welcome everyone this is dr. Mercola and you all are aware that cancer is a
profoundly important problem that challenges most all of us at some point
are certainly someone we know and we're really privileged today to speak with
dr. Dominick D'Agostino who is an assistant professor at the University of
South Florida College of Medicine and he teaches courses in molecular
pharmacology physiology and maintains involvement in several studies
researching metabolic treatments for the neurological disorders such as seizures Alzheimer's ALS and cancer so they're
all really related and it's interesting that we you know that there's there's a
central component that is really relevant for so many of these widely
diverse diseases so welcome and thank you for joining us today thank you glad to be here now we're really excited
because that you've got so you're you're really on the cutting edge research I'm
wondering if you could explain to our viewers how you became first became
interested in this area because it's so fast and I really look at you as one of
the primary leaders in establishing some of the basic foundational precepts that we have to treat so many of these Y
diseases especially cancer yeah thank you my my entry into this field of
cancer research was pretty unexpected actually uh I was funded to study the effects of gases on the brain
specifically the funding was from the office of Navy research in 2007 to study
seizures related to oxygen toxicity that are experienced by Navy SEAL divers
using a closed-circuit rebreather apparatus and as I delved into
neuroprotective strategies to prevent oxygen related seizures I came across
the ketogenic diet and and I found it interesting that the ketogenic diet is
very effective for drug refractory epilepsy and a variety of seizure
disorders and in studying this you know more
intensely I wanted to develop a ketogenic diet strategy for the warfighter
to protect them from the effects of hyperbaric oxygen and and I realized
that you know your brain can primarily runs off glucose for energy and during
periods of carbohydrate restriction or calorie restriction it can derive fuel
from ketone bodies so I delved into the nutritional physiology I guess you could
say of ketone body metabolism and and we further pursued ketosis as a strategy for oxygen toxicity and develop ketone
supplements which have been shown to be very effective in in addition to that
you know the research indicated that ketosis could be a therapeutic strategy
for a cancer and I came across the work of Thomas C ffred and and I came across
a large amount of evidence that suggested that cancer was unique in that
it was metabolically unique genetically it was it was very heterogeneous so
there a host of different genetic anomalies in cancer cells but one you
know characteristic is that they had this ubiquitous metabolic phenotype which was aerobic glycolysis so even in
the presence of oxygen it was shown that cancer cells continue to pump out
lactate suggesting that they're fueling their metabolism from excess glucose
consumption and you know from my perspective the only reason you know
cancer cells would be pumping out lactate and and deriving energy from
glucose at such a high rate would be because they are metabolically
compromised with mitochondrial deficiency so insufficient oxidative
phosphorylation which takes place in the mitochondria contributes to a compensatory fermentation so that the
cells are forced to get energy from somewhere and the
mitochondria are not functioning so this destabilizes the nuclear genome and
activates the oncogenes which which then kind of increase the glycolytic enzymes
and the ability enhances the ability of the cancer cells to derive energy from
glycolysis so you know in studying nutritional ketosis for an application
related to seizures and Navy SEAL divers I came across a body of evidence to
suggest that not only was therapeutic ketosis neuroprotective and it
functioned ketone bodies function as an alternative fuel to enhance brain
metabolism decrease reactive oxygen species and and also they have a brain
stabilizing effect which you know we can exploit with the ketogenic diet which we
call nutritional ketosis or ketone supplements but that there is a body of
evidence suggest to make that cancer itself would be responsive to
therapeutic ketosis because nutritional ketosis involves carbohydrate
restriction so that would decrease glucose availability to cancer cells and
it would increase the production of ketone bodies from the liver and your
normal cells have the metabolic flexibility to readily adapt to using
ketone bodies for fuel and cancer cells lack this metabolic flexibility to do that they can't derive significant
energy from from ketone bodies the large majority of cancer cells so in testing
our nutritional strategies or ketone strategies for seizures we looked at a
few cancer cell lines and saw a robust effect probably about four years ago and
so it all started started about four years ago as you know just a simple
observation in a glioblastoma cell line and that led to the work we're doing now
so you're really on the beginning stages of this because four years isn't really
a long time time is yeah it goes so I'm I'm a nun brand-new into this and
you know a junior faculty member and but it's such an exciting field to be in because there's really not a lot of
people doing it yes and the reasons for that are you know interesting I guess
you could say there's not a whole lot of money and there's really not a whole lot
of people understand nutritional biochemistry but nutritional physiology
is not really appreciated kind of how our nutritional strategy influences the body as a whole not just at the level of
you know the biochemical level but well as a whole that's one of the reasons why
I'm so excited about connecting with you and dialogue and understanding what
you're doing because you're really one of the upcoming researchers that's going
to I mean you've got your whole career in front of you and you're really
passionate about this and you're really going to uncover so many foundational key solutions to these challenges these
health challenges as so many of us are relatives faced what I'd like to do is
deconstruct some of the very eloquent language that you use to explain what
you're doing and sort of simplify for a large number of our viewers who are
aren't as educated in nutritional biochemistry so if I can summarize this
and correct me if I'm wrong the most of our cells in our body our own cells have
the metabolic flexibility use either fat or for sugar which is basically the two fuels that we can do except for cancer
cells there's some aberrant aberration that really allows them not to use this
fat or the ketones as a fuel and they really can only use glucose so it's sort
of a derivative of what they're what dr. otto warburg
of discovered actually received a Nobel Prize for the night in the 1930s - did
he learn that glucose or sugar is really the primary fuel substrate for cancer
cells but yet oncologists have ignored this for 80 over 80 years and no don't
use it therapeutically which is just reprehensible almost criminal because so
many people suffer needlessly because they don't have access to this simple nutritional therapeutic strategy but
essentially that's it you know is that to take advantage of this metabolic
metabolic differential that the cancer cells Rico just don't function
fatso if you can shift over and here's I guess where the confusion is at least my understanding and please correct me if
I'm wrong because you're the expert here that most of us have this we store Sh we
have limited stores of sugar we only store it as in the form of glycogen
typically in our muscles or liver but that storage is relatively short
typically twelve hours or so maybe and some people go to two or three days but
it's relatively short worse fat we can go on for months almost many of us so
and it's this conversion so that because if we essentially if we eat
carbohydrates all the time we continually replete that glycogen store so we never get down - there's always
sugar available for cancer cells so it's a matter of depleting those glycogen
stores and going to ketosis so maybe if you can expand on what what I just sent
attempted to simplify what you mentioned so yeah yeah that that's a good point
and you bring up a lot of you know a few interesting questions here you know in
theory it's pretty simple right you eliminate carbohydrates you decrease the
glucose availability and you should in theory starve cancer cells of the primary source of energy glucose the
thing is that our physiology is a little more complicated than that and and when
we you know restrict carbohydrates we may prevent the spikes in blood glucose
and the spikes in blood insulin which can these spikes are actually very
pro-inflammatory they kick on a lot of they can kick on oncogenes and enhance
cancer cell proliferation and the metastatic process these spikes can so
the ketogenic diet and carbohydrate restriction can can you know reduce the
spikes in blood glucose and blood ketones or and in blood insulin but it
does not have a major effect on baseline levels of blood glucose unless the
calories are restricted so kind of getting back to what you're talking about the ketogenic diet is I think a
it's a very good strategy to make calorie restriction tolerable because
when your body in your brain in particular is craving
glucose and say for example you go on a calorie restricted diet but it's a high
carbohydrate diet you're still getting fluctuations in blood glucose and the
brain goes through these intermittent periods of glucose deprivation and you
know your brain gets very hungry it's very it's not a very comfortable feeling
nutritional ketosis which occurs with carbohydrate restriction and is further
enhanced with calorie restriction forces the physiological shift from a glucose
based metabolism to a fatty acid and ketone metabolism and when your body is
shall we say key to adapted the brain and energy metabolism is more stable your mood is more stable it may take a
few weeks to adapt to physiologically to this but a nutritional ketosis can be
made maintained and sustained with carbohydrate restriction and is further enhanced with calorie restriction and I
think kind of that's where you are getting at that total calories really need to be restricted and also protein
so protein is gluconeogenesis gonna genic immuno acids in protein and if
protein is at say for example 2 or 3 grams per kilogram per day that is
probably going to feed in to the gluconeogenesis stores which is
necessary in the liver to drive the ketogenesis
in the liver so you really need to decrease glucose availability
carbohydrates and protein consumption to deplete liver glycogen to maintain and
sustain nutritional ketosis well that that would be an optimized you know approach
I'd like to tease out those details because you had meant it just to again
sort of simplify the process you had mentioned this this rate of protein
consumption with 2 to 3 grams per kilogram that is I'll is the reason you
mentioned that says the typical amount of protein that a person is consuming
you know it's what I consumed for many years and
you know into body athletics and and you know more physically active I'm
physically active today and my protein consumption is probably half of what it used to be but my performance
