Andrew Koutnik, Ph.D.
@AKoutnik
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Mission: Optimize Type-1 Diabetes Metabolic Health & Patient Outcomes 👨🔬Researcher 🔬Metabolism 💪Type-1 Diabetes 👨👩👦👦Father & Husband Views My Own
Joined December 2011
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Pinned Tweet
🚨Please share your lived experience with Type 1 Diabetes & Food
(5-10 minutes survey):
We have heard from >800 people internationally, but we need your help! Please share!
@AnnalijnConklin
@JimJohnsonSci
@JDRF_Canada
@JDRF
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Quite a # of KETONE studies published in the last 30d:
Quick review
-Autism Spectrum Disorder (mitochondrial)
-Cardiomyocyte Stem Cells
-Novel Exogenous Ketones
-Insulin Resistance
-Mental Fatigue (cognition)
-Memory Older Adults w/o Dementia
🧵1/n
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🧵Very-low carb (ketogenic; LCHF) vs high-carb diet (HCLF):
-1-month isocaloric
-Middle-aged males (40y/o)
-High-intensity performance (>85% VO2Max)
-1-month glycemic control
-Cardiometabolic parameters
Our hypothesis was wrong...
What did we see? 1/n
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Our family just moved to Santa Barbara, CA 🌄 for a lifelong dream.
I am joining an amazing team at Sansum Diabetes Research Institute to focus on nutrition & metabolism in Type-1 Diabetes, Type-2 Diabetes, & Obesity 💙
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Type-1 Diabetes
Keeps getting better
HbA1c: 5.5%
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Type-1 Diabetes & Very-Low Carbohydrate Diet:
Safety🧵Please share for those it may help.
1/n
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🚨
@AmDiabetesAssn
Keto Diets in Diabetes: Evidence in Type 1 & Type 2 Diabetes?
I will be presenting the EVIDENCE on carbohydrate restriction in diabetes in ADA Nutrition Webinar (FREE).
👇 Please SHARE for all to attend!
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Type-1 Diabetes
Closed loop.
Time to give it a shot.
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Type 2 Diabetes Remission in 56% on very low CALORIE diet over 12 month
Very impressive!!
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CGM in >5600 people without prediabetes or diabetes.
-40% would've been reclassified as pre-diabetic.
-3% as T2D.
Similar to what we saw in 30% of this athlete cohort.
Maybe CGM need to be considered in capturing people at risk?
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Everyone is speaking about CGMs causing eating disorders (with near certainty).
Can someone show me the citations that have led to this certainty?
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Best 6 min clip I have seen succinctly describing the situation.
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Day 61:
#type1diabetes
#JourneytoNormalGlycemia
Today's HbA1c: 5.5%💙
...normoglycemia complete...T1D journey continues...
CGM👇
#Type1Diabetes
accountability project:
Last 2-3months, I've had:
⬇️physical & mental energy
⬆️hyperglycemia
🔀glucose
Answer? At-home HbA1c test: 6.1%...
Far higher than my normal. I own this.
This is my journey back to where I feel my best:
HbA1c<5.7%.
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For those interested in a recent blog discussion of the recent Type-1 Diabetes Carbohydrate Review in JCI... See here:
@davidludwigmd
@AmDiabetesAssn
@JDRF
@cadiulus
@JakeKushnerMD
@krististors
@DominicDAgosti2
@BrittanieVolk
@DikemanDave
@Type2CEO
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Dr. Brendan Egan &
@DrAdamPSharples
MASSIVE & authoritative review on the molecular responses to exercise (100pages; Beautiful figures; Inevitable classic)
Update on prior review (; which was cited ~2000x)
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For those interested in <45min discussion (remaining are questions) on VLCD in T1Ds here is a update-to-date talk I gave on the topic:
@cadiulus
@JakeKushnerMD
@DominicDAgosti2
@JimJohnsonSci
@DikemanDave
@JDRFceo
@Type2CEO
@glycogentheory
@kevinnbass
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@AlexZverev
not allowed to take insulin to manage his
#type1diabetes
on the court?
Is this true
@rolandgarros
? Can't be? What does this teach kids with
#type1diabetes
? Blocking insulin use is DANGEROUS.
