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Dom D’Agostino — The Power of the Ketogenic Diet

“If medicine wants to focus on prevention, there’s no better tool than nutrition.” – Dominic D’Agostino Dr. Dominic “Dom” D’Agostino (@DominicDAgosti2) is an assistant professor in the Department of Molecula

Published: 06.07.2016 | Description ist written by The Blog of Author Tim Ferriss

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Hello, ladies and germs, this is Tim Ferriss and welcome to another episode of the Tim Ferriss show where each episode I deconstruct a world-class performer to tease out the rituals routines habits purchasing decisions Etc that you can handle 8 test in your own life, whether they are from Athletics entertainment business military or otherwise, this episode is a round to with dom D'Agostino dumb.

That is dr.

Dominic D'Agostino is an assistant professor in the department of molecular pharmacology and Physiology at the University of South Florida.

Morsani College of Medicine.

And that is a mouthful and a senior research scientist at The Institute for human and machine cognition ihmc for 10 reps after a 7-Day fast and I consider him a friend.

I call him.

He's on speed dial for me with many of my metabolic and nutritional questions and many many of you after the last thing it was two to two-and-half our conversation with dom and if you haven't heard that you can go to Firework week.

com dom dom and it will take you to that URL after that episode.

He and I were deluged with enthusiastic follow-up questions about ketosis ketones cancer, etcetera.

The following is Dom answering your most popular questions with a particular focus on ketones ketosis ketogenic diet cetera.

And for that reason, you could consider it the ketosis masterclasses, especially combined both episodes with this one stands alone.

If you want to listen to their couple of things that are not mentioned at length necessarily run detail for instance the types of canned sardines in oysters that he eats King Oscar and Wild Planet Foods.

This is from the first episode in the show notes is where you can find the Sardine.

That's also why Whole Foods around the country sold out of Wild Planet Foods sardines is this episode and then the candle oysters would be Crown Prince.

Oysters vegan find all that in the show notes at four hour work week.

Campo dumb for the first episode and we cover a lot and what I would suggest is dumb did this on the road.

It takes a few minutes for me to get warmed up be patient listen to it.

And if you want to skip around I mean there a few things for instance around at believe 8 minutes 55 seconds.

So just call at 9 minutes after this intro ends.

Can you gain muscle on the ketogenic diet and related questions around 52 and 20 seconds after this intro.

How does he handle travel with a z-pack? And if you're really considering exploring ketosis or just consuming exoticness ketones like the keto Canada and ketoforce that I've discussed with dom and also with Patrick Arnold very famous biochemist for performance-enhancing compounds.

Shall we say then? This is also relevant because there is data to suggest that you can slow for instance to a growth by consuming the synthetic.

Sounds even if you're still consuming glucose or producing glucose, which is very very exciting for all sorts of reasons.

This is going to be dense going to be worth it and just be patient and I think that if you have an interest in these types of metabolic therapies, whether it is for performance enhancement and what's a endurance or for anti-cancer purposes or otherwise, you will find a gym with in this conversation, which is more of a monologue I suppose.

So, please enjoy this conversation with dom D'Agostino.

If you want to say hello to him, you can certainly do so on Twitter.

It's imagine that at Dominic Dominic D'Agostino d a g o s t i and then the number to I guess it was Dominic dagostino steak Dominic D'Agostino me to kiss his Twitter in the also be in the show notes and I you can buy Paul show notes at four hour work week.

Com podcast and what a fucking login enjoy first question is will be under the ketogenic diet category under that category is also some questions on fasting.

I think Alex David Wright's despite all the evidence seems that many dietitians and researchers.

I got to clinicians still frown heavily on ketosis.

Why is there so much resistance? So I think the main reason would be the lack of Education in the medical community and an even in the dietetics programs.

So having gone through a nutrition science program in my undergrad 20 years ago.

There was a little bit of discussion on low-carb diets, very little if any discussion about a ketogenic diet.

There was a discussion of a negative discussion one day.

I remember on the Atkins diet to a particular professor at the time at least two spies that tie it so that that's a problem like, you know, registered dietitians who are supposed to be at the the cusps the front of understanding serve nutrition and how to manipulate nutrition for Optimum Health or weight loss in most of the patients and video with a really trying to lose weight or manage type 2.

Baby beast and we know the ketogenic diet is like a big hammer, you know for type 2 diabetes has to follow up with say put it that you diabetic intermission within like 2 weeks or so, we could see that you know, that that's known.

I think the big stigma comes from the dietetic community is that it's just not feasible for people to fall and you know, she lower the carbs what type of macronutrient are you adding you're adding fat right in saturated fat has been demonized certainly was demonized back when I was in college, you know over 20 years ago and That's going to be hard to change.

I think our stance on that has softened up considerably but it's going to take some time to change the minds of the people who are the major influences which would be the medical community and static program.

Then you took except that the the low-carb ketogenic diet really has a place and right now it's really doesn't have a place.

It's getting more attention as good as it doesn't have a place in the medical community to so the lack of Education there and teach in the medical college and I'm on the I was on the medical freaking committee vote for medical school for number of years ago.

3 years said, the curriculum is already so compressed and it's tries to fit in as much as possible.

The information is where to buy a If you want to say that towards covering what's on the the boards at the medical students have to take the USMLE so day.

There's just no room to fit in nutrition into the medical curriculum.

So doctors are not going to have an appreciation of nutrition and they're certainly not going to have an appreciation for the ketogenic diet.

So the medical school that teach at tho does have a functional medicine to the group of kids that are very enthusiastic and really smart and they they really want this information and they have a a lunch sort of seminar series that they have people come in and talk and then going to talk my students or research Associates have given and talking this and the feedback has been really good.

I mean they they want the information but it's just not talk in the general curriculum and it needs to be so nutrition.

Is really the foundation of our health and and this medicine wants to focus on prevention.

There's no better tool than attrition rate exercise helps but probably not as good as nutrition.

So nutrition research to there's just a lack of good research on low-carb diet and ketogenic diets are some out there if you look but the rigorous should have control multi-university trials looking at the effects of a high carb diet versus training vs.

Low carbers ketogenic diet.

He's a really difficult studies to do and they're really expensive and you know, it comes to have the question of who's going to fund these studies what kind of institutional support do you have to run? These studies are the people at the end? Knowledgeable do they have a team dietitians that can control the parameters that are needed to ensure diet compliance.

