STEM-Talk Episode 185: Andrew Koutnik discusses metabolic health, athletic performance and growing up with type-1 diabetes
Today we have our good friend and colleague Dr. Andrew Koutnik on the show. Andrew is a research scientist who studies the influence of nutrition and metabolism on health, disease and performance. He specializes in Type 1 diabetes and works with a wide range of people to improve their metabolic health and athletic performance.
Andrew is a visiting research scientist at IHMC and has worked with Harvard, Johns Hopkins, NASA, and the Department of Defense to develop evidence-based strategies for overcoming complex health challenges.
He is a graduate of Florida State University and earned his Ph.D. in medical sciences at the University of South Florida, where he worked with another good friend of ours, Dr. Dominic D’Agostino, who has been a previous STEM-Talk guest.
Show notes:
[00:02:50] Dawn welcomes Andrew to the show and asks him about his website, andrewkoutnik.com, the quote on the site’s homepage “Demystifying complex science to help you thrive in your health journey,” and the tagline “Challenging the status quo of metabolic health, human performance, and the management of type1 diabetes.”
[00:05:31] Ken asks Andrew how old he was when he first learned he had Type 1 diabetes.
[00:08:32] Dawn asks why Andrew believes his Type 1 diabetes is one of his life’s ultimate assets?
[00:12:51] Ken mentions that Andrew grew up in Tallahassee and that despite suffering from childhood obesity, he was relatively athletic as a child. Ken asks Andrew to talk about his childhood.
[00:14:20] Dawn asks Andrew to talk about the weight-loss journey he underwent as a teenager.
[00:17:25] Dawn shifts gears to ask Andrew about how he got into science, mentioning that when he was younger, he never saw himself becoming a scientist.
[00:20:19] Dawn asks if it is true that Andrew was the sort of kid who would constantly asked questions.
[00:22:11] Dawn asks Andrew if it is true that after enrolling at Tallahassee Community College, it took him a while to decide on his major.
[00:22:58] Ken asks Andrew to talk about the impact that his undergraduate anatomy and physiology class and professor had on his journey.
[00:24:44] Ken mentions that after graduating from FSU, Andrew went to the University of South Florida where he worked with Dominic D’Agostino, who is both a previous STEM-Talk guest and a current colleague of Andrew’s. Ken asks Andrew how he met Dom.
[00:27:46] Dawn asks Andrew how he came to work in Dom’s lab.
[00:29:00] Dawn asks Andrew if his wife is still in touch with her former roommate, who connected Andrew and Dom.
[00:29:21] Ken asks Andrew to touch on some of the research he did with Dom while he was pursuing his Ph.D.
[00:31:49] Dawn shifts gears to talk about Andrew’s work in metabolic health and Type 1 diabetes. Dawn explains that a study published by the University of North Carolina found only 12 percent of Americans were metabolically healthy. Additionally, researchers from the Friedman School of Nutrition Science and Policy at Tufts University found in 2022 that only 6.8 percent of Americans had good cardiometabolic health. Dawn asks Andrew how he works with people who want to improve their metabolic health.
[00:34:19] Ken asks Andrew for his thoughts on the sentiment that a ketogenic diet is hard to sustain.
[00:36:55] Ken mentions that Andrew was part of a review that looked at carbohydrate restriction for diabetes, which is a practice that had been in use since the 1700s. It fell out of favor once insulin was discovered in the 1920s. Ken goes on to explain that carbohydrate restrictive diets, like the ketogenic diet, have regained popularity for the treatment and management of diabetes, weight-loss and a range of other health issues such as migraines, cancer and depression. Ken asks Andrew to first explain the history of carb-restrictive diets as a treatment of diabetes.
[00:39:43] Ken asks Andrew to talk more about the aforementioned 2021 review and its argument in favor of a medical nutrition therapy for diabetes management.
[00:47:21] Dawn quotes a passage from the American Diabetes Association website that reads, “Before insulin was discovered in 1921, people with diabetes didn’t live for long. There wasn’t much doctors could do for them. The most effective treatment was to put patients with diabetes on very strict diets with minimal carbohydrate intake. This could buy patients a few extra years but couldn’t save them. Harsh diets, some prescribed as little as 450 calories a day, sometimes caused patients to die of starvation.” Dawn asks Andrew if he feels that this quote discourages the use of carb-restriction and medical nutrition therapy for diabetes management.
[00:49:22] Dawn asks Andrew how the treatment of diabetes went from the use of insulin being prescribed along with carbohydrate restriction, to purely pharmacological interventions.
[00:50:59] Dawn asks Andrew to talk about the significance of the fact that carbohydrates are the only macronutrient directly digested into glucose, making carbs the main determinant of postprandial glycemia and insulin requirements, which creates a mismatch between insulin kinetics and glucose.
[00:55:29] Ken pivots to talk about the work of Jeff Volek at Ohio State University, one of the founders of Virta health, and our guest on STEM-Talk episodes 43, and 149. Ken goes on to explain that Virta offers nutrition-based approaches to losing weight and reversing diabetes. Virta has an impressive track record of success with Type 2 diabetes. The average weight loss for those using Virta’s system is 31 pounds, and enrollees reduced their medications by 63 percent. Ken asks Andrew why these are such impressive achievements.
[00:57:07] Dawn asks Andrew about the concerns people have about low carbohydrate diets for diabetes.
[01:00:24] Dawn asks, given that total medical costs for diabetes in the US is approaching a billion dollars a day, if Andrew could discuss how research into medical nutrition therapy for diabetes should become a priority.
[01:02:44] Dawn pivots to talk about Andrew’s work in optimizing human performance, mentioning that he recently put out an article on Substack titled “Revolutionizing Sports Nutrition: New Insights on Low-Carb vs High-Carb Diets in Strenuous Exercise Performance.” Dawn explains that this article was based on a study Andrew and his colleagues published challenging the conventional thinking that carbohydrates were essential to athletic performance. Dawn asks Andrew to talk about the origins of the conventional wisdom that carb-loading is essential for athletic performance.
[01:06:21] Ken asks Andrew to talk about the physiology behind the potential of low-carb diets to improve athletic performance in certain contexts.
[01:08:47] Dawn asks Andrew to give an overview of his 2023 paper titled: “Low and High Carbohydrate Isocaloric Diets on Performance Fat Oxidation, Glucose and Cardiometabolic Health in Middle-Aged Males.”
[01:13:41] Ken comments on how active, athletic and outwardly healthy-looking people being prediabetic is likely more common than people think.
[01:15:35] Ken comments that this incidence of prediabetes in athletes appears to be most common in endurance athletes.
[01:17:04] Ken explains that Andrew released a study earlier this year looking at the performance of triathletes who are adapted to very low-carb diets, as well as very high-carb diets. Ken goes on to explain that this study examined the belief that very low-carb diets would impair prolonged performance during strenuous exercise. Ken asks Andrew to explain the design of this study.
[01:20:27] Ken explains that the aforementioned study produced three key findings, which he asks Andrew to walk listeners through.
[01:23:48] Dawn notes that the ketogenic diet has become more popular in recent years, and that in response one can see numerous “keto-friendly” versions of typically high-carb foods, like breads and ice creams. Dawn asks Andrew what his take is on such products.
[01:27:50] Ken asks Andrew if it is true that he has some interesting research findings coming down the pipeline soon.
[01:28:36] Dawn wraps up our interview by asking Andrew if it’s true that he taken up jujitsu.
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