurd levels. I mean, north of 400, sometimes north of a thousand grams of carbohydrates. And so we were really interested. You know, a lot of people are talking about this, but is it true? And is it true that we need this? Because back in the 1800s, Reena, we've known that protein and fat was the predominant form of nutrient for Olympic athletes, the the highest tier of caliber of athlete. We see that in records, um, when you look at the history of what was given in the these big environments where athletes would eat together, what was on the menus, what was being served, you can actually look at photos, um, and you can see that it was a very protein and fat focused diet. But around the 1960s, that all changed. And the reason that all changed is because there was a physician, um, Jonas Bergstrom. And he had developed a technique to actually be able to stick a syringe in the muscle and pull out muscle tissue. And what they found in the muscle tissue is that they actually had stored glucose. And these chains, and these chains of glucose were called glycogen. And they said, "Wow, you know, we're storing glucose in the muscle as chains for use. It must be essential for performance." And what they did find at the time is that yes, okay, if you consumed more carbohydrates, you had more of these glucose molecules in the muscle, and it seemed to correlate with how long athletes could perform. And so this is when things started to change. But then in the 1980s and '90s, we had this new technique where we could stick a, a gas mask on athletes and we could see how many, um, how much oxygen they were consuming and carbon dioxide they were breathing out. And that's actually a sign of how much fat and carbohydrates athletes are burning. And when athletes would consume high amounts of carbohydrates, as you would expect, they would burn more carbohydrates. Sometimes north of 90% of their energy would be coming from carbohydrates. And it also appeared there was a link, an association between higher carbohydrates and longer performance. Again, none of this was causal, meaning that the amount of carbohydrates consumed, we don't know if it caused was the cause of of higher performance. But what we do know is that there was associations at this time. And this continued to pop up in the literature. And over time, these associations, not causal, associations between muscle glycogen and the total amount of carbohydrates your body was burning started to be linked to performance repeatedly. Now, that ultimately led to guidelines that said, look, if you're an athlete, you know, if you're a female, you can store on roughly up to around 300 grams of glycogen in the muscle and up to 500 in average bodyweight males. If you have that much in the muscle and you use it rapidly during exercise, you must have to replenish it with equal amounts if not more. And so this then arose these high glucose-centric form of guidance and recommendations. In fact, the most recent guidelines from the American College of Sports Medicine, dietitians associations, the United States and Canada, uh, ISSN, um, all these major organizations around sports say you need to have, you know, between 5 to 12 grams of carbohydrates per, uh, kilogram of body weight depending on how much volume of exercise you do. And again, for the average bodyweight male, this can go north of a thousand grams of carbohydrates per day at the high end. But did you need that? Well, so many of these studies that were showing these associations between glycogen and the amount of carbs that you're burning in the body were never actually causally linked to performance. And so we sat back and said, hm, that's interesting. All these guidance and recommendations over the last half a century have been guided based on an association. Let's actually test by controlling all these key variables. Let's say their body weight, the amount of activity that athletes were doing, the amount of calories they're consuming, all these other interactive variables that we know impact performance. Let's control all of that, Reena, and actually test if athletes consume very low carbohydrate diets, can they perform the same? And so, the first thing we did in two major studies was we did a randomized control trial controlling all these variables and had athletes adapt to a ketogenic diet for four weeks. That timeline's very important. We can talk about that later. But we asked them to consume this diet for four weeks. And we asked them to do six by 800 meter sprints. One mile time trial, which if you know, someone may think, oh, one mile, you know, no big deal. Uh, no, one mile at max effort is one of the most grueling, uh, forms of aerobic intense exercise. You know, we were pushing athletes over 85% of their total maximal aerobic capacity. And so when they did this, we found that after, uh, they could adapt to the diet for four weeks, they had no deterioration in performance, Reena. And that was eye-opening to us. It was, it was saying, okay, well, we were told for years, uh, over half a century that carbohydrates were essential to performance. But yet these athletes were consuming less than 50 grams per day and having the same performance at very high form, very high intensity forms of exercise. Now, we did a second follow-on study to look at the, the other extreme where athletes were riding for two to four hours. Iron Man competitors, actually. So, we had people who are Iron Man competitors come in and ride for two to four hours straight until they could no longer continue to push out any more effort. We called it hitting the wall. And we found that yet again, when athletes were on these diets for over four weeks in duration, they had no drop-off in performance. So these two ends of the extreme in in what your body can perform, whether it be, you know, very high intensity forms of like almost sprints, or it was sprints, 800 meter sprints to the opposite end of the spectrum, going for long periods of time. Um, we found that even very low carbohydrate diets were able to sustain that performance, which immediately upended this belief of, okay, well, you need carbohydrates to perform, even in these high caliber athletes. We found that that's not true. But what we also saw in these studies, Reena, was that in the original study in back in 2000 or 2023, we had middle-aged runners, very fit, lean body weight, you know, high, high fitness level, actually very high fitness level, they're competitive runners. We were seeing that up to 30% on the high carbohydrate diet were developing pre-diabetes. Now, this was the major shocker for us because yes, it is, you know, shocking to upend over a half a century of belief that carbohydrates were central to performance, but here we were seeing that athletes were actually developing health issues related to these, the type of diet they're consuming. But Reena, these athletes were supposed to be immune to metabolic problems. They were athletes, they were lean, they were exercising regularly. We, you know, we know that this happens in the general population all the time, but now we were seeing that even those we thought were most immune were not immune to the diet or the food environment that they were consuming. And so this major review was actually a byproduct of all of this thinking, wow, we were seeing this in two different studies and it seems to go completely against all these guidelines and recommendations. Let's look at all the evidence on the major nutrients consumed during exercise and see what actually predicts whether someone can perform or not perform. And the major implication of this review is that we found that yes, athletes are recommended to consume 60 to 90 grams of carbohydrates, uh, uh, during prolonged forms of exercise. But yet, we were seeing that the amount of carbohydrates required to maintain performance was dramatically lower. It seemed that there were studies elucidating that only as little as 10 grams per hour was sufficient to maintain performance. And the reason for that, Reena, was because all of this hyperfocus on glycogen and the total amount of carbohydrates your body was burning, again, remember it was just an association. But what we were seeing is if you look deeply at those same studies, that it wasn't just the amount of glycogen or amount of carbs and, uh, sugar the body was burning that was associated with performance. These athletes were actually developing low glucose levels or a clinical definition of what we call hypoglycemia. And there's no causal evidence between the amount of stored glucose molecules in the muscle or the amount of sugar your body burns, and performance. But we know that when your brain experiences an energetic deficit, that that reliably impairs not only muscle function, how you feel, but there is a well-characterized neuroendocrine counter-regulatory response where it releases stress hormones, uh, uh, catecholamines, what we think of as fight or flight, and reliably impairs performance quite potently and is mechanistically linked to reduced physical performance. And we saw this was the major kicker, uh, in this study and analysis that when we were looking at over 160 different studies that had administered carbohydrates and tried to find how it predicted performance, why, why was it causing better performance? 88% of the studies that actually showed an improvement in carbohydrates with performance, we were actually seeing that it wasn't the carbohydrate group we needed to look at. We saw that in the placebo group, the group that didn't have carbohydrates was developing hypoglycemia or low blood sugar levels. And that was the clue because it, again, you didn't have to look at the treatment group. You had to look at the group that didn't receive the treatment and found that 88% of these studies, more than any other biomarker, was linked to the, the reason carbohydrates were affecting performance, which showed that the reason athletes, even these, these people doing high amounts of physical activity, were seeing differences in performance was not due to the amount of massive amounts of carbohydrates they were consuming and the amount of glycogen or the amount of sugar their body was burning. It was actually due to this little amount of glucose in the blood. And that indicated to us that it wasn't the muscles that was predicting performance. It was actually the brain that was predicting performance. And this flips the entire philosophy around why people may or may not need nutrients, even athletes, but also those who don't engage in high levels of, uh, physical activity as well.

