#116 - AMA with Dom D'Agostino, Ph.D., Part I of II: Ketogenic diet, exogenous ketones, and exercise
Dom D'Agostino, a ketosis expert and Associate Professor at the University of South Florida, joins Bob Kaplan to discuss ketogenic diets, exogenous ketones, and exercise. He shares insights on metabolic flexibility, fasting alternatives, ketone measurement, and the science behind ketosis.
Deep Dive Analysis
6 Topic Outline
Dom D'Agostino's Current Research and Projects
Benefits of Intermittent Ketosis for Healthy Individuals
Recommended Books on Ketogenic Diets
Update and Comparison of Ketone Measurement Devices
Physiological Differences and Utilization of Ketone Bodies
The Role of Insulin Suppression in Ketogenesis
5 Key Concepts
Metabolic Flexibility
This refers to the body's ability to adapt its metabolism to efficiently use fat as a primary energy source, especially during periods of low carbohydrate or calorie availability. Ketosis or fasting can activate genetic programs that promote this adaptation.
Metabolic Memory
The concept that once the body has adapted to efficient fat burning and ketone production through ketosis, it retains this ability and can quickly revert to that metabolic state even after periods of consuming carbohydrates.
Glucose Ketone Index (GKI)
A ratio of blood glucose to blood ketones used to quantify the depth of ketosis. Achieving a GKI between 1 to 2 is often associated with deriving significant metabolic benefits similar to those from fasting.
Breath Acetone as Fat Oxidation Indicator
Acetone, a volatile ketone body, is exhaled in the breath and serves as a strong quantitative measure of fat oxidation. Its presence indicates that the body is actively breaking down fats for energy.
Insulin Suppression and Ketogenesis
The process of fat mobilization and the production of ketones (ketogenesis) is primarily driven by the suppression of insulin levels in the body. High insulin levels inhibit these processes, while low insulin levels promote them.
5 Questions Answered
Yes, intermittent ketosis promotes metabolic flexibility, activating genetic programs for more efficient fat burning and ketone production, and can also offer personal development and logistical advantages.
Recommended books include 'The Art and Science of Low Carbohydrate Performance,' 'The Ketogenic Bible,' 'Keto Answers,' 'Ketogenic Diet and Metabolic Therapies' (for science enthusiasts), and Dr. Eric Kossoff's book from Johns Hopkins on the modified ketogenic diet.
For blood measurements, the Precision Xtra and Keto-Mojo are reliable, with Keto-Mojo offering cheaper strips and GKI integration. For breath acetone, the Biosense meter is highly quantitative and correlates well with blood beta hydroxybutyrate in a fasted state, making it a strong indicator of fat oxidation and appealing for clinical use in children. Urine strips provide a basic 'yes or no' indication.
Exercise typically lowers breath acetone levels because ketones are being rapidly utilized as fuel. However, during the post-exercise recovery period at rest, acetone levels can rise again as fat oxidation and ketogenesis increase without immediate utilization.
Insulin suppression is a critical driver of fat mobilization and ketogenesis; studies show that an insulin infusion causes a sharp decrease in both fatty acids and ketones in the blood.
16 Actionable Insights
1. Monthly Restricted Ketogenic Diet
If you want benefits similar to fasting but have an aversion to it, try a restricted ketogenic diet for five to seven days once a month. This approach promotes metabolic flexibility.
2. Target Glucose Ketone Index
When implementing a restricted ketogenic diet, aim for a Glucose Ketone Index (GKI) between one to two to derive benefits similar to fasting. This can be achieved by restricting calories by 50% on a ketogenic diet for about six days a month.
3. Combine Keto & Time-Restricted Feeding
For enhanced benefits similar to fasting, combine a restricted ketogenic diet with time-restricted feeding to suppress mTOR and insulin, and potentially stimulate autophagy.
4. Keto Before and After Fasting
To prepare for and recover from a prolonged fast (e.g., one week), implement a ketogenic diet for the week prior and the week after the fast.
5. Read “Art and Science of Low Carbohydrate Performance”
To gain foundational knowledge on low carbohydrate performance, read “The Art and Science of Low Carbohydrate Performance” by Jeff Volek and Stephen Phinney.
6. Read “The Ketogenic Bible”
For a comprehensive overview of the ketogenic diet, including recipes and terminology for both laypersons and those interested in science, read “The Ketogenic Bible.”
7. Read “Keto Answers”
For laypersons interested in a modified ketogenic diet, read “Keto Answers” for recipes, tips, and troubleshooting advice.
8. Read “Ketogenic Diet and Metabolic Therapies”
For those who want to delve deeply into the science of ketogenic diets and metabolic therapies, read the book “Ketogenic Diet and Metabolic Therapies” primarily authored by Susan Masino.
9. Read Dr. Kossoff’s Modified Keto Book
For a clinical perspective on the modified ketogenic diet, look up and read the book by Dr. Eric Kossoff from Johns Hopkins.
10. Use Biosense Breath Acetone Meter
For a quantitative and reliable measurement of fat oxidation and ketosis, especially in a fasted state, use the Biosense breath acetone meter.
11. Prepare for Breath Ketone Measurement
To ensure accurate breath acetone readings, abstain from food, chewing gum, or alcohol for at least an hour before measurement, as these can cause false positives.
12. Calibrate Breath Meter Indoors
To avoid error readings and ensure accuracy, calibrate and use breath acetone meters indoors in a stable environment, as windy conditions can affect measurements.
13. Use Precision Xtra Blood Meter
For reliable and validated blood ketone measurement, use the Abbott Precision Xtra meter, which is often used daily and in published research.
14. Use Keto-Mojo GKI Meter
Consider using the Keto-Mojo GKI device for blood ketone and glucose ketone index measurements, as its strips are cheaper and it incorporates GKI into its algorithm.
15. Use Urine Ketone Strips
Use urine strips, such as the Siemens multi-stick SG, as a simple “yes or no” indicator to determine if you are in ketosis and get a relative reading.
16. Review Dom’s 2018 Podcast
Listen to part of Dom D’Agostino’s first discussion from 2018 to understand his background and how he became a credible voice on ketosis.
4 Key Quotes
I think one of the main benefits is that it promotes metabolic flexibility.
Dom D'Agostino
The more you do it, the more benefits you derive from it over time.
Dom D'Agostino
Breath acetone is a very strong indicator of fat oxidation.
Dom D'Agostino
You see a lot of that ketogenesis and fat mobilization for fuel is really a function of insulin suppression.
Dom D'Agostino
1 Protocols
Intermittent Ketosis for Healthy Individuals
Dom D'Agostino- Restrict calories by 50% on a ketogenic diet.
- Follow this for 5 to 7 days once a month.
- Combine with time-restricted feeding.
- Aim to achieve a Glucose Ketone Index (GKI) between 1 to 2.