For example, are they measuring blood ketones for all the participants in the ketogenic diet group so that rarely happens and that's the kind of you know oversight that needs to happen to be able to to do this kind of research and another research is really going to be important because that's what the medical community that's what they're going to look at.

They're going to want evidence standard care for drug-resistant refractory epilepsy Works remarkably well for that application, and I think it can work equally well for a number of other applications.

We're going to want the research to support that and I think that research you know is is in progress and I think the low-hanging fruit with Beach looking at type 2 diabetes and obesity.

And I think that's going to be one of the most important applications for a ketogenic or maybe not even connect low carb diet.

A low-carb diet is relatively easy to do but nutritional ketosis is considered really considered extreme and difficult to implement right? So that's why you the question why are researchers are dietitians frowning on this so it dietitian is going to have a difficult job getting their their patients to comply with this kind of diet and I can just tell you about it people come to me and Many of them that attempt a ketogenic diet just can't follow it.

It's really hard to follow and that's why I think something like the modified Atkins diet, you'll get four times the amount of compliance.

If you can get maybe ten percent of people that can follow ketogenic diet.

I would say if you screen them properly you could get at least 40% of the people to adhere to a modified ketogenic diet defined as to the following in a way that they had consistently have an elevation of what ketones day in and day out.

So it's much easier diet small talk a little bit more about that later.

I think we questions and there's also some resistance from the exercise Community to if people question is Woody Woody using the ketogenic diet for and stairs release on social media.

There's a lot of talk and discussion and debate.

About the ketogenic diet for endurance athletes long distance Runners, and I think it definitely has an application there bigger question.

I get a lot is it The ideal diet or can you gain muscle size and strength, you know doing resistance training during bodybuilding powerlifting with a ketogenic diet and I think you can know you can the question is who is it optimal? Probably not for everybody but I think it is for a ticket for a set population of people and I think you're as we age our carbohydrate tolerance decreases with age.

So the the over-40 crowd notes fit into that response remarkably well to a ketogenic diet I think in the context of resistance training or low carb diet, but we really need more research on that.

So hopefully we're we plan to do that.

So the next question I spent too long that questions.

I'll try to hit these more rapid fire.

The next question comes from grad grouse.

Could you please ask him about protein intake on it on ketosis? So it seems like there's thousands of different answers out there to this question.

Yes, everybody's got an answer to how much protein you should take on a ketogenic diet.

So in the case of me and the case, she contacts, you know treating kids with epilepsy.

It's been found that keeping your protein between 1 and 1.

5 grams per kilogram per day is really you need to kind of stay within that range too consistently stay nutritional ketosis as protein is Canby insulinogenic.

So you can excess protein can feed into gluconeogenic pathway and kick you out of ketosis or decrease your Ketone levels.

So I would say the higher protein though.

It's probably needed in people that are more active and also have you training and I think when you get the person who's an ectomorph and is super fast metabolism TV on top of that, you know, a friend of mine has an ectomorph and he has a very high output, you know, cuz it's you he works outside all day.

So she needs you to grams per kilogram per day and that with that's typically far above what most people would take for a ketogenic diet.

But his ketones Stave monthly high output is really high typical ketogenic diet with the classical ketogenic diet for to 1 ratio for parts to 1 part combination protein carbs has like 10% calories coming from Protein.

That's really low.

So a modified ketogenic diet is 25 5 to 30% calories in protein from protein percentage protein and that's the modified Atkins diet and it really evolved out of work done at Johns Hopkins Eric kossoff the leader in advancing the modified Atkins as a metabolic therapy for for kids and adults with seizures and that's really the diet that there a lot of athletes are using to my myself included non-athlete, but I think most of the people are not doing classical ketogenic diet just like 10% So yeah the protein intake very general recommendation 1 to 1.

5 grams per kilogram.

Matt Nelson ass the impact of the ketogenic diet on type 1 diabetes.

So it's an interesting situations that I have a type 1 diabetic student in my lap and do PhD student Marco student big guys 6 for 250.

Andrew koutnik is his name and enjoying the live with an intense interest in the subject and took it upon himself to try the ketogenic diet as a type 1 diabetic, right? So he tracks everything including his blood glucose continuously cuz he has one of the sort of Dexcom units that continuously measures his blood glucose levels and he's a remarkable subject for testing ketogenic food products, cuz we could just turn it insulin off.

So he has a glucose monitoring system and an insulin pump if we want to examine the glycemic index Glycemic response as you would say a different preaching use Andrew and turn off his his insulin pump and then look at his play seemic response to students.

It comes in very handy.

Andrew is a great Sport and he decided to try the ketogenic diet and she's written up some notes Here of things to sort of describing his response to choose a diet and Andrew kind of is very perceptive about many different things including his insulin sensitivity.

So he has really good handle on how changes in his body composition is exercise.

So when he does come through exercises training in the gym.

the frequency the consistency how that affects his his blood glucose the type of insulin that he uses and how that influences is caffeine uses fiber the composition of his meal the types of foods what he adds to his food since like cinnamon, so he's tracked like all these different variables and and how these variables influence his what glucose and the amount of insulin that he needs when he got around to the kitchen sink.

He realized it was Some really big Perks to Being type 1 diabetic and being on a ketogenic diet and the biggest would be the lack of blood can cause fluctuations.

So tremendous difference between in glucose fluctuations on high carb diet versus ketogenic diet daily fluctuations.

We're remarkably Tighter and he's been conversing with other type 2 diabetics who have switched from the diet that they have been prescribed and the ketogenic diet and Men's it's amazing the control of blood glucose that you have when you're on a ketogenic diet and not only is your blood glucose is remarkably control switch to a ketogenic diet, but he was able to reduce his insulin levels to about one-third of the amount of insulin that he was using for whenever you can reduce the amount of insulin for type 1 diabetic can do that.

That's a good thing.

So doctors need to acknowledge that he had a similar reduction in 24-hour insulin levels or no hidden tier.

He noted that there was a similar reduction in 24-hour insulin levels reported in individuals who were underweight who underwent a ketogenic diet but maintain, Body, wait till you list a number of different Publications to support service email observation that he saw when he switched from a high carb diet to a ketogenic diet for managing his type 1 diabetes is insulin sensitivity increased tremendously to in this has major implications potential protection against hypoglycemia.

