On this episode of the Flex Diet Podcast, I sit down with my good buddy and lab-coat-wearing performance wizard, Dr. Andrew Koutnik. We talk about how to boost muscle performance, improve body composition, and feel like an athletic human without dumpster-firing your health. We dig into cold water immersion (and when it can kick gains in the shins), blood glucose regulation, ketogenic diets, carbs (yes, they’re still awesome), and how to build metabolic flexibility that actually translates to better outcomes in the gym and life. Andrew shares some killer insights from his research at Florida State University, especially around keto diets and athletic performance. If you’re curious about whether low-carb can help or hurt your performance, this is your jam. If you want practical tools for a bigger physiological engine, tune in!
On this episode of the Flex Diet Podcast, I sit down with my good buddy and lab-coat-wearing performance wizard, Dr. Andrew Koutnik. We talk about how to boost muscle performance, improve body composition, and feel like an athletic human without dumpster-firing your health.
We dig into cold water immersion (and when it can kick gains in the shins), blood glucose regulation, ketogenic diets, carbs (yes, they’re still awesome), and how to build metabolic flexibility that actually translates to better outcomes in the gym and life.
Andrew shares some killer insights from his research at Florida State University, especially around keto diets and athletic performance. If you’re curious about whether low-carb can help or hurt your performance, this is your jam.
If you want practical tools for a bigger physiological engine, tune in!
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Speaker: [00:00:00] Welcome back to the Flex Diet Podcast. I'm your host, Dr. Mike T. Nelson. On this podcast, we talk about all things to increase muscle performance, improve body composition, do all of it in a flexible framework without destroying your health. Today on the podcast, got my buddy Dr. Andrew Knick, and we're super excited.
I guess I am super excited to chat with him. Uh, it's been a while since I've been able to chat with him, and his background is super interesting. I met him, uh, many years ago through mutual friends to talk a little bit about on the podcast. He is definitely focused more on the metabolic side and ketones and exercise performance.
And all of super cool stuff. Uh, he is also now at the College of Education, health and Human Sciences at Florida State University [00:01:00] and has done a PhD in molecular pharmacology and physiology and is also a type one diabetic. So he has done some very interesting, uh, self experiments, which I would not recommend anyone do.
Um, but that's how we initially, uh, met through some friends and I was just fascinated talking to him, um, because of all of the cool experiments and, uh, everything that he has, uh, been able to do over the years. Uh, he's produced some really, really cool, uh, science in terms of formal studies and yeah, just a lot of, uh, great stuff.
So. In this podcast, other than our mutual love for one of the best bands of all time, which is Lamb of God we talked about, uh, what it's like to do research and we talk about a just wide variety of topics. [00:02:00] Everything from cold water immersion, kind of what does the science say, what is personal experience, my cardiovascular response to cold exposure.
Sympathetic and parasympathetic nervous system responses. Then we get into, uh, blood glucose and the ketogenic diet, exercise performance. And he has some really, really interesting, um, data in that area about what, what really causes someone, uh, to stop exercising in relation to. Carbohydrates, glycogen and more.
I'll kind of leave it at that because I think it's a very interesting discussion and I really enjoyed that. May also kind of wrap up a little bit on the health implications of carbohydrate diets, fat oxidation, and some other stuff related to metabolic flexibility. So I think I really enjoyed this podcast, a fascinating [00:03:00] researcher and just, super cool guy. I could have chatted with him for another couple hours, so if you really enjoyed this one, let me know and we can have him back on again. 'cause I feel like we just kinda scratched the surface of all the great stuff he's doing. In terms of sponsors, uh, check out my friends over at Teton Ketone Esters.
The new versions should be out very, very soon. I don't have an exact launch date yet. Um, but I'll put the link down below. Uh, hopefully it should be very soon. So when you go there, uh, hopefully the site will be up and everything. Uh, full disclosure, I do some work with them on the science side and I am in the ambassador to them.
I haven't been able to use a product for a long time now, and it's been great. Uh, as of this recording, I am just making my way back via Austin, Texas briefly. And I brought a ton of ketones down to South Padre, Texas that I [00:04:00] used. My biggest thing I found as a benefit was after a longer kiteboard session of maybe two hours.
Um, I think like training's been pretty good. Like I felt physically pretty good overall, but, uh, trying to do new stuff, especially more technical stuff, back rolls, higher jumps, my brain would just be kinda cooked after a couple hours. I would have one or two cans of ketones and grab some electrolytes via element, and I felt pretty good to go again.
So I did that multiple times down there. So I think there is something to the cognitive enhancement, um, after high levels of work and different things like that. So, uh, check them out. If you want more information for me, uh, go to my newsletter. Go to mike t nelson.com. You'll see a tab for newsletter.
We are working on a new website. It'll hopefully be out in the next couple months. It's been a pretty big project. But either way you'll still be able to find all the [00:05:00] information there. You can see daily updates from me. If you really enjoyed this podcast, you will love the newsletter and it's totally free to hop on and subscribe too.
So thank you so much for listening to the podcast and without further ado, here's a great discussion my buddy. Dr. Andrew Knik.
Dr Andrew Koutnik: Hey Mike. It's an honor. Most people don't know this, but I think the first time I ever met Mike was at Experimental Biology. It was, man, it was almost a decade ago. And you had I, we over that. I
Dr Mike T Nelson: like hunted you down. I got your text and I was like, I hunted you down at the conference.
Dr Andrew Koutnik: Yeah, I know. I dunno how we exchanged information, but you, oh, you know what? It was
Dr Mike T Nelson: before that it was 2013, you were at a round table after one of Elaine Norton's events. That's
Dr Andrew Koutnik: eating at a restaurant. Mike, you were at the his camp. Yeah. Yeah. That was the first time. Yeah.
Dr Mike T Nelson: Yeah. But second EV was for sure.
Dr Andrew Koutnik: Yeah. It was so cool because I, Mike, you [00:06:00] have been, at that point, you had already graduated, you were already had your PhD and all that good stuff, but you still went to conferences even though you weren't as attached to academia as some people are. Mm-hmm. And it was cool to see that your personal passion, like you, you showed up and continuing to learn and paying to do so.
Yeah, because conferences aren't cheap, man. I don't know if you guys here have a 10 or not. If you're not getting it reimbursed by some institution or grant or whatever it's not cheap. So,
Dr Mike T Nelson: yeah. But that's where you learn all the cool stuff. I remember God years ago, like one of the first ones I went to outta state was it a CSM 2000?
Three to see like Stu Phillips and where I was staying with some friends 'cause I didn't have any money at the time. I ended up driving an hour and 45 minutes just for the single day at the conference. And I remember leaving and getting back at where I was staying at like three in the morning. And then the next day buddy of mine was doing a mega wave stuff.
So I went out to him and I was [00:07:00] like super fascinated with a mega wave. So I said, Hey, how much can I, pay you for a consult to answer all my questions? And he's like, ah, just take me to a steak dinner and I'll answer all your questions. So we went to dinner, which was another hour and a half away.
So I got to pick his brain for a while. And yeah, just doing those things like you, I think it also, there's something about having skin in the game and having the priority. Like I still remember like what Stu was talking about there with the hyper responders. He had just finished the study with, I think it was a 12 week or eight week hypertrophy study.
And you have the average. And I remember him saying. One poor bastard got smaller and weaker and two people were like two or three standard deviations above everybody else. And I remember just looking at that going, what I remember asking him, I said like, what the hell is going on with that? And he is like, we have no idea.
And that's what led him to look at, testosterone response, which showed no effect and a bunch of other things. And there's just something about the seeing stuff live. I think it's just more, [00:08:00] you remember it a little bit better, at least I do, I guess
Dr Andrew Koutnik: a hundred percent. Yeah. I've taken online courses before and in-person lectures are always much more impactful and you also get to go up and speak to them personally.
Oh, that's like the best part
Dr Mike T Nelson: is all the, conversations and hunted people like you down at eb and then it was like, was like, what are you seeing? Like what have you not published yet? I get it. You can't talk about a lot of stuff, but like Yeah, I love asking. Researchers, like what do they do in practice?
Because I think that always hints is things that you may not have enough data to say yay or nay, but what they're doing in practice, I always find is super interesting.
Dr Andrew Koutnik: Well, I want to say something on that because I think that's really important to what probably a lot of your listeners, 'cause I, I assume a lot of people are listening aren't necessarily all in graduate school or Yeah.
PhDs in academia, a lot of the people are probably looking for practical tips and what Mike is saying is super relevant because oftentimes you'll read a study, it had very strict constraints in a very strict environment to answer a very direct question, but understanding the [00:09:00] nuance and how that's applied.
Is really where the magic is, right? It's almost like an art, it's the art of taking science and interpreting it to individuals, right? And that's what we're all trying to do. Like, I got into science because I wanted to selfishly learn how I could get bigger, how I could get stronger, how I could get faster.
And then it transformed into a lifelong journey when I got diabetes or diagnosed with type one diabetes. For those of your audience who aren't familiar with that I don't produce insulin. I basically manually inject insulin. I monitor glucose and insulin every few minutes. I administer the insulin manually.
So I have total control of my own metabolism basically. And that turned into a research career where my own disease, my own passion for performance my own passion for optimizing management and helping other people has been, has led the way for me to actually do science in the first place. But what you're talking about when you actually get to speak to people, 'cause a lot of times what people don't appreciate, and I've let this guard down a few years ago 'cause I realized it wasn't the way to go.
And [00:10:00] academia and science as scientists was always so careful about what we say. Like, oh, God forbid we have an opinion and we say anything outside of what's directly put into a, don't forbid, you're human. Yeah. And have these opinions. But then what I also realized is there were so many things that I had opinions on that I would just keep secret.
And I wouldn't share because I'm like, I don't, I, that's controversial to have this opinion on this. And but the reality is like, the reason you go to that conference and you speak to that person privately is because they may be apprehensive to speak on what they think is the true application or what the real reality is.
But when you do speak to 'em, they're not in front of a mic. They're not behind a camera. They'll give you their honest, genuine pinch opinion of how it applies. And I think that is where you get the real insights, how it could apply to your life and how most people can apply. So for the last five years, I've really let down.
That shield or that cloak of protection around, sharing or having too much an opinion. 'cause I realize it doesn't help anyone to hold back. You know that because your opinion is [00:11:00] usually framed, often interpretation of a lot of science that you've learned over the last, Mike, for you probably, Mike's like 80 years old, right?
So like the last 60 years from Mike. Yeah. I'm 51 now. I'm old bastard. Yeah. Gandalf, but he listens to metal music, but for, for me, a little over around 20 years now, and so that most of that isn't just regurgitation of some scientific study because that's not real world.
It's the things that have been new, most insightful for me, Mike, by far is my personal lived experience, having to navigate what I've understood in textbooks and what I've learned in research and seeing how to apply to my direct life. Particularly because I have complete control over glucose and complete control over insulin.
Basically I run my own metabolism manually and there's a lot of pros to that. There's a lot of cons to that. And so that, that's really what led my journey. And I think to what you're saying, just, you get a lot of unique opportunities when you meet people and get to speak to them and extract that information along the way.
