Ep 154 - Dr D'Agostino | #1 Way To Double Autophagy & Lose Weight [EAT THIS]

Is thardine fasting help with visceral fat?

Yes, it was thardine fasting, you have extreme suppression of the hormone insulin and

your visceral fat is the first to go.

I give my dog thardines too, I tend to maybe gravitate towards cheaper ones.

Dr. Dominic Diagostino is a neuroscientist who changed how we understand ketosis.

Today he's breaking down how thardine fasting can help you burn fat, double your speed

to the topology, protect your brain and boost your immune system.

The research also indicates that when you do this, three, maybe you can extend to five days

that the benefits go at least a month.

It changes the body composition in a way that's more favorable to water only fasting.

When you come to the end of the fast, you're not in a nutrient deprivation state.

So can ketosis help the gut microbiome?

Yeah, it can be very beneficial for most people.

HSCRP is a better predictor for cardiovascular health.

I don't think that's even controversial now, although it's not talked about much.

If you're watching this, you likely want two things.

You want to lose weight, but you also want to prevent diseases like dementia and cancer.

And what if I told you there's a way to do both by flipping a single metabolic switch

and it starts by eating one specific food?

Now, as a health researcher, I'm always looking towards a science,

which is why I'm joined today by Dr. Dom D. Agostino.

He's a neuroscientist, him NASA and the DOD Trust

to optimize human performance in the most extreme environments.

Today we're breaking down the signs of thardine fasting,

a protocol used by Dr. Bos to crush insulin and drop body fat without losing muscle.

Plus, we're going to talk about the signs of ketosis

and the gut microbiome and a common carnival health food

that is slowly destroying your weight loss results.

Now, if you like me and you're disappointed by traditional healthcare advice,

one thing you can do is to join this movement of curious minds

and hit the subscribe button.

Because next week I have another massive episode with Dr. Bos

specifically talking about how butter can reverse insulin resistance.

But Dom, my first question.

As a neuroscientist, you deeply understand the body from a science perspective.

If somebody's coming to this episode, they want to lose weight

and they also want to prevent some serious disease.

What is the single biggest thing that they need to focus on?

Broadly speaking, I would say understand your metabolic health biomarkers

with insulin being at the top of the chain.

And that's not actually included right now

on a comprehensive metabolic panel, but it absolutely should be.

So if somebody wants to focus on insulin

and there are different ways that we can lower our insulin

and that's what we're going to talk about today,

I want to understand the role of autophagy to lower insulin.

Is that effective?

Well, autophagy is a consequence of keeping insulin low and suppressed

which does happen with fasting and happens with starting fasting too

and also happens with caloric restriction and time restricted feeding.

So autophagy is essentially a consequence of having high insulin sensitivity

and creating caloric deficit or a state of low insulin,

even in the context of a eucaloric diet,

which means you're getting enough calories to meet your energetic needs.

But if you restrict the carbohydrates,

you could keep insulin low enough to keep autophagic flux.

So we measure autophagy in the lab with various autophagy digling metabolites

and we can say that autophagy can be active.

It's a consequence of low insulin,

which is a consequence of following different dietary protocols.

If that makes sense.

It makes sense.

And there's a reason why I asked that because on the internet,

if people look at how to get into autophagy,

there are a lot of information about, do a 72 hour fast fasting for three days.

And I think many people might think,

is there another alternative where I can eat something

but still get the benefits of autophagy?

And that goes into a weird trick that you have been doing.

I think for the last few decades or last few years,

which is sardine fasting.

Now, not only can this help people lower insulin, lower glucose,

but it can also help people lose body fat.

What is sardine fasting?

Yeah, never thought it would become a thing,

but just by experience,

I got interested in sardines in 2001.

I was attending a conference and someone was selling a book called The Sardine Diet.

So I picked up that and that always,

and I started eating sardines in addition to tuna fish,

which I was also eating at the time, just added that.

I wasn't a huge fan until I started doing,

well, there's different types of sardines.

And if people are hearing this,

I would recommend that they buy specific brands of sardines,

like King Oscar or because your introduction to sardines

will dictate, you know, it's the first impression.

You want a good first impression of sardines.

And then you can, there's many different kinds

that actually taste pretty good.

So sardines are very high in omega-3 fatty acids.

My omega-3s are off the charts, DHA and EPA.

That's really good for suppressing inflammation,

but also omega-3 fatty acids have anti-catabolic protein

sparing effects.

So if you enter a state of a fairly significant energy deficit

through fasting, and you do it through sardine fasting,

which is given your body,

it's almost like a protein sparing modified fast

that's on steroids, or it's better than the existing sort

of template of the protein sparing modified fast,

which has been around for about four decades.

So with sardines, you get all the micronutrients

that you need pretty much,

and then you get the omega-3 fatty acids,

and your body does not enter any kind of state

of nutrient deprivation, which is,

so you get a high nutrient sufficiency

or you meet your nutritional requirements,

but your caloric requirements,

you enter it with an energy deficit,

and it's that energy deficit that really drives autophagy

and also drives the body composition alterations,

you know, the loss in fat,

and also the autophagy and other brain effects

that we're seeking from that.

So, and I could go into a little bit more details

of what it does from a metabolomic perspective.

I sent you some of my data and dexascans and things like that,

but it changes the body composition in a way

that's more favorable to water only fasting,

and it also preserves your energy levels,

and when you come to the end of the fast,

you're not in a nutrient deprivation state,

and it doesn't also alter your hormones,

like testosterone and other things,

which can be suppressed, especially if you go beyond three days.

Well, this sounds like the most brilliant strategy

that anyone could do.

I haven't done it personally,

but do you think that if I or somebody watching

does a sardine fast, so you're actually eating calories,

you're eating something, is that gonna have

the similar autophagy effects as them doing, for example,

with three day fast or a five day fast?

Is it similar?

I mean, you're talking about a water only fast.

Yeah, I think the main driver for autophagy

that you can measure, we measure things like P62

and other markers of what's called the autophagic flux,

and we do that in animal models.

And I've done a little bit in myself too,

but typically what you wanna look at is the hormone insulin,

your glucose and ketones,

and the glucose and ketones are really important

because the glucose level over ketones

in millimolar concentration,

which can be done with a commercial meter

that you can buy online,

we call that the glucose ketone index.

And if you can achieve and maintain between one and four,

and then maintain that for like 72 hours,

and your insulin will be just by default very low,

because it's restricting glycolytic metabolism,

and forcing your body to mobilize fatty acids for fuel

and make ketones.

And ketone production is more or less inversely proportional

to the suppression of the hormone insulin.

So as insulin goes down further,

ketone production will ramp up,

and a glucose ketone index between one and four

is one way to measure entry into autophagy

if you can sustain that for 72 days

if you don't measure insulin.

But there are commercially available kits

where you could do at home

or you could go to Quest Diagnostics

and just add an insulin test,

but it's the suppression of insulin,

the glucose ketone index.

