Episode 134 – Dr. Dominic D’Agostino


What’s up friends? Welcome to the Fit2Fat2Fit Experience Podcast. I’m your host, Drew Manning. Today’s episode is probably one of my favorites so far on the show. I’ve been super excited to have this guy on for a long time. I first heard about him on the Tim Ferriss show and ever since then, he has exploded in popularity. Luckily through a connection, I was able to have him come on my podcast. So, Dr. Dominic D’Agostino is my guest today. I consider him the expert on anything Ketosis. He is a professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida. And a senior research scientist at the Institute for Human and Machine Cognition. The primary focus of his lab work is developing and testing metabolic therapies, including ketogenic diets, ketone esters and ketone supplements to induce nutritional and therapeutic ketosis. Dr. D’Agostino’s lab uses invivo and invitro techniques to understand the physiological, cellular and molecular mechanism of metabolic therapies and nutritional strategies for peak performance and resilience. His research is supported by the Office of Naval Research, ONR and the Department of Defense, the DOD. He definitely knows what he’s talking about. I definitely consider him an expert in the field of ketosis. Today we dive into what ketosis is. We do try to keep it very basic, very simple, but he’s a smart guy and he knows the science behind it so sometimes he will kind of talk about the science and even I don’t know what he’s talking about! But I try and bring it back to layman’s terms, so all of us can understand what he’s talking about. I really do feel like a lot of people can benefit from this episode. So please share this with friends and family or someone who you think could benefit from nutritional ketosis. We also talk about ketone esters, ketone supplements, how the Navy Seals use this. The types of diets the Navy Seals are on, even though they don’t eat a ketogenic diet. He talks about how the keto diet can prevent brain seizures due to oxygen toxicity in these Navy Seals that dive at deep lengths and are under water for a long period of time. These ketone supplements can help prevent that. We also talk about how this can help endurance athletes, strength athletes and just your average joe out there. We also talk about how it can benefit Type 1 and Type 2 Diabetics, the difference between ketosis and ketoacidosis. So much good information here you guys, your going to love this episode.

Drew: Alright, Dom. Welcome to the Fit2Fat2Fit Experience Podcast, man. How are you doing?

Dominic: Great, thanks for having me.

Drew: Yeah man, I’m excited to finally connect with you. Your all the way in Florida, I’m all the way out here in Hawaii. It’s cool that we could do this.

Dominic: Yeah, I agree.

Drew: I know that your the Keto expert. So many people want to pick your brain about ketosis. I actually want to dive in first and foremost to find out more about your growing up and your past history, to find out what led you to your research on the Keto diet. Did you grow up in Florida?

Dominic: No. I grew up in New Jersey. I guess, I would even call it rural New Jersey. I grew up on a farm, baling hay and growing potatoes, soybeans, all that stuff. Just a farm boy. I got interested in working out and that kind of led me to nutrition to optimize my gains from that. I was familiar with low carb diets but it wasn’t until I dealt in neuroscience research that I stumbled upon ketosis.

Drew: Did you play sports growing up?

Dominic: Team sports didn’t always kind of resonate with me, but I played them anyway. I played like peewee football and then football through high school. I was kind of a skinny kid when I started high school, maybe 135 and I finished weighing about 200, like an even 200. But I was really strong for my size and I started lifting probably as a sophomore or a freshman even, late freshman or sophomore. I read everything I possible could on nutrition and mostly from muscle and fitness and Arnold’s Encyclopedia of Modern Bodybuilding. You know, kind of the staple resources that are out there. I was really interested in science in high school. It’s the only subject that really got me engaged. I challenged myself in like honors biology courses and things like that. For me, it was just a way to understand my own body better so I could enhance my size and strength, you know? I was a huge fan of Arnold Schwarzenegger and watched all of his movies. You know, Predator and Connan and Commando, all his movies over and over. So he was a huge inspiration to me, I kind of wanted to be like him. Like a lot of kids idolize people, that was a big part of it.

Drew: That’s kind of like how I was. You know, your …. how old are you? 40?

Dominic: Yes, 40.

Drew: Ok 40. So I’m just 5 years behind you. I think me growing up playing football as well, everybody wanted to be bigger, faster, stronger, put on big muscles. So I was kind of from the same era of trying to just …. big gains, big muscles. You know, reading those magazines, high protein diets, right? Low carb kind of came about towards my college, late high school, college years. So I can relate to that definitely. Fast forward a little bit, so you stopped playing football after high school, you didn’t play in college?

Dominic: I didn’t play in college. I was in college at Rutgers University and I trained a lot with the football players though. Many of them trained, kind of they did the football training thing and then they would also train in the normal gym. I would train with them, so I was training with some pretty high level people. I am a firm believer, put yourself in an environment where people are stronger and better than you. Whether it be academic or strength or size or whatever, and they will pull you in that direction, like you will get better. And through college, I grew a lot too. I grew a lot in size and strength. And at the same time I was majoring in nutrition science at Rutgers and also double majoring also in Biology. A lot of the classes I was taking, like Physiology and advanced Nutrition 1 and 2 and these courses, gave me more in depth understanding of human physiology and nutrition and biochemistry. I was pouring myself equally, as much time as I spent in the academics, I spent an equal amount of time online researching stuff or reading magazines to apply what I was learning.

Drew: So compare yourself to where you were back then, verses where you are now. Obviously, you advanced your studies and your knowledge. Do you feel like your in better shape now at 40 then you were back then at 20, with all the resource that was out and available to you at that time.

Dominic: Yeah, I think I know my body a lot better now. My body is different than it was at 20. I felt like I could kind of do anything. When your 20 and your just picking up heavy stuff and throwing in calories, you know, your just growing. You have a lot of growth factor and hormones that are raging. At 40, I feel more light on my feet. I’m not 250-260 that I was in the past, when I would bulk up even heavier. I stay at kind of a slim 225, and I feel best at that weight. For me to get under that weight, I really have to go hungry sort of. So if I eat sort of just to stay satiated and I stay with a ketogenic diet, I kind of maintain my weight. As long as I am hitting the major exercises in the gym. I’m a lot more flexible in the way I’m eating. Like some people may perceive the Ketogenic diet as a very inflexible rigid way of eating, although I kind of follow a low carb modified Atkins kind of approach. The Ketogenic diet I like to put in the realm of the clinical. I find it very liberating because I don’t get hungry, my cognitive performance is better. My energy is sustained throughout the day, much better. I don’t have to have frequent feedings to keep my energy levels up.

Drew: Yeah. That’s a perfect segment into what I want to talk about next. What is ketosis verses just your typical low carb diet, which is what was the craze 10-15 years ago with Atkins. So, some people might have some misconceptions about, ‘Oh, Keto is low carb.’  Yes, but there is more to it than that. Can you talk about …. let’s start out with what ketosis is for those who don’t even know?

