#074 Dr. Dominic D'Agostino on Developing a Well-Designed Ketogenic Diet and Harnessing Its Benefits
Apr 28, 2022
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Dr. Dominic D'Agostino, a leading expert on ketogenic diets, dives deep into the science of keto and its myriad benefits. He clarifies the types of ketogenic diets and discusses the importance of biomarkers for optimizing health. The conversation explores how ketones enhance brain function, exercise performance, and even their potential therapeutic roles in neurodegenerative diseases and cancer. D'Agostino shares personal insights and practical tips for those looking to harness the power of a well-designed ketogenic diet.
Different variations of the ketogenic diet exist, including classical, modified, and low glycemic index diets, each with its unique benefits and effects.
Supplementing with exogenous ketones, such as ketone esters or salts, can be an alternative for individuals unable or unwilling to adhere to a ketogenic diet, offering various effects and durations.
Maintaining optimal blood concentration of ketones between 1-3 millimolar is generally considered beneficial for achieving therapeutic ketosis.
Supplementing with electrolytes and other nutrients is crucial on a ketogenic diet to prevent deficiencies and support overall health and energy metabolism.
The ketogenic diet and ketone supplements show potential in managing neurodegenerative disorders like Parkinson's and Alzheimer's, with their metabolic changes providing neuroprotective effects and supporting brain health.
Both intermittent fasting and the ketogenic diet have shown metabolic benefits, and combining these approaches may maximize outcomes for neurological disorders and improve overall metabolic health.
Deep dives
Ketogenic Diet as a Therapeutic Approach
A ketogenic diet is a unique dietary therapy defined by an objective biomarker: ketones measured in blood, urine, or breath. To achieve therapeutic ketosis, individuals need to consume a high-fat, low-carbohydrate, and moderate-protein diet. Different variations of the ketogenic diet exist, from the classical (high-fat, low-carb) to modified versions like the Atkins or low glycemic index diet. These diets have been found to have various therapeutic effects, such as improving neurological disorders like epilepsy, metabolic disorders, and even weight loss.
Supplementing with Ketones
Supplementing with exogenous ketones, such as ketone esters or ketone salts, can be an alternative for those who are unwilling or unable to adhere to a ketogenic diet. There are various formulations of exogenous ketones, with different effects and durations. While a rapid spike in ketones can have counterregulatory effects and potentially disrupt ketosis, a more sustained elevation with a gradual rise is preferred. Combining ketone salts with medium-chain triglycerides (MCT) can help prolong ketosis and regulate glycemic response.
Efficacy and Difference Between Ketone Esters and Salts
Ketone esters, like beta-hydroxybutyrate (BHB) monoester, have been found to have a strong anti-seizure effect and can rapidly elevate ketone levels. On the other hand, ketone salts, when combined with MCT or other formulations, have favorable effects on glycemic regulation and anti-anxiety effects. While the efficacy may vary depending on the context and specific purpose, maintaining ketone levels between 1-3 millimolar is generally considered optimal.
Importance of Electrolytes and Other Supplements
On a ketogenic diet, electrolyte depletion and deficiencies in certain nutrients can occur. Therefore, it is important to supplement with electrolytes like sodium, potassium, calcium, and magnesium. Additionally, other supplements like omega-3 fatty acids, creatine, and acetyl-L-carnitine are often taken to support overall health and aid in energy metabolism.
Benefits of Ketogenic Diet for Neurodegenerative Disorders
The ketogenic diet has shown promising effects for neurodegenerative disorders such as Parkinson's and Alzheimer's disease. Research has demonstrated that the diet can improve cognition and brain function in animal models and some human studies. The metabolic changes induced by ketosis may provide neuroprotective effects and support neuronal health. While more clinical trials are needed, the ketogenic diet and ketone supplements are being explored as potential adjunct treatments for these disorders.
Ketogenic Diet and Epilepsy
The ketogenic diet has been widely accepted as a treatment for epilepsy, particularly in children. The diet's ability to alter brain metabolism and reduce seizure activity has been extensively studied. It is believed that the ketones produced during ketosis have an anti-seizure effect. While the exact mechanisms are not fully understood, the ketogenic diet has been successful in managing epilepsy in many patients, especially those who do not respond well to medication.
Ketogenic Diet and Migraines
Emerging evidence suggests that the ketogenic diet and ketone supplements may be beneficial for migraines. Some individuals have reported a reduction in the frequency and severity of migraines when following a ketogenic diet or taking ketone supplements. The exact mechanisms underlying this effect are not clear, but the anti-inflammatory and vasodilatory properties of ketones may play a role. Clinical trials are needed to further investigate the potential of the ketogenic diet for migraine management.
Metabolic Benefits of Ketogenic Diet and Intermittent Fasting
Both the ketogenic diet and intermittent fasting have demonstrated metabolic benefits, including improved insulin sensitivity and weight management. These dietary interventions share similarities in their ability to induce ketosis and alter energy metabolism. While more research is needed, there is growing interest in combining the benefits of both approaches to maximize metabolic health and potentially improve outcomes for various neurological disorders.
The Influence of Inflammation on Headaches
Inflammation, particularly neural inflammation, is linked to the development of headaches. Viral infections, such as shingles or herpes simplex, can trigger this inflammatory response and lead to severe headaches. The cascade of events is often associated with changes in the brain and systemic inflammation. Individuals may experience headaches due to various reasons, including reactions to certain supplements or substances. However, the ketogenic diet and fasting have shown promise in managing headaches, while also potentially benefiting individuals with autoimmune disorders.
The Potential of Ketogenic Diet in Cancer Therapy
The ketogenic diet has been the subject of research regarding its potential in cancer therapy. While certain types of cancer may utilize ketones as an energy source, most aggressive cancers rely on fermentable fuels like glucose and glutamine. The therapeutic efficacy of the ketogenic diet in cancer treatment lies in its suppression of insulin, limiting glucose availability, and potentially elevating ketone levels. Additionally, the ketogenic diet may enhance the immune system and sensitize tumors to radiation and chemotherapy. Ongoing research explores the synergistic effects of combining the ketogenic diet with other cancer treatments.
Considerations of a Carnivore Diet and Keytone Measurement
A carnivore diet, characterized by the consumption of exclusively animal products, has gained popularity as an extension of the ketogenic diet. While it may be beneficial for some individuals, long-term sustainability and optimal health benefits are still subjects of debate. Triglyceride levels and overall bloodwork should be monitored when following a carnivore diet, as certain metabolic deficiencies may arise. Keytone measurement, particularly breath acetone, provides insight into fat oxidation and can be an effective means to gauge dietary adherence and fat loss progress. However, the accuracy of various ketogenic products on the market should be carefully considered.
Dr. Dominic ("Dom") D'Agostino is an expert on a wide range of topics related to metabolic health, ketosis, and ketogenic diets. As one of the world's foremost experts on the ketogenic diet, Dom has personally practiced some variation of ketogenic diet for over a decade, bringing a substantial amount of practical experience along with his anecdotes from human and animal research.
In this episode, we discuss:
(00:00) Introduction to Dr. Dominic D'Agostino
(04:59) What is "keto” (and what it is not)
(08:42) Types of ketogenic diets
(15:27) Lifestyle Ketogenic Diet
(26:36) Biomarkers and hyperlipidemia
(29:41) Micronutrients and Supplementation
(33:40) Exogenous Ketones
(55:48) Optimal blood concentration of ketones (Dom's pick)
(01:13:31) Exercise performance and anti-catabolic effects
