All About Keto with Dr. Dom D’Agostino – PH120

All About Keto with Dr. Dom D’Agostino – PH120


so for me it was kind of liberating that once you’re in ketosis you’re not that hungry and then in the context of elevated ketones or sort of anti catabolic and I talked about that a little bit and it was it was it liberated me from food but when I I like to enjoy food I think food should be I don’t think we should deprive ourselves of food so depriving myself of carbohydrates that’s not something that I miss so and if people really miss that and enjoy that I don’t think they should eliminate it from their menu or their meals like I think we need to enjoy food that that’s part of the process but I enjoy food much more if I’m a little bit hungry I appreciate the food I enjoy it ketogenic food is like indulgent to me because for years that’s stuff I avoided so I’m still I’m more happy with my food now than I ever was I think and I don’t I don’t have like irrational food behavior this is episode number 120 of pursuing health featuring dr. daf-2 Agostino welcome to pursuing health I’m Julie Foucher family medicine resident and former CrossFit Games athlete here I bring to you information and inspiration from experts and everyday individuals for how to use lifestyle to maximize health thank you so much for joining me now let’s get started with this week’s episode hello there everybody and welcome back to pursuing health I’m sure that if you’re living in the world today you probably have heard about the keto diet if you haven’t tried it yourself but this is a topic I’ve touched on briefly in other episodes and in this episode I finally had the opportunity to sit down with one of the leading researchers on nutritional ketosis dr. Dom D’Agostino and we got into all of the nitty-gritty details a little bit of background about Dom before we get started he is a PhD assistant professor in the department of molecular pharmacology and physiology at the University of South Florida’s Missoni College of Medicine he’s also a senior research scientist at the Institute for human and machine cognition and the findings from his research uh nutritional ketosis have been utilized by Navy SEALs as well as NASA and he recently has been at the forefront of research on nutritional ketosis as a treatment for cancer alongside people like Professor Thomas Seyfried who I interviewed earlier on episode 97 of the podcast I had the opportunity to sit down with Tom at the recent 2019 crossfit health conference in madison wisconsin where he was presenting on some of the emerging applications of nutritional ketosis so we talked all about the basics of the ketogenic diet how it can fit into the everyday person’s lifestyle and some of the exciting new research that he’s working on right now before we get started this is a reminder that although I am now officially a doctor this podcast is meant to share the experiences of individuals and does not provide medical advice so with that we’ll get started with episode number one 20 of pursuing health featuring dr. Dominic D’Agostino welcome to pursuing health I’m very excited to be here with dr. Dom to Agostino thank you for joining me and thank you for your fantastic talk today in the CrossFit Health Conference very glad to be here thanks for having me yeah so I thought maybe we could just start off with what brought you to the CrossFit Health Conference and what were your initial thoughts I think this was your first use at first kind of big experience in the prospect community mm-hm yeah I was really inspired by the level of engagement and interest in this topic because I didn’t know I mean my understanding is that most of the CrossFit athletes kind of use a higher carb approach so I didn’t know I didn’t know what I was getting into so that’s why I asked that initial question in the beginning like how many people were high carb low carb and I connected with Greg Glassman years ago a few years ago and we had brunch together I think and I was amazed at his knowledge and comprehension of the literature including cancer and actually some of the stuff that we published and so I had a very enlightening engaging conversation with him and I know he knows my colleague Thomas Seyfried from Boston College and he had been a speaker in the past so I’m inspired that he is really pushing sort of this knowledge and in kind of this this health movement within CrossFit and I think he’s I’m inspired to see him giving back to the community like that like creating this educational sort of outreach to the community and really you know expanding their knowledge so they could be better practitioners and engage with their clients and and new people coming into CrossFit too I think will be inspired by that it is it’s an exciting time for sure and I think like we were talking about earlier we love to see it continue to grow yeah year after year yeah so so I want to talk a little bit about your background and what sort of your initial interests were and then what influenced you to become a research scientist okay yeah I was not a very good student in high school I was I grew up working on farm like hunting fishing riding dirt bikes ATVs that sort of thing that’s where is that in New Jersey central New Jersey not too far outside of like Princeton New Jersey it was called Allentown about a creme riche would be the name of the town it’s kind of not no town is just like a farming community gonna and and then I I became interested in improving my own health and performance mostly for football during my senior year okay and that I was poor like a C student and then I got motivated to improve myself performance and strength and I was motivated enough to take like an honors level bio course and I went from like C student to like an A student and like honors during my senior year and it was completely motivated really just a self selfish motivation to you know I knew you could dissect a cat and honors bio too and I think I took it for that and I just became totally I was reading Muscle & Fitness at the time and then I would actually dig up the references that you know a particular thing would be and it just it’s snowballed I was working out Arnold sourcing ur was my idol and it was like I would watch pumping iron and commando and all these things so I think I became you know very engaged in in powerlifting and and football at the time got me into lifting weights I think and my brother did so and that got me more interested in using nutrition as a lever as a tool to improve my performance and size and strength then I saw that of all the variables that were interesting to me there was all these different training programs but I looked at nutrition as being the main thing that could really guide my strength and gain so I majored in nutrition at Rutgers University and then was thinking forward like what I wanted to do and I realize nutrition the degrees in nutrition I really couldn’t do too much so I decided to double major in biology too because that would look better applying to med school yeah and I realized to get into med school you know it was very competitive and I needed research to do that so I did research in a respiratory neurobiology lab and I studied the neural control of autonomic regulation so how the brain controls respiration and heart rate and that was very interesting to me and I decided to not go the med school route but my PhD advisor talked me into doing a PhD in neuroscience at the time and the 90s was a decade at the brain so and it kind of fit my personality more of an introvert kind of thing and and she really talked up you know the program and everything and we had a pretty good chair for our program so I started into neurobiology and I studied what the brain what happens to the brain under low levels of oxygen and how it adapts and I was looking at you know lactate and glucose metabolism but mostly manipulating oxygen and at the time I started diving and doing more advanced diving certifications so that led me into looking at diving physiology and what the Navy was doing and that led me to a postdoctoral fellowship to basically understand oxygen toxicity seizures which limit Navy SEAL diving operations so I delved into a research project which was developing hyperbaric atomic force microscopy kind of an ambitious project and the Department of Defense was crazy enough to basically fund an equipment grant and a postdoctoral fellowship on basically using hyperbaric atomic force microscopy which didn’t even exist so we would have to build the tool to actually do the research that they’re funding me so is basically studying cells and figuring out what was happening at the level of the mitochondria from a fundamental level and what caused oxygen toxicity seizures can we prevent it can we mitigate this from being a problem to create a super-soldier scenario underwater to make them sort of as a countermeasure against this extreme environment so I spent about 10 years doing that and then that led me to ketones I looked at different drugs and then a metabolic intervention supplying ketones really was very promising so it turned me like that yeah it’s so interesting talking about your path because I think when I look when people ask me how did I go into medicine ap biology in high school was like the one class that really I think really turned me on to be fascinated by how the body works and biochemistry and and then the other thing that you mentioned oh and then doing research in college for med school like I did that too like all good pre-meds do but for me it was very much the opposite actually I said no I don’t really want to keep doing research forever I want to be doing medicine so it’s interesting how we all kind of find our paths it’s tedious is not for everybody and I think so my mentor when I was an undergrad even a junior at the time she sent me to San Francisco to experimental biology and I thought that was so cool like I had my poster and I presented I was like wow this is what scientists do and then they mingle and I was like I could and she seemed well off I mean not you don’t make much as a research scientist you live grant to grant so that was kind of scary but I was never really into like money or anything like it I just felt you know I would be happy doing this if I could have the intellectual independence to pursue my own ideas and develop that into a research grant and discover things it was very exciting to me very cool so you eventually found your way to study in ketosis and nutritional ketosis can you tell us a little bit about how you kind of stumbled upon