surprisingly is the same or higher so suggesting that all these years that I
consumed high very high amounts of protein my it was kind of unnecessary
because the ketones and fatty acids are protein sparing so if you replace the
protein and the carbohydrates in but but also restrict the protein and feed your
body fatty acids and an elevate blood ketones this will have a protein sparing
effect we say an anti catabolic effect and will helped you preserve lean body
mass and physical performance in the in the face of a calorie deficit and this
is why the ketogenic diet is an effective strategy for losing weight and
retaining muscle especially if it's complemented with resistance exercise or
some kind of physical activity but we do find that you know in measuring blood
ketone levels in humans and in animals that simple carbohydrate restriction
isn't enough you really need to lower the protein the American diet is pretty
high in protein and to achieve nutritional ketosis which is an
effective strategy for weight loss but may not be for everyone because some
people it depends you know what the question is if you're using it for weight loss or using it for you know a
therapeutic intervention for cancer or seizures and in those cases you would
want a more strict kind of like a classical ketogenic diet involves a protein restriction and and to some
extent calorie restriction especially if it's used for a cancer therapy well let
me continue to refine this a bit of where everyone here is certainly for of
dr. Atkins who it his time was really probably one of the most popular doctors
in the world and it was course responsible for promoting the ketogenic
diet and I think what you're discussing here is a revision of that because
typically the people and there are many people still use in Atkins approach but
when that's typically low carbohydrate high protein and which which will not
work it will not give you the results of that you that your achievement I think that is really the key crucial element
here and this protein of two to three grams per kilogram typically translates
out to a hundred one hundred fifty two hundred grams of protein per day for
some people which is an enormous amount and you know I'm I'm somewhat intrigued
with the concept of one of my mentors dr. Ron Rosedale who a suspect you're
familiar with also who's advocating a much lower dose of 1/2 of actually a
gram per kilogram one gram of lean body mass so it's even lower than that you
know so typically for someone like myself would be fifty maybe sixty
seventy seventy grams per day and and I'm wondering if you could comment on
that especially in light of this calorie search that's another important tweak
his his take on it and it has to do with you know the reason he promotes this so
much is this the the protein influences specifically some of the amino acids
like the branched chain amino acids influence on mTOR a million target of
rapamycin which is this massive pathway that seems to be commune ol r j-- lee
responsible for much of the pathology we see in cancer growth so and that that
protein he actually has a stimulatory effect on this and when you lower that
then you then then then it's uh it's more inhibited i guess so you know that
that I'd like to dialogue about that protein component and then in the
importance of the calorie restriction because the cal restriction is another
twist that dr. Rosedale doesn't go into but I believe there may be some validity
to that yeah I think we need to define kind of what the question is and and what the problem is that we want to
address nutritionally okay and you know it's not
you know I tell people the ketogenic diet it's not a one-size-fits-all
even carbohydrate restriction it's really not a one-size-fits-all and I
think carbohydrates can be titrated in perhaps you know individually I mean some people I know have a very high
carbohydrate tolerance and they can get 800 grams of carbohydrates per day and
they maintain a very lean a physique and and you know these are
exceptions to the rule but in in in Optima you know and maybe they would get a better results with carbohydrate
restriction but I haven't been able to convince them of that although they need
to get frequent meals so one advantage to eating a low carbohydrate higher fat
diet is that I can eat two meals a day and be totally fine whereas uh you know
several people I know including my girlfriend actually I mean she needs to
eat like every two or three hours because she has dips and blood glucose
levels and it's interesting and my lifestyle and I think most people can
kind of put themselves into this category is with favor and eating pattern that is not so frequent and so
getting back to your your original question you know it depends on what
you're using if you're using it for health management and weight loss and
shall we just put it under the unbanked ablack --it of metabolic health optimal
metabolic health would be achieved uh with carbohydrate restriction definitely
but with some level of calorie restriction either intermittent calorie
restriction or some level of calorie restriction to promote a calorie deficit
at least at certain periods of time and if there is a period of calorie surplus
it should be kind of given in and around exercise during or immediately after
exercise so we run into you know the situation that I think it can all and
Tom Seaver would probably agree with this that the benefits are of nutrition
are achieved when you can sustain a calorie deficit so you know we're all
familiar with the benefits of calorie restriction so from my perspective kind
of like a simple perspective it's like how do we achieve the benefits of
calorie restriction how do we maintain low in
insulin and low glucose levels so I agree that mTOR is a an important signal
once you have cancer so you know the amino acid leucine is a powerful
activator of the mTOR pathway now if a normal healthy person consumes you know
bolus ah's of leucine you know 5 grams you know a couple times a day which a
lot of bodybuilders and athletes do can this you know cause cancer this is it
this is an interesting question and it's a question that I've been researching
we're about to set up a study where we give large doses of branched chain amino
acids in a metastatic model of cancer so my opinion is that branch chain amino
acids which activate mTOR in a normal healthy person are not are not
counterproductive that they do not increase one's susceptibility to cancer
they the mTOR pathway is primarily activated in the skeletal muscle and and
the leucine is a very powerful stimulator of protein synthesis and by
stimulating protein synthesis in the muscle you you can maintain and build
more muscle and that's the metabolic tissue that consumes glucose and and is
basically you know the primary factor in your metabolic health so by restricting
your calories and perhaps supplementing with anabolic or anti catabolic amino
acids we can maintain a greater proportion of lean body mass in the form
of you know skeletal muscle and which will be a glucose disposal tissue and
which can help us maintain a lower blood glucose lower insulin levels and this
can in the long run this can potentially promote a metabolic physiology that can
prevent cancer and perhaps treat cancer so even you know one of the questions
that we want to address that even if you have advanced metastatic cancer if you
do a ketogenic diet and had high levels of branch chain amino
acids will that increase will that decrease survival time so this is a
question that i'm i waiver back and forth on and we don't we don't really
know and that's why we're setting up the experiment to do this size asian is a
nutritional company that makes a very popular branched amino acid product and
they've given us a charitable donation they have a product called extend and it's a very great branched chain amino
acid product and it's used by many people that I know in preparation for
athletic events and bodybuilding and such and there are anecdotal reports
that of cancer patients taking this throughout their chemo and it helped
them retain their lean body mass and had an anti catabolic effect so these
anecdotal reports have led me to you know develop a study to test this and
well that is kind of interesting because kind of stepping around your question maybe not answering it exactly as a
theory anything that would stimulate mTOR what you would you would expect to
make the cancer worse but these antal reports sort of I guess
refute that that believe yeah well you know the leucine is a powerful
stimulator event or in skeletal muscle right when when calories when you have a
calorie deficit your physiology is a little different it's true that you know
cancer cells do have a hyperactive mTOR pathway and it's kind of like the default pathway is already activated
right whether you know leucine can feed into that pathway and further activate
mTOR which is already activated is a question i don't think that has been
addressed scientifically and we have to realize that the activated mTOR is a
downstream consequence of metabolic dysfunction which triggers genomic
instability which then activates the oncogene so it's it's the mTOR
activation and and all uncle jeans are kind of like downstream
epiphenomenon of insufficient respiration due to mitochondrial
dysfunction so if you know so that's in working back it's kind of more of a
downstream ok event so what is it's already activate what is your belief
that activates it is this reliance on excess calories in conjunction with too many carbohydrates well I think I think
it's complicated I think there's environmental factors there's you know
the issue of metabolic health over time the aging process contributes to a
progressive mitochondrial dysfunction and a decrease usually in overall
metabolic health inactivity poor diet environmental factors you know radiation
chemicals there's a lot of things that can feed into this the bottom line is
that the the can't that the genome of the mitochondria is probably more
vulnerable than the nuclear genome so the nuclear genome has more robust DNA
repair mechanisms so overtime cellular damage inflammation you know poor
metabolic health will contribute to a progressive decline in mitochondrial
function and ATP production the cell needs to maintain its energy status to
preserve the fidelity of the nuclear genome and when that's compromised by a
defect in you know mitochondrial function and a collapse of the energy
systems that that maintain a proper you know genomic fidelity that that can
activate especially under certain conditions can activate the the oncogenes so if someone for example in
putting it into more of a practical perspective in someone who's is at poor metabolic health may be exposed to
environmental toxins things in the diet they are challenged by a virus for
example an illness that as the immune system you know that can set them up you
know to be to be susceptible to cancer we all have cancer in our body right now
you know our immune system is fighting it off so it's a failure of the immune system
to attack these precancerous cells from becoming cancerous cells that could be
important so it's and you know and having a robust metabolic health can
allow us to adapt to these toxins in the environment to these metabolic insults
to these pathological situations you know for example we know viruses can
cause cancer but if our our metabolic health and immune system is robust we