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β-Hydroxybutyrate, a ketone body, reduces the cytotoxic effect of cisplatin...important implications here
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@hubermanlab
@ChrisPalmerMD
@hubermanlab
great podcast w/
@ChrisPalmerMD
but...the ketogenic diet was used for obesity, Type-1 Diabetes, and Type-2 Diabetes (well) in advance of epilepsy. Banting (Obesity), Allen (T1D), Rollo (T2D)...all preceded Wilder Mayo Clinic epilepsy report in 1921.
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🚨 STUDY: Dietician knowledge & use of LOW CARB (1/3)
-67% of dieticians report ZERO/basic knowledge of LCDs
-69% of patients SELF-PRESCRIBING LCDs
-Reasons for no Rx: doubt of benefits, low self-confidence, no support from other health professionals
1/3
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Dream. Come. True.
SDRI is delighted to announce the appointment of
@AKoutnik
, as a Research Scientist. Dr. Koutnik brings a wealth of knowledge and expertise in metabolic therapies for health, disease, and performance outcomes in the field of diabetes to SDRI.
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>80years with T1D? Now 92
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Ketone biochemistry? Worth highlighting this review again:
Many studies will branch from this authoritative, technical, & nuanced discussion.
H/T:
@puchatek22ch
&
@ketonemics
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Microneedle-Based Detection of Ketone Bodies along
with Glucose and Lactate: Toward Real-Time Continuous
ISF Monitoring of Diabetic Ketosis/Ketoacidosis
Would be an incredible tool if it ever does become ext. validated, commercially available, & approved.
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Since
@TurtonJessica
et al. meta-analysis on Low-Carb & T1Ds, there have been 4 additional analyses with average ≤50g carb/day. I updated this table to show them all and there glycemic outcomes. Table 8 from: 1/n
@cadiulus
@JakeKushnerMD
@DikemanDave
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It is a common misconception that the "Ketogenic Diet" started with epilepsy in the 1920s.
Multiple published manuscripts and textbooks show their use in obesity, type 2 diabetes & type 1 diabetes in the decades to centuries prior.
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Glycemic variability in individuals WITHOUT diabetes?
Study suggests:
-GV is associated with measures of coronary atherosclerosis development.
-GV may predict cardiovascular events and type 2 diabetes
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Life Expectancy with Type 2 Diabetes?
Diagnosed at 50? 6 Year Shorter
Diagnosed at 30? 14 Years Shorter
Similar data in T1D. Cumulative impact of diabetes is real and should be addressed ASAP.
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Identical Twins?
22 identical twins consuming either a plant based or omnivore (plants and meat) diet.
Plant based:
-Lower BMI
-Lower Fasting Insulin
-Lower LDL
Not often you see a study like this in numerous twins.
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@cadiulus
@zoeharcombe
I don't understand why so many people in the Low Carb community spread information like this...It isn't helping anyone...I am legitimately wondering who this is intended to help and open minded to learning (but I must admit my speculations are not positive).
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Viral Infection, COVID19 & Ketone Bodies?
Summary discussion, experimental list, & more:
Amazing & passionate Collaborative Team
@BriannaStubbs
@GeriSciDoc
@DrEmilyGoldberg
@EricVerdin
@PTurnbaugh
So much to learn...
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Type 1 Diabetes
New case report show very-low carbohydrate diet prolongs honeymoon...
BUT
...this is actually the 4th such report.
Note that even this VERY POPULAR analysis of
Some of the worst advice a person with type 1 diabetes receives (at time of diagnosis) is "eat whatever you want and cover it with insulin". One (among several) way of defining the disease is an inability to metabolize glucose properly. I've long been puzzled, then, that dietary
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Ketone Bodies Impact on Hypoxic CO2 Retention Protocol During Exercise.
1/n
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Using anabolic steroid increases the risk of death.
To justify steroid use, the bodybuilding community often said, "but where are the bodies?"
...but here we are 🤷♂️
This study found an increase in mortality from both natural and unnatural causes among androgenic anabolic steroids users sanctioned in fitness centers compared with control participants.
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It has begun!!!
Type 1 Diabetes
Closing the loop.
Will provide updates throughout. First, I'm going to let it "run the show" for 4-5 days. Then, become more integrated to tighten things up.
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3-week ketogenic diet which may present new insight on keto-adaptation time?
Very nice study! Shows ⬇️myocardial fatty acid oxidation and oxidation in people with obesity.
...but note that ketone levels did not plateau within 3-weeks.
@davidludwigmd
has
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Type 1 Diabetes Community WE WANT TO HEAR YOUR VOICE on
#food
&
#dietstrategies
!!!