If you don't have the lab to measure

the components of the autophagic flux,

which research scientists do,

it's gonna be on what someone at home could do.

But yeah, 72 hours of a sardine fast

can essentially achieve that,

and it would mimic what would be more or less happens

with a three day water only fast.

And a five day fast, too,

you're getting into zones where fasting becomes starvation

when you start becoming nutrient depleted.

And if you have a lot of body fat,

then fasting is more feasible,

but if you are already lean

or you don't have a lot of fat to lose.

But there are, in the literature,

someone fasted for a year and came out the other end,

okay, and I've seen a lot of blood work

in individuals that fasted five days, seven days,

10 days, and even 40 days, like someone sent me a fat.

I advise not to do it, but when you go beyond,

and me included, if you go beyond seven days,

that causes a counter regulatory effect on your hormones.

So your thyroid will be suppressed,

your T3 levels, your testosterone

and other hormones can be suppressed.

And you generally want to not do that.

So a three day fast,

I've never seen any abnormalities in my hormones.

And that's why I'm kind of safe.

And if I advocate for a fast, it would be three days

with sardines.

That's really important to understand,

because I think that so many people have thyroid issues,

they have brain issues.

Cancer is a big thing that's ever increasing.

And if we can do something

where we're still eating and get some really good results,

it's a really plausible science-backed alternative

as opposed to just drinking water.

And I'm sure that people like to eat something.

Maybe sardines is not the best thing,

but we're going to offer some other foods that we can eat.

I want to get into your amazing results.

So you sent me both your Dexascan and your Genova

is at the Genova, your food sensitivities,

which I'd like to get into.

Genova diagnostics, yeah.

Like they have these kits.

And you know, I became aware of them

because patients that I'm connected to

that are managing everything from Parkinson's to cancer

to different, we're sending me their data.

And I was like, wow, this is really cool.

And I knew of Genova diagnostics,

but I didn't know of that particular kit.

And about in 2001, I believe I've started it.

And I don't know of anything that gives you

the advanced, comprehensive metabolic profile.

And also the food allergies,

which is I think could be important.

Also the heavy metals, which some people

I've been in contact with, you know,

they have a heavy metal toxicity, they correct that.

And then their metabolic,

their mitochondrial metabolic markers

improved dramatically after that.

So these are just some things that it's an advanced test

that it should be done in addition.

But yeah, that's what I sent you, the results from that.

Brilliant, and let's talk about these results.

So I first want to talk about your body fat.

First question for you might seem a bit bold.

How old are you, Dom?

50, going on 51.

OK, so that's really important because if somebody

is watching this and they're 50 plus or even like me,

I'm 42, you know, this is something

that can help you not only manage your disease risk,

but also help you reduce body fat,

because you are quite a lean individual.

But from doing side-in fasting from 2024 to 2025,

your body fat dropped from 10%, which is very good,

but it went down to 8.9%.

So my question for you, if somebody

wants to consider doing this, could they

get similar results from just doing this for three days?

Yes, they could, but I'd also add that resistance training

is a big lever to pull.

And when you're doing the fast, you

don't have to be deadlifting for a personal record

or anything like that.

But resistance training goes a long way

in triggering the signal for your body

to retain skeletal muscle and lean body mass.

And also, I do two walks per day or mandatory,

because we have dogs that demand to be walked.

And I tend to do that after like meals.

So even with the starting fat after I eat the starting,

the starting is I'll go for a brisk walk usually

about 15 to 20 minutes in addition

to resistance training pretty heavy-ish

about three times per week.

And that's important.

So my results may reflect the addition

of resistance training, which is the stimulus

to grow muscle, of course, but also to preserve it,

even in the context of a caloric deficit.

Perfect.

Is that indicative of your increase in muscle mass

by 2.7 pounds, because you were resistance training,

whilst also having a nutrient-dense food like sightings?

Yeah, it was part of that, too.

And that could be from the prior,

I think the prior measurement was taken at a time

where I was not focusing as much on like squats

or heavy squats and things like that.

So I ramped that up a little bit and going into that.

Yeah, I was actually surprised.

I was a little bit nervous for the results.

So when it came back, I was pleasantly surprised that I did.

But it's also important to mention,

I've done three day fast and five day and 70 fast before.

And I think with a seven day fast,

I lost nine pounds of fat free mass,

which could be, that could be glycogen,

because the muscle swells up with glycogen and that's water

and that shows up as muscle.

But I did make sure that I was hydrated

and I did take electrolytes.

Oh, and I did use ketone supplements, too.

I took about 20, wait, one, two, three packets,

18 to 20 grams of beta hydroxybutyrate salts.

The electrolytes in the form of sodium potassium, calcium,

magnesium, but it was bound to beta hydroxybutyrate.

And ketones are, by virtue of like,

with starvation and fasting,

ketones have an anti-catabolic effect, too.

So that was definitely a factor, I think, too.

Okay, all the things that I want to talk about.

So basically your body fat dropped quite a lot,

like because you were a low body fat,

but if somebody's watching this

and they look down and they see a belly

and they want to lose some fat,

you know, this is a plausible way to help reduce that

and or at least kickstart your body burning fat.

Does this target visceral fat,

in case somebody wants to think,

okay, I want to get rid of the jiggly fat,

but there's fat around my organs,

my doctor's telling me that.

Does sighting fasting help with visceral fat?

Yes, I mean, any kind of color deficit will,

but with sighting fasting,

you have extreme suppression of the hormone insulin.

At the same time, there are various things

within sardines, like the omega-3 fatty acids

at lower triglycerides and micronutrients

that enhance insulin sensitivity.

So I believe it's like it's greatly augmenting

your body's mobilization of fat stores

and your intra-omental visceral fat

is the first to go in that scenario

when you rapidly adjust to fasting ketosis, I guess you'd say.

That goes first, for sure.

Okay, I mean, the good news keeps on coming.

Let's talk about your insulin.

What happened to your insulin

after eating sardines for three days?

Yeah, my insulin measurement was 1.9,

which is it was flagged on the test as being too low,

but in the context of fasting and ketogenic diets

and pushing your body into the maximum fat oxidation state

that is very beneficial.

And even the, I talked to the scientists at Genoba diagnostics

that do the metabolomics,

and my lactate was not even like even measurable.

Really, it was very low

and they had never seen that before.

So it suggested on the test that I had

an extreme bottleneck in glycolytic flux,

which means that my gluconeogenesis too was not ramped up.

And I think with the sardine fasting,

and I should have measured cortisol and I didn't this time,

but what I think was also happening that it was not

a traditional like three day fast would ramp up

and jack up cortisol and glucagon.

And I think, and I have to measure this

and I didn't do it for this test,

but I believe that glucagon and cortisol

probably stayed within normal ranges

just because of prior tests,

where I'd measure those things in the past,

but not for this particular test,

because that would maintain glycolytic flux.