can fight it off and there are things in our environment that can prevent us from
doing that but I think optimal metabolic health is achieved when we make the cut
mitochondrial work hard and and we rely primarily on fats and ketone bodies for
our metabolism and the way to do that is with a carbohydrate restriction and you
know which can be further enhanced with calorie restriction and intermittent
fasting which we'll talk about a moment but before we hit intermittent fasting
so I think that's an important part of this is I'd like to comment on the
calorie restriction that you mentioned earlier which I don't think any researcher would disagree with I think
there's a uniform consensus the calorie restriction has been well established to
promote longevity at least in animal studies you know that's well accepted
non disputable non controversial dr. Rosedale believes that a big portion of
that benefit of calorie restriction is not necessarily related to the calories
but it's actually related to restriction of the protein inhibiting the mTOR
pathway and in an observation I've made and I think that most people would agree
with is that most vegetarians are healthier than the typical American there certainly are some unhealthy
vegetarians and I state that fully believing and promoting that I believe
that we need animal foods to say how optimally healthy but I think it may be
a quantity issue now my current belief in understanding is that many
vegetarians are healthy because they restrict their protein intake because it's really hard to get a lot of protein
from vegetables it just is a lot easier if you get if you get of a mantle foods
so I'm thinking and my belief now is that that there's probably a happy
merger between the two is that if you could radically reduce your protein
intake you know closer to the one grandpa days
the two or three that most of us are taking and in it make sure it's
high-quality protein we don't want animals protein from confined animal
feeding operations industrial farmed animals of course and you know free of
toxins but but it's just a matter of restricting that and having a lower protein intake in combination with the
other healthy foods that that may have a profound influence and may in fact be
one of the reasons why the vegetarians are so much healthier I mean obviously
there's benefit of any vegetables but many of them don't evils they just
restrict animal foods so and I think that's the the consistency is that this
lower protein intake may be may be profoundly beneficial maybe even more
beneficial than restricting the carbs independent of calorie restriction right
that's where you're going yeah you know that you know that's a possibility and I
think when you're getting a surplus amount of calories from from anywhere you know you're you're setting yourself
up for you know a metabolic unfavorable metabolic profile you know elevated
triglycerides you know and cholesterol and high blood glucose you know so if
you have a surplus of amino acids you know I guess the question is is that
going to be more dangerous than a surplus of glucose floating around in
the bloodstream amino acids have important signaling you know my you know events and they can initiate and that
it's an interesting question but I believe that you know a lot of the the vegans and a lot of vegetarians are very
particular about the food that they eat so I think some of the benefits the
claimed benefits from a vegetarian diet or even diet are due to calorie
restriction and it could be in an inadvertent calorie restriction because
you know a diet high in fiber where you're ingesting you know a large
portion of food that is not very digestible or readily broken down into
you know usable fuel although you it's counted as calories
is you kind of have this inadvertent calorie restriction phenomenon and I think it may explain for example the
Ornish diet it may explain you know some of these results that have been reported
in several books like the the China study where a plant-based diet you know
has shown to be a good promoter of health you know I've just I've seen a
lot of blood work from people that can basically eliminate plants from their
diet and go on a a ketogenic diet a high fat moderate to low protein a very
low-carbohydrate ketogenic diet and all the markers of metabolic health go in
the right direction in most of these people and and if they don't typically
what's happening is that they're not restricting their calories but most
people who follow a ketogenic diet do they inadvertently restrict their
calories without trying and reap the metabolic benefits of a calorie deficit
which is lowered blood glucose lowered insulin lowered triglycerides
paradoxically when you're eating more fat you know paradoxically your your
blood fats will go down you know because you're at a calorie deficit well an HDL
goes up you almost everyone that I see on these high fat ketogenic diets their
HDL actually goes up and improves well let's talk about the fat because I think
they're really Devils in the details and when we're getting we both that I think
we're both in agreement on this but we weren't really specific when we sit we
say increase the fat we're not talking about the most common fat that people
eat which is highly processed vegetable oils which are full of omega-6 fats or
trans fats like french fries and donuts we are talking about high quality fats
like avocados and butter and coconut oil and macadamia nuts and olives these
types of fats we know which dr. Rocio believes are metabolically neutral
because they don't tend to trigger those hormonal signaling events like leptin
and insulin and the mTOR pathway of course so there are sort of three calories that you can take and would
speak to the two I guess the importance of maybe not so much calorie restriction
is what you just mentioned in the example you shared with these people not
having plant-based diets but having profound improvements metabolically by following a ketogenic
diet yeah yeah I would agree that fats are an important source of fuel I think
the optimal fuel substrate really and pro-inflammatory fats can can really
wreak havoc on the body and these are the ones that you mentioned many of the
plant derived oils process oils can be can cause real problems and yeah there's
a difference between like an Atkins based ketogenic diet and a healthy q2
genic diet so and when someone talks about being on a ketogenic diet I like
to find out specifically what they're eating many of the classical ketogenic diet is
very high in dairy and I think I've observed in people and myself that when
I can minimize dairy protein dairy fat is is another issue which is not very as
problematic but but a ketogenic diet that's high in dairy protein can get
what I see is that people can have persistently high blood glucose levels
and a low level of systemic inflammation from the allergens that are in dairy
proteins and you know my body is very reactive to these things I get eczema
and all kinds of weird autoimmune kind of reactions but it's kind of a
persistent chronic level and think about what's happening inside the body and and
I don't think you know it's not like one person has it one person doesn't there's
a spectrum of of immune response depending on the person depending on the
the level of intake of dairy proteins and you know a lot of my friends are big
big fans of whey protein you know drinking whey protein shakes and I did that for many years I don't think it's
necessary I think a lot of the the fats can be used in place of protein and I
think fats are very protein sparing so decreasing the need for protein but the
ketogenic diet and going back you know to the optimal diet a ketogenic diet
it's high and in derry which is the traditional ketogenic diet can be
problematic and can prevent many of the health benefits that you can get from a
low-carbohydrate ketogenic diet so it really needs and a lot of nutritionists
aren't really up on on kind of these distinctions between they just view
macromolecules you know I just you know what are your macros you know and and I believe that more attention needs to be
paid to the actual composition of the macronutrient profile what that is given
to these people you know if you're a registered dietician and you're
assigning macronutrients to your client and kind of if it fits your macros kind
of phenomenon that a lot of dieters are using that the composition of the
macronutrients is is really important because some foods are potential
allergens and can really be counterproductive you know in for your
help and for weight loss and you know these things need to be taken into
account and it varies between individuals yeah and I believe Atkins
was guilty of the same error and that he didn't pay attention to the macro
nutrient composition yet along those lines and specifically with respect to
dairy the you know I'm a firm believer if you're going to have milk it should be raw and the pasteurization of the
milk actually changes the three-dimensional the tertiary
quaternary structure of the proteins which can contribute to the
allergenicity that you're taking but but the other hidden component and I really
strongly discourage people from drinking milk I just don't think it's the optimal
food for most people because even raw milk because not only did this protein
issue which you reference but there it's also associated with sugars and lactose
so and it's a it's a it's an it's an interesting combination but I I
personally consumed about a pound of raw butter a week so I think the raw animal
fats are profoundly beneficial and they're loaded with nutrients of course
that could that is difficult to get otherwise so yeah III think I think
you're onto something there in your observations that the people who are
following a ketogenic diet that includes dairy run into problems so maybe
you could is are there any other distinctions you noticed in your
observations because let me give a frame here to because you're not a medical
doctor your PhD but you you do help and assist many people in their in their
attempts to to apply what you're learning to treat their cancers so and maybe that's overstated or Mis incorrect
but maybe so that that's the frame and so I mean I'm wondering in that process of helping and assisting others what
you've noticed and learned maybe can share with us in people seeking to to
apply the proper ketogenic diet to achieve these benefits yeah that's right
I'm not a medical doctor and I'm not you know qualified to give medical advice
but a lot of people do come to me and for information about metabolic
therapies for everything from ALS to seizures to cancer and what I do is I
direct them to information one of the first websites is usually the ketogenic
diet resource a friend of mine maintains that website and they have a book on
that which is the a ketogenic diet handbook for patients and it's called
the ketogenic diet resource and tomcee for its book which is a good reference for people to go to although it's a
little too technical for the most people to handle but when people come to me I
direct them to a variety of resources I have a website keto Nutrition org which
I just put a lot of information on there and and what I ask to see is like hard
scientific evidence I like to see biomarkers of metabolic health you know blood work blood glucose blood ketones
c-reactive protein these things before during and after they've maintained