that and then how that has blossomed as you’re one of your big areas of research yeah sure well at the time I think it’s about 2007 I had connected with some people on an online like nutrition forum it’s more like a bodybuilding nutrition kind of forum and Mike dancer was his name and I’m still very good friends with him and he had what they call terminal epilepsy and because of my neuroscience background you know he was asking me questions about GABA and how to you know drugs and like that that he was on and I was researching to help him and discover that the ketogenic diet was what is a standard carrier when drugs fail it was for drug refractory drug-resistant epilepsy and I was funded to study a seizure disorder oxygen toxicity cause seizures so it’s thinking Wow for my love of nutrition maybe I can incorporate the ketogenic diet into my current research program I have now which was looking at different antioxidant drugs and anticonvulsant to prevent these seizures so I was like wow I could get back into nutrition so the science behind it was very very good and that was very surprising to me that it was basically one of the most powerful anti-seizure therapies that were out there was just so hard to implement and Johns Hopkins they were doing it the best so I connected with them and and then my friend had started the ketogenic diet and then I got busy you know with my my fellowship and everything and we didn’t talk for about three or four months and then he contacted me and said I haven’t had a seizure he was having multiple seizures away and then he had started it I gave him the everett like this is what you do and he took it upon himself to implement it and then it worked remarkably well for him and then my program officer had did some work on neuropeptide Y and I realized oh that goes up in the context of fasting and the ketogenic diet maybe if I pitched this idea of ketosis that he would fund at least the basic science research to get this into the pipeline to be used out in the field for Navy SEAL and he did so he came and I pitched it to him but he didn’t like the idea of a ketogenic diet because high-fat diets were you know if you bad they still are sort of but he liked the idea of of administering ketones as a nutritional agent sort of the ketogenic diet in a pill and he was like well investigate well whether ketones themselves can be anti cat our anti convulsant and we did that with ketone esters that we sort of developed and formulated and synthesized and we tested a number of things that didn’t work but this particular ketone ester worked and that became sort of the foe and I was about 2010 or 11 we started really doing like day-to-day experiments on that and then we made some observations in in different cell types under hyperbaric conditions and one was a cancer cell type and these particular brain cancer cells grew slower in the context of ketone supplementation and I also saw that they were vulnerable to high levels of oxygen so that became the PhD project dr. Angela Poth who stayed on with me now his research associate so she came in as a first year PhD student and she was very engaged she’s like I want to do this project and I was like I don’t have funding for that project I had a little bit of startup fund so I put her on that and then that blossomed into its own sort of pathway and studying cancer but my roots have been working with the office of Navy research and developing countermeasures in extreme environments it’s so interesting how like you mentioned when you know previously ketogenic diets were the standard of care for epilepsy before we had drugs and somehow now it’s only for the refractory cases like if you go to a doctor with a new diagnosis of epilepsy they won’t really endorse you going on that diet until you’ve failed every single other drug and then how you mentioned – the desire for to kind of put it in a pill form or to put it into something it’s sort of our it’s just an interesting observation of like how we’re conditioned in our medical system to want to have a pill for everything and as opposed to kind of changing our overall lifestyle it is a logistical thing because it’s nutrition is a lifestyle and getting people to change their culture if they’re vegetarian or if they’re you know indian or asian they tend to be more carbohydrate you know eccentric and then from a logistical standpoint from the military you know it could take several days to get into therapeutic levels of ketosis whereas if this is going to be used operationally you want to take it you know a half hour sixty minutes before going into your mission into your dive so you want something that gives you a neuro protection in that underwater environment but that also can it not impair performance so you don’t want to be in a ketoacidosis you don’t want to be in a ketogenic you know there’s narcotic effects of some of them they cause GI problems so you want to pick the optimal you know ketogenic strategy that works fast has a pharmacokinetic profile of like four to eight hours during the mission so so there’s a lot of things a lot of boxes that need to be checked for it to work and a diet was like it’s too right so it may be just the differences between that specific application versus a more general population or different disease applications which I want to get into today oh sure but maybe just to back up for people listening I think probably a lot of people listening I’ve heard of keto diet before if they they’ve heard of ketosis but could you just give us and kind of break down some of these terms like you did in your talk today about what exactly is a ketogenic diet or what is nutritional ketosis is there a difference yeah so the definition of the ketogenic diet is unique in that there is a biomarker it’s the only diet that I know of that when you eat the macronutrient ratios which need to be specific that adhere to the ketogenic diet ratios then it changes a specific biomarker that you can measure with commercially available technologies and that’s ketone bodies beta hydroxy butyrate or acetyl acetate and when those ketones are elevated within a specific range for beta hydroxy butyrate 0.5 millimolar you are in a state of nutritional ketosis and data indicates that if you get to 1 millimolar beta hydroxy butyrate that can give your brain about a 10% boost in energy so your brain uses what’s available and 1 millimolar blood concentration represents a significant amount of usable fuel for your brain and glucose levels really don’t change all that much so you are shifting the metabolic machinery and the fuel source of your brain and there’s advantages to that from a bio energetic standpoint and then from epilepsy standpoint or seizure from a neuropharmacology stand but you start to change the neurotransmitter systems in the brain and that’s something that we study and that became very interesting to me so the primary thing is carbohydrate restriction so even without the ratios and all that stuff if you just take a regular diet you know you don’t go too crazy on the protein but you drop the carbs down to 50 grams per day people that are active will get into a mild state of ketosis if you drop your carbohydrates down to 50 or 25 grams per day especially if they’re high fiber relatively non glycemic carbohydrates like vegetables then the majority of people will enter a state of mild to moderate ketosis where they will start getting some benefits from that how important is it if people are I mean I guess it depends on the application but how important is it to actually measure ketones and measure blood ketones versus urine ketones and I guess that that kind of balance of do you want to be in ketosis always or is there a bad or is there a negative implication of going in and out of ketosis yeah it’s a good way so I think it’s important especially initially to just document whether you are doing it right and measuring your urine ketone so they should be spilling out your urine if you’re and what we find sort of therapeutically is that when you are registering in elevation and ketones then you start to get the therapeutic effects so the ketones so we don’t it’s controversial now are the therapeutic effects coming from the ketones or the physiological state associated with the insulin suppression that stimulates the fat burning process and reduces glycolytic you know activity where you’re getting the benefit so that’s I believe if because if you just give pure ketones in the context of a normal diet you get therapeutic effects so we know it’s the ketones but it’s also probably insulin suppression as well just give the ketones does that suppress your insulin also it so over time if you give a really big dose that can actually increase insulin a little bit but if you give sort of the therapeutic doses that we work with and keep ketones and like the two millimolar range then insulin is like imperceptibly change really and you’re still you’re giving a source of calories that’s essentially non glycemic that’s really not impacting insulin much so you’re still driving the fat burning process if you give a whopping dose of the ketone ester you could get an insulin spike but it’s very small relative to carbohydrate it’s even relative to protein and it’s pretty small so it’s a like a non glycemic you know source of energy that’s not really impacting insulin much so that’s kind of like a benefit for staying fat adapted so for the average person though for athletes what we see is that they are good ketone utilizers so an athlete that engages in prolonged and prolonged would be over two hours three or four hours they typically have what we call post exercise ketosis it may be mild but their body is kind of used to going in and out of ketosis so they are they become good ketone utilizers so they’re ketones may elevate kind of high in the beginning but then their body clears ketones fast especially if they’re physically active so and I’ve seen that in athletes that they just like can’t get their ketones high but you know they’re in ketosis and if they’re active they particularly have low ketones but if they are active and they remain completely sedentary and in one spot then their ketones start to elevate because they’re not moving around and using them as fuel right so so in the lab you could do things like a ketone tolerance test where you give oral ketones and then you look at that rise and the volca tones and if that rise goes up and they start exercising and then it goes down really fast that’s a good ketone utiliser but a person that’s completely sedentary like a couch potato