10-minute research survey on food, diet & T1D: []
Please like & share to those living with T1D or those caring for someone with T1D
Living with type 1 diabetes, or care for someone who does?
@CORE_UBC
,
@SansumDiabetes
, &
@IPTN_Canada
want to hear about your experience with
#food
&
#dietstrategies
. This 10min survey provides valuable information for the T1D community & researchers.
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Thank you to the researchers, endocrinologists, PCPs, and advocates who continue to help people with T1D thrive everday. Seminally, thank you to the T1Ds who provide other T1D's and me with inspiration and made this disease a gift, not a cure.
#DiabetesAwarenessMonth
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"2/3 of those who took GLP1 in 2021 are no longer on the drug."
That is the first time seeing that stat.
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Our Sports Medicine Review: Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future
-Open Access
-43 pages; 320 citations
-
@MarkEvans_17
(1st), Tyler McClure, Brendan Egan.
Extensive discussion within & key take homes below:
1/n
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Avoiding the risks and complications of Type-1 Diabetes? Potential solution on the table for Type-1 Diabetics? Take at look (if you wish) at the argument for and against low carbohydrate nutrition in T1D and decide for yourself:
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Ketogenic Diet & Exogenous Ketone Research (published last 30day) 🧵
-Blood pressure/hypertension? 🚿 ↘️
-Cognition?🧠
-Myocardial glucose suppression?💓
-Immune response?
-Exercise cardiac output?🏃
1/n
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Type-1 Diabetes. 100% Time in Tight Range (70-140mg/dL) = ⬆️ my personal quality of life.
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3-Part Series on Type-1 Diabetes and Nutrition. Part 1 link found in this very kind post from
@krististors
&
@DominicDAgosti2
: ; Part 2&3 over the next 2 weeks.
@JakeKushnerMD
@cadiulus
@davidludwigmd
@DikemanDave
@BioLayne
@DrSarahHallberg
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Yes & George Cahill (1980) who showed that individuals who are keto-adapted (non T1D; fast 40days w/ BHB ~5.5mM) can maintain cognitive function when given 20IU of insulin to induce ~27mg/dL BG. Cunnane's MRI tracer studies support this. (All human data).
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This is terrifying "across 9.5million newly diagnosed cancer patients
...42.4% depleted their entire life's assets" 2 years after being diagnosed. Unbelievable...
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Low Carbohydrate Diets in U.S. Dietary Guidelines?
Expert consensus statements on lower carbohydrate diets
Consensus?
1) Definitions
2) Benefits, Risk & Research Gaps
3) Incorporation into U.S. Dietary Guidelines
4) Barriers, Concerns & Compliance
5) Role in Metabolic Health & Cultural Diversity
See 👇
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I am retweeting this again. This may be one of the best all encompassing conversations of T1D.
@PeterAttiaMD
and
@JakeKushnerMD
nail this conversation. Absolutely nail it.
Podcast is live: Jake Kushner [
@JakeKushnerMD
], M.D.: How to thrive with type 1 diabetes and how everyone can benefit from the valuable insights (EP.41) -
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Very-low carbohydrate diet in ultra-endurance open water 19.7km swim over 6.5hours in a (very good) athlete with type 1 diabetes.
-🤏 glucose excursions
-⬇️need for carbohydrate supplementation
-No episodes of symptomatic hypoglycemia
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No idea where this photo came from but it is awesome.
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Father's Day weekend complete.
All packed up.
About to fulfill a lifelong dream.💙
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Type 1 Diabetes
Attempted 400lb squat. Failed.
2min later, put it back on.
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Autism Spectrum Disorder (ASD) model
-BHB oxidation regulated mito. morphology (morphology -> mito. function)
-BHB elongates mito. through ⬆️NAD+ (redox)
-BHB promoted behavioral improvement in ASD zebrafish model
-Field:
2/n
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MAJOR THANKS to:
-
@levels
for providing all CGMs
-Tremendous work (already) in this space
@LouiseMBurke
,
@JohnAHawley
,
@PhilipPrins11
,
@LoreofRunning1
,
@DominicDAgosti2
,
@Gonzalez_JT
, many others..
-Participants: stuck to 2 diets & complied w/ 10week study protocol 💪
End 🧵
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Truly appreciate
@DominicDAgosti2
, our lab, and everyone along the way for making this PhD experience one of a kind!! 1/n
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Type 1 Diabetes
Pod expired. Insulin and pods at home...
