Recent investigations have shown supplements to not always contain what they say they do. Or at other times to have unwanted contaminants such as heavy metals. Learn to use 3rd party lab testing to select supplements that contain the active ingredients needed to provide the results you seek.

Sometimes on this show, we discuss using supplements as tools to get desired results. Examples in past episodes included curcumin, activated charcoal, NT factor, Greens powder, oxaloacetate and many others.

I’ve been aware for a long time that not all supplement products are equal in quality. For instance, if they actually contain as much of the active ingredients as the label says on them, or if they are contaminated with heavy metals or pesticides, for example.

Last year this issue was given more publicity when the New York State Attorney General’s office investigated supplements found at GNC, Target, Walmart and Walgreens, and sent ‘Cease and Desist’ letters to each for some of their supplements that neither contained the active ingredients, and at times contained other undesirable ingredients that weren’t listed on the labels.

The unfortunate takeaway is if you truly want the results from supplements — so if we talk about results that can be achieved through a supplement on this show – then you can’t just take it for granted and buy any supplement. You have to make sure they contain what you want and don’t contain what you don’t want.

In practice, how do we do that? I’ve been using a lab service for a few years now that tests and reports on the quality of supplement products. So I can select the products that will achieve the results while minimizing the cost. Sometimes you don’t need to buy the most expensive brand to get the best quality, which is kind of cool.

The service was ConsumerLab.com, which is a subscription service, so unfortunately, you have to pay. However, the good news is that an open alternative is now available that has been publishing extensive lab testing data on popular supplement categories.

That company is Labdoor.com. If you have the internet available it will probably be useful to check out the rankings the company is publishing while listening to this episode to see what the end result is, and what they’re actually publishing.

“I think there are categories where 70 percent of products fail, there are categories like creatine where 10 percent or fewer products fail. And then there’s kind of the in-between zones where, with fish oil, about a quarter of the products have rancidity [fat oxidation] issues. And so we’re filtering that, and that’s a part of our [supplements testing] purity score.”
– Neil Thanedar

Today’s guest is Neil Thanedar, CEO and Founder of Labdoor.com, and Founder of Avomeen Analytical Services, which is a company that specializes in product lab analytics to see what they are composed of. Labdoor is now four years in the making and sets to start growing at a faster pace and covering more supplement categories now that they’ve got some sort of funding behind them.

In this interview, Neil walks us through the types of analysis they run on supplements to understand their quality and some of the most interesting and useful results they found in the supplement markets. It features highlights, such as we shouldn’t really be trusting user reviews that you find on the internet on places such as Amazon – because there doesn’t seem to be much of a correlation. And there are other big similar takeaways, which, I’m sure, goes against what we’ve all been doing.

itunes quantified body

What You’ll Learn

  • Neil’s research interests and orientation towards quality control supplement testing (3:57).
  • Labdoor is a spin-off business, diversifying lab testing services compared to what’s offered by Avomeen (5:40).
  • Labdoor and Avomeen are split in leadership between Neil and his father (7:50).
  • A consumer-aligned model and efforts to eliminate bias in producing objective information (8:03).
  • The major quality control issues with dietary supplements (10:04).
  • Defining supplement quality and criteria used for rating supplements (11:13).
  • The technologies used for testing supplements and the science behind interpreting results (12:19).
  • Customizing supplement ranking formulas and tailoring results to individual customers, ex. vegan or child categories (18:54).
  • Establishing accuracy in nutrient analysis and maximizing trust in results (20:25).
  • How Labdoor manages an active role as part of the supplement industry (22:54).
  • Dealing with testing newer or complex composition supplement products, where research is still accumulating (25:05).
  • Consumer demands and targeting of testing results to differing audiences (27:15).
  • Labdoor’s role in supporting an informed market (29:21).
  • Overview of tested categories of supplements (33:10).
  • Discovering products and prioritizing particular supplements testing (39:15).
  • A severe lack of price correlation in the supplement industry (40:58).
  • Cooperating with companies when Labdoor testing does not confirm producer certificate of analysis testing results (42:08).
  • Labdoor’s plans for reaching out to manufacturers more proactively (47:23).
  • The potential of re-testing for capturing trends in the supplement industry and increasing confidence in obtained data (48:30).
  • Case studies and key takeaways for particular categories of supplements (52:19).
  • Little brand correlation in same category products and guidelines for choosing supplements (54:21).
  • Caveats for non-scientific approaches towards choosing supplements (57:20).
  • Future prospects of wide-spread product testing aimed at empowering consumers to make science-based health decisions (1:01:44).
  • Reasons for re-organizing the supplement market, such that the best products are making the highest sales (1:03:59).
  • Scientific or practical business assumptions which Neil has changed his mind about (1:06:06).
  • The biomarkers Neil tracks on a routine basis to monitor and improve his health, longevity, and performance (1:08:21).
  • Recommended self-experiments for improving mental performance (1:14:07).
  • The best ways to discover the field of supplement testing (1:15:55).
  • How you can best connect with Neil or find out more about Labdoor (1:18:54).
  • Neil’s request for you – The Quantified Body audience (1:20:32).

Thank Neil Thanedar on Twitter for this interview.
Click Here to let him know you enjoyed the show!

Neil Thanedar, LabDoor

  • Avomeen: A chemical analysis lab specialized in failure analysis work (when products go wrong). Initially, it was started by Neil but is now run by his father – a scientist continuing his work and research in his retirement years.
  • Labdoor: A company currently run by Neil focused on providing scientifically-backed analysis and ranking of dietary supplement products. The company offers objective information on supplements and aims to empower people to make informed decisions. Check out Labdoor’s supplement rankings.
  • Labdoor’s Facebook & Reddit: The two fastest ways for you to reach out to Labdoor. Hundreds of questions have already been answered on these forums and Neil hopes new ones will spark lively debates on topics across the field.
  • Neil’s Twitter: Where Neil shares his ideas about testing and his opinions on how Labdoor touches other industries.

Recommended Self-Experiment

  • Tracking Time: Keep track of how you spend time for 10 days in a row with an app such as Hours. You should discover many useful takeaways such as areas where you waste the most time or activities you should cut. Neil suggests repeating approximately every 6 months to track improvements and optimize over time.

Tools & Tactics

Supplementation

  • B Complex: It contains Vitamin B12 – a molecule which is used in the metabolism of every cell and acts in DNA synthesis and regulation. B complex also contains folate which is needed for DNA repair and proper DNA methylation – see episode 5 with Ben Lynch. This product contains the active forms of B vitamins increasing their bioavailability.
  • Curcumin BCM95: The active ingredient of turmeric, also found in limited amounts in Ginger. Curcumin is a potent anti-inflammatory and cancer preventative molecule. Previously we have discussed this supplement in the context of lowering oxidative stress or inflammation in episode 4 with Cheryl Burdette and episode 25 with Josh Fessel.
  • Activated Charcoal: This is a medical-grade purified product which is highly absorbent of toxins. It promotes a healthy digestive track and improves brain functionality. Taking activated charcoal reduces the body’s toxic burden – a subject discussed in episode 23 with Kara Fitzgerald. This is a lower cost (value for money) Activated Charcoal option.
  • NT Factor EnergyLipids: A blend derived from soy lecithin extract specifically. This product is formulated and used for supporting memory and cognitive function. There’s also an NT Factor Energy Wafers option which is a chewable product packaged in pieces.
  • Greens Powder: A mix of alkalizing green foods, antioxidant rich fruits, and support herbs. This product is used as a dose of whole food nutrition – essentially aiming to supply a healthy background of nutrients.
  • Oxaloacetate (Aging Formula): A metabolite of the Krebs Cycle which improves blood sugar regulation, improves energy levels, and increase endurance. Previously we discussed oxaloacetate as an anti-aging supplement in episode 30 with Alan Cash and in the context of blood glucose regulation in episode 22 with Bob Troia.
  • Fish Oil: This supplement is useful against inflammation. Fish oil can be used post workout sessions or if inflammation is part of a disease state. Labdoor tests EPA and DHA content (beneficial Omega 3 fatty acids) in fish oil supplements. According to their data, often there are products which contain 50% Omega 3 instead of the labeled 90%.
  • Lypo-Spheric Vitamin C: These are liposome encapsulated vitamin C tablets and this maximizes the bioavailability of the active component. Previously we have discussed Vitamin C and its potential for preventing colds in a timely manner by tracking Heart Rate Variability (HRV) in episode 41 with Marco Altini.
  • Calcium: This supplement is aimed at improving the composition of bones. Calcium also plays a key role in muscle contraction thus this mineral supports neuromuscular health. The major benefit of calcium is lowering the risk of developing osteoporosis.
  • Magnesium : This mineral in supplement form is used to support nerve, heart and muscle functionality. See episode 17 with Dr. Carolyn Dean for testing and fixing magnesium deficiency.
  • Zinc: An essential mineral which plays a role in many enzymatic functions. Zinc supports immune system function and is an important component of the body’s antioxidant systems.
  • Creatine Monohydrate: This product is targeted for using after workouts to aid in the recovery process. Approximately 5-10% of these products are faulty, according to Labdoor supplement testing results data.
  • Garcinia Cambogia: A small fruit traditionally used to enhance the culinary experience of a meal and as an aid to weight loss. Garcinia cambogia was the worst category recorded by Labdoor. Up to 70% of products in this category do not actually contain the active ingredient (defined as less than 10% of the labeled ingredient quantity).
  • Ginseng: This supplement is effective for mood, immunity, and cognition. Examining the ginsenoside content is important in these products because Ginseng quantity is different from the active ingredient. This causes consistency problems because extraction processes differ. Neil advises patience before purchasing these supplements and, of course, waiting for Labdoor’s data on particular products.

Diet & Nutrition

  • Protein Bars: In the future, Labdoor plans to take on testing food beverages. For example, increasingly protein bars are marketed as a meal replacement, thus approaching the supplement (or functional food) category. Eventually, even well-known products such as a McDonald’s Big Mac, a Chipotle burrito, or liquid beverages such as Pepsi could be tested.
  • Baby Formula: Manufactured food products targeted for feeding infants under 12 months of age. Often, these are manufactured using methods similar to those used for the production of supplements.

Tracking

Labs Tests

  • Liquid Chromatography: Chromatography is a diverse set of laboratory techniques for the separation of mixtures. Detecting the concentration of specific substances out of a whole is key for objective supplement testing results. In liquid chromatography, the mixture is turned into a liquid phase which moves through a column or plane (solid phases used for detection). Individual chemicals can be detected based on a constant property, ex. by affinity for the solid phase coating material.
  • Gas Chromatography: This method is used for analyzing compounds that can be vaporized without decomposition. In vaporized form, chemicals travel through a column at different speeds and reach the detection surface at different times – known as retention time. This is a constant for individual types of chemicals and is the principle behind detecting particular types of chemicals in gas chromatography.
  • Mass Spectrometry: Mass Spec or MS as it is known is becoming increasingly popular for analysis of all types of samples from testosterone and other body metabolites or proteins to understanding the composition of any material.In a typical MS procedure, the sample is initially ionized by bombarding it with electrons. These ions are then accelerated by subjecting them to an electric or magnetic field. Individual substances are detected according to their mass-to-charge ratio. Ions of the same mass-to-charge ratio undergo the same amount of deflection on the detection surface. This is transferred into information about concentration.

    Liquid / Gas Chromatography is often used as a pre-analytical method for preparing isolated sets of chemical subgroups, before digging deeper using mass spectrometry to obtain accurate supplement testing results.

Apps

  • Headspace: A meditation, or mindful awareness, training app. It is useful for improving mental performance, to relieve anxiety, and increase endurance.
  • Lucid: An app focused on mental training for professional athletes.
  • Hours: An app used for tracking activities throughout the day, thus mapping time expenditure. This is useful for improving mental performance. Because tracking itself can be time-consuming, Damien suggests undertaking focused projects – one lasting a few weeks before moving to the next.

Other People, Books & Resources

Organizations

  • ConsumerLab: A company offering supplement testing service. Damien used ConsumerLab Reports until Labdoor appeared on the market and started offering supplement testing free of charge.
  • Thorne Research: A company manufacturing dietary supplements, separated in programs tailored towards health categories, ex. cardiovascular or immune support. Their products are usually sold through doctors, thus Labdoor has missed these in their initial supplement testing categories.
  • Life Extension: A manufacturing company producing supplements including vitamins, minerals, herbs, or hormones.
  • Elysium: A relatively new company gaining ground in the supplement industry, partly due to their science-strict operational and marketing model. Elysium is sponsored via venture capitalism investments – a business model different from Labdoor’s.

People

  • Gary Vaynerchuk: Recognized by Neil as an important voice in the understanding the link between marketing and consumer trust.

Other

  • Yelp: Neil draws a parallel between Labdoor and Yelp – a service specialized for ranking business of different categories ex. restaurants or shopping venues. This comparison demonstrates that Labdoor requires customer and manufacturer feedback to grow its business and to accomplish more ambitious challenges.

Full Interview Transcript

Click Here to Read Transcript
[Damien Blenkinsopp]: Neil, thank you so much for joining us.

[Neil Thanedar]: Yeah, absolutely. Thanks for having me.

[Damien Blenkinsopp]: You’re in a pretty niche area. There have been a couple of companies around which have been testing supplement products for a while. And of course there’s been a fair amount of news over the last year or so talking about the high variability in supplement quality, and whether we’re getting what we want.

So I was just interested in how you got into this whole area. Where did this start for you?

[Neil Thanedar]: Yeah, absolutely. I grew up in research, I grew up in science. My dad’s a Ph.D. Chemist. When I was two years old he quit his job as a researcher and started his own lab. And it was just him for a couple of months, and he slowly grew that lab all the way up until I was in college. So he had retired by the time I was in college.

When I was trying to figure out what I wanted to do with my career, the first thing I really wanted to do is, I had really thought about biotechnology or inventing new medicines. And those had been the first things I had thought of. And throughout the process, I found out that the existing process, the existing medicines and supplements just weren’t clean; they weren’t safe. And so I jumped right back into the same industry that my dad did, which is quality control.

And so right out of college I started a lab. It was a chemical analysis lab called Avomeen. We did product development and failure analysis work. We figured out for manufactures when something went very wrong: a pill had a black dot on it, your baseboards were yellowing, there was an odd smell coming from a multivitamin. Any sort of something going wrong, the company would come to us, we would do all of the testing required to figure out what they should go and fix.

(00:05:40) [Damien Blenkinsopp]: You just mentioned baseboards. What are baseboards?

[Neil Thanedar]: Literally the baseboards like in the floor, that connect the floor to the carpet. That little white strip? That’s actually a product that we did once. The white boards were turning yellow as soon as they were installed.

[Damien Blenkinsopp]: So you actually started from analyzing a broader spectrum of products, not just dietary products.

[Neil Thanedar]: Yeah. It was anything from that to household cleaners to a sunscreen to a multivitamin to even pharmaceuticals. Generic versus brand name medication.

And so we were doing it, but we were doing it in a very reactive way and we were doing it for manufacturers. And really one day I just had the idea that really we should do the opposite business.
What if we could, instead of being reactive we could be very proactive. We could go into a Walgreens or CVS and buy every product off the shelf and pretest it. So you would already know if it was good or bad. And if something failed, you would know ahead of time.

At this point, I had — as kind of a back-story — my dad had come in and started working with me to come out of retirement. He was starting to work at Avomeen. And so what I decided was I really felt like LabDoor needed its own focus. And so we kind of split up, and he went and he’s taking care of Avomeen now, and I fully run LabDoor.

So this was, for me it was a new way to work in the business. I kind of just jumped into the industry expecting it to be like it always was, and then just one day being the new person. I was just like, hey this is weird, why don’t we just start by testing everything?

(00:07:15) [Damien Blenkinsopp]: Cool. So how long has Avomeen been around?

[Neil Thanedar]: So that company has been around for about seven years now. And LabDoor has been around for just over four. It’s been all LabDoor for me for the last four years.

[Damien Blenkinsopp]: Okay. Cool. It’s very interesting. So it’s always good to see a family business. Your father’s kind of proud of you for carrying it on, the whole research lab area.

[Neil Thanedar]: Yeah, it’s so interesting. We always talked about it, but it was never something he asked me to do. It was just always interesting to me. And I think the science is so fascinating, when you figure out exactly what’s inside something. You get to break things down and you get to reverse engineer, it’s just fun.

The problem in the industry is really just, how do you get paid. Consumers need to see the data but they’re not going to pay ahead of time. It’s really just paying for this testing that’s the hard part.

(00:08:03) [Damien Blenkinsopp]: Right, yeah. So I guess you’ve got a slight advantage because Avomeen is associated with you, but how does LabDoor get paid so that you can do this for everyone else? Because the information is available for free, right?

[Neil Thanedar]: Yes. And so, what we want to do is do all the testing ahead of time and help you have all the data to make the research decision. And then what we’re finding out is that people, the next thing you’re doing is buying. And so if we just affiliate links down, we’ve got 10 percent of the conversion. And that really is most of the business.

And I think it’s what we, we love that kind of alignment with the consumer. So you’ve got the sense of I don’t get paid unless you actually find something you like. If you return it, we lose the commission. It’s this whole process where we can really be performance based.

And it’s also something where it’s sustainable. Every single day, there’s going to be tens of thousands of people who shop this site. They’re going to buy stuff, and that’s going to support the next round of testing.

[Damien Blenkinsopp]: Right. And I’m guessing it doesn’t matter what they buy. Are you putting Amazon links on most of the stuff?

[Neil Thanedar]: Yeah. So it’s really easy to put it on every single product. And we get some debate about this. The D and F products have affiliate links on them too.

[Damien Blenkinsopp]: The DN…

[Neil Thanedar]: The D and F. So it’s A through F. Every single product has the link.

[Damien Blenkinsopp]: Right. Well, I think that’s the way to go because you’re unbiased.

You’re not there to promote one product versus another. It’s just that you provide your objective information, and if someone buys something from using the information on your site to make that decision, you get a commission. But like you say, you’ve put a few links on the worst products and the best products, so there’s no official bias there.

I bring that up because there are some sites out there on the web which have been out there for quite a long time, and I’m sure people are aware or these – which are basically just affiliate review sites. And they have their number one product where they are getting paid, and all the others they are not getting paid. And obviously, they are just trying to cash in there.

But yours is a professional company without the bias.

(00:10:04) [Damien Blenkinsopp] Okay, so let’s talk about supplement quality to actually understand what the issues are. What is the context for us first? Why should people be interested or worried about dietary supplement quality?

[Neil Thanedar]: I think there are two parts of it.

I think the first part is actually that there are some products that legitimately have problems. They’re either massively under-dosing — and that’s maybe a third of the products that we see. So the active ingredient isn’t there, there are some sort of heavy metals or purity issues. And that might be the D or F grade products on the site.

And then there’s really this other group of products that you should worry about quality-wise — I would say the B and C products — where they’re just not highly concentrated. Maybe there’s some famous brand that you’ve always heard of, but like the fish oil is 50 percent Omega 3 instead of 90 percent Omega 3. Or the protein powder is 40 percent protein instead of 80 percent protein. And those are kind of the B and C products.

So those are the two things that you have to worry about: are you not getting what you paid for or are you really being cheated? These are the two types of quality control issues that we really find on a regular basis.

(00:11:13) [Damien Blenkinsopp]: Right. These are the most common things. How would you describe supplement quality? Because I know you’ve got your own kind of internal rating system, where you look through a whole bunch of different criteria.

[Neil Thanedar]: Yeah, I think what we really want to do is start by, it’s really kind of rewarding active ingredient quality and quantity, and starting to penalize for the negative inactive ingredients. And so, as much as possible it’s very, the calculations we try to be as intuitive as possible with it.

The number one factor is going to be the concentration of active ingredient. So it’s going to be the Omega 3 concentration in fish oil or the protein concentration in protein powder. Next, we’ll look at the quality of the active ingredient. We’ll look at the EPA and DHA in fish oil, we’ll look at the amino acid profile in protein.

We’ll look at label accuracy. So we’ll look at how those numbers compare to the label. And we’ll look at purity. We’ll look at mercury and PCBs in fish oil. We’ll look at arsenic, lead, and heavy metals in protein powder. And that’s really it. I think we want to try to look at purity and potency and figure out, ‘Does it work?’ and ‘Is it safe?’.

(00:12:19) [Damien Blenkinsopp]: Great. Thank you for that. So, how do we go about testing these things? What kind of technologies are you using to look at the supplements?

[Neil Thanedar]: Yeah, so it’s really kind of classic analytical chemistry. So we’re looking at chromatography and spectroscopy, like an HPLC or a GC-MS, ICP-MS.

[Damien Blenkinsopp]: Okay. Could you quickly describe that? I know what you’re talking about, but I think these are terms that the majority of people don’t really understand.

I look at chromatography as basically splitting things apart so that you can look at them. And then spectroscopy as actually doing the analysis. I don’t know if you’ve got a better way to explain it.

[Neil Thanedar]: So yeah, we’re basically separating, identify ingredients, and we’re figuring out their quantities. So an HPLC could actually look at anything from caffeine content or a kind of vitamin content, or it could even look at something like sunscreen content and look at the different sunscreen ingredients.

What we’d like to do, and I think this is a big part of our process, is if we can get a couple of HPLCs in the building and really ramp up our testing in supplements, that will allow us to start experimenting with other types of products that we could test.

And so really we’re looking at, in any of those machines, is we have standards of the ingredients. What are the best quality ingredients supposed to look like? You can run that through an HPLC and you’ll get a curve. Then you can run the product through the HPCL and get a curve and you can see the difference.

[Damien Blenkinsopp]: Great. So, when you say HPLC, what does that stand for again?

[Neil Thanedar]: It’s a High-Performance Liquid Chromatography.

[Damien Blenkinsopp]: Okay. Right, for separating things out.

[Neil Thanedar]: So yeah. I think those are the things where we’re not inventing, really. That’s not our, I mean there are a lot of scientific start-ups out on the market that are truly on the frontier of science. I think a lot of the work we do, there are new methods every year and things are advancing, but for the most part, it’s an established industry.

The testing part is established. I think the part that we’re trying to work on is – how can we test thousands of products. How does it get to a point where we test thousands of products?

[Damien Blenkinsopp]: I guess that’s primarily about cost?

[Neil Thanedar]: Yeah, it’s a chicken and egg problem, right? Because we’ve got to do the testing before you show up. So we need to, there’s kind of a constant process of kind of testing a little bit, add one more category, bring money back into the business.

And that cycle is really important to us. And the cycles are going faster at this point. We want to be at a point where we can test, instead of 25 products a month, 50 or 100 or 150 products a month.

[Damien Blenkinsopp]: So, with the approach to testing that you use, do you have to say what you’re looking for? Or does it actually show up, everything that is in the substance? So do you have to pre-decide that I’m looking for mercury, for example, or will you pick up other things in that process?

[Neil Thanedar]: You’re looking for specific ingredients.

[Damien Blenkinsopp]: Okay.

[Neil Thanedar]: So that’s the HPLC where you would look at caffeine versus a caffeine standard.

[Damien Blenkinsopp]: Yeah.

[Neil Thanedar]: And I think that’s the part that we haven’t quite, these ideas, these magical devices where you scan your food and it tells you every ingredient simultaneously. That’s truly on the frontier; that’s not science that exists today.

So we’d love to have more information on it. Until then there is, at some level, brute force work being done here. And at some level, we’ve got established panels of ingredients we can look for.

So you can look at all of the heavy metals at once, or you can look for a whole set of carcinogens at once. There’s a whole set of banned substances that you can all do in one scan. There are certain things that we’ve set up, and with everything else, there is a bit of brute force work. Especially with the active ingredients.

[Damien Blenkinsopp]: So when you say brute force, what does that mean?

[Neil Thanedar]: So you would have to, for example, for a multivitamin you would have to separate every individual vitamin out of there and test them each individually. And it might even be as far as vitamin A is going to be in the product in three or four different forms. So you would have to test each of the four forms of vitamin A individually.

That’s when I start thinking about, that’s truly where we start getting into reverse engineering for active ingredients. Where you need to get down to that individual level because we want our calculations to take that into account. We want to have, if different vitamins A forms have different bio-availabilities, we want to use that as part of the calculation.

[Damien Blenkinsopp]: So I guess in your process of trying to understand each new area, you plan a new category. For example, fish oil you’ve done, but then you come across something else so you’re like okay, maybe this is a growing supplement or something that people are getting more interested in so we’ll attack this category now.

I guess, first of all, you’re looking at some research to kind of see what the issues are, what kind of things you want to look at. And then you have these standard things, like carcinogens and metals that I’m guessing you’re looking for in most things, just because… I guess if something is made in China, the odds that it could have some metals in it, that’s one of the big concerns.

[Neil Thanedar]: It’s even beyond that. I think, well also almost every supply chain is global at this point. So we just test everything for heavy metals off the top. So those are certain things where it’s just automatic. An ICP-MS is expensive, but it gets a lot of use.

Whereas something like each individual ingredient, I think we have to make a decision on [what to test]. For example, with protein powders, we started with a very simple analysis. We started with just a [unclear 0:17:35], nitrogen analysis. So we were just looking at the total nitrogen content. And then we started looking at total amino acid content, and then we started looking a pre-amino acid content, subtracting pre-amino acid content out.