Am I talk so he's talking about the work of George Cahill from Harvard in 1967 in the mid-sixties 1967 polish in observation of its subjects to when adapted to a state of starvation ketosis were remarkably resilient against insulin induced hypoglycemia.

So they suppress their blood glucose levels with IV and shoes insulin down to something between 1 to 2 millimolar and that would be universally if not fatal would put someone into a coma or seizure.

So and we know that having blood ketones elevated make you remarkably protected against hypoglycemia.

So that has real practical consequences from a safety standpoint.

If you're driving, you know, how many accidents are caused by a result from hypoglycemia and people who are diabetic now in our daily talks in the lab and these benefits essentially eliminate the potential downside of type 1 diabetes in the short-term and long-term, right so short term you're talking and acute hypoglycemia mitigating that is really important, but also the long-term so if you're High carbohydrate diet and you have huge postprandial Excursion in your blood glucose that's going to end you do that repeatedly that that's going to cost a lot of harm, you know in the long-term and that can be completely eliminated or significantly attenuated in type 1 diabetics using a low carb approach or a ketogenic diet protein subject and I don't want to face my comments or suggestions off.

you know that the people that communicate to me and seen firsthand what it did to Andrew who not only has much better control over is type 1 diabetes, but incredibly has incredible amount of muscle and strength and continues to surpass a lot of his lifts in the gym while following a ketogenic weight loss coach sagemoor list transitions from a ketogenic diet to low carb in kind of bounces back and forth then stay cooped up all the time now, but he has told me that he feels best while he's honest and certainly uses much less insulin.

So there's some resources out there to point people too cuz I do get about at least one or two questions a week on this out.

I went to go to the ketogenic diet for type 1 diabetes ebook and that's on ketogenic diet resource.

Calm and the authors of those Booker Ellen Davis and dr.

Keith Runyan Lenoir Dr.

Running has been on serial podcast talking about his use he is a type 1 diabetic is a medical doctor with type 1 diabetes.

Next question.

I want to dress is by oheneba.

Narquois.

Ask the question ketogenic breath analyzer for split.

So which one is faster the blood glucose Ketone meter by Abbott Labs the Precision Xtra and one that I use personally is the freestyle Neo things called is really the gold standard if you're getting into this and you want to if you're not on tight budgets, I would recommend measuring every day.

If you're really serious and to do it the same time of day everyday and I think that's really important and the breath acetone meter.

That would be the the ketonix meter is really useful and I just really need some more development and testing from my perspective.

So we know from at least you know, why maybe two studies breath acetone levels correlate with seizure control.

So I think if you have kids that are managing a disorder and they don't want to be their fingers in out at 4 not to be pricked.

I think these breath acetone meters are great for kids in and talk to you know parents and kids enjoy doing could you blow in and you have like these pretty colors you get the blue and with low ketones are green and then orange and yellow I think and read so they're very convenient for giving you a arrange.

Acetone that can correlate with seizure control.

So I think more work needs to be done with them.

They're non-invasive and I think there's I'm interested in and it's actually using these devices to look at other volatile organic compounds that may be important help biomarkers.

For example, you know gives you information on oxidative stress.

So you have things like isoprostanes things that could detect from what I'm interested in is like oxygen toxicity Elementary Austin Texas State blowing off certain bolts are organic compounds and I think our gut microbiome to influence the gut microbiome will influence the volatile organic compounds are coming out of my mouth and I think these things to be picked up and once we understand and we can develop devices to measure these thing.

And I think I don't know one has done it yet, but I don't know why it's not possible.

But saliva Ketone measurements.

I think that might be you know something to look into tell if anyone out there is listening.

So maybe a saliva Ketone measurement system could be useful.

The next question is Jeff Henderson and he writes I'd be really curious about how ketosis affects performance at altitude.

Should I live in Big Sky? Montana do a lot of backcountry ski touring climbing mountaineering.

I've noticed a significant performance increase while in ketosis.

I'm currently trying to get enough friends willing to do a ketogenic diet so I can put together an actual experiment with a decent-sized data set.

So I don't know what he measured it that I would love to hear down slots on this.

Okay.

So there's any increase in brain blood flow when you are instead of nutritional ketosis.

So that may reverse some of the the things that we know happen as a response to altitude.

There's some individuals can have hypocapnic cerebral vasoconstriction.

So that could maybe be reversed or mitigated in part with nutritional ketosis.

There's also things like at altitude you can have an increased intracranial pressure and died actually has a well described diuretic effect Tali milde, but it can be reduced in the intracranial pressure that people at really high altitudes can experience.

So we know too that the energy production that are our bodies in general probably can we generate energy more efficiently with ketones then it can with other types of fuels with glucose in particular and then we can probably drive more energy for oxygen molecule.

And I would probably direct you to some of the work that was done by Richard Beach Islam and they did work with a working perfused heart preparation still looked at the Delta G of ATP hydrolysis, and they look at different talk efficiency of the heart which increased significantly when the preparation was profuse with ketones relative to glucose.

So there's also a book written by Andrew Murray and shoe Montgomery and that book title of its how wasting is saving weight loss at altitude might result from an evolutionary adaptation.

So this book kind of describes how nutritional ketosis May mitigate.

Some of the weight loss is associated with being altitude.

Peter attia, also give a talk remember correctly at ihmc lecture.

He gave a discussion on the performance enhancement of fact that he had with ketogenic diet and also describe cycling at high altitude.

I think the balance of the data from scientific perspective and from feedback that I get would suggest that instead of ketosis can dance exercise performance at altitude.

Another person.

I've been communicating with recently is Patrick sweany heat.

He actually recently teamed up with professional mountain biker Rebecca rush and they did a climb and it descend on Mount Kilimanjaro mountain bikes.

So this is a mountain bike climb and that the mission was totally self-supported meaning that they didn't have any Porters to carry them or anything and they didn't they abstain from using acetazolamide, which is Diamox that the medication that you take for altitude.

And so they did they did.

Get altitude sickness.