Dominic: Ok, I do like to take a step back when we talk about ketosis and I like to put it in a context, first in a context of fasting. Because, that’s kind of like, ketosis is a natural state of our physiology that our ancestors would go in and out of. I think that’s important to understand and it’s not a metabolic derangement. Most doctors are taught that, maybe I’m guilty of that. I’m at a medical school and that’s what our students are taught. I try to get in a little bit of education about nutritional ketosis. Ketosis is, if we take the view of fasting, when you stop eating, you have limited glucose availability through your glycogen stores, right? And primarily your liver glycogen. And once that’s depleted, your body will quickly liberate free fatty acids for fuel. These fats are liberated from our adipose tissue and long chains fatty acids typically don’t cross the blood/brain barrier very readily, so the liver, it further enhances it’s fat oxidation and converts many of these fatty acids into ketone bodies through accelerated fat burning in the liver. Ketone bodies, I like to call them water soluble fat molecules, because they are broken down into smaller molecules that when they are in the blood, they can readily transport across cell membranes. Even easier than glucose really, because you have the use of various transport mechanisms that allow it to get into tissues and function as fuel more efficiently than glucose. It can cross the blood/brain barrier and become a highly efficient fuel. It’s even been called an upper fuel because you can sort of derive more energy per oxygen molecule out of it for the brain. After you have fasted for a couple of days, your brain adapts to using ketones for an energy source. The ketogenic diet, or a low carbohydrate diet, that’s restricted enough in carbohydrates, and sufficient enough in fats, mimics that state of fasting. If you were to draw blood out of someone on a clinically implemented ketogenic diet, it would look like they are fasting. That is done medically for the medical management for epilepsy and other seizure disorders. Early reports of fasting controlling seizures led clinicians into the direction of the Ketogenic diet because they say they could mimic that physiological state. Looking into that a little further, that’s interesting that it works clinically in that way to manage epilepsy. It must be enhancing or preserving or in some way altering brain function to make it function normally in a pathological state. That’s kind of how my research got into that. Ketosis, the nutritional Ketosis is defined by a macronutrient ratio that’s low in and sufficient in protein, very high in fat and low and restricted enough in carbohydrates that you sort of have depleted liver glycogen or glycogen reserves, to drive hepatic ketogenesis or liver ketogenesis. And when your in that state, you can derive a lot of benefits from it. But the diet to achieve that state, it’s important to understand, is different in individuals. Whether they are sedentary or an athlete, a child or a 56 year old man.

Drew: Yeah. But that’s a great starting point. So basically, what you are saying is your body can run off two different kinds of fuel sources. Glucoses, which is what most of us in today’s day and age, are used to running off of, right? Or ketones, but ketones are more efficient fuel sources. But in order to get into ketosis you have to either fast, right? Or you can mimic that by changing up your macronutrients to a high fat, moderate protein, low carb approach, where some people might think, ‘Oh, low carb, but then a lot of protein and a lot of fat as well.’ But I think that was the approach back in the 90’s, was cut off carbs but eat a lot of protein. And that’s where people can go around it the wrong way, because the proteins convert into glucose, if you eat too much of it, correct? It’ll bump you out of ketosis, for some people.

Dominic: It can, yeah. It definitely can. Too much protein can convert over to glucose through gluconeogenesis. It can also stimulate the hormone insulin. There’s a little bit of question as to how much gluconeogenesis is actually altered by verifying protein consumption, that still needs to be studied. Some studies show that it stays fairly constant. It has not been studied in the context of like bodybuilders, who are eating 200-300, I mean I was 450-500 grams of protein back when I was like really trying with my metabolism. Like a typical meal would be like steak and eggs and wash it down with a metrix on my way to school. And I would eat again in two hours. No one has studied that sort of thing and people are actually doing that. There are guys out there, I talk to football players and athletes and powerlifters that are sort of eating in that way, 300-400 grams of protein a day and that just has not been studied. I’ve actually gotten blood measurements from some of those people eating 350 grams of protein a day and many of them are hitting ketosis. They are doing 2 1/2 hours sessions in the gym and then like a high intensity cardio interval training at nighttime or something like that. Maybe they are taking drugs and stuff too which could alter that. I’ve seen guys who have contacted me and they are not following a traditional Ketogenic diet, they are low carb but they are still hitting blood ketone numbers …. and some of them are supplementing with MCT, so that could further bump you up into ketosis.

Drew: So really quick, let’s say for example you eat a quest bar or you have like whey protein, has whey protein been found to spike your blood sugar levels verses like grass fed burger or bacon and eggs, something like that? Your saying there are no studies on that or what about whey protein?

Dominic: That’s a good question. I have found personally that liquid calories, like just a pure whey protein will kick me out of ketosis. An equal amount of protein from a meat source, has a different metabolic response in me and in pretty much everyone that I see. If your going to take whey, I think there is a lot of potential out there for a shake to have a base of coconut milk, like either coconut milk powder or MCT powder with whey added to it. And then that would slow the gastric emptying time and release the whey into the system a little bit slower so you could still maintain ketosis. Yeah, that would be my suggestion so if someone could do that themselves or you know …. waiting for someone to make a product like that. I think that would be something that I would take personally. I don’t really tolerate dairy protein very well though, so I am also a big whole foods person. I like to eat my meals instead of drink it. But I think it could be a useful product for some people.

Drew: So, ok getting back to the Ketogenic diet. Who would you recommend this diet not be for? Or do you think everybody across the board could benefit from this diet? For example, like a strength athlete, endurance athlete, someone who is trying to lose 200 pounds. Someone who is trying to gain lean muscle? Or are there certain types of people out there that probably wouldn’t benefit from a ketogenic diet?

Dominic: Well, I would need a lot of information to answer that, but I think most people that I have been in touch with have definite health benefits from a ketogenic diet. But it really depends on where their starting point is coming from. I’ve seen tremendous response in people who thought they were eating well and they were Type 2 Diabetes and insulin resistant and they were moderately overweight. They were primarily on a high carb low fat diet and they have had a remarkable response to nutritional ketosis. And some women on the other hand, have not responded as favorably as I would have predicted. So I think the variability seems to come more with women and with women athletes. But men, I think men are just hardwired to be able to fast. *laughing* When women have a dip in their blood sugar, that hypoglycemia sends a stress response to their brain and I think they have some hormonal considerations they need to address. But once they are adapted, there are some female athletes that thrive on a ketogenic diet. But I think the take home message is that the women are a little more variable, where the large majority of men adapt really well, especially if they are athletes.

Drew: So what are some, in your opinion, since your in the industry, what are some myths about ketosis that some people have or still think about the keto diet?

Dominic: Myths? There are quite a lot of them and they come from different circles. That ketosis is a dangerous state to be in. I can’t tell you how many talks I have given and I have like a clinician or even a dietician really, say, ‘Well, what about ketoacidosis?’ Ketoacidosis is a particular metabolic state that is specifically associated with Type 1 Diabetes, where there is a lack of insulin. The body has really tight control over insulin and when your on a ketogenic diet, which I will call nutritional ketosis, your body regulates its ketone levels within a pretty tight range. And you will have ketone uria, you’ll break them down and use them as metabolic fuel and if your ketone levels start to rise too much, you’ll have ketone induced insulin release. So the ketones will actually cause a small release of insulin from the pancreas and that will shut off ketogenesis in the liver. There are a couple of other mechanisms too. But that is sort of the main one and that would prevent anyone with a normal physiology, anyone who doesn’t have a pre-existing metabolic derangement in the form of insulin insufficiency, to do really well on the diet and to maintain their own ketone levels.

So you have Diabetic ketoacidosis associated with type 1 Diabetics and then you have alcoholic ketoacidosis, which is kind of something in and of itself. If you are dehydrated and you’re drinking alcohol on an empty stomach, you can have pretty altered electrolytes and you see this sort of …. my friends work the ER in New Orleans and you see it during Mardi Gras, when people just drink too much. Or they are on spring break, you get kids coming in who have this sometimes because they go on a binge drinking and they don’t eat for a couple of days and they can get into trouble. So one would then predict maybe that it’s not a good approach for a Type 1 Diabetic. But I’ve got to tell you, there’s a lot of Type 1 Diabetics that have contacted me that said this was the key thing to wean them off of excess insulin. When they are following a high carb approach, they were bumping up their insulin more and more and then they found they could cut back their insulin 60-80, sometimes 90% less insulin. Whenever your using less insulin, injectable insulin, that’s a good thing. It would be hard for your doctor to argue against that. If your following a nutritional program that requires far less insulin, that’s really, really a good thing. That’s what happens with Type 1 Diabetics, but they have to have better oversight over their ketones because they could potentially get into trouble faster, if they didn’t have an insulin pump and they didn’t have it managed well. One of my students is a Type one Diabetic and he does really well switching from high carb to ketogenic diet. There is a doctor in this area, Dr. Keith Runyon, and he wrote a book, The Ketogenic Diet for Type 1 Diabetics, that you can find on Ketogenicdietresource.com. There are two books he wrote, one is The Ketogenic Diet for Type 2 Diabetics and he was brave enough to write a book for Ketogenic Diet for Type 1 Diabetics. This is because he’s a medical doctor and he has Type 1 Diabetes and the guy also runs like marathons and stuff. He has used the Ketogenic diet for that.