if it starts to rise and they start exercising it goes down much slower so I mean the same thing with glucose right yeah so I think you have to kind of view it sort of in that context that if you were following the kids doing it and doing everything but your ketones are not into that like one or two millimolar range but only stay in the point for 2.5 even at 0.5 like most normal people will never get to that most normal people standard ayah is like point one maybe 0.2 in the morning so 0.5 is actually several fold higher so that’s still significant that still means you’re you’re oxidizing fat and probably getting some benefits from that and maybe using ketones very efficiently and that’s not why they’re building up it’s like we wouldn’t be chasing high glucose numbers like we shouldn’t really be necessarily chasing high ketone numbers but so you talked about some of the physiologic impacts of nutritional ketosis relative to the brain and to energy and a little bit in general about metabolism but what are what are some of the other physiologic effects that we know of from being in that state so there’s a bio energetic state yeah you’re giving a source of fuel and then an interesting thing we’re looking at is the increase in blood flow so I didn’t get to talk about it but I had one student dr. Shannon Kessel who did her PhD with me and she looked at the effects of ketones exogenous ketones on wound healing so for wound healing we’re always you know putting something on the wound and hoping it’s going to improve it some you know this or that agent that increases some growth factor or whatever but like the wound healing society never really gave a whole lot of thought into changing systemic physiology to reduce you know maybe chronic inflammation reducing blood glucose will increase perfusion to tissues right so when you have a diabetic wound the ATP concentration in that wound tissue may be reduced by 90% right so if you lower blood glucose you have greater perfusion of blood to that tissue and the ketones also increase something called adenosine adenosine is a powerful vasodilator if you give an injection of adenosine the person will drop down because of you know low blood pressure because your your your vascular dilates so what we see using a Doppler blood flow measurement is that blood flow you know increases in the tissue with acute hyper ketone emia which using a ketone supplement and then the wound healing process is sped up to probably by a number of things reduce reactive oxygen species reduce inflammation and also the increased blood flow is supplying ketones which I can actually stimulate metabolic processes in the wound tissue to enhance the wound healing so we saw and we have not published it yet but it is a PhD dissertation because my student went on to do other things she’s working with the Quito pet Sanctuary and helping dogs so she’s so passionate about helping dogs she had gone back and published that but she did amazing work basically demonstrating a very profound even the president of the wound healing society dr. Lisa Gould MD PhD said this is remarkable like we used her model of ischemic wounds and so that’s something like I never talked about yeah like I’m highlighting here is something that’s really important to fall back on because ketones are enhancing blood flow you know a wound is is something like my sister is a nurse practitioner and deals with these ischemic wounds from from patients from bed sores and things like that and it’s like billions of dollars yeah like so here we have something that we’re not rubbing some kind of cream on or anything we’re changing the patient’s metabolic physiology to increase perfusion to the wound tissues positive side effects that that may have healing about whatever other metabolic something maybe they feel better and start moving around and yes but blood flow and things like that so you’re changing you know you ask what are the other things like you’re changing blood flow you’re changing neurotransmitter systems you’re lowering inflammation and then the ketones can activate gene pathways we think that can help increase cellular protection right so through histone deacetylase it’s activating things like superoxide dismutase which protects the cells from oxidative stress or inflammation so these are things to that that we study especially in the context of like oxygen toxicity it’s important and I think when you elevate ketones you see a proportional effect at lowering glucose and we think that lowering of glucose is very important for some of the therapeutic effects we see definitely what about you had a great slide in your presentation of some of the known applications of nutritional ketosis and then some of the emerging applications and you’ve talked about many of them already but yeah can you fill in the gaps on what are some of the things that we know that the science is pretty good at telling us that yes this is a good idea and then what are some of the things that are kind of on the new frontier sure well the things have been around for a while or pretty much all seizure disorders so a large majority of them and that would be like epilepsy the etiology of epilepsy is largely unknown but like temporal lobe epilepsy absence seizures you know Lennox gusto syndrome Gervais do syndrome there’s now Angelman syndrome I had that in the emerging but I would kind of put that maybe in the solid you know evidence group and then there’s these neuro metabolic genetic disorders like glucose transporter pyruvate dehydrogenase and then there’s like a number a whole bunch of the rare neuro metabolic disorders that are very responsive to the q janked it’s actually the only thing we have for them right now there’s scientists working on gene therapies but in the meantime you know you’re kind of keeping them alive and functional the ketogenic diet by virtue of elevating a metabolite that their brains can use for energy when if pyruvate dehydrogenase is blocked you know their brains can use ketones because you bypassed that or if the glucose transporter is deficient you’re restoring energy through ketones so these things have been around for a while the things that are kind of new are like weight loss and type 2 diabetes Verta health is doing an amazing job you know spearheading a whole movement of using of treating a dietary disease with dietary therapy really I mean you’re treating carbohydrate intolerance you know it’s kind of silly to treat carbohydrate intolerance with carbohydrates we did we got sidetracked but yeah it just makes sense so I think that’s you know a really big area of research right now that’s gaining a lot of traction were the ADI is actually starting to change guidelines my student as I had mentioned in my talk and Rakuten egg soon to be dr. Andrew coot nick is type one diabetic and he has convinced me even though I would say early on in my talks if you’re type one diabetes you know if you have that don’t consider this diet well he came into my lab starting his PhD dissertation as a type one diabetic and transition to lower carb and then in phases ketogenic and I feel he is more productive and his wife would probably agree he’s more safe from hypoglycemic episodes if he stays in that mild state of ketosis so that is something that I mean you could get in a lot of trouble years ago yeah if you say if you advocated a low-carb or even a ketogenic diet but now research is validating that there’s groups online where people are using like very low carb diets to manage type 1 diabetes and whenever you have less fluctuations in glucose that’s a good thing and I think most doctors would have to agree ethically that if you’re using less insulin to get better glucose numbers like that’s a double whammy of good right and you can’t if the patients did that and started doing that on their own and their endocrinologist borates them for it that’s an unethical thing I mean the numbers tell the story right especially if they’re wearing a continuous glucose meter okay you can’t argue with the data that’s and they’re they’re really you know if you have type 1 diabetes it’s really scary I didn’t even know it was brought to my attention by my student Andrew that here are the 10 things you’re most likely to die of it increases your odds of dying more likely to die from each one of these 10 things like you know from heart disease to cancer but things you wouldn’t think of like in an automobile accident you know you have a hypoglycemic episode you’re more like the diet like everything he went down the list so simply managing your blood glucose from you know what he would show me before to after like looking at those after numbers that’s adding years to his life it’s not a decade to his life and quality of life yeah so in medical costs down the road so that was inspiring and I think that could be like almost like the next frontier and that’s really like shoving it in your face right the medical establishment and especially the endocrinology and a visa so that’s really paradigm shifting so and then of course cancer too and when I get into this it was very little kids very controversial subject and now we have over thirty registered government registered clinical trials that are ongoing and most of them are using the ketogenic diet as an adjuvant and some may be as sort of you know a palliative or supportive care for advanced you know disease but uh but it’s really inspiring to see that work there’s some evidence that other metabolic drugs like pi3 kinase inhibitors that their therapeutic function kind of works optimally or only works in the context of insulin suppression through the ketogenic diet so that’s work by dr. Luke Kindt Lee is doing some things and published on that so yeah we’re working with a number of different institutes to do that also Alzheimer’s disease is another viewer member of the slide showing glucose brain glucose hypometabolism is the hallmark characteristic of Alzheimer’s disease well you have amyloid Intel plaques of course right but you know that’s kind of like like a downstream epiphenomenon of impaired glucose metabolism you know when brain energy systems fail you start the breakdown of these proteins and accumulation of these proteins happen but I think it’s neuro inflammation glucose hypometabolism creating an environment where toxic proteins like amyloid and tau do not get processed and then I get cleared and broken down perhaps the glymphatic system which is activated during sleep at night is not effectively clearing these so sleep is another thing and we’re looking at the effects of ketosis