So the goal of what they're trying to do Patrick sweany and Rush the goal of the expedition was to raise $1 for every foot of climbing they did so that amounted to a little over $19,000 for an organization called the world bicycle relief and Patrick had communicated with me prior to attempting this Mount Kilimanjaro bike ride, and any kind of Coach them a little bit and just talked about the ketogenic diet how you do it and sent a number of emails just Google Patrick sweany bike ride and should bring you probably to this events and give you more information on it.

And the next question is from Lindsey Watkins.

Is he a side like to hear about any differences or considerations females? To have with the ketogenic diet.

So whatever observed is that in this may even apply to our rodent models the transition into ketosis can be more difficult for females in general.

It seems that there are more variable in their responses reactive.

I would say too low blood glucose levels, especially initially.

And I would recommend that females trying this sort of.

Ease into it before just going all-out ketogenic and so is slow transition into a ketogenic diet may be dropping your carbohydrates.

If you're at 200 down to 150 just do it in 50 gram increments and titrating it down.

Another option would be the use of exhaustion ketones.

You know, when you go on a ketogenic diet your brain goes through what I called glucose withdrawal effects and you might be able to fill that Gap initially until your body starts making ketones up regulating the transport in utilization ketones.

You might be able to fill that Gap by taking exogenous ketones this ride.

The CH would be the kind of been the most ketogenic fat out there another issue that females run into is that when a lot of women start this Can you start a ketogenic diet in a calorie deficit so they go right into a calorie-restricted ketogenic diet.

So you have sort of the double whammy you have no glucose very little glucose getting to the brain and then calorie restriction on top of a radical shift in macronutrient, you know profiles are diet so that they're going to get a reactive response from that hypoglycemia and in some women can manifest itself in strange ways from fainting to irritability to foggy headedness.

So the idea would be my suggestion would be to keep your Your calories actually higher when you start ketogenic diet.

So you want at the calorie Surplus at least initially to help with the transition that's high in fat to do not it's hard for some people.

It's just me in the fitness industry when they start a ketogenic diet have to be not afraid of eating fat.

So, you know, a hundred grams of fat per day is really not a lot of fat some getting upwards of about 200 250 300 even on Sundays except for the average size female you want to get, you know, at least a hundred grams of fat of words to you know, depending on your size and your output maybe even up to 200 grams of fat.

That would be my suggestion is there to help with which females now the hormonal changes that have been reported? Buy some females following ketogenic diet suppression of thyroid to just looking through my emails here different females.

Yeah, that seems to be sort of the that one of the major concerns when I put a little deeper the people that are getting you know, a suppression of their hormones through exercising animals chew sometimes for 6 hours a day training front of that.

So the scenario that you have is your transitioning your body to a new diet high-carb to low carb on top of calorie restriction.

You do have an energy deficit that's caused by a restriction of calories do carriers and also overtraining and overtraining is the fastest way to cure really kick down your hormones for males manifest is low testosterone for females to manifest in many different ways.

Most the thing that I see Marisa's.

Canon T3 so the next question comes from Cami Orien and she asked in a female obtain a sub 10% body fat the ketogenic diet.

And if so, is there a daily calorie threshold relative to my basal metabolic rate or other factors to reach that level also, another common question women wanting to do the ketogenic diet to get as lean as possible course.

There's a lot of women in the fitness industry or Fitness competitor that are using this approach.

The first question is I don't know what she's doing if this is for cosmetic reasons or if she is Natalie and wanting to just perform optimally as possible and thinks she gets needs to get below 10% body fat.

So the first question I would have for her is why do you want to get below 10% body fat essential fact from my understanding in women is between 8 and 12% So roughly 10% fat is needed for normal physiological hormonal body functions in women, and I think it's important to keep above that entirely dependent on the person, you know, some women are just naturally very lean and and other women have a higher set point.

I would advise against trying to achieve 10% body fat for performance unless you're genetically exceptionally lean to begin with when highly-trained women at just 50% body fat, which is very lean forward.

Trains and diets to suck 10% body fat they tend to get these hormonal issues.

I would call it functional hypothalamic amenorrhea so you can have that a term.

I believe it's an article on this and this is extremely common in the fitness industry and and sometimes it's not easily Riley versa.

So if a ketogenic diet approach is use it will be a greater fat turn over and I would advise to like the last question against consuming less than 100 grams of fat that were sent to me by women that work doing ketogenic diet or like 60 grams of fat grams of fat is then 100 grams fat specially for a female athlete keeps your fat metabolism to optimize and it also, you know his sources of ketones.

So probably the most experienced individuals on this topic cheating sub 10% body fat would be female fitness competitors who routinely get below 10% and it's mentioned that they do report a lot of menstration irregularities and are aware how to do.

So, this is some of the women that come to mind would be shannan Penna or Shannon yorton Penna from Quest Nutrition who is really a very experienced Fitness competitor and just an overall great person around and she has Been state of ketosis I think for at least 2 years now and crust nutrition is sort of developing testing.

Ultimately the marketing ketogenic diet food products.

They already have the quest MCT oil powder, which is fantastic Renee boat show.

How does ketosis affect the microbiota specifically the balance of for Mickey D's to bacterial that's a great question and it's highly dependent.

Upon that diet that you're following right? It's really we're just at the cusp of understanding the gut microbiome and they're so relating this question to the ketogenic diet and to give an answer on it.

It's kind of difficult because there's many variations of the ketogenic diet.

Atkins would be much more liberal in the amount of vegetables that you consume when I've garnered just from reading what I can as far as Studies have been done that in in talking with the scientist who are this area of research is that you can train your gut microbiome to sort of be ketogenic.

There's bacterial species in your gut and I don't know I have a list of them that actually Thrive off fat and these bacterial species tend to be the beneficial Very good for us.

So that changes dramatically, you know as when we change our diet our gut microbiome also changes its diet and we'll adjust the ratios of various species in the guy and a shift towards more bacterial species that thrive off fat my general recommendations to optimize the microbiome and my knowledge is nowhere near that of your researchers out there like Alessio Fasano pediatric Harvard Medical School ihmc lecture so I can see is the institute for human and machine cognition lecture on this topic.

So I would recommend that listeners go to that lecture and and look up Alycia Fasano.

He does not stay the ketogenic diet.

But he is the leading expert and most knowledgeable person out there on the gut microbiome.

So for those following a ketogenic diet things that I think could optimize the microbiome would be the obvious things.