Dr Mike T Nelson: And another tip [00:12:00] for people is, I think high level organizations in general will pay you for both. So like I just did a talk for F1 racing the other day. I was super nervous about it because it's like super, they're all wonderful humans, but very data driven. But yet you're talking to their coaches. So at the end of the day, they wanna know, well, okay, this is great and we wanna be very research focused.
We wanna make sure we're doing the correct things, but at the end of the day, we have to do something with this data. And so it was fun to say, okay, here's the research. Here's what we think about, respiratory rate, resting heart rate, HRV, all this stuff. Here's where kind of the limits of the research are.
Here's what I've noticed over the past, in this case six years of looking at respiratory rate, HRV, all these combined to try to make it useful to them. And I think those conversations are also what most people in the air quotes, the really real world are looking for. They wanna do stuff that's correct, but they also need a little help to translate it into, okay, [00:13:00] what do I actually do with this information?
And I feel like social media being very polarizing is either you're only a researcher and you can only talk about research and that's all you can ever talk about. Or you're only a coach and you can only talk about coaching, you can't talk about research, and it gets a little muddy when you're in between trying to figure out how to apply this to it.
My second caveat is my new pet peeve is. Researchers who haven't even run their own experiments or don't coach anyone, like telling people exactly what to do, like hyper specific protocol wise. And you look at that and you're like, no, no single person's ever survived this. Like, you have not used this with like a single person.
Because yes, the research on Tabata says this, in reality it just breaks down. So those are my old, well, I get off my lawn type speech now.
Dr Andrew Koutnik: Yeah, I can tell you that's, well, I think in many ways I got lucky just because it was, you, if you find something in literature and immediately you're [00:14:00] like, I had tried that and it didn't work for me.
That gives you a really powerful tool. Yeah. This, and I think in graduate school or, I was going through academic training. I remember se hearing a quote and I thought it was one of the most powerful 'cause it was absolutely true to me. And it applies to everyone, which is. When you have a dear hell belief, a very strong held belief, and later with evidence, you come to find out that it was shattered.
That's one of the most powerful moments because you realize, well, look, I, okay, I don't have it all figured out. I thought I did. I don't have it all figured out. And that allows you to be open-minded to all possibilities, even the ones you held most here. But also realizing at the same time, to your point about coaching and the relationship between those I've actually coached a number of elite athletes, and I will tell you it's a hundred percent my experience also, and that you find that what in the literature is a great place to start.
But the problem is mm-hmm. First off I, particularly when you're working with elite athletes, they're [00:15:00] usually not on the middle of a bar graph, no. A lot of times you're looking at these athletes and you're thinking, okay. This is what the science shows and you see this all the time, like, no, you're wrong.
'cause the science has showed this. You're like, well, hold on. That's true for the average person in those constraints. However, what if you're the person who is the outlier on the top or the bottom of that bar graph and you're doing something that's working for you and or you try something, it doesn't work for you, but the science says otherwise you shouldn't keep doing that.
If it's not working for you or if it is working for you, you shouldn't abandon it just 'cause the science says you shouldn't. For the average person, maybe it does work for you. Maybe you're that outlier that it uniquely applies to. Because what science gives us is the average of what's most likely to happen for the population at large.
So it gives us the best starting place. But if you, it's very important to also consider the practitioner component, which is the direct application and how there are layers of translation that go from a very. Strict laboratory setting out into the real world. [00:16:00] And then understanding how to modify, iterate, and adapt with an individual is a really cool experience as well, because it does open your mind that, it opens your mind more so to the constraints of what science can offer, which is the best tool that we have to understand the world around us, but also understanding that there, it's not infallible.
And the interpretation is where things usually fall down. Understanding that, hey, it does show this, but this person ri me schwan differently and they do, and I'm gonna trust what I see in front of my eyes. So, that's all I'll say on that note.
Dr Mike T Nelson: Yeah. And I had a conversation with my buddies, Dr.
BEUs and Dr. Tommy Wood a while back, and we were all comparing notes and it, and one thing I didn't appreciate probably 20 years ago was. How freaky the real freaks actually are. Like how far standard deviation wise they probably are from the norm in certain things. It's just to be on the side of say like A NFL and see a 285 pound human moving that fast.
It's [00:17:00] just utterly mind blowing, so it's hard to appreciate how far away from the norm, like the actual true elite people are.
Dr Andrew Koutnik: They're, yes. And that's just one example, right? Yeah. But even on the average person level there's always this the average split over, the dots are split all over the bar graph.
You just typically only see the bar in the middle of it. For most of these studies, and we've gotten away from that a little bit in science, you start to see individual responder data showing more of that, because I think it just gives a better perspective of d distribution of. How someone may respond to an intervention, a treatment or so even their metabolism or the physiological response to a stimulus.
Stimulus could be exercise, it could be nutrition it could be cold exposure, which we talked a little bit about earlier before we started this. And we will talk a little bit more about it. But either way, I think it opens up a, it's just a really cool thing to appreciate. And I, that's something I appreciate about you a lot, Mike, is that you've been a coach for a [00:18:00] very long time and you've learned from other coaches and you're involved in science and have been for years, and you go to learn from the best in the world, but you also apply it.
And I think that's a beautiful interaction. It really gives you the best of all worlds if you were to ask me. But I'm biased,
Dr Mike T Nelson: so, oh, well thank you. I appreciate that because I just think that's where all the interesting stuff is, like the application of it and a lot of stuff I've tried doesn't really work at all.
Other things I've like thought, eh, I don't know, this is wacky. Eh I'll try it. And the reality is like, if. So I've often said if I am doing a research study, I'm the best thing to do is to eliminate any placebo, have a sham control, set everything up so that the thing we find is the actual thing for someone's coming in and I'm doing work on 'em.
Honestly, at this point, if I know something has worked for quite a period of time, even if there's not much literature, I'm probably gonna try to placebo the shit out of them, which I get [00:19:00] a lot of crap for. But that person, as long as it's safe and you're not doing anything unsafe, they're only paying me for the result.
Like they don't care. A 17 study said this thing should not work, and they got a demonstratable result that they can repeat safely. They don't give a rat's ass about what any of the literature says. They trust you that you're reading the literature and you know where to go and you can get to a faster starting point, but they're literally only paying you for the result.
And so they're actually like these two different. Ends of the spectrum and neither one is right or wrong. It just depends on the context of what you are actually trying to do at that point. And I feel like that gets conflated all the time back and forth.
Dr Andrew Koutnik: Dr. Mike T. Nelson, let me tell you something that was the most evidence-based thing I've ever heard.
There is no stronger performance enhancing effect than the placebo effect. Correct. So if you go in to try to help someone and don't at least attempt to convince them that what they're doing matters and can work for them, you're losing out on one of the most evidence-based approaches [00:20:00] in performance enhancement that we know based on science, right?
Beyond, yeah. We have science to show that
Dr Mike T Nelson: it works.
Dr Andrew Koutnik: It a hundred percent, it works better than anything else consistently. Yeah. However that said, obviously on top of that is adding evidence-based strategies as well.
Yeah.
To give, 'cause you want the results to, imagine you give, the encouragement, the placebo effect of the intervention itself, but then also amplify that response.
By actually giving evidence-based tools that do actually enhance, let's say, performance or maximize someone's overall health. So that's always the goal because keep in mind that placebo may enhance effects, but if an intervention is truly augmenting or improving performance in some way, it's gonna be above that, right?
So it's a stacking effect. That's why you have typically a placebo group in most trials if you're really trying to elucidate if something do ha doesn't have an effect. So if you do both you induce a placebo effect, but you also give evidence-based strategies you truly amplify. Hopefully the response that you get out of people.
Dr Mike T Nelson: Yeah, and one [00:21:00] of the little tricks I'll do, if it's a new technique or something, I'll explain it to someone and they might be like, that's the dumbest thing I've ever heard. That's never gonna work. I'm like, perfect, come on over. Because if it, if I can show on an N of one or n of two, N of 30, whatever anecdotal that it works in the face of your no SIBO believed effect.
I'm probably thinking there's something there. So initially on new stuff, I actually try to find people who tell me that's the biggest bunch of bullshit I've ever heard in my life. Perfect. Come on over. Because if it works in that population with a nocebo, I feel a little bit more confident that there's probably something actually going on there physiology wise.
Yeah. Yeah.
Dr Andrew Koutnik: I could, I definitely agree with that. Definitely agree with that.
Dr Mike T Nelson: So what are your thoughts about, I think cold water immersion fits into this area where, similar to you, we were talking before the podcast, like I've done it most days. I've been home since 2020. I took an old freezer, converted it right before COVID [00:22:00] and so when COVID happened, wasn't teaching wasn't going anywhere.
So it was like the air quote, perfect experiment to try a bunch of stuff at home. And we can talk a little bit about the research I think is split ands context specific and a bunch of other stuff. But I will say anecdotally. I felt amazing. Like I doing it in the morning, I would do it after my aerobic exercise.
And the two things that shocked me the most were one, even after two years of doing it, almost consistently it was easier, but that second, right before you get into like 41 degree water, I still had the hesitation of this is dumb. Like that hesitation never completely went away. And then I always felt pretty good after it and I was like, oh, I'm so glad I did this.
Dr Andrew Koutnik: Yeah. It sounds like almost everything in life that's worth anything. It involves some level of effort or work, right? Yeah. But yeah, so I, so there's a little background here because Yes, please. I recent, so [00:23:00] I almost wonder how I tell this story, but I think it could start by going around 15 years back.
So when I was early. Years in my research career, some of the first work we did was in cardiovascular health. Looking at the impact of how, psychiatric or subclinical psychiatric conditions, anxiety, depression burnout, distress, an, anger isn't a condition by any means, but it's a mental state.
And we would look at the interaction between how people with subclinical levels of something like depression or anxiety would respond differently to someone who did not to a known cardiovascular stimulus. And one of those stimuluses besides doing, exercise, like a 30% of hand grip for, you'll say three minutes.
One of the most reliable ways to induce a stimulus was cold exposure. In fact, you didn't have to do these, cold plunges or whole body plunges. We actually stuck. Just the hand up to the wrist into water, and [00:24:00] it was an ice bath basically. Essentially what all the influencers are doing nowadays, we're talking about at least they were over the last year.
We would do that just for the hand, 'cause it was one of the most evidence-based, reliable ways to induce a sympathetic nervous system response in a cardiovascular. Cardiovascular changes that we could then see how people responded to it. Because we found that people who had higher levels of depression, even subclinical, not diagnostic, would elevate in their sympathetic activity, but then they would struggle to bring down their sympathetic activity, unlike those who didn't have subclinical depression.
And so we would see that pretty consistently across other metrics like distress as well. And so what it was essentially. We were just using this as a tool to ex to induce a stressful stimulus in the firm. A sympathetic nervous system response. But what would happen is then sym sympathetic nervous system metrics would rise, parasympathetic would drop, and then when you pulled the handout, you'd watch the recovery response.
