--- title: "The Metabolic Health Conversation We Can’t Keep Avoiding" entity: "blog" canonical_url: "https://www.drkwadwo.ca/blog/ketonescarbsdiabetes" markdown_url: "https://www.drkwadwo.ca/llms/blog/ketonescarbsdiabetes" lastmod: "2026-02-13T15:54:34.000Z" --- I’ll be honest. I come on the mic hyped sometimes. But this episode felt different — because what Dr. Andrew Koutnik is doing as a Type 1 diabetic is something I rarely see in clinical practice… and it forces a bigger conversation we all need to have about metabolic health, agency, and what “normal” should actually look like. If you’ve ever felt stuck in your health… If you’ve been told “this is just how it is now”… Or if you’re trying to make sense of the noise around keto, carbs, performance, and metabolic disease… This interview is worth your time. ## Andrew’s story starts where a lot of stories start: childhood obesity Andrew shared that as a kid, he struggled with obesity for years. Eventually, through diet changes, he got the weight off. And then, about a year later, everything changed. On a family trip, he became seriously ill — nausea, vomiting, frequent urination — and ended up in the ER with a blood sugar of 596 mg/dL (about 6x higher than normal). He was diagnosed with Type 1 diabetes, spent two weeks in hospital (including ICU time), and suddenly had to learn something most people never think about: How to become a master of your own metabolism. Because when you’re Type 1, your body no longer produces insulin — and insulin is the “thermostat” that keeps blood sugar in range. No insulin = no buffer. Every meal, every workout, every stressful day becomes a real-time metabolic experiment. ## The part that hit me: most people don’t realize how serious Type 1 complications can be. In the episode, we talked about the downstream risks that come with poor metabolic control: - eye disease - infections - cardiovascular disease - changes in the brain over time Andrew admitted something important: early on, he didn’t fully understand those long-term implications either — not until he became a scientist and started seeing how quickly damage can begin when glucose is highly variable over years. That’s the wake-up call. Not fear-mongering — just reality. ## Why he went low-carb and keto: reduce the biggest driver of glucose swings Andrew noticed that among all the factors that affect blood sugar, carbohydrates created the biggest spikes and required the most insulin correction. So he asked a simple (but powerful) question: If carbs drive the biggest swings, what happens if I lower carbs? He adopted a very low-carb ketogenic approach over a decade ago. And three months later, he walked into his doctor’s office — who at the time was the American Diabetes Association president — and the doctor’s reaction was: “Andrew… what are you doing?” His HbA1c was in the range of someone without diabetes. The part I loved? His physician didn’t dismiss him. He leaned in — brought in residents, had Andrew present, and stayed curious. That’s how medicine should work: outcomes first, ego last. ➡️➡️Watch Podcast Episode Here➡️➡️ ## The 10-year case study: the “LDL fear” versus the full metabolic picture One of the major criticisms of ketogenic diets is concern about LDL cholesterol. Andrew addressed that head-on by tracking his own health over 10 years on a ketogenic approach with extensive medical records. What stood out from the discussion: HbA1c ~5.5% over a decade (essentially normal glucose control) insulin requirements dropped significantly blood pressure and triglycerides remained normal advanced cardiovascular assessments showed no signs of atherosclerotic changes or heart dysfunction over that window. He also made a key point: in large Type 1 diabetes cardiovascular data, LDL may not be the top driver compared with other modifiable risks (like glycemic control, blood pressure, triglycerides, and more). Big idea here: Metabolic health isn’t one marker. It’s the whole system. ## Sustainability isn’t willpower. It’s quality of life. Andrew said something that should be printed on a billboard: People eat for maybe 1–2 hours per day… …but those choices affect the other 22–23 hours. So why choose something that gives short-term pleasure, if it costs you: - energy - mood - focus - training quality - patience at home - overall wellbeing For him, the “sustainability” debate isn’t theoretical. He sticks to what works because his quality of life depends on it. And honestly, for many people without Type 1 diabetes — it’s not as dramatic, but it’s the same pattern. That post-lunch crash? The brain fog? The cravings? That’s physiology talking. ## What we feed our kids matters — fast This part made me laugh… because it’s too real. Andrew talked about how giving kids certain high-sugar foods can change the entire next stretch of the day: - mood - impulsivity - behavior everyone suffers And it reinforces a simple truth: Food doesn’t only affect weight. It affects the brain. ## “Fit but unhealthy” athletes and the carb conversation We also got into performance — because most sports fueling advice is carb-heavy. Andrew made a provocative case that the sports nutrition world may overhype carbohydrates for performance, and that in some cases, high-carb strategies could push some athletes toward metabolic issues — even if they look “fit.” He described research showing that some athletes can drift into prediabetes, and that dietary shifts can reverse that without necessarily harming performance. If you coach athletes, have teens in sport, or you’re training hard yourself… this part alone is worth watching. ## The message I hope people take from this episode I’m a “rah rah” guy because I believe this: You have more agency than you think. Yes, there are barriers: - cost - environment - shift work - time - stress But the goal isn’t perfection. It’s ownership. Start. Try something evidence-informed. Track how you feel. Adjust. Repeat. Because the trends are clear: metabolic disease is common, and it’s catching up to people earlier than ever. And no one is coming to fix it for you. ## Watch the interview If any of this resonates — watch the full conversation with Dr. Andrew Koutnik here ➡️➡️Watch Podcast Episode Here➡️➡️ And if you do watch it, I’d love to know: What stood out most — the Type 1 story, the keto outcomes, or the performance/carb discussion?