So there’s a whole range of how we get to the final data. I think the work’s never done because the next thing we’d want to do in protein is get into are there specific amino acid ratio [that are] more bio-available. So could we build into the calculations a system that scores the amino acids? That’s something that we would be interested in doing.

So at some level, there’s this constant improvement that has to happen. Many of the products on our site we’ve tested only once, because we test on a yearly basis and it’s the first year. That’s another thing that’s going to improve the data. So year two or year three, we’re going to get more data, we’re going to see is there any batch to batch, year to year variation.

So all of that stuff is part of our expansion process. It’s part of our growing process where it’s why we purposefully limited it to 25 products per month. That was our case, and we can hold to that. And we can consistently deliver that kind of quality, but we’re not going to go in and say, hey look we have 100,000 products on our site. It’s just not possible to do.

(00:18:54) [Damien Blenkinsopp]: Right, it’s not feasible. It sounds like you’re going to be on a learning curve. Say you did protein like two years ago, you do it another year and you’re like, you know what, last time we learned this, so we can integrate that and we can look for that this time, and that’s going to be important for the new formula.

Is that the process you’re going for with some of the main supplements?

[Neil Thanedar]: Yes. And it’s also, you get a lot of consumer feedback after that, because we might build our quality rankings based on usually very quantitative, what we talked about. Very quantitative factors like concentration.

But then what we need to figure out, and what we’d love to add, is more types of rankings. So there are other reasons or other ways for people to make a decision. And so we used to just have one set of rankings, and we found out that some people weren’t buying the number one.

And we said, hey, why do people not buy the number one? Oh, there are some people who are vegan so that’s not their number one. So we added a vegan filter. Some people were buying products for kids, and so we added a children filter. People were buying by value, so we added a value ranking that’s completely separate value ranking.

And I think in a perfect world, there would be, you could take a test where we would just know who you were, and your perfect LabDoor rankings would show up. And they would be perfectly customized to you. We’re on that lifelong path of getting to the point where we can perfectly customize it to you.

And quality and value and kind of vegan and sugar-free; we’re hitting the major ones right now. And then it just keeps getting better and better.

(00:20:25) [Damien Blenkinsopp]: Excellent. And so how accurate is the volume aspect? So you can identify and say that fish oil has DHA in it, or it’s non-oxidized. But how do you understand the actual amounts of this, and how accurate is that?

[Neil Thanedar]: So we’re looking at percentages.

So if you look at a fish oil capsule, it’s anywhere from 10 percent of that capsule is Omega 3, to 90 percent is Omega 3. If you tested the same product again that was at 90, you might see it at 92 or 88.

There might be a little bit of a variation there between tests, but you’ve got a good sense. The product that tested at 90 versus the product that tested at 80, there is a clear separation there.

[Damien Blenkinsopp]: Sure. So what is the swing, and is that, I mean that could be just due to each capsule, right?

[Neil Thanedar]: We’re taking an average of at least 10 plus capsules. So we’re getting a little bit of a range there.

It’s that kind of a range, so maybe in the 2-5 percent range. Sometimes in certain categories with many ingredients sometimes you see a 10 percent variance. But these things are pretty consistent. Once you put that first test out, you have good data.

And I think that 10 percent variance off of the label; the labels are often very inaccurate as well. So the labels tend to be more than 10 percent inaccurate. So I think what we want to do is as soon as we put that first data point there, you’ve already got better data than you had before.

And now our job is to go in and solidify that. And so there’s a constant tradeoff between ‘do we go to a new product’ or ‘do we test the old product again?’

[Damien Blenkinsopp]: Right. So when you’re taking the average, are you taking, say from one bottle you’re taking like 10 capsules or are you trying several bottles? How do you approach that?

[Neil Thanedar]: No, so we’ll want to take it all of it from the same lot. So we’ll try to buy three or four bottles and have it be the same lot.

And so then we might need 50 to 100 total samples because you might be 10 per test or similar. So you will end up using about 100 of those capsules in a round, and save the other 300 just in case a company comes back and questions the data, we need to retest. All of these kinds of things, so it’s important for us to do.

So we’ve got a decent range there. And I think what we found out is these companies are generally doing between two to four major batches of product a year. If you grab any one of those products off the shelf, you get really close on that first test. And then everything after that, we just have to test every year.

(00:22:54) [Damien Blenkinsopp]: Right. So you’ve mentioned lots and batch. Are they the same thing?

[Neil Thanedar]: So I think a lot of people would think, I mean there might be multiple lots in a batch. So it’s a little bit of manufacturing lingo.

I think we are starting out, so that’s part of our learning curve as well. We’re trying to get more into how manufacturers work, and how that side of the industry works because I think we jumped in just totally as consumers. And we were just like how can we figure out how to make this data out.

And then what we found out was there’s different, I mean from the industry there are companies complaining about, hey you’re sharing our proprietary blend. Don’t do that. Or, that data is wrong, or our data shows something else. Our internal lab says something else. And there’s a lot of that.

And in the early days I think we almost didn’t have the time to handle all of the information at once, and if we had to focus on one thing it would be consumers. We’d want to focus on the people who are taking the products. But now I think, as we step back and get a little more organized, we’re starting to figure those things out.

How do you talk to companies, how do you manage the system, how do you figure out and return that data back to the manufacturer? If we find something, can we alert them? I think we want to do a better job with that, we want to do a better job of being a part of the entire industry, instead of being this kind of renegade on the side.

[Damien Blenkinsopp]: Right. Do you get a lot of manufacturers reaching out proactively to you then? Has that happened a lot?

[Neil Thanedar]: It’s a slow, steady pace. There might be a manufacturer a month or something who will come out.

And I think there’s a whole range of them. I think the majority of the complains are honestly like A- companies who…

[Damien Blenkinsopp]: Right. The one’s who really care.

[Neil Thanedar]: Yeah, they really care. “I’m number 8 and I want to be number 1, and here’s why.” And there’s literally 20 reasons why, and five studies attached. And we love that; that’s wonderful. If you do that, our scientists will read all of those studies and we’ll talk about it over a meeting and it’ll be interesting to us.

And if you can convince us, [great]. That’s one of the big things that the protein manufacturers are trying to argue, add an amino acid scoring system. And maybe the ranking will shift a little bit. I don’t think it’ll do very much, but there might be a few products that fall out.

(00:25:05) [Damien Blenkinsopp]: Yeah. So I guess there’s the other subject that some of these products have been around for a long time. So protein is pretty well standardized as a market, and fish oil as well. But of course, then you have some of the newer supplements.

Those must be a bit more challenging because the research can still be evolving, in what the active ingredients are. “We’re not 100 percent sure, but we think it’s this one” kind of stuff.

[Neil Thanedar]: That’s a tough one. I think that is a lot more in our calculations. So the testing is much more straightforward.

So the nice thing is, even if we’re testing a nootropic or something, there would be specific ingredients where even if the clinical research hadn’t completely proven that that ingredient works or not, we could 100 percent know whether it’s there or not. We could at least know that.

[Damien Blenkinsopp]: Right. Because the first thing you’re doing is you’re just comparing the label. The label says it has this, and actually, it has something a little bit different in it. So it’s an easy comparison to start with.

[Neil Thanedar]: That’s easier. The part that we need to figure out, and sometimes we’re staggering that. We might really focus first on the ingredients that have really clear claims.

And now we’re kind of, we are getting more and more into specialty products now. So we are now ramping into testing B complex in glutamine and all of the joint support.

So now we’re going into things that have more complexity or variety. We’re starting to unpack our old categories. So now protein is going to have protein bars, and protein shakes. There’s going to be new categories.

[Damien Blenkinsopp]: I mean, a protein bar tends to be pretty complex in its makeup, right? It has all sort of ingredients.

[Neil Thanedar]: We want to figure out the protein quality in the protein bars because that’s such an important thing. We’ll start testing vegan Omega 3s in the next couple of months.

So it is that kind of constant process of expanding the existing categories, getting into new categories, and then doing the research on the fly. And we’re finding that in some places there’s not good research.

When you test an ingredient, and you have all the data and then, it’s garcinia cambogia and there’s no great evidence that says that it works. And in many cases, we still try to plug that data into our rankings, and you get like in our garcinia rankings, there’s not a single A grade product on the ranking. Because there’s just not enough efficacy in the calculation to get the score up.

(00:27:15) [Damien Blenkinsopp]: Right. So you have five criteria. [First is] label accuracy, which is very straightforward for you guys, you basically just compare. Then you have product purity. What is that exactly?

[Neil Thanedar]: We’re just looking at the heavy metals and contaminants versus upper limits.

[Damien Blenkinsopp]: Okay, great. And then the nutritional value, would that fit more into what we were just discussing about garcinia cambogia? How would you say that?

[Neil Thanedar]: Garcinia cambogia. No, nutritional I would think like the RDAs or daily values of the macronutrients.

So that’s what we’re looking at. We’re working on all of these names, and we’ll have to figure out exactly what they are.

[Damien Blenkinsopp]: Yeah.

[Neil Thanedar]: But I think nutritional value, I pour it over the daily value type stuff.

[Damien Blenkinsopp]:Okay, so you compare there. And then you’ve got ingredient safety.

[Neil Thanedar]: So I’m looking at the quality of the inactive ingredients. So what’s the safety risk of the inactive ingredients?

[Damien Blenkinsopp]: Okay. So if people don’t like aspartame or something in their pills, there you go. And then projected efficacy, would that be going back to our other discussion right now, as in is this really an active molecule?

[Neil Thanedar]: Yeah. So that’s concentration of active ingredient and the quality of the active ingredient.

[Damien Blenkinsopp]: Okay, cool.

Just so people know when they go to your site what they’re looking at and how to navigate it properly. So it makes a lot more sense and they understand where things are at, and how these things are based over time. And obviously, the label accuracy is the thing that they can trust the most from the get-go.

[Neil Thanedar]: It’s really interesting, and I think we look at it that we want to have different people weigh it different ways. That’s another part of our learning curve.

Some people want to be entirely efficacy focused. So it’s just like, give me my active ingredient. And I think that’s really important to people. “I want a 95% pure Omega 3.” And some people are very focused on purity, and purity is the only thing that matters to them. And they’d almost rather take a placebo that’s pure.

And then there’s a group of people who are all about honesty and label accuracy. And I think what we want to do is we have our own weighing system, and I think we’d love that as part of the personalization process.

We’d love to have a process where you put in your own weights for what you think is most important, and the rankings change based on that.

(00:29:21) [Damien Blenkinsopp]: Great. A lot of people in the supplement industry have certificates of analysis from the manufacturers. Is this something you get from the companies?

I guess you’re not reaching out to all of these guys, you’re just kind of buying up the products.

[Neil Thanedar]: No, it’s really a retail process for us. It’s an independent purchase.

The A- people will send us their certificate of analysis. And that’s fine. Anytime we’re working with manufacturers and there’s science going back and forth, we’re in a good place.

[Damien Blenkinsopp]: Yeah, cool. So their certificate of analysis is basically the same kind of analysis or something similar, to say what’s in it, that they’ve had done either by their manufacturer or themselves or a third party lab normally. And then they can compare it to yours and say hey, I want to be A+.

[Neil Thanedar]: Yeah, and sometimes it’s the other way. Actually, more often it is a request for a certificate of analysis from us because they want to go to their supplier and complain.

[Damien Blenkinsopp]: Ah, interesting. So do you think they’ve got false certificates of analysis? Or they just didn’t…

[Neil Thanedar]: Well there’s just so many moving parts in any of these supply chains. So if you’re making a multivitamin you might be sourcing 30, 40, 50 ingredients. And so if you see the LabDoor report and two are off, you know which supplier that is and you can go find out.

And that’s something that’s really interesting data that could help the supply chain and manufacturers. And honestly, we just haven’t found a way to package that data back up. It’s just that we’ve always purely focused on how to get the data first to consumers.

And as we build up more and more data, as we start seeing trends and see more years of data, that will be another type of business that I think would be interesting for us. Because that’s important to us; I think we’d want to be more and more integrated over time.

I could see a place where maybe LabDoor does all of those types of certifications. Instead of an Organic certification and a Gluten certification and the Tested for Sports certification all being different companies. LabDoor is going to have to do all that testing anyway. So if we could somehow say look we’ve already done the testing, here’s the certification, that could be a really interesting thing for us.

We’ll look at every part of the industry in every way that we can help. That’s part of the expansion process, it’s part of how we learn, how we grow, how we provide more value.

[Damien Blenkinsopp]: And now just to consumers but, like you say, to the manufacturers and the suppliers to improve the supply chain in general. Because it’s not necessarily the brand owners.

He could design a great product and he could ask a manufacturer depending on his due diligence, and [unclear 0:31:59] just to pick up on these things. And the testing given to him might not be his fault, but it’s not exactly what he wanted in the first place.

[Neil Thanedar]: Yeah, I think it’s between that and there are so many things that they’re focusing on. And I think that we want to be the place where if you’re a manufacturer, just focus on making the best product. We’ll help show it to consumers; don’t spend money on marketing, spend money on quality ingredients.

And we’ll give you the data you need. It’s really transparent; we’re really transparent with the A- people about what it takes to get to an A. And we’ll do that with everyone else.

Every company knows, obviously, the reason I’m losing to the number one guy is they have twice as much Omega 3 per gram as I do. Now I know that it’s going to be three times more expensive for me to increase my Omega 3 concentration. But that’s a tradeoff, and they’re going to have to make that equation.

And we would love it if LabDoor was driving so much sales to the high concentration folks that the math eventually worked out, that you should just make higher quality products.

[Damien Blenkinsopp]: Right, because you’ve provided more information into the market, and more people are making informed decisions, and thus it becomes more in their interest to raise the quality because their sales volume increases based on it.

(00:33:10) [Damien Blenkinsopp]: So what types of supplements have you looked at so far, and as an overview how have you found the general quality of supplements to be? Was it what you expected? Especially based on the articles that all came out last year about testing Walmart, CVS Pharmacy and places like that. There were a lot of issues that were brought up then.

[Neil Thanedar]: I think, well there are a couple of things. So one, we’re about to release glutamine, which will be our 20th category. So if you go to LabDoor.com/rankings, you will see the 19 rankings we have done so far.

So it is more than just protein and fish oil, there’s multivitamins, prenatals. We’ve also looked at vitamin C and D, calcium, magnesium, and zinc. We’re trying to go through category by category of the most popular.

And so under that list of the top 20 are the next 50 that we’re looking at. And those, really, consumers go in and vote on what they want to see next.

[Damien Blenkinsopp]: Oh. So you’ll do that, if people are like, “Yeah, I want this reviewed.”

[Neil Thanedar]: Yeah. LabDoor.com/rankings.

[Damien Blenkinsopp]: Okay, and they can vote for something new that they want ranked.

[Neil Thanedar]: Yup. And so there’s a whole bunch of categories in there. We’re just trying to grab them as quickly as possible.

So some of the most popular ones on there like glutamine and B complex and glucosamine are already in the lab. We’re already working on them. And just keep voting. Basically, you’ll get an email when that category is available.

What I’m going to try to do is over the next year or so finish those 50 categories. Really go through and say hey, in the supplement industry you can really come up with any major product and LabDoor will have it. Have at least one set of data on it. Just enough to get you in.

And I think once we do that and really get the lab fully up and running and instead of 25 products a month we really should be doing 100 plus product per month. That’s when I would say maybe we’ll look at other categories.

Maybe we’ll look at food and beverage, maybe we’ll look at meal replacement. I mean, we’re already kind of there. Protein bars are already starting to touch meal replacement and functional foods. Even baby products, like baby food and baby formula, are really on the edge of being a supplement; they’re manufactured in very much the same way.

And so any of those types of things we’d love to be in places where you feel like there’s some uncertainty. If you feel like, I don’t know what I’m buying, that’s enough for LabDoor to jump in.

It doesn’t necessarily need to be the supplement industry where you get data every week saying something goes wrong. I think it’s even a case where you are buying baby formula and you have no idea what’s in it. At any point where there’s any of that kind of insecurity, you should look to places like LabDoor to get some science and data, and make that decision with more backing.

I actually don’t think that the, I want to try to make sure that the supplement industry doesn’t get all negative stories. Really that’s where it’s starting to go, it’s really kind of pushing it to a lot of negative stories. And that’s not really our market. You’ll see that LabDoor is not the person driving a lot of those stories.

[Damien Blenkinsopp]: Sure. I mean, what do you think of the market? You’ve got the data on nearly 20 categories now. Where would you say it’s at? If you had to explain in objective terms, where is supplement quality currently at?

[Neil Thanedar]: I think there are about three even groups of companies.

There are a third that are doing a really great job. And those are basically the A products in the market.
There is a third that are like the B and C products that are just not worth it for the money. And those are usually the guys using brand or marketing to sell products. And then you’ve got the D and F…

[Damien Blenkinsopp]: When you say brand or marketing, could you give an example of that, maybe naming a specific company? But what does that mean to you? Brand or marketing?

[Neil Thanedar]: These are companies that I’ve literally looked at some of these companies that have, first the head of R&D works for the head of marketing in a lot of these companies.

You’ll see these companies haven’t made significant investments in R and D but are spending 20, 30, 40 percent of their budget or more on marketing. And these are companies that are truly spending more on marketing as a percentage of revenue than they are on the products themselves.

And you see that in the data. And those become the B and C products that are actually usually, more expensive than the A products. We’re finding that there’s really no correlation between price and quality. There’s just none in this market.

There are people who are in the middle group who are just medium quality for high price.

[Damien Blenkinsopp]: Right. So you’ve got some products which are brand driven. They’re a premium brand and have put a lot of good marketing behind it, but actually, the product doesn’t back it up.

[Neil Thanedar]: Yeah, that’s the second third.

And I think the third is honestly the D and F grade products, where people are honestly cheating. There are, and it’s different by different categories.

Something as simple as a creatine product you usually don’t have to worry about as much. It’s just creatine in a bottle. There are fewer things that could go wrong. Those products, maybe 5 or 10 percent of products, have problems. But there are things like garcinia, 70 percent of products have problems.

[Damien Blenkinsopp]: Wow. So it really does vary a lot by [category].

So creatine has been around for a long time, and it’s extremely standardized. So I imagine there’s a bit of market development. There must be so many manufacturing facilities now that the technology is well standardized at creating creatine and everything, so it’s a little bit easier.

And it’s also something very straight forward. It’s not like it gets damaged easily, like fish oils and so on. So yeah, I guess each category can be quite different.

[Neil Thanedar]: Yeah, so each category is quite different. Overall, it’s about what we need to do is try to get people to the top third as much as possible. If we can do that, if we can really help you focus when you’re in the store.

Because that’s what’s happening in the store. There are 100 fish oils. And how are you picking with 100 fish oils? And I think that’s why the branded marketing thing works so well.

When there’re 100 fish oils, you see the brand you recognize and that just makes that purchase easier. And what we want to do is say, what if those 100 fish oils were instead ordered from one to 100 in some sort of other system based on science?

(00:39:15) [Damien Blenkinsopp]: Yeah, excellent. A couple of questions. I realize you probably don’t want to name companies, but I’m interested in the Trusted Science brands, the ones that look like they’re doing research and backing it up with content like Thorne Research, Life Extension. People tend to trust these kinds of brands.

I don’t know if you’ve looked at those types of brands. Not necessarily those guys, but similar ones which are putting out a fair amount of content on their sites, and they talk about their research. Do those tend to have reasonable quality?

[Neil Thanedar]: We haven’t tested as many of those yet, and I think the reason why is because our initial way of picking the most popular products by category was to use online best-seller lists. And the Thorne and the Life Extension are usually sold through doctors so we missed that in the first round.

[Damien Blenkinsopp]: Probably a bit more expensive for most people as well. That might be a smaller market.

[Neil Thanedar]: It’s more expensive and just in different channels.

We’d like to prove that. We’d love to test those products and see is there really a price and quality correlation there. Because otherwise, industry wide there is zero price correlation. And there are honestly categories on our site where literally the cheapest product in the category is the number one in quality.

[Damien Blenkinsopp]: Wow.

[Neil Thanedar]: It’s amazing. It doesn’t work [unclear 0:40:29] maybe in handbags or cosmetics. So these are the types of industry where that works, right?

[Damien Blenkinsopp]: Could you give us an example? Is that something like creatine? Where it’s very simple?

[Neil Thanedar]: It might have been creatine. It might have been something like creatine where the people who were really trying to jazz it up with the fancy box, and five artificial sweeteners and not enough creatine, those are the people who are expensive and at the bottom.

And vice versa; the people who just throw 100 percent creatine monohydrate in a bag do pretty well.

(00:40:58) [Damien Blenkinsopp]: Cool. Okay, so we talked about the price correlation, and that there isn’t much, which is interesting. You looked at online reviews from consumers on Amazon as well, I noticed just recently. What were your results there?

[Neil Thanedar]: Same thing. Zero correlation. And what we might need to figure out is they might be answering totally different questions. The user reviews might be totally answering the qualitative question, and we’re answering the quantitative question.

And first of all, there are certain categories of supplements, like a multivitamin for example, where other than pill size there isn’t that much qualitative that you need to worry about. You’re not taking a multivitamin like, oh I feel better today.

There’s not that much qualitative to do. These decisions should be more quantitative. They should be more scientific. And so the thing we try to talk about as much as possible is for most of these categories we should be letting user reviews go and really be focusing most of our energy on scientific reviews.

[Damien Blenkinsopp]: Yeah, well unfortunately, they’re not around everywhere. You’re working on it, but it can be hard to come by.

I used to use Consumer Lab Reports, which is the other company that was doing it. And then you guys came along, and it’s a free service versus a paid service, so it helps me out that way.

(00:42:08) [Damien Blenkinsopp]: What I want to bring up, I don’t know if you’ve seen this new company, which is kind of trying to position itself right at the top of the supplement industry which is Elysium?

[Neil Thanedar]: I’ve seen that, yes.

[Damien Blenkinsopp]: With their anti-aging. And they have a scientific board of directors.

So they’ve really tried to go more the scientific approach that we should be trusted, we’re using a pharmaceutical grade production process. We have a scientific board of advisers of some of the top scientists in this area in the world.

I found that was really interesting and really encouraging in terms of really taking a step up. And it’s got VC funding. So it’s a completely different business model, really.

And I guess it’s only been possible now because of the size of the market, where they can now have a VC driven model where they can go and get top scientific advisers on board, sometimes Nobel prize winning guys to be able to raise the standard a lot.

So, it would be interesting if you help with your work to promote that kind of activity as well.

[Neil Thanedar]: Absolutely. I feel like guys like that are the new generation of the Thorne and Pure Encapsulations. And there are more people like that. I think honest companies really try to do that not just in supplements but in cosmetics and household products.

So there are a lot of places where there’s renewed interest in that kind of high quality and direct to the consumer brand. And I think that fits really well with where LabDoor is. I think we want to, we need to get to a place where that product is in a category, versus the other people.

And that would be really interesting. There’s now food test on some of those same ingredients, for example. And there are a lot of generic manufacturers who have the same ingredients as Elysium does, but there’s an issue of do you trust the generic manufacturer.

[Damien Blenkinsopp]: It’s interesting, because I looked on Amazon, of course, for the ingredients — because they’re being transparent about the ingredients, which is another thing. Not all companies will tell you exactly what it is in the product.

Some companies you can ask them for their certificate of analysis. A lot of consumers don’t know that, but you can just contact them. And sometimes they’ll give it to you. It depends on their policy. And sometimes they’ll say sorry we don’t hand out that for propriety reasons. Or whatever.

So there are a fair number of certifications out there. I don’t know if you’ve looked at any of these. Sometimes we see these stamps on products and we don’t really know what’s behind them, a lot of the time. Have you looked at any of those?

[Neil Thanedar]: We’ve looked at it a little bit.

So, I think my general issue with certifications is there are many of them and consumers don’t really understand what they all mean. I worry that in a situation where if you give too much information, it’s an overload and actually doesn’t get paid attention to.

So that’s one of my issues with certifications. What we’d like to do at LabDoor is to try and figure out if there’s some way to get beyond a certification, beyond a pass/fail system and get to is the product really good.

Because there are two different parts to this. There’s the part where hey here are the third, or two thirds of the products that are bad. That’s fine, but I think our business is really dependent on can we help you make a good decision. Can we help you get into the good third?

And so what we need to do as much as possible is find that way of saying I’m just highlighting the good products. I think for us that’s really we have to keep focusing on it that way. And so I want to, as much as possible I would like that not to be certification based.

I think if we wanted to say, look it’s not about whether it’s organic or not, it’s about what’s the quality of the product. And in many cases, just because it’s organic doesn’t mean it’s pure, in many cases, organic products can catch a lot of heavy metals.

[Damien Blenkinsopp]: Yeah, that’s a good point.

[Neil Thanedar]: So all of those things we don’t want to get into, we don’t want to outsource the decision to that single certification. That you really should be having your decision on a holistic approach to the product.

[Damien Blenkinsopp]: Yeah. I guess whether it’s organic or not, that’s kind of a philosophy. But at the end of the day, it’s the pesticide resides and the heavy metals that people are really interested in, a lot of the time.

[Neil Thanedar]: It’s very much like the filters, to me. So, if you want to have a vegan filter, or a sugar-free filter, or an organic filter, a non-GMO filter in your life I think that’s fine.