And in the case of the sardine fast,

that my lactate was like not even measurable

and there was markers of fat oxidation and ketone oxidation

and overall mitochondrial flux.

And that was unlike anything they had ever seen before.

And it was higher than I had seen in previous tests,

having done this test before another test.

And that's, I think that's what people are looking for.

Yeah.

Absolutely.

So it seems like your body fat reduced muscle mass increased

as a consequence of also doing resistance training.

Your insulin dropped targeting visceral fat,

what happened to your LDL and your triglycerides?

Yeah, triglycerides are in the 30s,

which again, it's like really, really, really low.

My LDL cholesterol has historically been quite high

because I follow a low carb ketogenic diet.

And when I did like a clinical ketogenic diet,

it was in the 300s.

So that's alarming to many people.

And my APOB, which is probably better than LDL,

was about 165.

So in around two years, two or three years ago,

I started using a drug, not a statin,

but a drug called a zedamide.

And it's also sold to Zedia, the brand name.

And a zedamide blocked the NPC1L1 receptor.

So that basically sucks up cholesterol

from the gastro, that's your cholesterol transporter.

And I took a dose of this

and it cut my cholesterol on APOB in half.

So I was on that drug

and then I further did genetic testing

through GB Health Watch to show that I have a mutation.

And I overexpress, I guess there's a gain of function

for the NPCL1 receptor, not to get too complicated.

But it's also important to know that there's people out there

that have, you know, greatly elevated LDL and APOB

to low carb diets and ketogenic diets.

And many of them are what we call hyperabsorbers.

So I'm an extreme example of that

because I have a genetic anomaly for this transporter.

And a little tiny baby dose, a monotherapy of a zedamide.

And I break it in half.

So it's just five milligrams per day

has kept me for the last years, you know, about 190 LDL

and APOB about 90, I think.

And otherwise it would be really high.

And I don't know if that's,

it's not having any negative effects for sure.

And I do not want to use a statin.

But my APOB and LDL largely did not change during the fast.

Some doctors would say it's still elevated

but I'm not going to take further, you know,

I don't think it's necessary to.

And also I've had a carotid scan.

And my my vascular age was 34

and there was no evidence of softer,

no evidence of any plaque in my vein.

And that's good for a 51 year old,

especially having a vascular age of 34 was a good sign.

So I'm not, I don't want to lower my LDL anymore

and I'm not even sure it's necessary.

But I'm doing it because my LP little A is also high.

And there's cardiovascular disease,

strokes and stuff in my family kind of distant relatives.

So I'm just being a little bit prudent

in my use of a drug that really doesn't have any side effects

to yet to my knowledge.

Okay, well, I think people would be thinking,

well, do I need to lower my LDL cholesterol?

What do I need to do with respect to that?

So I'd like to talk about that further in our conversation

because you don't really,

you think another marker is more important

than LDL cholesterol, which we'll talk about.

But getting back to the side-in fasting,

now bone health is very important,

especially as people age.

Do you know what happened to your bone health

after doing the side-in fasting?

Yeah, my bone health is like maxed out on the chart.

So I'm kind of like an outlier on that.

So my bone density, yeah, is if you look,

I think, yeah, I sent you the bone marrow density.

Yeah, it was really, again, the clinic that did it,

so this is very unusual to see that.

And I think what's important,

I think the message that's really important

is that I have been on a pretty strict ketogenic diet

for almost 20 years, definitely well over 15 years.

And ketogenic diets get a lot of pushback

because of the mild metabolic acidosis

that some endocrinologist will say happens.

But I have been on in some form of ketosis

for like almost two decades

and my bone health is really off the charts.

The main driver for that is, you know,

weight bearing resistance exercise and muscle, right?

So bone, there's no reason for bone

to have a very high bone mineral density

if you're not putting stress on it.

And what puts stress on bone, it's muscle.

So typically what we see is that bone mineral density

will correlate with skeletal muscle mass

and also heavy resistance load bearing training.

And I think that's really important.

And that's why, you know, it's important to,

if you're losing weight, whether you're a GLP1

or a low carb diet to continue resistance training

because as you lose weight, you're gonna lose muscle

and that could impact your bone density,

especially in women, very important for women to do that.

As Dominic discussed today,

your health comes down to what you eat,

your immune system and your gut function.

And you can eat the cleanest diet in the world

like carnivore or ketube.

But if your gut barrier is strained,

other parts of your body and how it functions

are going to feel it, think of it this way.

Our modern world is constantly putting strains on our gut.

And when this happens, toxins leak into your bloodstream

and it triggers a response that travels

throughout your whole body, leading to that foggy feeling,

all that tired feeling.

And instead of focusing on energy and focus,

your body is distracted, fighting these tiny fires

in your gut.

And that is why I have made Armicle Oström

a staple in my morning routine.

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It is literally nature's blueprint

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And Armour is a whole food powerhouse

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which is why I've been feeling so much more energized

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And for my carnivore friends, the unflavored version

is 100% carnivore.

And I just do four scoops in cold water every morning

to keep that gut very as strong.

So if you want to try Armour, just head to armour.com

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There's also a link down in the description.

So I love you, Dom, because it's so important

to not only talk about sardine fasting,

a protocol that people can use every day

to help them lose weight.

But you know, it's the important stuff

that you're talking about, which is, yeah, I did this,

but I also resistance trained.

I've been doing a ketogenic diet for, I think you said,

two decades, 20 years.

So, you know, all of these things,

along with the sardine fasting,

is important to improve your metabolic health,

including exercise, which we'll talk more about.

So I want to talk now about what do people have to eat

in terms of the types of sardines, how often, and how much?

The type of sardines will depend on your palate,

and there are ones that you can get at the dollar store

that are probably okay.

I think they even have the last time I bought some sardines.

I give my dog sardines to,

I tend to maybe gravitate towards the cheaper ones,

but chicken up the sea, for example.

They have sardines.

And then the third party analysis

on the heavy metals of them are good.

So they have pretty good sourcing and sustainability.

And I think they're mostly caught in Portugal.

So, like, if you want to go to the cheap route,

sardines in water, I think would be the cheapest.

You can get them almost for a dollar to a dollar 29 it can,

if you really shop around and look for deals,

and if you buy them bulk.

And then you could get, maybe the higher end would be

king oscar, which sells them,

and they're different flavors.

And I like to get the extra virgin olive oil.

And another thing I've been experimenting with

is cod liver and cod liver,

which comes in the same size can,

but it has three times the amount of calories.

And the cod liver, very high in omega-3s,

and the cod liver is actually sitting in cod liver oil.

So, you have 660 calories in a small can,

that you have about three times the amount of calories

of sardines.

So they're very good for traveling,

and it will say Icelandic cod liver.

And we're on our way to Iceland too.

So I'll build it, kind of get it from the place.

So that is another option.