Drew: Interesting. That’s interesting. I wonder if there has been backlash from people in the medical community from people who have kind of gone after him, to kind of challenge him in a way. It sounds like from his perspective, and he’s a medical doctor and so he knows what he’s talking about and he’s Type 1 Diabetic himself, your saying?

Dominic: Yeah, he’s Type 1 Diabetic. I probably have at least a dozen Type 1 Diabetics that have contacted me that sort of stay in touch. I will respond back to people and some people I want to hear back from them, more than others, kind of. When they contacted me and asked could I use this approach with Type 1 Diabetes and I give them a cautious, ‘Well maybe, do the research, read this book, read into it.’ Everyone who has contacted me and has tried this approach, it has worked wonders. Occasionally you get people that can get completely off insulin. I think maybe their pancreas is making a little bit of insulin. I don’t think you could completely get off insulin, but a few people have reported that they could. But most people just cut their insulin dose at least in half, if they are eating a standard diet. From a standard diet to a ketogenic diet, they can cut their insulin at least in half and sometimes 60-80, even like I said 90% less insulin.

Drew: That is cool. That’s what I am trying to touch on. The Ketogenic diet for the most part, I think there’s a lot of people that could benefit from this diet, not just people that are trying to lose weight or lose fat. But people with medical conditions, like Type 1 or Type 2 Diabetes. Then I want to shift over to another thing I kind of hear in the industry about strength athletes putting on muscle and then also endurance athletes, because everyone is like, ‘You’ve got to have carbs to put on muscle, you’ve got to have carbs to run marathons.’ What have you found in your research for those people who are trying to gain lean mass and those people that do endurance running who have been set in their ways for so long with a glucose based diet?

Dominic: I get this question a lot and our lab is primarily an animal model lab, but we do subcontract out human research and we started doing that. I would say we are about 2/3rds or more animal model research, but we do have some human studies that we’ve completed and hope to continue to expand in more human studies. The research on the Ketogenic diet for strength athletes has shown up to this point, it doesn’t give you an advantage in terms of strength and size but it does give you an advantage in terms of maintaining and being able to add, enabling you to add strength and size while losing body fat faster. You get a stronger recomposition effect and that’s even in kids, like college age kids. What I want is to kind of reproduce this study and do it in guys that are 50 and 60 because I think you’d even get a better response because we become more carbohydrate intolerant as we age. I think the Ketogenic diet can be a tool that can be used perhaps continuously, but maybe in the younger population intermittently during periods when they want to enhance their body composition or their power to weight ratio. Whether it be for powerlifting or something like that, a stronger package pound for pound. The first study that we published in 2012, it was with collaborators in Italy and it was with gymnastics. There was a variety of exercises like dips and pull ups and things like that, to look at their strength. They were able to maintain their strength performance on a Ketogenic diet and able to reduce their body fat more than with a standard diet. That’s pretty common, but gaining, a lot of kids will contact me, like 20 year olds asking, ‘Can I bulk up on a Ketogenic diet?’ I grew up in an Italian family and we ate lots of pasta and carbs. I tolerated it really well. I couldn’t continue to do that now. I wouldn’t carb up for my desk job here. But when I was younger, I did a lot of farm work and was pretty active and went mountain biking and things like that. I had more time to work out in a gym. Maybe you could titrate your carbohydrates based on your activity, but generally speaking, when your younger, your carbohydrate tolerance is much greater. As we age, it may be due in part to a lifestyle where your maybe not as active as you were when you were a little younger. But generally as we age, our carbohydrate tolerance goes down, so I think if we shift towards eating low carb, that’s a good thing. Most people could benefit by using a Ketogenic diet whether it be continuously or just intermittently through periods of the year. I think maybe we weren’t supposed to eat the same way all the time and food availability was always changing based on seasons. It’s good to kind of fluctuate and to allow our bodies to adapt to different types of eating maybe different foods to, to promote metabolic flexibility in that way. I admit, I’ve been on a Ketogenic diet pretty much continuously because I am always trying different Ketogenic recipes, different ketone supplements. As I speak to you, I am opening up a package now of a new Ketone product that came out. I like to kind of maintain, I feel better myself, staying in a state of ketosis and it’s part of my research. But if I wasn’t a researcher in ketosis, I would probably kind of rotate my diet a little bit more.

Drew: That’s what I was going to ask, is there any downside to staying in Ketosis for a long period of time or is there a certain period of time that is optimal? I guess it’ll differ per person based on their goals, but is there any danger to staying in a state of ketosis for a long period of time? Like what your doing?

Dominic: I think they would need to get blood work to determine that, but based on what I’ve seen, if someone was to follow like a 3-1 or 4-1 ratio Ketogenic diet that’s used in the clinical realm, that’s like 90% fat, 85-90% fat and the protein is pretty low, like 8-10%, so that’s pretty extreme. And following that could probably lead to some changes in blood lipid profile, that could be alarming to most doctors and the general medical community with an elevation of LDL, maybe an elevation in triglycerides. If they have not kept to calorie constricting, they probably wouldn’t see the rise in triglycerides. But if you look at the data, there is a population of people out there that have drug resistant epilepsy that have been on the diet and continue with the diet for decades even. Their blood work looks pretty good. I know some of them and you can look at the studies. Some of the early studies showed an elevation of triglycerides and some abnormal blood work, but many of these studies were not done in kids and some of them were also on anti-epilepsy drugs. They were also using a ketogenic diet product called “KetoCal”. Back then KetoCal was primarily, it was basically casing and hydrogenated soybean oil. Yeah, it had a lot of hydrogenated fats. It think now they’ve took the fats out but it’s still far from ideal. You could formulate a ketogenic diet that would be much better than that. I think their continuing, Nutricia is continuing to improve that product as the nutrition community learns more about different types of fats. So people will point to some of those studies and say, ‘Look, the Ketogenic diet can be dangerous. Look what it did to these kids. They had high triglycerides.’ That’s a 4-1 ratio diet, that’s very extreme relative to what athletes are doing with a modified Atkins diet. I think it’s going to vary depending on the person, but generally no. Generally, I don’t see it as, unless …. everybody’s metabolic physiology is different. We are all a unique metabolic entity, I like to say. The field of nutrigenomics is probably going to contribute a lot into this question in the next 3-5 years. I think it can predict whether you have a deficiency in a betaoxydation pathway that would reduce your capacity for your liver to make ketones or reduce your capacity for certain tissues to utilize ketones as an energy source. Or whether you will become deficient in a particular micronutrient if you go on this diet. I think our tools for nutrition are increasing expedientially really as technology advances. I think in the future you can envision a technology that you can allow us to analyze a drop of blood and give a good kind of overall prescription of a diet that you shouldn’t follow, not necessarily a diet that you should follow. But it can tell you the data from 23 and me, you can take that data and export it to a number of different services out there that are at least advertising that they can do that right now. I have a list of about 10 of them, I am still researching them to figure out how valid their services are. That’s really exciting to me. I know that I’m a fast caffeine metabolizer. But I know someone who’s not, my fiancé freaks out if she has a little espresso and her heart starts racing. So like I have the gene that allows me to metabolize caffeine very fast and I know a few people that are extremely sensitive to it. And the same thing can happen with diet and with different types of foods. You can have someone who is just intolerant to high levels of fat. I think they are few and far between, but I think they are out there and it’s not like they are or they’re not, it’s like a spectrum in many cases. A spectrum based on your genetic profile.