I think that’s just a fundamentally different decision criteria that’s almost like the quality and value ranking. We’ll let those things be, let them cross, and that is useful as a filtering tool.

[Damien Blenkinsopp]: Also, I think we kind of covered this, but have you come across instances where the certificates of analysis have been different to what you found?

[Neil Thanedar]: Yeah. What we’ll do is there’s a kind of a standard process.

So if we have our testing and our certificate of analysis, a company comes with their own, then we will go to a third party lab and we will get testing done there.

And the idea is basically if the grade goes up, we’ll pay for it. If the grade goes down, they pay for it. And that’s it, right? It’s just I think that is, we want to figure out a system where it’s just [fair].

I mean, at any given point we’re defending 700 products, and soon we’ll be defending thousands of products. And so we want to be able to say at some level we want to be the referee and we understand that not everything is going to be 100 percent perfect. And we’ll just be open to it.

And if you think that something is wrong, challenge us on it. And challenge us with scientific data with a certificate of analysis and look we’ll test it. We can always test more. That’s possible. The thing we can’t do is kind of get into shouting matches with companies.

(00:47:23) [Damien Blenkinsopp]: Yeah, sure. So in terms of, to give people an idea, how often does that come up? Does it come up a lot or is it relatively rare?

[Neil Thanedar]: I would say it’s less than five percent of the companies who will ever kind of come and talk to us.

And I think a lot of people indirectly come and talk to us. We’ll get emails from their customers complaining, or things like that. There are all kinds of side things.

I think it’s something where there are some very passionate people on the manufacturing side of the industry, and I think we’ve tried to be really open with it. I think it’s important for us to actually be talking to more of the industry.

I actually should be going – and I’ll do more of this — is going and travel, spend time at supply side conferences, where people are actually talking to the manufacturers. I need to do that. And I think that’s something that as we get bigger I should be talking to half or more of the industry.

Because I think if LabDoor’s data gets back to the companies, it’s going to be good for the industry. It’ll have rapid feedback. You’ll have feedback from consumers and from the lab. Both of those things are incredibly valuable for manufacturers, and it’ll make the products better.

(00:48:30) [Damien Blenkinsopp]: So we’re talking about the technologies you’re using are relatively standardized now. They’ve been around quite a long time. I think they’re currently getting better in terms of cost, right? They’re expected to get cheaper over the next years. That was just a training I was at recently.

But I was just wondering if you think there’s some variability. So say if they did come with another certificate of analysis and then you went to a third party lab, how much variance does there tend to be between labs?

Because just in my own testing, I test a lot of different things, and there’s a fair amount of variability between the labs, unfortunately. We’re still in the middle of a kind of, I guess it’s mostly the processes and ironing out all of these things, and some of the technologies are getting more mature over time and more stable.

For these particular technologies, how stable would you say they are in the accuracy?

[Neil Thanedar]: You’re getting good data out of it.

I think even in a situation where there’s a 10 percent lab-to lab-variation, firstly there are different labs and I think [with] the labs we use we’re seeing some 10 percent variation. And in many cases, we were talking about 2-5 percent batch-to-batch variation.

So even different labs, different product in a different batch, we’re seeing pretty similar results. And that’s just some of these products, and it’s with the established companies. The thing that we’re finding is there are some companies where the product is vastly different, from category to category. There are certain things where I worry less about that.

I think what we need to do is build repeat testing into the model. Because any sort of calculation like this the confidence goes way up when you get the second, third and fourth test. So I think that’s where we’re at right now.

The first test is good data, and it’s important for consumers to get it. And then every other test, the second, third, or fourth, you get a lot of increase in confidence, and then you just have to be consistent. Then you have to get on your yearly or every-other-year basis, and we’ll be humming along normally.

And so I think for us, LabDoor Year 5 out of a 10-year process of really kind of stabilizing everything and having a fully operational machine. And then we’d want it to just automatically test products.

Like every month people request new products, we test it. We’re automatically getting into new categories, we’re automatically maybe thinking about new ways to rank products, we’re getting deeper and deeper into personalization. But it’s a very, it’ll be a very consistent improvement process.

[Damien Blenkinsopp]: Have you got plans to retest any categories yet? Or are you doing your first retest with any category yet this coming year, or is it going to be a little way off yet?

[Neil Thanedar]: No, I think, well yeah, we’ll be doing retesting. I think we’ll get multivitamins retested next year. There will be whole categories.

We want to be, in 2017 if we can get to the point where we are not just, we’re marking the dates on when we tested it last and predicting when we’re going to test it next. And really as much as possible, say the popular categories are every year, the less popular every two years.

And again, just like everything, we can start shrinking those things because right now we’re on basically two-year testing cycles. And we want to push everything to yearly testing cycles.

And it would be great to say that LabDoor 2016 protein data is this and 2017 protein is this, and let’s see the trend of which brands have been consistently at the top and consistently at the bottom. Those are all things that it is about, we need more lab capacity. We need more testing.

We’re going out and we’ve raised venture capital. And so that’s a big part of this process and a big part of the reason why we think we can do 100 products a month next year instead of 25 products per month. That’s a big part of that too.

That’s how we’re going to get there. We’re going to have to get there 100 products a month at a time. We’re not going to be able to download the database of 100,000 products because that doesn’t exist.

[Damien Blenkinsopp]: Yeah. It’s step by step. You’re building lab capacity basically over time and trying to make sure it’s monetized. So it’s a step by step process. Great.

(00:52:19) [Damien Blenkinsopp]: Now let’s talk about some specific case studies from some of the more interesting takeaways. What have been some of the worst lab results you’ve seen in categories?

[Neil Thanedar]: I mean, the garcinia cambogia was still the worst category we ever saw. There were fully 70 percent of the products that did not have the labeled active ingredient.

[Damien Blenkinsopp]: So they had zero, had nothing?

[Neil Thanedar]: No, they had less than their quantity, but they had…well we’re talking about 10 percent or less than the label claimed, that kind of thing. For most of those products. To the point where it’s essentially nothing.

And what that is is that was a lot of fly-by-night, they are usually selling on Amazon. This is something where you can just spin up a brand out of nowhere, white label it, throw it onto Amazon and there’s no check. There’s nothing between you.

And then theoretically, there are user reviews between you and that product, but then these companies buy user reviews too. And so that’s it, there’s literally nothing between you and this product hitting the market.

And so we’ve seen, the cool thing is you go and look at a lot of those affiliate links and they’re broken, which means that the products have come off of Amazon, so not being sold anymore. And so there’s some sort of cat and mouse game there.

I’m sure some of them have spun up and made new products, and we’re going to have to go chase those down. But at least in some of those cases, we’re seeing that they’re gone, they’re not there anymore. And I think in those cases we do our job, when we show people what’s right and wrong. I think we’ve done a good job.

I think there are categories like that where 70 percent of products fail, there are categories like creatine where 10 percent or fewer products fail. And then there’s kind of the in-between zones where with fish oil you’ve got about a quarter of the products have rancidity issues. And so we’re filtering that, and that’s part of purity; that’s a part of our purity score.

So we’re seeing in different categories there are issues, but I think in the other categories they’re more like, hey there’s this like, half of the products that you need to avoid. Or there’s 30 percent of products or 10 percent of products you need to avoid. It’s still worth checking. Right?

In any of these situations, it’s still worth checking, but that’s the range we’re at. Somewhere between 10 and 70 percent you’ve got to worry about.

(00:54:21) [Damien Blenkinsopp]: Excellent. So, as you were talking there, I kind of took some guidelines or rules away from the situations you brought up.

Do you have any guidelines in your mind from the research you’ve done so far, on like if there is no data, having been through your research process, have you seen any patterns where you’re like, okay instead I’d use this heuristic to decide which product to buy, if I don’t have access to the data right now.

[Neil Thanedar]: We’re not seeing very much brand correlation. There’s not a ton of brand correlation.

One thing we find is that companies that only make one or two things do really well. So like a company that specializes in probiotics does a really good job in probiotics, but actually has a B- multivitamin or something. Those types of things happen a lot.

And so you have a protein specialist or the creatine specialist that does really well there; fish oil is the same way. So think about that. I think that might be one thing to think about, people who are specialists.

And then really other than that, send us the link on LabDoor and we will add it to our site. I think we need to test those products. We’ve had the luxury I think a little bit of kind of growing quietly. I think a lot of people are just learning about us five years later.

And we did that on purpose. And we did that very, kind of fundamentally we said we’re going to just focus on one category. We won’t go to the press saying, hey LabDoor is this great company, we’ll say hey look at LabDoor’s fish oil data, or look at LabDoor’s Vitamin C data. Look at LabDoor’s multivitamin data.

That part of it I think we’ve been focused on just, come listen to us about what we know. We’ll be an expert in certain things. We’ll be a destination in one category at a time.

And now I think we’re at a point where we need to move faster. And I think that’s why we’ve gone and raised more money. We are kind of going in and buying HPLCs and bringing them into the building. We’re buying auto-samplers. All this kind of stuff to make things go faster.

And so at this point, if you can find things that are specialty products and you trust them, take them. Otherwise, I’m really at the point where I’m waiting. I’m actually saying, well I’m thinking about taking curcumin, but I’ll wait six months until LabDoor tests it.

I might be in that process, I think because I know curcumin is going to be one of many other categories that are going to be… You’ve got an extract that certain companies, certain products are going to really pull a lot of heavy metals out of that extract. There are different extraction processes.

[Damien Blenkinsopp]: Yeah. There are some like that which are going to be challenging, for sure. Because it comes from turmeric, and turmeric can come from all sorts of places. So you can tell that one is going to be a complex one.

[Neil Thanedar]: And that reminds me of something like Ginseng, where the ginsenoside content you can look at. Ginseng is different than the active ingredient, and so you’re not always getting the same extraction. And it’s not consistent. And so in cases like that, I would basically say wait. And that’s how I do it. I wait until LabDoor has some data.

[Damien Blenkinsopp]: And you’ve got the inside guide to that. Okay. Great.

(00:57:20) [Damien Blenkinsopp]: The other heuristic I was thinking of was you were talking — because I’ve seen this a lot in Amazon — is you have these one product wonder companies, where they basically just make one product. And I think they just pop up.

There’s a new fat loss supplement that they just kind of jump on board. And you see that this company otherwise doesn’t seem to be anywhere or doing anything, but it’s just made this one product. Even it’s website sometimes isn’t great.

But on Amazon they’ve got thousands of reviews, and sometimes they’re at the top of the category. And you’re like what’s going on here? And often they’re giving away products for reviews, and they’re using a whole bunch of marketing tactics to establish themselves there.

But if you look a bit more into the company they don’t have a strong background and they’re just going to come and go. So that’s one of the things I’ve also noticed a little bit that might be worth thinking about.

[Neil Thanedar]: Yeah, we see those a lot too. I think LabDoor is really meant to replace heuristics with kind of a scientific method as much as possible. And I think that’s just really what, bringing us all the way back to the beginning, it’s really what motivated the idea of LabDoor at the beginning.

It was just the idea of imagining standing in a Walgreens with 100 options, and how are you making that decision? You’re going to use the heuristic, you’re going to use… If you were buying wine you would buy the second cheapest. There’s all these goofy heuristics that you can use. Maybe you buy the cheapest, maybe you buy the house brand, maybe you buy the famous brand, you buy the most expensive.

Everyone’s got their system. And we are kind of just consistently finding that any one of these heuristics has no correlation to the scientific data. So you really just have to keep coming back to the data to make your decision.

[Damien Blenkinsopp]: It’ll be interesting at some point for you to publish which heuristics were the worst in correlation.

[Neil Thanedar]: Oh man, I’d love that. That’s a great one.

I think we mess with this all the time, and I think this is another thing that we’d love to do more at LabDoor is get outside of just the testing that we have to do to grow the site. If we’re able to test 100 or 150 products we might have some leeway to take 10 or 20 or 50 products and just say, hey you want us to test a Chipotle burrito or a McDonald’s BigMac, we’ll do that too. Just because it’s interesting to us.

Or we might want to get into talking about user reviews. We might want to talk about trying to figure out a system to verify user reviews, or figure out whether…

Maybe actually teach people about these correlations. Teach people that there’s really no correlation between price and quality. So you shouldn’t use price. There’s no correlation between user reviews and quality in these categories.

And you should really think about what kind of products are experienced based products, where 10 minutes after you finished your meal you know whether it was good or not. And which products are truly scientific products.

[Damien Blenkinsopp]: And which are just subjects of experience. Someone’s just like, oh yeah I kind of like the brand and I bought it and I really enjoy the brand.

[Neil Thanedar]: Yeah. And so we really want to make, we have to figure that out. And I think that is such a — I mean we did that in VC meetings.

We literally, I was walking to the elevator after one of these VC meetings of an investor who said no. And he said, “You know the entire history of the universe, marketing has won.”

[Damien Blenkinsopp]: Marketing will find a way.

[Neil Thanedar]: And I said look, maybe we will. And we’ve kind of thought about that, and we said look maybe we just need to market the science better. We need to figure out ways to make the data easier to understand. We need to go, and that’s part of our team.

And so I think we’ll do that. We’ll find easier ways to teach this. Maybe we’ll redo the Pepsi challenge. And you redo the Pepsi challenge and you talk about, hey, there were problems with the Pepsi challenge. First, Pepsi was running the Pepsi challenge, and there are some credibility issues there.

And all of these things, and you can teach people through very simple systems that they already understand. “Hey this is how you’re currently making decisions, and this is how you are currently being marketed to and here’s how you should be marketed to. You should be marketed to based on science, based on the data, based on transparency and objectivity.”

[Damien Blenkinsopp]: I think the fact that Elysium and other companies like that are now showing up is showing that there is something changing.

Of course, marketing is always going to be important but I think some of this authoritative input is starting to become a lot more important, and trust. You see it across the markets, and there’s a lot of people talking about it. And so Gary Vaynerchuk and I, some of these people — I don’t know if you’ve ever heard of him.

[Neil Thanedar]: Yeah. Yeah, yeah.

(01:01:44) [Damien Blenkinsopp]: Yeah. But I think they’ve definitely got a point about trust for authority, and so on. And it’s going to become bigger and bigger. What are you looking forward to in this space? Are there going to be changes in technology which are going to help you over the next five or even 10 years do a better job of this? What are you looking forward to in this space?

[Neil Thanedar]: I honestly think it’s, for us, it’s as simple as getting 10 times bigger. I think if we get 10 times bigger every part of the system makes sense for us. And I think that’s what we’re trying to figure out.

We just got to 15 employees. This is a pretty tight unit here. And we need to go, as we grow from 10 to 100 employees here, and these are going to be mostly science and technology folks, those are the structures right now where we’ll be able to unpack some of these jobs. People who are doing five or six or seven jobs will be just doing one.

And we’ll be able to add some redundancy, we’ll be able to add more testing, we’ll be able to go faster. And really we’ll be able to, the spool engine will be running where, well really the old categories are paying for the new categories. All of that stuff needs to happen.

And as we grow, as we do that, I think this is where I see LabDoor becoming a more and more mainstream brand over the next 5, 10 years. And I want to have, very much like more experienced products like restaurants, you don’t buy without checking Yelp.

I think you really want to say for scientific products, for medical products, for health products, you don’t buy without checking LabDoor.

[Damien Blenkinsopp]: Where you want a functional benefit, you’re looking for this functional benefit.

[Neil Thanedar]: Does it work if it’s fake? Then, the more you think about that, you make so many decisions like that.

I just did this with a household cleaner. I was thinking about buying this Method cleaner versus this Honest company cleaner versus this Clorox cleaner. Does the green cleaner work? Does that organic certification matter?

You’ve got all the same problems. Is there anything toxic in this? I’m going to breathe this in, I might eat it. You’ve got all the same problems as you do with a supplement, and you make that decision even more casually than you do with a supplement because there’s even less data.

And we have to get into more and more of these categories. And I need it to be in a place where maybe I have your whole profile, I know exactly what you’re allergic to, I know exactly what your preferences are and I’m helping you in the entire drug store to make quality decisions.

(01:03:59) [Damien Blenkinsopp]: For a little case study there, I’ve been testing a whole bunch of pesticides and heavy metals and so on.

One of the more unique and interesting things I came out with in my samples was really really high atrazine mercapturate. Which was interesting because it’s been banned in the EU where I’ve spent some time since 2004 I think.

And so mine was off the chart; it was like 96th percentile. So I was hunting around trying to figure out where this stuff was coming from.

[Neil Thanedar]: Wow.

[Damien Blenkinsopp]: And I recently, I’ve been keto since January and so I started using different oils. One of them was macadamia oil, and it just happens to come from Australia where atrazine isn’t banned.

And I’m guessing [it’s out] because I’ve stopped that now. I looked into the research and it’s very probable that that’s where it came from. So I’m guessing that will be gone from my system the next time I test.

But yeah, just to say that this isn’t a theory. It happens and if you test your own body samples you can come up with stuff, and you’re like, “Whoa, I’m eating something toxic and I had no idea, didn’t even think about it.”

And I’m one of the guys who tests a lot more and thinks more about this stuff than most people. So if I’m getting that kind of effect, I figure most people are getting more of an effect than me.

[Neil Thanedar]: Absolutely. It’s so important to check. And I think, there’s too much. I hear too many of these stories.

Whenever you see that new negative supplement story, I think what happens is people withdraw and they become less likely to buy. Or they become more attached to their existing purchases. They stick to their existing brands.

And I think both of those kinds of withdrawing motions are wrong; you actually should go out and get more data. But the problem is it becomes this thing where there’s a lot of negativity and you don’t want to go out and get more data.

And so I think what we want to do with LabDoor is say look, well focus you on the best products. We’ll focus you on the A grade products, and let’s make it a good story. Let’s focus sales in the market, let’s put 100,000 of people a month and let’s focus them on the best products in the market.

Let’s reward companies for doing a good job and making a great product. And let’s see if there’s something really positive that we can do. Can we really reorganize the market to where the best quality products are making the most sales?

(01:06:06) [Damien Blenkinsopp]: Alright, so this could be a more challenging question, I guess. Just because some people wonder about this, but it can be really interesting what comes out of it.

Is there anything you’ve changed your mind about in the last few years in the testing area, or in supplements in general? Is there an underlying assumption of how you go about things, or what you’ve been thinking, that you’ve kind of turned on its head?

[Neil Thanedar]: There’s been a couple. I think one of them was really, we’ve kind of gone in two different directions with the data. We started with very technical, these long reports.

And then we went all the way in the other direction with this A through F grade, which was very simple, and the rankings were very simple. And we definitely needed to do that because I think that’s really what helped people actually use LabDoor.

And what we’ll probably do is slowly taper it. Our idea is to do every version of it. We’ve actually thought about this idea, we used to think of that as a fight between more data or less data. And I think the answer is actually all of the above, but we need to organize it.

So first you see the A, and the A breaks down into five categories. And those five categories break down into this data. And so what we’re trying to do, as much as possible, is everything. This is the point where we used to get into these fights of more or less, and I think the right answer is everything. And that’s one of the big things we’ve learned.

I think the bigger one, in terms of my mind changing, was really — we talked about it a little bit earlier — the manufacturers. I think I used to just be 100 percent consumer focused, and just said this is all about being the consumer watchdog.

And it still is about being the consumer watchdog, but more importantly, we are a marketplace that’s organizing these decisions for consumers. And so I think when it really comes down to it, our job is connecting consumers to the best companies and the best products.

And if that connection then makes us really good, and it’s not… The thing where we show people that there’s a bad product on the market is part of our job, but it’s not the core job.

And I think that was the thing that we switched. We came out there kind of guns blazing wanting to try and find the bad stuff, and increasingly we’re realizing that our job is just to find the good stuff.

(01:08:21) [Damien Blenkinsopp]: Okay. I’d like to hear a little bit more about you.

Do you look at improving your body and use of tracking? You’ve kind of already given us a couple of takeaways, but is there anything you track in terms of metrics or biomarkers or anything like that? For yourself?

[Neil Thanedar]: So these days my biggest focus is very, really into mental performance.

So I have a tracker of my major daily tasks that I do. And then I have a time tracker, where I’m measuring how much time I’m spending in a day learning versus planning versus training versus communicating versus executing in the business.

And so I’m separating my time and I’ve been using that to figure out… And I’m using that for optimization right now. For example, I’m noticing that as our company scales, I’m just noticing more push from executing to communicating. I’m seeing that switch, and really communicating is starting to become the more dominant mode.

And so I think for me between that and between more… I really like Headspace and Lucid, which are two mental training apps. Lucid is more focused on almost professional athletes. It might be more of strength training for your mind. Whereas I think something like Headspace might be more about conditioning, and it’s more about the endurance of kind of long-term training.

And so really that’s been my focus. In terms of my physical health, it’s really simple. I have Vitamin D and Fish Oil that I take every day, and protein and creatine that I take after workouts, and that’s really my base stock. There’s not really much that I’m doing.

There are, after that I’m curious about a lot of different ingredients that I’m waiting for us to test. I used to be a wrestler for many years, so I have achy knees. And so I’ve always been looking for joint supportive curcumin products. So that’s been something that’s really curious to me.

I really have been curious about nootropics and different kind of mental [supplements]. I’d love to see more caffeine plus thiamin plus other ingredient research. Try to figure out ways where LabDoor can get better at thinking about synergies between ingredients.

Those are things where it’s almost like we need to figure it out. We need to figure out the science before we can do the ranking, but those are the types of things we’re figuring out. And I think if we did that I would love to experiment more into the nootropics side, if I could get it right.

And so that’s how I track, but I think the last two or three years have been very mental focused. I feel like maybe the 10 years before that, between sports and through college I was so focused on all my physical numbers. And every since LabDoor especially it’s been very focused on my mental output.

[Damien Blenkinsopp]: Great. So that time tracking thing that you’ve done, are you tracking every minute of your day with an app in your phone or something? How do you do it?

[Neil Thanedar]: Yeah, so it’s an app called Hours. So all you have to do is turn it on in the morning, and then you switch it between different tasks. I don’t switch it between things too often, so it might only be five or ten total transitions per day. It measures it over time.

That’s really the most zoomed out version of it, and I try to do these things in sprints. So it reminds me the same thing of calorie tracking. I got a really great recommendation from a dietician once that said, “Track every calorie for 10 days and then stop.”

And that’s basically the same thing I’m going to do with this tracking. I’ve been doing it for seven days; I’ll do it for 10 every quarter or every six months, something like that. And I would come back to it and make sure.

The Headspace or Lucid I’m actually doing that at least, Headspace at least 3 times a week, mental training at least 5 times a week. So those I’m actually getting into the gyms, so to say, and getting my work in. But the really detailed tracking I try as much as possible to limit into specific sections.

[Damien Blenkinsopp]: Yeah. Tracking can be time-consuming. That’s the way I found it, to be more beneficial as well, basically doing what I call projects.

I do a project for a couple of weeks or something, make an adjustment. Hopefully, an action or something comes out of it and then move on to the next.

Actually, a lot of my friends have also done the time tracking thing. I did it for about 3 months, many many years ago. I learned so much about where my time was going, and I made adjustments on an every day basis. I haven’t gone back to it; maybe I should go back to it at this point, because who knows what’s happened now.

Did you get any, what are your big takeaways so far in the seven days? Do you make any changes, like, “Wow, I’m spending a lot of time there”?

[Neil Thanedar]: One thing that was initially bothering me that I felt like I wasn’t spending enough of my time actually executing.

And I think it actually taught me that when I was actually tracking what I was doing with that time instead, I was realizing that it was a lot of casual, like grab someone for 10 minutes and talk to them about something specific that we’d want to improve. And that was really high-value time.

And I was scared to do it because I felt like sitting at my desk writing emails seems much more productive. So I think that was really what it is. And I think so much of the mental training and kind of this work was actually just kind of confidence that you’re doing the right thing.

This is kind of just bringing the calm down, and kind of just bringing yourself into your zone as much as possible, and just feeling like… Just getting your priorities right.

I think that was the other thing. I had my priorities right and I was worried about it. And I think that’s why the 10 days really works because it’s just a nice check in. And if you feel like you’re doing a good job, or in the time like now that’s a bit of a transition, you can make a move.

(01:14:07) [Damien Blenkinsopp]: Great. Great. If you were to recommend one experiment someone should try to improve any aspects of their body, like mental performance or whatever you would think to have the biggest payoff, or likely to have a payoff, what would it be?

[Neil Thanedar]: I’m going to make sales for this mental training.

I came up with a system where also I think part of habit forming is attaching it to something. Attaching it to something where your new habit is attached to something that you do a lot.

And I think, one thing I noticed was I always get into moments where I’ll work for an hour or two, and then I’ll get up and want to pace or something. And then I’ll come back and sit down.

And so what I did is I said the first time, I noticed that the trigger for the pacing was something like I would get agitated or I had been working for too long. That’s the trigger. It feels negative, something negative is that trigger.

And what I attached it to is that first time I felt that kind of, I need to get up off my desk and go somewhere else, the first time of the day I felt that I would take my mental training app and do a 10 minute session. In that moment where I’m frustrated and agitated, I would take that moment.

And there are a couple of magical things. First, every single day of my life I have an agitated moment, so I always train. And it reminds me that when I’m agitated, it calms me down and then I get back. So it’s like a positive rep.