Got a syringe and manually pulled the remaining insulin out of the pod. Doing CGM and MDI boluses on 30min schedule.
Type 1 diabetes always throws curve balls...
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Ketogenic Diet & Pancreatic Cachexia:
1) KD:⬇️pancreatic tumor burden.
2) KD:⬆️cachexia.
3) Survival: Cachexia > Tumor Burden.
4) Dexamethasone (atrophy agent) offset KD cachexia.
Super interesting & demonstrates the complexity (art) of considerations in oncology.
Ketogenic diet promotes tumor ferroptosis but induces relative corticosterone deficiency that accelerates cachexia
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Not every day you see:
1) US Army article on
#type1diabetes
?
2) US Army article discussing Richard Bernstein management approach?
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Ketone body administration alleviates chemotherapy adverse events?
#Foodismedicine
@DominicDAgosti2
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After recent presentation on Type-1 Diabetes. I extended the discussion on concerns versus benefits on very low carbohydrate diet in Part 3 with additional refs, tables, and figs
@JakeKushnerMD
@MetabolicSummit
@DominicDAgosti2
@Type2CEO
@DrSarahHallberg
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Congratulations to
@KevinH_PhD
and team on this recent publication! Certainly interested to dig into this:
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Dissertation submitted!! Proud of the last 5 year looking back. Excited to defend!!
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#Type1Diabetes
accountability project:
Last 2-3months, I've had:
⬇️physical & mental energy
⬆️hyperglycemia
🔀glucose
Answer? At-home HbA1c test: 6.1%...
Far higher than my normal. I own this.
This is my journey back to where I feel my best:
HbA1c<5.7%.
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It has been 4 years since
@tedx
talk. I still feel very passionate that nutrition remains a critical component of changing patient outcomes. Patients and clinicians need access to, and education on, these therapeutic strategies. 1/2
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Congratulations to
@FlockhartMikael
, Larsen & Team:
Prolonged endurance exercise associated with INSULIN RESISTANCE in endurance trained athletes?? This topic is getting very interesting....
Why???...1/n
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ADA Webinar on Low Carb Diet Today 👇
📅 Join ADA & NSMIG on April 23, 2024, 3pm ET for a panel on the effects of the ketogenic diet in type 1 & type 2 diabetes.
Register:
@ElisabettaPoli7
@AKoutnik
Join the conversation with our Professional Membership:
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#WorldDiabetesDay
Thanks to the many people from the diabetes who have changed my life! Hope to do the same!
@SansumDiabetes
@JDRF
@AmDiabetesAssn
@JimJohnsonSci
@glycogentheory
@MiriamETucker
@MCRiddell1
@5Dess
@Geeks_thatSpeak
@RpratleyMD
@DikemanDave
@AnnalijnConklin
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Type 2 diabetes & LONG TERM glycemic control (9 month RCT):
Strength training > aerobic or aerobic + strength in this cohort (n=186 patients).
Wasn't expecting that?!
@DrNadolsky
@mackinprof
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Very entertaining and unique dyanmic between
@BioLayne
and
@DominicDAgosti2
on
@joerogan
. Both experts. Both good people. Both coming from differing perspectives. Both have been friends to one another for >decade. Awesome discussion worth checking out.
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MCT improves memory in NON-demented older adults
-Systemic Review; 6 RCTs
-4/6 MCT studies ->⬆️memory older adults
-Larger improvement with larger cognitive deficits
7/n
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Type-1 Diabetes.
Recent DEXA scan. Have been tracking this for a decade now.
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Was asked about perspective on Low Carb in T1D community from doctors and patients alike. This is my perspective of this in summary: 1/n
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Type-1 Diabetes
Pre-Exexcise Low Carb (21%) v High Carb (52%) Meal
⬇️ Insulin 30%
⬇️ Coefficient of variance 42%
⬇️ BG drop during exercise
No Brainer
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Backlash from type 1 diabetes community on general population access to CGM?
ALOT has been learned about glucose from the T1D community using CGMs, FIRST. That was its origin.
I don't think we should be prevent access to others who want this data also.
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Ketone Bodies Attenuate Wasting in Model of Atrophy
Open-Access Link:
Associated Article Link:
Tweetorial below (rational, findings, takeaways) 1/n
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Recent publication 🧵:
What happens when you provide 1000kcal HIGH- VS LOW-Carb Military Meal Ready Eat (MRE) food equivalents prior to exercise?