on sleep sleep quality sleep duration so that’s another I mean I had people tell me for years they had to take some medication to like sleep or to stay awake McKenna Phil or something like that and that like one patient like got completely off of it with the ketogenic diet is now sleeping and feels better than ever so I get these reports a lot I don’t know what to think about a lot of this but once you get like you start to get more and more of it yeah and then they send me papers I was like okay there is scientific rationale to what you’re seeing and yeah people send me disorders like like kabuki syndrome which is genetic disorder like two doctors reached out to me and they just happened to be at the same Institute and now we’re doing research on a genetic disorder and we’re giving ketones as epigenetic therapy like I never could have thought like like you know that that’s completely mind-blowing like years ago I would have never thought we would be administering ketones you know in the you know for epigenetic therapy and this is work that came out at Johns Hopkins so we have the Kabuki mouse model and prior work by dr. Berenson he’s now in Iceland but we’ve continued on sort of with those studies so we went in directions that I never could have thought and even like the work we’re doing in at NASA I would have never in a million years thought we would be you know doing that doing these operational studies where we ourselves our crew members on the study so it’s it’s taken those ketones have taken us in many directions and I feel very fortunate and grateful for all the things and it’s brought me here to impress it yeah so you mentioned that you know there’s some effects of the ketones themselves and there’s some effect of the insulin lowering properties of being in nutritional ketosis so I guess what I want to ask is for the average healthy person generally healthy person well is there as an additional advantage for them to be in a ketotic state versus just in a low carb diet where maybe they’re not actually producing a lot of ketones so I think for the normal healthy like CrossFit person yeah my belief is that so I kind of stay in nutritional ketosis all the time I bounce in and out sometimes but it’s rare that I get more than 50 grams of carbs a day but I’m not very active either but I’m like a desk i sat on a desk a lot but I work on a farm so we owned a farm and I’m always doing like heavy farm work stuff so that’s sort of my Jim yeah and I feel better and I think most people will – like people that I talk to even like guys like Rob Wolff has said and other guys that maybe they’re low gear is not as good you know that Drive in the beginning but but they’re more lucid and they’re more engaged and they can focus better on a KJ so I think intermittent ketosis doing it through intermittent fasting where you could do fast for 16 to 18 hours and then eat kind of whatever you want within reason but if you eat low carb or even ketogenic then you can kind of get the benefits of that you go into ketosis fast or get a little deeper doing the fasting phase so I think that’s one way to go about doing it or just periodically every every once in a while get your body into a state of ketosis and that accelerated fat burning and production of ketones will your body like you will be changing things acutely obviously but I believe that you’re changing things you’re activating genetic programs you’re to the extent where that if you go back to a regular diet and then go again to fasting or the ketogenic diet it’s like this metabolic memory that I talked about is that you your body knows what to do you enter that state faster you don’t feel sick when you enter the state you feel Claire and the more you do it the easier gets and the more benefits you derive from it over time 10 20 reminds me a little bit of like dr. Walter long goes work with the fasting the making and the periodic like you don’t maybe you don’t do it for so long but if you do it periodically good idea allows you to reset I I think that’s a good approach I you know I don’t know if that’s optimal but what the way that is sort of pitched and the accessibility that that has like it’s a lot easier for some people to tell them you know just don’t eat right you know just eat within this defined window this amount and just have to do it you know five days a month right instead of changing your whole right part of it is the buy-in and the actual practical application yeah yeah but I am a big Whole Foods person and I’m big on like we have I know there was some talked about chickens not being good but we have I eat a lot of my wife’s Hungarian so she we have a lot of organ meat so we do a lot of liver beef sardines I love sardines and we have chickens too but we eat the eggs right and then chicken livers and hearts we do a lot of chicken and which was a little weird for me to eat in the beginning but yeah that’s a big staple in my diet which we also learned today liver right was the most nutrient-dense yeah yeah vitamin A though maybe it could be toxic to if you eat a lot of it but I do try to eat liver like once or twice a week and I think that I’ve been in situations where I’ve been sort of malnourished I was doing fasting experiments and I would have the liver and then like my whole system it’s almost like a liver buzz Wow like because it’s so nutrient dense and maybe it was restoring either iron or b12 or something and I’m really kind of in tune with my body and it’s probably the only food that if I eat if I’m in a calorie deficient phase or something where you can like feel the energetic effects of it it’s like yeah that’s very interesting I’ve had several talks in the last few weeks about liver and it seems like now it’s something I need to start making with who ran well so actually I heard Terry walls speak a couple weeks ago I was talking to Zoey okay hearing it again today nope a salad do you know do you know I haven’t yeah he just interviewed me for his podcast and you know in in preparation for her podcast I started listening to some of his previous ones and he eats raw liver oh well I haven’t done that yet but he’s a medical doctor and he’s really big like conventionally trained I think and I think he may be doing Crossfit so he’s very fit very fit kind of buff guy but he’s super big on liver and eating it raw I haven’t done so are there any states you mentioned at first you thought maybe type 1 diabetes would not be a good idea for ketosis but are there any considerations that general people should have obviously you want to work with if you’re gonna do this maybe you want to work with your physician or an option expert but but where people should maybe be wary or maybe it’s not a good idea yeah absolutely I think any kind of liver disorder like cirrhosis or things that your if your liver enzyme values are off so the liver makes ketones and it does put some stress on the liver when you enter a state of ketosis pancreatitis if you have like an inflamed pancreas any kind of pancreatic issues in the past kidney stones have been about five times higher in kids that did the ketogenic diet but now a recent study when they use potassium citrate and they look at that it’s like a non-issue so it was presumably the kids just weren’t drinking enough because your appetite suppressed but your drive to thirst is also lower too so kids who kind of run a little bit dehydrated so I would say you know cautiously be cautious with kidney stones any kind of liver function pancreatic function I think you should be you know very very cautious when you do that and I can’t think of like too many other I mean there’s a number of different like fatty acid oxidation disorders like there’s a whole record yeah but you know there’s a spectrum for that and but they are out there where the Q Jiang diet could be pretty bad like there are occasionally people will just have like a violent reaction to cage egg dye and I think well maybe they have an underlying fatty acid oxide like thirty different enzymes and if you’re you may not be totally absent in one but mildly deficient based on some snip or something and then you just don’t it prevents you from fully adapting or even partially adapting to a ketogenic diet or just a high-fat diet and some people just have fat intolerance like they eat it they get nauseous and they throw up like but my body seems so like crave fat yeah so I do a well on it how about any differences between men and women because I think I don’t know if this is more on on a calorie restriction sort of effect or if it’s the ketosis but I have seen women where it’s affecting like their menstrual cycle or can have different hormonal effects yeah so what I think there’s a number of things going on there and that could very well be the case but you have to look at a number of different things are they overtraining are they in a calorie deficit are you know I think those two things are important in assessing those kind of claims that that’s happening but female physiology it’s very reactive and responsive to low insulin and low glucose so there could be a hormonal cascade that’s kicked click kick Don by hypoglycemia that wouldn’t necessarily be as dramatic in males and I think I think it affects that hypothalamic pituitary axis in ways that I think males are more resilient when it comes to fasting carbohydrate restriction and female psychological behavior in addition to physiological effects we’ve had in some females in the lab that attempted the fast and they like like fainted but they you know you suppress hormone insulin has a diuretic effect you hypovolemia and you get orthostatic hypotension and then you just in females it could be a little bit more dramatic like their response to that low low insulin low glucose so I think maybe they just need to be more cautious and allow more time for adaptation and and monitor I mean these are things that we need to know because a lot of research as you had mentioned before I think that is done on males a lot of NIH sponsored research so now we’re looking at a balance of males and females but generally speaking yeah I think my wife is very anti ketogenic like ever she tolerates carbohydrates and a large amount of carbohydrates very well or if I ate it I would be especially at this because I’m fully like adapted it yeah ketones now that yeah I would be intolerant to it from a GI perspective and just from an overall feeling respective yeah but I think a good point to look at all those other factors so so many times you know like you said there’s the sleep there’s the how many calories you’re