You could even do this for a, [00:25:00] three minute window and then look at the five minute recovery response afterwards. And you can see this reliable drop in sympathetic nervous system, usually below the baseline if the person was healthy, and then the parasympathetic would rise above the baseline after the stimulus.
It models a lot of what we know about exercise and that exercise. Is in of itself a stressful stimulus in the body. But the reason it induces these all these health benefits is because that acute bolus of stress then induces a counterregulatory response, an antioxidant response and anti-inflammatory response.
The reduction in the sympathetic nervous system that elevation, the parasympathetic that leads to these more chronic changes within the day that accumulate to a life better lived a healthier life in a more resilient biological entity. And so, we, so we would do these hand exposures with cold, but we also would ask people, and we were the researchers, so we were going in the room too.
We would ask them to sit in a [00:26:00] full fledged cold room, near freezing temperatures to see how whole body cold exposure, not just head out like they were actually in a freezing chamber monitored controlled environment. Yeah. To look at their sympathetic nervous system response, actually heart rate, variability response.
With supplementations like El Citruline, which is a Oh yeah. Precursor to nitric oxide. And we thought, okay, if you give a precursor to nitric oxide, that would help elevate the resilience to some of the. Cardiovascular responses in cold. And what we found is that things like exercise and things like cold reliably are so powerful that no supplement's gonna stop them from inducing their ne necessary effect.
However, we do see that there is a amplified response with some of these supplements to help bring down the nervous system or bring up this parasympathetic nervous system for those who are unfamiliar. That's the fight or flight response. To put a very layman simply, that's, there's a lot of nuance in there.
Mike [00:27:00] knows this all too well, and then the rest and relaxation response. And so they did augment the ability to recover from those responses. But nonetheless, exercise and things like cold exposure we're reliably able to force a response. And the reason that's so important. Mike is because imagine you are in an exercise environment and you just took this supplement over the counter and it forcefully inhibited your body from responding the way it needed to, from a blood flow perspective, from a oxygen update to tissue perspective, to a nervous system perspective that would compromise your adaptive your survival.
Let's say, analogy people use is you're running away from a tiger or a dinosaur, they're trying to eat you. If your body took this supplement and it stopped it from doing that then you'd be in trouble. You need those things to happen. They're supposed to happen. So, so reliably, unless you're truly drugging a response.
Those are power. Those are often more powerful stimuluses than any of these kind of over the counter supplements often and are, they're just a [00:28:00] super powerful stimulus. But I think the reason you're asking this, Mike, is 'cause I went on a trip to Switzerland recently and we were there and it was the most beautiful place of all time, but.
They had these beautiful lakes we're in St. Morris for a conference. I was speaking there and the lake is fed directly by glacier water. And so it is very cold. And so at the conference, there's a lot of people into the whole, health and wellness stuff. I'm like, Hey, we're gonna go for a cold punch tomorrow at 7:00 AM I'm like, great.
I usually wake up like 4:00 AM so like I can meet the time criteria. No big deal there. I have kids by the way, which made me wake up way too early. But either way. So I got used to that early time and so I went out there and I'm like, okay, let's see how this goes. I walked in, huh? Instantly. Like it just took.
All, and I've done all these experiments. I've sat in a very cold tub for a Department of Defense grant. Like I I've done all these things before, but this was just different. It was like waking up first thing in the morning. I wasn't mentally even prepared. I just did it, walked in and I literally took my breath away and I was like, oh man.
Like, it [00:29:00] almost feel like I'm cardiac arrest. Like this is crazy. It was such a powerful stimulus, but with having type one diabetes I don't have I'm able to stop, or what we call in science clamp my insulin response. So that's what I did. I actually didn't administer any insulin. I held it steady.
So there wasn't this immediate a response and insulin response, and I was able to see my glucose response to it. So there's these known mechanisms within the body how stress can induce hyperglycemic or elevations in blood glucose. And there's been some really fascinating studies that come out recently on this topic.
But nonetheless I walk into the water. I, it was. Definitely induce a stress response very clearly, subjectively and perceptually induce a stress response. I get out and my blood sugar just climbs well over a hundred milligrams per deciliter rapidly, super rapidly. And I was like, that was incredible.
Five minutes, super powerful. And I, after that one morning, I did it every single morning. But what I also [00:30:00] found, 'cause I looked at literature, I was studying this as a method for inducing stress for over 10 years. The evidence isn't so powerful and overwhelming to say what a lot of people says.
It is like this super biohack tool and health and wellness. But I will acknowledge that when I went in that water and I got out, my day was way better. Yeah. Like the rest of the day was just way better. It was totally different than exercises and how it the stress response and the perception of it.
However, I will say that, it was a lot like exercise in that you have this elevation and kind of difficult moment, the stress induced difficult moment that leads to this much more pleasant and peaceful day. And that was definitely my subjective experience. In fact, I went home and I'm like, started looking up on the train ride back from St.
Morris to Zurich in Switzerland. I was looking at my wife, I'm like, I what a cold plunge. Lemme see how much these things are. I was reaching out to friends, like who have done it before or have them, [00:31:00] and I'm like, how, what's a good company? I started looking, I'm like, holy smokes. Yeah, these things are like super expensive.
And I like started looking at my wife. I was like showing her the phone. I'm like, Hey, you think I can what do you think it's a good idea. Like, trust me, I think it's a good move. And she's like, yeah, I don't know. Yeah, I don't know. That looks like a hefty price to pay for that. But yeah, that's my experience both scientifically and personally with cold exposure.
And if I if it wasn't such a heavy price, I'd have one in my garage right now. Trust me.
Dr Mike T Nelson: Yeah, you can do the converted freezer thing. Mine's going on six years now and I have to drain it again now. And it, the one thing about the freezer is if people do that one, obviously this is not medical advice.
It's not designed to be put water in, don't ever get in when it's plugged in, blah, blah, blah. But the sides of them, the metal's really thin and so it'll chip a little bit. So I have to drain it every so often and then take silicone and patch all the little spots in it again. So pretty soon it's gonna have more silicone than metal on the walls in there.
And now I've gone through two ozone devices and now I have to buy more of [00:32:00] a, in industrial grade ozone to, to stick on there. But it's worked. The other thing to watch is the look for the compressors that have temperature ratings. The cheap compressors are only rated for like. 50 to 75 degrees, the better ones are rated for a bigger temperature range.
So those are usually a little bit more heavy duty. But than that, it, it works. There's obviously a lot of, professional ones people can use. And yeah, I, same thing, like in a perfect world, if I could do it each day and I, you got in streaks and do pretty good, get up, do some cardiovascular exercise in the morning, do a little meditation, do the cold plunge, and then just start your day.
And it works really well for sure.
Dr Andrew Koutnik: It's interesting you said that combination too, which is the cardiovascular, the cold plunge and meditation. All three of those are things that I have defaulted to as super effective ways to start my day. And I'm not sitting here telling you, oh, look, the science says this is gonna improve your cognition and wellbeing doing this.
It is actually what I've [00:33:00] done through lived experience of, like, I, when I was waking up, when our son was first born, it'd be like two, 3:00 AM and like ever since then, I've woken up basically from four to 5:00 AM for the last six years. And with that I've found that like you can immediately jump into work.
It's extremely effective to do that, but I've also found that just walking.
Mm-hmm. Yep.
Also, like I, my experience with cold plunges I was talking about and actually maybe more than all of that, the mindfulness and meditation. I did a 30 day course from Sam Harris's waking up app, and it just Oh, nice.
Yeah. Yeah. Transformed. Yeah. Transformed my entire. If someone's unequipped or unaware of mindfulness and meditation, I feel like, at least for me, there's so many different tools and strategies out there to like explore it. But Sam Harris really spoke more so to me than other platforms did or other ways to do it.
'cause he is a scientist. So there would be times where I was doing his meditation in the morning and it didn't happen right away. Like I really had to stick with it. It was actually my wife who went on a Ppaa camp. Are you familiar with that? Mm-hmm. Mike? [00:34:00] Yeah. Yeah. Alright, so my wife is on a VPAA camp and she came back and ex like, she just said, okay, is one of the most amazing, transformative things I'm gonna ask you to try something.
I'm like, well, she did, just stay multiple days without talking to a single person, meditating for almost the entire day. Like seven, 10 hour stretches of meditation. Like very hard. This is not an easy thing. It's not just sitting down, no putting on your phone. Like, it's a very difficult thing to do.
Most people would not do it or survive it unless they were forced to. But she did, she came back. She said, I want you to try something. I want you to, I remember this is, we're in this little, like 900 square foot town a condo in Tampa when I was in grad school. And so this little apartment, we're in the living room doing this.
And I didn't have like a biohacking room. You have a living room to try these things. And so I, she sat me down. She's like, okay, I want you to just sit down and only try to focus on your breath. I'm like, what do you mean? So she explained, she walked me through it. She's like, but I want you to be aware of how [00:35:00] quickly you lose your concentration on your breath.
And so I'm sitting down, closing my eyes, took a deep breath, and it was supposed to be for 20 minutes, but I just sat there for 10 minutes and I could not go more than two to three seconds without a thought arising. That distracted me away from my focus on my breath. And it immediately clicked for me. I don't even have control over the next thought that arises so much so that I felt in that moment more distracted than I ever did in my entire life.
I just never knew it until I actually paid attention. And when I started paying attention, then I realized I need to do something about this. And I looked at various platforms and I came across Sam Harris. He speaks like a scientist, and I remember trying his meditations in a really unique and pivotal moment in my life, Mike, and it literally transformed it.
Just the conscious awareness. Of what your mind [00:36:00] does often without your awareness is one of the most transformative experiences I think someone can go to. But back to your original point, you mentioned three things that people were like, oh, this guy's like a biohacker. I should, I don't need to do that.
I bet if you did try mindfulness and meditation or as some form of exercise or cold plunges that you will, on the average probably find some powerful effects to many of these things, at least if you had some guided help about how to do it the right way. It's, but it's funny. Those are the three things I can most often cite as like go-tos as reliable strategies to improve the rest of my day, to improve my focus, improve my cognition, and just feel like I'm at peace.
Not like I'm running away from a burning building with every project I'm doing frantically trying to get everything done. I just feel at peace while I'm doing the same project, with the same level of efficiency. And it's just a di completely different lived experience.
Dr Mike T Nelson: It's a. A different sensation to be able to, for most people, myself included, to be able to focus and [00:37:00] to get tasks done with efficiency, but not like, ah, like being stressed, 'cause like for most of my life I had to be stressed to focus on anything. And it's been a weird sort of transition of, okay, I can be alert, I can still focus on things, but I don't have to be stressed. Obviously there's gonna be a little bit of, sympathetic and all that other kind of stuff for focus, et cetera.
It doesn't have to be like, oh, eight pots of coffee or, just all amped up to do anything. And similar to you, like we did a zen style meditation in Costa Rica. God, it was probably maybe six years ago now, and never done anything like that before. I'm all excited we get there and I, the guy was awesome, was actually Dr.
Ben Haus was his dad, and he's wonderful. And so we get there and we're all ready to do the first meditation of the day. And he's like, okay, here's what you do. Here's how you sit. And you find a spot and just about, a foot true in front of you. Eyes slightly open, [00:38:00] and if thoughts come by, just pretend they're like clouds coming by in the sky and just acknowledge it and then let it go.
