How does ketosis help prevent muscle loss during fasting or illness?

Ketones are anti-catabolic, meaning they have a protein-sparing effect. When the blood is flooded with ketones, the body is less likely to break down skeletal muscle for gluconeogenic amino acids, as ketones can replace glucose as the primary fuel source for the central nervous system.

What are the therapeutic benefits of ketones beyond energy production?

Beyond energy, ketones like Beta-hydroxybutyrate act as HDAC inhibitors, activating genes that enhance endogenous antioxidant mechanisms (like superoxide dismutase and catalase) and protecting DNA from damage. They also have anti-inflammatory effects, suppressing inflammatory pathways linked to age-related chronic diseases, independent of their metabolic impact.

Can exogenous ketones mimic the benefits of therapeutic fasting?

Yes, exogenous ketones can create an artificial state of ketosis, leading to an acute and sustained reduction in blood glucose. This mimics many effects of therapeutic fasting, potentially sensitizing tumors to chemotherapy while protecting healthy cells, and can help ease the transition into nutritional ketosis by preventing glucose withdrawal symptoms.

What is a safe and beneficial range for blood ketone levels?

A moderate, mild ketosis range of 1 to 3 millimolar is generally promoted for health and longevity benefits, including performance and resilience, with minimal adverse effects. Levels above 5-6 millimolar can cause a mild metabolic acidosis which needs kidney compensation.

How can I accelerate entering ketosis and minimize the 'keto flu' symptoms?

Using exogenous ketones can significantly speed up the process and reduce discomfort during the transition from glucose-dependent metabolism to ketosis. By providing the brain with ketones, it helps maintain neurophysiological homeostasis, bypassing the stress response and glucose withdrawal symptoms often experienced in the first 24-48 hours of fasting.

Are there any toxicity risks associated with consuming exogenous ketones?

In studies, rats administered very high doses (25g/kg/day) of various ketone supplements for 15 weeks showed no known toxicity, liver or kidney stress, or other abnormalities. The main limiting factor for humans is gastrointestinal intolerance, with diarrhea occurring at high doses before any dangerous biological toxicity is reached.

What common foods and supplements does Dr. D'Agostino incorporate into his ketogenic diet?

Dr. D'Agostino's diet includes sardines, oysters, eggs, asparagus, broccoli, spinach, and kale. He utilizes MCT oil (powdered form for tolerability), coconut oil, and butter for fat. He also supplements with BCAAs. His dinner often includes mixed greens, avocado, artichokes, and fatty proteins cooked in various healthy fats.

What impact does Metformin have on cancer and metabolism?

Metformin dampens signaling pathways associated with cancer growth and proliferation by activating AMPK, mimicking calorie restriction and fasting. Animal studies show it can increase survival times in metastatic cancer models by 40-50%. It primarily works by regulating hepatic glucose output and possibly inhibiting mitochondrial complex one.

What is cancer cachexia and how can it be mitigated?

Cancer cachexia is a physiological state where the body catabolizes muscle tissue (lean body mass) due to inflammatory factors released by the tumor, leading to wasting and decreased survival. Protocols being developed to mitigate it include nutritional ketosis, BCAA formulas, specific exercise types, and potentially selective androgen receptor modulators (SARMs) or other drugs that preserve muscle mass.

How can one build up mitochondria and enhance their efficiency?

Being in a state of ketosis, especially combined with exercise, can increase mitochondrial biogenesis and efficiency. Ketone metabolism enhances energetic flux through the mitochondria to produce ATP while preventing the formation of superoxide anion, a harmful reactive oxygen species. This allows for more energy to be derived per oxygen molecule.

How can the ketogenic diet improve sleep quality?

Ketosis can lead to better fuel flow to the brain without glucose fluctuations, enhancing the restorative processes during sleep. It also elevates the GABA to glutamate ratio in the cerebral spinal fluid; GABA is an inhibitory neurotransmitter that promotes relaxation, potentially leading to needing less sleep (e.g., 1-2 hours less) without morning fog.

Does the ketogenic diet or fasting have applications for neurodegenerative diseases like Alzheimer's and Parkinson's?