And any time I can turn that, you try to take a negative rep and turn it into a positive rep it’s always a huge improvement. Because it does a [unclear 1:15:35]. And so I’m trying, as much as possible, to focus on the atomic unit of the habit, and just getting it right each time.

[Damien Blenkinsopp]: Cool. Thanks for that. This is really interesting. Basically attaching it to something that happens to you all the time. And that you want to get rid of. So you’ve got that trigger, and you just turn it around.

(01:15:55) [Damien Blenkinsopp]: Okay. Where should, I mean we probably already know, but where should someone look to learn more about this topic from you?

Are there any good books or presentations on testing? Is there any more information if they want to geek out on this?

[Neil Thanedar]: The thing you want to do, I mean obviously for anything testing related go to LabDoor.com/rankings, that’s where we’re going to do all the voting. So to vote for things, I think that really helps us. Send us emails or Twitter or Facebook messages and tell us what you want us to test and we’ll test it.

Everything after that I think what we’d really like to do, and I think I really want to focus on people knowing that there are good supplements in every category. These things are safe. This market is safe. And it really is a matter of just doing your research.

And I think as much as possible if we can push and we can get into a sense where we’re focused on the research, and we’re buying based on science, that’s really what’s going to drive this. The more and more people who buy through LabDoor, if I can go to a company and they know that 20 percent of their sales are from LabDoor, that starts becoming a thing where, hey this is one of my major sales channels.

And that’s going to happen. And I think right now we might be in the 5 or 10 percent range for some companies. And we’re growing. And in some companies, it’s in different ranges.

And we want to get that up, and we want people to pressure themselves to focus more on science. To really make these decisions the right way. And I think it will pull up. I think the whole industry will come up and we will all get better products, and we’ll all be healthier out of it.

[Damien Blenkinsopp]: So when they go to your website, are there more details on what you’re doing? If some of the guys are listening to this today and they want to understand better what you’re doing, are there any resources on your website or anything they could look at?

[Neil Thanedar]: So, that’s honestly something we’re not doing a great job of right now.

So there’s some stuff on our site. If you go to LabDoor.com, it’ll explain how we make money, a little more detail to explain what labs we use and things like that. It even, on our top bar, it will say how we grade. So if you want to click there and get deeper into what the five grades mean, that’s something that we can do as well.

But I think the thing that we want to do this year, over the next 12 or 18 months a big focus for us will be bringing people into the lab. Can we do experiments for you? If anyone had a question or just wanted to do an experiment, I’d want to be able to do that more. I want to be able to bring cameras into the lab more.

All of that stuff, I want people to ask those questions. We’re working through YouTube right now. We’re trying to, we have a new studio that I’m standing in now that we’re trying to [use] to answer questions as much as possible.

And so I think for us, as much as possible it’s just being as transparent as possible, and doing Podcasts like this. Just talking to people. I think the first four or five years we needed to be quiet and do our work as much as possible.

And this is we’re just doing that transition point where we might step out, look up, and say hey people come look at this. We’ve got something here.

(01:18:54) [Damien Blenkinsopp]: Excellent. How can people best connect with you? Either you or the company?

[Neil Thanedar]: Facebook and Reddit are the two fastest ways that people get to us.

So if you want to talk to the company it’s just Facebook.com/LabDoor, or our Reddit user is just LabDoor and we’ve answered hundreds of questions on there. And sometimes that sparks lively debate, and we love that. The idea of why should certain rankings matter? Why does label accuracy versus projected efficacy, the weightings. It gets really into the details. That’s a really interesting way to do that.

I’m on twitter if you want to find me at Neil Thanedar. On Twitter, you’ll find I’m using talking about LabDoor or different things, like my ideas about testing. I think as we grow I started to think more and more about how LabDoor touches other industries.

While at the core we’re this scientific lab, there’s a big part of us that is a technology start-up. There’s a big part of us that is an online media company. At some level we’re journalists. And so as it unpacks, as we get deeper and deeper into LabDoor, my interests of what LabDoor can have kind of expanded.

So if you have any ideas about what we should test next or what, hey you should grade it differently, or you should think about LabDoor in a different way, I love thinking about that. I love dissecting what are the moving parts in any sort of industry. Not just ours, in any industry or business, it is fascinating to me.

So unpacking those is always so interesting. So yeah, ask me questions about that, happy to chat forever about stuff like that.

(01:20:32) [Damien Blenkinsopp]: Excellent. Thanks, that’s great. Do you have anything to ask or request from my audience? Anything specific?

[Neil Thanedar]: It really is, never buy supplements without checking LabDoor. Use our affiliate links, help support LabDoor’s business. And if there’s anyone that you know that, just help spread the word at this point.

I think we are right in that phase where I mean Yelp is really only 15 or 20 years old at this point. It took them a good 5 or 10 years to establish that brand. And that’s really that zone that we’re in right now, where we’re going from this ugg start to this trusted rating agency.

And part of that, most of that, is really going to be people telling their friends about LabDoor, and saying once you try it, you trust it and you keep using it. That’s really our business, and we’re going to grow as fast as people help us grow.

And so as much as possible, if there’s any way that your folks can share the word, we’d love that.

[Damien Blenkinsopp]: Okay. Thank you.

Neil, thanks for your time. It’s been a really great interview. I really learned a lot about the whole testing situation, and where it’s at. So it’s going to be really useful for everyone.

[Neil Thanedar]: Yeah, absolutely. Thanks for having me.

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Ketone bodies, whether gained from fasting, keto diets, MCTs or exogenous ketones have many potential applications with benefits ranging from performance, to health, to longevity and mitigating symptoms and risks of certain diseases.

There is growing evidence that ketone bodies, whether they come from fasting, keto diets, MCTs or exogenous ketones have potential applications across many areas from longevity to performance, to health and mitigating some of the risks and symptoms of certain diseases like cancer and neurologically inclined deceases. As such the whole ketone body area is what I call a high leverage area due to the many potential upsides.

So I’ve personally been investing more time into experimenting in this area as the payoff for that effort, looks pretty promising. You’ll have noticed that I’ve done a fair amount of fasting and since late 2015, that also includes the exogenous ketones and playing around with the ketogenic diet. More to come on my results with all of those in future episodes.

This interview is a very in depth look at many of the applications of ketone bodies and the nuances of their use in the body.

Ketones have a unique effect of being… anaplerotic… [This] helps to generate the bioenergetic intermediates [including] the Krebs cycle intermediates… to energize the brain when fuel flow is kind of low.
– Dominic D’Agostino

Today’s guest is Dominic D’Agostino. Dominic has something that I found relatively rare but makes for extremely valuable interviews. He has a combined prospective coming from both research and self-experimentation. He has a considerable amount of lab work and research specifically done into ketogenic diets, ketones, ketone driving supplements and a growing number of applications. And he has done a lot of his own self-experimentation for many years in this area.

Dominic is currently an associate professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida, and he’s also a senior research scientist at the Institute for Human & Machine Cognition (IHMC). His research is focused on developing and testing ketogenic diets, ketone supplements, and amino acid formulations for a broad range of therapeutic and performance applications.

His laboratory uses in-vivo and in-vitro techniques to understand the physiological, cellular, and molecular mechanism of nutritional ketosis and supplement formulas. His current efforts are focused on evaluating different methods for inducing and sustaining nutritional ketosis and how this can be optimized to the specific individual and applications. So, we’ll see in today’s interview that there are a lot of nuances and it’s a bit more complex than just boosting your ketones.

Dominic’s research is supported by the Office of Naval Research, The Department of Defense, Support Supplement Companies, and Private Foundations.

Special Note: In the interest of full disclosure, since late 2015 I own a company (Ketosource.co.uk) that develops ketogenic and ketone driving supplements, foods and drinks for the UK.

The episode highlights, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know if you want more on this topic in the comments!

itunes quantified body

What You’ll Learn

  • Using exogenous ketones to mitigate some of the impairments of sleep deprivation (all nighters, or jetlag) (5:50).
  • How the stress response from scenarios like jetlag will kick you out of ketosis (and can be compensated for via exogenous ketones) (13:00).
  • Dominic’s background research and how his career has evolved to working on ketone bodies and ketogenic diets and their applications (14:50).
  • Recent research with mice that may indicate that ketosis reduces anxiety (17:00).
  • Screening a range of different naturally derived exogenous ketone agents for their therapeutic and performance benefits (18:40).
  • A once to twice per year fast or nutritional ketosis protocol for potentially activating a range of beneficial genes (37:50).
  • The press-pulse ketone body strategy for the management of cancer (40:40).
  • The benefits of the ketogenic diet for the management of epilepsy over the pharmaceutical alternatives (49:20).
  • Using the ketogenic diet to restore normal appetite regulation (50:15).
  • The various health, performance and longevity applications for ketone bodies (52:00).
  • Potentially reducing tremors in Parkinsons and Alzheimers with the use of ketone bodies (57:10).
  • Evaluating the legitimacy of recently raised safety and effectiveness concerns related to ketone salts and MCTs based on scientific facts and their track record over the last two decades (1:01:10).
  • How racemic exogenous ketones suppress glucose more effectively than non-racemic exogenous ketones (1:13:40).
  • Using MCT oil powder as a staple product for coffee, baking and protein shakes to boost the ketogenic profile of your diet (1:16:00).
  • Avoiding liquid meals in order to be able to elevate protein intake higher while remaining in ketosis (1:18:00).
  • What a typical ketogenic day looks like for Dominic in terms of blood ketone measurements from morning to evening and how he optimizes it (1:20:00).
  • How Dominic has identified his optimum ketone and Glucose-Ketone Index ranges for mental performance (1:21:00).
  • To standardize and control for your blood ketones and glucose you need to be fairly sedentary (1:34:10)
  • Dominic D’Agostino’s recommended self-experiment with the largest potential upside with the tactic to test and biomarkers to track (1:42:00).

Thank Dominic D’Agostino on Twitter for this interview.
Click Here to show him some appreciation for doing this interview!

Dominic D’Agostino

Recommended Self-Experiment

  1. Tool/ Tactic: Start Intermittent Fasting with fasting windows of 18 hours and eating windows of 6 hours each day. Dom recommends listening to Matt Mattson’s talk on IF before you start.
  2. Tracking: Get some baseline lab tests before you start the IF and again 3-4, and/or 6-8 weeks afterwards to see the positive impacts. Your lab tests should include fasting glucose, triglycerides and hs-CRP.

Tools & Tactics

Diet & Nutrition

  • Well Formulated Ketogenic Diet: The high fat, low carb, moderate protein diet that puts you into ketosis with typical blood ketones of between 0.5 and 3 mmol/L depending on execution and the person. Not suggested for children, teens or people in their 20s with good insulin sensitivity in general.
    Foods Dominic Makes Particular Use of:

    • Coconut Cream: Combines the fats with some of the fiber from the coconut flesh. Coconut cream is also known as Coconut Butter.
    • Ghee (Clarified Butter): Butter that has had the dairy proteins removed to leave solely the fats. As such it is considered dairy-free.
    • Wild Sardines
    • Sour Cream with Live Cultures: Didn’t find a link to this – if you know a good source please let me know in the comments.
  • Fasting Protocols

  • Intermittent Fasting: Sometimes referred to as short-term fasting due to the typical 16 hour to 20 hour fasting window. Dom noted that he has spoken to a fair number of high-performing CEOs doing this routinely recently.
  • Fat Fast: A modified intermittent fasting protocol whereby you restrict caloric intake in the fasting window (e.g. 18 hours of day) to some fats, exogenous ketones and/ or MCTs instead of a pure fast (no food or calories). Dom finds this method effective and that he tends to be less hungry going into the eating window (i.e. 6 hour window).
  • Periodic Fasting: Typically refers to fasts spread out by once per week or once per month. We’ve done past self-experiments on the once per month periodic fasting protocols via a 5 day fast, 10 day fast and fast-mimicking diet.

Supplementation & Drugs

Exogenous Ketones

Dominic’s lab has looked at a variety of exogenous ketone formulations in different scenarios and applications. Amongst their papers are included improved blood lipid profiles1 and non-toxic metabolic management of cancer2.

MCTs and C8 (Caprylic Acid)

  • Brain Octane: Pure Caprylic Acid (C8) from Bulletproof Nutrition.
  • Keto8: Pure Caprylic Acid (C8) oil from KetoSports.
  • Quest MCT Powder: MCT powder that Dom is using as one of his staples mixed into coffee for example.

Dominic’s Sleep Deprivation Effects Mitigation Cocktail

  • Exogenous ketone: Take your pick from one of the exo ketones listed above. Is beneficial to combine with MCTs such as C8 or MCT powder.
  • Caffeine: Needs no introduction – use coffee or your other favorite
  • Huperzine A: A nootropic herb used for cognitive enhancement via modification of acetylcholine levels.

Drugs

  • Metformin: A drug which is used to improve blood sugar regulation in diabetes. Researchers are looking at its wider applications with cancer treatment as it has been found to inhibit insulin secretion.
  • Ringer’s Lactate: The long term use of this racemic solution was noted as evidence as to the safety of racemic ketone salts.

Tech & Devices

  • Hyperbaric Oxygen Therapy: Increasing the amount of oxygen in the body with the use of a hyperbaric oxygen tank which uses air that is more highly saturated with oxygen and which is compressed. Dominic has worked on research with Doctor Thomas Seyfried looking at its application for cancer therapy in combination with ketogenic diets3.

Tracking

Biomarkers

    Glucose/ Ketone Metabolism

  • Glucose: Dom suggests aiming to keep values between 60 and 80mg/dl and that if you can maintain this all other biomarkers should be fine.
  • Glucose Tolerance (OGTT): The Oral Glucose Tolerance Test is a glucose challenge test whereby you take a certain number of grams (e.g. the typical standard is 75 or 100 grams) of glucose and test your body’s ability to regulate glucose and bring your blood glucose back into normal range over a certain time period (e.g. 2 or 4 hours). Dom used the OGTT to assess his insulin sensitivity – the more insulin sensitive you are the quicker your blood glucose returns to normal fasting levels e.g. between 60 and 80mg/dl optimally.
  • HOMA (Homeostatic Model Assessment): An alternative method to the OGTT used to assess insulin sensitivity/ insulin resistance.
  • Glucose-Ketone Index (GKI): This index was conceived by Thomas Seyfried and discussed in detail with him in episode 16. It assesses the weighting of the metabolism towards ketone vs. glucose. Lower values are ketone driven metabolisms and higher value (especially over 20) can be associated with heavy glucose metabolisms associated with chronic disease. Dom brought a new angle to this marker with an optimum everyday target he shoots for of between 2 to 4. Previously we discussed Thomas Seyfried’s recommendation of undertaking a 5 to 7 day therapeutic water fast once or more times per year targeting a GKI value under 1.
  • Lipids

  • Triglycerides: Dom believes this is the most important biomarker to watch. Optimum levels estimated as below 40mg/dl.
  • HDL: Higher HDL levels are said to be protective and beneficial. Dom’s value are around 90 mg/dl.
  • LDL: Dom believes keeping values in the normal to normal high reference range are perhaps optimal. This puts levels at approx. 80mg/dl to 110mg/dl. We previously discussed LDL in more depth in episode 7.
  • Other

  • hs-CRP (high sensitivity CRP): CRP (C-Reactive Protein) is a very common marker of inflammation that is used to assess cardiovascular risk amongst other things. It tends to drop on a ketogenic diet. Dom’s values have been between 0.1 and 0.2 since he quit dairy (Note: Damien’s levels are also at this level).
  • IGF-1: IGF-1 was discussed in more detail in our FMD episode. Dom’s IGF-1 values dropped significantly after quitting dairy.
  • Heart Rate: Typically heart rate is measured as the biomarker Resting Heart Rate (RHR) for standardization, which is an average of the beats per minute. See episode 1 to understand the use of RHR.
  • Blood Pressure: Optimum ranges are for systolic between 90 and 120 and dystolic 60 to 80 expressed as for example 110/70 mm Hg.

Lab Tests, Devices and Apps

Devices for Measuring Glucose & Ketones

The different approaches to measuring ketones provide different perspectives on your ketone metabolism. These can be looked at in terms of the ‘window of snapshot’ that they represent. Some methods have a snapshot of a longer duration, so provide more of an average reading, while others provide a direct status of that exact moment.

Moving from the more average-based value end of the scale to the more direct status end you have:

  1. Measuring ketones via the urine (via the ketone body acetoacetate) has the longest snapshot with it representing your ketone values over the last 5 to 6 hours.
  2. Measuring via the breath (the ketone body acetone) has a smaller snapshot window of the 2 hours leading up to the measurement.
  3. Measuring via the blood (via the ketone body beta hydroxybutyrate) provides you a snapshot of your ketone level at that exact moment.

The various devices available for glucose/ ketones testing and mentioend include:

  • Urine Ketone Strips: . Both hydration status and becoming keto-adapted interfere with the measurement values provided by this. Dominic recommends starting with urine test strips as they are the cheapest and effective until you get keto adapted.
  • Ketonix Breath Meter: Currently the only breath acetone meter. If you are moderate to high on this meter you are effectively in ketosis (i.e. typically over 0.5 mmol/L). Dom recommends this in particular for epilepsy since breath acetone has been correlated with seizure control.
  • Blood Glucose & Ketone Monitoring Systems
  • Precision Xtra: The most popular meter for testing blood glucose and ketones in the U.S. Has a broader reference range than the NOVA providing values for lower blood glucose levels instead of the LOW error.
  • Freestyle Optium Neo: Freestyle Optium Neo is the upcoming replacement for the PrecisionXtra, it comes from the same company and has similar functionality – the only difference in the meters seems to be a rebranding exercise.
  • Novamax Plus: Novamax Plus is a slightly cheaper meter with some greater accuracy and sensitivity concerns than the Precision Xtra or Freestyle Optium Neo.
  • Dexcom G5 CGM: A Continuous Glucose Monitor that Dom is about to start experimenting with for blood glucose optimization. Peter Attia has also been using this tracking device recently to optimize blood glucose regulation. We discussed continuous glucose monitoring and the devices available in episode 43

Other People, Books & Resources

Books

People

Researchers

Other Mentions

  • Tim Ferriss: Has been experimenting with the breathe hold extending effects of ketone bodies via ketogenic diet and exogenous ketones.
  • Ben Greenfield: Has been experimenting with using exogenous ketones for free-diving.

Organizations & Companies

Other

Full Interview Transcript

Click Here to Read Transcript
(05:32) [Damien Blenkinsopp]: Dom welcome to the show.

[Dominic D’Agostino]: Thanks for having me, Damien.

[Damien Blenkinsopp]: Yes, it’s great to connect. So you’re just back from a trip to Budapest and you just told me that you’re doing something to bypass the jet lag?

(05:42) [Dominic D’Agostino]: Yeah. Sometimes depending on circumstances I try to prioritize sleep and try to get between six to seven hours sometimes eight on the weekends if I can. But in the absence of sleep, I like to test certain things.

Usually happens once every month or two or I’m going to have to skip one night completely and have to get thrown right back into the fire of work again. I’m doing that now, and testing some different exogenous ketones in combination with caffeine and some Huperzine, and a few other little things in a stack formula that I’m working on.

It seems to be working because I’m functioning and I’ve been able to manage my tasks in a way that allows me to get stuff done.

[Damien Blenkinsopp]: So, this could be a new jet lag formula? Or if you want to keep going on sleep deprivation and work for a night or something…

[Dominic D’Agostino]: Yeah. So, inevitably people will come to the situation where they have to meet a deadline and stay up all night to get something. I don’t recommend doing it all the time because you can get burned out. There is no pill that you can take that will substitute for sleep.

But there are ways to extend your productivity and performance with two or three days of no sleep. I don’t like when those situations arise, but I worked on ways to mitigate some of the impairments that accompany that.

(07:13) [Damien Blenkinsopp]: That’s excellent, that sounds like another application for exogenous ketones I had not thought of. I know there are a whole bunch I want to discuss with you because it seems like there’s quite a few of them. So now if you want to work all night, they can help with that.

I’m tempted actually, what is the mechanism behind that specifically for sleep, is it just a pure energy thing or?

[Dominic D’Agostino]: As far as sleep? Mitigating sleep?

[Damien Blenkinsopp]: Why would exogenous ketones help with?

[Dominic D’Agostino]: Yeah, I think there are several ways that they can help. You can formulate things to provide energy to the brain. There’s various, what we call tricarboxylic acid cycle intermediates, including alpha-Ketoglutarate, creatine – is actually something that could be beneficial to the brain when energy reserves are low, and ketones have a unique effect of being anaplerotic. So if something is anaplerotic it helps to generate the bioenergetic intermediates which include the Krebs cycle or also called the TCA cycle intermediates.

Essentially just helping to energize the brain when fuel flow is low. Many of the TCA cycle intermediates are also precursors to neurotransmitters. For example, alpha-Ketoglutarate is a precursor to glutamate, and then from glutamate through glutamic acid decarboxylase we make GABA.

So, ensuring that we have efficient energy flow to the brain and sort of stimulating anaplerotic reactions and bioenergetic reactions we can replenish the neurotransmitters. Being in a state of ketosis too, can also be glycogen sparing.
I always had the opinion that when we sleep, part of the function of sleep not only restore neurotransmitters but to also restore brain glycogen levels.

Glycogen is actually stored in the astrocytes of the brain. Astrocytes are not just for support cells they have a really important function that pertains to glutamate recycling and sort of dynamic interactions with the synapses and recycling of neurotransmitters and restoring brain glycogen levels is a function when we sleep.

I think we need to look into this more but I have a theory that being in a state of strong ketosis could prevent some of the glycogen depletion that accompanies a normal day in a person that is normally sort of carbohydrate fed.

Where the brain is sucking massive amounts of glucose but if you’re ensuring that it gets a steady fuel flow of ketones it’s going to be glycogen sparing in that way. Sort of like what Jeff Volek is doing with the athletes and it showed in a recent metabolism paper, that being keto-fat adapted and keto-adapted can actually be very glycogen sparing. If you look at the muscles of lead athletes on a carbohydrate restriction, amazingly their glycogen stores are topped off in the muscles.

I think the same thing is happening, I see no reason why it wouldn’t happen in the brain. Our energy reserves in our brain tank, adenosine goes up, neurotransmitters are depleted – we want to sleep. Being in a state of ketosis can slow that process, and exogenous ketones can be a tool in a toolbox to help with that.

[Damien Blenkinsopp]: That’s really fascinating. It’s like the biochemistry of sleep, we’re getting tired and I think we understand on a very basic level but you’ve just broken down quite a few mechanisms which lead to us needing to sleep and how to counter them.

[Dominic D’Agostino]: Yeah, sleep is a really complicated subject. I did my Ph.D. in a pulmonary critical care department that was also a sleep lab. So I sat in on a lot of rounds and meetings with residents and fellows about the mechanics of sleep.

It’s just a fascinating subject, and something I’ll probably get more into research wise. But I do teach the medical students about obstructive sleep apnea and central sleep apnea, that’s some of the research that I did in my Ph.D.

(11:22) [Damien Blenkinsopp]: Excellent, and you’re on a keto-diet as well right still?

[Dominic D’Agostino]: Yeah. I maintain that but I also like to cycle a little bit because I think a lot of the therapeutic and performance enhancing benefits can be achieved with nutritional ketosis but I also think it’s good to have relative changes.

Not to stay on something all the time, but to adjust your macronutrients a little bit, and also maybe your calories a little bit, and occasionally fasting. These relative changes can produce some pretty good performance and therapeutic effects.

[Damien Blenkinsopp]: It’s kind of like exercise like promoting metabolic flexibility, is that where you’re coming from?

[Dominic D’Agostino]: Yeah, that was what I was going to say and relate it back to a hormetic effect where relative changes are good. For a while, I just stayed on the exact same ketogenic diet for a long time and I started adjusting and playing around with different supplements and I realized it’s good to sort of adjust the diet and even adjust your calorie levels sometimes. My life is variable, it kind of fits on with my lifestyle too.

[Damien Blenkinsopp]: I feel the same way. I’m probably doing the something a bit more varied these days. So, it’s just interesting, you said you are basically stacking exogenous ketones for sleep on top of your keto diet. Does that push your levels quite high?

[Dominic D’Agostino]: At least doubles or maybe triples where I would be. I have noticed in the past that if I just stick to my normal diet and I cross time zones. I’ve been in at least a dozen time zones for the last month and a half, two months.

When I do that and I miss a complete night of sleep, coming from Southeast Asia completely flips circadian. I realized that I get a stress response from that I think my cortisol goes up, my sympathetic nervous system can be activated. And I notice that can kick me out of ketosis a little bit or I’ll have levels that are — I would predict there would be much higher based on the macronutrient profile that I’m eating and even fasting.

So, I find that exogenous ketones can sort of help in those situations where I put my body into an unaccustomed stress.

(13:36) [Damien Blenkinsopp]: That’s very interesting. I’ve started to use some of the supplements, exogenous ketones for different scenarios a bit like that situation but we can talk about that later. So, I wanted to give people a background, would you say your focus area is ketones, ketogenic diet? Is that what you’d call your focus area of research?

[Dominic D’Agostino]: Yeah. I’m classically sort of trained as a neuroscientist. I did my PhD in something very specific, it’s patch clamp electrophysiology where you measure from individual neurons and you record the membrane potential, firing frequency input resistance of individual neurons, either in cell culture or in a brain slice, and studying pharmacology and the metabolic activity. I became very interested in observing fundamental neuronal activity.