Drew: So, let me stop you there and ask you right before we move to the next question I had, is there a minimum amount of time that someone should experiment with nutritional ketosis before they throw it out the window? For example, they feel horrible on day 2 or day 3 and they are like, ‘Oh this is horrible, I should just stop.’ Is there a minimum amount of time, 30 days or 60 days where they should go all out and to really experiment to see if it’s really for them or not?

Drew: Like what should be the minimum amount of time that they should try it before they say, ‘It’s not for me.’

Dominic: I would say no less than 3 weeks, definitely no less than 3 weeks. I think a lot of the fatigue and sluggishness you feel occurs in the first 2 weeks and usually most people by the 3rd week, they are starting to feel better. You really probably want to go 4-6 weeks, but I would say no less than 3 weeks to give it an honest to goodness shot. There are some things you want to do right off the bat. Ensure that your sodium is adequate, that your overall electrolytes consumption is bumped up pretty significantly. Being in a state of ketosis has a diuretic effect, so you are eliminating more water and with that water goes sodium, potassium, calcium, magnesium, so these things supplemented would be a good idea. I was getting a lot of calf cramps at nighttime and I found that supplementation of magnesium in the form of magnesium citrate, that solved that problem within 3 days. I did blood work where my magnesium was on the low end of the spectrum, almost out of range, but when I supplemented, that put me in the high normal range of magnesium. Since then, I’ve been in that high normal range and I never got cramps again. I went almost a year or so getting cramps and didn’t supplement magnesium, but that was my only side effect.

Drew: I’ve heard about taking too much magnesium as well and what that can do to your system. *laughing*

Dominic: Yeah, depends on the form. What form are you talking about? Like magnesium oxide is ok, but you know, there are some studies on it that show you just need to take more of it, but people can have an intolerance to it. It can cause some GI issues. The form of magnesium is pretty important. I have a powder at home, I forget what it’s called. It’s magnesium citrate, it’s one of the more popular powders. It’s like supposed to make you calm and relax, which magnesium sort of does that and I take it before I go to bed. Since I’ve been taking that product, that has really remedied. But the first really good magnesium supplement that I took, that I felt worked, was magnesium glycinate. So it’s magnesium bound to a protein or amino acid, is what I would recommend.

Drew: Shifting gears here a little bit, well actually we forgot to talk about endurance athletes. We talked about strength athletes. What about endurance, the Ketogenic diet for endurance athletes?

Dominic: Yeah, being fat adapted gives you a lot of advantages for an endurance athlete. First and foremost, you have better access to a greater reserve of fuel. So your fat oxidation pathways are significantly upregulated over time and if you just look at your fat oxidation capacity, it could be 2-3 fold higher. Jeff Volek recently published a work, he’s worked in metabolism on that, he gave a great talk on this, if you go to IHMC evening lecture series. He gave a great one hour to 45 minute talk on research of high carb basically. Elite level high carbohydrate diet based athletes and elite level athletes that were following a high fat diet. He just looked at oxidation. The highest fat burners in the high carb group were not even close to the lowest fat oxidizers of the ketogenic diet group. So their fat oxidation capacity were literally like 2-3 fold higher and that has very practical advantages for an athlete for having to refuel during the work out. When your refueling and undergoing strenuous physical exertion throwing in calories into your GI system is really not a good thing. Because your GI system takes a lot of energy and really a lot of blood to make it sort of work properly and when your running a marathon or your all out physical activity, you don’t want to have to be pounding calories, especially in the form of sugary syrups and stuff that could cause GI issues. Water and electrolytes, yeah, I think they are things that are easily absorbed. These fat adapted athletes, they’ll tell you, they just feel better fasted. They don’t even try to drink like MCT or anything during the race. We have plenty of fat stores for a marathon. Your not going to waste away during a marathon, you just give your body fluids, give it electrolytes and if you are fat adapted, you’re good to go. If you are not fat adapted, if you’re carb dependent or sugar dependent and you do an ultra marathon, you are going to have to do a significant amount of refeeding during that. A fat adapted person may need to refeed too, but being fat adapted is also very glycogen sparing. Because you are liberating more fatty acids for fuel, you are kind of sparing your liver glycogen. And someone who is fat adapted, leading up to a race, they could continue eating their Ketogenic diet foods, but maybe bump up their calories. You know, eat an extra 2000-4000 calories leading up to it and their glycogen reserves will fill up. It won’t fill up like carb loading, but they will fill up enough and it’s probably good to have even a tiny little bit of extra fat too.

Drew: Ok, yeah that’s what I was going to say. For people that if they are not fat adapted, they shouldn’t just stop eating carbs the night before a race and then a bunch of fats expecting to see the benefits of eating the fats instead of the carbs before a race, because their body is still depending on the glucose, right?

Dominic: Yes, that’s just one thing. The other thing would be less inflammation, less damage in guys that are Keto adapted or fat adapted. We think there’s good evidence now that ketones have an anti-inflammatory effect. We did some work using exogenous ketones with our collaborators at Yale and showed that there is a particular inflammatory pathway, the NLRP3 inflammasone actually. That was published in Nature Medicine. It showed that the ketones suppress an inflammatory pathway, that when it’s activated, leads to the liberation of all sorts of inflammatory cytokines that can cause muscle damage and inflammation. Keeping that inflammatory pathway suppressed during rigorous exercise, is a really important thing. We are doing some follow up work looking at cytokine levels. Follow up work from that paper determines specifically how it’s doing that and what cytokines may be most important. So you have the inflammatory component and you have ketones, so your brain running off ketones may likely provide a lot of advantages. Even for athletes who are not particularly having to think and do exhausting mental activities when they are running. But the ketones probably delay the onset of mental fatigue or the perception of exertion. Like branch chain amino acids kind of do that too by eliminating the serotonin to the brain, so that perceived exertion could be less. Caffeine does that too and the studies have not been done yet, but we think the ketones, having a steady fuel flow to the brain and keeping the brain happy, has significant advantages mentally for an athlete when it comes to perceived exertion, just delaying central fatigue that may be contributing to impaired exercise performance. Especially with long duration exercise performance.

Drew: So a really quick question about that, because I want to get into exogenous ketones here in a little bit. But before that, from what I’m hearing as far as that goes, I was going to ask you about Keto and CrossFit athletes and Keto or nutritional ketosis for CrossFit athletes and for NFL players. So those types of activities. I don’t know if you’ve done research on CrossFit athletes or NFL players yet, but what have you seen or heard about benefits? Or maybe non-beneficial things with the Keto diet in those type of athletes?