Fasting and nutritional ketosis may help prevent or mitigate the onset of neurodegenerative diseases. Ketones enhance cellular defense mechanisms and reduce inflammation. In animal models, the state of ketosis, exogenous ketones, and calorie restriction can limit the accumulation of amyloid and tau plaques associated with neuropathologies like Alzheimer's disease.

Key Moments

Dr. Dominic D'Agostino on Fasting, Ketosis, and The End of Cancer

Tim Ferriss

Howto & Style7 min read187 min video

Nov 20, 2015|136,862 views|1,294|86

tim ferriss 4 hour workweek 4 hour body 4 hour chef forbes timothy ferriss entrepreneur author writer best-seller public speaker angel investor

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Key Moments

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TL;DR

Dr. D'Agostino discusses ketosis, fasting, and metabolic therapies for performance, longevity, and cancer.

Key Insights

Ketosis, whether induced by fasting or ketogenic diets, offers anti-catabolic and protein-sparing effects, potentially improving body composition and maintaining strength, even promoting muscle hypertrophy with adequate protein intake.

Ketones are more than just an energy source; beta-hydroxybutyrate acts as an HDAC inhibitor, influencing gene expression related to antioxidant defense and anti-inflammatory pathways, offering protective benefits against cellular damage and age-related chronic diseases.

Exogenous ketones can rapidly induce a state of ketosis, potentially mitigating the 'keto flu' symptoms and enhancing the benefits of a ketogenic diet without strict carbohydrate restriction, although consistent elevation seems to offer greater therapeutic effects.

Fasting and ketogenic therapies show promise in cancer treatment by metabolically stressing cancer cells, making them more vulnerable to conventional therapies like chemotherapy, and potentially enhancing the body's resistance to treatment side effects.

Metformin and Dichloroacetate (DCA) are metabolic drugs with anti-cancer effects that can synergize with ketogenic diets and fasting by further compromising cancer cell energetics, activating mitochondrial self-destruction in cancer cells, and improving survival rates.

The adaptation to a ketogenic state leads to increased mitochondrial biogenesis and efficiency, improving oxygen utilization and potentially offering benefits for neurological conditions like Lyme disease by reducing neuroinflammation and restoring brain homeostasis.

INTRODUCTION TO METABOLIC THERAPIES AND DR. D'AGOSTINO'S WORK

Dr. Dominic D'Agostino, a leading researcher in molecular pharmacology and physiology, focuses on developing and testing metabolic therapies, including ketogenic diets, ketone esters, and ketone supplements. His work, often funded by organizations like the Office of Naval Research, explores how altering metabolic physiology through nutrition can prevent disease, enhance performance, and even treat conditions like cancer. Nicknamed "Dom," he is renowned for both his intellectual contributions and his personal experiments, such as deadlifting 500 pounds for 10 reps after a seven-day fast, highlighting his deep commitment to understanding human metabolic potential.

THE PHYSIOLOGY OF FASTING AND KETOSIS

Fasting is the quickest way to induce ketosis, a metabolic state where the body primarily uses ketones for energy instead of glucose. After depleting liver glycogen (typically 24-48 hours), the liver mobilizes fatty acids, which are then converted into ketone bodies—water-soluble fat molecules that can cross the blood-brain barrier. Ketosis is clinically defined as blood ketone levels above 0.5 millimolar. A strict ketogenic diet, typically 75-90% fat, 20-25% protein, and minimal carbohydrates, mimics the metabolic state of fasting, providing a sustained supply of ketones for fuel.

KETOSIS AND ATHLETIC PERFORMANCE & HYPERTROPHY

Contrary to common belief that high insulin is necessary for muscle growth, D'Agostino's research suggests that ketogenic diets can maintain and even increase strength and lead to muscle hypertrophy. Ketones are anti-catabolic, preserving muscle mass by reducing the need to convert amino acids into glucose. A modified Atkins diet (70% fat, 20-30% protein) has shown promise in advanced lifters, leading to similar increases in lean body mass but greater fat loss compared to Western diets. This highlights the protein-sparing effect of ketones, especially in calorie-deficit scenarios, optimizing body composition.

