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Dom D'Agostino Returns (Full Episode) | The Tim Ferriss Show (Podcast)

Tim FerrissTim Ferriss
Howto & Style3 min read118 min video
Aug 14, 2016|28,899 views|265|17
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TL;DR

Dom D'Agostino discusses ketogenic diets, health benefits, and exogenous ketones.

Key Insights

1

Ketogenic diets offer significant benefits for type 2 diabetes, epilepsy, and potentially other conditions.

2

Protein intake on a ketogenic diet is crucial, with general recommendations of 1-1.5g/kg, but needs adjustment for activity levels.

3

Females may experience a more challenging transition to ketosis and require careful attention to calorie and fat intake.

4

Exogenous ketones can offer benefits even without full keto-adaptation and may aid in performance and certain medical conditions.

5

While LDL may increase for some on a ketogenic diet, it's important to consider other biomarkers like triglycerides and inflammation.

6

Ketosis can positively impact performance at altitude and may mitigate issues like hypocapnic cerebral vasoconstriction.

THE MEDICAL COMMUNITY'S RESISTANCE TO KETOSIS

A primary reason for skepticism towards ketogenic diets in the medical and dietetic fields stems from insufficient education. Many nutrition programs offer minimal to no coverage of ketogenic diets, often presenting them negatively. The demonization of saturated fat and the perceived difficulty of adherence contribute to this resistance. Doctors, lacking comprehensive nutrition training, are unlikely to appreciate the therapeutic potential of such diets, particularly for conditions like type 2 diabetes and epilepsy, where it has shown remarkable success.

PROTEIN INTAKE AND TYPE 1 DIABETES MANAGEMENT ON KETOGENIC DIETS

Protein intake on a ketogenic diet is critical for maintaining ketosis, typically recommended between 1-1.5 grams per kilogram of body weight. However, individuals with higher activity levels may require up to 2 grams per kilogram. For type 1 diabetics, transitioning to a ketogenic diet can dramatically reduce blood glucose fluctuations and significantly lower insulin needs, as demonstrated by a student's experience. This approach can also increase insulin sensitivity, offering protection against hypoglycemia and mitigating long-term damage from high glucose excursions.

FEMALE CONSIDERATIONS AND BODY FAT GOALS ON KETOGENIC DIETS

Females may find the transition into ketosis more challenging, experiencing greater variability in response to low blood glucose. A gradual introduction and potentially the use of exogenous ketones or MCTs can ease this process. It's advised to maintain adequate calorie intake, avoiding a steep deficit, and to not shy away from healthy fats. Pursuing extremely low body fat percentages, below 10%, is generally not recommended for women due to potential hormonal disruptions like functional hypothalamic amenorrhea.

IMPACT OF KETOSIS ON PERFORMANCE AND MICROBIOTA

At high altitudes, a ketogenic state may enhance performance by increasing brain blood flow and potentially mitigating altitude-induced issues like hypocapnic cerebral vasoconstriction and increased intracranial pressure. The body may also produce energy more efficiently from ketones. Regarding the gut microbiota, a ketogenic diet can train beneficial bacterial species that thrive on fat. Optimizing the microbiome on a ketogenic diet involves incorporating prebiotics, probiotics, and fermented foods, while research on this interaction is ongoing.

EXOGENOUS KETONES: SAFETY, EFFICACY, AND APPLICATIONS

Exogenous ketone salts are generally considered safe and effective, despite some differing opinions in the scientific community. Studies demonstrate their utility in conditions like fatty acid oxidation disorders, where they can be a vital treatment. While debate exists regarding racemic versus specific enantiomers, current research suggests racemic beta-hydroxybutyrate salts are not dangerous, even in children, and can effectively raise blood ketone levels. Exogenous ketones can offer benefits even without full keto-adaptation, showing promise for therapeutic and performance enhancement.

NAVIGATING DIET AND SUPPLEMENTS ON THE GO AND LONG-TERM HEALTH

Maintaining a ketogenic diet while traveling or attending conferences is feasible by packing energy-dense, keto-friendly foods like sardines, oysters, and macadamia nuts. Stimulants like caffeine can aid adherence by suppressing appetite and providing energy, but moderation is key. For long-term health, monitoring blood work, including LDL, triglycerides, and inflammatory markers like CRP, is important, though an elevated LDL alone may not be a cause for concern if other markers are healthy. Supplementation with magnesium, Vitamin D3, and melatonin can support overall well-being.