We always talk about or hear about would be probiotics.

So green vegetables preferably in raw form salads things like asparagus turn the artichoke cinnamon is kind of Prebiotic and probiotics.

So like the bacillus if it is, there's a number of other bacteria out there that could be supplemented don't have it.

I don't feel like you drink diet would compromise the gut microbiome in anyway, even those individuals that limit their there fiber, so I haven't heard that It's been a problem for them.

But to prevent it from being a potential problem the use of these prebiotics and probiotics fermented foods things.

Like sour cream are part of my diet is important to pick up sour cream that has a good complement of live cultures in it.

Another thing that people emailed me about and I think Rhonda Patrick actually mention this to me and passing and people emailed me about the benefits of a supplement.

It's called vsl3 vsl number 3 supplement and I think Sat, I haven't taken it myself, but just from the number of emails.

I got from people who have taken the supplement and they've taken it with a ketogenic diet.

Not that they had problems before the ketogenic diet, but they felt that it was a good compliment to the ketogenic diet supplement is a probiotic supplement its use for people with crohn's disease colitis IBS, if you've used an antibiotic, which I just did actually just finish a course of antibiotics.

I got a strange bug bite in Southeast.

Asia got infected in the like MRSA.

So I took a full course of antibiotics and use a probiotic supplement that was similar to vsl number 3 and had absolutely no issue with any kind of got problems.

And typically the last time I use an antibiotic was over twenty years ago, and it completely destroyed me.

And this time I took a probiotic supplement and had absolutely no problems.

And I don't know if I would have had problems if I didn't take the supplement but and so a probiotic supplement may also be good.

Guess the lesson others and when you travel to and you move someone to a different location and there any additional time weeks you you're changing their gut microbiome and I think that really needs to be studied and I think in general we need to understand and we need to understand if the ketogenic diet disrupts the microbiome and we under have to understand things like travel can just dropped the microbiome.

I imagine there's many things that are destructors of the gut microbiome and As we start to do research.

I think these things will be more clear and things I can.

Optimize the microbiome and I think probably more importantly even for a serviceman and I know the Department of Defense is interested in this NASA's.

It shouldn't is obviously a space environments probably not putting guys and you know, moving them continuously across the globe is probably not the best way to optimize to the gut microbiome questions.

I think artificial sweeteners if we're drinking chlorinated water antibiotics in her food so many things to consider when we consider the gut microbiome, so relating back I went off on a tangent, but when it comes to the ketogenic diet and the gut microbiome, we still have a lot to learn.

Recommendations would be to have a diverse diet as much as possible and from my understanding the bacteria.

There's going to be a bacterial shift from carbohydrate driving back to Two bacterial species that thrive off fat so in my from my understanding that's not a negative thing.

So the next question comes from Mary to caller ID, and she is currently currently on the ketogenic diet.

However, she's confused.

Should I count my calories? I'm definitely restricting my cards and increasing my fat intake but keeping track of calories along with meal planning seems overwhelming if I don't worry about calories.

I will I gain weight on the ketogenic diet.

So yes, of course you also there's that simple thermodynamics.

If you if you're putting in more calories into your body, then you're burning off.

Those Surplus calories are going to end up as stored body fat or manifests itself in metabolic derangement four times a number of times when people transition to a ketogenic diet, they will, you know, just kind of go crazy with some of the ketogenic diet foods that are sort of indulgent and that would be things like butter or sour cream or you know, I can sit down with a bag of macadamia nuts or cashews and Paula.

That's a thousand plus calories in this is really important to understand the energy density of the ketogenic diet is about twice that of a normal diet.

So the amount that you're eating is smaller and it may seem like you're restricting so that the volume of food that's on your plate will be much less than when you were nanak Advance if you're keeping an isochoric.

But chances are that overtime that you'll you'll inadvertently self restrict on the kitchen sink.

So your blood glucose will be there's far less fluctuation means he won't have these big postprandial excursions in your glucose that kick off a surge of insulin that make you hypoglycemic, you know a few hours later and make you kind of craving another again.

So that whole cycle is eliminated in that was one of the most practical advantages that I've been able to realize from the ketogenic diet is the control hunger and I think that has a huge carryover effect when it comes to being able to have control of your food intake and not having your food intake sort of control you so tracking is very tedious process, but after you do it after a certain point Really don't have to say I can look at a piece of meat or oil or some green vegetables on my plate and just calculate the macros in my head really and sometimes I'll just wait on doing double check sometimes to make sure I'm right but it's not a nowadays.

It's a process before dinner, which is my main meal of the day.

I'll have a bowl of soup and a kind of soup that I have is usually broccoli cream soup or cream of mushroom soup instead of using coal dairy cream.

I use concentrated coconut milk in place of the dairy cream.

So it's not super dancing calories after eating that the amount of food that I want to consume this way cutting half its really so the next question comes from Comic Bushman his name and he asked how do you feel about the usual crappy food served at scientific conferences and parentheses the smartest people seem to have the worst lifestyle and she asked what are my nutritional tricks to survive attending these scientific conferences which about to jump on plane now and go to a scientific conference in Europe.

I know that the foods are going to be very tempting over there.

Budapest actually a very good food over there follow me around when I'm traveling and looking what I'm getting off the menu.

They probably wouldn't think I'm falling any kind of weird dietary pattern.

You can almost always get a salad and you can almost always ask for extra butter extra olive oil to put on the chicken beef or fish that it put on salad the generally limit Dairy protein when I'm home, but we'll indulge a little bit when I'm traveling for Jesus to my my recommendations for what I do as a probably mentioned before is my bags are packed now and I have a case of sardines in a case of oyster.

And they're packed an extra virgin olive oil.

And I also go to a store near me and I buy bulk.

Macadamia nuts.

Macadamia nuts are agree with me more than almonds and and other types of nuts is a tight end actually do have an appreciation for nutrition and they had fantastic array of food there for the conference is not so much but I think you know, it's it's always people people say I can't follow the ketogenic diet because you know, I'm a business person traveling all the time is just not possible for me to follow this diet.

So what should I do? I think it's actually easier.

It is far easier to follow if you are that kind of person who is on the move all the time so that food that you're consuming is much more energy dense.

It's less weights less things that you have to carry.