Now, as Dr. Kutnik mentions, we need to drop the carbohydrates to lower insulin levels and improve our health. But health is so much more than what we eat and our hormones. Sleep is actually the foundation of our health. And if you don't get into deep sleep, that itself can contribute towards insulin resistance. And that's why I pay so much attention to my sleep environment. I sleep in a cool room, a dark room, and I'm even very picky about my mattress. Cuz honestly, I never thought much about my mattress, but if it's too soft or you sink in, it can completely ruin your sleep. And I really struggled with this until I came across Helix Sleep, who are today's paid partner. Now, Helix isn't like your average mattress brand. They actually personalize your sleep surface for your body and your sleep style. You take a quick sleep quiz about your height, or weight, and how you sleep, and whether you like soft or firm. And Helix matches you with a mattress built for you, not something off the rack. And I did the quiz and my result was the Helix Twilight, their firmest memory foam mattress. And since I've switched, my deep sleep has really improved. And it's not just me. In a Helix Westper sleep study, 82% of people experienced more deep sleep. And here's the best part. You don't have to worry if it's not perfect immediately because Helix offers a 120-night risk-free trial. So, you can try it at home and if it's not right, you can return it, no questions asked. So, if you've been thinking about upgrading your sleep, especially if you share a bed or you know exactly how you don't want your mattress to feel like, Helix makes it simple. Visit helixsleep.com/primal to take advantage of their New Year's sale exclusive partner offer and get 27% off storewide. And thanks to Helix Sleep for sponsoring this episode because sleep is really the foundation of everything.