Dominic: Yeah, that’s a good question. I have not studied CrossFit athletes. All I can say is I do get feedback, and you know what you can draw from that may be biased. Maybe only the CrossFit athletes that are getting great responses are contacting me. A few have contacted me and just said, ‘I’m having a hard time keeping up the intensity in my routine. I switched to a Ketogenic diet and I’m just kind of struggling in the gym.’ I will respond back and be like, ‘Well how long are you doing it? What are your Ketone levels? Tell me exactly what your eating?’ And its like, ‘Yeah I’m on my second week now and I’m just kind of dragging.’ And a few of them got back to me and it was like, ‘Yeah you were right, I just stuck with it. I incorporated some MCT’s into my food and I read Jeff Volek’s book and I figured out that I was doing a few things wrong. Overtime my body adapted to it and I’m doing really well.’ I think your body’s capacity to adapt metabolically, especially in athletes is really great. You can actually change your metabolic physiology over time and I think that’s really exciting to me that you can just kind of alter your energy pathways with time. I know I have in my body. I can oxidise fat so much more efficiently and just run off fat and ketones more efficiently than I did when I first started experimenting with the diet. That’s a message that I want to convey to people. And I think that Jeff Volek and Stephen Phinney do that too when they give their talks and in their book. Just kind of stick with it and forcing your body to change its metabolic physiology is not like a real easy thing to do. But I think you can derive a lot of benefits from it. I think it’s really important to give the Ketogenic diet a chance because you’ve got to give your body time to adapt to it and that adaptation rate is going to vary depending on the person. I think there are ways you can help your body adapt to it too but I think there are  lot of benefits you can derive from eating just low carb and not necessarily Ketogenic initially. And that becomes kind of a gateway to the Ketogenic diet if you want to. Because when you transfer from eating high carb to low carb and not necessarily Ketogenic, that kind of weans your brain off the need for spikes in glucose or high glucose.

Drew: Oh, sorry how about …. go ahead

Dominic: NFL right? I think you were going to ….

Drew: Yeah, or football players in general. Like have you gotten feedback from NFL players or football players in general?Dominic: Yeah. There’s a few that, a lot of high school kids and parents of high school kids, are really enthusiastic about the Ketogenic diet because they understand the neuroprotective effects of ketones. When it comes to performance too, depending on your physician and everything, right? There could be a performance advantage. Most of the kids, when I talk to coaches, most of the coaches are trying to get a lot of their kids to lose weight, so they have them running a lot. Depending on where you are at in the state, like maybe in Florida or Georgia, we have a little bit beefier or heavier kids. They just need to kind of tone up and lose weight as they go into their position. I think we’re not studying NFL players, but I think it would be an interesting population to study. I think even if you just consider the neuroprotective effect of ketones ….

Drew: What does that mean? What does that mean, neuroprotective effect? Just so people know ….

Dominic: Well there is a lot of discussion …. anything regarding ketones and football, the questions I usually get have to do with brain injury and concussions. So, that has been a big topic of discussion with the investigators that I talk to. When your brain is running off ketones, it has a lot of higher energetic capacity and also the ketones have an anti-inflammatory effect. We know that after we get traumatic brain injury or concussion, there’s an energetic crisis that is sensed in the brain. That energetic crisis results in impaired glucose metabolism and there’s half dozen or more different pathways that have been indentified. Internalization of the glucose transporter from the membrane, the glut3 transporter, pyruvate dehydrogenase complex PVH, that becomes less active. So these are the things that allow brain cells to use glucose for fuel,  they don’t work that well. So these pathways that are impaired with brain injury have little or no effect on ketone metabolism. An elevation of blood ketones would allow an alternative energy sub-straight, to sort of bathe the brain and restore brain energy metabolism in the face of that glucose energy crisis. After brain energy, if you can preserve and continue normal brain function, that’s really an important thing to do. We know the Ketogenic diet, it’s kind of a mystery in some ways, we don’t know exactly how it works. We think it works 20 or 30 different ways, kind of all synergistically together. The important thing we do know, is it preserves brain homeostasis, and normal brain activity and doing that in the context of brain injury, I think it’s extremely important. That’s sort of from an energy perspective and also from a signaling perspective, which I don’t want to get too deep into the science. But we know there is specific pathways in the brain, that when they are activated, leads to significant neuro inflammation. This chronic sort of encephalitis that athletes have, this chronic inflammation, leads to the downstream consequences from the brain injury. We think the suppression of specific inflammatory pathways, like ketones, can prevent that from happening. And that’s sort of a big focus of our lab now, is to look at those inflammatory pathways.

Drew:  That is awesome, man. For me, that is groundbreaking. I think a lot of people will find that type of information, that knowledge, very beneficial for them specifically or for someone that they know that plays football for example. We will see where this goes, 5-10 years from now. I don’t know, I mean the research is just very interesting to me. We will have to have you back on again and talk about that kind of stuff when you find more data on that. Ok, I want to shift gears here and talk about exogenous ketones. Ketone supplements, for example Kegenix is a company I was introduced to. I tried out their product, their exogenous ketone supplement. What is that and why would it be beneficial for people to take verses like a nutritional ketosis type of diet? Where do you see that supplement fitting in and why is everybody talking about? Why is everybody so excited about these exogenous ketones?

Dominic: I think there’s …. my lab, probably about more than half of what I do is on these exogenous ketones. We also look at metabolic drugs and the Ketogenic diet. The interesting thing about exogenous ketones, we were talking about NFL players, right? So say you get a hit and get knocked unconscious and you get significant brain injury, and your not on a Ketogenic diet, if you put that guy on a Ketogenic diet, it could take 2-3 days to get into ketosis. If you have an exogenous ketone supplement, he could be in ketosis in like 10 minutes, really, or under an hour for sure. In 10 minutes you start to see an elevation of blood ketones pretty quick. That’s from a therapeutic point of view, that’s really important. I’ve always been interested in inducing, like rapidly inducing nutritional ketosis, sustaining it and supporting it. And that’s what exogenous ketones do. I approached it from the perspective of the Navy Seal diver that could experience oxygen toxicity seizures, right? They need something they can take right before a mission that will preserve their performance and prevent them from going into a seizure during their mission. That’s really difficult to do with the Ketogenic diet so that’s where our original exogenous ketone, was the ketone ester. These are really potent and they taste absolutely horrible, but perhaps in the future we can make them in a way that’s more affordable and that doesn’t taste like gasoline. Now Kegenix, is a product and there are other products out there, kegenix is really a product that is kind of paving the way and developing a beta hydroxybutyrate and combined with medium chain triglyceride formula. This formula is kind of based off some research we did in the lab showing that a ratio of beta hydroxybutyrate in a mineral salt, so you combine beta hydroxybutyrate with sodium, potassium, calcium or magnesium and those ketone salts are formulated with a medium chain triglyceride powder, which is a form of fat. When it’s mixed together and ingested, the fat sort of acts to sustain that level of ketosis over time. And more or less functions like a delivery system and different ratios work better than other ratios. That’s what Kegenix essentially is, and there is various cofactors and a few other things added to help promote and sustain that nutritional ketosis. Things that also enhance fat oxidation are included in the product. And whenever your enhancing fat oxidation, your enhancing your ability to make ketones because naturally, if your in ketosis without an exogenous ketone product, those ketones are a result of fat oxidation. The product can actually enhance your own endogenous ketone production, while simultaneously providing it’s own source of ketones to the body.

Drew: Interesting. I was surprised first of all, I had heard these exogenous ketones taste horrible and they are very salty. For example, I had Kegenix and it actually tasted really good. So that was the first thing that surprised me, these taste really good. Your talking about the Ketone Esters, those things are the things you haven’t found a way to make those taste good yet, right?

Dominic: They are more potent in a gram per gram basis. They are more potent and they are also made sort of synthetically, whereas Kegenix are derived from products that are derived from nature actually. So the precursors are more or less found in nature where the Ketone Esters, they probably fit into a category that’s made depending on the type of Ester and the particular formula, it could be in the realm of a prescription medical food. They may be better off being put into a capsule and not into a shake that you drink. The future of exogenous ketones really lies in developing something that tastes good no matter how potent or how effective a product is, if it doesn’t taste good, it’s not going to work. I think that there is a lot of potential to develop various ketone salts. A lot of work still needs to be done by our labs and hopefully other labs will study this to screen out what forms of beta hydroxybutyrate are most effective, tolerable, palatable and that could be put into a formula. Various formulas can be developed for a specific application, whether it be for the football field or a military scenario, or for a medical scenario. You have a situation like status epilepticus, when kids go into a constant sustained seizure. When you are a kid, you don’t want to give them large doses of anti-seizure drugs, because it can cause developmental problems later on. But we know the diet works, but implementing the diet takes time, right? So if you have a kid in status epilepticus, if you can give them …. a lot of these things can be put into an IV formula or intragastric, so you can quickly deliver the ketones to suppress the seizures and to control it and your giving the body something that it has naturally anyway. If you measure the blood, its bio-identical. The ketones that are elevated in your blood, from the Kegenix product, are bioidentical to the ones your body makes its own way. I think that’s very important.