BEYOND ENERGY: KETONES AS SIGNALING MOLECULES

Ketones are far more than just an energy substrate. Beta-hydroxybutyrate (BHB), a primary ketone body, acts as a histone deacetylase (HDAC) inhibitor. This means it can influence gene expression, upregulating genes involved in endogenous antioxidant mechanisms (like superoxide dismutase and catalase), which protect DNA from damage and enhance cellular defense. Additionally, ketones have potent anti-inflammatory effects. Research conducted in collaboration with Yale demonstrated that exogenous ketones can suppress a specific inflammasome linked to age-related chronic diseases, independently of their metabolic effects, underscoring their broad therapeutic potential.

EXOGENOUS KETONES: ACCELERATING KETOSIS AND THERAPEUTIC APPLICATIONS

Exogenous ketones, such as ketone esters or salts, can rapidly elevate blood ketone levels, offering a way to induce or sustain ketosis without strict fasting or carbohydrate restriction. This can mitigate the 'glucose withdrawal' symptoms (e.g., brain fog, headaches) often experienced during the transition to ketosis. Originally developed for military applications to enhance resilience and safety in extreme environments (like preventing oxygen toxicity seizures in Navy SEALs), exogenous ketones are now being explored for broader health benefits. D'Agostino's rat studies demonstrated that acute administration of ketone esters could elevate ketone levels to starvation-level ketosis within minutes, offering significant protection against seizures.

METABOLIC STRATEGIES FOR CANCER THERAPY

Cancer cells typically rely heavily on glucose and glutamine for energy and growth (the Warburg effect and glutaminolysis). Fasting and ketogenic diets metabolically starve cancer cells, which often have defective mitochondria and cannot efficiently utilize ketones. This metabolic stress can trigger apoptosis (programmed cell death) and autophagy in cancer cells, while healthy cells, being metabolically flexible, adapt to use ketones. Fasting before chemotherapy can sensitize tumors to treatment while protecting healthy cells from harm. D'Agostino advocates for integrating ketogenic diets, intermittent fasting, and exogenous ketones as foundational anti-cancer strategies.

METFORMIN AND DCA: DRUGS FOR METABOLIC CANCER TARGETING

Metformin, a common diabetes drug, mimics calorie restriction by activating AMP-kinase and regulating hepatic glucose output, dampening signaling pathways associated with cancer growth. While its exact mechanism in cancer is debated, animal studies show Metformin can increase survival times in metastatic cancer models by 40-50%. Dichloroacetate (DCA) is another promising agent that activates pyruvate dehydrogenase complex, forcing cancer cells (with their defective mitochondria) to use pathways that trigger their self-destruction (apoptosis). Both drugs are relatively safe and cheap, and DCA is being explored in clinical trials for glioblastoma. These can synergize with ketogenic diets and fasting to further compromise tumor energetics.

PERSONAL PROTOCOLS AND NUTRITIONAL GUIDELINES

D'Agostino's personal anti-cancer protocol, if he were diagnosed, would combine standard care with a strict, nutrient-dense ketogenic diet (e.g., wild fish, grass-fed meats, healthy fats like olive and coconut oil). He emphasizes intermittent fasting (one meal a day, often dinner), consuming exogenous ketones 2-4 times daily to maintain consistently elevated ketone levels (1-3 millimolar or higher), and titrating Metformin and DCA to therapeutic levels. His daily diet includes eggs and fish for breakfast, bulletproof coffee with butter and MCT powder throughout the day, and a large dinner with fatty protein, vegetables cooked in fat, and a keto-friendly dessert like coconut or sour cream mousse with dark chocolate and blueberries. He also integrates regular fasting periods of 5-7 days a couple of times a year.

KETOSIS AND NEUROLOGICAL BENEFITS: SLEEP AND COGNITION

Ketosis appears to offer significant neurological benefits. Many individuals, including D'Agostino, report needing less sleep (e.g., 1-2 hours less) and experiencing improved cognitive sharpness without morning fog while in ketosis. This is attributed to more stable fuel flow to the brain, enhanced restoration of neurotransmitter balance (e.g., a higher GABA to glutamate ratio), and increased mitochondrial efficiency in brain cells. Ketogenic diets have long been effective in treating drug-resistant seizures by restoring brain homeostasis, even in the presence of underlying molecular pathologies like glucose transporter deficiency syndrome. This suggests a broad neuroprotective and neuro-restorative effect.