I became very interested in the metabolism that was supporting that. I realized that the life that I was seeing on the amplifier of the oscilloscope, these neurons firing was completely a result of the electrochemical and the electrical gradients between the neurons, they’re like little batteries.

That was generated completely by the metabolic activity so cells they need to maintain negative 56 kilojoules per mole of energy and they will do anything to do that. Some substrates and some means of generating ATP are more efficient than others. In my early work, I was actually looking at lactate.

I was interested in Ringer’s lactate, so racemic Ringer’s lactate is actually used on the battlefield and also in surgery when people have a lot of massive blood loss. Lactate is extremely efficient fuel, and I studied hypoxia in the brain and ischemia, and I was interested in lactate for that. That got me interested in this whole idea of developing and testing metabolic substrates to preserve and enhance brain energy metabolism in the face of extreme environments.

Our work for the last decade has been funded by the military. So I’m interested in particular situations that would accompany military operations, like a navy seal using a closed circuit rebreather with high levels of oxygen. He’s susceptible to a limitation of his mission, would be oxygen toxicity seizures so the fundamental neuroscience that I learned in my Ph.D.

I applied that to developing and testing metabolic base therapies to preserve that cognitive function and metabolic resilience in the environmental extreme of high-pressure oxygen. That’s sort of a fun thing to do because there’s many ways to do it. I’m always looking for the next, or the optimal formula, of ketones and that’s why we don’t focus on any one particular exogenous ketones. We screen a variety of ketogenic agents or formulas of them to identify the one that’s most neuroprotective or anticonvulsant.

Now, we do cancer studies and we do wound healing, performance applications – and it might be a different ketone for different applications and we’re testing that now. In Budapest, we actually presented some really interesting work on anxiety. So if we induce a state of nutritional ketosis, the anxiety levels go down pretty significantly. In a rodent model, they’ll spend more time in like an open-arm of an elevated plus maze.

Perhaps that reduced anxiety can play a role in reducing seizures too, so it’s another variable that we need to look at. I probably went off on a tangent. My background was neuroscience and now I do what I would call a nutritional neuroscience or metabolic based sort of strategies to target neuronal processes and neuroprotection.

(17:43) [Damien Blenkinsopp]: How many years have you been doing this now?

[Dominic D’Agostino]: I started neuroscience research as an undergraduate in 1997. So, it’s going on about — 1996 or 1997 — so about 20 years now I’ve been into neuroscience research. The office of navy research, post-doctoral fellowship, was the first large grant money that I’ve got, and that was 10 years ago.

It took me about four years to recognize that the most potent strategy for oxygen toxicity for mitigating that, which I was being funded to do would be a ketogenic approach. Then the ketogenic diet at that time was recognized as something very obscure even just six years ago. So the funding agency really wanted a ketogenic diet in a pill per se.

In addition, to our ketogenic diet research which I feel is also very important we have developed these synthetic and actually naturally derived ketogenic agents to mimic the effects of fasting, the ketogenic diet, and also to further augment the therapeutic efficacy of the ketogenic diet. If the ketogenic diet can only get you to one to two millimolar, and we boost it in another one or two millimolar with exogenous ketones. We’ve realized that, that can be very beneficial.

Not everyone can follow a ketogenic diet including performance applications or for therapeutic purposes.

[Damien Blenkinsopp]: People find it quite hard. I don’t think it’s relatively complex to get into it. I speak to a lot of people who think they’re in ketosis but they’re not.

[Dominic D’Agostino]: Yeah, I do too.

(19:25) [Damien Blenkinsopp]: It’s a little bit tricky I think. So, alas comes the supplementation and so on which could make it easier. I think what’s really awesome about you, you self-experiment as well in addition to your research.

You’re always looking for this stuff and I know you’ve been on a keto diet for a long time, when did you start that?

[Dominic D’Agostino]: Yeah, that’s the fun part of this research that I’m really excited about. Well looking back, I did low-carb diets for a while because I was always into powerlifting, fitness, and nutrition. So, I would experiment, and I was under the impression that being on ketosis was bad.

When I did a low-carb diet or what I call the ketogenic diet, I remember smelling like ammonia. Because it was basically a very high protein, zero carb diet, with a normal amount of fat. Then I got educated I guess, being connected with the folks at John’s Hopkins who are using this on a clinical setting. I read the book by John Freeman and Eric Kossoff at John’s Hopkins, which is a great book, ‘The Ketogenic Diet’ for epilepsy and other disorders that’s out there.

There are one or more popular books on Amazon. I realized wow I didn’t know what a ketogenic diet was. I didn’t realize it has this fascinating history. You know written with Travis Christofferson, we wrote a three part of series on Robb Wolf’s blog about the ketogenic diet the history. When I actually got into the 4:1 ratio ketogenic diet, the John’s Hopkins which is like 90% fat.

And I transitioned into a state of nutritional ketosis, it was kind of difficult in the beginning. After about two or three weeks I adapted quite well and started realizing the neurological benefits. The appetite suppression was pretty extreme it was difficult for me to maintain my weight even.

(21:16) [Damien Blenkinsopp]: In terms of losing weight?

[Dominic D’Agostino]: Yeah, because my protein level was really high. I think I was getting probably 300 grams of protein a day which is really high. So, I had to drop that down to about 100 grams of protein a day to hit those macronutrient ratios.

Probably about 120 grams a day of protein, which was a relative change that was really low. When I reduced my protein to 1/3 but elevated my fat, and I still kept going to the gym. But at the time my academic career was sort of going full steam and I was in the gym less, but still making it once or twice a week.

My weights that I was handling on major exercises were maintained so I realized that being in a state of nutritional ketosis had a pretty profound anti-catabolic effect. So, I figured I’d be wasting away if I wasn’t getting my body all these protein. But I was amazed that I could eat.

I even started experimenting and went down to like 60 or 80 grams of protein a day. Even after a couple weeks and months I was able to still move the same weights.

So it really blew my mind that shifting the metabolic physiology to being more fat and keto-adapted had this sort of protein sparing anti-catabolic effect. Which makes sense if you look at it through like an evolutionary lens.

So if we stop eating and we didn’t make ketones to fuel this big, highly energetic organ in our head. If the ketones weren’t providing fuel for our brain we would liberate a lot of gluconeogenic amino acids from the skeletal muscle, and we would quickly waste away probably in a week or two, for a lean individual. That’s important to recognize in the context of using a ketogenic diet for a weight loss strategy and also for body composition.

For example, athletes that need to make weight which many sports do — wrestling, boxing, mixed martial arts – keeping that power to weight ratio is important. We think from the studies that we’ve done, we actually just got a study approved finally for publication yesterday showing elite level athletes or advanced lifters that the ketogenic diet is quite effective for body composition alterations and preserving strength and muscle strength and performance.

So that should be out pretty soon in general strength and conditioning. We realize that the ketogenic diet has far more applications than just pediatric epilepsy, which was it’s original application. We’ve probably studied about 10 different applications now in our lab.

(23:59) [Damien Blenkinsopp]: Excellent. So I wanted to run through some of those applications. First of all taking a step back because you mentioned lactate earlier. I think the majority of us assumes that glucose is the main metabolism. Then we learned about ketones and we think maybe there’re two substrates that we’re using for metabolism.

As I understand it, it’s a lot more complicated right? That we’re using a number of different fuels at any time?

[Dominic D’Agostino]: Yeah. I think the big ones for brain metabolism, which our laboratory originally focused on and now we’ve branched off, would be glucose would be the primary fuel for most people. Then ketones are sort of a backup fuel.

If you’re on a ketogenic diet, you’re running this hybrid engine and you’re using both fuels at the same time. With ketones probably the most efficient of the two. Then lactate too.

When we exercise, we mobilize a lot of lactate and put a lot of lactate back into the bloodstream through what’s called the Cori cycle. We convert that back to glucose and then replenish liver glycogen or muscle glycogen. But that lactate can also go past the blood brain barrier across which is called the monocarboxylic acid transporters and provide a source of energy for our brains.

Lactate metabolism in the brain can also occur under conditions of oxygen deprivation, so it may be beneficial. That was also an interest in my earlier work, using lactate to preserve bioenergetic processes in the absence of oxygen. What we call hypoxia or anoxia, which is a complete lack of oxygen.

Interestingly ketones can generate more ATP per oxygen molecule consumed. In a hypoxic situation, ketone metabolism may also be able to preserve the bioenergetic state of the brain. That’s something that we’re also looking into hypoxia and ischemia protection of the brain with various fuels, ketones, lactate preventing or an alternative substrate to glucose.

In certain situations, neuropathologies and even a hypoxia, stroke, a brain injury for traumatic brain injury can cause a quick impairment of glucose utilization of the brain. By internalization of the GLUT3 transporter and also inactivation or reduced activity of Pyruvate dehydrogenase complex, the PDH complex, can be impaired under certain conditions of brain injury. Even certain viruses that cause neuroinflammation can impair this rate-limiting step for glucose metabolism.

So, alternative energy substrates are a way to bypass that glucose block.

(26:37)[Damien Blenkinsopp]: It’s like a diversification strategy?

[Dominic D’Agostino]: It is, in diving we always talk about being redundance. You need a level of redundancy to ensure safety. I think the brain does that pretty nicely. So we achieve that with fasting.

We have an alternative energy substrates being utilized in the absence of glucose. It’s interesting to be able to delve into that and understand what happens during fasting in different states. From my perspective, it’s a fascinating field of research to develop naturally derived or synthetic agents that can mimic those processes.

(27:17)[Damien Blenkinsopp]: Right. Because we are on a ketogenic diet do we also use fatty acids directly for energy substrates or do they have to be turned into ketones first?

[Dominic D’Agostino]: Yeah. Hepatic gluconeogenesis will be in a state of fasting, completely dependent upon the liberation of fatty acids from adipose tissue. Fat mobilization is directly almost correlated to a ketone production in that fasted state.

Our heart can use fatty acids more efficiently than glucose – our heart is an awesome fat burner. The skeletal muscle is an awesome fat burner especially in the keto-fat adapted athlete, the liver, various organs can use fatty acids quite efficiently. The long-chain fatty acids do not readily cross the blood-brain barrier.

Short chain fatty acids do, and medium chain fatty acids can actually cross the blood-brain barrier. So, that was actually an interest of mine and we did some brain metabolomic studies where we took out the hippocampus of some rodent models that we looked at. We saw a high level of the C8 and the CA10 MCT that we administered to the animals.

I think if you look at the ratio between the blood levels and the brain levels. I think there was a kind of like a 1:5 ratio, so that wasn’t readily getting through but a lot of it was getting into the brain. Of course, the brain was metabolizing it.

Our numbers might have not correlated precisely in a 1:1 ratio in that way. But it’s clear that our body can use fatty acids as fuels, and it’s an incredible fuel for our mitochondria. Because it metabolized exclusively in the mitochondria through oxidative phosphorylation.

(29:03) I would say ketone molecules are I’d like to call water soluble fat molecules, sort of an excessive beta-oxidation or accelerated beta-oxidation in the liver, contributes to the accumulation of acetyl-CoA which drives ketone production, and hepatic ketogenesis. So the acetyl-CoA essentially condenses to form acetoacetate. Then beta-hydroxybutyrate and these spill into the bloodstream.

So it’s interesting that the liver is a massive ketone producer but it lacks certain enzymes that prevent the liver from using the ketones as an energy source so it lacks succinyl-CoA transferase for example.

So, the liver will produce massive amounts of ketones. Then dump it into the bloodstream primarily for our central nervous system to maintain energy flow to the brain, then the central nervous system, and probably the heart too. The liver is a greedy organ, if you fast and you eat, the amino acids and glucose will basically stay in the liver and the liver will take what it needs and put whatever is left into the bloodstream.

But with ketones since the liver does not metabolize ketones it puts them immediately in the bloodstream when it’s burning fat for energy. Looking at it through an evolutionary lens, that function is to ensure that our brain gets adequate fuel flow. In the absence of food, if our brain tanked because we’re hypoglycemic, we wouldn’t be able to hunt.

So, being very lucid and having our brains energized during a period of food deprivation ensure that our species survived. The humans that weren’t able to do that did not get on and live. I think we’re sort of hardwired in a way to function optimally when we’re in a fasted state and that’s important to recognize.

Also, in the context of a society that’s programmed to give three high carbohydrate feedings per day. The metabolic program that is activated during fasting is largely silenced because of the societal norms, associated with our macronutrient profile, but also our eating pattern which is frequent feedings throughout the day.

(31:22)[Damien Blenkinsopp]: Yeah. One of the reasons I ask this is because I’ve had some fear and scared feedback about fasting for instance, which is a bit more of an extreme situation like ketogenic diet normally. One of the things I did was publish some of my own information on YouTube and I got some crazy comments from people saying I was going to die because my glucose was low.

I think it was 3.3 millimolar or something about 54-55 mg/dL. My mother’s a nurse and she saw the numbers and she was quite shocked at the time as well. Everyone thinks that we’re driven solely by glucose metabolism that’s the only thing they look at. So I think it’s really interesting that we have several various fuels that we can be going on, turns out that the glucose isn’t that important.

Someone else just sent me the numbers recently and they were the lowest I’d ever seen, like I was doing a fast and she got 1.8 millimolar with her glucose. I don’t know if you’ve seen anything that low.

[Dominic D’Agostino]: I did. Well, when I fasted for a week I tried some strategies, I probably shouldn’t talk about it here.

[Damien Blenkinsopp]: Okay. In case someone else does it.

[Dominic D’Agostino]: Yeah. After fasting a week, I was staying around the mid-fifties to low fifty’s and occasionally I would dip into the high forty’s depending on my activity and things like that. I did some strategies — I’ll label it as “strategies” — to lower it down to a level that the meter didn’t read, so it just actually was flashing low.

The lowest my meter was able to read was 25 or 26 mg/dL. I assume 25 that’s the limit. I spent a good part of the day with it flashing low and unable to read. I was using the Nova Max meter, and I was using the Precision Xtra Meter and also using the Neo Meter, so I had three different meters and I was scrambling.

[Damien Blenkinsopp]: Is that the Freestyle Optium Neo?

[Dominic D’Agostino]: Yeah. The freestyle like a lower profile sort of meter than the Precision Xtra. So I had three different meters, and I was measuring and I was like, “Oh no I don’t even know what my glucose is. All I know it’s probably under 1 millimolar range.”

I was starting to feel a little bit — using different pharmacological strategies to lower it — but I realized that I was at a level that was universally fatal for everyone if I didn’t have my ketones elevated.

[Damien Blenkinsopp]: Right. But if you had been admitted to the hospital, they’ll put you on the emergency ward most probably if you walked in like that.

[Dominic D’Agostino]: Yeah. During this particular day, I was preparing for a lecture, I was writing a grant it was really a productive day. As I was working I was doing these things and I would do measurements and work for a little bit more and it just goes to show it was a very dramatic demonstration an alternative energy source.

For me, that has tremendous implications therapeutically for someone that’s experiencing insulin shock or a neurological disease with impaired glucose metabolism. So we worked very closely with the glucose transporter type 1 deficiency association. It’s a rare disease where the brain does not have glucose available due to deficiency of the GLUT1 transporter.

There are many different diseases like that. I was also inspired by the work of George Cahill, there was a study that was published in 1967. The first author was Oliver Owen and they fasted subjects for 40 days.

In another report that wasn’t originally published with the original report. I found it in another book they administered insulin, 29 IU of insulin they gave IV. In these fasted subject they lowered the glucose down to 1-2 millimolar and kept it down there.

[Damien Blenkinsopp]: So it’s like 35 mg/dL somewhere around there?

[Dominic D’Agostino]: It’s not even that it was about that 25 range that my meter couldn’t read. So one millimolar would be 18 mg/dL. That inspired me, I was thinking if these subjects can fast for 40 days I could do a week.

It’s about five years ago or so that’s when I did the week long fast and did some experiments on myself. One of the most interesting things that happened to me was my breath hold time. So at the time I was outside a lot.

I was in and out of the pool, taking short walks and trying to stay active, keep my mind off of food. Because the main challenge was just the pleasure of eating was not there. I was swimming I was under the pool and I realized, “Wow,I had been down for quite a while”, and I wasn’t gasping for air.

I got back up to the surface and my girlfriend was there at the time, now my wife, and I started testing my breath hold time. I was like, “Keep an eye on me.” Normally I could do over a minute about 90 seconds, but I was able to stay down for three to four minutes which is remarkable.

I don’t have any kind of specialized training. I’ve been wanting to take a freediver course. I know Ben Greenfield did and we exchanged emails when he was going through that because he was trying exogenous ketones. But I found that after one week of fasting, I had a profound prolongation of my breath hold time. I think that’s fascinating to me.

Fasting does definitely start to shut down your metabolism. I think my body temperature probably went down a degree or two so the metabolic demands just weren’t there. But I think our drive to breath has a lot to do with our CO2 sensitivity.

So there’s receptors in the ventral respiratory group and the ventral surface of the medulla that sense CO2 levels and drive the urge to breathe. We also have the carotid bodies, at the bifurcation of the common carotid artery that sends oxygen and CO2 and they also mitigate or they also play a role in the drive to breath.

I think there’re interesting mechanisms going on there. A desensitization in some way or in combination to just altering our metabolic physiology. I think that has some practical benefits for different sports, maybe military operations.

I want to study that a little bit further with adaptations that happen during fasting.

[Damien Blenkinsopp]: Yes, very interesting. I’m wanting to go and test that out with freediving.

[Dominic D’Agostino]: A number of other people have, I think I might have mentioned it once or twice very briefly, not as descriptive in other podcasts but other people went out there and did it.

I think Tim Ferriss did it. I’m not sure if he’d blogged about it yet but he sent me quite a few texts and emails just saying that dramatically enhanced his breath hold time. So, I’m pretty sure it’s a real phenomenon.

(38:15) [Damien Blenkinsopp]: Very cool, to kind of round that conversation off. I get these emails, like I said, some people are scared because they get injured in fasting particularly a very low glucose levels of 30-35mg/dL.

Do you think that’s something to be concerned about or is it absolutely no problem? Typically, they have ketones like six millimolar, somewhere around there at that stage?

[Dominic D’Agostino]: I wouldn’t recommend that for a long term sustainment of life. Because there are a lot of biological processes that require glucose: red blood cells, your kidney, certain immune cells, and even biosynthetic processes like the generation of certain neurotransmitters are in some part glucose dependent. I think it’s good to get into that level and I’m going out on a limb by saying this to be a mainstream sort of medical college.

I actually think it’s very good to be in a state of nutritional ketosis with sustained hypoglycemia for a period of time, and to do that at least once a year, preferably a couple of times a year. I think what really kicks on a genetic program that activates so many biological processes that I think could be protective from enhanced insulin sensitivity to autophagy, to activating a number of different genes. There’s certain ones obviously, ampakine is activated, mTOR is suppressed.

You put tremendous metabolic stress on glycolytic cancer cells or pre-cancer cells that we may have in our body, sort of an immune activation. I know Dr. Adrienne Scheck is doing some work with the ketogenic diet and she’s doing some elegant work on the immune activation, and from the gist of it and from other bodies of literature it supports the idea that the immune system becomes hyper-vigilant, to recognizing and attacking existing cancer cells when we put our bodies into the state of fasting.

Either prolong fasting or even the ketogenic diet. I think it’s good to do that sometimes. But say if you’re on the ketogenic diet all the time in the state of moderate ketosis and then you fast.

You probably won’t get the same benefits as a person who’s on a high carb diet and did a fast. It would be a lot harder for that person who is on a high carb diet to do a fast. It would be greater stress because it’s that relative change or that pulse.

Thomas Seyfried and I we’re going to work on, it was originally his idea. We talked a lot about this press pulse phenomenon for the metabolic management of cancer. The press would just be a mild state of nutritional ketosis and the pulse could be periodic fasting or some of the things that we’re interested in. Such as hyperbaric oxygen therapy that could be pulsed exogenous ketones to further allow for a greater hypoglycemic response.

Also, you could pulse various cancer-specific metabolic drugs like 2-deoxyglucose, or dichloroacetate, or 3- Bromo Pyruvate] could be used. The press would just be nutritional ketosis and that would metabolically compromise a lot of the highly glycolytic, which corresponds to highly aggressive cancer cells.

(41:41)[Damien Blenkinsopp]: When you say press that would be like something chronic that you’re doing?

[Dominic D’Agostino]: Yeah. We know that being in a state of nutritional ketosis causes suppression of the hormone insulin. The cancer cells that light up on a fluorodeoxyglucose PET scan, a FDG-PET scan. The PET [or PET-CT] scan is really the gold standard technique.

I would say when it’s coupled with the CT scan allows you to precisely locate where that hypermetabolic activity is. So the PET-CT is an incredible, gold standard tool to assess the location and aggressiveness of existing cancer cells. The greater the standardized values that are coming out, like 2.5 would be sort of the normalized value.

If you have a PET scan showing SUVs of a 100 or 250, those cancer cells are very aggressive.

[Damien Blenkinsopp]: So they show up as the big red and yellow blotches?

[Dominic D’Agostino]: Yes.

(42:47)[Damien Blenkinsopp]: Yeah, we spoke to Gene Fine on a previous episode he was talking about the PET scan.

[Dominic D’Agostino]: Oh yeah. Actually Dr. Fine, you probably know he did a study for 28 days. He did a study with a ketogenic diet and he selected patients based on their PET scans. The topic that I was going to touch on is that insulin suppression correlates with ketosis.

I think even the title of his paper didn’t even mention the ketogenic diet, it was something like insulin inhibition therapy can be used to target cancer. It didn’t even talk about the ketogenic diet. But if you read the paper, he basically used the ketogenic diet to suppress the hormone insulin as a therapy for managing these hard to treat cancers or people who have failed the standard of care.

So, that would be the press that I’m talking about. The ketogenic diet limits glucose availability to the cancer cells. It suppresses the hormone insulin which drives IGF-1, mTOR and other factors that cause cancer cell growth and proliferation. I don’t know if Dr. Fine talked about it, but he has a number of publications.

I was inspired by his work and I actually got us to look at exogenous ketones and the effect on cancer cells. We find that if you limit glucose, suppress the hormone insulin and elevate ketones, the ketones themselves have anti-cancer effects. So, we did a study, we published in the International Journal of Cancer.

The first author was my graduate student at the time, Dr. Angela Poff, she’s now a research associate following up on this work. We gave ketones to highly aggressive cancer cells that have a glioblastoma-like origin. When we grew the cancer cells in the presence of ketones, even in the presence of 25 millimolar glucose, it inhibited, it dramatically slowed down cancer growth and proliferation.

(44:47) We did a viability testing where we looked at live cells and dead cells and the ratios of that. We found significantly more dead cells when we grew the cancer cells with ketones even in the presence of glucose. The take home was that ketones were probably turning down or shutting off a lot of some of the glycolytic mechanisms and there’s previous reports suggesting that ketone metabolism can turn down glycolytic metabolism.

So, that would be the press.

[Damien Blenkinsopp]: It sounds like a signal even for the cancer cells?

[Dominic D’Agostino]: Yes.

[Damien Blenkinsopp]: For them to switch them off even if they can’t use the ketones?

[Dominic D’Agostino]: Yeah, we think so. Now, we need to mechanistically dissect those kind of signals that are happening with the ketones because they do high-level sciences. Our lab approaches things a little different. We don’t sort of identify a target and then work up from that.

We screen a lot of things at the top and find out what works. Then, once we found out what actually causes animals to live longer or produce a neuroprotective effect then we go and try to find the mechanism.

(46:00) [Damien Blenkinsopp]: That sounds like a little bit like the pharmaceutical drug research process where they screen many many molecules for doing something. Correct me if I’m wrong. It seems like maybe it’s an efficient process to find things that work by just screening a lot of things and then focusing on the things that are working.

[Dominic D’Agostino]: Okay. So, it’s a little different, with pharmaceutical companies they actually target a mechanism or a biological kind of process and enzyme.

[Damien Blenkinsopp]: So they’re all looking for an end result right?

[Dominic D’Agostino]: Yeah. We’re testing a bunch of things, we don’t even know how they work. We’re testing various ketogenic exogenous ketone formulas and we don’t even have the pharmacokinetic nailed down yet. We don’t even know specifically how they’re metabolized.

We feel that it’s really important to get this research done so we can get these therapeutic agents out there as fast as possible. We screen a lot in various agents, first in human or first in animal, and then we identify what works. But the mechanisms, the metabolism is incredibly complex.

What we find is that it’s not working through one particular mechanism, it’s many different mechanisms working in synergy. The ketogenic diet, you have an increase in the GABA to glutamate ratio or ATP production you have a greater bioenergetic potential of the mitochondria. You have more TCA cycle intermediates.

The list goes on and on. There’s a science paper showing that ketones beta-hydroxybutyrate is a HDAC inhibitor. We published a nature medicine paper showing that inhibits the NLRP3 inflammasome and that’s independent of metabolism.

(47:41)[Damien Blenkinsopp]: So it’s like a huge dynamic system? There’s no way you can see all of the mechanisms going on there? As you’re saying you looked for the end effects and then you started looking for the mechanisms.