And the potential advantage for the canned cod liver,

it is very high in vitamin A.

So you just need to be,

they could get two high levels of vitamin A

if you eat a lot of cans.

Is that the ketogenic ratios are higher in cod liver.

So, but, I mean, we're talking about sardine.

So cod liver, if you really want to stay in a state

of high ketosis, this could potentially be replicated

with cod liver, or, you know,

but the sardines will have more protein for sure.

And it'll depend on your palate.

So I encourage people to, if they're just starting out,

I would say just go for the more expensive ones first,

because your first impressions are big with sardines.

And my first impressions were not very good,

so I used them kind of sparingly about 20 years ago.

And then I titrated them in,

especially when I went to Europe,

and would see like in Croatia or in Greece,

I think for example, or Portugal,

like there's just tons of different varieties of sardines,

and some of them taste really good.

So I would say avoid sardines in soybean oil,

corn oil, or like vegetable oil.

And if you want, I do like the idea of sardines

in extra virgin olive oil is a good thing,

because you get the extra fat calories that are ketogenic.

OK, very, very simple.

So look at the quality of the sardines,

especially if you're just starting,

maybe the more expensive version,

as opposed to the $1 version.

How often, if I want to do this,

how often do I need to do this?

Well, it depends on your context and why you're doing it.

And one idea that I think is shared by other scientists,

too, it just heard some, I won't mention their name,

but they're kind of big and influencers.

But they're also scientists,

tenured professors, they're doing it now,

and they're doing three to five days once a month.

And this could fall back on Dr. Walter Longo,

who advanced the fasting mimicking diet.

And I do believe he sells some products that are like a kit

that you can buy for five days,

and essentially very low calories.

About the same amount of calories as three sardines per day,

or three cans of sardines per day.

But I would argue that the sardine fast

is kind of much better in regard to the microdutrance

and also the proteins and omega-3s.

So you could follow a protocol like three days,

you know, done once a month.

And that could be situationally

when the timing is right for you to do it.

But the research also indicates that when you do this,

three, maybe you could extend to five days

that the benefits go at least a month

to six weeks or more.

So, and Walter Longo is published on the fasting mimicking diet

and the same thing would happen.

I believe maybe to a greater extent with a sardine fast.

So if you do it like once a month,

that metabolic reset could really be pushing your body

towards more metabolic flexibility.

And I have often talked about like,

when if you lift weights and build up to a certain level

of strength and take time off,

your strength comes back really quick

when we call that muscle memory.

If you diet down to a certain level

and then you get out of shape and then diet again,

it tends to go a lot easier and faster.

And I call that, I call that metabolic memory.

And when we do this type of fasting,

we're changing many different metabolic parameters.

We're changing our metabolic physiology.

We're also changing brain energy metabolism

and the neuropharmacology of our brain.

This is why I studied the ketogenic diet

because it has applications for seizures

and other disorders.

But we're also activating gene transcription

and we call that, or gene expression

and we call that epigenetic effects.

And the increase in gene expression

and associated pathways when that gets ramped up,

you're fundamentally like changing your body.

And then those pathways get the epigenetic effects

or preserved, even if you're adicutosis

for longer period of time.

So this is an area that's emerging right now,

that epigenetic changes, even for women that are pregnant,

what they're exposed to during their pregnancies

has effects on the offspring.

And that's like epigenetic effects.

But we know that I believe there's,

everybody agrees that there's this muscle memory.

And I think I have often been talking

about metabolic memory that these intermittent fastings,

are deemed fastings, whatever you want to call it,

actually has like long-term beneficial effects

through epigenetic changes.

Okay, so that makes sense doing a sudden fast once a month

for three to five days,

just that short period time to get you into deep ketosis.

I now want to turn our attention to what ketosis

can do in the entire body, beyond just weight loss.

So can ketosis help the gut microbiome?

Yeah, generally speaking, it can be very beneficial

for most people.

And I do think that if you add the diversity

of your ketogenic diet could offer additional benefits

in regard to the diversity of your microbiome.

But I think the jury's still out

that having a very diverse microbiome is beneficial.

But the people who study microbiome, they say it is,

but I've not, you know, the data is not very conclusive

on that.

But I will say that there's certain species of bacteria,

acrimensia, for example, actually that goes up

on the ketogenic diet.

And the acrimensia, you know, species helps the gut,

Mucosa generate the mucosa lining, the mucous,

that protects your gut.

It's very protective and it actually helps you preserve

the integrity of your gut and prevents intestinal permeability

that is associated with like leaky gut and things like that.

And then the, you know, lactobacillus, bifidobacteria,

like these things, which can be found

fermented food can be beneficial.

So having some like truly fermented sour cream or, you know,

that could be beneficial for some people.

But, you know, there's some research that have been focusing

on low carb diets, ketogenic diets, and they see benefits

and their proponents that the changes in the microbiome

are actually, they are actually leading

to the anti-seizure neuroprotective effects.

I am a little bit less convinced of that because in our lab,

we can give exogenous ketones without changing diet at all

and see an anti-convulsive activity just from the ketones.

So I think there's a lot of different things,

a lot of different moving parts when you follow a ketogenic diet.

And of course, it changes your whole metabolic physiology

and even hormones in a way that is changing your sympathetic

nervous system, your parasympathetic nervous system.

Like even the neurotransmitters GABA go up, for example.

And these are all beneficial too, especially in the context

of metabolic psychiatry, which is a rapidly emerging field

where ketogenic metabolic therapies are being used

for things like schizophrenia, bipolar, major depression,

anxiety disorders, Norexia nervosis.

So there's all registered clinical trials now

looking at ketone metabolic therapies for those disorders.

Largely spearheaded some by the NIH,

but largely spearheaded by the Bazooki group,

which is a philanthropic organization

that's funding some of the work.

Amazing.

So we can improve our gut health and the gut microbiome

by simply not eating all of these carbohydrates

that we're told to eat.

The next benefit perhaps of a ketogenic diet

or entering to a state of ketosis, mental health

and brain disease, can ketosis, you know,

if somebody's worried about brain disease,

like Alzheimer's, Parkinson's, can that help being in ketosis?

Yes, and I think again, it's very nuanced conversation

and the research is ongoing, but there's published research

if you just even systematic meta-analysis reviews on this.

And also there's a lot of clinical trials right now

if someone was to go to clinicalchiles.gov

and just type in ketogenic diet.

You'll find many different trials.

Evidence-based applications include, you know,

Alzheimer's disease, weight loss diabetes

and those things, you know, obviously can help.

You know, there's registered clinical trials

on polycystic kidney disease, migraine, Parkinson's disease.

We study different inborn errors in metabolism

that are neuro-metabolic,

but so they're like more evidence-based

and then there's emerging, what I call,

emerging evidence-based applications

and that includes psychiatric disorders.

And I believe there's about 40 to 50 registered clinical trials

on psychiatric disorders.