ADDRESSING TOXICITY AND MITOCHONDRIAL HEALTH

Concerns about the toxicity of exogenous ketones are largely mitigated by the body's natural regulatory mechanisms; GI intolerance (diarrhea) will likely occur before any harmful biological effects. Long-term rat studies administering high-dose ketone supplements (25 grams/kg body weight per day) have shown no adverse effects on organ health or clinical chemistry. Ketones are bioidentical to what the body produces naturally and are even present in some foods (e.g., milk from ketotic animals). Ketosis significantly impacts mitochondrial health by increasing mitochondrial biogenesis and efficiency, improving oxygen utilization, and reducing the formation of reactive oxygen species. This repair mechanism is crucial for conditions like Lyme disease, which can cause profound neuroinflammation and mitochondrial dysfunction.

LIMME DISEASE AND KETOSIS: A CASE STUDY OF NEUROINFLAMMATION

D'Agostino postulates that the benefits of ketosis for individuals recovering from Lyme disease (as observed by Tim Ferriss and others) stem from its potent anti-inflammatory effects. Lyme disease, caused by spirochetes, induces severe systemic and neuroinflammation, leading to symptoms like fatigue, cognitive dysfunction, and muscle pain. Ketones, being highly permeable to the blood-brain barrier, can dampen neuroinflammation and help restore nervous system homeostasis. By reducing blood glucose spikes and insulin levels, a ketogenic diet further limits inflammatory processes. Additionally, improved mitochondrial efficiency through ketosis could help repair damage caused by the disease or prolonged antibiotic treatment, leading to overall symptomatic improvement and enhanced cognitive function.

FUTURE DIRECTIONS AND PERSONAL PHILOSOPHY

D'Agostino's research continues to explore the synergistic effects of various metabolic interventions, aiming to combine calorie restriction, ketogenic diets, exogenous ketones, Metformin, DCA, and hyperbaric oxygen therapy for maximal therapeutic benefit. He views ketones as a "fourth macronutrient" due to their energy-containing and signaling properties. His personal experiences and scientific rigor have made him a staunch advocate for metabolic flexibility and the power of nutritional strategies. He emphasizes that while his research might be considered "oddball" for a pharmacology department, the profound and consistent results in areas like seizure control and cancer therapy validate its importance and potential to revolutionize health and performance.

Mentioned in This Episode

●Supplements

●Products

●Software & Apps

●Companies

●Organizations

●Books

●Drugs & Medications

●Concepts

●People Referenced

Ketogenic Diet & Fasting for Health and Performance

Practical takeaways from this episode

Do This

Follow a modified Atkins diet (70% fat, 20-30% protein) for muscle growth and performance.

Incorporate MCT oil and powdered caprylic triglyceride for sustained ketosis and better tolerability.

Take Branch Chain Amino Acids (BCAAs), especially if dealing with muscle wasting or intense training.

Eat fiber-rich, low-net-carb vegetables like artichokes, spinach, kale, broccoli, and asparagus to support ketosis.

Consume fatty protein sources (fish, grass-fed beef, chicken with skin) and cook vegetables in healthy fats like butter, olive oil, and coconut oil.

Experiment with intermittent fasting or one meal a day (OMAD) to enhance metabolic benefits.

Consider exogenous ketones two to four times a day, especially for therapeutic applications like cancer, aiming for 1-3 millimolar levels.

If considering Metformin for cancer prevention, titrate the dose gradually to comfort and closely monitor blood work.

If suitable, fast for 5-7 days once every quarter to purge precancerous cells and stimulate the immune system.

Include a keto-friendly dessert like sour cream/coconut cream with dark chocolate powder, cinnamon, salt, and stevia for satiety and fat intake.

Avoid This

Avoid purely ketogenic diets (85-90% fat) if the goal is maximum muscle growth, especially for younger individuals.

Do not go cold turkey into a multi-day fast on a high-carb diet as it can cause severe discomfort and stress.

Do not overdo protein, as a sudden spike in amino acids can kick you out of ketosis.

