Ketogenic and low-carbohydrate diets often focus on a specific carbohydrate target: keep your net carbs under 30 grams. But as registered dietitian and certified diabetes educator Franziska Spritzler demonstrates in this presentation from Metabolic Health Summit, a carbohydrate target is not a therapy. Effective implementation means a full assessment of medical history, medications, labs, food preferences, lifestyle, and the motivation that will carry a patient through year one and beyond.

Spritzler specializes in low-carbohydrate and ketogenic nutrition and has extensive experience helping people use these approaches to improve metabolic health. The creator of lowcarbdietitian.com, she walks through the practical decisions clinicians face: when a ketogenic diet is warranted versus a more flexible low-carbohydrate approach, why she recommends 1.2 to 1.8 grams of protein per kilogram rather than the RDA's 0.8, how to manage medication adjustments for patients at risk of hypoglycemia or hypotension, and how to handle electrolytes, carbohydrate counting, sweeteners, and plant-based variations without losing the patient along the way.

Questions Answered in This Episode:

• What actually separates a ketogenic diet from a low-carbohydrate diet, and when does the difference matter?
• Why is the protein RDA too low for long-term metabolic health, and what range does Spritzler recommend instead?
• Who should avoid ketogenic diets entirely, and why are most contraindications manageable with closer supervision?
• How should medications be monitored and adjusted when a patient begins carbohydrate restriction?
• Should patients count net carbs or total carbs, and why are packaged "net carb" labels unreliable?
• Can a ketogenic diet be done as a vegetarian or vegan?

A practice-tested blueprint for turning carbohydrate restriction from a prescription into a therapy patients can sustain.

Special thanks to the sponsors of this episode:

✅ Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here.
✅ iRestore: Get a special discount on the iRestore Illumina Face Mask with code LINK here.
✅ fatty15: Get an additional 50% off a 90-day subscription starter kit with code METABOLICLINK.
✅ Zocdoc: Find and instantly book a top-rated doctor here.

More Links

• Franziska's website: lowcarbdietitian.com
• The Metabolic Initiative (expert lectures, CME, ad-free episodes, live Q&As; first 7 days free): membership.metabolicinitiative.com

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

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Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Join us for a live Q&A with Dr. Ben Bikman here.

For the 100th episode of The Metabolic Link, Ben Bikman, PhD, professor of cell biology and physiology at Brigham Young University and author of Why We Get Sick, returns for a milestone conversation with co-hosts Dominic D’Agostino, PhD, and Victoria Field. Together, they examine what clinicians are measuring, what conventional approaches may be missing, and how the science of metabolic health continues to evolve.

Bikman argues that the clinical picture of metabolic health remains glucose-centric and lipid-heavy while the earliest signal, elevated insulin, goes unmeasured. He explains why women stay insulin sensitive at far higher body fat than men and what menopause takes away, why visceral fat is misunderstood, and how a fatty liver can be miscounted as lean mass on a DEXA scan. That last point is why he now says he was wrong about GLP-1 drugs, and why he thinks they should be prescribed as something other than weight loss medication.

Questions Answered in This Episode:

• Why does standard bloodwork detect metabolic dysfunction so late?
• Why are women more insulin sensitive than men at the same or higher body fat?
• What actually changes metabolically during menopause?
• Is visceral fat inherently dangerous, or is something else going on?
• Why did Dr. Bikman change his position on GLP-1 medications?
• Should GLP-1 drugs be prescribed as weight loss drugs at all?

This milestone episode offers a rigorous, physiology-first look at where metabolic science stands today, and what researchers and clinicians may need to examine next.

Thank you for listening, watching, sharing these conversations, and helping us reach 100 episodes. We’re incredibly grateful to have you as part of this community.

Special thanks to the sponsors of this episode:

Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here.
Cowboy Colostrum: Get up to 25% off with code METABOLIC here.
iRestore: Get a special discount on the iRestore Illumina face mask with code LINK here.

More Links

• Dr. Ben Bikman's website: benbikman.com
• Insulin IQ: insuliniq.com
• YouTube: youtube.com/@benbikman
• Instagram: @benbikmanphd
• Featured study: White Matter Lipids as a Ketogenic Fuel Supply in Aging Female Brain: Implications for Alzheimer's Disease

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

• Instagram
• Facebook
• YouTube
• LinkedIn

Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

What can 21 days of continuous glucose and ketone data, recorded during a 1,000-mile cycling journey, reveal about managing type 1 diabetes on a ketogenic diet?

Dr. Ian Lake is a UK-based primary care physician who has lived with type 1 diabetes for more than 30 years. After two decades of conventional high-carbohydrate management, he adopted a very low-carbohydrate, ketogenic approach and began examining insulin not simply as a glucose-lowering medication, but as a metabolic hormone whose requirements are influenced by nutrition, exercise, sleep, circadian rhythm, hydration, and stress. His new book, Shifting Gears, documents the ride and the lessons he took from it.

Dr. Lake treated the journey as a 21-day personal experiment, wearing continuous glucose and ketone monitors while consuming roughly 20 grams of carbohydrate per day. In this conversation with Dr. Dominic D’Agostino, he shares what his data showed: an average ketone level near 1.2 mmol/L, daily insulin requirements declining from the mid-20s of units to around 16, and an episode in which glucose and ketones rose together after he had taken too little insulin.

Dr. Lake describes how, in his case, one unit of insulin brought his ketones from approximately 3.0 to 0.9 mmol/L within about 20 minutes. He and Dr. D’Agostino use the experience to explore the distinction between nutritional ketosis and diabetic ketoacidosis, the essential role of adequate insulin, and why ketone readings must always be interpreted alongside glucose levels and clinical context.

They also discuss insulin sensitivity during prolonged exercise, the practical challenges of adjusting insulin during endurance activity, and research suggesting that fat-adapted athletes may sustain high rates of fat oxidation at relatively high exercise intensities.

Questions Answered in This Episode

• What did 21 days of continuous glucose and ketone monitoring reveal during a ketogenic, 1,000-mile cycling journey?
• How did prolonged endurance exercise affect Dr. Lake’s daily insulin requirements?
• How is nutritional ketosis different from diabetic ketoacidosis, and what role does insufficient insulin play in DKA risk?
• What did Dr. Lake observe when his glucose and ketones began rising at the same time?
• How might fat adaptation influence fuel use and endurance performance?
• What are the practical limitations of continuous glucose and ketone monitoring for real-time insulin decisions?

This conversation offers a rare look at 21 consecutive days of glucose, ketone, insulin, nutrition, and exercise data, while also emphasizing that Dr. Lake’s experience is an individual case, not a substitute for personalized medical supervision.

More Links:

• Shifting Gears, Dr. Lake’s book, on Amazon
• Type1Keto, Dr. Lake’s site featuring the book and the Zero Five 100 project

Special thanks to the sponsors of this episode:

✅ Zocdoc: Find and instantly book a top-rated doctor here.
✅ fatty15: Get an additional 50% off a 90-day subscription starter kit with code METABOLICLINK.
✅ Toups and Co: Get 25% off your first order with code METABOLIC.

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

• Instagram
• Facebook
• YouTube
• LinkedIn

Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.