So let me just summarize. So at the beginning, you said in the 1800s that most people, they can survive off protein and fat. There wasn't the need for carbohydrates. Not to say that nobody should have carbohydrates. There just isn't a sufficient need. Fast forward to when you have athletes and then they put athletes on carbohydrates. They didn't actually show causation that athletes perform better with carbs. It was just a correlation. The glucose in the muscle does not make you perform better. It's the, it's the sugar, the glucose in the brain and in the liver and in the blood that fuels performance. That is accurate, and it's very important for the audience to realize that we have to, put it simply, two pools of, uh, glucose. We have a large glucose pool, which is the muscle. You know, the muscle can store up to 300 to 500 grams of of glucose as glycogen. And then you have this small glucose pool, which is the amount of glucose circulating in the blood. I mean, equivalent to around 5 grams or so, um, throughout the entire body. So like a, a teaspoon of glucose is the amount in in circulation. That little amount is essential to to life, is essential to surviving. But almost all the focus has been on the muscle because of how much it holds and thinking, well, if you have stored glucose in the muscle, it must be essential to performance. But the reality is that that wasn't the most important predictor. The most important predictor was the small glucose pool, which is the amount in the blood, but also the amount in the liver. And your audience may ask, well, why is the liver important here? The liver is important because it is the only tissue that not only stores glucose but also releases it into the bloodstream to maintain brain energy metabolism or blood glucose levels. The muscle only can take in glucose. It cannot release it. So when the body gives you, let's say, you consume carbohydrates and you spike insulin levels, and insulin then shuttles glucose to various tissues. The three priority tissues that it gives glucose to, the first tissue it gives it to is the liver. Over 66 to 75% of insulin, when released, goes to the liver first. That's how the body has set it up. And the reason it does that, Reena, is to protect your brain. It stores the glucose in the liver so that when your blood sugar goes low, you will have glucose available to ensure your brain has energy, no matter what. The second place it goes is the fat. It goes to the fat, binds to the fat tissue, and potently blocks fat breakdown because again, insulin is a storage molecule. It indicates abundance. It indicates that you have abundance of nutrients. So we need to stop breakdown of things like fat. So it blocks and dramatically suppresses fat oxidation. And then the last tissue, which is at the lowest priority level, is the muscle. The reason that's the case is because the body has shown us it's not essential to go to the muscle to maintain function, uh, to maintain the ability to to optimally function as a human being. The only reason it goes to the muscle is because it's over, it's over, it's over, it's overfilled. It's, uh, there's an abundance, so much so that the liver is already full, blood is already full, uh, and now the fat has already, uh, been bound to and blocking its breakdown. Now, after all that's addressed, we have such an abundance of this insulin, such an abundance of glucose, that that overabundance now then goes to the muscle. So the muscle is the last place that the, the body prioritizes to then store these nutrients. And it, that teaches you something. It teaches you that it is not the top priority in body's function. Uh, but we, we think about athletes or people who exercise, it's even a more stark example of where the body places its priority to maintain physical activity, to maintain physical function. And this major review illustrated for over a hundred years that that signal has always been there. But largely, we have ignored it. And major institutes like the Gatorade Sports Science Institute, uh, pushes extremely high levels of carbohydrates, and they have been recommended for frankly years. But what we are seeing is that not only are those not necessary, that those recommendations may be 6 to 12 times higher than are necessary, but in some cases, we are seeing athletes are experiencing metabolic dysfunction or signs of even things like pre-diabetes in these athletes. And the reason we felt this is so important is not, Reena, for telling an athlete how to perform at the highest end. Although that the implications of this review do tell us about that. What we're really trying to illustrate is that this is a, this is a review that illustrates what's important for health, even for those we thought were immune to metabolic arrangement and are not like athletes. So even those who are doing abundance of physical activity, who are lean, who are exercising a lot, which we can consider on the the healthy extreme over here, can still be affected by our food environment. And that the type of foods, the amount of foods we're consuming, particularly carbohydrates, can have a potent impact on their health and and develop signs of of clinical conditions like pre-diabetes. And so the implications obviously are huge for the general public that if even if athletes need to consume virtually no carbohydrates to perform, clearly those who are not even engaging in high levels of physical activity like these elite level athletes are, do not need those high amounts of carbohydrates that have been recommended, uh, by the dietary guidelines of America and other entities for years. And we know that our food environment is the number one cause of major metabolic derangement in the form of things like obesity. And so it is important that we speak about this and share this for, for not just people who want to perform well, but also to make sure that people are healthy and know that you do not have to compromise health to perform. And that's, I think, essential for people to appreciate. I think so. I think this doesn't just apply for elite athletes. It's for every single person because most people aren't elite athletes.

Let's turn our attention to understanding insulin and carbohydrates. If someone is just pretty sedentary, and I say this because 90% of people in the US are sedentary. So let's assume that they don't exercise that much. If you eat too many carbohydrates, what's the impact on insulin? So immediately, let's say you cook some potatoes or rice or bread or pasta, and you consume that food. The very first thing that happens is it goes to your stomach, and your stomach starts to break down those carbohydrates into individual sugar molecules. Those individual sugar molecules are absorbed through the intestine into the blood and raise blood sugar levels. This is why when you eat those foods, uh, also we talked about orange juice earlier, you'll see the spike in in blood glucose levels if you test your blood with a finger stick after you eat these foods. Once that elevates, there's this very unique but small organ called the pancreas. The pancreas is like a thermostat for blood glucose levels. It will detect the amount of glucose that's elevated, and in proportion to how high it goes, will sense that elevation and release insulin. So if you consume a lot of, let's say, rice, uh, and your blood sugar goes very high, your body will immediately say, "Okay, we need to release an abundance of insulin into the circulation." The first place that insulin is going to go is the liver. That's going to go to the liver to then store glucose as glycogen to protect your brain when you have little glucose in your diet or if you were to go through a, a famine or a fasting period, uh, of time. So, this is a protective mechanism for the brain. Next, after it goes through the liver and stores it there, it's going to go to the fat tissue and bind to the fat tissue and signal to the fat, "Oh, we have an abundance of food in our, uh, in our environment right now. We need to store as much fat as possible. So, we're going to stop fat from being broken down." So once it stops fat from being broken down, it then goes to the muscle. Only after the liver has taken up the insulin and glucose, and only after the fat has been, uh, stopped from being broken down. Then it goes to the muscle and signals the muscle to say, "Now we need to take the overflow into the muscle, the abundance, the excess amount into the muscle and store it here just if we need some some extra forms of energy outside of things like fat, uh, that we have literally weeks and months of energy on our body, uh, in the form of fat energy." So that's how the body responds to carbohydrates in the diet. The insulin response is a signal of abundance, and that's when the body stores and stores and prevents breakdown, particularly of things like fat.