I'm like, okay, cool. And he is like, are you ready? And I'm like, what else do we do? He's like, that's it. Now do, that was like the only instruction. And I'm sitting there going, oh, holy crap. People spend their whole life just trying to master this one. Very in theory, simple thing, but extremely hard to do.
Dr Andrew Koutnik: And it's one of the most powerful experie, but yet extremely effective. Yeah. Yes. Most powerful journeys. One can experience and a lot of the to give analogies to people who may have never experienced this and think this is just woohoo stuff. And we're like over here in the mountains with tie dye shirts on, just burning trees down and like, having deep thoughts.
What I'll say is when you're talking about these things and they're there response and their power, that these are the areas [00:39:00] where science is like. Not gone into great depth with, but obviously we're talking here about the clinic, the, our personal experience with it. Yes.
And how powerful it has been for us on an individual level. But you hear about this a lot as well, and it's only oftentimes after people have pushed the envelope in trying it, that the science starts to follow up. And, but either way I, yeah. Fascinating stuff. What you can learn from just paying attention sometimes.
Dr Mike T Nelson: And one other thing, we'll transition to your new study coming up. So when I measured back to the cold water immersion and just running neuro own experiments, I did this a couple times and I would prick my finger, get my blood glucose, it'd be like, low nineties, mid nineties, maybe high eighties.
And then this was probably two years into doing cold water during the COVID times, like pretty much all the time. And when I would get out. The first one measurement I got, my blood glucose was 51. And I was like, what the hell? This has gotta be an air, and so I poked my finger again [00:40:00] 57. I was like, ah, this thing's a piece of crap.
So do it the next morning, 85. Okay, get in the cold water. And I was doing, probably 41 degrees for like five minutes. It was, the first, you takes your breath away a little bit, but then it was, pretty easy. And each time my blood glucose would be in at least the sixties, like it would be profoundly dropping or any thoughts on that, because yours is going up and which makes perfect sense to me because it's a sympathetic stressor, but then is there an acclimation?
And then of course there's a role of insulin and everything else in there and all the other mechanisms.
Dr Andrew Koutnik: So to distinguish Mike from me, Mike's one better looking. Okay, there's that, but two, his pancreas also works. Correct. And so one key aspect of metabolism is that when you have a blood glucose elevation.
In normal human environments, if you don't have type one diabetes or type two diabetes, or even signs of pre-diabetes or obesity, which all comes some degree of changes in insulin or in my [00:41:00] case, I don't have the production of insulin anymore, you will have a dose dependent second to minute, instant release of insulin proportional to the blood glucose elevation that immediately goes into the bloodstream.
Okay? That's number one. And so the compensation for that is instant. So insulin is a one of the most powerful, I would argue, the most powerful al metabolism. It's known for its anabolic properties, mostly known though for taking glucose outta the bloodstream and storing into various tissues, whether it be the liver for liver, glycogen, or the muscle for muscle glycogen.
Now, it also does maybe more than any other hormone does in the body as well beyond that, but that's, it's where most people know it. Now, in this case, where Mike is getting the cold, he may. Have had a glucose elevation, correct. In which case he was, he would have been met with an insulin elevation or insulin elevation that would immediately and rapidly in a do peanut manner, pull those into key tissues.
There are other [00:42:00] mechanisms, though, that may also contribute to the hypothetical why of why you see this blood glucose drop. There is the anticipatory, not anticipatory, but the known responses some have was shivering. The involuntary contractions, which we know at least over longer periods of time, typically associated with studies of exercise can cause glucose uptake independent of insulin.
But those are usually in exercise settings where it's much longer duration. We know the same thing can happen with caffeine intake when you actually cause involuntary contractions and that Im, that's called through glute four translocation. There's and there's other po plausible mechanisms.
Right. But the reason I shot through the roof is. Why might go down is because you can actually look at studies even in athletes where they're about to begin a really high stress exercise endeavor. And they will spike in glucose sometimes, but then they'll immediately come back down.
But in associated with that is their insulin response and it immediately comes back down. [00:43:00] And so, I would SI would speculate without complete certainty here, Mike, that it's probably in part or mostly explained by an insulin driven response, but also po possibly some insulin independent effects as well.
'cause I'm unaware of any known literature on cold potentially causing the reduction in glucose output. 'Cause you talked about this, you said, I walk up to the water and I pause. What that tells me is you're anticipating a stress response. Yeah. We know. Yes. So we know in the brain. The amygdala will sense that signal of stress, push it to the hypothalamus.
That's then pushing out multiple mechanisms. Okay? Some are directly neurologically linked to the adrenal glands. Some are also lead to changes in, let's say the adrenal glands are released. Something called adrenaline, well that's actually an epinephrine, but also norepinephrine. Those molecules are known to go to the liver and [00:44:00] help facilitate the breakdown of glycogen into glucose and release into the bloodstream, hence blood glucose elevation.
There's a new mechanism at least discovered in mice, but it's brilliant paper in nature that recently came out that showed that. There might be a new mechanism. 'cause the historical mechanism was typically focused around the HPA axis hypothalmic, pituitary adrenal axis. So this idea of the brain's anticipatory response signaling a signal to the adrenal glands.
They induce stress molecules and the stress molecules increase the breakdown of historic glucose. So glyco, so meaning glycogen, lysis, glycogen, lys lysis meaning the breakdown of glycogen and hence the glucose elevation. But there's another mechanism outside of that and also the cortisol response. Is this known this nature paper that came out, that showed that mice who were a brilliant study by the way where they actually induced a fear response [00:45:00] and blocked some of the traditional pathways of glucagon adrenaline responses and otherwise.
And induced a direct signal from they say polys synaptic linkage. Basically multiple nerves connected together directly from the brain all the way down to the liver. And it actually directly wires the liver to start inducing glucose neogenesis. So actually the production of more glucose. And so there's actually emergent mechanisms, and I do believe this mechanism is real because they only showed in animals.
But I actually buy this because not only in the, did they optically stimulate that part of the brain and it actually induced hyperglycemia. They dis it through fear responses. They did it through they actually traced the synaptic electrical signal direct to the liver, like they did some amazing controls in this study.
A, a beautiful paper, but I actually think it's real. I also think it's real because there are children, I like parents of children with type one diabetes [00:46:00] who get these powerful hyperglycemic responses going up 200 milligrams per deciliter. So basically tripling the normal level of glucose. If not more just in anticipation of a sports game they're gonna play.
And so sometimes some of these parents will ask their endocrinologist otherwise like, look, this is inducing troubling hyperglycemia. No. Someone will be put on beta blockers. Well, what does a beta blocker do? So a beta blocker is blocking the signal of the adrenal glands, catecholamine or adrenaline response in the liver.
So you're isolating out or controlling for that altogether, but you still don't completely block the blood glucose elevating effect of stress. And this other mechanism would explain why there's an independent mechanism outside of beta that beta blockers would. Reliably inhibit that's still present.
And so it's totally in my mind, physiologically plausible and aligned with what we see in drug environments and other settings, but all the way back to the original point that, [00:47:00] yeah, like to your question around why do you think your glucose decreases, I would think it's being in response mostly because you're also describing other aspects of your experience, like the anticipation of stress that would reliably induce an elevation in glucose.
That will give the caveat though that they did show that repeat exposures to stress, at least within the day, did not induce the same grade of glucose elevation. Which is also my lived experience. So there's also the possibility that with chronic habituation to cold exposure, there might be a differential response over time, but who knows?
We'll see. We don't know the science on that yet. These are all speculation.
Dr Mike T Nelson: Yeah, no, that's super interesting. I think there's old literature to show, like the liver is primarily under feed forward mechanisms too, and anticipation of stress, it'll basically just start dumping glucose into the bloodstream because for survival purposes we're wired that we can tolerate some elevations in glucose long-term it runs into issues, but we can't tolerate drops in blood glucose real far without, ketones [00:48:00] or other fuels on board.
So it seems like physiology is hedged towards, eh, if we're gonna air, we're gonna air a little bit high just to prevent any lows from happening.
Dr Andrew Koutnik: To your point, that's actually exactly one of the most recent studies that came out a bit controversial in the exercise performance space that actually looked at what were the key drivers of exercise performance and one of the key drivers above muscle glycogen above.
The level of oxidation of carbohydrates or fat was actually the maintenance of blood glucose levels. In the blood was the primary determinant of exercise performance. And we've subsequently submitted a review that is, looks at over a hundred years of evidence, over 600 citations, over 160 exercise performance and exercise metabolism studies with multiple net analysis in one that's preliminarily accepted, that looked at the system at, or looked at historically.
The key precedence of how we [00:49:00] think about performance and what actually reliably drives performance, obviously, depending on context, there's obviously different parameters that drive co performance in different variables, like aerobic versus anaerobic, short versus long duration, et cetera. But one of those key factors that was pulled out wasn't per se, my muscle glycogen wasn't per se, carbohydrate oxidation, but one of the most historically known mechanisms that drives the at least lack of performance is hypoglycemia or the, and not even so much Mike getting to hypoglycemic.
'cause many athletes won't actually experience this unless they go for a very long duration, strenuous, prolonged exercise bout, but it's actually the magnets of blood glucose that appears to be one of the most reliable predictors of why something like carbohydrates improve performance. It wasn't so much that carbohydrates induced some unique response that caused performance improvement.
It was when you looked at the [00:50:00] placebo group in those trials where you found that almost ubiquitously, at least in these longer duration trials, that the placebo group was dropping in blood glucose, oftentimes endo hypoglycemia. And this was a major confounder, not acknowledged in some of the historical studies.
Going back to Bergstrom, who first Oh wow. Discovered muscle glycogen and showed an association between burn needle, between Yes. The burdensome needle where it's a needle. You put in your muscle, you twist it, pull it out, I've had it done for on me. And they found that muscle is stored, or sorry, glucose is stored in the muscle.
And obviously if it's stored in the muscle, it must have something to do with performance. Right. Well, they showed that if you provide carbohydrates prior to exercise, not only do you improve performance, but if, especially if you load up the carbohydrate or glycogen pool in the muscle, that the more the carbohydrates you gave caused more glycogen in the muscle and that was associated with longer.
Exercise. So the delay of fatigue during exercise, and that was a persistent theory. And still today, since [00:51:00] the 1960s. And then in the 1980s, there was really powerful work from Kohler, C-O-Y-L-E multiple studies actually showing that there was a direct relationship between the degree of carbohydrates that are oxidized and the ability to delay fatigue during exercise.
And so it started with muscle glycogen, and there's still a lot of many mu like programs are about glycogen loading. And then there was all these trials looking at carbohydrate oxidation because we were able to measure it. And again, they were showing these constant associations, higher car intake, higher carbohydrate oxidation, delayed fatigue, then we see these models like the crossover effect, where all these models were rising specifically in these, nuanced studies and athletes showing that as you were getting to higher and higher intensities, that you were becoming increasingly more reliant on carbohydrates as a fuel source, and increasingly less reliant as fat as a fuel source.