All of these mechanisms that you just brought up and started piecing them together to see how it worked after you’ve got the end result that you wanted.

[Dominic D’Agostino]: Yeah. The important thing is that it works and then the secondary important thing is to find out the mechanism. Because once you do know the mechanism, if the majority of the therapeutic effects or performance enhancing effects are due to a particular mechanism, out of many mechanisms. Then we can tweak the molecule of the formula, the pharmacokinetics, to further enhance that particular mechanism.

Then we can go back and tweak the formula, or the molecule to make it hydrolyze faster or to increase the sustainment of it, or deliver it in a certain nanoparticle formula to a particular tissue or something like that.

(48:37)[Damien Blenkinsopp]: So we’ve already spoken about quite a variety of basic applications, benefits of ketone based metabolism, and ketones. Could you just go through the top ones in your mind, maybe the ones that we haven’t already covered? So I know a lot of people are focused on weight loss for instance.

[Dominic D’Agostino]: That probably goes back to what they call the ‘Banting diet’. That even predates some of the work that I first got attracted to in epilepsy. So, epilepsy that would be the big thing.

The ketogenic diet, the only thing that is used for standard of care in mainstream medicine is the management of epilepsy. I always harp on this too, the ketogenic diet is grossly underutilized as a tool for managing epilepsy because it works when drugs fail.

It works in about two-thirds of the population. Imagine the efficacy of it if it was the first line of therapy. If you have a child that’s two or three years old and you load them up with anti-convulsant drugs, we know that these anticonvulsant drugs cause developmental delays. It’s even more important in pediatric epilepsy, I think to start with the ketogenic diet.

I just like to throw that out there. We’ve already talked about epilepsy. So, epilepsy would be the big one and obviously weight loss. You have the original Banting diet. Then Atkins came out with what he said was his famous diet but it was really a playoff with the Banting diet. It allows for effortless weight loss because when you’re in a state of nutritional ketosis the ketones function to control appetite.

It prevents your appetite from controlling you. We don’t really know the mechanisms that regulate appetite control, are incredibly complex. But we think that the ketones are essentially telling the brain it’s in a fed state, that’s the simplistic way to put it.

(50:32)[Damien Blenkinsopp]: Okay. Ketones get converted back into fat? Because people know that you basically pee ketones out when you first get onto a keto diet. Is that one of the mechanisms also?

[Dominic D’Agostino]: Well, yeah. If you collect all the urine of someone that’s on a ketogenic diet and then you look at how many calories are there, it’s pretty marginal. I think Atkins even advertised, “Look you’re peeing out fat, you’re peeing out calories.”

But it only came down to like 50 to a 100 calories or something like that. I think the big effect, the metabolic advantage really, is not that you’re burning more calories. I think there’re different organizations out there that we’re trying to prove if there’s a metabolic advantage to being in ketosis.

I think the big advantage that we need to focus on is appetite regulation. Our current diet of processed carbohydrates contributes to appetite dysregulation. The ketogenic diet is very effective at restoring sort of normal appetite behavior because there’s no fluctuations in blood glucose.

If we’re on a carbohydrate based diet and we go hypoglycemic that’s going to trigger an intense craving for carbohydrate re-feed to re-establish that glycemia. That’s completely abolished on the ketogenic diet.

So when you’re on a well formulated ketogenic diet, the craving that you’d have with hypoglycemia is going to be significantly attenuated if not abolished. We talked about weight loss and type 2 diabetes pretty much every disorder out there. Let’s think cancer, even kidney failure, neurological diseases like Alzheimer’s disease and many other pathologies are sort of linked pathophysiologically to the metabolic dysregulation and also obesity type 2 diabetes.

If a diet does promote a healthy weight loss and sustainment of that weight loss, it’s going to be therapeutic for many other disorders. Some of the things that we study include Alzheimer’s disease, ALS, we have a really active cancer research program in the lab. I have two Ph.D. students right now studying.

One is looking at Metformin and other cancer-specific metabolic drugs but combining it with a ketogenic diet. His main thing is to locate drugs. But we think some drugs will synergize with the ketogenic diet.

In another project is looking at the ketogenic diet or exogenous ketones and branch chain amino acids to mitigate cancer cachexia, which is muscle loss or wasting, so we’re looking at that. Exercise performance we’re looking at that. The most recent data that I’m really excited about because of the pretty robust effect as far as some of the behavioral models that we use.

One particular model is the elevated plus maze which looks at anxiety. We found that being in a state of nutritional ketosis that was induced completely with exogenous ketones stimulates in the elevated plus maze which is like a rodent going out on a catwalk. You can go into a cave or come out into an open area where you’re on a plank and you’re elevated in the air.

It’s a very anxiety producing situation. In our rodent models validate as a very useful model. We’ll spend much more time on the open arm and less more time hiding in the cave. We think that has significant implications for military personnel with PTSD and anxiety in general, and a lot of depression too is also sort of a comorbidity there with anxiety, a lot of depression, and anxiety fueled.

[Damien Blenkinsopp]: You’re saying that they’re willing to go out walk on the plank, take that risk and feel comfortable with it?

[Dominic D’Agostino]: Yeah.

(54:28)[Damien Blenkinsopp]: Do you measure it by time spent on the plank?

[Dominic D’Agostino]: Yeah. Less anti-social behavior I guess. We set up this elevated plus maze and then we have a whole video imaging system above it. We keep the animals as low stress as possible.

We have the same person working with the animals so they’re not experiencing different smells, and things like that. The room is very very quiet. We pay attention to circadian, light on light off things.

There’s a lot of variables that need to be controlled and then we image them in the absence of ketones. We see how much time they’re like in the middle, in the open arm, closed arm and our video camera system sort of can track all that. We have various programs and algorithms that do all the calculations for various things.

We do a bunch of animals just on a standard high carb diet. Then what we’ve been doing is testing various ketogenic agents, or various exogenous ketone and ketone formulas that would be administered 30 minutes prior to being put in this elevated plus maze, and being there for a couple of hours. Then we’ll track all that information, it’s all done blinded.

We have one person who’s, usually two people part of the project that’s administering the agent. The person that does the analysis does not know what the animal is receiving. We’ve got a pretty robust effect with a few of the ketogenic agents on reducing this anxiety behavior.

That’s some new data that we just presented literally less than a week ago in Budapest. That’s what I’m just returning back now. So we want to follow up on that. We used one dose, we need to determine what would be the optimal dose.

There’s a lot of work that we still need to do to optimize that and maybe think about putting together a formula that could be beneficial for people.

(56:30)[Damien Blenkinsopp]: Very cool. One of the ones you didn’t mentioned is Parkinson’s, is that something?

[Dominic D’Agostino]: Yeah. There’s an earlier study I think that was done by Dr. Theodore B. VanItallie. Dr. VanItallie is like 96 years old. We still communicate on the phone and through Email.

He was one of the original ketogenic diet researchers. He did a small sort of pilot study showing that people with Parkinson’s disease can follow a ketogenic diet and that being in a state of nutritional ketosis reduced the tremors associated with Parkinson’s disease and prevented some of the symptoms. Not a cure, but it could help manage some of the symptoms associated with Parkinson’s disease.

There really hasn’t been a good follow-up study to that. I know there was a ketone ester that was developed at NIH and a study at Oxford. There was that group that had a clinical trial open. But I think they might have had some problems recruiting people into that clinical trial, that opened a few years ago.

I know there was a clinical trial looking at the effects of exogenous ketones on Parkinson’s disease. And if we weren’t tied up with so many other projects I would be jumping on that. Because I was able to observe on Alzheimer’s patients when they took a medium chain triglyceride supplement, or even exogenous ketones. They would have pretty dramatic tremors.

And some Parkinson’s disease-like symptoms can be manifested in people with Alzheimer’s, especially advanced Alzheimer’s. I was able to observe and also got feedback from caretakers that when they induced a state of nutritional ketosis it really rapidly stops the tremors associated with that. So, that needs to be followed up on.

The pharmaceutical industry dictates a lot of what studies are done. Because you need a strong financial backing on top of a university, or chain of universities that supports this kind of research. On top of a review board, an IRB, that will prove this kind of research using these nutritional metabolic substances. There are many hurdles that need to happen.

Then you have to recruit patients on top of that and convince them that it’s not a drug but it’s a nasty tasting food that could potentially benefit you. They were like — well, it’s easier for a child, a son or a daughter [who] is bringing in their mom who is typically in a situation — 80 or 90 years old.

They’re not going to want to try to formulate some nasty tasting shake to do that. It’s much easier to just give them a pill. These are some of the things you see, the feedback that you get from people who are trying to implement these kinds of nutritional protocols in patients.

There’s a lot of hurdles. A lot of people ask me, “Well, if it’s so effective, how come science is not using the ketogenic diet or exogenous ketones to treat all these disorders?” I could write a book on the reasons why, but nutritional research is so hard to do.

Because nutrition is really tied into the lifestyle thing, and getting institutional support, getting the expertise needed, ensuring that patients are following through and complying with the protocol. All of these things are hard to do. A supplement, in theory, is a lot easier but we’re at the very initial stages. Because these are just new entities that just developed.

(1:00:16)[Damien Blenkinsopp]: Right, it’s only two and a half years you’ve had the ketone salts for instance, and the esters a bit longer?

[Dominic D’Agostino]: A little bit more than that. I would say the ketone ester was actually developed probably about 20 years ago, if you look into the animal literature. Then they were dropped because it was thought that they’re very expensive to produce and they taste like jet fuel.

Some of the people that originally developed these things, like Henri Brunengraber. He’s like a hardcore metabolic physiologist-scientist who develops a lot of remarkable things. But he kind of drops it and moves on to the next thing.

There’s also sharing the chair of his department and running a billion other things at the same time. So, I dug up some of this research and realized, “Wow, why didn’t anyone follow up on this?” Then I saw some of the work that was funded by DARPA, showing that they were the secret project.

They were using these ketone esters for warfighter performance enhancement. I found some patents and some files on that. I was like, “Well, this is what I need to explore, for use of CNS oxygen toxicity.”

Not only can the ketones potentially mitigate the oxygen seizures but the ketogenic diet was super effective. Even independent of the ideology of the seizures that it tends to work which is really remarkable. But instead of giving an anti-convulsant drug to a warfighter, which can dull your senses and impair your physical and cognitive performance.

You could be giving an anti-convulsant neuroprotective substance that enhances the physical and cognitive performance. It seemed like a win-win situation. I’d rapidly grasped this idea and just went into this manic state of writing grants and writing proposals, and digging up all the research.

Then, I was calling my program officer and I was like, “You need to hear this information and what I’m going to tell you.” We actually had a little meeting at our university and he was like, “We have to do this.” He was very generous to fund some of the initial basic science proof of concept research that demonstrated the efficacy of this ketone ester in mitigating oxygen toxicity.

It worked better than anything we had ever tested or anybody had ever tested, even drug wise. That’s going back in 2009 or 2010. From there, I’m really in safety because I’m really scared about bringing something to market that could potentially harm someone. I know there has been some discussion out there about the quote and quote dangers of a racemic beta-hydroxybutyrate salt.

People need to recognize the difference between someone’s opinion and scientific fact. The scientific fact is that racemic beta-hydroxybutyrate salts have been used for decades for treating a disorder called MAD, Multiple acyl-CoA dehydrogenase deficiency. I get Emails from the patients or from the parents that are treating their kids with this, and it’s like a miracle for them.

I also get Emails from parents that are treating their kids with glucose transporter type 1 deficiency syndrome with a racemic beta-hydroxybutyrate (sodium beta-hydroxybutyrate), which is actually a prescription you can get in Europe.

But they’re also using these commercially available ketone salt products which would be the ones that you might be familiar with. There’s KetoCana from KetoSports, Pruvit makes Keto OS, Forever Green makes Ketopia. The Kegenix product which is the one I’m testing now. It’s a really excellent exogenous ketone product.

This idea which was talked about in various podcasts, I think in Bulletproof podcasts and Ben Greenfield’s that racemic sodium beta-hydroxybutyrate was dangerous and ineffective. It is an opinion and there’s no science to back it up.

If you go back and listen to the podcast you’ll hear the speaker actually reference no actual studies. So, it has an intellectual property supporting the non-racemic, so that needs to be acknowledged and appreciated.

What is appreciated from my end, the science backing up the efficacy and the safety are really profound – like I’ve said on expert panels to approve some of these molecules. And no toxicologist or physiologist could find any evidence that racemic, which is the DL version of beta-hydroxybutyrate, was dangerous in any way.

For example, if you’re a medical doctor or a combat doctor on the field and you’re treating soldiers that have a loss of blood or you’re in the emergency room just talking to the ER doctors, use the Ringer’s Lactate and that’s Racemic lactate.

So, L-lactate would be the natural lactate that you would find in your body. The DL would be in an enantiomer or a mirror image of that lactate. Both of the lactate molecules get metabolized to energy. So, the same things happen with ketones. So the D and the L version get metabolized to ATP, to energy.

A lot of the metabolism has been worked out with very elegant tracer based fate association studies by Dr. Brunengraber at Case Western. Lactate Ringer’s has been used in millions of combat troops and emergency rooms. If there was a danger to using a racemic metabolate, there would be a lot of dead bodies around – and that has not been the case.

Actually, it’s FDA approved, it’s widely used and accepted, and it was even studied the difference between L-lactate and Racemic lactate before it became a standard of care. Actually, it was looked into, and it had exact same effect.

So, if you use the Racemic versus the L-lactate have the same effect at preserving the metabolic activity of the tissues and being protective in that way. So, that needs to be acknowledged that when statements are made, that they could be an opinion and not validated by scientific facts.

The ketone supplements that are on the market now that I’m aware of are very safe and from feedback, they’re very effective. I don’t support any particular ketone supplement that’s out there. I’ve tested all of them and they tend to elevate my beta-hydroxybutyrate and the .5 – 1 millimolar range for one dose.

So, for me to really boost my ketone levels up, I have to take a packet and a half, or a dose and a half, which I can tolerate pretty well. But I think there’s a lot of room for improvement and the products that are out there.

I hope to work with these companies, hoping that they will fund research to support the further development and evolution of these products for different applications.

(1:07:30)[Damien Blenkinsopp]: Excellent. Thanks for going through that because that’s something I have my eye on as well and wanting to get some more facts. Something else that was thrown out, a couple of things was that the racemics were less efficient or were ineffective?

We also have all of the MCTs which people are using to kick up their ketones as well. We have the C8 and C10 of the MCTs, there’re various products around. Another statement that was said they were undesirable and you should avoid those as well unless you really had to take them.

For instance, if you have Parkinson’s it was okay to take them but otherwise you shouldn’t be really taking them. But a lot of people are taking these. Right now, there’s a bulletproof brain octane. I’m sure a lot of people are taking that.

KetoSports has got their own product that I’ve been taking for a long time personally. I don’t know if you have got any comments on that?

[Dominic D’Agostino]: Yeah. I study a lot of very expensive exogenous ketone products. But the more I look into medium change triglycerides, especially the C8 oil which is digested and assimilated much differently than long-chain fatty acids. When you consume it, it basically perfuses the liver.

I mean it goes right to the liver via hepatic portal circulation. It goes right through to liver and is burned as energy. So, they’re poorly astrophied, which means they’re not re-astrophied back and packaged into chylomicrons, like long-chain fatty acids.

Once they reach the liver, it’s basically an obligate oxidation. The medium chains are almost completely oxidized to ketone bodies. Some of them will spill into the bloodstream because we find them in the brain tissue and other tissues.

But it’s independent of the various transporters too. For the medium chain triglycerides to get into the mitochondria there’s various CPT-1, for example, is not needed to get the MCT into the mitochondria. So, they bypass a lot of these rate limiting steps.

And you consume them, it goes right to the liver, you generate a lot of beta-hydroxybutyrate and some of that gets into the bloodstream. So you have the combination of ketones and the medium chain triglycerides going right to the mitochondria. And that can be very therapeutic and beneficial for many different disorders.

You have to realize that the person making that statement that MCTs are dangerous or ineffective, has some underlying personal interests in advancing the commercialization of his particular exogenous ketone, and that needs to be appreciated and understood.

From our perspective, we’re interested in testing that particular ketone formulation and 20 other, and finding out the truth, finding out which is most effective, which is safe. When it comes to the racemic, and the statement that racemic beta-hydroxybutyrate is not as effective. We have not found that out to be the case.

Actually, the first ketone ester that we studied for oxygen toxicity was a monoester of the R-beta-hydroxybutyrate we have formulated. And that did not prevent CNS oxygen toxicity, which actually was very strange to me. But the more research I did I found out that you needed to elevate both the acetoacetate and beta-hydroxybutyrate in the blood to mimic some of what happens naturally, physiologically.

The acetoacetate through spontaneous decarboxylation to acetone, or maybe it has it’s own metabolic effect independently. The elevation of acetoacetate was absolutely critical. It also in the presence of beta-hydroxybutyrate but it was absolutely critical to elevating both ketone bodies to get the anti-convulsing effect.

We published that in the American Journal of Physiology and showed the pharmacokinetics and seizure work with that. So, we screened a lot of agents and found out the particular ketone ester that we found to be most effective was 1,3-Buntanediol acetoacetate diester]. So it was 1,3-Buntanediol that was racemic, so it would make racemic beta-hydroxybutyrate.

But even the non-physiological enantiomer gets broken down and converted to Acetyl-CoA and some of that goes back to the physiological enantiomer so it all gets broken down and metabolized similarly to Ringer’s Lactate which is used in millions of patients.

But the important thing about that particular molecule is that when it’s consumed orally it gets hydrolyzed and it rapidly liberates the acetoacetate. Then the 1,3-Buntanediol gets metabolized in the liver and elevates beta-hydroxybutyrate. So you have both ketone bodies elevated in the blood. We find that it’s absolutely critical to get a certain level of acetoacetate to get the anticonvulsant effect.

(1:12:30) One thing I didn’t talk about was Angelman Syndrome, which is characterized by impairment of motor function and also drug resistant seizures. It’s extremely effective in an animal model of Angelman Syndrome.

If you look at Angelman Syndrome and the ketogenic diet, you come across case reports showing that it basically puts Angelman syndrome patients into remission, at least for seizures. So, it’s highly efficient for that.

So, the first ketone ester we studied was this R in the enantiomer, the hydroxybutyrate, and it was not effective. So it was actually the racemic version of a ketone ester that was most efficacious.

But we’re interested in exploring all different pathologies and finding out which one. So, we have not found out that the R and enantiomer is any more efficacious for any other disorder than the racemic. I think that’s important to acknowledge.

We also found that medium chain triglycerides tend to formulate really well with this exogenous ketones. Not only are they carriers but we think they enhance the transport across membranes and they improve the pharmacokinetic profile, two of many of the ketones salts. So when it’s formulated with MCTs which have the nice advantage of also being ketogenic.

One of the benefits of racemic, the other enantiomer, so there’s D and L. The L-enantiomer tends to impact the liver in a way that reduces hepatic gluconeogenesis. So, you have this hypoglycemic effect that is very well characterized by our laboratory and other peoples laboratory.

[Damien Blenkinsopp]: So you’re saying that ketones go up and the glucose goes down?

[Dominic D’Agostino]: Yeah. It’s more pronounced with the racemic and we don’t know why that is.

(1:14:22)[Damien Blenkinsopp]: Is that beneficial to some of the applications more than others? Weight loss for example?

[Dominic D’Agostino]: Yeah for weight loss, maybe for seizures too. We know that reducing glycolytic metabolism can be beneficial for seizures but also for cancer. As I mentioned, we have pre-active cancer research program.

The lower we can get glucose or glucose response to a meal, the lower we can reduce that, the better therapeutic efficacy we think the agent will have. If we formulate the agent with food, so every time our animal models will eat the food they’re getting a dose of it.

Instead of injecting into the animal or ‘gavaging’ it in the mouth for our cancer studies, we actually take these ketogenic agents and formulate it to about 10 to 20 percent of the weight of the food. Then we count the macronutrient ratio, and then they eat it.

Every time they’re eating the food they’re getting a dose of ketones with the glucose. Because we do a lot of our studies formulating with a high carb diet. Because we want to find out the therapeutic effects of the particular agent and distinguish that between the ketogenic diet.

But we also published a study, about a year ago, where we formulated the ketogenic diet with the ketogenic agent. We did this with a ketone ester and found that it further enhanced the anti-cancer effect of ketogenic diet.

(1:15:48)[Damien Blenkinsopp]: Okay. I’ve got a few questions about this. There’s some MCT powders on the market which combine glucose. Me coming from a ketogenic perspective, that’s not something I want to take with the MCT powder. There’re other powders which don’t have the glucose.

Is there anything to think about or is it not really an issue? Because there’s this effect of the ketones pushing down the glucose anyway? Would it have zero effect? I haven’t tested it myself yet.

[Dominic D’Agostino]: Yeah, the MCT powders on the market like Quest Nutrition?

[Damien Blenkinsopp]: Not Quest, they don’t. It’s basically the generic ones. There’s this cheaper one, generic one, where they’ll put glucose syrup in it and some other glycemic ingredients.

[Dominic D’Agostino]: Yeah, with my interest in the ketogenic diet and staying in ketosis, I would rather get my carbohydrates from things like vegetables, salads, blueberries and dark chocolate. Basically encompasses my carb intake there. So I would avoid that.

A staple product that I use, I have it right by me right now is the Quest MCT oil powder. I did a little bit of beta testing for them as they brought that to market. We went back and forth, and I tested that a lot.

I consumed a lot of that and I did tons of the blood work and got to the point where I was really impressed with the product. There’s not too many products that I consider staple products, maybe about a half a dozen in total that I keep with me all the time.

That MCT oil powder is great, it’s very versatile. You could use it in baking, you could put in my coffee, you can add it to protein shakes to further boost the ketogenic profile of your shakes.

[Damien Blenkinsopp]: Do you take that with you? I take this stuff as well, I’ve got it right next to me as well in my coffee [unclear (1:17:32)]. What I was going to say is that you take that on top of your ketogenic diet?

But I think an interesting thing, I talk to people and they’re taking the exogenous ketones or the MCT powder as a normal diet, or the body builder’s diet where it’s high protein, and they’re not doing a keto diet.

Then there are other people who are interested in getting keto but finding it difficult. They’re using it to ease into the keto diet. So there’re a couple of different applications people use them for different things. I’m just wondering what you’re ideas are in those scenarios.

Dominic D’Agostino]: Yeah. If I put the Quest MCT oil into my coffee or shakes or things like that. I generally try to avoid liquid meals, because liquid meals digest totally different. The only liquid meal that I have would be my coffee, and I would put in some coconut oil and MCT on top of that.

Occasionally, I put in butter or coconut cream. I’ve been using coconut cream instead of full cream. The benefit is that I can elevate my protein a little bit more. I generally eat two meals a day now that I’m home and not traveling.

My meal in the evening is about twice the calorie count. So, I get about a third of my food calories in the morning and about two-thirds in the evening, but I get a lot of fat calories during the day I guess. Because I’ll make my coffee and whip it up and then bring it in a thermos, and drink that mostly in the morning. Then I’ll have a little kicker in the afternoon maybe.

That fat balm, I guess if you want to call it that and occasionally take some exogenous ketones too during the day, if I’m testing different products. It just adds to my total fat macronutrient ratio.

I probably get — with the coconut cream, the butter, and the MCT oil powder — probably get about an extra 100 grams of fat from that. So that allows me to eat a little less fat with my meal in the evening, and that makes it maybe a little bit more palatable because I could add some more protein.

On a typical schedule, I will do my physical activity in the evening. Then I’d like to couple that with a little bit higher protein intake.

(1:19:51)[Damien Blenkinsopp]: Right. So using the exogenous ketones or the MCTs to offset gluconeogenesis? Is that the idea?

[Dominic D’Agostino]: Yeah. This morning I had three or four eggs cooked in coconut oil. I usually have sardines, oysters, chicken, or steak from the night before. Then I’ll have a little bit of green vegetables cooked in fat, and that will be my breakfast.

It will be roughly under a thousand calories, somewhere around 800 – 1000. Then, I’ll get 1,500 – 2000 calories in the evening. During the day, I might even get an extra 500 – 1,000 just of fat or ketones.

I stay semi- fasted, so if I eat 6am or 7am I feel the best when my ketones get highest between like 3pm and 6 or 7pm.

(1:20:53)[Damien Blenkinsopp]: Okay what levels of ketones would you have then?

[Dominic D’Agostino]: I say high but it’s not really that high. In the morning when I wake up it’s maybe 1.0, sometimes .5 if I ate more blueberries or chocolate the night before. Right now, approaching noon, it would start to creep up about 1.5.

Then towards the end of my work day, I’m usually approaching about a 2.0 – 2.5 or somewhere around there. If I’m lucky I budget my time where I can go to the gym so I will be typically be working out. Then if I go home I’ll do some stuff, take my dog for a walk, do some sprints, and that’s when I feel most energetic – when I’m fasted, and in ketosis.

(1:21:40)[Damien Blenkinsopp]: Right, and you’re saying your blood ketones would be 2.5 or something like that and you’d feel that’s when you’re most energetic? Or you feel your best at that time?

[Dominic D’Agostino]: Yeah. I try to subjectively do this too. Basically, I would carry my meter, and I would be like, “When do I feel most energetic, and lucid?”. Then, I would measure my glucose and ketones at that point.