So that makes sense that if someone eats too many carbs, it goes to the liver, and too much of that can cause fatty liver disease. And then if it goes to the fat, you get overweight. And if it's all too much, you get insulin resistant. Is that the right kind of chain of sequence that can happen? People have all these diseases. I have fatty liver. I have insulin. Well, they say I have elevated insulin. I'm overweight. I have XYZ. Because of that high insulin cascading to all these different things? Precisely. So for a long time, people thought, well, fatty liver, which is now has this very advanced term called metabolically associated steotic liver disease, they use the term metabolically associated because we know it has to do with metabolism. Um, and but the term fatty liver, which was originally used, actually describes what happens to the liver. You start building up fat. And originally it was thought by the scientific community, well, if you consume more fat, it will cause more fat to be placed into the liver. But there was a study by a close friend of mine named Elizabeth Parks back in the day that actually found that it isn't so much the fat that causes fatty liver. It's actually the carbohydrates, specifically the insulin response to the blood glucose elevation from carbohydrates that binds potently to the liver because again, remember, the liver is the most, is the first place that this insulin goes, and that insulin then stores. Again, we talked about insulin being a powerful storage hormone, stores not just glucose, but also fat in the liver. And so in excess amounts, people develop fatty liver disease with an overabundance of insulin. In fact, we've seen this, Reena. We've actually conducted studies where we were specifically looking at obese patients, uh, people who were obese. We were about to put them on a 12-month, um, randomized control trial to change their diet. And when we were assessing these individuals for not just their glycemic control, but also we were doing total body MRI scans. So we were actually able to look at the gold standard, the highest refined way of looking at their body composition. But one of the tissues we were looking at the composition of it was their liver. And we found that we had these patients who all had obesity, all of them had pre-diabetes. We didn't know it, but they came in and when they were assessed, all of them also had pre-diabetes. And when we looked at their scans, their MRI scans of the liver, over 80% of them, I think the exact number was 86% of them also had fatty liver disease by the amount, the diagnostic amount of fat that was the percentage of fat in the liver. And we saw that when you have obesity, we have historically known that insulin levels rise. As you start accumulating more adipose tissue or fat cells in the body, they start to enlarge, insulin levels rise proportionally. So as as you become, let's say, a little overweight, uh, and your insulin levels start to double, we know that the sensitivity to insulin can also reduce around 33, 36%. We know that even before people develop diabetes or pre-diabetes, that these levels can go up to six-fold higher, six-fold higher before you see any signal of glucose change. And that is six-fold more anabolic hormone, meaning, uh, six-fold higher levels of fat storage hormone, six-fold higher levels of glucose storage hormone. Uh, again, this is a storage hormone. It's one that also suppresses fat breakdown. So the higher these levels get, the more the body stores and views you in a state of abundance and prevents you from breaking down tissues like the fat for energy. And this is a progressive condition that ultimately results in things like type 2 diabetes, where you have full-fledged resistance to insulin. The amount of insulin in the body can sometimes be sometimes 10, 10, 20, 30 fold higher, uh, in the body. And that abundance of insulin causes not just storage of of nutrients, but also damage to various tissues. So insulin in and of itself also can cause elevation in blood pressure levels, can change the the health of your blood vessels or your cardiovascular system. And this is why when we see diseases like diabetes have these extremely high levels of risk for cardiovascular, uh, events like a heart attack, a stroke, um, uh, or one of these major cardiovascular diseases or cardiovascular disease, it is infinitely higher in in forms of diseases like diabetes. Not just because of elevated glucose levels, which we know is the number one predictor of cardiovascular, or number one risk factor in cardiovascular disease and diabetes, but also the overabundance of insulin. It's, it's always higher in forms of diabetes. So yes, you're 100% correct that insulin not only is the driver for fatty liver disease, it's the driver for insulin resistance. You can't have insulin resistance without an abundance of insulin. You have insulin's always a part of the equation when it comes to these major diseases. It isn't the only signal. High glucose levels are are the number one risk factor, but insulin is always a, a long for the ride and sometimes the driver of it in the form of obesity and type two diabetes. I hope people heard that that you could have elevated insulin before your blood sugar, your HbA1c even increases. You can't even see that you're pre-diabetic. Your insulin is already elevated.

So would you say that if somebody were to quit or lower the carbohydrates that could fix insulin resistance, even fatty liver disease and all of these diseases? We know that the evidence has been around for two centuries that it can reverse, uh, not just manage, but reverse and, uh, and also prevent obesity. And it was standard of care for 200 years for type 1 diabetes and type two diabetes, uh, before the discovery of insulin. So yes, we know that diseases like obesity and and diabetes can be not just prevented but reversed by these conditions. It's actually arguably the most evidence-based diet that has been has the most historical evidence. And actually, the American Diabetes Association acknowledges this in their 2019, um, guidelines or the consensus report on nutrition. They state that the very low carbohydrate diet, also known as the ketogenic diet, is the most evidence-based diet for managing this disease for things like glucose control, uh, body weight, blood pressure. So, this has been known for quite some time, but we've known for over a hundred years that this diet can also address how the brain functions. Uh, it can affect one of the most, uh, clear examples was in seizures, where it can start to change the brain chemistry and ultimately reduce the incidence of, uh, seizures, um, in the absence, uh, or a similar to, or sometimes more potently than medications can. But now we're seeing this emergence of evidence in a number of different diseases, cardiovascular-based diseases, but also mental health disorders, uh, things like bipolar disorder, schizophrenia, and mental conditions where there have been an abundance of literature where there really was none. There's this rapid emergence of evidence that's demonstrating that things like schizophrenia, bipolar, depression, uh, all are starting to see positive responses to lowering the carbohydrates in the diet, lowering the insulin as a consequence to lowering the carbohydrates in the diet, and then seeing this cascade of metabolic changes in the body that appears to consistently show positive improvements in how not just the brain is functioning, but also the symptoms and other issues that are coming out of mental health disorders. And so that's a powerful illustration that at the forefront, when we think about what impacts our health, we should be focused on nutrition first. Nutrition should be the priority because you can't, you know, the saying is, you can't outrun a bad diet. And we know this is now true from a study, uh, across 34 different or 34, 36 different countries from Duke and other researchers all the way to China, where showing that the food environment is what's driving obesity. But we know that things like exercise can also have potent impacts on insulin sensitivity, dramatically enhances insulin sensitivity, and is overall just good for your health. But these are two pillars of overall lifestyle that should be the forefront, frontline therapy for individuals with these conditions before we start considering the array and cocktail of drugs that we see pushed, um, onto patients almost immediately before they even try lifestyle interventions. Uh, and and this is really important for, for not just those who in your audience who are trying to empower themselves to improve their health, but also healthcare practitioners, individuals who are treating patients or helping patients on their journey, including coaches on how to improve patients' health.