nutritional ketosis or calorie restriction and in hundreds of people
that I looked at you know I see all the markers of metabolic health improving
everything is going in the right direction with carbohydrate restriction
and with calorie restriction so yeah I don't give diet advice specifically but
I give people the they send them in the direction where they can find the
information and there are many simple tools that people can use for example a
blood ketone and glucose meter that you can buy at any drugstore and these are
you know can quickly get blood glucose and blood ketones and you can assess
your response to a nutritional intervention and then titrate the
calories the macronutrient ratios to optimize your body to be in what we call
the metabolic zone and the metabolic zone our definition of it is that the
blood ketone levels actually rise to the level blood glucose and above so if you
can produce sustained hypoglycemia with carbohydrate and calorie restriction and
elevate blood ketones you can it actually makes the the hypoglycemia
tolerable so the ketones replace the glucose as the primary energy fuel for
the brain and it basically keeps the brain metabolism optimized and prevents
fluctuations in in your mood and your energy levels if you can sustain
therapeutic ketosis with a carbohydrate and calorie restriction and if a person
can do that and they need to take it upon themselves because someone who's
250 pounds with metabolic syndrome is going to have a different adaptive
response to calorie restriction and carbohydrate restriction than the lean
athlete that's a hundred and seventy pounds who's using it you know for for
to treat a condition so it's not a one-size-fits-all and the carbohydrate
threshold that's needed for individuals to maintain nutritional ketosis can vary
widely like I can get a hundred and 150 grams of carbohydrates a day sometimes
if I'm really active and still maintain nutritional ketosis we're interested yeah and only if I'm very active most
active and it's high in fiber okay you know so that that's this
distinction to if someone's getting a hundred grams of carbohydrates well are
you getting it from broccoli and salads or are you getting it from cookies candy
you know so you need there needs to be cleared and that's why I think the just
assigning macronutrients you know for diet can be counterproductive in some
ways so I think the composition of the food is equally important especially in some people that just have very stubborn
persistent allergies that will impact their metabolic health and overall physiology if your body is fighting
something off with an allergic reaction it's going to compromise the metabolic
health so that's why removing allergens from the diet is important and there are
several books out there that address this issue Elaine Canton wrote a book called the
Canton ketogenic diet and that's been a useful resource for a lot of people that
come to me they say you know I want to start the ketogenic diet but uh you know
I can't eat dairy how do I follow it if I can't eat dairy or if I can't you know
eat these other foods and and there's not a whole lot of ketogenic diet books out there that promote the diet and give
an outline of the diet that's dairy-free and Elaine cantons book addresses that
and I think you know there's as people are becoming more aware these issues
that you mentioned especially with dairy I think people are looking to seek
resources that can guide them to maintaining nutritional ketosis with a
restriction in dairy protein well let's talk about the word that the meter that
you mentioned that people can get the drugstore I'm assuming this finger prick
model and that there's a stick a stick of regions or strips that you would use
and purchase the independent of that do these require a prescription of a form
of the physician or can anyone walk into a drugstore and pick up one of these
yeah and there's a variety of models out there I use the most common one that you
hear people talking about is Abbott Labs makes it it's called the precision extra
and the glucose meter strips are about 50 cents per strip but the ketone strip
skin range from you know $3 to $6 per strip so they can be expensive but what
I find that is that patients may just use a blood glucose our blood ketone
meter maybe once a week and they'll use the urine ketone strips you know
throughout the week to check their urine ketones and they may just do a couple
blood measurements typically you know if your blood glucose stays 70 and below with carbo - below with carbohydrate
restriction it's a there's a good chance that you know you'll be in nutritional
ketosis um another you know since what you see a research when we people do
this when they're below 75 you can save yourself the expense and inconvenience of doing the blood ketones because
you're most of the time you're going to be able you're ain't going to be in
ketosis yeah yeah and you know a cheap way to do it is just with a urine ketone
strips and if you're in ketosis by evidence of you know ketones in your
urine the you're in a situation where you likely have depleted glycogen stores
in the liver you're maintaining low blood glucose so the the driver for hepatic ketogenesis is low blood glucose
and low glycogen levels in the liver depleted glycogen so your body really
won't make ketones and they won't spill over in the urine unless you've achieved
that level of glycogen depletion so that's a good biomarker that you know you're in nutritional ketosis I opted to
use the blood ketone meter the precision extra meter there's a Nova Max Plus
meter that measured ketones but this measures them lower than we found that
it's relatively inaccurate we found that the precision extra meter which I have a
number of these meters another one is the cardio check meter and this is an
interesting meter because it can measure glucose ketones HDL LDL triglycerides
and a number of things so these are you can buy these any CVS Walgreens and is their process require no prescription
required your requires money that way so the strips are pretty expensive and
you can get them at diabetes wholesale you know places online amazon.com sells
them online what I typically do a Bay you can get them on eBay I look for a
sale and I buy a whole bunch of them at one time
typically thousands of them because we do so many experiments I literally
bought like 20,000 ketone strips you know because we do so many so many blood
measurements with the experiments that we do so I have a big stash here that
that we use and and we compare the measurements to the biochemical assays done with very expensive equipment at
Case Western University and we found that these meters are actually very
accurate they're the ketone measurements are accurate and the blood measurements
are are they're they're precise and/or accurate so they're measuring you know
repeated measurements of the same sample give you the same the same numbers and
they're also you know in the same ballpark yeah it's wonderful stuff and
then thanks to the exponential growth and technology and I suspect in the
not-too-distant future we have a little sensor we can put into our smartphone and then be able to analyze it that way
for even less expensive but that would be ideal yeah like a little band-aid you
know I'm working with you know I know some companies or foundations that are
working on this where you just put something like a band aid that has nano
sensors that can detect blood in your capillaries and basically give you a
metabolomic profile of all the metabolites yeah in your you know I
think this technology is available to do this it's going to take some R&D to
actually develop a commercialized product but but ultimately you're going
to want to have a protocol that you follow to achieve metabolic excellence
as which is really why we're meeting today to help us understand what that protocol would be so and I want to tap
into your expertise because you guide so many people through this so for the
average person who's interested in this intrigued with this concept it was
either as concerned about optimizing her health and longevity or treating
existing cancer or preventing cancer the the typical person is not fat adapted their prime there's two fields to burn
fat and carbs and most people are I would say it I suspect to a degree over
99% are adapted to burn carbs as their primary fuel so that our goal is to help
them transition to that and the part of the to achieve this metabolic excellence
but part of the reason for that too is is when you'd alluded to earlier is that when you are adapted to burn fat as your
primary fuel you're you are flexible you don't have to eat every two to three hours you can go for a full day and not
be hungry and that is the key and it just seems like it were blowing smoke but your hunger disappears because you
have fuel to burn if you're not adapted to burn fat than you don't then you
absolutely have to have those carbs otherwise you're going to be miserably
hungry so becomes a crisis situation absolutely I mean you'll kill your food
yeah major practical advantages she's not fat adapted so how how do we do this
you know if my perspective and you know you know I've got less experience than
you certainly in helping people apply this practically but it is this concept
called intermittent fasting where we gradually allow people to restrict the
window at which they're consuming food so I tell people to stop eating anything
all food is set for water for three hours before they go to bed and then to
gradually extend the time that they're consuming their first meal to the point
where they're skipping breakfast and they have a six to eight hour window
where they're restricting their calories to it so in a set in a sense you almost
have to calorie strict although I don't tell them the calories trick but it's
sort of an artifact of following that concept because you're not eating food as long as the day so and in that period
to provide substrates till to make the transition to fat fuel burning as their
primary fuel is to use a fast to break down real easily that are healthy like
full of medium train track which means like coconut oil which can substitute
frequently for the glucose at least give them the energy that they that they
don't have until they switch over so I'm morning what your comments are on that and any revisions that might make it
easier for people to follow yeah it's a lot of good points you bring up there a
lot of good topics of discussion you name it I've tried it you know I've
tried intermittent fasting I fasted for one week
and you know and I found that it was very tolerable I was I had the benefit
of already being fat adapting her keto adapted but the third day was a little
bit you know I got a little bit hungry but I wasn't hungry after about the
fourth or fifth day and by the seventh day it was very easy and actually gave a
you know a seminar on nutritional seminar on the day the the last day of
my fasting and you know showing people and I showed people my blood glucose
which was 51 and my ketones were like 5 or 6 milli molar so earlier in the
morning I think I was like 44 something my blood glucose so if a doctor saw that
they would think I would be you know in in a coma so so you name it I've tried
it and I think the you know from a practical standpoint the the important
question is what's what's a person going to follow so from my perspective the