eating how much you’re trained here are you just under high stress situations all day long all that is going to impact your HPA axis and then if you do the ketosis on there it might be like especially in females one extra thing yeah kind of tipping you in the wrong direction yeah so it’s multifactorial I think it’s important that if if a female is going to do it or anybody is going to do it it might be good to go into the diet without being in a calorie deficit so the situation usually presents itself it’s like when the female you know starts the ketogenic diet they start it during a weight loss phase or something so they go into it and it’s like a triple whammy right so they go into it ooh you know increasing the amount of exercise decreasing the amount of calories and of course cutting the carbohydrates so it’s like you have all these three things working together and your physiology is just reacting and wait is that one way to go about doing it is to transition to a ketogenic diet and maybe even do a surplus amount of calories do two or three days you know so balance it out do you like you caloric or maybe mildly hypo caloric and do a day or two or three and in the beginning where there’s some surplus amount of calories and I think that kind of resets your your metabolism and then kind of ease into it in that way so you know but I haven’t I’m just speculating I think the pro it’s at its really important to keep the protein sort of adequate and maybe even high too especially if you’re an athlete sure yeah so speaking of athletes you talked a little bit about this today and one of the question-and-answer periods but you know I think it’s been well studied and more endurance athletes we’re talking we’re here at the CrossFit Games where the majority of people who are listening are people who are doing maybe one workout a day but it’s a high intensity workout is ketosis still a favorable sort of place to be to fuel that type of a lifestyle it depends on the individual yeah I think individuals that are at the top of their game are usually very carb tolerant but that doesn’t mean that it’s optimal so I think my belief is that if you train in a mildly you know glycogen deficient phase then you’re adapting your body for metabolic flexibility where you have greater access to your body’s own fat stores but also burning the fat that you’re eating in your diet too and I think a higher fat diet lower carbohydrate diet you know normalizes and stabilizes insulin which gives you more steady fuel flow throughout and during game time or go time you might want you titrate the carbohydrates back in during training train low training in a carbohydrate sort of low insulin state and that will adapt your body to be metabolically flexible and then when you engage in competition and you want to experiment before you actually engage in competition you titrate the carbohydrates in a very calculated and strategic way and assess and basically use the carbohydrates or the glucose or glucose polymers or whatever as a performance-enhancing substance right and like you’re supposed to do with caffeine right exactly yeah so yeah I actually the ketogenic community may cringe but I think sugar is a performance-enhancing like drug or substance and I think it can be titrated back into the diet for athletes and it needs to be it doesn’t need to be a lot and I think it can have neurological effects but you may also want to eat a diet a low carbohydrate diet if you eat up to competition you can actually replenish and restore glycogen just by increasing your calories you know you don’t have to carb-load prior to an event so if you’re eating you know even 50 grams of carbs a day or whatever on a low-carb diet and you’re a week away from competition you just titrate the calories back in 25 to 30% calorie surplus over you know four to five days we’ll do that you back off on the calories a little bit and then get carbs back in around gametime I mean these are all things after communicating with dozens if not hundreds of athletes you know we’ve sort of worked out sort of sort of a general guidelines that seem to be working it makes sense from a physiological standpoint and it seems to you know work operationally we don’t have yeah I’m not anti carb in any way but I I’m just I can appreciate the benefits of low carbon being metabolically adapted and then reintroducing carbohydrates back in strategically but really adapting your body from a training phase you know to run off low carbs and then periodically putting carbohydrates when they can be advantageous and that and it sounds like you came from more of a powerlifting background is the same sort of thing apply for lifting yeah I mean I’m kind of thinking of it from that perspective too you know you’re powerlifting at least the way I did it or occasionally do it is you know the workouts are so short that it’s not going to really affect your deadlift unless you’re in there for hours on end but my workouts from start to finish / like 3540 minutes but if you are a high-volume you know if you’re doing a high-volume training over three or four hours I think it can affect your overall performance you may lose some some gas in the tank towards the end but even my good friend and colleague in some way Lane Norton who’s really into powerlifting a natural bodybuilder he he is not an advocate of the ketogenic diet but he looks at it as a tool and toolbox and would probably even say the ketogenic diet is not optimal but it’s not going to impair your performance even for powerlifting in the context of powerlifting and I believe it may aid in weight loss if you need to meet sort of you know if you’re trying to compete in a certain weight class I’m of the opinion that ketones are sort of anti catabolic and it may help that weight help you meet that weight class requirement and more less painfully I guess instead of being starving on this yeah yeah what do we know about ketosis in the microbiome you said this is something that you’re you know excited to be studying more but yeah I know at least from what I have seen I know that it does it does make changes in the microbiome but what do we know so far yeah we don’t know a lot and if someone says they know I would be skeptical so yeah that’s a real it’s that’s really a sign they they really don’t know anything if they say they know it’s kind of like physics you say you know that means you really don’t know but we do know from the perspective of the anti-seizure effects that there’s two species that of bacteria that seemed to apply and one is para bacterial DS and another is Ackerman’s yeah I don’t know it’s a there’s two species that are impacted at least in rodent models when they follow ketogenic diet that they contribute to the neuro protective anti-seizure effects but you know rodent aren’t people so but I know there are probiotic companies probably jumping on the bandwagon now and making progress that will increase those species hey I mean it’s it’s maybe worth a shot but we do know your gut microbiome is dependent on so many different factors you know and your geographical location your gut bacteria eat what you eat so your diet will impact the diversity of the microbiome and the total now I think some of the comments I would say is that high carb diets increase small intestinal bacterial overgrowth like the SIBO thing and you know and someone approached me like years ago it’s like I had SIBO what are you talking about see I didn’t even know what it was yeah and I am convinced just by the volume of emails that I get that carbohydrate restriction and even you know intermittent fasting like cures this SIBO thing that was brought to my attention and the more I look into it you know small intestinal bacterial overgrowth is a very real thing and it affects many people in different ways they get irritable bowel syndrome well they’ll bloat up and low-carb and intermittent fasting it’s sort of especially when it’s combined together is almost like a cure for that for many people yeah so maybe it’s just another symptom of access carbohydrate in the diet that works but yeah fueling the nasty bugs which can over produce certain you know gases and then create a pro-inflammatory state that affects the tight junctions that hold the you know intestinal cells together and stuff – they are very those tight junctions and the integrity of the gastro mucosal lining is very very sensitive and you know that’s like your immune system about 70% of your immune system is like in your gut and if you permeable eyes or in any way compromised that barrier to the environment it’s like you know you are exposed to in the environment your gut you are one you just have a hollow tube through you yeah and if those tight junctions are compromised or you have a leaky gut you are introducing you know stuff proteins you know chemicals into your bloodstream and then your immune system becomes preoccupied dealing with that and that leaves you susceptible to infections you know even things like like viruses that we have maybe like like herpes simplex or Borrelia or T gondii I was reading about you know cat scratch fever and things like I was reading about a whole bunch of different you know bacteria and viruses that we Harbor that our immune system keeps them at bay but if it’s challenged in any way by physical or emotional stress these things can reactivate like things like shingles and you know I had people contact me that had like shingles and they their cure for a shingle is just to start fasting as soon as they feel like an episode coming on and they have like certain things that will you know cue them in then they fast and then it never they never get like shingles like stuff like this it’s like I never thought I’d be studying I was like yeah someone needs to study that they told me oh you need to study this because I’ve observed this and it’s like it’s great but you know it’s good information but it makes sense right you know you fast and then that’s that stimulates your immune system and your immune system becomes more vigilant at attacking bugs that would otherwise not or viruses that would otherwise not have viral shedding or proliferation so so fasting is a very elegant and very effective and we’re you know evolutionarily hardwired for that to work and I think that’s what CrossFit is – right I mean it’s like it’s elegant it’s simplistic and it’s effective and like fasting or carbohydrate restriction it’s like the same thing and I think that’s probably why it appeals to Greg Glassman and because it is just so elegant and simple and highly effective exactly