In your bag sardines and oysters and macadamia nuts take up a very small amount of weight relatively speaking and they have a really high energy density so I can and I tend not to like to take a check bag when I travel to Scientific conferences.

I can bring just my carry-on and gets in a calculated this get about 10,000 calories in a bowl of food on my carry-on really easily all my clothes for a week.

So I couldn't do that if I was so the next question comes from Willie shirt men do stimulants 8 in ketosis and are there any particular stimulants that are good? Yeah, I think caffeine has a ton of research behind it.

The military is a big fan of caffeine in the military has a really high bar in regards to your car to their safety and efficacy and their incorporated into different food products.

Like the first rash is First Strike ration something they make up there in Natick feeding Center there in space way to Sugar can I eat? I think they need to change that has long been a staple in my diet in the form of coffee right now sippin on my coffee with MCT and caffeine is just starting to kick in and and I feel it and I feel good on caffeine and I don't feel any negative effects from it over 200 mg of caffeine in me raises my blood sugar 100 mg seems to be the sweet spot.

200mg of caffeine will cause a hangover activation of the sympathetic nervous system may be producing anxiety and it tends to caffeine mobilizes free fatty acids from adipose.

But it also kind of breaks down glycogen from the liver if my glucose is sitting at 7070 and I take 200 milligrams of caffeine.

I'll see you pump up the 75 maybe even 80 with seems to be a good sweet spot for me.

There's caffeine is an appetite suppression has antioxidant effects in the form of coffee.

And have a couple papers on my desk started reading about the the effects of coffee on liver function to Improvement liver function to another stimulus that I like to talk about and I used a lot when I was younger is ephedrine ephedrine hydrochloride.

I don't know if it's still available.

It's it's we use it in the did experiments on pseudoephedrine and CNS oxygen toxicity, you know.

Lots of Sudafed before they go diving because they want to be clear so they can equalize right if you're not can't equalize it.

If you reserve a whole day to go diving and your stuffed up and you can't equalize then you're out of luck.

You know, you can't you can't.

It's too painful and can be really dangerous to ephedrine is actually pretty big.

We did a study showing that ephedrine can actually decrease latency the seizure at a particular level of hyperbaric oxygen that would you know, simulate a Navy SEAL diet to say 132 feet sea water on the brain with with ephedrine a high dose.

So that's the thing is it's all relating to the dose.

I think ephedrine is a great stimulant that could eat in ketosis and it can help the release a fat from adipose and enhance beta oxidation of fat in the liver.

Personally.

I've seen that ephedrine can kick me into ketosis pretty fast since I drink caffeine stack it can kick on afib and some people so sure she has to do is get high in 15 or more per day but 25 mg dose of ephedrine or less per day can elevate your mood.

Can can cause pretty significant noticeable appetite suppression and it's more of a psychological effect when it comes to getting a physiological response 50 mg 200 mg a day of ephedrine to get a really measurable increase in fat oxidation rates and that would give me side effects.

So and again I don't I don't even I'm not sure if that's still legal.

So don't don't take this as a recommendation.

Can I improve your adherence to a nutritional protocol just simply by suppressing your appetite and giving you more energy which you're going to want to go work out exercise longer and I would strongly advise against the use of amphetamines.

I don't see their addictive and generally people who take these.

It's just have a bad outcome.

They get addicted to it.

It's not physiologically psychologically mode a finial is something I've kind of been interested in testing and if but I've never taken it, but I've talked to people who have taken it.

I did get an email just yesterday actually from a woman who's been on modafinil for over 15 years continuously and she was able to get off of it when she had the narcolepsy I think but she was able to get off of it when she got into a stick nutritional ketosis and a really nice email wrong email.

It's just saying that like this basically the ketogenic diet kind of saved her from this continuous abuse.

She thought you know, her use of modafinil was through more less I can infused of it for many years.

So it's approved for military use and for Mission.

So in a state where sleep deprivation is unavoidable and you need to maintain cognitive resilience, the use of modafinil can be a good idea.

Tim actually asked me to to address this question can a vegetarian or a vegan follow a ketogenic? You can look up best z-pack.

Keenya is the lead dietitian for the Charlie foundation and it may not be posted on the website.

But I know she works directly with patients and customizes a vegetarian and vegan ketogenic diet many other patients and uses to achieve ketosis shoes at higher amounts of MCT oil if there's a couple websites to that I noticed you did a quick search online keto motive k e t o m o t i v e Keto diet app or two websites that I find were really helpful in regards to listen to foods and The Sting the type of different recipes that a vegetarian or vegan ketogenic diet could be adjusted to how do we help people that are vegan fall cute and I think the solution the main problem will be the protein.

It's just hard to put together foods that have a compliment of essential amino acids.

So you could just supplement with essential amino acids.

And that's one option in the other option would be plant-based protein isolates that are hemp.

Yes rice protein isolate you have pea protein isolate or 10 years ago that is plant protein, but it had a lot of carbs in it and nowadays you can get 30 grams of protein with like one or two or maybe three grams of carbs and that completely fits in with a vegan ketogenic diet to one of the products that kind of stood out and it just looking at the reviews and and with the taste in the macronutrient profile would be a product called mrm.

Veggie Elite protein powder and the chocolate milk is very good.

So if you take this mrm veggie Elite protein powder and mix it with coconut cream or what would be concentrated coconut milk throw in 1/2 avocado or Ensign MCT oil C8 oil and do it.

So the the will make sure that I made up was 80% of the calories were from fat and 25% of the calories were from protein.

So just take treated like one scoop of protein powder.

I think and in 15% of the calories were from carbohydrates and it was really pretty much fiber Co to one if we go, so too would be fat and one would be a combination carbs and protein.

So if we're related back to the classical Johns Hopkins ketogenic ratio ratio is that they used and it's 900 calories and and that was a really good example of a pure vegan and I posted that on my Facebook yesterday.

So yeah ketogenic diet is possible pretty easy for two vegetarian a little more difficult for a vegan.

I'm going to work on this and maybe even work with a colleague of mine to write a book that cover the subject and if someone hasn't have written some blogs on online, but not a whole lot of resources out there for vegans at want to do a kitchen.

So many people ask question.

Should I be concerned if the ketogenic diet increases my LDL or LDL P Hart Lumber little bit concerned and still learning about it.