biggest hurdle here is compliance compliance to a dietary strategy that
makes calorie restriction feasible and possible so and and you know
carbohydrate restriction high-fat diet intermittent fasting is one way to
achieve that and I found that one meal per day kind of left me a little bit I I would tend to consume a little bit too
much food I think on the single meal I found two meals a day to be optimal for
me although when I'm traveling sometimes
I'll go a whole day without eating or sometimes I'll just eat once per day for
example if I'm traveling in Europe you know or foods more expensive or I have a
pretty you know busy itinerary one big meal at the end of the day is great and
can cut down on your budget for food too you know so it there's a lot of advantages as you alluded to to this
pattern of intermittent fasting and I think that it is a good strategy to promote metabolic health and to maintain
nutritional ketosis if the person and adapt to it you know some lifestyles
people you know cannot readily adapt to it but I found that most people can if
they give it a try most people are resistant but once they
try it they're amazed at how much better they feel you know and and it's also you
know you ask the question are you an elite athlete are you you know why are you doing it and if your goal is to
build muscle if you're into you know powerlifting it might be intermittent
fasting may not be the best strategy for you or how about a pregnant woman which
is I would also include that category yeah I think or someone with adrenal
stress - yeah yeah I think there's there's much to be said for just eating
when you're hungry right and I think that you know we're programmed you know by the the can by the norms of society
to eat breakfast you know dinner and lunch and with snacks in between right
right and and we've also been told that eating more frequent meals is more beneficial and breakfast is the most
menial a day yeah and those meals should be high in carbohydrates and this
creates you know a pattern of eating and I believe is unhealthy and the and it's
just not feasible I mean with with my work schedule and it would just be hard
it would kind of tap into my productivity so and you know I've frequently I get blood work you know
many probably about four to five times a year and I've gradually shifted from
eating six meals per day which I used to eat when I was you know very active more
active in athletics and to this pattern of eating which is like two meals per
day and all the you know my weight has come down a little bit but I still maintain I'm about 100 kilograms or you
know 225 pounds and I can maintain that my metabolic health is good so I'm
overweight but I've been able to use an intermittent fasting proto if you want if you want to call eating just twice
per day kind of like a week intermittent fasting protocol I've been able to
maintain my strength and my power-to-weight ratio
you want to call it that with by reducing my meal frequency I'm actually
stronger now pound-for-pound than I was when I was eating that it's amazing once
you get the body what it needs yeah yeah and the body does is pretty smart you
know it just kind of takes what it needs when you give it the the right foods and
and I find that if your if your overall physiological health is better your body will kind of break down assimilate and
utilize the nutrients that you give it much more efficiently
so those it'll you'll have a repartition effect and then the the nutrients will
go preferentially to rebuilding and maintaining muscle and and into energy
pathways that kind of give you sustained energy effects whereas you know if
you're eating carbohydrates or you're overeating carbohydrates it just cause a metabolic situation where you have pro
inflammation you're you fluctuations in blood glucose which can decrease your
your cognitive and physical performance so you know a colleague of mine Jeff
Volek he works with advanced athletes you know these ultra endurance runners
who run like a hundred miles at altitude you know in the rain over hills and he
develops their nutritional strategies and Jeff Volek has written books the art
and science of low carbohydrate performance and has shown conclusively
that at least in endurance athletes requiring stamina and strength that carbohydrate restriction and even an
intermittent fasting type feeding schedule is is actually optimal to
enhance physical performance so he's demonstrated this and has a number of studies that I in Jeff has published
probably over 250 peer-reviewed articles Wow so he's definitely put out enough
research that I validate this pattern this way of eating this carbohydrate
restriction and decreased meal frequency yes and that is a great strategy if
you're going to use that but if your goal from my perspective is longevity
and optimal health I don't think that's a why
strategy to achieve that it's kinda Cotter productive and far more a fan of the high-intensity slower less frequent
type of exercise although I used to do longer entrances and ran marathons when
I was younger and yes wise but I want to comment on one point you mentioned
earlier which was that and I respond and respect that and recommend that people
also is that listen to your body that eat when you're hungry but the caution
in the caveat I think that one needs to apply here is that that's valid if
you're adapted to burn fat as your primary fuel if you're adapted to burn
carbs your body's going to lie to you because it's going to want to fill those
glycogen stores up so I'm wondering if if you can from your experience in
guiding people through this process what your range is that you find people
required to make this shift if they're applying intermittent fasting is a tool
to achieve fat fat adaptation yeah it's a good question and there's no easy
answer to it but and I think it varies tremendously some people just like to
eat I mean some people like I think the fact of you know they add the time the money and and you know they enjoy eating
and eating as a pleasurable thing and I don't think people should deprive
themselves of eating and if eating more frequent is pleasurable to them and they can maintain metabolic health doing that
then you know I don't try to change their eating pattern if they don't want
to people need to want to change and usually that results from some kind of
underlying pathology the doctor tells them they need to lose weight they're
trying to get in shape for an event or something
I have a daughter yes exactly so in these situations you need to you know
assess the person's current eating strategy you need to assess their
metabolic health blood blood work is important you know if they're you know
if they have some renal insufficiency if they have a you know different if
they're if they're hypercholesterolemia if you know there's factors that need to
be considered before give someone advice for a nutritional
strategy but I think calorie restriction is basically the benefits cannot be
denied and any eating pattern that promotes a tolerable means for calorie
restriction is going to improve overall health and metabolic health and what's
the range of time you think it takes people to achieve that in your
experience is it one week two weeks three weeks three months it depends on where they're coming from but I think
within four to six weeks most people can fully adapt and embrace an a low
carbohydrate reduced meal frequency eater an eating pattern and I think it
takes about four to six weeks and actually this would correlate with the
the exercise performance studies done by Stephen Finney and Jeff Bullock that
showed that the performance deficits that you see with carbohydrate
restriction restricting carbohydrates can actually drop physical performance
and then this starts to come back up you know to baseline at about four weeks and in about six weeks at least in advanced
cyclists they can achieve far better and that would be that's kind of evidence
for me that their keto adapted in the sense that their body is better
utilizing transporting ketones maybe across the blood-brain barrier and that
they're they're fully utilizing and optimizing optimizing fats and ketones
for fuel and this may correlate with just an overall sense of well-being paying that you know their body is fat
adapted Akito adapted their brain their organ their whole physiology is in tune
and adapted to this nutritional ketosis is so and that that can be hard for some
people because it's literally forcing their body to use a fuel that it doesn't
want to use but it's mimicking the physiological phenomenon of starvation
right in the body doesn't want to be in starvation for survival
so carbohydrate restriction mimics you know the physiological so there isn't
fasting I believe most likely the reason this works is that it follows one of the principles that I've
is pervasive to good health which is rap too we replicate our ancestral practices
and our ancestors did not have access to food 24/7 so they regularly went through
periods of decreased calories so that's what probably why this is works if our ancestors didn't then we wouldn't need
to do that but we have to honor our biochemistry and to achieve those
benefits so the four to six week window is phenomenal that's good to know and
then I would encourage people to stick with it you know to get through that use
a lot of coconut oil to give yourself energy until you achieve I mean you
could do it with the meters that you mentioned but you also this is such a
huge point the hunger disappears when your hunger for carbs disappears you
know you are burning fat because that's one of the side effects and it's obvious
as plain as day is not a mystery that it's like that turning lights on in a
room you'll know as soon as it hits because it's it's so obvious and it's so consistent I mean it happens to almost
everyone I would agree there are some people that
fail to adapt to the ketogenic diet but they're the exception rather than the
rule and and most people who say you know I try to kid ranked I I just
couldn't do it and I was like well tell me what you did you know it's like well
I was eating you know like 200 grams of protein and like 30 grams of fat and
zero carbs I was like no you're following a high-protein diet yeah you
know and your your blood glucose was all over the place and you weren't making
ketones because you're not giving your body the fats that are you know needed
you know you know the ketones are a product of the liver
so basically give your body fats feed the liver fats from your adipose tissue
or from you know fats from your diet and it will make ketones and and I think it
really comes down to having that sustained nutritional ketosis to fuel your brain and keep your brain happy
shall we say during periods of reduced glucose availability and it's those dips
in blood glucose that it's going to create that glucose withdrawal syndrome
in the brain it's a dysphoria I guess you would say you just you just don't
feel good your and I see it all the time and
that I know that skip a meal you know like I got to eat now I got we got to
stop someplace I got to eat you know because I ate three hours ago and I
carbohydrates and now I'm hungry again and I got to eat something and when
you're when you're fat adapt you forget what that feels like right it's just I
remember feeling I used to be a lot of fish and rice and pasta and you know I