it’s going back to the basics yep so I want to touch a little bit on cancer I had previously dr. Seyfried on the podcast and he talked in great detail about his research and I know you’ve worked with him yeah expensively maybe for people who didn’t catch that episode or who are not as familiar could you give us just an overview of sort of the metabolic theory of cancer the Warburg effect and why ketosis may be helpful for preventing or treating answer sure I was turned on to Tom Seaford and like 10 years ago to explain some of the observations that we had in cancer cells so the Warburg effect if I could summarize it in a sentence it would be damaged mitochondrial oxidative phosphorylation which is how mitochondria make energy with compensatory fermentation right which is basically fermenting sugar you create lactate and creates ATP in a more efficient manner but it can when you have damaged mitochondria you default to this more archaic you know form of energy production so embryonic cells that are proliferating have very high rates of glycolysis or substrate level phosphorylation but normal cells normal healthy cells do not proliferating and so they have their energy system is mitochondrial oxidative phosphorylation like a 90% of their ATP is derived from mitochondrial function so there are many things in the environment that can damage the mitochondria and the mitochondrial DNA and that could be chemicals inflammation hypoxia radiation viruses viruses that cause cancer actually our viruses that are more likely to attack the mitochondria so progressive mitochondrial damage leads to a mitochondrial dysfunction and that leads to lower levels of ATP production and the cell can sense an energetic crisis the nucleus has sort of like these there’s energy sensing you know pathways that are basically that the the nucleus can sense the ATP levels in the total cell and also in the mitochondria it’s this is crosstalk that occurs and and when the nucleus is sensing an energetic crisis when the bio energetic state of the cell becomes decreased it kicks on a genetic program including the activation of aqua genes and so it senses damage to the cell kicks on these oncogenes many of these oncogenes transition the cell’s metabolic machinery there’s metabolic rate programming from oxidative phosphorylation which is good clean energy to glycolytic you know processes including fermentation so as that happens there’s a point and it varies between the organism and the cell type and the tissue type where that normal cell transitions to become a tumor cell that’s metastatic and proliferative if it activates if the mitochondrial damage is very extensive it may trigger apoptosis and the cell dies if the mitochondrial damage you know occurs in a way that activates a genetic program that makes the cell resistant to apoptosis and basically it stimulates a whole cascade of genes that in douse that cell with it makes it immortalized and basically stimulates all the processes that increase glycolysis aerobic fermentation or a terrific glycolysis and proliferation so all the characteristics associated with a tumor cell and including invasiveness and metastasis and immune evasion and and things like that and deregulated metabolism so the metabolic theory of cancer posits that that enabling factor of a normal cell to a cancer cell is a result of a metabolic dysregulation and lower levels of ATP stimulate genomic instability because DNA repair processes in the nucleus are a highly atp-dependent process so if energy levels fall then the DNA in the nucleus cannot repair itself and then you’re kicking on oncogenes so the metabolic mitochondrial impairment is the initial insult and that could occur from all those things I described from chemicals a hypoxia radiation insulin resistance leads to inflammation or active oxygen species all these things it’s called the oncogenic paradox right so all these things multiple things can result in the same and how does it do that because the DNA is complex I mean there’s all these different you know and different cancers result in different sort of genetic mutations but the it’s important to acknowledge that the DNA of mitochondria do not have the immense repair processes that the nuclear DNA has and said mitochondrial damage it’s pretty easy to do in radiation studies kind of show that that’s like a great model of producing carcinogenesis so so you know backing up a little bit mitochondrial damage metabolic derangement low ATP triggers genomic instability triggers activation of oncogenes and that triggers a normal cell transitioning into a cancer cell so the field right now it does not really believe that the the field believed that it’s a genetic disease and what the mitochondrial theory of cancer which out of Warburg sort of advocated for and Tom seaford sort of revitalized I think and maybe a few other people but tom has been instrumental in spearheading this idea of cancer as a metabolic disease and did it in a very elegant way in his book cancer as a metabolic disease there was a review written in 2010 that inspired me and in a few years ago I wrote another review with Tom Seaver cancer as a metabolic disease therapeutic implications of that so we wrote a review we’ve done like seven articles together but that was one of them so what does that mean I mean some people say well who cares how it starts we know the Warburg effect does happen and there’s this metabolic derangement so let’s let’s worry about you know treating the cancer and hitting these glycolytic pathways but if the were if the cancer is a metabolic disease sort of theory is true that has immense implications on how not how we treat the cancer but how we prevent cancer and preventing cancer is probably more important right I mean you know you avoiding it is probably is the most important thing to do and unfortunately Cancer Research is not fun preventive studies so we need to hopefully I mean we I try to generate funds through you know through various means that are sort of you know alternative income things and putting my own personal income to solve some of these problems which is not much so I try to make headway when I can but I think that’s a really important question that we need to figure out is that the implications of cancerous metabolic disease are tremendous and you know now top tier cancer researchers are targeting the basically developing drugs that target specific metabolic camp pathways in cancer like pi3 kinase inhibitors and they tend to work only in the context of a ketogenic diet with insulin suppression so I think when I got into this there was no cancer metabolism conferences and now there’s about a half dozen and these are kind of the same people who were like attacking Tom I’m not gonna name them by name but they were attacking him it’s like some kind of flaky dude that didn’t know he was talking about and now now you see an explosion of research on PubMed and even conferences on basically developing therapeutics to treat cancer as a metabolic see if so it’s kind of yeah so he has done a lot to the field and actually it’s its paradigm it’s gonna take a while and I think Tom and I don’t agree completely 100% on everything but we agree to disagree but I think he’s a very vocal critic of the standard of care which includes radiation chemotherapy but I think for liquid cancers lymphoma testicular cancer and a few other like early stage cancers it can be life-saving and I know that because I have family members and friends and people that I know that did it but they did it you know I advocate for them to use a ketogenic diet if not huge ain’t done low-carb and I’ve even had students with you know leukemia that went through therapy but did a ketogenic had absolutely no side effects and they’re doing remarkably well now so on the therapy note you and dr. C if we talk about this press pulse therapy you can talk about what’s involved in that sure so the press pulse therapy is sort of the idea behind that is not that you go in with like a flamethrower and a knife and try to eradicate the cancer and that you have a more gentle approach and we call it metabolic management of cancer so you first thing you do is create an environment that stops or slows cancer growth so one way to do that is to get your body into the metabolic state of therapeutic ketosis which is lowering blood glucose and elevating ketones and we use a biomarker that Tom actually developed in Slab called the glucose ketone index so if your glucose is 3 if you can get it down that low and your ketones are 3 we call that a glucose ketone index of 1 and experimentally if you can achieve that that level of insulin suppression reduce glucose availability and perhaps the therapeutic effects of ketones at the very least slow cancer growth so you can do that you can use a drug like metformin and they could do like exercise and you know meditation and things like that from a psychological perspective these things can help at the very least slow slow down cancer and then make it a vulnerable target for the pulse therapies and the pulse therapies could be I’m an advocate of using the standard care when it works so that’s chemo radiation and in some cases immune based therapies and right and then we study hyperbaric oxygen therapy so if you increase if you reverse tumor hypoxia by saturating the tumor with high levels of oxygen that actually creates an environment so the the po2 of the tumor so radiation works better if there’s oxygen in the tumor right so the efficacy of radiation therapy is proportional to the po2 of the tumor so if you hyper oxygenate the tumor or make it less hypoxic and you do that an hour or two before radiation therapy you’re not only generating reactive oxygen species in the tumor you’re increasing oxygen which is a substrate that radiation is basically working on to create the oxidative burst that kills the tumor so radiation you know we’re taught that radiation damages DNA and that’s how it kill cells but that’s only about 20% of the damage that radiation caused is actually from damaging DNA so it creates reactive oxygen species about 80 percent of that and those reactive oxygen species so this is like well no but maybe I mean it’s well known scientifically proven like what I just said is a fact but I don’t think a lot of people understand that so you really need to increase oxygen that’s the important thing and tumors are resistant to radiation because they’re hypoxic and if it’s hypoxic and you’re blasting it with radiation it’s not going to do much because you’re not you don’t have the substrate