Optimizing Ketosis and Ketogenic Living

Practical takeaways from this episode

Do This

Gradually ease into a ketogenic diet, especially for females, by dropping carbs in 50g increments.
Maintain a calorie surplus initially when starting a ketogenic diet, particularly for women, to help with transition.
Consume at least 100g of fat per day for female athletes to optimize fat metabolism and ketone production.
Track your macros initially on a ketogenic diet until you can estimate them accurately.
Incorporate prebiotics (e.g., green vegetables like asparagus, artichoke) and probiotics (e.g., VSL#3, sour cream with live cultures) to optimize gut microbiome.
Pack energy-dense, lightweight keto foods like sardines, oysters, and macadamia nuts for travel.
Use caffeine (100mg sweet spot) for appetite suppression, antioxidant effects, and energy without jitters or blood sugar spikes.
Consider exogenous ketones like MCT oil or ketone salts when starting keto or for acute benefits, even on a low to moderate carb diet.
Supplement with Vitamin D3 when sun exposure is limited, melatonin for sleep/jet lag, Idebenone for mitochondrial support, and magnesium to prevent cramps.

Avoid This

Do not avoid fat or be afraid to eat sufficient fat when on a ketogenic diet.
Do not aim for sub-10% body fat for women unless genetically predisposed, due to risks of hormonal issues like functional hypothalamic amenorrhea.
Do not stress excessively over elevated LDL on a ketogenic diet if other markers (triglycerides, CRP, HDL) are in good range.
Do not ignore elevated triglycerides on a ketogenic diet, as this indicates poor adaptation to the diet.
Do not use amphetamines as stimulants due to their addictive nature and negative outcomes.
Do not take exogenous ketone products like Kegenix after 3-4 PM to avoid disrupting sleep.

Ketogenic Diet Protein Intake Recommendations

Data extracted from this episode

Diet TypeProtein Intake (g/kg/day)Calorie % from ProteinTarget Population
Classical Ketogenic Diet1-1.510%Epileptic children
Modified Ketogenic (Atkins) Diet1-1.5 (or higher)25-30%Athletes, General Public

Dominic D'Agostino's Lipid Profile on Modified Ketogenic Diet

Data extracted from this episode

MarkerValue (Modified Keto)Value (High Carb Diet)Notes
Total Cholesterol238
HDL9850Doubled from previous high-carb diet
Total Cholesterol/HDL Ratio2.4Looking good
Triglycerides40-70
CRP (Inflammation)0.1-0.32.410 times lower than on high-carb diet

Exogenous Ketone Effects on Oxygen Consumption (Peter Attia's Study)

Data extracted from this episode

ConditionPower Output (Watts)Oxygen Consumption Change
Before Exogenous Ketones (mild ketosis)180 (fixed)Baseline
After Exogenous Ketones (elevated ketosis)180 (fixed)Decreased by 5-8%

Common Questions

Resistance stems from a lack of nutrition education in medical curricula, a historical bias against high-fat diets, perception that it's too difficult to follow, and limited rigorous, controlled studies on low-carb diets compared to high-carb or Mediterranean diets. Many consider nutritional ketosis extreme.

Topics

Mentioned in this video

Products
Abbott Labs Precision Xtra

A blood glucose ketone meter considered the gold standard for measuring ketones.

MRM Veggie Elite Protein Powder

A plant-based protein isolate recommended for vegan ketogenic diets, especially the chocolate mocha flavor, noted for its favorable macronutrient profile.

Kegenix

An exogenous ketone product that uses a patented blend of beta-hydroxybutyrate and MCT, offering sustained ketone elevation and a powerful energy/focus effect. Described as tangy/bitter with green tea extract.

Quest MCT Oil Powder

A product from Quest Nutrition, described as fantastic and a go-to product for Dom D'Agostino.

Ketopia/Ketonix

An exogenous ketone product by ForeverGreen, described as tasting good and containing caffeine from green tea.

Quest Coconut Powder

A product from Quest Nutrition, mentioned as a staple in Dom D'Agostino's diet.

Crown Prince Natural Oysters

A brand of canned oysters that Dom D'Agostino consumes.

Freestyle Libre

A blood glucose ketone meter, likely referring to the Freestyle Lite or Precision Neo, used personally by Dom D'Agostino.

Ketonix meter

A breath acetone meter useful for non-invasive ketone measurement, especially for children managing disorders like epilepsy.

KetoSports KetoProven

An exogenous ketone product using racemic salts, noted for tasting really good, smooth, and creamy, with a higher sodium concentration.

Ketocal

A product used for ketogenic diets in kids at Johns Hopkins, which often contained hydrogenated vegetable oils and led to elevated triglycerides.

Fire & Kettle Bone Broth

A high-quality bone broth that Dom D'Agostino uses to make soup, noted as a bit pricey.

Supplements
Phenibut

A form of GABA with a phenyl ring that crosses the blood-brain barrier, providing calming effects and deep dreams, used occasionally for sleep or jet lag.