And as I mentioned, you know, bipolar, anxiety, depression,

schizophrenia, but also a traumatic brain injury,

which is something that, you know, we're interested in studying.

So the research is emerging, the case reports are there,

the RCTs are emerging, there's a few of them.

And it's a very active, keep in mind that five years ago

there were like no clinical trials, 10 years ago, definitely none.

And now if you just put in ketogenic diet

into clinicalchiles.gov, you get about 450 to 500 clinical trials.

So that just, and then it'll take,

it'll take years, sometimes five to 10 years,

if it's a longer trial, for that research to hit PubMed.

So just, you know, for listeners out there,

and there's already a spike up in PubMed,

although the Google Analytics kind of came down

because there was this big surge on keto.

So Google does its own thing,

but I mostly focus on the peer reviewed publications

in PubMed and also what's in clinicalchiles.gov.

And that will, that's essentially,

will give you a window into the validity

of the science and the application

of ketone metabolic therapies.

And there's also a lot of discussion about,

further augmenting the ketogenic diet

with ketone supplementation.

You know, that could be everything from MCT oil

or ketone esters or ketone salts

or various exogenous ketones.

So we work on that front too.

All the things I want to talk about as well.

So we mentioned the ketogenic diet

can help with the gut and gut health.

It's a big issue that drives so many disease.

Ketogenic diet for mental health, brain issues.

I'm also talking to Dr. Georgia Eid next week

about how the ketogenic diet can help with mental health.

So there's so much areas of research.

This is an area quite interestingly

where a ketogenic diet can help with cancer.

Not to say that it is a treatment for cancer,

but if you want to lead with the story of Dr. Fred Hatfield

who used a ketogenic diet in his own story,

what happened with him?

Yeah, Fred was maybe one of the first,

I just started getting interested in ketogenic diets

and not formally doing research,

Fred was a dear friend and mentor of mine.

And I think around we connected face to face

personally around 2008, I believe.

And he was diagnosed with advanced metastatic prostate cancer

that spread to the hips and had metastatic bone cancer.

And he was undergoing different treatments

that weren't really working at all.

And I had just like this, you know,

I was studying ketogenic therapies

for a military application,

which is central nervous system oxygen toxicity,

which is like something Navy SEALS get

if they use a closed circuit rebreather.

But in the process of researching that,

I had various cells and some of the cells are cancer cells

and we observed that they failed to grow

in the presence of ketones and they died.

If you knock down the glucose and gave them ketones,

the neurons loved it, but if you grew cancer cells

and you restricted the glucose and putting ketones

like they would rapidly die.

And that was an interesting observation

that I kind of did not expect.

And I was just using a particular cell model

because it was easy to grow

and I was comparing it sort of a control

for another project.

And we don't have to go into the details.

But it gave me insight.

It's something that was happening with cancer cells.

So I researched it on PubMed

and then I found the work of Dr. Thomas Saferead.

And that really interested me.

He had a publication in 2008.

And then I got really interested

because I had some PhD students that wanted to study it

and he published a review article

in Nutrition and Metabolism,

entitled Cancer as a Metabolic Disease.

And what he was saying in that review article,

basically was explaining some of the observations

that we were making in the lab using confocal microscopy

looking at the mitochondria of cancer cells.

They were dying and exploding

when we were hitting them with high oxygen

and it was kind of, I was observing the warberg effect

but I didn't really know what it was at the time

because I was not a cancer biologist

but I self taught myself this.

I'm a cell biologist and neuroscientist

and metabolic physiologist.

But long story short,

we basically developed the very robust preclinical

ketogenic diet research lab

and we've published a number of articles

on ketone metabolic therapy.

We've also published articles on like metformin

and different glycolytic drugs.

So targeting the warberg effect,

targeting this accelerated sugar metabolism

in cancer cells, brain cancer

and advanced metastatic cancer is what we study.

So getting back to Fred, Dr. Hatfield,

so he was a well-known powerlifter at the time

and squatted kind of raw 1,000 pounds

which is even like unheard of today.

And he was a well-known authority in powerlifting

and just like a big brain behind the fitness world

we connected, I advocated that he tried this,

he did and he went into rapid remission

which is not gonna happen with everybody

and I don't think we should promote

the ketogenic diet as a cure for cancer

but in his case, he did the sardine fasting

and he did, he was also very spiritual

so he would do a lot of prayer and meditation

and I think while he was in a state of fasting

and then I think I recommended sardine

so he got, he liked love sardine

so he got into that and would do cycles

of the sardine fasting

and then he essentially had no evidence of disease.

So that doesn't mean of remission

but it just mean that they couldn't find

like cancer in his body

and then that was 2008

and I think in 2017, Fred died of something totally unrelated

to cancer but he was only given a short time to live

when we met, when we first met

and he sort of like, you know,

was the person doing what I was studying in the lab

and it was almost like this proof of concept that, you know,

and then also talking with Dr. Thomas Safereed

he was telling me that he had patients

and he was telling me the ketogenic diet

works better for cancer than it does with epilepsy

or seizure disorders

and I was studying seizure disorders

and I knew it had a very solid track record for that

and I was like, okay, maybe this is something I need to study

and I had a little bit of startup friends

as they transitioned to a tenure track position

at my university

and that got Dr. Angela Poff

or at the shoe of the PhD student at the time

on her project

and then like Dr. Andrew Kutneck

who you have mentored, you know,

he actually used Dr. Safereed's model

looking at cancer kexia

and one of the benefits of being in ketosis

is that it's anti-canabolic and muscle sparing

and also reduces significantly inflammation

which is a driver for muscle wasting

and Dr. Nate Ward, he studied more like the anti-cancer drugs

but he has a lab at Moffat Cancer Center now.

So I've had a lot of very talented students

kind of come into my lab studying cancer mechanisms

and preclinical models

that have helped us move the science

and application of ketone metabolic therapies

into the clinic

and we did recently get with the Moffat Cancer Center

a very high score on an NIH R21 grant

to move ketone metabolic therapies

into the clinic for enhancing immune-based therapies

specifically the immune checkpoint inhibitors,

the PD-1 inhibitors for lung cancer.

So that just got approved

and I'm working with Moffat to advance this dietary therapy

as an adjunct

as a way to further enhance the adaptive immune system

that makes immune therapies work better

and work is already being done at University of Pennsylvania

and other institutions.

So we're not the only one doing it

and I think there's a couple dozen trials right now

going on looking at ketone metabolic therapies for cancer.

But I think Thomas Safry largely started that

and then we did the preclinical work

and then other institutions followed

with the clinical trials.

Wow, so there's so many different applications

of just increasing your ketones

so using a different fuel source for your body.

What does this mean for somebody watching?

They have a disease, maybe we haven't spoken about,

maybe it's not cancer,

maybe they might have got problems,

but they don't know it,

maybe it's not a brain problem,

but they have something for them.

How do you think increasing ketones might help them?