Again, based on a model. As a model, based on assumptions came out of these studies on subsid [00:52:00] oxidation. But one key thing to elucidate in the limitations of those studies is not a single one was causal. They were all association studies. And within those same studies, those marquee studies that literally changed the field and how we viewed how one of the most commonly used genic age in sports performance like carbohydrates improves performance was based on association studies.
But in those same studies, you also saw the blood glucose reliably dropped in the control group. And what's a more powerful response? A shift in the type of substrate being oxidized or a one of the most powerful survival mechanisms called the neuroendocrin, conal regulatory hypoglycemic response.
That is literally trying to save your life. Meaning that when your blood glucose drops, your body goes into a fight or flight response. You, one, you have reduced glucose in the brain, so you're reducing the metabolic substrate that the brain often [00:53:00] uses unless you're on, let's say a ketogenic diet or you have high lactate levels which are alternative fuels for the brain.
Ketones, lactate, you're highly reliant on that. So you have lower substrate availability to this key tissue that helps you perform. 'cause oftentimes people think about physical performance, they think about their muscles functioning, when in reality it is the brain that is driving these effects. So if you deprive the brain of a key substrate and then also induce one of the most powerful counterregulatory hormonal responses and neuroendocrine responses, there is.
It reliably impairs performance. In fact, you don't have to look though further than literature in Type one diabetes where there's commonly looked at hypoglycemia and it reliably impairs performance 10 to 20% powerful reductions in performance and incredibly reliable. I don't know of a study where you went, someone went into hypoglycemia and they performed equivalently ever.
It's just such and I'm someone who's lived experience of having type one diabetes. I can tell you that is the most [00:54:00] reliable ways, if a lot of athletes have fear around glucose variability with type one diabetes. Mm-hmm. Because it reliably, if they go low, they get terrified because they know it's gonna impair their performance.
Whereas if they run high, it's not an immediate life-threatening circumstance and it has less of a performance impairment effect. But there is a, there is an effect though. We know that high glucose levels alone can actually shift and lock people into. Glycolytic metabolism just by blood glucose levels being higher alone.
Yeah. If you clamp all their factors, clamp insulin, all their factors, high glucose alone can drive the use of glucose in the body. So so either, so back to your point about blood glucose being such a critical asset that our body requires, we're talking about, we have about, estimated if you say five liters of blood, one tablespoon of glucose circulating in our blood, and that disruption of glucose if it goes low, is what your body will do [00:55:00] more to protect than any other metabolite in the body, any other metabolite in the body, which is why there's so many powerful regulatory mechanisms.
That will completely shift your perception of the world and how you think to the point where you can have slurred vision you could become unable to move as well. Like it's a powerful effect on that has on the brain, but it's trying to protect you and save your life. But we see these effects even at maybe not a life-threatening level, but even at meaningful levels in performance when we look at that from exercise context.
Dr Mike T Nelson: Yeah, that's super interesting, and again, going back to what we even talked about at the beginning of the show a little bit, that again, doesn't mean these studies were necessarily wrong or that, like you said, carbohydrates do reliably increase performance. But it's fascinating to me that sometimes the underlying mechanisms of how they're doing things can change over time because I'm sure there'll be a bunch of people saying, oh, see, carbs don't work.
It's like, no we're saying [00:56:00] they, they still work, but the mechanism of which we think they're working. May not be the same. And Yeah, that's what I've always wondered about, even like muscle glycogen levels, like what's the lowest you've ever seen in the literature, like 30, 40%. Like you can't drive it to just zero, which to me is always interesting.
It's like, okay, so we know it's important, but we also know you can't drive that thing all the way to zero. So there's gotta be either some massive amount of, buffer or physiologic headroom or something else going on there than the simple story. We were, what I was always told of, oh, carbohydrates do this and fats do this.
And then you look at it more and you're like, oh. Aerobic and anaerobic metabolism, that's not really clearly as defined as I thought. And all these fuels are working in concert with each other. It's not like you're just turning on one or two or three light switches and away you go.
Dr Andrew Koutnik: Absolutely.
And that's actually one of the key things we tried to, to elucidate in a recent randomized [00:57:00] controlled trial. We did an Ironman completers, our Ironman competitors. Yeah.
Dr Mike T Nelson: Tell
Dr Andrew Koutnik: us about that. Yeah, so, we had run a study in 2022 to 2023 where we were curious about this concept of these, ketogenic diets.
There's this amazing literature on their health, their potential therapeutic qualities in various contexts. For over two centuries. So since 19 seven, sorry, 1796, there was a patient named John Rollo who actually discovered that you could basically reverse. Type two diabetes with low carbohydrate diet.
So we've known and actually with standard of care for type one and type two diabetes management and saved the life of patients with type one diabetes, at least extended their life substantially before discovery of insulin. So this, these diets have been around for over 200 years, but they've had this emergence of evidence in different neurological disorders.
Man, there's this fascinating work particularly out of the Zuki group and some of the work they funded and thinks smart initiatives [00:58:00] where they're actually showing that some patients are able to put their schizophrenia or bipolar disorders and remission using these diets. We don't have randomized controlled trials out yet, but we, they're ongoing.
But some of the observational analysis and anecdotal reports are quite compelling and the mechanistic plausibility is there, but there's all this emergence and interest and this therapeutic effect of the diet. But one concern is that there's this phenomenon of the fit, but unhealthy athlete, this push for more and more carbohydrates all the time in a world, or at least in the United States, in the developed world being one of those major countries that were leading the way in metabolic health dysfunction.
We, oh, there's multiple reports. One not too long ago came out that said that 88% of Americans have some form of metabolic suboptimal metabolic health, that number increased to 93% in a more recent analysis from Tuft University. Basically what that means is that they scanned a huge swath of the American population and found that in these large data sets that you almost every [00:59:00] single person either has elevated glucose level, high triglycerides, elevated body waste waist circumference a key metric known to be associated with suboptimal health.
At least tons of data around those metrics showing that when going in the wrong biological direction, it costs consequences. That means that nine outta 10 people in a room have in America have suboptimal metabolic health. Well, now we know that obesity rates are now at 60 over at 68% in adults. We know that children, that those rates are around 20%.
We know that pre, over half the American adult population has prediabetes. The numbers are stark and the rises of almost every major chronic disease. And so the question is, there's this, there one strategy, not the only one. Okay. But one powerful strategy that we know can be incredibly effective is one exercise of course, but also nutrition and particularly powerful nutritional strategies that remove a lot of the food products in the food environment.[01:00:00]
Drive overfeeding and ketogenic diet removes is one strategy where you dramatically reduce carbohydrates and the diet. A lot of the process and refined forms of carbohydrates are are very common in the American diet. They're kinda like the 70% of the grocery store in the center.
And a large number of the American population is consuming these products, at least to some degree even kids as well, either way. Long story short is that these diets have been shown forward two centuries to, or have powerful therapeutic effects, but there's all, one apprehension someone may have is like, well, I'm a, I'm an athlete and I perform and yeah, that I have this issue over here on my health, but like, I don't wanna do a diet that's gonna impair my performance.
I care about my performance. And so there's been this stigma around these diets impairing performance because it was the belief that carbohydrates were essential to performance. Well. Only way to find that out is actually to test it. Because there's all these trials, particularly from 2017 to 2020, from a really prominent researcher named Louis Burke and John Hawley, like [01:01:00] world leaders in the world of sports nutrition, ran these really rigorous trials anywhere from five days to three weeks in elite level race walkers.
So elite Olympic level race walkers doing ketogenic diets and showed impaired exercise economy. So a measure of efficiency during exercise. But what we really care less about performance, right? Yeah. And so they were showing marginal, 2% decrease in performance and a couple of these studies.
And so for the average person, that would be completely undetectable. But if you're an elite level athlete, that's the difference between first and second place. And so that got a ton of attention. And so we were really interested. There had been, are these diet really impairing performance? Is that true?
Because it had been known since the 1980s by a researcher named Steven Finney. 'cause I actually had a that. He was able to show no difference in performance in some athletes. And that was a very controversial study. Yeah. And so I actually sat down a year and a half ago, or not a year, almost two years ago with Steven Finney and we had a very detailed conversation about some of that work.
And he [01:02:00] told me, Andrew, when I first did that study, it was very fascinating to me, is that he himself is a really avid cyclist. Mm-hmm. And he is like, I was running this study, decades ago and I remember when I first initiated it and when they initiated the ketogenic diet arm. He would race alongside these cyclists these, these cycl these cyclists he had in the study.
And he was a good cyclist. He said, they were, he would acknowledge they were better than him. But he would just say look, initially when we started the study in baseline, they would, I would have to be in their tailwind, I'd have to ride their coat tails, so to speak.
'cause it, I didn't, it's a common technique in tour of France riders or cycling riders. If you ride behind an athlete, you can reduce some of the road resistance. And he said, I had to ride behind these athletes 'cause they were so much better and faster. But when we initially, the ketogenic diet in the first week, they would have to ride in behind me to be able to keep up 'cause their performance would be impaired.
But something happened after the three week mark where they just started blowing past me again. Something unique was happening. And so he would tell me, I think there's something very special about this four week window. And what we have known in the [01:03:00] literature is if you actually historically look at things like ketogenic diets or analogous nutritional interventions like fasting that you don't see.
Everyone's always said, well, look, no, even in some of Louis's Burke work and very short duration forms of exercise, she saw these massive increases in fat oxidation, carbon oxidation, proportionately reduced. You see these powerful shifts and ketones elevate. And she just said, okay, well, they adapted.
They're already adapted. They're look at these clear signals of adaptation. But yet, if you actually look a little bit deeper 'cause this some is a field that I've been in for almost a decade and a half now, specifically looking at these nutritional strategies and their impact on overall physiology mechanistically and also just outcome based, like performance based.
And if you look back to some of the original studies back in the 1960s, that when people do these type of ketosis or ketogenic based interventions, that metabolites don't plateau until after the 30 day mark. So basically after the th the four [01:04:00] week mark, so there's clear changes in adaptation, still ongoing.
That are happening upon diet initiation that don't all occur within the first, let's say, five days to 21 days. We know there are multiple metrics that extend beyond that, and if you're interested, we can go through those like step by step. But upon the first food intake of a ketogenic diet, number one, you reduce the glucose input into the body.
That then triggers a reduction in insulin. The most powerful anabolic hormone of the body is now reduced. That removes the blockade on fat breakdown and oxidation. That also increases other molecules like glucagon and catecholamines that facilitate not only fat breakdown to higher levels, but also things like ketogenesis in the liver.
So now the body upon you can see elevations in ketone bodies, which is the end product of fat metabolism. This whole process initiating within the first 18 hours of [01:05:00] initiating just like ketogenic diet, not even a fast, just ketogenic diet. We see that over the next, few days to weeks reductions because insulin also causes sodium retention and water retention.
Body weight, decreased sodium changes initiate that takes around two to four weeks to normalize. We see within the next, let's say, 24 to honestly all the way up to 21 days. Within the first five to 21 days, the literature shows that people start seeing these shifts in substrate oxidation.