Drew: Let me talk about the application of these exogenous ketones, like Kegenix. For example, instead of waiting 2, 3, 4 or 5 days, however long it takes to get into a state of ketosis, you could take this product and essentially bypass those days and then from there, just sustain a ketogenic diet. Your kind of bypassing 4 or 5 days of having to transition from glucose over to ketones, correct? Within 60 minutes?

Dominic: Yeah, that’s I think a really practical application. When people start a ketogenic diet, they go into what I call glucose withdrawal, their brain goes into glucose withdrawal and it can send …. it can put your body into a state of stress. If your body senses hypoglycemia, your going to have a dump of cortisol. Your adrenal glands are going to be activated and your epinephrine, your adrenaline is going to be even further activated from the hypoglycemia. It will lead to shaking, high heart rate, perhaps palpitations. If you supply your body with ketones, it’s sort of more or less telling your brain, it’s not going into a physiological energy crisis, right? It will impact our physiology in a way to just preserve normal physiology as you transition into a Ketogenic diet. That’s important.

Drew: Here is what is so cool about that is, we are all into hacking things in our life to make life simpler. And this sounds like an awesome way to hack the Ketogenic diet without having the ‘keto flu’, as some people call it, which is what I think your describing there. Your kind of hacking that, bypassing that, jumping right into a state of ketosis by just taking this powdered drink and it taste good by the way. But let me ask you, later on down the road, your taking the product, your eating a keto friendly diet and your into a state of ketosis. Let’s say for whatever reason your like, ‘You know what, I’m having a bad day. I’m going to have some donuts and some beer.’ Are you saying people could have that, but then afterwards take Kegenix or some exogenous ketones and then be right back into a state of ketosis, or does it take some time to get rid of all that glucose you just had? Or is this product saying, even if you have glucose in your system, you could transition over to ketones within 60 minutes?

Dominic: Yeah, you could stay in nutritional ketosis independent of carbohydrate intake. So yeah, and that’s how we really started studying ketones is because the military, they didn’t want to implement any kind of carbohydrate restriction. Most of their food sources are MRE’s are carb based and even what they call their first strike ration, you know something you take immediately before battle, is basically corn syrup, sugar and caffeine. *laughing*

Drew: Oh my gosh. *laughing*

Dominic: Yeah, the military is kind of archaic in the way they think about their nutrition program, but that’s changing I think. I’ve been giving talks there and stuff. You can follow a high carb diet and take exogenous ketones and still measure your blood and it would indicate that your at a level of ketosis consistent with a person that is on a Ketogenic diet, a strict Ketogenic diet.

Drew: Will your body choose ketones over the glucose? Is that what your body will do or does it …. I guess I’m asking if there is glucose and ketones in the system, it’ll choose ketones over glucose?

Dominic: Your body will use …. I get this question a lot, and it’s a really good question. If your getting glucose and getting ketones in your blood, or from your diet, your body will use whatever is available. So if your keto adapted, it may use proportionately more ketones for fuel, your brain may do that. As we age, there is great work by Stephen Cunnane, that showed as we age, our brain has impaired glucose metabolism. But as we age, our ketone metabolism does not increase, so we can potentially derive or get more benefits, the aging brain from ketones. But generally speaking, our brains and our cells are already hardwired to use ketones as an energy source. We have what’s called the monocarboxylic acid transporters and there’s MCT transporters 1, 2 up to 4. MCT transporter 2 is in the brain. It’s the same transporter as lactaid actually, so yeah, our bodies have that. If we were to stay in ketosis, like strict ketosis over time, the protein for that transporter is sort of upregulated and increased over time and our bodies manufacture more transporters on the membranes of the cells. And that’s been shown in animal models and we think that would happen in humans too. And also the ketolytic enzyme increase over time. So if we are forcing our body to burn more ketones for fuel and forcing our tissues and our physiology as a whole to use ketones as an energy source, the metabolic pathways will increase. So the various enzymes and the metabolic pathways that allow us to derive energy from ketones are upregulated and can be sustained over time when we have the diet. So the take home from that, or the implications could be, if you are fat adapted and you are keto adapted and you take a ketone supplement, you may have better transport and utilization of those ketones. That’s sort of what we think but we need to do a study to confirm that. There’s an exercise study that was done at Oxford with a ketone ester and it looked like more or less at elite level athletes, but they were carb adapted, they were following a standard diet. They benefited tremendously from exogenous ketones, as far as power output rowing. So one could argue though, if you are an athlete, you produce more lactate and your probably bouncing in and out of ketosis because you have these depleting workouts, so your already somewhat fat adapted and keto adapted. To really answer this question, Jeff Volek might be working on it, we really need to take tissues, muscle biopsies and do some pretty elegant global metabolomics and also tracer based metabolomics, where we look at the fate of glucose and the fate of exogenous beta hydroxybutyrate with tracer based technologies.

Drew: So basically what you’re saying is even if someone is in nutritional ketosis, even taking exogenous ketones could benefit them when it comes to performance enhancement verses just your typical keto diet, right? Is that what your saying?

Dominic: Yeah, so if you are on a standard diet or if you go off the Ketogenic diet and take ketones, you are still using those ketones for energy and you’re still getting benefits from it. There is some pretty good evidence out there from our lab and other labs showing that you have better utilization of glucose when ketones are in your system. We don’t know exactly why, but we think ketones enhance insulin sensitivity. Ketones influence various endogenous antioxidant pathways, that when they are influenced and certain oxidative pathways or oxidative stress markers are decreased, that can enhance insulin signaling in a way that would enhance peripheral glucose disposal. If we give a bolus, a big dose of an exogenous ketone and we look at blood glucose, it goes down. So the question is, why does glucose go down if your giving exogenous ketones by mouth or with the food or with an intragastric lavage? There are two reasons for that, either it’s decreasing hepatic gluconeogenesis or it’s enhancing peripheral glucose uptake from the tissues, and I think it’s both. I think both things are happening. Insulin is working more effectively and our tissues become, have a greater capacity for transporting glucose and the liver is kind of turning down its gluconeogenesis because its sensing, hey I have energy here so I don’t need to dump all this glucose into the bloodstream. The liver is a really incredible energy sensing organ. That’s why a healthy liver is a really good thing. If your taking something that impairs your liver function, whether it be some kind of drug or alcohol or something like that, it’s really messing up your metabolic physiology. I always tell people, look at your liver enzymes. Your liver enzymes are a really good bio marker for your overall metabolic physiology and your general health. If your liver is working well, everything else is probably working well.

Drew: Ok, interesting. So basically, because I know people are going to ask me this, because they might not understand everything you just said. *laughing* Let’s say they are a Type 2 Diabetic and they miss donuts and they miss sugar. They could take the exogenous ketone supplement and then just get away a little bit with some cheat meals here and there verses if they didn’t have the ketones in their system.