But if your LDL or ldl-p skyrockets and stays elevated after several months, you might want to be concerned about it too or just kind of be more, you know, pay more attention to tracking certain aspects of your your your health, but you can leave your information in your your blood lipid levels.

So the number of LDL particles may be increased because you're also carrying more triglycerides before you get a lipid profile test done.

And you start looking at these numbers make sure that you're rested make sure you're not stressed.

Make sure you don't have any kind of infection which will increase it.

So what I think seeing the kids aren't diet is that the LDL will go up and down 50% of the people who follow a ketogenic diet.

And especially if the calories are not restricted if you're restricting calories on a ketogenic diet, which many people do that use a diet to manage for the management of epilepsy or cancer even in that population with the ketogenic diet is restricted about 25% of them will email back and say well my doctors falling in this is going up but a lot less if See this phenomenon.

I think it's important not to stress out about it and took a look at the big picture.

So the first book I had was the book from Johns Hopkins that was written by John Freeman in their clothes off and that described, you know, you did classical and of a dairy-based 4 to 1 ratio classical ketogenic diet and that kind of shifted my numbers and interesting ways might my LDL went up assorted my HDL double the most from Mike 52 must a hundred after about four to six months.

I think it's the right now.

My HDL is 98 right now.

I've transitioned into what I call a supplemented modified Atkins are modified ketogenic diet and supplemented because they do take in C8 and I do take in some migs options ketones.

Some of the products that are on the market talk about that little bit more.

So I'm using a supplemented modified ketogenic diet similar to the macronutrient ratios that described you know on the on the website buddy Foundation website has a description description of my ratio is looking pretty good.

My total cholesterol to HDL ratio is like 2.

4 right now for my last blood test.

San Mateo cholesterol is 238 and my HDL is 98 triglycerides range from 4270.

East numbers are really similar to other people that have emailed me that were concerned and my information microwave inflammation.

CRP was really low.

I'm going to do a whole cytokine.

I say when I was on a high carb My CRP was 22.

4 a couple times now.

It's like point to so literally in the last 3 blood work that I look looking at.

Now it range from Fleet 12.

3.

So when I was on a high carb diets, literally Ten Times Higher rarely have gotten sick when I'm on the ketogenic diet and I do think that it helps with immune function.

That's another area I could talk about, you know, we talked about the ketogenic diet being kind of a Panacea for everything else pictures the common cold.

I have not had a cold probably maybe one called in the last 6 years and I used to routinely get a cold every Year at least once or twice a year.

So in the last 5 years, I have one cold that I could remember but infection I did get I traveled overseas.

I believe it was $200 and I picked up some kind of stomach bug or probably a virus I think and and this really skyrocketed my LDL.

So I thought a little bit about stress and infection through increasing that and that was really surprising off the charts.

So it may have been something wrong with the test.

But but I think something to consider that when you do get these tests done you want to make sure your body is truly at Baseline when you're looking at the effects of the ketogenic diet.

So in general I would not be concerned with an elevated LDL unless it was in other biomarkers were also out of wax.

So the things to look at would be your triglycerides your CRP and if your HDL goes down, that's not a good thing.

I think thing that I kind of focus on most is triglycerides if your triglycerides are elevated, that means your body is just so you can't deny that it's not a one-size-fits-all diet Define about Quarter to the 30 people just you know, how these abnormalities in the blood work that would indicate they're not adapting to the diet.

Maybe they could give it more time.

But you know, it's giving it three to four months and still have elevated triglycerides pretty rare and you know, most of the people that I talked to kind of thrive on a ketogenic diet, but you do have many people who just you should not follow it the next kind of branch of questions and then address would be exhaustion is ketones.

This is a question that popped up recently and it comes from Carson Row dozens of people have asked me this question.

So I want a dresser front to is it dangerous to use Ketone salts which are received so there's The Ketone salts it on the market now from my understanding have a d and an L configuration.

Dr.

Richard veech on is an expert on podcast some dr.

Veatch said that he would avoid Ketone salts at all costs something about Rio versus mimicked molecules Exedra is Dom and others like Patrick Kane have said these are good and fine what gets what's going on? So the doctor beaches I admire part in the sexy doctor each was kind of mentor to me getting into this area.

I think it was back in 2008.

I didn't even know that 2009.

I didn't know that exhaust is ketones existed until I found some of his patents and patented even predated his were from doctor on recruiting Grabber AT Case Western think the first was like a Canadian patent in the early 90s on Ketone Ester to dr.

Veach has been a mentor to me in this process and make you helping me understand through the benefits of exogenous ketones.

So his comments on the Ospreys podcast and more recently Ben Greenfield podcast have created a lot of confusion because his comments were not scientific fact, they're his opinion and that's really important to keep in mind.

Also.

Keep in mind that doctor each has a lot of intellectual property sort of tied up in the r enantiomer of the Ketone Ester.

So more specifically the R-13 butanediol are beta hydroxybutyrate mono Esther the means like the single Esther that he's focused on so the the appearance of these Ketone salts in the salt the beta hydroxybutyrate is not you know, completely tied up at 2 with sodium.

So it's actually balanced acrossed four different monovalent and divalent cations, right? You have a sodium potassium calcium and magnesium that many of these products are using like the kegenix products may think I'm not exactly sure what the blend is but the doctor Beach is.

Kannah Creek call about the sodium content in about the the body called the non-natural isomer that was found in there.

It could under doctor beaches working very hard to commercialize been working hard for a decade or more to commercialize the mono ester of the are beta hydroxybutyrate.

So who is Peaches colleague? They've actually published Gather demonstrated the metabolism of racemic ketones and a number of Allegan studies.

He actually used these are Tracer Bay studies were labeled carbons ketones and could see where they go and it was clear from the science that the S enantiomer just simply goes gets broken down to a Scenic Highway and can't even enter convert back to buy further elevating levels of acetylcholine a that can actually kind of feedback into the biosynthesis of the are beta hydroxybutyrate.

The one that I'm thinking about looked at the r and the S 1 3-butanediol metabolism in the liver of rats.

There's no data to The poor doctor reaches claim that the Ketone salts that are on the market are dangerous or ineffective and that would include keto Sports keto Cana prove its products kill OS you have the key Genex product is also using the racemic salts for Evergreen has product key tonics for keto so many emails doesn't hundreds of emails.