grew up an Italian family where it was basically a pasta base you know a family
or lots of bread and I remember feeling hungry and like the feeling like I need
to eat right now I need to eat something and I don't feel that way anymore if I
actually have to remind myself to eat its metabolic item and flexibility once
you achieve this oh yeah it's really worth the effort it's four to six weeks
of somewhat discomfort no question but it's uncomfortable feeling but
definitely worth it worth the effort I want to comment on you know I would
agree with you that that two meals a day is probably optimal I've what I find myself doing though because just the
hassle factor inconvenience I mean I will eat two meals a day but frequently
when I'm at home only one meal a day but I substitute snacks around that so and
the snacks are typically to macadamia nuts for two reasons ones because
they're the highest nuts and a highest fat in any nut that I know of and the
lowest protein so it's closest to that that with that metabolic window that you
want and then also a candy that they make from coconuts primarily coconut oil
some coconut flour coconut flakes and some natural sweeteners like stevia so I supplement that so I'm getting
other calories and fats around that big meal a day which typically varies from two o'clock to four o'clock in the
afternoon so if you ever try played with something like that we're having these
smaller or little snack meals around that I do that my my typical morning
routine is to wake up and actually have an amino acid supplement which by the
way is leucine a little bit of losing a little bit of mineral admixture and some
spirulina actually tends to be just a buffer for the amino acids and you know
I'll have a little bit of an amino acid mixture when I wake up with some
spirulina and a few things plant-based proteins actually just a small amount
and then I brew coffee I don't know if you're familiar with bulletproof coffee
oh yes yeah yeah so basically and then I take almost the third of a stick of butter
and kind of blend it up and whip it up with some strong coffee and I'll sip on
that and just kind of work you know wake up early in the morning 5:00 and just
I'll have the most productive you know two three four hours of working just off
fat yeah essentially off the butter and and then I have to kind of force myself
to eat to eat breakfast you know and this is kind of contrary to what I was
just talking about but I know if I don't eat breakfast and I get into a work
pattern and I'm at work until like eight o'clock at night you know I probably
will get hungry during the day so I might have a couple you know free-range
eggs and a little bit of sardines and broccoli you know I know that doesn't
sound like very appetizing breakfast right like sardines in the morning but
it works but that's typically what I eat yes it's really heavy on fat and you
know kind of moderate with the probe with the protein not you know I used to
eat like a dozen egg whites and and oatmeal I remember that being you know a
staple breakfast but now you know Bobbi stick sticks yeah and I cook it in
coconut oil and usually have some kind of greens like broccoli asparagus or
spinach omelette or something like that some mushrooms and that'll sustain me
the butter in the morning with my coffee and a high fat moderate protein low carb
breakfast will sustain me for half of the day twelve hours and and I might hit
some you know MCT oil in the middle of the day coconut oil or a little Advent
amino acid supplement that I tape occasionally and then I you know
breakfast is per hour dinners my bigger meal of the day and it typically follows some kind of
physical activity whether it be you know walking the dog or going to the gym or
you know some kind of physical activity so I kind of I'm have it immediately after and and it's typically you know
protein a big salad and and lots of fat my fat intake is probably about 300
grams a day believe it or not so percentage-wise how many calories would
you say are from fat is it like seven percentage-wise like 70% of your calories are from that uh yeah I would
say about that yeah on some days it might be as high as
lo is 50 and on other days that may be as high as 80 or 90 oh yeah but about 70
that's pretty accurate yeah that's basically what I follow to about 70
percent fat most people most conventional nutritionists or dietitians would strongly disagree with that of
course our research here has evolved you know by basically I was studying the
effect of neuroprotective agents and seizures and I stumbled upon nutritional
ketosis as an effective way to prevent seizures and that led to a whole number of projects probably five or six
projects that are ongoing now that are giving compelling evidence to show that
metabolic therapies in the form of calorie restriction ketogenic diet or ketone supplements so what I didn't
really mention a similar two MCT product that we develop and test ketones esters
ketone salts and so creating nutritional or even starvation ketosis without
dietary restriction is a is of interest to the military because they are aware
that nutritional ketosis has a very powerful anti seizure effect which is
important for Navy SEAL divers that use the closed-circuit rebreather so if if
we can achieve that without calorie restriction or without carbohydrate
restriction and elevate blood ketones to the level of fasting ketosis we can in
essence feed the brain a an alternative fuel that can enhance brain metabolism
and preserve brain function under periods of stress and under periods of
oxidative stress for example high pressure oxygen breathing so the ketone
supplements ketone esters and ketones also we developed have been shown to be
very nerve protective and we've published a report on that and in the
American Journal of physiology actually the title is therapeutic ketosis as a
seizure prevention against oxygen toxicity
and tomorrow actually there'll be a press report out a press release on our
paper that was recently accepted in PLoS ONE journal it's an open access journal
so readers will be able to to get this and the title of it is the ketogenic
diet and hyperbaric oxygen as a therapy for metastatic cancer so as you know
most people who die of cancer die of not the tumor per se but the metastatic
process and there there's really no treatment or cure for metastatic cancer
so that's one of the reasons we wanted to study it because no one's really
studying it because it's hard to show efficacy in any kind of animal model of
metastatic cancer and we've demonstrated that the ketogenic diet by itself can extend survival in animal models of
metastatic cancer but when it's combined with hyperbaric oxygen therapy three times per week that there is an additive
effect and that you get a significant reduction in tumor growth decrease in
tumor size and and significant extension of life when therapeutic ketosis achieve
with the ketogenic diet is combined with hyperbaric oxygen so tumors thrive in a
low oxygen environment as a tumor grows it exceeds its ability to supply oxygen
to the center of the tumor and that low level of oxygen and we call hypoxia actually further activates the oncogenes
the cancer promoting genes activates things like if one alpha veg F igf-1
signaling goes up and hyperbaric oxygen can reverse tumor hypoxia intermittently
and in doing that it can actually turn off the oncogenes and there's published
reports on this more importantly is that you know the tumour thrives in a low
oxygen environment and when you and it's adapted to that low oxygen environment
so when you saturate a tumor with oxygen because the mitochondria are damaged it
over produces oxygen free radicals in the form of superoxide anion and this
this oxygen induced increase in free radicals can actually cause the
tumor to kill itself it overproduces for your articles you know in the presence
of high levels of oxygen this is a band ratification damage can damage the tumor and when that natural form of oxidative
stress is given to the tumor during the ketogenic diet so the ketogenic diet will put metabolic stress on the tumor
cells by limiting glucose availability and elevating blood ketones which your
normal cells can use but cancer cells can't use so it compromises the
metabolism of the tumor and then you hit the tumor with a high pressure of oxygen
but a hyperbaric oxygen which is breathing 100% oxygen at an elevated
hyperbaric pressure or at one atmosphere now and we use like 2.2 atmospheres or
2.5 atmospheres of oxygen which will probably increase the tumor oxygen
tenfold so we're using a natural form instead of radiation which works by
killing cancer by causing free radical formation by destructing by destroying
the the tissue and creating free radicals a hyperbaric oxygen is just a more natural way to do it without
damaging the natural cells and it seems to be synergistic with the ketogenic
diet so there will be a report on this tomorrow a press release and the paper
will be available tomorrow a place that has the link to that will put it in the
though yes so uh and we also you know I'm working
with the foundation called winning the fight for neuro neurodegenerative
diseases and this is a foundation primarily to treat patients with ALS and
I've been testing what has been termed the Deanna protocol so the Deanna a
protocol is a metabolic therapy that elevates blood ketone levels and and
actually is a combination of nutritional supplements that includes alpha
ketoglutarate which is a Krebs cycle intermediate and energy
metabolite a soluble form of Co Q 10 a soluble ubiquinol gaba the amino acid
GABA and caprylic acid which is an 8 carbon medium chain triglyceride so
these things in combination and have been shown anecdotally in patients to
stall the progression of ALS and this observation was first shown in Deanna to
Doane her father is a retired orthopedic surgeon his name is dr. Vince two-tone
and they have a foundation they contacted me and they you know I met
Deanna I met with a family and I observed that they were getting a real
therapeutic effect to this metabolic therapy which involve elevating blood
ketones and in giving the body high energy intermediates in combination with
cofactors like soluble coq10 to enhance metabolic efficiency and the reason why
this works is that all neurodegenerative diseases are associated with impaired
energy metabolism and that the impairment of the cell to make energy
causes the membrane potential to collapse and then it over secretes
glutamate which is a an excitatory amino acid transmitter it can activate the
NMDA receptors AMPA receptors which can be excited toxic so the the hallmarks of ALS pathology is glutamate
excitotoxicity excess calcium and oxidative stress and these are I believe downstream epiphenomenon or downstream
consequences of failed energy metabolism so if we address the issue upstream by
giving a metabolic therapy that fuels the the cells in this case the motor
neurons for ALS that helps the cells maintain ATP production within the cell
it'll the cells will maintain their resting membrane potential and it will
prevent the the collapse of the metabolism which contributes to excess
glutamate excitotoxicity so many of the therapies now are just you know blocking the glutamate
receptors or blocking the accumulation of the protein the toxic proteins that
occur as a consequence of failed energy metabolism the therapy that we're