Dominic: I do that too. I follow a Ketogenic Diet 95% of the time, maybe 98% of the time, but I do go out and I’ll have sushi, I’ll have popcorn at the movies sometimes or if there is cheesecake or something like that, I give in. When I do this occasionally, I become even more obsessed with measuring my glucose. What I find is that my glucose rarely bumps up. I typically stay about 3.580, I did a lot of glucose measurements when I was in college, because I did a whole project on diabetics and I did tons of glucose measurements. My glucose measurements now are much better, showing that even though I’m not giving my body carbohydrates, my ability to transport and use glucose has not been impaired, right? I think that’s kind of an important consideration because there is some evidence out there that in some people, if they transition from high carb to low carb and they reintroduce carbohydrates into their diet, that can really kind of screw them up. They dump a massive amount of insulin, or their glucose levels shoot through the roof. That has not been the case for me. I tend to tolerate, maybe having a cheat meal every once in awhile is preserving that insulin sensitivity and kind of enhancing and preserving my bodies ability to use glucose and carbohydrates for fuel instead of completely eliminating them all the time. So if I throw them into my diet, it’s almost like a foreign substance. I think even for people who are doing low carb, it maybe good to occasionally have a carbohydrate refeed, which is probably normal to our physiology, even when we were kind of evolving.  But maybe couple that carbohydrate refeed with a work out. If I know that we are going out to dinner and it’s some kind of restaurant where the kind of food that I want to eat is high in carbohydrates, I will try to arrange it such that I do some kind of physical activity before or throw in my work out before or even after. That’s how I do it. But if I eat a ton of carbs, if I don’t couple it with exercise and I eat a high carbohydrate meal and I go to bed, I wake up like 3 or 4 in the morning starving. It’s like I have a massive insulin dump and that causes, there is a postprandial hypoglycemia from that. I eat the carbs, my body is so insulin sensitive, probably from the ketones which is a good thing, right? But the carbs kick me out of ketosis, so my glucose levels shoot up, my pancreas releases insulin, the insulin does an incredibly good job because my body is very insulin sensitive and then I go hypoglycemia and I wake up hungry in the middle of the night. Out of curiosity, I will check my blood glucose and it will be like 56 or 54 and then I check my ketones and it’s like .2. So that’s why I feel like crap, because my glucose is real low and my ketones are low, so my brain is really going into a stress response saying, hey there’s no energy here, like your hypoglycemia but where’s my ketones. In that case, probably Kegenix would be a good thing or some MCT oil, I like the MCT oil powder that Quest makes and just throw it into a shaker bottle and drink it. Kegenix kind of wires me up so I tend to not take Kegenix after 3 or 4 in the afternoon, because I think it has some green tea extract in it, which is a great fat burner, but there is a little bit of caffeine in there and I just try to eliminate all caffeine after 3 in the afternoon.

Drew: Yeah, I’m the same thing. I like the MCT oil from Quest as well because it’s a good supplement as well to add to the diet. Ok, a couple of last questions here and one of them is from me and one of them is from a friend. What about a nutrient density in the ketogenic diet because you’re eating a lot of high fat, you know your eating some carbs, hopefully it’s from vegetables. But if your eating like zero carbs, what about nutrient density? Does that play a roll with gut permeability and your microbiome, does it have any effect on that kind of aspect of your health?

Dominic: Yeah, I’m a big fan of having fiber. When I switched to eating low carb, it was actually a lot more vegetables, because my previous diet was a lot of fish and rice or chicken and pasta, steak and a sweet potato. So now my meals actually have …. I eat like a salad every day. I have some kind of vegetable every day, whether it be a lot of asparagus, cauliflower, broccoli, spinach and kale, those sorts of things. So that keeps my microbiome healthy, I think. I’ve never had any kind of GI issues. Growing up I did have a lot of …. what would I call it, like a nervous stomach …. I didn’t know what it was when I was growing up. I would eat like a big bowl of cereal before school and like every time I got to school, like I felt sick, as a kid. And I do have like a lactose intolerance and like a mild intolerance to wheat. I just thought it was a normal part of eating my breakfast, like I felt sick after and had an unsettled stomach. *laughing* When it comes to nutrient density, the Ketogenic diet gives a lot of …. it’s fairly liberal in the amount of vegetables you can eat. Green leafy vegetables are obviously, really low in carbs. We do, once or twice a week, we do cauliflower mashed potatoes, since that’s part of it and just a big salad every night. I think raw veggies really help your gut microbiome too. Everyone asks me why we aren’t studying the microbiome. We are interested in doing that, we’re writing proposals for that, we just haven’t gotten it funded yet. We want to further understand how low carb and Ketogenic diet affects the diversity of the microbiome and just the overall bacterial colony. Whether it decreases total bacterial count and how it shifts the microbiome. There’s a little bit of concern that a mouse microbiome is different than a humans, obviously it is. So we want to do a tandem mouse and human study at the same time. And if there is similarities in that, we can easily control a mouse diet, right? We want to formulate it in a way that best reflects a population of humans that we’re working with. Get some initial baseline data and then change that diet over time and if we can see some parallel shifts in the microbiome, that’s awesome. That would mean the mouse model is a great model to work with and then we can do a lot of interesting things. Like we could determine how changing the gut microbiome affects the response to chemotherapy or changes the response to various metabolic drugs we are looking at. This is a big interest to the clinical community.

Drew: Ok, so last couple of questions here from Facebook. How does the Keto diet affect blood circulation, erectile dysfunction, libido, testosterone, that kind of aspect, the sexual aspect. Any feedback or research studies you have on the Keto diet and those kinds of things?

Dominic: Ok, well we did study blood flow in the form of ischemic wounds and we did a doppler blood flow measurement with ketone supplementation and we showed that there was a significant elevation of blood flow to the wound, which was made ischemic with a particular model. That’s enhanced the wound healing process. What we did not determine is what caused the increase in blood flow and we think it was a vasodilation effect, which may impact other things too. So supporting that hypothesis was the recent finding, we didn’t really publish it yet so I’m not going to talk too much about it, but there was an elevation of adenosine. Adenosine is a neuro protector, but adenosine is a very powerful vasodilator and the Ketogenic diet and ketone supplementation, increases the adenosine levels pretty significantly in the blood and that’s a potent vasodilator. An enhancement of blood flow would make sense. There were a couple papers published, one paper in particular, looking at brain blood flow and showed that elevating ketones caused a 30-40% increase in brain blood flow. When you have vasodilation to the brain, you can actually get a headache. And I can tell you just from self experimenting with various exogenous ketone supplements, when my does get up kind of high, I start to get a bit of a head rush and even a bit of a headache. Because I think I have too much blood flow to the brain and I actually start to get a little bit anxious because I think my brain is like a little bit overstimulated. Although we’ve done some recent work, can’t really talk about it yet because we are working on the manuscript, but I will just tell you that with anxiety, when animals are put in a state of nutritional ketosis they do much better when it comes to anxiety. They have more exploratory behavior and we’re screening a bunch of different ketone supplements to determine which ones work best. As it pertains to the blood flow, we have some good data to show that ketones do increase blood flow, we didn’t look at all the different organs. *laughing* Consistent with that, is an elevation in tissue and blood levels of adenosine.

Drew: Ok, is there a specific millimolar level that is optimal for pre-workout?  Like if your about to do a pretty strenuous workout, like a 3 millimolars verses like 1-2, what is the optimum range to be in pre-workout?

Dominic: That’s a good question. I feel best between 1 and 2. Once I get up about 3 and even 4 and 5, maybe its because of the things I have to do to get to that level, whether it be fasting or a really strict Ketogenic diet or a big dose of supplement that’s kind of pushing my GI tolerance. Whenever I get to that 4 or 5, I just felt unwell. But I usually stay sedentary, because I am testing myself, right? But if I was to get up to 5 millimolar and just run all out, which I haven’t done yet, maybe that would be optimal. But when it comes to my normal daily activity and going to the gym and doing my short little 30 minute workouts I do, I feel best staying between 1 and 2 millimolar. And sometimes when I leave the office, if I’m really strict with my diet and slam a Kegenix or something, I get up to 2.5 or something and I really feel good. But generally right around 1.5-2, is when I kind of feel at my best.