I think there's a big interest in the longevity field

and I wake up every morning and I have a lot of emails

and a lot of people just want to,

maybe there's cancer in their family,

maybe there's Alzheimer's for example,

and they want to live the longest life,

the best life that they can.

And there are many longevity pathways

that are targeted by the ketogenic diet and even ketones

and that could be, you know, it reduces insulin,

it increases autophagy or autophagic flux.

We can say that mitochondrial efficiency

and bioenergetics reduces oxidative stress,

inflammation, it reduces and then there's,

but my last PhD student that graduated,

studied the metabolic control of epigenetic regulation.

So when ketones are elevated in the blood

and circulating and go to the brain,

it, there's, there's ketone-induced gene expression

and that could be through something called

histone deacetylase enzymes,

that kind of also methylation patterns are changed

and then we also know this phenomenon

called beta hydroxy butylation.

Now not to get too technical but the important thing

is that beta hydroxy butylate,

the ketone molecule can directly interact

with something called a histone

and it can bypass other mechanisms

and directly impact the histone

and to influence gene expression.

That's called beta hydroxy butylation.

The same thing happens with lactate and this is called lactolation.

So that's an emerging field that a lot of

mechanistic scientists are focusing on.

So visceral fat, metabolic flexibility

and I mean my background is really ketosis

for neuroprotection.

So protecting the brain, reducing neuroinflammation,

enhancing neurotransmitter systems

and as we age, the glucose metabolism of the brain

declines pretty steady but the ketone metabolism

of the brain basically is preserved.

So what does that mean?

As we age, I'm in my 50s and it starts

actually when you're in your mid 20s.

So you are, so people my age and older,

especially they have reduced glucose energy

metabolism in the brain.

However, if you give them ketones,

their ability to use ketones and to enhance

and brain energy metabolism is preserved.

And Dr. Stephen Cunein has published on that

using an FDG PET scan and a ketone PET scan

and looking at things like mild cognitive impairment

and a number of investigators are looking at that

and replicating that work.

So I think that what I just described there

is just, you know, ketone metabolic therapies,

the state of ketosis, whether done continuously

or intermittently is impacting, you know,

metabolic physiology, gene expression

and brain function, inflammation states.

So all these are beneficial.

And but also, you know, everybody is a unique

metabolic entity.

So I think that doing blood work is going to be important

because any radical change to your diet

can change things in ways that could potentially be unpredictable.

So keep up on your blood work and I say,

you have objective biomarkers and you have subjective.

If you don't feel good on the diet,

something's wrong, even if the objective biomarkers

are improving, and vice versa.

So you want to feel good, have lots of energy,

but also have, you know, your cardio metabolic biomarkers

should be going in the right direction

to when you follow the diet.

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Okay, so lots of benefits from just simply increasing

your key tones and shifting what you eat,

eating less carbs, eating more healthy fats and proteins.

So I wanna ask a big question that people have

which is about cholesterol.

Now, you mentioned earlier that your LDL cholesterol

is like really high and you're taking a drug for that,

but broadly speaking, so it's not you, it's not me

because I also experience a similar thing.

But for somebody that's doing, you know,

higher fat diet, not in the carbohydrates,

the LDL increases, you say that HSCRP

is more important than LDL cholesterol.

Why is that?

Yeah, I think if we look at the data,

the human randomized controlled trials

and even the epidemiological data

that HSCRP is a better predictor for cardiovascular health,

I don't think that's even controversial now,

although it's not talked about much.

But HSCRP elevated is an indication

that something's wrong with your body

and that could be a variety of different things.

But typically is a result of poor metabolic health

which can be vastly improved

with simply carbohydrate restriction,

ketogenic diets, you know, improving your diet quality.

And a lot of people suffer in the United States

and abroad from energy toxicity

just simply eating too much.

So I think we should start there

and the easiest way to reduce energy toxicity

is through carbohydrate restriction

and just intermittent fasting.

Everybody's gonna be different,

but HSCRP responds dramatically to an energy deficit,

but also responds for me very dramatically

being in a state of nutritional ketosis.

So independent of weight loss,

my HSCRP typically hovered around like,

I don't know, two to three to five one time

and now it's like non-detectable,

like 0.2, 0.3 sometimes,

but usually like 0.1 or, you know, non-detectable.

So, indeed, I get usually on the test

and that never happened prior to,

I did get HSCRP only measured maybe three times

prior to transition to acute tissue.

So I only have a baseline of like three,

but now I get it measured three times per year.

And it's always low, only in the context of like,

one time I had like a little stomach bug

I came back from like the Philippines

or something like that and it actually reminded me

that any kind of when your gut is compromised in any way

and you have a leaky gut,

that radically triggers your immune system.

And my HSCRP was like six or seven or something.

I recovered really fast,

but and that's only because I had a little

bacterial gastroenteritis or maybe viral enteritis

or something, but I recovered very fast from that.

But I think a lot of people suffer

from chronic inflammation

and I think one way to address that,

the fastest and easiest way to address that

is with a starting fast maybe

and just with improving your diet,

carbohydrate restriction and then periodic fasting too,

I feel significantly contributes

to my like non-detectable HSCRP.

And also my genetics are such that I have a genetic marker

that basically indicates that my body produces

low amounts of TNF alpha,

which came up in my genetics and two tests.

So I do tend to have just lower inflammatory markers

just according to my genetics,

but also I can have pretty robust inflammation flare-ups

from time to time for different things.

And that's why I've also advocated

for using fasting and therapeutic utosis situationally.

And this has been brought to my attention

because some people have,

could be herpes, simplex virus or shingles

or Lyme disease.

Tim Ferris comes to mine because now he's public about it

but years ago he was not,

but we communicated through texts and things like that

that he was suffering from Lyme disease

and the only thing that really worked

and moved the needle for him was ketogenic diet

but therapeutic fasting.

He did exogenous ketones and everything too.

So if people have periodic flare-ups

and we all harbor different infections

and that could be viral, that could be mold or bacterial

and or just being a cold or COVID or whatever

and situationally or sometimes I just feel inflamed

or just I'm coming down with something

and I don't know what it is.

But then I was like, okay, tomorrow

I'm just gonna start my three day fast

and then boom, nothing like my glands will get swollen

and then boom in a day or two, I feel fine.

And I feel like that quickly nipped it in the bud.

So whatever thing was in my body,

it just deactivated it.

And we do know, and that's actually why we have research now

at Moffat Cancer Center that this state of ketosis

all comments the adaptive immune system.

The adaptive immune system, there's the innate immune system

that generally keeps us healthy and it's kind of functioning

in the background and your adaptive immune system

is kind of like the Navy seals that go after

and target any kind of infection

that could be creeping into the body or whatever.

So we do know from work from multiple labs

that being in a state of ketosis

and it correlates with the elevation of BHB

enhances the adaptive immune system

and that's kind of, if I'm honest, that's why I do it.