And I find that basically if my glucose is about 3.5 millimolar and my ketones are about 1.5 to 2.0 is when I personally feel the best, as far as energetic. So that would be a glucose-ketone index if we use the Thomas Seyfried’s calculation, of about 2.0. When you’re approaching 1.0, you’re starting to get into that therapeutic range.

But I think for all intensive purposes, for the normal person, if you keep between 2.0-4.0. It would be very abnormal for someone in a normal society to even approach that. If you’re hitting that then you’re doing really well.

You’re in an altered metabolic state. If you can sustain that, I think you’re going to get a lot of therapeutic and performance benefits from that.

[Damien Blenkinsopp]: So 2.0 – 4.0 in the GKI — glucose-ketone index — from Thomas Seyfried?

[Dominic D’Agostino]: Yeah.

(1:22:58)[Damien Blenkinsopp]: Which we covered in his episode in the past. Yeah, the only time I’ve got below 1.0 is when I’d be fasting. I’ve tracked full days as well, every half an hour I’ve tracked, it looks pretty similar to yours.

I’ve heard you say before that over 5.0 millimolar, in terms of ketones has some metabolic downsides. So, I was wondering about the ranges. Are there ranges that people shoot for between this 2.0 – 4.0 basically? You don’t really want to be lower?

Right? Say on the GKI, you don’t want to be going down to 1.0 unless you’re fasting or doing some pulse?

[Dominic D’Agostino]: Yeah, unless you’re really in a total fasted calorie restricted, deprived state, I think between 5.0 and 6.0. I think there was a report in a 60 day fast up to 8.0 millimolar. So that it may be beneficial there for just maintaining that energetic flow to the brain.

But if you’re on an isocaloric diet not calorie restricted. I think staying between 1.0 – 2.0 is probably good. If you’re mildly calorie restricted or maybe towards the end of an intermittent fasting, the fasting portion of an intermittent fasting day, approaching 3.0 may be optimal.

I based this upon thousands of blood measurements that I’ve taken and literally hundreds of blood measurements from other people. Between 1.0 – 3.0 millimolar I think is good. We’ve even seen it in animals, once you dose them up to about over 5.0 they start hyperventilating.

You create a mild metabolic acidosis that needs to be compensated for, so that you get the hyperventilation, they start getting even drunk and sedated, when you really start getting up there and has signs of ketoacidosis. In cases where they’re sedentary, that could be the reason. If you’re approaching 5.0 or 6.0 millimolar and you’re in an all-out sprint, you’re using that.

So maybe in the case of an athlete approaching the higher numbers could be beneficial if you train for that. But say you’re not trained for that and you dose up really high. Your body perceives it as a foreign acidic-metabolic substrate that has to neutralize, your bicarbonate compensates, and you have respiratory-renal compensation that needs to compensate for that.

I just had this discussion in metabolism and physiology with some people that I really respect. They were making the argument that anything above 4.0 or 5.0 is really going to be toxic to the body. I didn’t argue against that but we agreed upon — and there’s some pretty sharp minds in the room — anywhere between 1.0 – 3.0 was probably optimal.

As you know staying in 2.0 – 3.0 range is really hard to do with diet. But staying in a 1.0 range is pretty easy to do with a diet. I do a modified Atkins or modified ketogenic diet, and that’s pretty easy.

Then if I add a little bit of exogenous ketones or some C8 on top of that. I can easily boost that up to 2.0 – 2.5. I think that would give me a metabolic, performance, and cognitive advantage. I’m pretty sure about that.

So, that’s what’s exciting to me. So, not using exogenous ketones in the place of a low carb diet — but you might be able to do that too — I’m actually thinking about doing some experiment of getting off of my ketogenic diet for a period of time.

Not going super high carb but just being out of a state of nutritional ketosis and then adding supplements back in and then doing some blood work and see what happens there. I just haven’t got around to doing it because I enjoy eating ketogenic so much.

[Damien Blenkinsopp]: Right. Once you get into it for a while it’s like you don’t have to eat very often.

[Dominic D’Agostino]: It’s almost like I dread doing it.

(1:26:51)[Damien Blenkinsopp]: I was testing some of the supplements, the different supplements. I don’t think I didn’t do it very well. But what I was doing I was eating in the evening basically a high-carb meal lots of rice to put myself out of ketosis.

I did this for about a week and then tested different supplements in the morning. For the first reason, I don’t think it was a great control because I am basically keto-adapted now. I tend to pop straight back into ketosis relatively quickly.

I’d like your feedback on that whether it’s a decent control. Maybe I’m no good as a control because I’ve been just keto-adapted for a while and also may be I’d have to go for a few days ‘carbing’ it to make it a bit more realistic. What are your thoughts on that?

If you’re trying to do some normal, the first thing is, going back to your point about exogenous ketones. You’re saying like if someone just takes it straight off as some people are doing right now. They’ve been on a carb diet the whole time.

Then they can’t necessarily utilize those because they’re not keto or fat adapted. How long does that take? Should we be taking a lot of these when they haven’t really had that much exposure?

Do they have to take them over a period of a week or longer in order to start getting more benefits from taking them?

[Dominic D’Agostino]: Yeah, that’s a good question. Interestingly, we can use exogenous ketones even if we’re not keto-adapted at all, and that was our first study that we did for CNS oxygen toxicity. It was actually rats eating a standard rodent chow which is 60-70 percent carbohydrates.

We gave a single dose not even feeding it chronically, 30 minutes prior to doing a deep oxygen dive. It worked remarkably well and that really surprised me. So, taking a little bit of a step back, we use the R-enantiomer of the beta-hydroxybutyrate, and it didn’t work.

But then when we found out the ester that did work, that particular compound worked remarkably well. That kind of changed my thinking because I approached it with the understanding or the bias that you really need to be keto-adapted. But if you are adapted to burning fat and ketones for fuel, what has been shown is that you do up-regulate the transporters and the enzymes associated with ketone metabolism.

So, you will theoretically be deriving more benefit from exogenous ketones if you have been previously adapted to a ketogenic diet. I think from a practical standpoint, say you’re on a ketogenic diet and you choose to transition to eating carbs for some reason and then you throw ketones back in. Since you’re adapted to a ketogenic diet already, I think you’ll use those ketones more efficiently even by following a carbohydrate based diet.

We have some evidence to indicate that glucose disposal is enhanced in the presence of ketones. So, it may actually be enhancing insulin sensitivity. The glucose goes does, if you have animals eating a high carb diet and you bolus exogenous ketones, the glucose goes down remarkably low. Much more than you even get with something like Metformin.

What we don’t know why that’s happening, we want to look at the liver metabolimic profile. I think it could be influencing the liver in some way, and may be decreasing hepatic glucose output. Really it’s your liver that dictates your blood glucose, it’s all happening in the liver.

So, if you turn down gluconeogenesis in the liver, you would see a decrease in blood glucose. But also if you’re enhancing insulin sensitivity you would be facilitating glucose disposal and peripheral tissues with ketones. I know Dr. Richard Veech at the NIH has written about that and suggested that ketones actually do enhance glucose uptake and insulin sensitivity.

I get the question, what if you throw ketones on top of carbohydrates? What are the cells going to use? I think the cells will use what’s available to them and we know that the brain might not be able to use the certain types of fatty acids but they can use MCTs.

If you have glucose and ketones in the blood, your cells, your muscle cells, brain cells will be using both fuels. There’s some evidence that suggests that it will be using the glucose more efficiently in the presence of ketones. Because we know ketones can lower reactive oxygen species.

Excess ROS production can decrease insulin sensitivity and cause protein nucleic and lipid peroxidation that can inhibit glucose transporter processes. Even translocation of glucose transporters to the membrane or even PDH complex could be sensitive to the Redox state of the cell.

Ketones tend to normalize or prevent an oxidative environment that could potentially impair glucose transport and insulin sensitivity.

(1:31:56)[Damien Blenkinsopp]: There’s such a wealth of information in this area. It’s not like ketones are a panacea, but there’s just so many applications we’ve spoken about today, so I could go on talking to you for absolute forever. I’m conscious of your time also.

I wanted to round off of a bit of what you do more in terms of optimizing yourself and what you think is effective. For instance, in terms of blood ketones, you said you’re tracking your blood ketones. Have you used the other methods, the urine or the breath method?

The strips for the blood can be a little bit inaccessible in the UK, in the US sometimes, and also they are really expensive. The price varies. I’m sure you have your own ways of getting them but for everyone else it can be a little bit difficult, particularly in the UK I’ve found.

What do you think of the breath? There’s the Ketonix looking at the acetone instead. Do you think that correlates with the blood ketones, and it’s an okay way to try and optimize or not?

[Dominic D’Agostino]: Yeah, it’s a good question. I get this frequently. What I would say the breath, if you’re measuring moderate to high on a breath acetone meter you’re definitely in ketosis. I like it, and I wish it was more quantitative because I’m a numbers guy.

I think we’re all sort of what’s your number? There was like a ketone competition in the lab and my friends like, “You know what’s your ketones today?”. So we like numbers and I wish the unit could be designed.

I believe [unclear (1:33:20)] who’s working on a quantified meter. I like it, and I think it’s great for kids that are trying to manage their epilepsy because breath acetone has correlated with seizure control. So if you give this to a kid and he blows in it and he sees colors and he gets excited, I think that’s great.

It’s giving you a relative level but it’s not a precise level. But it’s also a snapshot of your level of ketosis over the last couple of hours. So your blood, beta-hydroxybutyrate can change.

I’m standing here in front of my desk and talking to you and relatively sedentary. But if I was to go and take a brisk walk on the other side of campus which I do occasionally to get things signed. I’ll come back and measure my ketones, and it’ll be cut in half.

It’ll go from two to one, or below one, just from brisk walk where it should be increased right? Because I should be mobilizing fat, I’m burning fat. But I’ve burnt those ketones for fuel during my movement.

(1:34:25)[Damien Blenkinsopp]: So then it goes into glycogen? I’ve seen this before and I didn’t understand it, that’s why I’m pretty curious.

[Dominic D’Agostino]: Well, it’s burned as fuel. Ketones are substrates, so they’re going to be burned up as fuel. And yes, you may mobilize glycogen from the liver so your glucose can actually go up. You might have some lactic acid from your muscles and through the Cori cycle goes back to the liver and you get some glucose in the blood.

The stress, the sympathetic nervous system from moving and running across traffic and navigating or whatever you do when you walk, that can contribute. What I really found that’s most important is you need to be completely calm and sedentary when you make these measurements to get accurate measurements to prevent the variability.

We have this issue with our rodent studies, we need to pull the food from them for about four to eight hours, to normalize the blood glucose. Because you have some that are nibbling on food, some that have gorged, others haven’t eaten. So the glucose is going to be all over.

To standardize and normalize glucose, you need to remove their food for a little bit and the numbers are tighter. The same thing applies for measuring ketones, especially blood ketones, you need to be fairly sedentary to do it. I really like the urine ketone strips, got a bad wrap, but I like the urine ketone strips.

They’re still used by John’s Hopkins. So, before you go spending a lot of money on getting ketone strips for the meter. You want to first confirm that you’re actually in ketosis on a urine strip.

If you’re registering 15 or 40 mg/dL on a ketone strip then it’s like, “Okay, at least if I take a blood measurement now. I’m going to register something on my blood meter and it’s going to be ‘I’m in ketosis’.” I remember the other meter, I think it’s the Novamax meter, would just give you this annoying, ‘low’, it won’t even read your number on it.

One person went out and bought a couple hundred hours worth of strips and have like 17 lows on there, and have come to find out you’re just eating too much protein or they think it’s okay to drink fruit juice. I forgot what the situation was.

Well first change your diet, then go out and get some urine ketone strips. Once you’re actually in ketosis on the urine strip then go back to the blood meter. And come to find that they tweaked their diet a little bit.

They did it until they were measuring ketones on the urine strip and they went to the blood meter, and bang they get 1.2 and they get all excited. So they could’ve saved a lot of money.

(1:37:04)[Damien Blenkinsopp]: Right. Because the urine gets a bad wrap, because it stops working once you get more keto-adapted. But when you’re first on a ketogenic diet and you’re trying to check that, that’s not going to happen. Right?

[Dominic D’Agostino]: Hydration state too, also plays a role, and less ketones will spill into the urine over time because you’ll conserve them as fuel. The transporters change a little bit. But if your hydration — if you’re drinking lots of water those people who carry water around with them and drinking.

Your urine ketones may register pretty low. Sometimes I wake up dehydrated and I would check my urine ketones will be quite high, whereas my blood ketones would be quite low. So, that’s just an indication of my hydration status.

It’s also a snapshot of what your ketones were over the last four, five, six hours because that urine is collecting in your bladder over time. So it’s sort of a snapshot of what’s happening through the course of the day, whereas your blood ketone is a snapshot of your ketone level at that point in time.

(1:38:04)[Damien Blenkinsopp]: Right, just a bit of information more about you and what you do these days? In terms of tracking things, it seems like you’ve tracked a lot yourself. Are there things that have stood out for you?

Overall, the time that you’ve tracked yourself and you found really useful insights from? Any quants or anything you’ve changed something you do in your life because of that?

[Dominic D’Agostino]: Yeah, I think initially when I started doing the ketogenic diet it was very dairy based. I was taking lots of creams, a stick or two. Two sticks of butter a day. So, I had a really high intake of dairy fat, probably about 200 plus grams of fat per day of dairy.

My LDL went up pretty high and my triglycerides went down a little bit but not really low. Then, I started replacing some of the dairy fat or the whole cream with coconut cream, and just using a little more coconut oil, getting more avocado in from my fats.

I still get dairy fat, by a sour cream that has live cultures in it. I’ll probably get about 50 to 70 grams of fat per day from dairy instead of like 250 grams of fat which I was getting initially. My lab test has improved. I guess you would say, I think my insulin sensitivity is better.

My glucose I can get lower glucose numbers now after eliminating some dairy. My triglycerides are really low now, they stay at 40s to 50s, I think it was 36 at one time. My HDL has improved and better and it’s really high, like 90 something.

My LDL went from really high to normal, but normal high. Now, which I think is completely normal and actually maybe even optimal. My IGF-1 levels are really low now compared to when I was on dairy.

I think dairy may have been contributing a little bit to some insulin resistance or maybe I was just getting a surplus amount of calories. My CRP levels also are the lowest now than they’ve ever been. I mean it’s like 0.1 or 0.2.

[Damien Blenkinsopp]: Right. Basically nothing, that’s the bottom of the range.

[Dominic D’Agostino]: Yeah, it’s like totally bombed out. I just feel better. If I eat a lot of dairy, I do wake up a little bit slightly congested, stuffy in my nose but it’s not bad.

I wouldn’t call it an allergies, and it could be due to allergies. But eliminating that has sort of helped, not eliminating, but reducing the amount of dairy. I don’t get in a whole lot of dairy protein. Maybe a slice of cheese here and there but I limit that. I limit casein. I don’t take away protein anymore.

The dairy that I get is primarily dairy fat. I was actually thinking about, I get very little butter, but I was going to switch to Ghee, and do some clarified butter. The triglycerides I would say for people to look at, for physiological biomarkers, your heart rate, blood pressure, sleep is an important one.

I wear the FitBit Charged. It’s really fun to look at my heart rate during the course of the day and in my sleep, and those sorts of things. I have a Dexcom that I’m going to put in. And I want to…

[Damien Blenkinsopp]: Is that the latest one? Is it the 4 or 5?

[Dominic D’Agostino]: Yeah.

[Damien Blenkinsopp]: I know Peter Attia is playing with that.

[Dominic D’Agostino]: Yeah, the 5 I think it is. So, I’ve just been traveling I just wanted to wait until I was put it in one spot and I can test it. I’m interested in trying that, and maybe working with some companies too, to do a glucose and ketone Dexcom.

I’m hoping to try that. That would definitely fit into your show. Yeah Quantified Self, and get some data for that, that would be good. As far as looking at physical biomarkers, you want to look at blood pressure, heart rates, sleep, and all these things improved when I got on a ketogenic diet.

I think there were various reasons for that. The lab test, the simple ones are probably the most beneficial ones. Triglycerides are the things that I look at the most. My HDL I think is important, and CRP, and of course your blood glucose. If you’re keeping glucose levels between 60 – 80, and doing that pretty much all the time.

Everything else is going to be good, that’s what I find.

(1:42:35)[Damien Blenkinsopp]: You said you did an insulin sensitivity, was that the homo or was it something else?

[Dominic D’Agostino]: No, I didn’t do that. I did the glucose tolerance.

[Damien Blenkinsopp]: Okay, the challenge.

[Dominic D’Agostino]: Yeah. I did like 50 grams, 75 and 100 grams I think. I think that was like over four hours, the 100-gram ones. Yeah, you drink the nasty Slurpee glucose and look at that. I’m extremely insulin sensitive. I dispose of glucose very fast.

I can also get a little bit of a hypoglycemic effect. If I’m on a ketogenic diet, and I go off of it. For example, I get some rice, sushi, or something like that, I will dip down into the low 50s and bounce back up again – very, very insulin sensitive.

(1:43:18)[Damien Blenkinsopp]: Thanks for that. If you were to recommend one experiment. I can guess what you’re going to say. So, we should try to improve the body whether it’s health performance longevity with the biggest payoff.

What would that be? How should they track it to make sure it’s getting that payoff?

[Dominic D’Agostino]: It depends on the person really. I don’t think low carb ketogenic diets are ideal for people in their teens or early 20s because they may be extremely insulin sensitive. I know I have tons of friends and I’ve even measured their glucose levels, and they’re great.

They stay pretty low, the glucose levels and they have adapted really well to a high carb diet. They wouldn’t want to do a ketogenic diet. So, maybe you’re expecting that kind of answer.

But, I think periodic fasting would be an important thing to do. I’ve been talking to some high-level CEO people and they tell me, “Well, I’ve been doing this anyway because I’m so busy. I wake up and I just work all day, and just go home and eat at night.”

But if your pattern of eating — like my patter of eating — I was obsessed with eating every two hours especially when I was really into lifting. I felt I had this preoccupation with food, preparing my meals, carrying it with me. I think it’s very liberating to not have to do that and to realize that your performance, energy levels, are not going to tank if you eat one meal a day.

If you were to do a short term fast, initially, and to do that every once in a while. I think, not only is very good for your metabolic health. I think it’s also good for your state of mind because it tells your body. It tells your mind that you don’t have to be sort of psychologically dependent upon food.

I would go five or six hours, and I’ll be like, “I’m starving I have to eat something.” I have been around people that are like that. My wife is kind of like that, she’s an incredible carb burner.

But if we’re traveling and she’s gone four to five hours without having a meal. I could see it in her mood and in everything. But that’s fine we’ll stop and get something to eat, and usually we’ll have coffee or something like that. But it’s interesting to see, and she sees it in me, “How could you go this long? Aren’t you hungry? What’s wrong with you?”.

She understands it now. She’s watched me do so many tricks and everything. If you’re not a big fan of being hungry. If you’re not a fan of having to eat every two or three hours because you’re hungry. I think doing some intermittent fasting would be a really good experiment for you to do.

I actually interviewed Mark Mattson at IHMC. So, I’m also a research scientist at Institute for Human and Machine Cognition. We interviewed Mattson, I think you did too for a podcast. He really went into the benefits of intermittent fasting and he’s at the National Institute of Health.

If you get a chance, he gave a brilliant lecture, presentation. If you go to IHMC lectures and look up Mark Mattson, he gave a great talk on this. He talks about all the health benefits.

If you do embark — if your listeners embark on [an] intermittent fasting experiment it would be interesting for them to track their blood glucose levels, their ketone levels, their triglycerides and their c-reactive protein. I think in each one of those biomarkers, if you want to call them that, will improve with intermittent fasting. I’ve seen it.

(1:46:51)[Damien Blenkinsopp]: You’re saying the 16-hour window or one day? Because you said short-fast, do you mean like a one day, 16, or 20 hours?

[Dominic D’Agostino]: Yeah. You could do every other day eating. But I think the easiest thing to do for most people would be, what I’d do if I do intermittent fasting maybe once or twice a week now. I eat two meals a day but like once or twice a week I’ll eat one meal a day, and it varies depending on what I’m doing and testing.

But it will be 18 hours of fasting and 6 hours of eating. Actually I get home late, so it ends being about 20 hours of fasting and four hours of eating. So, it will be 7pm – 11pm. I’ve done it [with] water and abstained from putting fat into my coffee.

I’ve also done what I would call ‘fat fast’, so I would put in some MCTs in my coffee and maybe get a ketone supplement during the day. I would still call that a fast because it’s basically non-glycemic.

[Damien Blenkinsopp]: Yeah, probably has very similar ketone and glucose effects.

[Dominic D’Agostino]: Yeah, I actually find that it’s optimal. So, I would call that a modified intermittent fasting protocol, where you would get in some fats and exogenous ketones during that fasting period. I’m a little less hungry once I go into that eating window.

I think that’s good too, so I tend to not over eat that much. My body is still strongly in a state of ketosis that has probably enhanced a bit with the supplementation. It tends to dampen my appetite a little bit so I’m not as ravenous.

But I don’t generally don’t get that ravenous anyway when I eat. But, I would experiment with that the intermittent fasting. I think it’s so easy to do. I mean intermittent fasting is easier to do than the ketogenic diet that’s what I find with people.

So, do some experiment, get some initial blood work, read up about it, listen to Mark Mattson’s talk on [the] IHMC website and you’ll find it there. I’m sure there’s a lot of blogs on the subject and do blood work before and three to four weeks after.

You’ll see pretty big effects, especially six and eight weeks after. You’ll see even bigger effects on your lipid profile and metabolic biomarkers.

(1:49:04)[Damien Blenkinsopp]: Excellent thank you so much for that, that’s a great one. Where would someone look to learn more about your topic? Are there any good books or presentations on the subject you’d recommend if they want to learn more about the whole subject of ketones and ketosis?

[Dominic D’Agostino]: One of the go to book that I would recommend is Jeff Volek’s ‘Art and Science of Low Carbohydrate Performance’. It’s a mandatory reading for students entering the lab just to get a hand on what the ketogenic diet is. The Ketogenic Diet Resource is a website maintained by a friend of mine, Ellen Davis, and I think has a lot of good information on it.

But I maintain a website to throw up links, compile links in there called ketonutrition.org. If you click on resources from the homepage, it will take you to dietary consultants, books, publications, list of podcasts, and lectures on there on a variety of subjects that hit on pretty much all the topics we’ve discussed. I probably need to get on there, but it’s relatively updated. I’ll probably update that in the next month or two.

Metabolic Optimization too, that’s a website that I started with Travis Christofferson who wrote the book ‘Tripping Over the Truth’ which is an excellent book that covers the metabolic theory of cancer. Travis and I maintain the website Metabolic Optimization, and we have Thomas Seyfried on.

We’ve had Adrienne Scheck, we’ve had Bruce Ames actually was our first guy. We’re going to line up a bunch of other speakers on metabolism so that’s another area where they can look up information on these topics.

[Damien Blenkinsopp]: Great, thanks for that. Are you active on Twitter? Where could people also connect with you and keep updated of what you’re at?

[Dominic D’Agostino]: I tried to post at Twitter maybe once or twice a week, not like super active. But on Facebook I post a little bit more. My page is maxed out, I got 500 or 5,000 people following me.

So I’ll probably create a more public page. But you could still follow me because I post things open to the public. I will post usually one or two studies per day, or podcasts or lectures per day on my Facebook page which should be very easy to find.

It’s always sort of topics relevant to the interests or the topics that we covered today. Sometimes I dual post on Twitter and Facebook, important things that pop up as far as studies and lectures and things like that.

(1:51:39)[Damien Blenkinsopp]: Excellent. Of course, we’ll put links to everything you’ve mentioned here in the short notes. Is there anyone besides yourself? You’ve already mentioned a few people, but was there any you would pull out and you would recommend if people wanted to learn more about the subject? Are there are some other people that you would recommend also?

[Dominic D’Agostino]: Yeah. My colleagues, there’s so many of them. I try to stay very active in collaboration. It’s really good for scientists to collaborate to help get their work out there. Also, to get other people to validate the findings that you did in the lab.

So, I know you’ve had Thomas Seyfried. He’s a great friend and colleague of mine. Adrienne Scheck is a fantastic scientist and a pioneer in ketogenic diets and moving the ketogenic diet into clinical trials at Barrow Neurological Institute.

There’s some of the mentors that even got me into this field — would be Dr. Eric Kossoff. He’s a neurologist at Johns Hopkins. He’s been a pioneer in using a ketogenic diet for kids with epilepsy, so look him up.

John Roe who’s a neuroscientist and pediatrician. He was originally at Barrow Neurological Institute and he was the first scientist I ever connected with to discuss this. The use of the ketogenic nutrition for oxygen toxicity.

Dr. Richard Veech he had a profound influence on me when I first got into this area of ketogenic diet and discovered exogenous ketones. It was his reviews on the subject. So if you look up on some of his reviews on ketones and the therapeutic effects of ketones, they’re really good.

Susan Masino has been really supportive of our work and she’s doing some really innovative work looking at the effects of the ketogenic diet on adenosine. Adenosine is a neuroprotective substance that’s elevated, has anti seizure, anti-convulsant, neuroprotective effects.