to create the reactive oxygen species so hyperbaric oxygen therapy in the context we think of IV vitamin C so IV vitamin C does not work well on its own don’t you know Mexico clinics tell you it works and all this thing but don’t believe that IV vitamin C it does work pretty well it can enhance chemotherapy and we believe that in the context of metabolic therapy and hyperbaric oxygen that the IV vitamin C drives fenton chemistry to cause a pro-oxidant effect that in a non-toxic way can enhance other therapies but does not work good you know by itself but it can enhance other modalities and it’s doing it in a non-toxic way so we like IV vitamin C oral vitamin C doesn’t you can’t get to the concentrations you need to use it sort of as a drug and then the other thing would be metabolic drugs including things like 2d oxy glucose 3 bromo pyruvate you know metformin I talked about that that can be used continuously but there’s other drugs coming online that are very powerful and have very serious side effects but they can be used ideally in a press pulse fashion where you have this continuous press where you’re compromising the tumour you know growth and proliferation and metabolism and then you hit it you know with three weeks on three weeks off of like two deoxy glucose which we know inhibits glycolytic process ease if you inhibit tumor glycolysis you’re impacting like the pentose phosphate pathway which endow is the cancer cells to produce glutathione so you’re crippling its antioxidant effects right so so there’s there’s very sort of mechanistic sort of rippling effects when you inhibit glycolysis is not only targeting like tumor energy it’s targeting like tumor and endogenous antioxidant pathway is tumor signaling like insulin signaling things like that so we we think like in the future you could develop a cut and I just mentioned a few things but there’s like actually a big expanding toolbox that this idea of not trying to eradicate the tumor when people have a tumor in their body they just think of it as like an alien they want to cut it out slash it burn it with radiation but but it’s likely that like people like you and I can have tumors and they might come and go and it’s like we’re can Tsering all the time so it’s like a process it’s like a verb right we’re having mutations and our body corrects them and things like that so we want to keep our immune systems healthy we want to keep our mitochondria healthy if our mitochondria are healthy the our genomic stability the fidelity of our nuclear genome will be enhanced by enhancing the mitochondria ability to make energy so that may sound like a stress but or like a stretch but like you know ketogenic periodic ketosis intermittent fasting exercise probably the biggest fresh air you know healthy relationships things like that like stuff that we really need to advocate for will keep the organism in a healthy state where the malady of you know cancer will not occur or will suppress it and then some people are just unfortunate they are genetically sort of hardwired to get these mutations and to get cancers and there’s certain cancers but only a minority maybe 7 maybe 10% of cancers are like really somatically driven from somatic mutations there’s so so much that we can do epigenetically we can and really impact the expression or suppression of genes associated with cancer absolutely yeah it’s fascinating so I want to start wrapping up but I am curious about your self experimentation because I know you mentioned you kind of got into this in high school because you were mainly interested in your own kind of performance with football and I know you said you’ve even done experiments as part of your formal research where you’ve been experimenting on yourself and then I think I’ve heard that you do some myself experience outside of that so I’m just wondering you’re kind of what drives you to do those things and if there’s been anything interesting that you’ve learned by doing this on yourself that then has you’ve taken back into your research yeah I think it’s important for I think you’re much more engaged in the actual research if you are tinkering and experimenting on yourself and I I honestly I don’t know why other people don’t do this right you know the first talk I gave I won’t say where it was at but it was a conventional you know neurology conference about epilepsy and I mentioned you know and I do the ketogenic diet and and people are like whoa laughter after that we didn’t know you had epilepsy you know no no I just do it because you know I’m researching it and I want to get a feel for what foods I can eat and things like that and they just thought that was bizarre and this is like you know 10 years ago so fast forward now keto is all the rage everybody’s you know but before that yeah but it gives me a really good insight into what I’m all about our lab is very focused on doing the basic science research clinical and operational stuff from military how can we we are convinced of the benefits for many different things you know it’s not done a cure-all for everything but it’s a very very powerful hammer for so many things so from my perspective if I can make this accessible and readily implementable and and you know make it easier for people to implement that may be doing more good than even the basic science tinkering stuff we’re doing in a lab so I am highly motivated to do that and maybe even there’s a little bit because I want to personally feel better and like in but I so what I will do is you know see it see how low I can get my glucose levels down and and I’ll tinker with that and get it into ranges that should be putting me into a coma but you know I did early studies where supplemental ketones kept me alive and functioning and you know so these were some of the reading in your basement or like with like with someone around in case something yeah yeah yeah I do it like everything’s kind of very structured like I go to this level okay I’m okay go to this level you know document and from a metabolites point of view but that has you know I talked about the Cahill studies where they fasted subjects for 40 days injected them with insulin dropped their glucose down to like 20 milligrams per deciliter 1 millimolar lower so I became curious because I had tools at my disposal that I could sort of do that but even make it safer because I had exogenously tones which they didn’t have back then and I could do it in a very incremental way not infuse insulin in me you know I could you know there’s different ways to do it so I I experimented in ways that validated to me that ketones could be life-saving in the context of for example insulin shock or you know fatal hypoglycemia like like the this is like really important for people to know this and like there’s no publications on it like in theory you would look at the data oh that should work but they didn’t have exogenous ketones but now we do had these tools and they could be saving lives in the clinic so and I know of some studies that are actually funded you know starting now and and in a couple years what I’m telling you will probably be published and that could revolutionize the way we treat people so but I needed to validate it on myself it was kind of interesting to me so and I did things like fasting for like seven days and I lived a lifestyle where I was forced feeding myself six meals a day for like probably more than a decade and maintaining you know my body weight to like two forty to fifty just because I wanted to be is like big and strong as possible so fasting was so contradictory to what I used to do I used to get like never having nightmares about like missing a meal oh my god like I’m in lo at some location it’s like oh when did I eat last oh my god I have no food for the next I got to get home tomorrow but I’ve never liked things I used to panic about it so for me it was kind of liberating that once you’re in ketosis you’re not that hungry and then in the context of elevated ketones or sort of anti catabolic and I talked about that a little bit and it was it was it liberated me from food but when I I like to enjoy food I think food should be I don’t think we should deprive ourselves of food so depriving myself of carbohydrates that’s not something that I miss so and if people really miss that and enjoy that I don’t think they should eliminate it from their menu or their meals like I think we need to enjoy food that that’s part of the process but I enjoy food much more if I’m a little bit hungry I appreciate the food I enjoy it ketogenic food is like indulgent to me because for years that’s stuff I avoided so I’m still I’m more happy with my food now than I ever was I think and I don’t I don’t have like irrational food behavior or I just eat until I get sick like I don’t do that anymore I think I used to do that in the past with carbs or like a bowl of cereal or something I would eat and it would literally be full but it would still like be hungry and keep eating for some reason is talking about that carve fat combo we can just keep eating it forever yeah yeah I can’t imagine ever being like that because I mean I think I just rewired my brain like I don’t have that hedonic sort of instinctive drive to just eat as much of those cookies or chocolate cake so it’s just like nauseating looking at it you know it’s crazy how quickly you can shift your brain over yeah and maybe you know you’re younger if I’m in my teens and I’m growing and I’m my output is high my food cravings or my psychological effects but I think my relationship with food has changed dramatically you know and I think that’s that’s a beneficial thing and I could see like people who have like psychological issues with food like going low-carb and then adapting your body to that over time I think will really serve them well I think it will prove their relationship with food that’s a whole nother topic myself oh yeah I can tell myself to or whenever I go through periods where I start eating just like more carbs just kind of sneak back into the diet you just it’s like you’re you’re you can’t think clearly about food anymore yeah yeah you all of a sudden are having your brain hijacked with these cravings it’s very interesting yeah okay so I finished with three questions with every guest so my first question is what are the three things that you do on a regular basis that have the biggest positive impact on your health okay and none of it will be diet so I think yeah so the biggest thing is like getting out in nature yeah so what I do is we have a farm a 77 acre like hobby farm in Florida in Florida