Now, as Dr. Kutnik mentions, there are so many benefits to your health when you drop the carbohydrates. One is lowering insulin, one is burning more fat, and one is better brain function. And when it comes to your overall health, one thing you probably haven't thought about is your health insurance. And let's face it, health insurance premiums are skyrocketing to compensate for the increase in chronic illness. And I'm sure if you're taking control of your health like I am, you want to make every dollar count. And I have firsthand experience with health insurance, thinking a minor procedure would be covered, only to find out that it's not. You end up paying out of pocket plus your premiums. And if you're anything like me, well, this can make you feel really frustrated and really confused. And that's why I'm so proud to have Crowd Health as a sponsor of today's episode. Now, Crowd Health works differently. First of all, they are not an insurance company. Here's how it works. It's a community-based healthcare platform. For under $100 a month, you get access to a team of health bill negotiators, low-cost prescription, and lab testing tools. And of course, you join your crowd, like the Carnival crowd, to cover unexpected healthcare expenses. But here's why it's really important. Right now, it's open enrollment. Now, this is the period where you can sign up again. But this is where insurance companies increase their premiums. So, if you want to stop playing the health insurance game, try Crowd Health. So far, Crowd Health members have saved over $40 million in healthcare expenses. So this open enrollment period, take your power back. Join CrowdHealth to get started today for $99 for your first 3 months using code primal at joincrowdhealth.com. That's joincrowdhealth.com with code primal. CrowdHealth is not insurance. Opt out. Take your power back. This is how we win. Join crowdhealth.com.

I want to think about the audience right now who might be thinking, "Okay, Dr. Cutnik, you have convinced me I want to quit or lower the carbohydrates." What do you think is going to happen in the first 3 days or a week for somebody that that says, "Okay, no bread, pasta, rice, potatoes. I'm just going to have like meat, butter, maybe carnival keto with some vegetables." What's going to happen in those first few days? The changes happen rapidly, Reena. They happen at the very first meal. So there is clear evidence that at the very first meal when you choose a low carbohydrate meal, just change the first meal, that glucose levels in the blood immediately change. Insulin levels immediately change in response to that meal. Within the first 18 hours, you see your first signal of the changes in the body and metabolism that start to happen widespread on things like fat oxidation. We see the

Elevation of things called ketone bodies, which is a byproduct of elevated fat metabolism. We see those start to elevate it by 18 hours. Now, this is all within the first 24 hours, rapid changes.

But within the next 7 days, this lowered insulin level starts to cause a cascade of changes. The lower insulin level starts to allow the fat to be broken down. So the amount of fat that was once being stored because of the overabundance of insulin, that lowering of insulin allows for the fat to be liberated and start to become a higher portion of the amount of of nutrients and energy the body's utilizing to function. And so we see that that free fatty acids start to elevate in the blood. This is all happening right immediately within the first seven days.

But what a lot of people want to see, which is, you know, the sometimes why people engage on a ketogenic diet is to lose weight. Well, that happens almost immediately. And the reason it happens is because insulin stores not just uh glucose, but with every gram of glucose, it also stores three grams of water. So when you start lowering insulin, you also lower, you know, three-fold the amount uh proportionally the amount of water that is now not being held in the body. So you start to release more water, start to release more sodium, and that actually starts to persist for up to two to four more weeks. So you're going to persistently see the amount of water that you're retaining in various tissues start to drop.

This is also why when people do low carbohydrate based diets and start to eat carbs, they just balloon up and they're like, "Oh man, I feel bloated. I feel it must have been the the gluten in the bread." It's like, well, no, it's actually just the carbohydrates that's doing this to you. It's this it's the carbohydrates that are causing you to store an excess amount of of water in these various tissues and you feel quote unquote bloated. Um but that can linger that starts immediately but lingers for weeks.

This is also why you see this dramatic reduction in blood pressure for many patients who have elevated blood sugar levels because now they're no longer storing excess amounts of fluid. Obviously blood pressure is the amount of pressure on the blood vessel wall and if you have excess fluid floating around it's excess pressure right and so that starts to decrease as well but you start to see changes in appetite you start to see changes in your your your drive for various foods almost immediately and this persists for the first four weeks and so again you see an immediate change in glucose immediate change in insulin and that then drives it almost flips the switch from a sugar and carbohydrate predominant based metabolism to a fat predominant-based metabolism. And around 2 to 4 weeks, you see that most of the major changes from shifting from okay almost completely relying on carbohydrates as the fuel over towards fat has almost completely flipped on its head. And now your your fat is now storing the vast majority of your energy, which is what people often want because they want to lose fat. Can't lose fat if you can't break it down and burn it. So that occurs and all this begins and persists for up to around the first 3 weeks.

But what we see is that everything really hits this pivotal moment and and kind of normalization around the 4-week mark where you start to see blood glucose levels start to initially they they drop and then they stabilize. Around the four-week mark, we start to see that uh the levels of ketone bodies in the blood immediately begin to elevate within the first 18 hours and then they hit a peak around the 3 to four week mark and then they they stabilize at the four-week mark. And this is also the same timeline that we start to see normalization of physical performance in athletes who are uh engaging or shifting over to a ketogenic diet. So there is really a host and cascade of different changes that occur in various tissues particularly the fat particularly the muscle. Um your brain starts to now rely on not just glucose but a proportion of it starts to increase to rely on things like ketone bodies and over time your hunger changes. Your body weight persistently changes and this persists uh up to around four weeks where things start to begin to normalize and many of the major metabolic changes. Now, if someone's trying to lose weight, they may continue that change because they're constantly consuming less calories, which allows them to ultimately maintain a persistent weight loss well beyond just the water weight they're consuming. Uh, which is one of the most common reasons that someone engages on a ketogenic diet. So, there really is a cascade, Reena, of metabolic changes that's occurs in the body when someone lowers their carbohydrates. But again, it all starts with lowering insulin. How exciting.

Um, I have two follow-up questions, but I do want to ask about high fat for life because I think that people need to make a lifestyle change, not just a diet for four weeks. So, projecting further than 4 weeks, what how does high fat enhance metabolic flexibility and fat loss at a lifestyle perspective? Like you don't have to diet and count your calories. This is a lifestyle. Like you are lean and fit because you do a lifestyle that suits you. So how does high fat fit into that?