testing and I think the therapies of the future will be metabolic therapies that
address the underlying metabolic dysfunction associated with the cell and for some reason you know in patients
that have ALS they are responsive to TCA cycle intermediates or Krebs cycle
metabolites when these are giving at high doses it seems to restore energy
metabolism perhaps in the motor neurons which decreases the symptoms so the
question is are we just decreasing the symptoms are are we stalling the
pathology though I Deanna has been taking this for Deanna to Don has been
using this protocol for several years now and it seems to she has beaten the
odds as far as you know progression of ALS which is a terrible disease and a
number of other patients I think there's a thousand patients that have registered
with the foundation at you know Johns Hopkins Duke University Emory and these are being evaluated it's too early to
tell but our animal studies definitely showed an extension of survival with this metabolic therapy that elevates
blood ketones do you think this would be also helpful for other neurodegenerative diseases like Alzheimer's or Parkinson's
or even autoimmune motor dysfunction diseases like a multiple this muscular
dystrophy yeah it's funny you mentioned Alzheimer's disease actually today in
the paper the Tampa Bay Times here there's a story of Mary Newport and I
sure hoping it all in the mine yeah so as you can see Mary's you know in the
corner there with her husband and you know another report showing that the the
Alzheimer's Institute here has actually started a clinical trial to determine
they have coconut oil and a placebo which is you know olive oil or some kind
of plant-based oil and that they give to patients I think they're 60 patients in
the trial and the question is you know does does giving coconut oil enhance brain metabolism to
to delay the Alzheimer's pathology so they're going to look at you know not
only cognitive function but actually you know do an amyloid PET scan to see if
it's impacting the progression the pathologic I think the same supplements
would be helpful the same something that's usually for the ALS would be
helpful in those diseases like Alzheimer's yeah that's that's a very
good question and you know I know the Foundation has is in discussion with the Alzheimer's Institute because they have
reports Alzheimer's patients have contacted this this foundation that
primarily specialize in ALS therapy but they are reports from Alzheimer's
patients that are are telling them that it's working for Alzheimer's disease
that the tremors are decreasing that there's an improvement in cognitive
function so this is perhaps might put pressure on you know the Institute to
run a study to test the deana protocol which is being used in many ALS patients
to perhaps you know use it in all server stations in Parkinson's disease patients
to have reported I've had several contact me because they
know we're doing the animal studies on the transgenic animals that are models
for these diseases and we saw a positive effect and they don't be published soon
but other people what do you talk about the possibility of using it for
autoimmune motor disease like most muscular dystrophy yeah they're that big
either I have a student of mine has MS and and maintains nutritional ketosis
he's on a calorie restricted ketogenic diet he essentially does intermittent
fasting with coconut oil and MCT throughout the day and he appears to
install the progression of his MS and it's just one observation there but a number of people maybe about four or
five people with MS MS have contacted me and kind of given me you know the
protocol that they're using which typically involves some kind of
ketogenic diet calorie or did or not with lots of coconut oil and MCT oil and some of them rub the MCT oil
or coconut oil into their skin it does have the ability to be transdermally cross and into so you know whether it
elevates blood ketones through that way we have not tested that yet but they
seem to be getting a therapeutic benefit at least symptomatically in their in ms
and and in other neurological diseases but ms is is an interesting one and you
know i think a nutritional strategy is very important in ms because I think the
immune system is obviously you know an important in in driving the progression
of the pathology and their MS is really a mystery but removing toxins and
removing potential allergens from the diet is very important now can you also
provide us with the list of those resources that someone could use if they
wanted to apply this because that was I think you mentioned a number of moment
books and number of websites yeah I think a good place to start would
actually be for cancer you know you're probably aware of Tom Seaford's book
cancer as a metabolic disease and you know this is a very academic and it's a
little probably too technical for most people but within this book there are
patient protocols that are being used for clinical trials with the restricted ketogenic diet for glioblastoma brain
tumors so I know the protocols in this book are going to be the ones that are
implement implemented in clinical trials so I think that's important to know so I
highly recommend this book if a patient brings this book to their doctor there is irrefutable evidence that tom has
amassed in this book to support cancer as a disease of metabolic origin and
support showing that cancer of all types have a are genetically heterogeneous a
diverse but they have this similar metabolic phenotype which is the Warburg effect
which is aerobic glycolysis you know so even in the presence of oxygen they continue to use glucose of the fuel and
pump out lactate so with that knowledge we can exploit that and the protocols described in this book the data
presented in this book gives the reader a firm understanding of of what cancer
is of how to prevent it and how to treat it if one has it and and there are a number of you know
there's case reports in the book there's specific protocols in the book and
there's a firm history of kind of how we got into the present state you know
we've developed a large variety of genetic therapies that are having no
effect you know the human genome project has given us a lot of different therapies and and none of them are
working so something has to change and anyway the combination of anecdotal
reports animal studies case reports that are documented I think that that book is
a very important resource for patients and for their doctors to support the use
of these metabolic therapies another book I mean we I think we talked about
briefly is more of the history of cancer is the emperor of all maladies you're the biography of cancer so this is a
great book to read prior to reading Tom's book because it prevents it
presents the whole history of cancer right and it's very author is very
articulate and he it reads like a you know a very suspenseful novel but it
leaves the reader kind of desperate for you know a therapy it's basically kind
of talking about the failure of modern medicine to provide us with an answer as
to why cancer occurs how to prevent it and how to treat it and I think Tom's
book picks up where that book leaves off and it gives a firm scientific
background in rationale for a metabolic origin for cancer
and in Dells into the biochemistry and the physiology of how a metabolic
therapies work and how to implement them and there are resources within the book
that can guide the patient for that and a friend of mine by the name of Ellen Davis maintains a website that has been
really helpful for a lot of patients I'm come in contact with it's one of the first websites I direct people to and
that website is the ketogenic diet resource and the ketogenic diet resource is a very comprehensive website that
describes how to implement the ketogenic diet and there's recipes on there you're
featured on there there's a lot of you know links to your your website and
recently Ellen Davis has finished a book that is a patient hand guide for using the ketogenic diet for the metabolic
management of cancer and you know the problem I get with Tom's book although
it's very eloquent and he can kind of break down you know biochemistry in
fairly simple terms it's still over the head of many patients that seek a
resource to help them so Ellen has completed a patient guide to the
ketogenic diets on her website and it's been a tremendous resource for people
wanting to try the strategy and you know the blood ketone and glucose meters that
we talked about would be an essential tool to assess the important biomarkers
the blood beta-hydroxybutyrate which is one of the main ketones and
blood glucose to ensure that you're in nutritional ketosis and you're in that
metabolic zone that we talked about then if a patient achieves the metabolic zone
that therapeutic zone is when ketones actually are elevated above blood
glucose and if those biomarkers can be achieved and maintained typically what
you see is either you know the tumor slows and grow
there's it completely stops growing or it starts shrinking so you get three
response occasionally you'll have people that go into remission quickly after and
there's some anecdotal reports of people with advanced metastatic cancer going
into remission with with nutritional ketosis and in the people that I know
the few reports that I've seen one of them I actually one person I encourage them to do a therapeutic fast so and
when implementing metabolic therapy for cancer I think it should be encouraged
that if the patient is healthy enough that they should undergo a therapeutic
fast of five to ten days up to two weeks if they're able to do it if a patient's
overweight they can they should be able to achieve two weeks ten days of fasting
at least a week I mean I I did a week and it was fairly easy but you know my
health was good so I think the fastest way to get into nutritional ketosis is
with a therapeutic fast and during this fast you know a patient can take
non-caloric nutritional support which could be in the form of you know chicken
broth or coconut oil I think coconut oil and MCT oil although
they provide calories they can help someone you know overcome the the glucose withdrawal symptoms that
typically hit on day two or day three of a complete fasting so I found that that can be helpful in some patients but a
therapeutic fast followed by a restricted ketogenic diet is an
effective way for a patient to implement a strategy to metabolically manage their
cancer now they can use this as a standalone therapy and or they can
combine it with standard of care so uh you know my my second ation would be you
know to track the tumor growth with a cat scan or MRI and if you implement a
metabolic therapy and the tumor shrinks or the tumor blood markers go down then
I would discourage someone from using a chemotherapy or the standard of care
especially if the standard of care has been shown in their particular cancer to
be largely ineffective for their type of cancer which is often the case
especially with metastatic cancer almost like you cancers are responsive to the standard of care now my colleague at
Barrow Neurological Institute Adrienne Scheck has is is working on and I think
has has gotten the administration there to conduct a clinical trial that
combines the ketogenic diet with radiation now I'm not a big fan of
radiation and Tom Seaford is not a big fan of radiation but Adrienne Czech is a