Do not rely solely on drug studies or food additive studies that administer agents in a single bolus dose if seeking realistic, sustained effects.

Do not ignore the importance of electrolytes during fasting, as sodium loss can cause headaches and dizziness.

Do not use NSAIDs after workouts if the goal is hypertrophy, as they may inhibit inflammatory mediators linked to muscle growth.

Avoid excessive dairy fat if concerned about high LDL particle numbers, opting for alternatives like coconut cream.

Common Questions

For muscle growth and hypertrophy on a ketogenic diet, aim for a moderate protein intake of about 25-30% of total calories, which is almost double that of the classical ketogenic diet. This level of protein, combined with adequate fat, can support muscle growth. For advanced lifters, strength and performance can be maintained or even increased while losing proportionally more fat.

Topics

Cancer Metabolism Fasting Longevity Health & Longevity Nutrition & Diet Mental Health & Psychology Metabolic Flexibility Muscle Hypertrophy Mitochondrial Health Exogenous Ketones

Mentioned in this video

People

Neil Gaiman

Author of The Graveyard Book.

Peter Attia

A mutual friend and colleague of Tim Ferriss and Dr. D'Agostino, known for his work in optimal athletic performance and fasting.

C.S. Lewis

Author whose book 'The Screwtape Letters' Dr. D'Agostino reread after being inspired by Francis Collins.

Pavel Tsatsouline

A strongman and fitness expert mentioned by Tim Ferriss as a guest on his show.

Ellen Davis

Manages the Ketogenic Diet Resource website and co-authored a book on ketogenic diet for type 2 diabetes.

Josh Waitzkin

Chess prodigy mentioned by Tim Ferriss as a type of guest he deconstructs.

Arnold Schwarzenegger

Celebrity and former governor mentioned by Tim Ferriss as a type of guest he deconstructs.

Thomas Seyfried

Professor at Boston College and author of 'Cancer as a Metabolic Disease', who developed a metastatic cancer model and is a collaborator of Dr. D'Agostino.

Eric Kossoff

A colleague of Dr. D'Agostino at Johns Hopkins, who has done extensive clinical work on the modified Atkins diet.

Jeff Volek

A researcher at Ohio State (likely Jeff Volek) who has done remarkable work comparing fat-adapted and carb-adapted athletes' substrate utilization.

Siddhartha Mukherjee

Author of 'The Emperor of All Maladies'.

Tim Ferriss

Host of The Tim Ferriss Show and author of The 4-Hour Workweek and The 4-Hour Body.

Travis Christofferson

Author of 'Tripping Over the Truth', whom Dr. D'Agostino is collaborating with; described as a gifted writer.

Anthony Robbins

Motivational speaker whose book 'Personal Power' was influential for Dr. D'Agostino in his college days and which he gifted to friends.

Robb Wolf

Friend of Tim Ferriss and Dr. D'Agostino, whose blog featured an article by Travis Christofferson and who discussed Lyme disease with Tim.

Patrick Arnold

Brilliant chemist mentioned but not discussed in detail.

Dominic D'Agostino

Assistant professor at University of South Florida Morsani College of Medicine and senior research scientist at IHMC, specializing in ketosis, fasting, and deadlifting.

John Freeman

Author of original studies on the ketogenic diet's efficacy for drug-resistant pediatric seizures.

Kevin Rose

Tim Ferriss's friend who observed that artichokes seemed to spike ketone levels.

Rolf Potts

Author of Vagabonding.

Francis Collins

Former director of the NIH, leader of the Human Genome Project, and instrumental in finding the gene for cystic fibrosis, whose spiritual book 'The Language of God' influenced Dr. D'Agostino.

Rick Lanahan

Former astronaut and vet who brought to Dr. D'Agostino's attention that cows are ketogenic.

George Cahill

A researcher at Harvard Medical School who conducted a fascinating study fasting people for 40 days, which inspired Dr. D'Agostino's own 7-day fast.

Organizations

New York Times

A prominent newspaper that listed The 4-Hour Body as a #1 bestseller.

Department of Defense

Another funding source for Dr. D'Agostino's research, especially related to military applications of ketones.

Rutgers University

University where Dr. D'Agostino pursued an undergraduate degree in nutrition science and biological sciences.