yeah so we’re like a new sort of farm owners so we’re putting the fence and now or getting cows that’ll be you know completely like grass-fed and we got chickens and things like that but we have to rescue dogs so in the morning I generally like wake up and sometimes it might not even be light but I take the dogs and I get that sunlight as soon as the Sun gets above the treeline like we go walking around the fields we had like zucchini and other things growing and we just we get out and we just do like it’s even a 20 or 30 minute walk and it was hard for me to do at first because in the morning that’s when I’m in the zone to write and get like my work stuff done to take to break away from that and to get out there and walk and that kind of resets the clock and kind of gets the clock in the circadian going so that’s like really important but so that’s that’s one thing in just creative downtime so schedule that in even if I don’t schedule it in then it doesn’t happen and and that affects my psychological health yeah I think must be really challenging with all the different demands that you have on your time how do you prepare that well I have to actually have to like scheduled in like 30 minutes of doing something creative that’s not like filling out admin paperwork for a grant or something like that or writing so or just email some emails can kind of be creative your responses but it’s really like 30 minutes of just kind of brainstorming writing in my notebook journaling or something like that or just thinking of new ways like I’m in kind of in this trend of sustainable farming so I’m always writing about different strategies for that said that and then yeah I mean I just guess just like being with my wife like not thinking or doing about anything and then reserving time like she’s really my priority so I just and sometimes like you know I have to just kind of give in to what she wants to do you know and just be like clear my plate okay you want to go dancing or study this or watch this and it’s like yeah I’m just completely committed to just being in the moment and I think yeah that’s about let’s like the three that’s like the important stuff like relationships are super important like Sun and being outdoors and then you know food is sort of like that peripheral thing but that just I don’t have to think about that that’s automatic yeah what the second question is one thing that you think would have a big impact on your health but you have a hard time implementing it so I am like a spiritual person but implementing spirituality is is kind of hard for me so like meditation is one and I downloaded a meditative app I guess maybe I can match it sam harris is waking up like it’s guided meditation and I thought it was beneficial but it just cannot stick to it like meditation is kind of hard especially got it so I think I want to I know that’s beneficial and I know that could be part of my creative downtime or something so I want to invest a little more time into doing that but I generally like read things that are more spiritual so I engage in kind of the literature on that but when it comes to like spirit oh you’re not going to get it by reading to be you know to really change or fit you have to it’s experiential right so I’m trying to figure out a way there so we have so many things going on right now so it’s hard to just clear my mind to be to have that spiritual mindset so I need to invest more time into that I think definitely yeah yeah have you ever have you ever tried heart math as I have not tried it yeah yeah I don’t know education apps go because it does give you that feedback so it’s kind of interesting I see some people have more success with that especially if they’re they need kind of that validation am I doing this right funny you mention that yeah that’s like on maybe even on the list of things that I put a star next to that I gotta try this yeah they’ve had tons of research it’s really interesting yeah okay last question is what does a healthy life look like to you well it’s all what we’re striving for balance right and so I think balance is really important on the top of that thing so there’s like if there’s like a Trinity right so it’s like move your body which CrossFit is a big advocate of fuel your body properly with the right types of fuel right and then I would say sort of spirituality relationships but that’s like in one category so like nutrition exercise stuff that we’ve been taught but very specific and then relationships or and and spirituality too which is like part of that could be like a personal thing but because I said Trinity I got into one so yeah so that’s but I do think that like spirituality it’s like part of its internal but it’s also the relationship you have with other people and how you you know and that relationship is sort of the experience of you know you have to kind of you live it through yourself so for me that could be and there’s different like for my students like my students are unique I feel like I have a personal relationship with them I try to be friends with them and then of course my family but my wife you know being at the top of that chain but and then your circle of people can grow to much and then you start to get diluted and then use start to reduce the amount of time where you should be prioritizing to the key people in your life so being able to you know my I say my circle is always like open it’s like a sea and it’s always adding people but I need to you know trim away the people like sometimes people come into your life and you they serve a certain function you to them and them to you but sometimes you have to let go to let new people and do that but you don’t want your circle to get too wide because you have to keep the main thing the main thing which is you know allocating time for your immediate loved ones and you know your wife and your family and things like that so I need I kind of I don’t really struggle with that but I need to remind myself that all the time yeah I think it’s a good practice to go through just am I really spending the time the places that I want to yeah I think I need to self-analyze because I just engage and sometimes I’m just like in a reactive mind say it like I gotta do this and that but I need to take a step back and be more reflective and then I think journaling really helps like haffley sort of the Tim Ferriss got me started on like the five minute gratitude journal because a journal like oh and then I just it’s somehow I stopped doing it when things got real hectic and now I’m getting back to it and I think that’s really important too to just reflect you know on your life and the things that are important once you journal it kind of makes it definitely well this has been amazing where can people find you if they’re interested in learning more about your research or things you’re doing I tell them to go to keto Nutrition dot o RG org and we have a blog and we have consulting information about we have podcasts on there things like that I’ll put this podcast on I’m excited to do that and yeah it’s kind of like a one-stop shop and we’re constantly like working on that too and my assistant Christy you know is helping to build that out so yeah I guess that mmm yeah that’s it yeah well thank you again for sitting down with me thank you again for being here at the Health Conference and being here it’s great I mean the weather really helps too it’s like low humidity 75 but yeah we come we’ve been doing it as our vacation week every year we just come and hang out for the whole week so great idea yeah very good thank you your research and seeing how things evolve I appreciate that thank you thanks hey there are thanks so much for tuning in to this episode nutritional ketosis is a topic that I know is talked about and experimented with so much these days so I was really excited to go straight to the source with Tom in this conversation and learn about his cutting-edge research in the field here are some of my biggest takeaways from our conversation number one was that ketosis isn’t necessary Sara Lee for everyone or for all the time so whether you have a medical reason or you just really love carbohydrates a ketogenic diet is just one tool in the nutritional toolbox I really liked how Dom talked about the importance of enjoying food and not having a negative relationship with food as very important things to consider ketosis is also something that can be dialed on and off in a way that fits your unique situation so it’s always important to work with a healthcare provider that can help to tailor it for you my second takeaway was about nutritional ketosis for high level athletes so from my personal experience I used to think that nutritional ketosis would not be very beneficial for high level athletes especially those who are required to have high power output like CrossFit athletes but after this conversation I’m thinking about things a little bit differently and I’m very curious about what we’ll learn in the coming years there’s still so much that we have to learn but I wonder if there are ways that ketosis could be used strategically to optimize performance even for someone like a CrossFit Games athlete my third takeaway was about the importance of self experimentation so we touched briefly on how Dom has experimented on himself and how this informs his understanding of what he’s studying in the lab I also like how he talked about how he feels really great when he’s in ketosis and he discovered this through his own trial and error I think to some degree self experimentation is so important for all of us and is necessary in order to devise in order to identify what works best based on our own individuality so I hope you guys had some good takeaways yourself from this conversation thanks again so much for tuning in to make sure you never miss an episode and to receive exclusive content from me head to my website Julie Foucher comm and subscribe to my email list if you like what you heard don’t forget to subscribe and consider giving the podcast a five star rating on iTunes also don’t forget to share your stories if you or someone you know has used lifestyle to overcome a serious health challenge please send me an email at info at Julie Foucher com I’ll choose some of these inspiring stories to share here on future episodes don’t forget you can train with me through beyond the whiteboard by visiting train with Julie Foucher comm thank you again so much for listening and I’ll catch you next time on pursuing health [Music] you [Music]

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