So fat oxidation starts to precipitously rise it seems like around 21 days. Most of those seem to plateau. At that point. You also see around the four week mark is when you start to see, or at least two to four weeks, renal metabolism start to normalize. You also see that things like substrate oxidation start to normalize, but there's a lot of hypothetical unknowns in these studies over time.
Without tracking and controlling for key confounders in these [01:06:00] studies. So what we did in our study is we were particularly interested when looking at the impact of, let's say, a ketogenic diet versus a high carb diet and these Ironman competitors. We wanted to know what happens if we control their body weight, what happens if we control their calories, control their activity, and just shift the macronutrients around.
So what we're trying to do is remove known confounders of performance. Body weight loss is a known confounder. Caloric restriction is a known confounder. Changes in activity levels are known confounders. So if you're constantly putting another stress stimulus in your body, like progressing your exercise training program, that's gonna be a big confounder.
And so people had said, we know that they were saying we know that glycogen and carbohydrate oxidation are essential to performance. And we know that, that's why, high carb diets are superior for performance. So what we did is we ran a six week crossover, randomized controlled trial on iron ran competitors controlling [01:07:00] key variables like activity, key variables like caloric intake, these key confounders we track ketones over the entire study.
We tracked continuous glucose monitoring to ensure compliance, but also get a metric of metabolite, normalization, or plateauing or the change that was happening. And then we asked them to hit the wall. So what does that mean? We asked these athletes to go until they could not go further. We asked 'em to stay strenuous, prolonging exercise at 70% of their vo, O2 max, until they volitionally could not do it anymore, or they hit hypoglycemia.
And in this trial, at the end of it all, we then looked at the difference in performance. They reliably, as we expect the ketogenic diet had an increase in fat oxidation reduction in carb oxidation. We also ask them, we know that historically in the studies that if you do a low carbohydrate diet in athletes, we see that muscle glycogen is lower for at least the first 12 weeks.
In fact, there's no study in athletes I know of when you do a ketogenic diet where athletes don't [01:08:00] see a reduction in their muscle glycogen compared to their baseline levels or compared to the other diet. And so we did a model that reliably reduces muscle glycogen. And this was a six week window, not even 12 weeks.
Right? So the earlier in the diet, the more you'd expect the muscle glycogen to be lower. And then we also ask them to come in over a 15 hour, prolonged overnight fast. The idea being is that we're trying to not only have a diet with lower muscle glycogen, but also liver glycogen. We're trying to put all the stimulus in there to say, okay, if this intervention over here, the ketogenic diet has low glycogen levels and we, and everyone's saying that glycogen is associated with.
Or causing improved performance through carbohydrates. And then we're also gonna show, do a diet that we know reliably shifts substrate oxidation. If in theory, if they have no diff the ketogenic diet arm should, based on our theories, have reduced in performance. Right? That's what we thought.
That's what you should have an decreased performance. But what we found is that despite these massive differences in how this model works around muscle [01:09:00] glycogen, so much lower on the ketogenic diet, arm, muscle, and liver 'cause of the prolonged overnight fast as well. And also these dramatic shifts in the substrate oxidation, the reduction in carbohydrates, and increase in fat oxidation that they would reliably help reduce performance.
And we asked 'em to hit, hit the wall, so to speak. And in these Ironman competitors, we found that when you did a very low carbohydrate diet, there was ketogenic because it did produce ketone bodies as well. There was no difference in performance. Now. That clearly showed to us that this theory, that these, levels of subrate oxidation, particularly carbohydrate oxidation or levels of muscle glycogen, we're not holding up in randomized controlled trials where you control key confounders and actually attempt to isolate all variables to test that effect.
It wasn't happening, but we asked another question, which is we wanna now trickle in just enough glucose to normalize or just enough glucose to normalize circulating blood [01:10:00] glucose levels. Now remember in early on this podcast we talked about, hey Mike lowering in blood glucose causes all these negative effects on neuroendocrine responses.
And I'm telling you, it impairs performance like you don't have to look much further, but Google for yourself while you're listening to this. And, but what we wanna now do is we wanna trickle in just enough glucose to keep blood glucose levels normal, not drop. And how do we do that? We provided the equivalent of one teaspoon of glucose every hour, so around 3.4 grams every 20 minutes or 10 grams per hour.
So the sta the gold standard right now is 60 grams per hour, 90 grams per hour, some up to 120 grams per hour, depending on what study you look at and what modeling analysis you look at, that's gold standard. But we did six to 12 times lower because we didn't wanna put enough glucose in the system to cause an endocrine response, a substrate oxidation response or a glycogen response.
We only wanted to put enough into maintain [01:11:00] glucose, and we did that and both the low carbohydrate diet and the high carbohydrate diet both improve performance 22%. But it could not have been Mike because of differences in substrate oxidation. It could have not been because of differences in muscle collection based on the model system we were studying.
Both groups got hypoglycemia at profoundly high levels. Without carbohydrates, just the trickling in of blood glucose of one teaspoon per hour completely eliminated hypoglycemia in both arms associated with a 22% impor improvement in performance. So we were directly trying to test this theory of what was the causal impact in a randomized control trial setting of what was the key determinant performance.
But we had done another study prior to that when looking at short duration exercise, similar design only four weeks adaptation and high level runners lean, 50 kilometers running per day. They were an elite, [01:12:00] but they were like a high end level weekend warrior, so to speak. And there were racing and competitive races and local races and state races, so they were athletes.
And we did, we, instead of doing this long duration exercise. We did the opposite. We said we're gonna, we've always been told that carbohydrates are essential performance during very high intensity exercise. So we're gonna ask them to do a very high intense form of aerobic exercise. We're gonna ask 'em to do a one mile time trial.
Now, someone may say a one mile, that's no big deal. No. Try to run the fastest mile of your life and tell me it's no big deal. Yeah, it's horrible. So that's, there's that. We also asked 'em to do a six by 800 meter sprint. So sprints as well repeated sprints for not a short duration, not like 30 seconds, but longer than that.
And also one mile time trial like in these athletes. And what we found again is that there was no difference in performance in the ketogenic diet versus low carb diet, but. So showing the two ends of the spectrum where we think carbohydrates would be very important. These very long duration exercise bouts where you hit the wall in essence, modeling like a [01:13:00] Marathon Ironman athlete type segment for a triathlete.
And it's other than the spectrum where you have these more highly glycolytic form of exercise. But what we also found in the short duration exercise is that these athletes were performing north of 85% of their VO two max when based on the crossover concept, Mike, that they would, should be, in theory, oxidizing near 0% fat during that exercise.
It wouldn't be zero, right? It would just be near it. Yeah, it'd be very low. Be very low, around 12% to be exact. But what we found is that these athletes were oxidizing. Over 1.5 grams per hour at 85% of their VO two max. And some athletes were north of 1.85 grams per hour. Some north of two. The highest ever fat oxidations ever recorded, but no one had ever looked at intensities that high with fat oxidation on a ketogenic diet.
Sustained at least up to four weeks in duration. So [01:14:00] what we found across both of these studies is that if you actually allow athletes to adapt to a diet for long enough, they adapt and sufficiently to have the same level of performance across both diets, saying that you can eat what you want, Mike, you don't have to do a high carb diet because it's gonna inherently improve your performance.
You can do whatever diet you want as long as you habituate it to it long enough, and maybe you wanna do it for things outside of performance. Maybe you need to do it for health reasons. There's a key thing that came out of this study as well, at least the first study in 2023 that was published in the shorter duration exercise bout.
We had put CGMs on these athletes for four weeks in duration, and we found that 30% of the athletes on the high carbohydrate diet arm, and by the way, it's a crossover trial too. So that means it's we're controlling for genetics and environmental factors within these athletes and is randomized and not all that.
So, about as rigorous as we could hope to accomplish in these settings to [01:15:00] elucidate macronutrient specific changes on performance. What we also found in when assessing continuous glucose monitoring for over four weeks in duration on both dietary interventions that the athletes on the high carbohydrate diet, 30% of them had fasting blood glucose levels.
Not on a single time point, but of the average of every single morning over. Four weeks had glucose levels consistent with pre-diabetes. Mm-hmm. And they never knew that. And this gets to this phenomenon and when we publish this data, and by the way, it was completely resolved with the ketogenic diet.
All those, all the athletes that had higher glucose, actually everyone but one athlete had a reduction in blood glucose on this diet. And this gets, I actually had a number of people that was actually hard for me to believe. 'cause I'm thinking 30%, are we serious here? Like, that seems absurd. But there had been published literature up to that point of this fit but unhealthy athlete phenomenon that athletes [01:16:00] can perform well but actually be unhealthy.
And one of the key components they talk about driving this phenomenon is these highly glycolytic process forms of carbohydrates that athletes are consuming at very high volumes during exercise. And so what we found is that redu reducing that. Dramatic, like completely normalizes their glycemic control within days of initiating the diet.
Like almost immediately resolve that issue. But I was hearing when after we publish this, I'm like, that's gonna be controversial. I'm sure that a lot of people gonna like, think that's nonsense. It, and like, hey it's a CGM measurement. It's not an HBA one C, which is a two month average of your glucose.
We couldn't use that by the way. 'cause the study was four weeks in each arm. Yeah. It isn't a fasting glucose, well, fasting glucose is one single snapshot of one time point in one morning we did 280 time points over four weeks, two 80 time points per day, over four weeks. There's are a lot of reasons why we did this measurement over the other ones.
And I isolated out 24 hours verse fasting. We did everything to make sure that this was [01:17:00] real. But there was a number of clinicians and actual athletes reaching out to me personally saying, Hey, look, that's me. That is actually something that happened to me. In fact, there is a, an Ironman champion 2017, it was 17 2018.
His name's Lionel Sanders came out and publicly disclosed that he himself was taking the recommended amount, by the way of carbohydrates, recommended by most nutritional guidelines by the ISSM guidelines, or sorry, I and super support or ISSN. Yeah, ISS NM guidelines. The ISSM. Yeah. Academy of Dietetics Nutrition International Guidelines, A CSM guidelines.
They'd all say, five to 12 grams of carbohydrates either way. Somewhere between 400 to up to a thousand grams of carbohydrate per hour on average body weight. Male. And this 'cause the elite level over exercising over four hours per day. So he would qualify at that higher end. Either way, he was doing that and he said he started to feel lethargic.
He was having poor sleep. He didn't feel well. He didn't feel [01:18:00] like he was recovering well, and he went to get blood work. Everything was fine except he had pre-diabetes. Yeah. And then he made shifts in his diet to dramatically reduce the amount of process, sugary, starchy forms of carbohydrates in his diet.
And not only one resolved his pre-diabetes almost instantly, just like we had showed in athletes, but also went on to win the Half Ironman champion chip after that. Now he didn't go to zero carbohydrates or anything like that, but it just goes to show that, there's reasons, when we talk all the way back to when we were first talking about this, we're talking about glycemic control, and then we talked about performance and how actually glucose levels are actually a huge determinant of exercise performance and some of the studies we've done, but also some, a review a large review we've also conducted.