Institute for Human and Machine Cognition

Institution where Dr. D'Agostino is a senior research scientist.

Johns Hopkins University

A medical institution known for developing the classical ketogenic diet and modified Atkins diet for seizure management.

Office of Naval Research

One of the funding sources for Dr. D'Agostino's research, specifically on metabolic therapies for defense applications.

University of South Florida Morsani College of Medicine

Institution where Dr. D'Agostino is an assistant professor in molecular pharmacology and physiology.

IRB

A committee that reviews the ethics and safety of a study before approving it, often presenting a hurdle for researchers.

NASA

Mentioned as a place where Rick Lanahan, a former astronaut, highlighted that cows are ketogenic.

Boston College

Institution where Thomas Seyfried is a professor and developed an advanced metastatic cancer model.

Harvard Medical School

Institution where George Cahill conducted his fasting research.

NIH

A major source of funding for scientific research, which Dr. D'Agostino's advisor was funded by.

Navy SEALs

Military personnel whose underwater missions face risks such as oxygen toxicity seizures, leading to research on exogenous ketones to enhance safety and performance.

Yale

Institution where colleagues of Dr. D'Agostino demonstrated that exogenous ketones can prevent activation of an inflammosome linked to age-related diseases.

Charlie Foundation

An organization that works with Johns Hopkins University on ketogenic diet therapy for children with drug-resistant seizures.

Ohio State University

Institution where Jeff Volek conducts research on fat-adapted athletes.

Concepts

Ketogenic Diet

A diet typically composed of 85-90% fat, developed by Johns Hopkins group, often challenging for muscle growth due to lower protein.

mTOR

A signaling pathway associated with driving cancer growth and proliferation, which leucine can activate.

Warburg effect

The metabolic phenotype of cancer cells, where they primarily derive energy from glucose metabolism and also use glutamine at high concentrations (glutaminolysis).

Glutamate

An excitatory neurotransmitter in the brain, whose balance with GABA is restored by a ketogenic diet, contributing to improved sleep and brain homeostasis.

Modified Atkins Diet

A diet composed of about 70% fat and 20-30% protein, shown to be effective for managing seizures and suitable for performance/bodybuilding.

IGF-1

A growth factor that can be increased by high doses of testosterone and is generally associated with global systemic anabolic effects.

autophagy

A cellular process of self-eating and waste removal, which therapeutic fasting can trigger, potentially purging precancerous cells.

HDAC Inhibitor

A class of compounds that Beta-hydroxybutyrate falls under, known to activate genes for endogenous antioxidant mechanisms and have anti-inflammatory effects.

Pyruvate Dehydrogenase Complex

A metabolic enzyme pathway activated by DCA, which in turn activates cancer cell mitochondria, leading to apoptosis.

Supplements

Ketone Esters

Potent orally active ketone molecules that can rapidly increase blood ketone levels, originally developed for military applications to enhance resilience and safety.

Branch chain amino acids

Amino acids that Dr. D'Agostino takes in the morning, which help get energy to the brain and are being studied for their muscle-preserving effects in cancer patients.

GABA

An inhibitory neurotransmitter in the brain, naturally elevated by the ketogenic diet, which can promote sleep and brain homeostasis.

MCT oil

A fat source used to supplement ketogenic diets and boost ketone levels, often used by Dr. D'Agostino.

Butyrate

A short-chain fatty acid generated in the gut from soluble fiber, which can enhance and contribute to gut microbiota health.

Ketone salts

Exogenous ketone products that are being developed to be more palatable and capable of inducing mild ketosis independently of carbohydrate restriction or fasting.

Phenibut

A substance that can be taken before bed for sleep, similar to GABA.

Keto Kanna

A powdered beta-hydroxybutyrate product from Keto Sports, used by Dr. D'Agostino to bump up ketone levels in the morning.

MCT powder

A powdered form of medium-chain triglycerides, specifically caprylic triglyceride, that is more tolerable than MCT oil and can significantly boost ketosis.

Extend

Scivation's popular BCAA product, which Dr. D'Agostino uses and is studying in cancer patients (with glutamine removed).

