The Joe Rogan Experience Episode 994 with Dom D’Agostino

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What is the ketogenic diet?
  • It was observed long long ago that fasting (for 2-3 days) was a cure for seizures, as fasting puts you into a state of fasting ketosis
  • Ketosis is when you have a blood concentration of ketones greater than or equal to 0.5mmol
  • Ketones are produced by the liver from fat (either from our own body fat during fasting, or the fat we eat) and are used, instead of glucose, to create ATP (energy)
  • The ketogenic diet mimics the physiological state of fasting by supressing insulin and raising blood ketone levels
    • Insulin is released by our pancreas to help shuttle the glucose that we eat into cells
  • Essentially the ketone bodies replace glucose
Ketogenic Diet Odds and Ends
  • The strict ketogenic diet involves consuming about 90% of your calories from fat and 10% from protein/carbs
  • The modified ketogenic (or modified Atkins) diet involves consuming ~70% fat, 20-30% protein, and other non glycemic vegetables. This has around 90% of the benefits of the traditional ketogenic diet and is what Dom follows.
  • The body is very adaptable to switching fuel sources (fat and glucose)
    • Because of this, before heavy training (cycling, MMA), it might make sense to consume some sort of low glycemic, high molecular weight carbohydrates (sweet potatoes, yams)
    • However, you should be fine most of the time producing ATP for those short bursts of power you need, as long as you are consuming significant fat calories
    • Dom recommends consuming creatine phosphate (~3g a day) daily to help create those short bursts of power
  • Many people report not feeling any sort of “crash” after large meals on the ketogenic diets
    • This occurs due to the lack of glucose swings
  • The ketogenic diet works well because its non-glycemic
    • We control our appetite instead of our appetite controlling us
    • There is no rise and fall of glucose which makes us moody, hungry etc. and causes cravings
  • As we age, we become more carbohydrate intolerant and insulin resistant, so the benefits of the ketogenic diet increase as we age
  • Ketones lower blood glucose levels
  • Your brain can create ATP more efficiently from ketones compared to glucose
    • Many people have an impaired PHD enzyme (Pyruvate Dehyrogenase), such as people with Alzeimer’s Disease. This enzyme helps convert pyruvate (which gets converted from glucose) into acetyl CoA which is in turn used to make ATP. Ketones, on the other hand, completely bypass this conversion step.
    • As we age, glucose energy metabolism tends to decrease, but ketone energy metabolism tends to stay constant
Dom’s History With the Ketogenic Diet
  • Turned on to it in 2007 on a nutrition forum
  • He has a PhD in Cellular Neuroscience
  • Dom’s post doc work involved studying seizures.
  • Seizures sometimes occur with Navy Seals who are underwater using a closed circuit rebreather (which doesn’t emit bubbles)
  • Dom’s research involved examining cells/mitochondria within metabolic oxygen chambers, to mimic underwater environments
  • What he found – ketones enhance brain energy production and resilience in extreme environments (high pressure and high oxygen)
What does Dom eat and supplement with?
  • Dom is a huge fan of Wild Plant Sardines in olive oil
  • Other fatty foods Dom loves: egg yolks cooked in butter,  macadamia nuts, fatty cuts of meat, fatty fish, olive oil, coconut oil, MCT oil
  • Dom uses ButcherBox for meat
  • Check out the recipe for ketogenic pizza
  • Dom supplements with magnesium, helps to avoid camps
    • You can also get magnesium through the epson salts in isolation tanks
  • Many people commonly eliminate vitamin b12 food sources on the ketogenic diet, so it may be a good idea to supplement with that
  • Great keto foods
  • Dom has noticed people who choose to go dairy free on the ketogenic diet loose more weight
  • Dom recommends Dry Farm Wines on the ketogenic diet
    • 3 glasses tends to kick him out, but 2 is fine
    • Dry wines are superior with the ketogenic diet
    • White wines are a no no
Exogenous Ketone Supplementation
  • Exogenous ketones – essentially mimics the ketogenic diet by providing the body with an external source of ketones
    • Can further elevate ketone levels while on the ketogenic diet
    • Can put someone into ketosis without necessarily following a ketogenic diet
  • Dom takes Kegenix and Pruvit Keto OS products that mix beta hydroxybutyrat (BHB – a type of ketone produced by our liver) salt with MCT (medium chain triglyceride) powder
    • The MCTs delays gastric absorption and further boosts ketone levels
  • It’s been estimated that per every millimolar of BHB in your blood, it gives your brain about a 10% boost in energy
    • Therefore, exogenous ketone supplementation can help keep you alert when you’re running on minimal sleep
  • The exogenous ketones you buy are derived from natural sources
    • There’s a D and L form of BHB, a mixture of the two is known as “racemic”
    • The D form is more likely to be broken down and used as a source of energy
    • The L form tends to stick around more within the cell, has anti-inflammatory props
  • Can you get the same benefits of a ketogenic diet by following a standard American diet and supplementing with exogenous ketones?
    • Not at this time with the exogenous ketones supplements that are commerically available.
    • The more carbohydrates you consume, the more ketones you need to reap the benefits.