But let's get to a bigger question, Mike, around the health consequences related to, nutrition choices that people have. And that's been a key area of our research focus over the last. To be totally honest with you, my personal experience with having Type one diabetes, I, you never stop thinking about nutrition because of how much it impacts your [01:19:00] daily experience, but from a research perspective over, a decade and a half and so, yeah, there's been some interesting counterintuitive findings that we've had over the years that we're not to be expected, but certainly opened up a lot of unique understanding that appears to shift the, at least the way I think about.
Things like nutrition, things like exercise performance and potentially what drives that. And to your point, it wasn't like we're saying carbohydrates didn't improve performance. In fact they did. But what, how they were doing that the dose that was required, all that is very much in question.
'cause nowadays, athletes are pushing, hell, I saw an article come out the other day that said the athlete was pushing 200 grams per hour and running around talking about how impressive it was that they did this. It's like, I don't think that's what you want. You want the minimal effective dose, you want the least amount of that nutrient possible to maximize its outcome.
And so, when you actually look at dose response studies, Mike, you don't see consistent findings of greater improvements in performance with higher [01:20:00] levels of carbohydrates. That's actually, and it's openly acknowledged in some of the most prominent reviews. One is in sports medicine by asker.
He's a prominent was a prominent researcher in this field. And just acknowledging that we don't really know if this dose response thing is a real thing. We know that carbohydrates from improve performance all the way back to the 1921. And Boston Marathon runners from Harvard physicians testing their glucose levels and giving carbohydrates and seeing improvements in glucose.
Over a hundred years we've known this, but how much, why, when to apply it? And it seems to be, maybe it isn't as much as we think it is to improve performance, but also it seems like the performance enhancing effects of carbohydrates are much more isolated to at the moment of exercise and less to do with the habitual diet that you consume.
And so the habitual diet you consume, one could contend is more important for your overall health. Less so for performance at least. And what we've seen in the literature and our own personal results with some of the randomized control trials we've done.
Dr Mike T Nelson: No, that's awesome. And I really love the study because it was very [01:21:00] well done and very controlled, but it also allowed for.
Adaptation periods and a couple questions. So on the crossover effect, I have I've lost track of how many athletes I've seen. Now I've seen, and they were all endurance athletes, maybe just because that's the only data we, we had. Several of 'em basically had no crossover effect whatsoever, right? So for listeners, they were pushed so far on the carbohydrate oxidation that even on a ramp test, when they're doing low to moderate intensity exercise, they're on a metabolic heart.
Their fat oxidation never crossed 50%, right? The two curves are just, and the first time someone, a buddy of mine, Jeff Rosschild years ago told me this. I was like, that's bullshit. No way. He, I'm like, send me the data. And so he sent me like a couple snapshots of athletes and I was like, holy crap. And then, I'm a nut job.
So I have my own metabolic heart here to do testing and all that kind of stuff. And you test enough people, and I've seen it a few times. And historically, again, this is [01:22:00] anecdotal. Those athletes were, I would say, on the higher threshold of performance. But if you poke around into it, they were also very susceptible to having really amazing races.
And like DNF like did not finish at all. And my thought was if they're so biased on the car they might be able to operate there. From a pure performance standpoint, we can argue this is not the best idea for health as long as you could uptake and you could keep those carbohydrates coming in through the digestive system and things like that.
But if you had GI upset, you had extra stress, you missed a station, whatever, they just seem to completely fall off the map. So my bias, and I'd be curious about one, your thoughts on that, and then two related to metabolic flexibility. To me it makes more sense to push fat oxidation as high as you possibly can, as it may not even be the backup system anymore. Maybe it's ketones, maybe it's other things [01:23:00] to try to buffer some of that performance and also buy you some better health along the way without compromising still the high end performance. I know there's a lot in those two statements.
Dr Andrew Koutnik: Yeah. So, well, number one, one of the key things that comes back is there's a yeah.
So you're gonna to re-prompt me for a few of these, I will say. Yeah. Yeah. All good. But there there's a lot of feelings or thoughts that some of the original strains that came out and said that, carbohydrate oxidation are, essential to performance is these efficiency studies.
They weren't performance outcomes studies per se. They're efficiency studies and they're all typically less than four weeks in duration. 'cause to be fair, it's not easy to run a diet trial for four weeks on the same person. We did a two week crossover. So we're talking like, this is 10 weeks per subject.
That's long trial, a huge commitment where the controlling activity, a lot of work goes into these things to be fair. And so it's not like you can always do that. But so when looking at these [01:24:00] exercise studies and considering some of the more, well, let me back up for a second.
So to, can you explain, ask me your direct question one more time before I go on too hard of a tangent.
Dr Mike T Nelson: Yeah. So the first question is, what has been your experience with athletes that are super hard on the carbohydrate oxidated than the spectrum? Like my bias is, I think from an absolute pure performance standpoint, you might be able to get away with it and you might be the elite of the elite, but I do think it's costing you health.
And I do think your performance variability. Is unacceptable. Meaning anecdotally what I've seen is if one of those athletes, everything is dialed in, when they're good, and they may actually win a lot of like big time races when they're not, it's just an absolute disaster.
Dr Andrew Koutnik: Yeah. And so to, so actually I want to, I might actually somewhat pivot this degree yeah.
To your direct, to your que direct question. So we've actually looked at the literature and re [01:25:00] have redone this crossover effect in a number of settings and found that we don't always see it reliably that there is this reliable crossover effect. There was this kind of direct historical dogma with the crossover effect that, hey, we have this whole model based on some studies that have come out from some of the most prominent researchers, that there's this dose dependent response in certain key metrics.
But we've done that same exact dose dependent up trial at steady states along the way and see that some athletes don't even have a crossover effect. Yeah. They're highly gly politicly predominantly or highly. Predominantly reliant on glucose Yep. As a fuel substrate. And when actually looking a little deeper, there's numerous examples of that in literature that there isn't this predominant fat oxidation even at low intensity exercise Yep.
For everyone. In fact, most of those studies were in the context of high carb diets and very good athletes. What happens if they're in a different setting or they're the average person? We don't see that reliable effect. And yes, you can almost put people into a static state of almost predominance carbohydrate [01:26:00] oxidation at these higher levels.
And there's evidence for this. Right. In fact, one, a great example of this, and I think this is insulin related by the way because what if you think about the underlying mechanism of this, why would someone be trapped into higher glucose based metabolism? Well, what happens when you consume glucose?
Well, your blood glucose goes up. What's the most reliable effect of blood glucose elevation and insulin response insulin. If insulin goes up, and we talked about this, the insulin's one of the most powerful hormones in all of human metabolism, if insulin goes up, its affinity to binding to tissues is variable, but it's extremely sensitive to fat.
So if it can touch the, it does at very low levels in concentrations, actually a bind to fat and shuts down fat oxidation. Yeah. So if you're eating high levels of carbohydrates during exercise, there's plenty of evidence that actually shows you block degrees of fat oxidation. And then Mike, you paradoxically break down muscle glycogen [01:27:00] because now you are forced to use that as a fuel substrate 'cause you're blocking the fat oxidation potential or you're blunting it dramatically.
Dr Mike T Nelson: You're forced on carbohydrate oxidation. You're taking the lever and just jamming it all the way to the right.
Dr Andrew Koutnik: You are, and if you actually look at studies where you infuse carbohydrates to variable degrees, you actually just sh see, you don't see higher energetic output. You just see a shift in where the substrates are coming from.
Yeah. So if you, the high oxidation
Dr Mike T Nelson: of carbs.
Dr Andrew Koutnik: Exactly, you're just shifting it from fat to carbohydrates. And then a paradoxical earlier breakdown of muscle glycogen, which is why people think they're taking carbohydrates during a race to begin with. Like, oh, I'm sparing my muscle glycogen. Not necessarily.
You may be spiking insulin, which we've seen historically in studies and then forcing the body to utilize muscle glycogen as a fuel substrate. So you paradoxically break down muscle glycogen earlier on. And so I am convinced, Mike, that we're going to see a shift, especially with the health predominant derangement we see in the western world where most athletics are at a, where [01:28:00] athletes are put on the, some of the biggest pedestals of all time, but yet are accumulating health consequences.
Some of the best in the world oftentimes ascribe to their dietary choices often because they think they have to eat that way to even. Continue to have a livelihood in their sport, when in reality the evidence continues to accumulate that maybe you don't need to do that, at least to the same extreme degree that they're doing it.
And then in fact, there might be consequences to making those extreme choices. And pushing, in this case very high levels of carbohydrates during exercise. I'm just not convinced that is a optimal choice. And whenever I talk about, Hey, wouldn't it be nice to find the minimal maximal output from the minimal dose?
So minimal effective dose is what they call it in the scientific literature. That's what we want. When you someone's doing a therapeutic drug trial in a clinical population, you want the least the smallest dose possible to maximize the clinical therapeutic benefit. [01:29:00] Everyone wants that because what happens when you get too high, there's off-target effects, almost always.
Well, guess what? When you get to these levels of like over 60 grams of carbohydrates per hour, upwards of like 120 grams of carbohydrates per hour. You're, there's there no model can explain the amount of carbohydrates consumed and where it's being oxidized. It's it, because the amount of oxidation that's occurring based on all the measurement tools we have would be like 30 less, at least less than 50% of it.
So what's happening to the rest of it? It's clearly not being oxidized based on the measurement tools that we have. It's something else is happening here. And one could argue why would you do that? Why not just give the amount required to to perform optimally? And I think that's where we're gonna get to some very important dose response studies with some colleagues of mine actually looking at tracer based analysis on these responses.
So it'll be some interesting things to come in our understanding of nutrition in the context of sports, but extending beyond that to actual health of the athlete themselves. 'cause I remember hearing this quote and I loved it. No [01:30:00] athlete should be sacrificed at the alter performance.
Meaning, they should not have to go. To that they, they should not have to sacrifice their own personal health to reach elite level performance. But I think right now some are,
Dr Mike T Nelson: yeah. And I think there's always gonna be trade-offs and there's a, like for example, I don't work with a ton of endurance athletes, but the handful of ones that I worked with, my first question is, okay, so you wanna run a marathon?
Let's take a marathon as a thing. Cool. Like, where are you currently at? Like, are you kipchoge trying to break a two hour marathon? Are you at three hours? Are you just trying to finish the marathon and not get kicked off the course? Because to me that spectrum is light years apart. Maybe we could argue, and we could talk about this too, the elite of the elite.
Maybe carbohydrates are much more important for them. To what degree? It's probably debates. My argument is you probably need to be pieing the carbohydrate into the [01:31:00] spectrum. However, most people are not there and they probably will never be there in their life. They're like, well, I just, it's a personal thing I want to do and I want to feel better.
Great. And in that case, my bias, I think you'd probably agree. Let's look at fat oxidation. Let's try to get that as high as possible because you just told me you want consistency and you want more health metrics, so I know if we can get you more reliant upon that, it's gonna be easier. Odds are your variability of performance is gonna go down and we're gonna get some health benefits from this.