Well, what we find historically in the the literature is that when someone just reduces their carbohydrates, they usually volitionally meaning by choice reduce their calories and this allows them to reduce their body weight allows them to to maintain that reduced body weight over time. This is this is very common uh and one of the most common consequences of going on a ketogenic diet is losing weight. Um and is actually something that we have to coach athletes to say, "Hey, hold on." Like the goal is actually not to lose weight. We need you to keep your calories higher. But for many people, they just they that's not their goal. They just want to do something that makes it easy to not feel hungry and to and do that uh without having to take an abundance of pharmaceutical and and and often very expensive pharmaceutical and technological tools to assist them on that journey. And so uh this is the one of the most evidence-based ways from a nutritional perspective to do that. But yes, as you mentioned, the most important factor is sustainability.

One of the common criticisms that someone with in the scientific or clinical community will say is well hold on like are you going to be able to sustain that diet? Um and they'll say well you know I you know I've seen in the scientific literature that you know some portion of patients won't be able to maintain the diet. And the thing I immediately say is, well, hold on. Every lifestyle change, whether you incorporate a medication into your life, whether you change to any form of a diet or exercise intervention, always requires work, hard work, and uh and and requires tools and knowledge. All of them have data that suggests that there's a percentage of patients that struggle to maintain it, which is why it's so important for patients to find the right resources. Re, I know you provide those for many patients. And so, it's important to find good resources to understand that if someone's telling you, you know, a healthcare practitioner, your doctor saying, "Oh, well, you can't do this." It's like, yes, you can. Yes, you can do it. Um, and if someone's saying like, it's like the analogy of you like, "Hey, I want to go run a marathon. I have a goal of running a marathon. And imagine the doctor goes up to you and says, "You know what? I've looked at the science on this." And the science says that the vast majority of people who try to run a marathon will never run a marathon. In fact, maybe less than 5% or maybe less than 1% of all people will ever achieve that. So, I recommend you don't start in the first place. Imagine that's the type of thinking that someone has when they walk into a doctor's office. But maybe instead they should say, "You know what? That's amazing that you want to improve your health. I'm going to give you all the right resources on your journey." So you don't have to struggle the same way that people do who don't have these same resources or the right tools. And that's the way we should start thinking about this because we know that there are tons and tons and tons of people who maintain these approaches if they have the right resources and they dedicate to a lifelong lifestyle change with these interventions and it's a totally achievable lifestyle strategy. In fact, we have published the longest ever uh sustained longitudinal uh study on the cardiovascular effects of the ketogenic diet and it was over 10 years in duration. So clearly it can be maintained over extended periods of time. The evidence shows that it can be. So anyone who's telling you it can't be is frankly discouraging you from from your health journey and is standing in your way. And it it's important that patients know that it is possible and also important for health practitioners to know it is possible and to look for resources that help guide them to guide patients on their journey. I can't tell you how many people in our go carnival community have said, "I'm doing carnival keto ketogenic. My doctor is telling me my LDL's up cholesterol. This is not healthy for you. You need to be on a statin or eat some carbohydrates." So the more community support, the more like-minded people that we have around and resources, the better it is.

So question around actual tips and what to eat. How much fat do you have to eat? Not so don't say as a percentage cuz I think people get really confused around that. If you can imagine a plate, where is the fat and the meat and whatever else you eat like what does it look like so people can understand what they have to eat?

I think if people view this as a protein centric diet, it actually helps them a lot more because if you look at a plate uh that someone's eating on a ketogenic or very low carbohydrate diet, what they're actually doing is typically prioritizing protein. They're typically thinking at each meal I should have a protein source. Now, that doesn't mean you need to have this lean protein source like egg whites or chicken breast. I mean, you can, but that's not the goal of a ketogenic diet. The goal of ketogenic diet has to have the essential nutrients and let's start start first with protein. So you're going to have some form let's say of meat, chicken, salmon, um some form of protein on that plate that's going to give you those essential amino acids that you need, but also it's going to have a healthy amount of fat with it as well. And often fat, which is the uh overwhelming new form of calories in the diet, is typically just coming along for the ride. It's typically just coming along with the protein you're consuming. And on these diets, if someone chooses to have, let's say, uh traditional form of what we call a quote unquote well-formulated ketogenic diet, necessarily carnivore. We can talk about that in a second. They may include things like salad, uh, green leafy vegetables, cauliflower, other forms of fibrous vegetables that don't spike insulin levels. and they may say, "Okay, for that uh salad, I want to have a little bit of, let's say, uh olive oil or some type of dressing on it." And by default, as long as it's not sugar-based, that's also going to make up the fat calories. So, if you focus on first and foremost, okay, I want to get protein. And for the average person, that may mean, okay, like a protein the size of their fist, okay, on on the plate, then, you know, some form of green leafy vegetable if they're going to, you know, focus on a ketogenic diet. Um, and then allow them to have fat to just to up to the point in which they feel satisfied with that food. I don't ever think of there used to be an approach in the or uh health influencers in the ketogenic diet space who pushed you need to consume excess amounts of fat. No, like fat's calories and if you it's very easy to uh just if you just forcefeed yourself fat, then yeah, you're going to you're going to gain weight if you overconsume those. You can gain weight if you overconsume fat. But if you focus on protein, which is essential for the body, but also supports your muscle, but also is the one of the few nutrients that actually has the highest level of what they call satiation, meaning that it reduces your hunger after you consume it. That's an amazing nutrient. And prioritizing that, but not prioritizing having very lean forms, just focusing on the ones that are nutrient-dense. And this can, yes, include eggs. Yes, it can include things like steak and beef, but also obviously things like salmon uh and other nutrients like this. What we know that the that these are very nutrient-dense forms of foods. You can have the green leafy vegetables and you could have a salad dressing on those if you so choose that has uh uh it is fat focused. Uh, but that's really what a plate look like. It's kind of a a colorful plate that has a focus on on green leafy vegetables, a protein source like let's say like a salmon. Um, and that's and and with any type of, let's say, seasonings on that plate that can help support um the flavor profile of that food. That's what a plate typically looks like. And if you go to your grocery store or uh a magazine store or bookstore, you can look at the health aisle and usually on the front of that health is a is a salad plate with some fish on it. What that that's a ketogenic meal, you know, that it doesn't and they're not usually promoting a ketogenic diet. They're like, "Oh, they're promoting a Mediterranean diet or DASH diet." But what they're actually showing on the front of that as a visual is actually a ketogenic meal. And so a ketogenic, well-formulated ketogenic meal is very much in line with overall health. It incorporates uh uh various nutrients that help with health and function um is very much aligned with with overall health. Now, someone takes the step to go to carnivore, which many people have found a lot of success with because that just taking it to one step further has helped people to really break through the wall, the barriers they often have uh with getting to the weight loss goals they want or or the health goals they want in general. Um, then that's a really uh protein focused approach again because the protein has a high satiation component. You're getting a lot of the essential nutrients from the fat and the protein there. Um, and that's really the focus of that approach.