Drew: Gotcha, ok. Well, cool man. Here’s the thing Dom, I have like 50 other questions to get to but we will kind of cut it off right here, otherwise this will be like the Tim Ferriss Podcast. *laughing*

Dominic: *laughing*

Drew: So just to wrap up though, like I do at the end of all my Podcasts, I like to ask some rapid fire questions. We’re not going to talk about Keto really or anything ‘sciencey’, so just kind of answer yes or no. Does your fiancé eat Keto friendly foods? Is she in ketosis like you?

Dominic: She is this week because we are trying out products from a new company that is making prepackaged ketogenic foods. She loves them. This company has done a remarkable job, I don’t think they are ready to go public yet. So generally no, she’s like a really good carb burner, but this week yes because we are trying prepackaged Ketogenic foods that taste awesome.

Drew: I think I know the company you are talking about. We won’t mention it yet.

Dominic: I know you don’t, actually I think your thinking of another company but it’s a colleague of mine that’s an epileptologist actually.

Drew: Oh really! Ok, never mind then. *laughing*

Dominic: There are a couple companies forming out there so there is probably going to be some competition in this space.

Drew: Awesome, ok cool. Are you planning on eating Keto friendly foods on your honeymoon, after your wedding?

Dominic: *laughing* Yes, I am because I already have a bag packed that has like oysters packed in olive oil and my sardines and I have a lot of Kegenix packed. I also have my MCT powder packed, and I actually have my blood meter and all my strips with me. I will be …. we’re going to be experiencing culture, is a big part of our travel. So I will not hesitate to try the foods that are native and very specific to the regions that I’m in.

Drew: Just slam some Kegenix afterwards, right? *laughing*

Dominic: Yes, exactly.

Drew: Ok, well what about your wedding. Is there going to be cake there and is it going to be a Keto based cake?

Dominic: *laughing* Yeah, yeah. That’s a good question. So, we kind of debated this, should I sort of indoctrinate all the wedding people into ketosis or force my …. I’m not a big believer in forcing my dietary regiment onto other people, like I’m very sensitive about that, for various reasons. But I think there is going to be low carb options. We are going to do kind of like a standard cake but we may have some low carb, Keto options, maybe. We are still kind of debating that.

Drew: If Rutgers or USF played in a football game, who would you cheer for?

Dominic: *laughing* Yeah, that’s a hard one. That’s actually a hard one. When I first came to USF, I was always rooting for Rutgers, but now since I’ve been here, almost 10 years now, I kind of have been rooting for USF. Just because I know some of the football coaches and actually my doctor works for the USF football team too. I like to see everybody happy around here so I kind of switched to rooting for USF as of the last couple of years.

Drew: Gotcha, that’s totally fine. What’s your current deadlift PR? Because I know you are a beast with the deadlift and you …. didn’t you fast for 7 days and deadlifted 550 for 8 reps or something?

Dominic: Yeah, I did 500 for 10 and then I did 585 for one. My best PR, I haven’t deadlifted in about 5 weeks, I think. I can always pull 675, that’s kind of like my max. My best is 675, 7 plates for 5 reps, is probably the best I ever did but I was pretty heavy. And 725 is my all time kind of highest that I’ve done, that’s conventional stance but now I pull sumo stance because my back, as I age at 40, I’m starting to feel my back is a little more stiff so I’m trying some mobility work and to be safe, I’ve switched my stance up from conventional, which if I went for a PR I would go conventional but now I do sumo. I just feel it’s a lot safer.

Drew: Ok, last question for you, the most important one. Would you ever do, because obviously i’m known for doing my Fit2Fat2Fit journey where I gained 75 pounds of pure fat in six months and then lost it in six months, would you ever do a Fit2Fat2Fit on purpose to show how the keto diet could maybe benefit the weight loss? Would you ever do that type of experiment?

Dominic: You know, I was just thinking about that. I was thinking about completely going off the Ketogenic diet and doing not force feeding myself carbs to get fat but just switching to the diet I used to follow 20 years ago, when I was 20 and that macronutrient ratio which is like 60% carbs and just doing that for 2 maybe 3 months and doing my blood work and seeing what happens. I would do that, but I wouldn’t force feed myself or purposely do anything unhealthy. I don’t necessarily think a carbohydrate based diet is necessarily an unhealthy thing to do, especially for an athlete. But if your carbing up for a desk job and most people have desk jobs right? Unless your work output is really high, I don’t think a high carb diet is optimal by any stretch of the imagination.

Drew: That’s funny because any doctor I ever talk to is like, ‘Absolutely not, I wouldn’t do anything unhealthy to my body.’ Even Dr. Oz, when I was on his show, they asked him to do this type of diet or sedentary lifestyle for 30 days and then do an episode on it, and he refused to do it. So, I wasn’t surprised but it would make for an interesting experiment. I’ll talk to you about this off the air about that, the experiment idea that you had, because I was going to talk to you about that. Ok, Dom, I will let you go, but thank you so much for coming on. Very great information, before we leave though, where can people get in touch with you on social media or your website?

Dominic: Yeah, you can find me on Facebook or Twitter, I post on there, probably like once every day or two, something usually research based. And I have a website, KetoNutrition.org. It’s just a compilation of links that’s more or less information, people looking for consulting. I also started a website with Travis Christofferson called, MetabolicOptimization.com. We do Podcasts with the leading experts in metabolism and nutrition and we recently had Adrienne Scheck on and she did a great overview of her cancer research that she’s doing. So those two, KetoNutrition.org, MetobolicOptimization.com and you can find me on Twitter and Facebook.

Drew: Ok, man. Well we will put those in the show notes and thank you, seriously once again. Congrats on the wedding coming up, man. So happy for you and we’ll have to have you back on again in the future to answer the other half of the question. *laughing*

Dominic: Great, I look forward to it. Thanks for having me on this one.

Drew: Ok, man. We’ll talk to you soon.

Dominic: Ok, thanks Drew. Bye.


Alright you guys. I hope you enjoyed today’s episode with Dom. I know I did. And so if you did enjoy it, please share it with friends and family, someone that you think could benefit from learning about Ketosis, nutritional ketosis. You guys know I’m doing a 30 day experiment on nutritional ketosis right now and I’m taking the Kegenix product during those 30 days as well. I’m loving the results. I’m loving how I’m feeling. There is no ‘Keto flu’. I could tell I was in Ketosis within the first 60 minutes of taking the product. I feel great you guys, so definitely go check out Kegenix.com, especially if you just finished listening to this episode. I know your going to be curious about learning the science behind it. I know I was and that’s why I did my research after hearing about Dom on the Tim Ferriss show. I dove into ketosis and the benefits of it. I started following Dom’s research and started following Kegenix. It’s a great product you guys. There is nothing else like it that’s out there. It’s a whole new industry, in my opinion. It’s a whole new category in the supplement industry. There’s nothing else like it. So check it out Kegenix.com. If you guys enjoyed todays episode, I plan on bringing a lot more great people to interview to bring this kind of information to you. Please subscribe to our Podcast on ITunes, please leave us a five star review if you feel the information is valuable. Definitely share it with friends and family. We love you guys. My website is Fit2Fat2Fit.com, all my social media handles are @Fit2Fat2Fit. Lynn, who wasn’t here today, she couldn’t do this episode, her website is 2fitathome.com and her social media handles are @2fitathome. Thank you guys once again for joining me on the Fit2Fat2Fit Experience Podcast. We will see you back here next week with another great episode.