You're not at the elite level where we need to pound you with a hundred grams of carbohydrates per hour or what or whatever. But it seems like the popular message is. If you're running a marathon, you just need to mainline carbohydrates. That's the thing to do for performance. And meanwhile, Bob's running a 9 35 split time,
Dr Andrew Koutnik: well, so, as the last bit of a cliffhanger for your audience and those in the sports nutrition world. We often, you're talking about [01:32:00] substrate oxidation. We're talking about carbohydrates. We're talking about the potential applicable to elite level athletes or not. One of the common arguments, of course, based on a lot of things we were talking about before is that fat oxidation could never maintain elite level performance.
And this is largely based on this crossover concept of that if you're oxidizing a certain, in order to perform a certain output to, to hit world record times, that you would require a certain amount of carbohydrates to even or a certain amount of carbohydrates to subject to even achieve that.
Right? Based on our understanding of how much you can oxidize at particular levels of intensity, and these elite level athletes are performing at very sustaining, very high intensities for very long durations, which is why people tend to believe that these lead low athletes need higher carbohydrates because of this, largely based on the crossover concept.
Well, I want to give you one anecdotal case. Yeah please do. There was a case in the literature of a world record athlete. Achieving a world record Ironman triathlete time in a lab [01:33:00] setting. Okay? They were number two in the world. They actually went into the lab and got tested. What you find is that over half of their world record time, their predominant fuel substrate during that exercise wasn't carbohydrates.
Yeah. It was
fat oxidation. So that leads to this open-ended question. If fat oxidation can't maintain elite level, high-end performance sustained over regardless of the timeframe, but this very high levels of the percentage of VO O2 max, then how is the best in the world predominantly fueling over half their race predominantly on fat oxidation?
How is that possible? I think is just something for people to ponder on and think about. This isn't a promotion of one way or the another, but I will say I'm a promotion of overall health as a live patient. I wanna be bigger, stronger, faster all day, but I also live with a disease that could take 20, 10 to 20 years off my life if I let it just run awry and allow metabolic dysfunction that's often commonplace in my disease to just continue.[01:34:00]
And I, so I lived the experience daily of the consequences of nutrition. And so people may not have that same level of in your face impact when it comes to food, but it over a lifelong lived experience, there are clear implications to what you eat and what you do with your overall lifestyle that are gonna impact your health.
And I think if anyone could leave with a message of that, it isn't that you have to do any one particular strategy, but maybe it's time to, to think about that for your own personal health and consider trying new things, maybe one. Intervention doesn't work for you, try another, but finding your path to health regardless if you're an elite level athlete or someone who's listening to this pockets the first time just trying to get off the couch,
Dr Mike T Nelson: would you agree that the higher percentage use of fat, we could even say this is at 70% vo O2 max or whatever marker.
I would propose, and there's some data I think, to support this, that is actually a pretty damn good marker of metabolic health. Would you [01:35:00] agree?
Dr Andrew Koutnik: I am uncertain. I would say that there's good evidence to suggest that might be the case, but it's very context dependent, I think. Yes. Yeah. Yes. Very context dependent.
So I would say, I don't know. I can see why the data would suggest that, but I'm not so convinced that I would say yes to that answer. But I would say that there's plenty of evidence to suggest that there would certainly be an association between those who oxidize more levels of fat versus the relative person in the population.
Now that I'm more convinced of that. If you were to compare to the average person in the population, if you have high levels of fat oxidation compared to them, would you tend to be healthier? I would say yes, almost certainly. That's probably the case on the average of an epidemiologic, 200,000 Yep.
Population study for sure. Absolutely, for sure. But when you start looking only amongst the athletic population, you're shifting from one to the other. Does it mean you're healthier or not? It's really hard to mince that apart. We saw overt elevations in glucose consistent with prediabetes, and so that was a clear signal as they ever got.
And [01:36:00] it was associated by the way. With the degree of fat oxidation. So the degree of responsiveness to the diet induced blood glucose drop was associated with how much fat they were able to oxidize. So it was actually a signal in our study and at least association that your responsiveness to the diet seemed to predict your ability to substrate certain substrates like fat.
Dr Mike T Nelson: How plastic do you think the crossover point is? Like how far do you think with training, if somebody said, Hey, just for giggles, I want to get the highest amount of fat use per hour. Like, do you, because it seems like, you go all the way back to like Jeff Ick faster study and your study and other studies.
It seems like the longer we study it that amount of fat that we can use seems to be going up and up overall.
Dr Andrew Koutnik: I would say 85%, I think you start you see it. For people who are highly fat adapted on these ketogenic diets, I think 85% is where you actually on the [01:37:00] average might start seeing some of this crossover.
Or right above that, depending on the degree of adaptation, the athletic background of the athlete, we've actually looked at that in a paper called low fat ketogenic diets glucose homeostasis and the crossover concept so people can look as open access. So we've actually looked at that exact question.
Dr Mike T Nelson: Yeah. And I wanna echo your other point too, that, so when I did my research, I was, again, a metabolic flexibility. And one of the arguments was we were trying to find a non-invasive marker for metabolic flexibility. So we baseline people to, VO two max test, and then I think we did 30% of ET and 60% of et.
And we looked at how much the RER moves in terms of a variability analysis. But what also came out of that was if you just pull people off the street, most physiology textbooks, back to what you were saying about the crossover effect. Is that if we stick them on a treadmill at 30% of ventilatory threshold, one, these people are gonna burn a ton of fat.
Like that's just the way it is. That's a crossover effect. And [01:38:00] to your point, there's actually other literature, like Hal did 1 19 99, EC did one 2015. I did one, 2015, showing that the variability in how well people use fat at that low intensity, overnight, fasted, recreationally active, these are not, metabolically deran people, varies from like 10 to 93%, like massive variability just in recreationally healthy people of how well they're able to oxidize fat.
Dr Andrew Koutnik: I think there's one key variable that's often missed in a lot of these studies. And then I'll have to pop out to get my son from school. Yeah. All good. Good. So the last thing I'll say on this note is that. When you look at these studies historically, even the meal you had the night before can matter the degree of yes, it does.
Glycogen levels in the liver matters. Yep. Your overall metabolic status matters. And obviously the habitual diet that you've been consuming over multiple weeks. Leading into that all matter, which is why when we did our randomized controlled trial, we controlled for all of those variables. We controlled for the habitual diet.
We controlled for what the [01:39:00] timeframe before performing the exercise bout. We did it with carbs and without carbs. And we did this on six weeks of two different dietary interventions, controlling body weight calories, activity and just splitting over the macronutrients. And so with dietary monitoring on top of that, so which is not to say that other evidence is not rigorous or well done, it's just to say that this is an evolution in our understanding of known confounders and trying to account for them and then answer the same question.
Dr Mike T Nelson: Yeah. My last quick point, I'll let you wrap up, is that. Doing my own metabolic heart testing and stuff. I've seen that, like, so looking at RM RMR and looking at RER during RMR, I've had some athletes, a hundred percent carb oxidation. You put 'em on like 50 watts on a bike they drop immediately to fat oxidation.
So it does make you think about a lot of the other things that are confounding a lot of the standard published research. Awesome. So where can people find out more about you if you want to be found and follow up and everything else?
Dr Andrew Koutnik: I put a lot of free information on Andrew [01:40:00] knik.com if anyone's interested.
I also am active on Twitter and Instagram at Twitter's a Konik, A-K-O-U-T-N-I-K, Instagram at a konik PhD. And I try to put out as much information I can all free for people to try to navigate their own health and performance journey.
Dr Mike T Nelson: Awesome. Yeah. I would highly recommend to check out all your stuff.
It's really good and. It's always nice to see different well-educated perspectives and all the stuff you've done over the years. So thank you so much for all of that. And thank you so much for the studies and for sharing everything today. We really appreciate it. Hey
Dr Andrew Koutnik: man, rock on.
Dr Mike T Nelson: Awesome. Cool man.
Thank you so much. You gotta run, but
Dr Andrew Koutnik: we'll chat soon. See you buddy. Cool man. So can I just exit outta, this is all good.
Dr Mike T Nelson: Yep. I'm
Dr Andrew Koutnik: just gonna hit end and we're all good to go. All right, perfect. All right, Mike, awesome chat. Appreciate it man.
Dr Mike T Nelson: See you
Dr Andrew Koutnik: buddy.
Dr Mike T Nelson: Bye.
Speaker 2: Thank you so much for [01:41:00] listening to the podcast. I really, really appreciate it. Huge thanks to Dr. Andrew Knick for being on the podcast. Uh, I really appreciate all the wonderful stuff. He is done and just taking the time and effort to kind of question what's really going on. And his credit. He's done the, the n oh one experiments and published formal, uh, literature at the same time, which is no easy task.
Anyone who's done. Human subjects, uh, trials, especially on a bigger scale, knows it is a monster pain in the ass to do. But, uh, these are the things that move everything forward, uh, so we have a better idea of what's going on. So, uh, big shout out to him for all the great stuff that he is done. Awesome discussion.
Make sure to check out all his great stuff on, uh, his links and especially Instagram. Uh, he's got a lot of great stuff, so make sure. To check him out. If you want more stuff from [01:42:00] myself, uh, go to mikey nelson.com. You can hop onto the newsletter, get the daily free newsletter, insider information, uh, very similar to this podcast.
If you enjoy the more geeky side of the fitness based on actual research and experience, I think you'll like it and it's completely free. If you're looking for ketones, check out my friends over at Teton Ketone Esters. Uh, the new site should be up very soon. It might be up boning list to this. It might not yet.
I know they're working hard on getting everything done and updated as soon as possible with a bunch of great, uh, new products that I think you'll really enjoy. Right now I've been using, uh, some of the older products because it's the same ketone Esther molecule. And as I mentioned in the intro, it's been super helpful when I've been down, uh, kiteboarding for long hour sessions, uh, at a go.
So it's what I've really enjoyed it for [01:43:00] and excited to get back home. And I have been using them, um, at higher doses on kind of more CNS heavy days, uh, especially with doing more grip stuff. And it seems to help. Um, there's no published research of anyone who's looked at that, but. I don't know. It just seems to make a, a big difference, especially on the days.
I just feel a little bit off. Um, many times those days become pretty good which is kind of crazy and it's not a, a stimulant of any kind either. So check them out below. Full disclosure, I do some scientific work with them, advisement, and I am an ambassador, uh, to them also. And thank you again, Dr.
Andrew Knick. Thank you for listening to the podcast. Really, really appreciate it. If you could do us a favor and hit the old like buttons, subscribe, rank, leave us a review, all that great stuff, uh, really does make a huge difference to getting, uh, guests like Dr. Andrew on the podcast [01:44:00] and other big time name guests, the better distribution that we have to show.
Numbers allows us to get, uh, higher quality guests and more popular people on the podcast. And so far to date I haven't spent a dime on advertising and it's gone well. And a lot of that is thanks to you for helping for the distribution and doing all the great stuff with the algorithms to move us up in the rankings there.
So thank you so much, greatly appreciate it. Hope you enjoyed this one. We'll talk to all of you again next week.
Speaker 3: There's something wrong with his hearing aid. Yeah. What's wrong? I can't hear with it. Oh, no wonder. It's too far away.
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