    • With various ketone esters that are in development, maybe
Measuring Ketone Levels
The Many Benefits of a Ketogenic Diet
  • Type II diabetes results from a carbohydrate intolerance
    • Our government spends around $200 billion annually on managing Type II diabetes
    • People who suffer from Type II diabetes, should be on the ketogenic diet
    • Check our Virta Health who is using nutrition to manage Type II Diabetes
  • People are beginning to put dogs on the ketogenic diet
    • Check out the Ketopet Sanctuary which implements a ketogenic diet in dogs with cancer
    • If you look on a package of dog food, carbohydrates won’t be listed, even though it’s the primary component
    • Ideally dog’s should be eating whole+raw foods, organ meat, and greens…not carbohydrate based dog food
    • Check out the Ketopet Sanctuary free ebook
  • Glucose Transporter Type 1 (GLUT-1) Deficiency patients have severe hypoglycemia within the brain. This causes seizures and lack of mobility. The ketogenic diet completely reverses their symptoms.
  • As it turns out, the ketogenic diet serves as a metabolic therapy for pediatric epilepsy as well
    • Check out Mike Dancer – only the ketogenic diet stopped his seizures
    • There are now ~150-200 clinics worldwide that serve as ketogenic diet therapy clinics for seizures, but most commonly, drugs are used first
  • Alzheimer’s Disease: What if Their Was a Cure: The Story of Ketones by Dr. Mary Newport
    • As mentioned before: Many people have an impaired PHD enzyme (Pyruvate Dehyrogenase), such as people with Alzeimer’s Disease. This enzyme helps convert pyruvate (which gets converted from glucose) into acetyl CoA which is in turn used to make ATP. Ketones, on the other hand, completely bypass this conversion step.
  • Exogenous ketones reduced anxiety behavior in rats
  • Ketones function as signaling molecules that inhibit inflammatory processes
  • Migraines
    • Clinical trials on using ketone salts for migraines
    • Also works with nutritional ketosis
    • Migraines are possibly linked to neuro-inflammation
    • Other data shows migraines are possibly linked to mini seizures in the brain
  • There are quite a few studies being done on autism and the ketogenic diet
  • Being in a state of nutritional ketosis could really benefit HIV and shingles patients
  • Ketones improve wound healing
    • Ketones thin out the blood (increases blood flow), and are able to get to the wound tissue which is lacking oxygen/blood flow. The ketones restore energy to the wound site (allow cells to replicate and heal the wound faster). Also persistant anti-inflammatory effects.
    • With just exogenous ketones, the wound healing rate increases ~25%
  • Check out The Charlie Foundation
Are there any negative side effects?
  • Some negative side effects with children – limited protein can reduce growth
Cancer and the Ketogenic Diet
  • Dom imagines a new standard of cancer care in conjunction with the ketogenic diet
  • Tumors require glucose for growth and can’t effectively use ketones for fuel
  • Ketones also help protect healthy cells from radiation damage, so you wouldn’t feel as run down after undergoing chemotherapy
  • Also would include hyperbaric oxygen therapy
    • Under very high levels of oxygen, cancer cells, which have damaged mitochondria, tend to produce more reactive oxygen species. This oxidative stress potentially triggers apoptosis (celll death) at a level of oxygen that’s not really toxic to the healthy cells.
  • CBD oil may have synergistic effects with the ketogenic diet in relation to cancer treatment
  • Max Love Project for cancer treatment
Staring Out on The Ketogenic Diet
  • Staring out on the ketogenic diet
  • It takes about 3-6 months for your body to really get adapted to using fat, as opposed to glucose, for fuel, and you derive more benefits from the ketogenic diet over time
  • Keto Flu – many people report feeling very tired during the first 1-2 weeks of switching to the ketogenic diet
    • Typically, athletic performance starts to drop originally, returns to baseline around 6 weeks, and tends to surpass baseline around 3 months
  • Dom recommends the Avatar Nutrition app for tracking macronutrient intake
  • Visit
  • During Dom’s first 7 day fast (only water, some electrolytes, about 1/3 of his normal coffee intake), he reports getting a ton of stuff done as not eating frees up LOTS of time
    • Hard for the first 2-3 days, but very easy after that
    • Dom reports that it “quieted” his mind, and allowed him to get a ton of work done
    • He lost 8-9 lbs. but it came back quickly
    • During a lift on the 7th day, he deadlifted ~500lbs. for 10 reps
  • Dom encourages people prone to cancer to experiment with fasting
    • Purges the body of cancerous/pre-cancerous cells
    • It’s like house keeping
    • Dom describes it as a reset
  • Man goes 382 days without eating
  • Dom also sometimes practices time restricted eating and only eats between 5pm-11pm. He notices his ketones really start to rise after 14-18 hours of fasting.
    • Even doing this 1-2 times a week has some benefits
  • If you don’t choose to follow the diet, Dom suggests even just going into ketosis via fasting or diet at least a few times a year for anti-inflammatory reasons
How do vegans stay on the ketogenic diet?
  • Best you can really do is ~60% fat
  • Need some sort of shake/ketone supplement to stay in keto
  • Possible but much harder
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