I keep, I keep, I pull the trigger, if you will.

If I feel something coming on and that's why I don't

put it into my schedule the fast

but I kind of have it on a sliding scale

where I can use it situationally.

Perfect, well let's talk about practical takeaways

so people can do this in a way that's when I get them results

including eating sardines.

I think people don't like to eat sardines

but if they can embrace the weirdness

and get some great results

that's gonna be extra exciting for them.

I wanna ask about ketones.

Does MCT oil boost ketones?

Yeah, it does.

I use MCT every day and MCT oil goes right to the liver.

Unlike long chain fats get packaged into chylamicrons

and they have a more of a circuitous route

to get into circulation.

But MCT oil, you consume them

via the hepatic portal circulation

they go right to the liver

and you start producing ketones.

Also, what I did not know at the time

until we did brain metabolomics

is that when you consume MCTs

they get into circulation

and they cross the blood brain barrier.

So they convert to ketones.

MCTs will be transformed into ketones,

not all of them but some of them.

And also MCT, medium chain fatty acids

will get into circulation

and then they can cross the blood brain barrier.

I did not know that until we did some studies

and then we take out the hepocampus

and we do metabolomics and it's like,

oh, it's like full of MCT and it's like had to go back

because I don't even think that was in the literature.

But now I think, I mean, that was 15 years ago

but now I think we largely know

that MCTs can carve.

So when you take MCTs, you're elevating ketones

that's beneficial.

And then the medium chain fatty acids

too can be used by the brain as a source of energy.

But it's kind of small relative to exogenous ketones.

So just keep that in mind.

But it's still beneficial.

So can I have a few tablespoons of MCT oil

if I want to do fasting,

if I don't want to do fardine fasting?

Can that help me reduce visual flat, reduce insulin?

I'm still having some fat.

Yeah, I would say be cautious, right?

Because even me, I consume a lot of MCT

but if I do it on an empty stomach,

I still have problems with it

and I have a large tolerance MCT.

However, my tolerance for MCT is vastly improved

if I take it with some kind of protein

or mix it with some other kind of fat.

So for example, it's my sound gross

but like if I'm having a can of sardines,

I'll maybe put it into a bowl

and then put it in a tablespoon of MCT oil

but also a tablespoon or two of apple cider vinegar

and it kind of stir it up

and it's kind of tangy

and the apple cider vinegar totally neutralizes

any fish taste so that's for people

who don't like fishy smell and taste, that'll help.

And that's kind of like my go-to, right?

So I'll do, yeah.

Can of sardines, MCT oil and apple cider vinegar seems to be,

and the apple cider vinegar too,

the acid from the apple cider vinegar

tends to delay gastric absorption

because when the food's in the stomach

and it moves to the duodenum

through the pygoxfincter

that your body has to adjust the pH

and to creep by carbon things.

So it's sort of the acidity of what's in the stomach

will delay the entry of that food

into the small intestine where it gets absorbed.

And then that's important

because that'll impact the rate of rise

of the amino acids and other things in circulation.

And if you attenuate that rate of rise,

that will then further reduce

or prevent the rise of insulin.

So you can further suppress insulin

by sort of using the, using fat

and also apple cider vinegar

tends to sort of delay gastric absorption in a way

that reduces the attenuates the entry

of the nutrients into circulation

that would otherwise like trigger

a larger insulin response.

Okay, make sense.

So the idea is to lower your insulin

any which way possible

and a ketogenic diet is a great way to do that.

Typically not eating too many carbohydrates,

which goes to foods

because there's so many different ways

of eating this way.

Some people talk about just eating one food.

Sardines, beef, eggs, butter, MCT world.

But as a neuroscientist who studies this for decades,

what do you think are the best five foods

everyone should eat every day?

Well, I would definitely say if we're going to

like the most nutrient dense superfood in the world,

that would probably be beef liver.

Would probably be like the highest.

And that's sad because nobody likes that.

I know, but they should try it.

Although I tend to default to like chicken liver.

My wife's from Hungary, so we have heart

and liver every, I think we're having it tonight.

We have it every week, right?

But with liver, just be careful with,

you can get hyper vitaminosis.

So you get talks with levels of vitamin A

if you eat it a lot.

So yeah, like once a week is fine.

So yeah, beef liver and beef, Sardines, eggs,

and you know, so they're all animal-based carnivore diet.

So right there, you're not going to have any nutrient

deficiencies because even liver has like vitamin C

and some people may come down on the carnivore diet

because there's no fiber and you'll be deficient

in vitamin C, but nobody got scurvy eating carnivore diet.

And I think liver and meat, especially fresh meat,

if you don't, if you have like a little bit rare raw,

heating meat and liver really high

can neutralize the vitamin C.

But yeah, so you asked for five foods, I think, right?

So just fish and general.

So yeah, yeah, Sardines, liver, well beef liver,

beef, Sardines, eggs, eggs are like an extreme powerhouse.

And wow, this is a very carnivore centric,

but I am off for me personally.

I tolerate broccoli really well.

So I don't eat a whole lot of it,

so I'll just buy like the organic.

And what I do, I cut the tips off like the floret part

and I chew up the other parts for my dogs.

So it's like the fiber that tends to help them poop.

And I do believe that there's a lot of benefits

to broccoli, sulfur, fain, and things like that.

We do some research in the lab with sulfur, fain.

So I am of the opinion that if you're eating a big steak,

it's probably good to eat it with a little bit of broccoli.

I mean, it could be like a garnish kind of thing,

but I think that the micronutrients

and the various antioxidants in broccoli

also help to neutralize the heterocyclic amines.

So when you cook meat, you do generate

some potentially toxic intermediates

and they're called the heterocyclic amines.

But if you have a little bit of broccoli with it,

it doesn't take a lot, like it just could be a small amount,

you're kind of neutralizing that.

So beef is like amazing, it's like a super food

and you could actually make it more nutritious and beneficial

and attenuate any negative effects

by just having a little bit of broccoli with it.

So that's my thoughts and I think there's science

to support that some people may.

But I think if you're eating a lot of cruciferous vegetables

and a lot of a very heavy plant-based diet,

yeah, you have oxalates, you have various plant chemicals

that for me personally, it just tends to blow,

it doesn't help me anymore.

But so I tend to, I have apple, berries,

and a little bit of broccoli.

And it doesn't, just enough to get maybe 20 to 30 grams

of fiber at the most.

And what I just mentioned there,

so that would be 50 grams of protein,

or 50 grams of carbohydrates from the foods I just mentioned,

but about a third of that is fiber, right?

So it's going to have a very minimal impact

on your glucose levels and it will allow you to state deketosis.

So the fifth food would either be wild blueberries

or broccoli and it's a toss-up,

so I'll let people decide from there.

I would choose the blueberries and not the broccoli,

but that's just like my preference,

not that I eat blueberries.

I do too, yeah.