brilliant PhD researcher at Barrow Neurological Institute and she's done
some research on an a brain tumor model in rodents and has been able to achieve
complete remission in an aggressive brain tumor model with combining the
ketogenic diet with radiation so the as we talked about the ketogenic diet puts
tremendous metabolic stress on the cancer cells by limiting glucose
availability and elevating ketones which may actually have an anti-cancer effect
that we're studying right now so she has demonstrated that the
ketogenic diet can prolong survival but in several animals within the group that
received the ketogenic diet plus radiation some of them were completely
cured of their aggressive brain tumors and I'm not aware of anyone that has
been able to demonstrate this in this particular sin genic animal model of a
brain tumor which is is most similar to a glioblastoma so and I would Adrienne's
work is on is published on PLoS ONE journal if you just google the ketogenic
diet and radiation you'll come across this work and and this is an example of
someone that you know a study that combines the ketogenic diet with the
stain of care radiation and showing a synergy there that that is important once again
though you know we the the track record for the standard of care particularly
radiation is not very good but we have studded radiation with people eating a
standard diet in many cases that people are encouraged to over consume
nutritional products like ensure which is basically just like sugary milk and
to over consume excess calories to prevent the side effects associated with
radiation which is nausea and things like that so you know the question is if
perhaps we can unmask the potential benefits of the standard of care if the
patient is maintained in nutritional ketosis so that's a question that needs
to be addressed and studied my my gut feeling is that all attempts should be
made to pursue a non-toxic therapy for cancer and other neurological diseases
like ALS which is why it was interested in the synergy that you mentioned with
the hyperbaric oxygen what is it which is available from many natural medicine
physicians it's not that difficult to find so but I'm wondering you know if a
person has metastatic cancer what your gut feeling is because I know this probably hasn't been studied but if if a
person had that and they were to implement this radical
I mean pronoun pratical but very disciplined application of ketogenic diet with hyperbaric oxygen what the
effectiveness what your gut feeling would you say it's to me would be
probably over 7080 maybe even over 90% effective obviously it depends on when you implement it and how rigid they are
but what do you want your best guess as to how effective it might be that's a
difficult question and yeah just I think my quote my answer is that it'll be more
effective than metabolic therapy combined with hyperbaric oxygen will be more effective than than anything
currently available that I know of yeah you know there's a lot of but you know
reports on the Internet of this or that working you know lowering blood
producing a sustained hypoglycemia with therapeutic ketosis combining that
with another modality that's non-toxic like hyperbaric oxygen
therapy is a win-win situation in my book because you know you're not
compromising the long-term health of the patient the main side effect of
chemotherapy and radiation is cancer so you're damaging the genetic material the
DNA of cancer cells by hitting them with a cytotoxic chemotherapy and radiation
okay what you're doing here is you're just buying time if there's your system in your immune system is what you need
to fight the cancer so it's destroying the very process that
your body desperately needs very good point so you dear
you're wrote a robust immune system is very important for beating cancer
long-term if your immune system is compromised it's setting you up for
getting a major uh you know recurrence of cancer an aggressive form of the
cancer and setting you up for even different cancers in the future so
hyperbaric oxygen has been shown to be very immune stimulating you know in a
colleague of mine that was at University of Pennsylvania
Stephen Thumb was was there and demonstrated that hyperbaric oxygen can
increase stem cells the release of stem cells and the production of stem cells
so you have drugs like gm-csf which is sold as Lu kind g-csf which is
sold as neupogen i believe these things cost like $1,000 a week to take you know
and and they work by elevating by stimulating the release of stem cells in
the body by stimulating your bone marrow now hyperbaric oxygen has essentially
been shown to do the same thing you have a mobilization of stem cells so where
those stem cells go and if their therapeutic that's another question but
for example if someone has a wounded injury and they undergo hyperbaric oxygen you have a mobilization of these
stem cells and they tend to hone in on the sites of injury and assist in the
repair of the wound for example now how they're
doing that is also another question whether they're releasing anti inflammatory factors or actually
becoming cells of the same phenotype to build a scaffolding for the wound itself
is you know is what people are studying we're actually studying that so there are you know there are modalities out
there that are not in the pill form that are not sold by big pharma that there
may not be a profit potential in suggesting that someone you know do
fasting and the ketogenic diet but we know from the science from anecdotal
reports that these are very valid therapies that can be implemented
cost-effectively by the patient hyperbaric oxygen can be you know a cost
burden one of the questions that we want to address is do you need to get inside
a hardshell hyperbaric chamber to to reap the benefits of hyperbaric oxygen
therapy we're going to design a dose-response study where we just use Hyper we use 100% oxygen at normal
pressure so putting essentially you know a person could put on a mass and breathe
100 percent oxygen or using a low level of hyperbaric oxygen like 1.3 atmospheres of oxygen which there are
various soft shell chambers on the market for like anywhere from three to
five thousand dollars that are available that can increase the partial pressure
the barometric pressure and in a hundred percent you know environment you can get
mild hyperbaric oxygen so the question is you know will we get the same robust response in our animal model with that
and that could be very useful to us go stat practical what you're seeking to
find is the meed the minimally effective dose that's right yeah that's uh that
would be very profoundly useful information yeah and that's you know
it's a big difference between telling someone that they need to do you know two atmospheres of hyperbaric oxygen you
know five times per week which is the standard protocol you know to pay up to
$200 per session and go to a hyperbaric Clinic where they you know perhaps maybe 1.3 atmospheres of oxygen in a low-cost
softshell chamber or even 100% oxygen at normal barrack pressure just three times
a week could yield the same benefit so these are questions that we want to
address and we only test it you know we tested the the standard level of oxygen
just because that's what people do and it's kind of an arbitrary number but we
figured we'd start with that and then do a dose response to see you have to keep
this post because but even if people you fought your future experiments show that
they need the higher dose it's a little more costly but it's a lot less
expensive than alternative and it's a lot more effective so ultimately you
want something's going to work so it would great to find what the lowest dose
possible it's working but yet the high dose is probably more than worth it yeah
and I need to stress too that the work that we've done are was in an animal
model of cancer and and there have been reviews on the effects of hyperbaric
oxygen therapy in cancer patients and the the weight of the evidence supports
a therapeutic benefit to hyperbaric oxygen especially for things like
radiation necrosis and indifferent but all these studies were were not done in
patients that have achieved nutritional ketosis so nutritional ketosis I believe
will kind of synergize with hyperbaric oxygen therapy and will allow the
benefits to take place because and there's many reasons for that that I can
go into biochemically but I think you know that's what what needs to be done
and that's what we've shown even in our animal models giving a standard diet
hyperbaric oxygen therapy gave there was a trend for increased survival but it
wasn't like a major statistically significant finding it was only you know when we combined hyperbaric oxygen
therapy with a nutritional therapy that we we saw the true benefits and getting
achieve their metabolic benefits what yeah great well it has been an absolute
delight to connect with you you've enlightened so many of
this really important topic and I'm sure it will be reviewed by many over and
again because there's a lot of information here so I want to thank you
for joining us and I want you to continue your research and content and
hopefully we'll have a long collaboration and you'll update us in
the future on what you're finding yeah we have a lot of projects ongoing right
now so and one will be released tomorrow as I mentioned but yeah thank you for having me and it was a pleasure to be on
your show here and yeah let's keep in contact and and I can keep you abreast
of what we're doing to things on the horizon this is the main goal is to get
you know these therapies into clinical trials so we really need for that to
happen we need funding you know right now there's we've applied for funding
but it's really you know as you know the cancer industry or research is much of
its funded by the pharmaceutical company and there's really no companies like
that that are funding the kind of therapies that we're developing so you
know and we're positioned to to make even a little bit of funding go far so
if we can kind of develop the funding to validate these therapies in a
preclinical model that sets us up for you know getting approval to do this in
human clinical trials which will give the evidence that people need to be able
to embrace this therapy and for their doctors to to help them that the main
problem we see is that patients want to do this they know it's effective but
their doctors have never heard of it so they're not going to you know assist their patients and help their patients
implement these metabolic therapies simply because they're not trained in
nutrition for that's one of the problems but they are there they're looking for
the the human clinical trial and there's - you know there's the logistics behind
doing a diet study and and also who's going to fund it alright so we really
need to do this a lot of work ahead of us all right well thanks so much
you
so I think you've provided us with a wealth of information that people can
delve into and I'm wondering if you could maybe summarize some of the basic
principles and then perhaps most importantly provide the resources repeat
what you mentioned earlier that people can follow and go for more specific details with if they're intrigued with
this concept and want to integrate it into their lifestyle sure um so just a
summary of kind of my yeah my thoughts on it um okay well just kind of state
taking us a big step back from where we started my