I've gotten from you from this of people that were concerned and it's it's kind of easy the Doctor Who teaches a very esteemed kind of researcher and I think he firmly believes that the r enantiomer is sort of the way to go when it comes to exhaustion is ketones and I do too I think our lab actually the first Ketone Ester that we tested for CNS oxygen toxicity was the 1 3-butanediol Butyrate mono Esther in the are enantiomers and it didn't prevent oxygen toxicity seizures the elevated pretty much exclusively beta hydroxybutyrate and I was going to give up on the project and then, you know, I discovered an earlier patent by Andre grenon driver that had a 1 3-butanediol combined with acetoacetate and that to me made perfect sense, right? Because when you consume it the hydrolyzes in your gut so your released acetoacetate and that's one of the ketones at the body uses and the one tree butanediol goes to the liver and gets broken down completely 2 Beta hydroxybutyrate and the pharmacokinetics are beautiful.

You get a kind of a one-to-one ratio of eight hydroxybutyrate n-acetyl a state in the liver and it was in that particular Ketone Ester gave remarkable neuroprotection against seeing as Austin, Texas.

That was like the second Ketone Ester that we tested Patrick Arnold help me a synthesizer.

Once we got the the synthesis formula and under greeting Grabber was very kind to just give it to me in and tell us how to do it and that was racemic.

So that was racemic 1 3-butanediol which breaks down to the the two enantiomers of beta hydroxybutyrate.

So he's remarkably effective in our hands.

So they knew that there was more to the story than this.

I've also served with dr.

Veatch on various.

Workshops in can say that he's very he's very opinionated when it comes to the ketogenic diet and thinks diet.

It's horrible diet and high fat is very dangerous.

And and we know that's not the case, you know, and then there's not a whole lot of science to back up his claim that think there's one paper in kids and Johns Hopkins at follow the 421 surf classical ketogenic diet and I think many of the the kids were put on a product called keto, which is like hydrogenated vegetable oils and things like that and they had an elevated triglycerides not very surprising.

Right? So I think when we talked about the ketogenic diet, it's it's really important to acknowledge and most people don't acknowledge this in the medical community that the diet there's many many versions of the diet and we Still we have very little research.

You still need to determine the optimal ketogenic diet in regards to the fatty acid profile.

So we know we need it a much greater omega-3 to omega-6 ratio is going to be really important that the level of monounsaturated fats or saturated.

I'll say that no scientist is it when it relates to the Ketone salts? No scientist for toxicologists that I'm aware of which find beaches comments to to be true that the racemic salts are dangerous in any way unless of course you're consumed at really high amounts as we know water is toxic in high amounts.

All things are dangerous caffeine.

Of course, I talked about Tylenol quickly kill you if you take too much of its many studies actually show through clinical studies that actually show these Racine Salts are very safe in high doses even in kids given pure sodium beta hydroxybutyrate over periods of years and that actually leads me to question that was asked by Emily bent and she asked what's down to device for fatty acid oxidation disorders like mad or VLC add and medium chain or very long chain acetylcholine dehydrogenase deficiency.

So mad is short for multiple esoko a dehydrogenase deficiency and since being added to newborn screenings diagnosis have increased massively.

So there's a lot of kids are kids being diagnosed to the complications of this particular disorder can involve and acidosis.

Hypoglycemia other symptoms such as general weakness enlargement of the liver enlargement of the heart is really a problem.

So essentially what this disorder multiple a Soco a dehydrogenase deficiency is is mitochondrial inefficiency and it's interesting if you just go to her mad and type in Mad Mad D and ketones you get to this is one just one of the disorders that can be effectively treated with racemic beta-hydroxybutyrate salts.

And there's a number of studies highly efficient Ketone body treatment in multiple a soakaway dehydrogenase deficiency related leukodystrophy.

So that was published.

So that was using the Ketone salts Century that are on the market at least the sodium racemic sodium beta hydroxybutyrate salts in these kids some nice description summary of that another study buy a different investigator favorable outcome after physiological dose of sodium dl3 hydroxybutyrate in severe man.

So the sodium racemic beta hydroxybutyrate was given in this can be given in an oral dose work can be given IV in very high doses and no no side effects from this that those that you need to to get a measurable boost and blood ketones is not giving you a dangerous dose of sodium so that needs to be acknowledged and I think that was touched upon and Doctor beaches tours talk is that there's No way.

I think for them folks said there's no way that these Ketone salts could even increase ketones even point one or point to millimolar, but that's not the case.

We know that we can get levels in to the 1/2 to millimolar range if you taken off I think as the technology Circle Vols and we're creating various types of beta hydroxybutyrate salts from monovalent in divalent cations.

In addition to alkaline amino acids.

What can my nicely with beta hydroxybutyrate and it's another Avenue so you can kind of Envision a blend of beta hydroxybutyrate and spread across, you know, monovalent divalent cations in alkaline amino acids, like lysine Arginine citrulline either all these are all combined pretty nicely with a V8 hydroxybutyrate.

So another study actually comes from the Lancet shows dl3 hydroxybutyrate.

So racemic beta hydroxybutyrate treatment as a sodium salt and treatment of multiple a soakaway dehydrogenase deficiency.

So it's a really nice and study describing the use of this exogenous Ketone in several patients that have this disorder and it was really a highly effective in treating that so so in short Ketone salts the racemic beta-hydroxybutyrate salts are not dangerous and they're definitely not an effective or research needs to be done on all forms of exogenous Ketone salts and also, exogenous Ketone esters So a lot of work has already been done you no one could be more confident in you know, the medical applications of this and even potential performance applications because when they're consumed the liver function and kidney function is normal has been even with really high doses.

So the next question is Jeff Dean is she truly behind involved in kegenix.

The website is kind of sketchy and the product itself has a surprising number of carbs not sugars carbs, but obviously but still so he's asking am I behind she Genex or involving kegenix the kegenix for my product on the market is uses that the Exotics kitchen product is a great product to use it myself a used it yesterday.

Sometimes I rotate, you know different things.

I'm testing it uses a ketone formula a beta hydroxybutyrate medium chain triglyceride land that we sort of developed and tested initially in the basement.

We found that if you just take Ketone salts, and at the time these are exert of the liquid sodium potassium salts found in keto force that we weren't really