@PhilipPrins11
@DominicDAgosti2
@GCCExSci
Study Objectives?
1/n
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Mental health, Diabetes & Mortality. Those with depression & diabetes are consistently at 3x-9x higher risk for mortality regardless of the analytical model...and this was in a country w/ universal HC 😰 1/n
Up front & free to read in our Sept issue
#editorspicks
: Depression, diabetes, comorbid depression and diabetes and risk of all-cause and cause-specific mortality: a prospective cohort study
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This is what I consider a true inspiration. Dr.
@JustinGWilford
went BACK to school to get another PhD to learn how to empower his son who was diagnosed with brain cancer. He just graduate with his 2nd PhD...Dr.^Wilford and Audra run
@maxloveproject
to empower children...Unreal!!!
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When I got married & we had our two boys, perfect was not a thing. Just showing up and being consistent was prioritized. I actually became better at many things I had tried to "optimize" by letting go.
I realized afterward how much time I wasted on "optimization"/"perfection"
So many “influencers” and “lifestyle” gurus don’t have committed relationships or kids. Yes, strive to be healthy and excellent and all that, but sometimes the key to adult life is to let go of optimization and control, let good enough be good enough, order a pizza, and move on.
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Ketone Ester Improves Cognition After Mental Fatigue
-25g ketone monoester (KME) v no-kcal placebo
-40min Mental Fatigue Task + 45min Simulated Soccer Match
-KME:⬇️glucose,⬇️lactate, ⬆️correct responses
-Consistent w/ other work
6/n
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CGM Company Reported Revenue:
-Abbott: $4.33 Billion
-Dexcom: $2.45 Billion
-Medtronic: $2.34 Billion
Abbott reports its goal is $10 Billion. I suspect they may get there.
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#type1diabetes
#cgm
& acute mental health status
External factors can often be blamed for changes in mood, when often in T1D, glycemic control is a MAJOR influence. See video.
@IainCampbellPhD
@ChrisPalmerMD
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Keto-adaptation timeline? 🧵
It is all in how you define it (& in whom, how you implement ketosis, etc...): Ketones? Substrate Oxidation? Enzymatic Changes? Functional Changes? Metabolic Phenotype? Etc?
@B_Holmer
@DoctorTro
1/n
@DoctorTro
@AKoutnik
I did. I’m not sure what it confirms or disconfirms about the minimum time for “keto adaptation” to occur.
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Type-1 Diabetes
Fasted HIIT (6x400m uphill)
St.Patty's = Dropkick Murphys
Rapid IU 10m Pre-Exercise = ↔️BG
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See below video 🤣
#food
#nutrition
Please share or retweet for patients and caregivers
SDRI is conducting a survey for those living with
#type1diabetes
or caregivers to better understand the role of nutrition in diabetes. We want to hear from you! Visit to take the survey today!
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Where do the terms "Type-1 Diabetes" & "Type-2 Diabetes" come from?
...probably not where you think...
⌛️1951👇
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Please share for all interested!
Important discussion and will present new data on this topic!
@SansumDiabetes
📅 Join ADA & NSMIG on April 23, 2024, 3pm ET for a panel on the effects of the ketogenic diet in type 1 & type 2 diabetes.
Register:
@ElisabettaPoli7
@AKoutnik
Join the conversation with our Professional Membership:
0
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Wow!
Capillary C-Peptide testing?
Next? Insulin? Next? Continuous Insulin Monitoring? Next? Continuous Glucose/Insulin Monitoring... that would generate some incredible insights.
Right now, only T1D with CGM & pumps with insulin readouts see this.
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Indications of improvements in glycemic metrics in T1D on ~100g carbs/day compared to ~250g carbs/day. Hopefully more work is underway to build the body of literature on this approach in T1Ds.
Low versus High Carbohydrate Diet in Type 1 Diabetes: A 12-week randomized open-label crossover study. h/t
@glycogentheory
. I imagine we will see more of these trials in the future.
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Hard to imagine this respond was allowed but it is amazing:
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Type-1 Diabetes
Lower Body RE (trying to slowly increase strength to where it was)
I started incorporating 15minute of cardio after RE to see how it shifts CV metrics. We will see.
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Glucose levels in type 1 diabetes may slow cognition?
More data on this topic.
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New Publication (abstract only):
Multiple recent analyses have challenged assumptions on the exercise "crossover point." We re-evaluation assumptions and the link between diet, insulin, glucose homeostasis, and fat oxidation.
Full text soon...
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