I would say that you're generally more a heavy,

carnivore meat-based diet and adding in some veggies

or adding in some fruit as necessary.

And in terms of the nutrients that we need,

we can get a lot of them, as you just said,

from liver, not that anyone likes it.

Sardines, not that anyone likes it.

It seems like the stuff that we don't like is what?

Sardines?

People like, yeah, well, it's an acquired taste.

So you have to search out, you know,

the gourmet sardines first, so that could be, you know,

and some of them will be like $10 a can,

but they taste really good, I can promise you.

And then, yeah, beef liver and acquired taste,

but I'm telling you to give chicken liver a try

and cook the liver in like bacon fat

and just put salt and pepper on chicken liver.

And I mean, it's like, if you like pate, so it's like pate.

The pate is, you know, most people like pate.

It's very, like I avoided pate,

just because it sounded kind of gross,

but when you try it, it's, most people put it on bread, right?

But you could have a steak and put pate on top of steak,

which I have done, or cod liver,

which sounds crazy on top of steak,

but that's like a very, that's a nutrient powerhouse right there.

Don't knock it till you try it.

I have tried sardines, I do like it,

but I have a carnival keto community

and people are like, I don't want to do sardines,

it's disgusting.

And I've had macro, yes, yes.

So you know, when you're traveling and people try to do kind of one,

they think, oh my god, it's so hard to take a snack.

That ends macro any fish that's canned,

the highest quality.

So you're not having the heavy metals in mercury,

because we know some people, they poo poo sardines

because they say, oh, it's got all of these bad things about it.

But if something is working based on data and evidence,

it can help people.

Final question for you.

If people want to do sardine fasting,

but they don't eat a healthy diet the other days,

do you think it's dangerous to do sardines

or eating more fat if they eat carbs the other days?

Well, that will depend on, you know, their blood work

and their biomarkers.

And I think that's going to be important.

And a lot of people get scared away from sardines and fish

because of the heavy metals,

but I sent you my heavy metals.

I don't know if you saw that.

And it was like super low mercury and lead.

And with me eating sometimes like, you know, five to 10 grams

or five to 10 cans of sardines a day

and a couple pounds of fish per day,

like I'm eating literally like 10 servings of fish per day

for years.

So my heavy metals should be off the chart.

It's probably because I'm choosing sardines and macro,

but and my heavy metals are very low.

So I would, I think I also have very good detoxification pathways

and I also take alpha-poke acid.

So that is kind of helps with the detox pathway.

But I see no problem with that

with the scenario that you just mentioned.

But I do encourage people to test, right?

So yeah, testing is absolutely like important

because some people that I've been in contact

with or correspondence with have started different diets

and some red flags come up in the blood work

that should be addressed, you know, through,

I mean, it be like, you know, through adjusting their diet.

So what's the red flags?

Red, some red flags would be,

I've actually seen like low calcium, low magnesium.

And in kids like low carnitine is really low,

which is, so carnitine, carnitine acyl transferase

is transports the fats into the mitochondria.

And when you're ramping up fat metabolism really high,

you could deplete your carnitine.

So carnitine comes from meat, carn.

So carn, the word carnitine.

So if you're eating a lot of meat, you tend to not,

but like dairy-based ketogenic diets, we see that.

And then some electrolyte abnormality.

So that's why you do want to get a lot of salts when you,

so don't be afraid of salt,

especially the first two or three weeks,

the renanangiotensin system tends to like be very much in flux

and should level out in about three to four weeks,

but you need to be getting some grams of sodium per day.

Like, you know, everybody's anti-salt,

but yeah, you need to get sodium potassium, calcium,

magnesium into the diet.

And also for some people, I've seen like their liver,

their transaminases go up.

So AST, ALT, GGT will go up,

but that's just the liver's working harder

for beta-oxidation of these fatty acids.

And that puts strain on the liver,

but the liver's very resilient.

So I wouldn't worry about a transient elevation

in your transaminases.

But yeah, these are some things that kind of can show up

from time to time.

But the salts are real issue.

And if the sodium levels drop,

when you start a diet,

because suppressing the hormone insulin

has a diuretic effect

on what we call a naturaletic effect.

And naturaletic is that you dump out a lot of sodium.

And if you don't get that sodium into the diet,

you can experience things like orthostatic hypotension

and you basically, you get brain fog

and then you just feel a little bit dizzy

and you just not.

And then you just drink hydration and salts.

That could be like element, elements of good product,

or the ketone salts, which is sodium, you know,

BHB, sodium, calcium, magnesium.

So that's your killing two birds with one stone.

You're getting your electrolytes and elevating ketone.

So I advocate for that.

And that will mitigate largely the keto flu

that some people say they get.

I never had that.

But some people, when they start a Q-jank diet,

they'll have the keto flu.

And that could be largely mitigated

just by hydration, salts, and especially BHB salts.

Brilliant.

This is a really last question.

What do you think is the worst food

that people are eating on a high fat ketogenic diet

that's really stopping their results?

On a high fat ketogenic diet, a food that they're eating.

So I would avoid any boxed food that's marketed as keto

for one thing.

And I would actually have to say, I hate to say this,

but I would just say like dairy in regard

to prescription ketogenic diets

for the things that we treat.

Sometimes they're, you know, they're not getting a response

and it's just like, okay, knock out the dairy.

I hate saying that because I love dairy.

But, and then boom, they'll, they'll,

and they might have a mild dairy allergy

and that could be affecting their ketones.

So, but, and also nuts too.

Some people think that, you know,

a bag of cashews, for example, you can, can down that.

And some people say, I'm not losing weight

on a ketogenic diet.

And I would say, well, share exactly what you're eating.

And it's always like, well, I have nuts.

Well, how many nuts?

It's like, well, I get the bag and I start eating.

So, you can down a lot of calories from, you know, nuts.

So, I would say nuts are here like dairy too

can be problematic in some people.

But largely speaking, like ketogenic foods

are pretty, pretty healthy unless they're,

but I would avoid just ultra-process

ketogenic foods that are packaged.

Awesome.

Well, I'm gonna leave all the links for your work

in the show notes.

I just wanna say a big thank you

because sometimes science and the work that you do

is very complex.

And I think that this conversation

is gonna help people make it simple

because simple changes lead to results.

Thank you so much for your time

and keep doing great work.

Thanks for having me, I appreciate it.

And yeah, if people wanna learn more,

they can go to ketonutrition.org

or metabolic health initiative,

which we have a podcast on there

and an ACCME accredited platform.

So, you know, you can get CME credits.

If you're interested in everything

that I'm talking about,

so metabolic health initiative

and then ketonutrition.org.org.

Perfect, thank you so much for your time.

Thank you.

I hope you enjoyed this episode.

Check out this one with Louise and Nicola.

It is everything about how to protect your brain,

create teen and exactly what to eat

and what to avoid with optimal brain health.

See you next week.