Love it. So, it's protein centric but high fat in nature and we don't have to add lots of fat. If you're new to the lifestyle, yes, add fat, like add butter. It's not going to do anything bad. Um, but then as you get used to it, you can lean away from the butter and more towards the, you know, fatty cuts of meat. So, salmon, lamb, um, beef, eggs, all these whole foods. Um, so that goes to my next troubleshooting questions. As you know, you've been in the Go Carnival community. People ask you a lot of questions. There are two questions mainly around blood glucose and weight loss. So when they do carnival keto or ketogenic lower the carbohydrates they say my blood sugar whether that's tested by blood glucose or their HB1C is increasing or it's going high like let's just say it's over 100 like 120 and they're thinking it should be 70 or 80 or 90 and and this is a this is long term. So they're doing carnival keto for maybe a few months. Why do you think that is?

So I it's very important to put this in context because someone may hear that and say, "Wait, the ketogenic diet's raising blood blood glucose levels." No, no, no, no, no. When someone goes from a high carbohydrate-based diet to a very low carbohydrate diet or also known as a ketogen diet and some forms of that of the carnivore diet, you will reliably see a drop in blood glucose levels. You will reliably see a drop in insulin, sometimes up to 75 to 80%. Uh if you have diabetes, that can be even higher than that. Um and so those are reliable changes that occur. Now what Reena you're describing here is when someone gets into a normal level and then they start to see a slight tick up in things like blood sugar levels at the time. Now people describe this as a negative consequence uh like oh no I'm concerned my blood sugar is coming up when in reality this is potentially just a signal of physiologic um uh adaptation to reliance on fat where the body is becoming uh incredibly reliant on fat as a fuel source and then the body starts to uh prioritize fat as a fuel. And so carbohydrates don't become a predominant form of what makes up uh the energy needs of the body. And so the body's not sucking it into the tissues like it once did. And so um there is in some cases now not all the time but in some cases patients after they have reached normal glucose levels and reduced insulin lower body weight that at this stage they start to see a slight kind of re-elevation in glucose levels. By the way we see this in athletes. We see that in even in healthy athletes who are normal body weight uh by all signs completely healthy even those who clinically don't have any form of pre-diabetes they'll see this immediate drop in glucose levels and and those who are healthy who maintain calories and the same level of activity even they will start to have initial uh reinccrease in blood glucose levels into a place of homeostasis a place the body is readapted to those glucose levels and so that's not an uncommon thing we even see it in athletes who are who in these cases don't have disease and are healthy as well. So, um, and one way to potentially attempt to address that is to to play around with various nutrients. So, you can play around with trickling in other forms of nutrients. Like if you wanted to try carbohydrates, but it not abundance, right? We're talking about minimal amounts of that. And those are honestly tricks that many clinical uh people implement if they're concerned about certain lipid levels or things like elevations in um and glucose levels. But I don't think that's usually a thing to often be encouraged to people because it's more important for individuals to find a sustainable approach that works for them over time and allows them to maintain let's say n 80 to 90% of the good. You know no matter what approach you implement there's always going to be some percentage uh that comes as a trade-off right like like today every choice has a trade-off. Today, Reena, we're speaking today about uh health, wellness, nutrition, but that's a choice because I'm not also doing something else with my time right now. So, it's a choice of I'm putting my efforts here and I'm not going to put my efforts somewhere else. Same thing happens in your metabolism. Okay? If you're going to do a ketogenic diet, you can see lower glucose levels, lower insulin, lower body weight, um changes in your whole metabolism and burning more fat, less carbohydrates and sugar as fuel. Um, but yeah, like you may see elevations in things like LDL, totally addressable. Um, you may see other changes as well like a slight increase once you adapt and normalize glucose levels. Again these are these are um subtleties uh but when people usually approach utilize these approaches they are attempting to make major change in their health and wellness. They're not attempting to make subtle changes typically um uh in their overall wellness. So again, it's it's about the net positive of the approach and focusing on the overarching benefit of whatever approach you're implementing.

I like that you said that and the alternatives and solutions that people can maybe add in um a little bit of carbohydrates because it's the dose that is the poison. Carbohydrates are not poison, but we're just told to eat too much and ultrarocessed foods just blows it out the window. So, you can increase your carbs very very slightly or you can even change your macros in terms of protein and fat. I've seen that work for some people. Fat can help reduce the blood glucose and maybe so the HBO1C is a long-term measure of that. Um, but fat can definitely help to lower the blood glucose. Um, and also the time that you test also matters. So, if you're stressed, if you get anxious because you're testing your blood glucose, well, it's going to raise it as well. If you exercise, gonna raise it as well. So, all these different things.

Um, the other troubleshooting question is why is it that people can do carnival keto ketogenic low carb, they lose weight, it just stalls, it does not move. Why is that happening long term?