Leucine

An amino acid in BCAAs known to activate mTOR, which can be a driver of cancer growth, but Dr. D'Agostino argues its anabolic effects are skeletal muscle-specific.

testosterone

An anabolic agent used for muscle building and hormone replacement, which can increase systemic IGF-1 levels at higher doses (above 300mg/week).

1,3-Butanediol

A molecule used as a carrier to esterify ketones, forming ketone esters that can be ingested orally.

Stevia

A sweetener used by Dr. D'Agostino in his keto mousse/ice cream dessert.

beta hydroxybutyrate

A primary ketone body that functions as an energy metabolite and an HDAC inhibitor, impacting gene expression and antioxidant mechanisms.

Caprylic Acid

A specific type of Medium-Chain Triglyceride (MCT) that is highly ketogenic, found in MCT oil and powder.

Caffeine

A stimulant present in Utopian (cognitive enhancement agent), providing about 100 milligrams per serving.

Software & Apps

ketonutrition.org

Dr. D'Agostino's skeleton website, compiling useful links and resources related to ketogenic nutrition.

Ketogenic Diet Resource

A website managed by Ellen Davis, offering extensive information and books on ketogenic diets and their applications for cancer and type 2 diabetes.

99designs

A graphic design platform that Tim Ferriss has used for everything from banner ads to book covers.

PET Scan

An imaging technique that shows sugar or glucose metabolism, used to locate and assess the aggressiveness of tumors, based on the Warburg Effect.

Companies

Facebook

Social media platform where Dr. D'Agostino is active and can be found by his handle.

Scivation

A company that produces the BCAA product Extend and has supported Dr. D'Agostino's cancer research program.

Audible

An audiobook platform that Tim Ferriss has used for years and recommends.

Books

The 4-Hour Workweek

A book by Tim Ferriss, whose basis was formed by Vagabonding.

The Language of God

A book by Francis Collins that inspired Dr. D'Agostino due to its insights on science and faith.

Tripping Over the Truth

A book by Travis Christofferson that tells the history of cancer from a metabolic perspective, different from 'The Emperor of All Maladies'.

Emperor of All Maladies

A popular biography of cancer by Siddhartha Mukherjee that 'Tripping Over the Truth' offers an alternative perspective to.

The 4-Hour Body

A book by Tim Ferriss that became a #1 New York Times and Wall Street Journal bestseller, with early designs developed via 99designs.

The Graveyard Book

A book by Neil Gaiman that Tim Ferriss considers his favorite audiobook of all time.

Cancer as a Metabolic Disease

A book by Thomas Seyfried that is required reading for Dr. D'Agostino's students, detailing the science and history of cancer from a metabolic perspective.

Personal Power

A book by Anthony Robbins that Dr. D'Agostino found influential and gifted to his friends.

The Screwtape Letters

A book by C.S. Lewis that Dr. D'Agostino reread and found really good.

Vagabonding

A book by Rolf Potots that had a huge impact on Tim Ferriss's life and influenced The 4-Hour Workweek.

Products

Abbott Precision Xtra

A device used to measure ketone levels (millimolar basis) in the blood.

coconut oil

Used to supplement ketogenic diets and in cooking by Dr. D'Agostino, contributing to fat intake.

Drager Rebreather

A closed-circuit oxygen rebreather used by Navy SEALs for stealth during underwater missions, which carries a risk of oxygen toxicity seizures.

Drugs & Medications

Metformin

A drug used by type 2 diabetics to decrease hepatic gluconeogenesis and is being researched for cancer prevention and treatment due to its activation of AMPK and calorie restriction mimicking effects.

DCA

A drug that activates pyruvate dehydrogenase complex, killing cancer cells by causing their defective mitochondria to explode; used clinically for lactic acidosis and being studied for cancer.

Selective Androgen Receptor Modulators

Drugs designed to have anabolic properties without the androgenic side effects, specifically developed for cancer cachexia, but currently have minimal anabolic potency compared to anabolic steroids.

Doxycycline

An antibiotic mentioned in research as potentially causing mitochondrial dysfunction, which could be part of the mechanism behind Lyme disease symptoms and why ketosis helps.

Media

Wall Street Journal

A prominent financial newspaper that listed The 4-Hour Body as a #1 bestseller.