Caffeine

A stimulant with extensive research, used by the military for efficacy and safety, known to be an appetite suppressant and antioxidant.

Lion's Mane mushroom

Considered a nootropic or smart drug, included in For Sigmatic's mushroom coffee for cognitive enhancement.

MCT oil

Medium-chain triglyceride oil, specifically C8, mentioned as the most ketogenic fat used to aid transition into ketosis or supplement vegan/vegetarian keto diets.

VSL#3

A probiotic supplement commonly used for Crohn's disease, colitis, and IBS, and noted as a good complement to the ketogenic diet by users.

Xtend Perform

A branch-chain amino acid (BCAA) product by Scivation with leucine, isoleucine, and valine, along with a mushroom blend, used pre-workout, intra-workout, and during fasts.

Melatonin

Part of a sleep cocktail and used when crossing time zones, with typical daily doses of 1-5 mg and up to 10 mg for jet lag.

CoQ10

A mitochondrial antioxidant, with Idebenone being described as a more absorbable, drug version of it.

Vitamin D3

A daily supplement taken when not getting enough sun exposure, with dosage adjusted based on sun exposure.

Chaga Mushroom

A powerful antioxidant and considered a superfood, included in For Sigmatic's mushroom coffee.

Leucine

A branch-chain amino acid that is a powerful activator of mTOR, important for skeletal muscle growth.

Idebenone

A drug version of CoQ10, a mitochondrial antioxidant, more absorbable and used for managing Friedreich's ataxia to enhance cardiac function.

GABA

A neurotransmitter, sometimes taken before sleep for its calming effect.

Magnesium

A daily supplement (citrate, chloride, or glycinate) taken to prevent cramps and maintain adequate levels, especially when on a ketogenic diet and exercising.

People
Dominic D'Agostino

Assistant Professor at the University of South Florida Morsani College of Medicine and Senior Research Scientist at IHMC, specializing in metabolic and nutritional questions, especially ketosis.

Eric Kossoff

A leader in advancing the Modified Atkins Diet as a metabolic therapy for kids and adults with seizures, co-author of a foundational ketogenic diet book.

John Freeman

Co-author of a foundational book on the classical ketogenic diet from Johns Hopkins, alongside Eric Kossoff.

Keith Runyan

A medical doctor with Type 1 diabetes and co-author of the 'Ketogenic Diet for Type 1 Diabetes' ebook, who has shared his experience on podcasts.

Patrick Sweeney

Communicated with Dom D'Agostino prior to a self-supported mountain bike climb on Mount Kilimanjaro, using a ketogenic diet and abstaining from altitude medication.

Shannon Yorton Penna

A very experienced female fitness competitor from Quest Nutrition who has been in ketosis for at least two years and is involved in developing ketogenic food products.

Andrew Knauss

A PhD student in Dom D'Agostino's lab, a Type 1 diabetic who successfully adopted a ketogenic diet, significantly reducing insulin use and achieving stable blood glucose.

Andrew Murray

Co-author of the book 'How Wasting is Saving' discussing weight loss at altitude and ketosis.

Patrick Arnold

A famous biochemist known for performance-enhancing compounds, who has discussed exogenous ketones with Dom and Tim, and helped synthesize a specific ketone ester for D'Agostino's lab.

Rebecca Rusch

A professional mountain biker who teamed up with Patrick Sweeney for a self-supported climb and descent on Mount Kilimanjaro.

George Cahill

From Harvard, published observations in 1967 demonstrating that fasted subjects adapted to starvation ketosis were remarkably resilient against insulin-induced hypoglycemia.

Ellen Davis

Co-author of the 'Ketogenic Diet for Type 1 Diabetes' ebook.

Richard Veech

A ketone expert whose lab conducted work on ATP hydrolysis efficiency with ketones. Mentioned as a mentor to Dom D'Agostino but had controversial opinions on ketone salts. He has intellectual property tied to R-enantiomer ketone esters.

Peter Attia

Gave a lecture at IHMC on ketogenic diet for performance and cycling at high altitude. Also experimentally tested exogenous ketones from Dom D'Agostino.

Hugh Montgomery

Co-author of the book 'How Wasting is Saving' discussing weight loss at altitude and ketosis.

Alessio Fasano

Chair of Pediatrics at Harvard Medical School and a leading expert on the gut microbiome, highly recommended for his IHMC lecture on the topic.

Beth Zupec-Kania

The lead dietitian for the Charlie Foundation who customizes vegetarian and vegan ketogenic diets, often incorporating higher amounts of MCT oil.

Andre Brünngraber

A researcher at Case Western who held early patents on ketone esters, demonstrated the metabolism of racemic ketones, and kindly shared a synthesis formula with Dom D'Agostino.

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