Well, it depends on where they start and um what they're consuming. So, anytime someone implements a new dietary strategy and it involves reducing the total amount of energy you're putting into your body, your body is going to now utilize the energy deficit that you have from your tissue. So, imagine you have you need to have your body needs 2,000 calories to maintain your body weight and you consume slightly less than that. Say just one 1,500. There's a 500 calorie deficit. Uh your body's going to have to pull from that deficit from somewhere in the body. Now, this isn't to say that the only factor that matters is calories. It obviously there are a number of other factors that matter for for losing weight beyond calories, but we're just going to use calories as a simple example. But with that 500 calorie deficit, your body is now going to pull that 500 calories from some other part of the body. Okay? Because it's not being consumed and it needs to maintain energy. So one of the most common places is the fat. Now if you maintain that for a period of time, we know that with many lifestyle strategies, even including endurance exercises, one great example, your body will adapt to it over time. So if you start doing you start running for one mile a day, you're like, "Ah, I feel great. I'm losing weight." Well, that's awesome. Except your body's going to normalize to that one mile a day and your body is going to shift the metabolic requirements away from other things like the immune system and other areas over towards sustaining the energy for uh uh like running and as a result over time it stops helping you lose weight right so it's about the persistent change over time so some people depending on where they start um will have to make adjustments along the way but a lot of this comes down to where your body is from its metabolic rate so to speak and then ultimately uh your body's adaptation to a new set point uh a new caloric set point a new activity set point in the body. And so when someone stalls on these diets, it's typically because they've reached a level of new normal or a new set point um typically at a healthier place than they were before because they're usually lower body weight uh better metabolic biomarkers. But now in order to make progress further, this is where oftent times people will shift from things like just lowering carbohydrates a little bit to lowering it a lot more to then shifting from just ketogenic diets over to things like carnivore because these are all stepwise approaches to help people sustain um a lower caloric intakes that helps them strip more of the excess body tissue they have to lower their weight. So but everyone's very different here. We see that very everyone has different metabolic rates. Their ability to rapidly adapt to the diet also changes over time. And we also see that this is a very common phenomenon that the rate at which your body adapts is proportional to how rapidly the weight loss comes off. So very slow weight loss over time appears to allow you to strip more fat off the body more sustainably and get more out of every caloric drop. If you do it slowly, if you do it very rapidly, which most people frankly kind of need to do because they struggle with losing weight at all. So seeing rapid progress is important for people, um your body's going to adapt a little bit quicker to that. But that makes total evolutionary sense. If you have a rapid drop in calories, let's say you immediately went from, you know, eating, you know, a buffalo and uh a bunch of of fruit you found on the the trail, so to speak, and you just ate for an excess for a week, and then you go into this famine. Well, your body would want to say, "Oh, no. We need to survive this. Let's lower our metabolic rate as quickly as possible to this new normal." Because if you constantly just pulled and pulled away from your tissue, we would have never survived as a species. And so, what your body's actually doing is an evolutionary adaptation to the new amount of calories, the new amount of activity that you're giving it. And so if people want persistent progress over time, it's thinking about this upfront from a sustainable approach that is reliably shown to help people maintain weight loss. Look around you. Who's lost weight? Who's maintained it? Look for those examples. And then when you see those examples, ask them, you know, how did you do that? Uh what are the things that went wrong for you? And how did you overcome those? Because those are some of the best examples. Like a community group. You run a community group that helps people on this journey. So those community groups are extremely empowering because you have tons of people who've done this uh various different ways but all have found success on their journey to various degrees and as a result you can learn from each of them along their way because it's not a one-size-fits-all. There is fundamentals that help people on their journey that everyone can adhere to but then you have to ultimately adjust it and adapt it to you as an individual to optimize the outcomes you want. And this is where community groups and other settings like that can be incredibly empowering because you have an eclectic group of individuals from various backgrounds and various different health statuses, metabolic states that all are on this journey trying to overcome their own personal challenges to get to the the peak of their not just health but also performance.

So speaking about overcoming personal challenges, I wanted to end on this point which is talking about community the real life impact. Before our interview, I emailed you to ask you what was the biggest change or thing that happened in your life, something that's sentimental. So, I just want to read a little paragraph here and then get advice for those that might be struggling, confused, feeling hopeless, because there's lots of information about health, but this is what you said. You often struggle with your desire to change the world only to realize that the most important world to change is the one I wake up every day. So if that person right now they wake up and they feel hopeless, they feel like crap, like this is too much, what would you tell them?

It's something that's not novel. It's not new. It's the simplest piece of advice that someone can give. It's just to take the first step. Most people never take the first step. And if you ever want to walk run a marathon, if you ever want to dramatically lose weight, if you ever want to reach a level of health that you've never achieved in your life and you feel tired, you feel uh you know, you feel like you wake up with no energy, you feel like you can't really move or function like you used to. Sometimes it's about taking just one step. Most people's problem is that they think about the end goal and realize that's so overwhelming. I can't do that. It's so hard. I'm not. No one's asking you to do that. What all we're asking is for you to take the first step. And if you can take just one step in that direction, before you know it, you have now run a marathon. Before you know it, now you're at your new weight loss goal. Before you know it, you're starting to feel better. Before you know it, your whole lifestyle has changed. How you feel has changed. How your health now changes when you went to your doctor and got your blood work. Everything is now revolutionized. But it's not you're not changing that overnight. You change by taking the first step. And that's what most people never do. But you don't have to be like everyone else. And you can change your outcomes, but you have to take the first step.

Dr. Cudnick, I love that. Thank you so much for your time. All the links are going to be in the description, the study and our previous episode if people want to know what happens if you eat high fat long term. Thank you so much for your time, Reena. It was an honor and thank you. Check out this episode next with Dr. Andrew Cutnik. The longest high fat study has just been published. It's over 10 years. What happens when you eat high fat for 10 years? You'll find out with this episode. Finally, thank you for your interest in root cause healing and I'll see you next week.