So, we actually have a lot of these speakers [who] will be coming to our Metabolic Therapeutics’s Conference which will be held either the last week in January or the first week in February. We had a number of speakers, we had Eugene Fine, Colin Champ, David Ludwig, David Diamond, he was a colleague of mine here at USF and [we] talked about cholesterol and statins.

We had Eric Kossoff, Adam Hartman, and a bunch of scientists. So, I would tell your listeners to go to the Metabolic Therapeutic’s website. We’re in the process now of sending out the invitation for speakers.

And pretty soon, I think we might have a preliminary site set up for that, but we’ll be updating that soon with all the different speakers and the topics that are going to be talked about. We really try to emphasize basic science, so you’re going to find lectures on neurophysiology, cancer biology, proteomics, tracer based metabolomics.

Performance — Jeff Volek will be there talking about performance. It will be a mix of things related to not just the ketogenic diet but metabolism in general.

[Damien Blenkinsopp]: Sounds fantastic so anyone can attend that?

[Dominic D’Agostino]: Anyone can attend that, yeah. We should have the registration going up soon. The problem that we had is that last year the venue was small. We wanted originally to keep it small, to cap it at about 250, but we had to turn so many people away.

So, this year we’re going to blow it up a little bit and probably have about maybe 600 – 700 people, hopefully in the same venue. But we’re going to get the whole hotel. You’re going to find a lot of great companies there that are producing these exogenous ketones.

So, Pruvit is going to be there, probably Forever Green, the company Kegenix – they make a great product that I’ve been testing recently during my travels. KetoSports hopefully will be there, and Quest Nutrition has a big footprint in our conference and they have been incredibly supportive of our work.

Scivation, who’s really the leader in branch chain amino acid supplements, will be there. Let me see, we have a lot of good sponsorship supporting this area of research. It’s really exciting to me that it’s becoming so popular it’s easy to find companies that are now emerging that are interested in developing products that can enhance nutritional ketosis.

So it’s fun to see a market for this evolving. They’re are creating products that I think will be very beneficial to patients even that are following nutritional ketosis for managing a disease process.

I do get Emails every single day from patients that are using these products that made a world of a difference. They couldn’t get into ketosis and once they did or their trial did, they started getting all these benefits from the ketones.

[Damien Blenkinsopp]: It’s a super exciting area, you’re very lucky to be right in the center of it.

[Dominic D’Agostino]: Yeah. I do feel lucky.

(1:56:48)[Damien Blenkinsopp]: Just as a quick anecdote, I gave some MCT powders and C8 to my mother because she has tremors. They have been getting worse over time, and they are so much better it seems. She was really surprised by that.

But it is an exciting area, they have so many crazy benefits, so broad compared to the other things we looked at. Which is one of the reasons I’ve covered it several times in different episodes, fasting, ketosis, all of these.

Whereas most topics I don’t cover in many episodes but this one has just so many applications, it’s just interesting. I think it’s worthwhile for people to learn more and more about it.

[Dominic D’Agostino]: Absolutely.

[Damien Blenkinsopp]: Dom, thank you so much for your time. I really appreciate it, we’ve covered such a wealth of topics. I know there’s so much more you could talk about. So, thanks very much for your time.

It’s been great talking to you.

[Dominic D’Agostino]: Thanks for having me Damien. I appreciate it.

References:

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Putting the body into ketosis and controlling blood glucose levels may prove to be effective therapy against certain cancers. This real case reveals one aggressive self-experimenter who used a combination of the ketogenic diet, fasting and other tools to control his epilepsy and send his brain cancer into remission.

This episode examines the ketogenic diet as a tool to fight against cancer. It is a follow up of the episodes on ketosis and fasting that we have done with Dr. Thomas Seyfried in episode 16, and Gene Fine in episode 36. You definitely should check those out for context before or after you dive into this one to fill in any gaps.

We are talking to someone who has actually used ketosis by a combination of ketogenic dieting and fasting as a therapy to fight his brain tumor. Our guest has gone through a variety of extreme approaches to ensure he remains in a high state of ketosis. In his case, his life depended on it. This episode is not just for those with cancer or epilepsy, but also for those interested in the benefits of the ketogenic diet. You can take some of the tools he used to improve your own state of ketosis if you are having trouble maintaining it.

[W]hen I have my blood tests . . . and [test] a number of markers for potential tumor progression, internally, I am actually much healthier than before I had cancer . . .
– Andrew Scarborough

I met Andrew Scarborough at a conference where he spoke about his experience with ketosis and its effect on his brain tumor. After being diagnosed with a type of malignant tumor called an Anaplastic Astrocytoma, Andrew underwent several months of unsuccessful chemo treatment. He decided to take his cancer treatment and management of his epilepsy into his own hands and to go the ketosis route. This decision was based in a small part on researching Thomas Seyfried’s work, which we will also discuss in the episode.

Fortunately, this decision has yielded very positive results for him, and his tumor has shrunk. In fact, it has disappeared from scans (seen below) and his doctors are now giving him the all clear. Andrew is now working with London-based hospitals to develop clinical trials for treating brain cancer patients using an optimized ketogenic diet.


Andrew's brain tumor before and after being on the ketogenic diet.

Andrew’s brain tumor before and after being on the ketogenic diet.


There are a lot of details in this podcast on how Andrew went about using the ketogenic diet, including the types of foods he ate, how he optimized the diet for his situation, the extreme measures he has taken, and how he has been able to keep up physical activity. We will talk about everything on his journey, including things like eating bugs and sheep’s brain, and quitting eating plant-based foods altogether.

The episode highlights, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

What You’ll Learn

  • The beginning of Andrew’s brain cancer story (4:46).
  • Andrew is diagnosed with a grade 3 Anaplastic Astrocytoma (12:14).
  • After unsuccessful chemo treatment, Andrew devises a treatment using the ketogenic diet (19:19).
  • Using MRIs to visualize changes in the metabolic activity of the tumor due to the ketogenic diet (20:52).
  • Scans show complete remission since using the ketogenic diet (23:40).
  • Optimizing and maintaining the ketogenic diet for brain cancer management (26:40).
  • The biomarkers Andrew tracks to monitor the effects of the ketogenic diet (28:08).
  • The glucose-ketone index (29:13).
  • Andrew’s typical diet (32:58).
  • Maintaining a healthy 1:1 ratio of Omega-6 to Omega-3 (33:35).
  • The ketogenic foods Andrew eats (36:10).
  • Variations on the traditional ketogenic diet (41:30).
  • Supplementing the diet with insects (46:30).
  • Keeping up ketone levels and controlling seizure activity during exercise (50:16).
  • Andrew’s research on an optimized ketogenic diet for brain cancer patients (54:50).
  • More on Omega-6/Omega-3 ratios (59:15).
  • Limiting protein and fasting (1:00:32).
  • Using magnesium to prevent seizures during a fast (1:02:08).
  • Mimicking chemo naturally with diet (1:06:44).
  • The resources Andrew recommends for those facing cancer or epilepsy or interested in the ketogenic diet (1:11:47).
  • Andrew’s advice on what biomarkers to look at and where to start with the ketogenic diet (1:18:34).

Thank Andrew Scarborough on Twitter for this interview.
Click Here to let him know you enjoyed the show!

Andrew Scarborough

Tools & Tactics

Interventions

  • Hyperbaric Oxygen Therapy (HBOT): A therapy Dr. Seyfried believes may be beneficial to fight cancer but is relatively non-toxic in comparison to current treatment modalities (chemo and immuno-therapies). It exposes the body to higher levels of oxygen via having the person sit in a pressurized tank with higher oxygen concentrations. Andrew is adding this therapy to his current tools. Typically you visit centers that provide sessions inside hyperbaric oxygen tanks, however some new smaller and lower pressure HBOTs are now beginning to appear in the market that you can buy to use at home.

Supplementation

  • Ketosports KetoForce: KetoForce contains the endogenous ketone body beta-hydroxybutyrate (BHB) in sodium and potassium salt form. The compound BHB can be used as an energy source by the brain when blood glucose is low. Ingesting KetoForce raises the levels of blood ketones for 2.5-3.0 hours after ingestion. (Note: A similar product from the same company is Ketosports KetoCaNa). Andrew uses KetoForce to increase his ketone levels during gentle exercise.
  • Ancient Minerals Magnesium Spray: Most people with epilepsy have a magnesium deficiency. Magnesium supplementation has been used to reduce seizure activity in people with epilepsy. Andrew prepares his own magnesium chloride solution that he takes transdermally multiple times every day (about 230 mg per day) and during exercise, which can be a seizure trigger for him.
  • Curcumin BCM95: Curcumin is a derivative of turmeric which is an anti-inflammatory antioxidant and potentially has anti-cancer properties. Andrew takes Curcumin in tablet form with DHA because it increases the uptake of DHA to the brain.

Diet & Nutrition

  • Ketogenic Diets: The ketogenic diet is a low carb diet which raises the level of ketone bodies in the blood. Tumor cells are inefficient at processing ketone bodies for energy. The diet is commonly used to help control epilepsy in children.
  • Paleo Diet: A diet that mimics the nutrition of early hunter-gatherers, and consists of all lean meats and fish, fresh fruits, and non starchy vegetables.
  • Water Fasts: A water-only fast of at least 3 days and preferably 5 days is recommended by Dr. Seyfried as a tool to reduce cancer risk and to lower your glucose – ketone index to 1.0. They are the standard fast protocol used in most of the research studies looking at cancer inhibition or therapy for cancer patients. Learn more from Damien’s experience with a 5-day-water-fast.

Tracking

Biomarkers

  • Blood Glucose: A measure of the level of glucose in the blood at one point in time. Blood glucose is a biomarker for increased cancer risk. Therapies target reduction of blood glucose levels to limit cancer cell growth. Blood glucose levels vary throughout the day. Ideally levels should be kept below 100 mg/dL and below ~85mg/dL for fasting glucose. Andrew maintains his around 60-70 mg/dL.
  • Glucose – Ketone Index (GKI): The ratio between the concentration of glucose in the blood to ketone bodies in the blood. The calculation is Glucose (mmol)/ Ketone (mmol). Dr. Seyfried created the index as a better way to assess metabolic status. Therapeutic efficacy is considered best with index values approaching 1.0 or below. Patients with chronic disease like cancer have index values of 50 or more. Check out the episode with Thomas Seyfried here.
  • Cholesterol-HDL and LDL: The cholesterol biomarkers include lipoproteins and triglycerides which are found in the blood. There are standard markers that all doctors and labs will run, and some newer specialist labs that are more specific and accurate. There are two main types of lipoproteins, HDL and LDL. We covered these markers extensively in episode 7.
  • Omega-6/Omega-3 Ratio: Many Western diets are deficient in Omega-3 fatty acids, such as DHA, and have excess Omega-6 fatty acids. A high Omega-6/Omega-3 ratio promotes inflammation and the pathogenesis of many diseases, including cancer, whereas increased levels of Omega-3 (a low Omega-6/Omega-3 ratio of about 1) exert suppressive effects.
  • hs-CRP (high sensitivity C-reactive Protein): a marker for systematic inflammation that can be measured over a period of time to determine effectiveness of treatments such as the ketogenic diet. Ideally CRP levels should be <1 mg/L. High levels are associated with chronic inflammation, which is common in cancer and other chronic diseases.

Lab Tests, Devices and Apps

  • Glucometer: is a device used to measure the level of glucose in the blood. Andrew and Damien use the Freestyle Optium Neo Glucose/ Ketone meter. Andrew’s ketones and blood glucose levels hover around 65 mg/dl, which puts him somewhere around 0.6-0.8 on the Seyfried index. Check out episode 16 to learn more about the Seyfried Index.
  • Omega Blood Count: Measures the levels of Omega-6 and Omega-3 fatty acids in your blood. (Note: This test is only purchasable via offline retail stores such as pharmacies and health shops in the UK – an alternative test that Andrew recommends that you can buy online in US or UK is OmegaQuant.com)
  • Complete Lipid Panel: measures total cholesterol, triglyceride levels, HDL and LDL cholesterol, which are all found in the blood. High blood lipoprotein levels are associated with cancer.
  • Complete Blood Count: is a blood panel that measures the levels of the different cells in the blood. Numbers of the different types of cells vary depending on disease status and even between people. The test is often used to monitor cancer progression and treatment.
  • Magnetic Resonance Imaging (MRI): MRI scans use pulses of magnetic energy to visualize internal organs and structures. It can be used on almost any area of the body and provides information on tumors, bleeding, injuries, blood vessels, or infection. MRIs were used to monitor Andrew’s brain tumor.
  • Positron Emission Tomography (PET) scan: A PET scan is a functional imaging technique used to image body processes. A PET scan can be used to identify cancer presence and severity. A radioactive tracer, fluorodeoxyglucose, is used to tag cancerous cells so they can be visualized. Check out episode 36: Quantifying Cancer and Reexamining Which Cancers May be Inhibited by Fasts with Gene Fine to learn more about PET scans and cancer.

Other People, Books & Resources

People

  • Dr. Thomas N. Seyfried, PhD: University of Illinois, Urbana-Champaign. Dr. Seyfried’s research focuses on the mechanisms by which metabolic therapies manage chronic diseases like cancer, epilepsy, and neurodegenerative lipid storage dysfunctions. Check out Dr. Seyfried’s episode on “Water Fasts as Potential Tactic to Beat Cancer.”
  • Dr. Dominic D’Agostino, PhD: Assistant Professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida Morsani College of Medicine, and a Senior Research Scientist at the Institute of Human and Machine Cognition. His research focuses on developing and testing nutritional and metabolic therapies for neurological disorders and cancer. His own website is Keto Nutrition
  • Dr. Colin Champ, MD: A board-certified radiation oncologist and Assistant Professor at the University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center. He is also board-certified in integrative medicine by the American Board of Integrative and Holistic Medicine. His focus is the role and effect diet and nutrition may have in cancer treatment.
  • Dr. Adrienne Scheck, PhD: An Associate Professor of Neurobiology at Barrow Neurological Institute. Her expertise is in neuro-oncology and her lab has been involved in investigating the effects of the ketogenic diet on brain cancer.

Organizations

Books

Other

  • Ketogenic Diet Resource: Andrew says this website has answers to just about all the questions you could have.
  • Clinicaltrials.gov: This site can provide you with information on clinical trials that are currently being done relating to the ketogenic diet and different cancers.

Full Interview Transcript

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[Damien Blenkinsopp]: Andrew, welcome. Thank you so much for coming on the show.

[Andrew Scarborough]: Thank you for having me.

(04:39) [Damien Blenkinsopp]: Yes. You have quite an amazing story that a lot of people are very interested in hearing about. It’s always good to get the context of how this happened to you, and where it all started? Could you go into the beginning, how you made the discovery that you had this condition? How did it start?

[Andrew Scarborough]: Yes. I was studying a Master’s in Nutritional Therapy at the University of Westminster. This is before my diagnosis, and I was suffering from migraine headaches for a few months. Until suddenly I had lost my speech in February 2013, this was nearly 3 years ago now.

What I didn’t know at the time, that was my first partial seizure, and just being a man I carried on.

[Damien Blenkinsopp]: So to describe that, did you have difficulty saying words, or what exactly happened?

[Andrew Scarborough]: I went very dizzy, and then lost my speech completely for about five to six minutes, I was with a friend and we laughed about it because it was a bit strange. Because it was quite a cold day, it was February, I was just thinking when you get cold and shivering. You just stutter and loose — you struggle to speak, but it was a lot more serious than that.

I didn’t do anything about it. A couple of months later, I was experiencing very similar symptoms with pins and needles in my tongue and throat. To cut a long story short, I went on the train after a heavy gym workout. And, I felt like I actually have a lot of energy after the workout, even though I really struggled through it.

I just felt completely wiped out, even though it wasn’t the most difficult workout. I suffered more seizure activity afterwards, when I was getting on the train, very busy train actually in London to go home. And I devastatingly had a crushing headache, like my head was in a nutcracker.

The pressure was constantly building up, then I suffered a quite a traumatic brain hemorrhage, and grand mal seizure on the train, which wasn’t too pleasant, and the whole train stopped. I was rushed to hospital. There was so much blood in my brain that they didn’t know what to say, what actually was the cause.

As I was in hospital not knowing — feeling very confused not able to speak or walk at this point. I was given a CT scan and all that was shown was this massive blood in my brain. It looked like an explosion had gone off. I was still experiencing horrific grand mal seizures at this time, so I had things explained to me, and at the time, they were going in one ear and out the other, because I was so out of it.

That was quite a tough time from my family, and my first diagnosis was an AVM, which is an arteriovenous malformation. Because it looks so poor on the scans — because CT scans are quite ambiguous. All we could really see was just a tangle of blood vessels and arteries.

[Damien Blenkinsopp]: So, they thought it was an artery that had grown the wrong way, or you’d been born . . .

[Andrew Scarborough]: They saw it as being an unusual tangle of mess.

[Damien Blenkinsopp]: Okay, the arteries growing in the wrong way.

[Andrew Scarborough]: Yeah. They said, “No it’s not probably like that, it’s probably a Cavernous Hemangioma instead, which is a tangle of abnormal blood vessels, not tangled in the arteries.” Which is better because it was a bit less life-threatening, but I was given a number of misdiagnoses before. Eventually, I had an operation, because I was continually having these grand mal seizures that were starting to cause me cognitive difficulties, and my speech was getting worse, so I wasn’t able to speak at all at this stage.

(09:11) [Damien Blenkinsopp]: So, going back to the hemorrhage is that a stroke, is it the same as a stroke, or is it slightly different?

[Andrew Scarborough]: It’s very similar to a stroke, it was caused by the pressure of the tumor. Pushing against the side of my skull, and also it was between the speech movement area invading into the motor cortex, that’s why I had lost my speech completely. I had an operation not long after, in May 2013, to try and remove as much as possible, if this very vascular and invasive tumor, which was slightly larger than a size of a golf ball — but invading into the motor cortex area of my brain.

They couldn’t remove all of it because otherwise I would be completely paralyzed or dead. Because I was misdiagnosed, I should’ve had the operation awake but I was unconscious during it. The neurosurgeons said after, “Yeah we probably.”

If he has to do it again, he would have it awake so he could potentially get more out of it, but he couldn’t remove all of it because of where it was in the brain.

[Damien Blenkinsopp]: That’s interesting, what is the difference between you being unconscious and awake, are they able to get some feedback from you?

[Andrew Scarborough]: Yeah. You’re kept awake so they can monitor your responses, while they’re poking around in there to see what can be removed and what can’t, and what healthy brain tissue and what isn’t. One of the main issues with the brain surgery is it’s very difficult to distinguish what’s healthy tissue, and what’s the tumor.

[Damien Blenkinsopp]: So, this is what date now that you’ve had your surgery, and you’ve been given a clear diagnosis?

[Andrew Scarborough]: This point now? It’s two and a half years coming up to three.

[Damien Blenkinsopp]: Okay, it was a few months after your hemorrhage.

[Andrew Scarborough]: That was two months after that I’ve had the operation because they didn’t know what to do with me. There was a lot of blood in my brain, and if you think about a malignant brain tumor, it’s not a great thing if you’ve got a constant blood supply there — and it’s not a fantastic thing if you’ve had this thing that looks like an explosion in the brain, scattering around the cells, and blood everywhere. So, it just makes it more migratory, I guess if that’s the word.

More likely to spread into other areas, which is not ideal. I then had my pathology, finally, and it showed that the tumor was indeed extremely vascular. And there was still some significant scar tissue, as well as some slight enhancement there, but we didn’t know exactly what that was.

[Andrew Scarborough]: So you’re saying, is that a scan?

[Andrew Scarborough]: Yes, sorry.

[Damien Blenkinsopp]: Okay.

[Andrew Scarborough]: — This was the MRI scan after my operation.

[Damien Blenkinsopp]: Is that a straight MRI?

[Andrew Scarborough]: Yes, this was just a standard MRI, but I also had my pathology report from the amount of tumor that was able to be removed, and that came back as an Anaplastic Astrocytoma, which is a Grade 3 Astrocytoma — affecting the glial cells, the astrocytes in the brain, and quite important components of the brain. It’s not a great thing to have, particularly a high grade glioma, which is what mine was.

Brain tumors come in different gradings, so it’s like we’re staging how — with the brain it’s Grades 3 and 4 are highly malignant, and Grades 1 and 2 are slow growing. Grade 1 is typically a solid mass, that you can — if you can operate it can be curable. Even Grade 2s are known to come back, and do grow, but grow at a slower rate. But Grade 3 and 4 are the fastest growing, they grow quite fast. Mine was showing to be heterogeneous, it had quite a few Grade 3 cells in there.

[Damien Blenkinsopp]: Does that mean that it has different types of cancer cells there when you say heterogeneous?

[Andrew Scarborough]: Well, yeah. It showed numerous mutations. It’s very difficult to explain, but it showed that it wouldn’t be chemosensitive, it was negative for IDH1 which is a predictor of longest survival and chemosensitivity. It was also unmethylated for MGMT, which is a repair gene.

And that’s also — it’s not a good thing that it was unmethylated, so it was one of these gene mutations that they say is good to have for longer term survival. I also had tumor suppressor genes missing which again, with these Grade 3 tumors the timescale for survival is variable until it comes back. But in my case, I had just about the worse. It’s scenario terms with the pathology.

(14:33) [Damien Blenkinsopp]: So, did they give you a rough timeline, I guess at that point?

[Andrew Scarborough]: They said it was difficult to tell because of my age and the location of the tumor. Typically in that scenario, it’s around two years when it comes back, and that’s one of the best cases in that particular scenario. It’s a strange type of tumor because in a different scenario with different kind of pathology it can be up to five years or sometimes seven that it comes back.

It’s quite variable, but in my case it didn’t look so good, and I still had some scar tissue where there was lots of — healthy blood supply that could’ve had any enhancement that was present at the time, not great.

[Damien Blenkinsopp]: Must have been a shock, must have been a pretty big shock for you when that one came about.

[Andrew Scarborough]: Yeah, most definitely. I was told that even though my tumor was not chemosensitive that I should probably go ahead and have chemotherapy and radiotherapy, which I did for a short period because I was quite ignorant about it. I thought that it would potentially give me a bit more time.

But then once I’d looked into it I realized that it was only going to cause further mutations for me personally, and I didn’t want to see that. I started to learn my carbohydrate intake and go on a restrictive ketogenic diet after I’ve learned about it prior to my diagnosis, when I was studying a Master’s in Nutritional Therapy.

(16:17) [Damien Blenkinsopp]: Right, what was your lifestyle like before this all happened to you, and how old were you when this happened?

[Andrew Scarborough]: 27, 28. It’s difficult now thinking back, because my birthday’s at September 1, so I was 27 going on 28. It was two and half years ago and I’m 30 now.

[Damien Blenkinsopp]: So roughly 28 or 27.

[Andrew Scarborough]: Yeah. I was on a diet that I thought was healthy, so I was on a low fat, high carb with a complex carb diet, all whole foods, so I thought I was doing a good job, no processed food. I actually had quite a low body fat percentage and quite a high lean body mass. I thought I was very healthy, and I was very athletic.

I’d worked as a personal trainer for a few years. I was studying my Master’s in Nutritional Therapy and it was a shock to me that what I was learning in my undergraduate degree in Nutrition was completely useless, because I was learning all these new information that contradicted all the older information, but I was just learning about it. I thought it was interesting but it seemed to go against most of what I’ve studied for the past few years before that.

I thought I was healthy.

(17:44) [Damien Blenkinsopp]: When they gave you the diagnosis for the cancer —people at home are probably thinking, “Well is this one of those — metastasized, so it would spread to other parts of the body, or does it tend to stay concentrated?”

[Andrew Scarborough]: Yeah, well primary brain tumors typically just spread into the brain, which isn’t great because your brain is very useful. Apart from medulloblastoma, which can spread down the spinal fluid and into the central nervous system. It’s the central nervous system that can spread down the spine, and other also spread into the brain.

Mine is an astrocytoma, it would’ve just spread into the brain, and there can also be secondary tumors that come about as a response in the brain. It’s not a great type of tumor to have.

[Damien Blenkinsopp]: No, tumors are good ones to have, but it’s one of the nastier ones.

[Andrew Scarborough]: It’s the step down from glioblastoma, which is the most common type of brain cancer.

[Damien Blenkinsopp]: That always the worst, is the Type 4. . .

[Andrew Scarborough]: Yeah. I thought with my approach, with my own treatment strategy — I thought I have a little bit more time to play around with things and adjust to strict ketogenic diet. If I had a glioblastoma I would’ve pushed things a lot quicker. I did push things quite a lot, and I go to extremes with this diet and this approach.

(19:19) [Damien Blenkinsopp]: Yeah. Did you consider any other options? You said you took a little bit of chemo and radiotherapy —radiation, and pretty quickly you stopped, was that a couple of months?

[Andrew Scarborough]: I stopped after four months because I was proposed to have it for up to two years which is a long time, and I said no after a few months experiencing how horrible that was, and still having these horrible seizures. I thought, “Well, I want my quality of life to be good at least.” I stopped it, because my scans were still showing this enhancement.

I thought, “Well, we don’t know if that’s necrotic tissue or scar tissue, or if it’s the tumor activity.” But I thought that, because my tumor looked so glowing on the scan that it was potentially very responsive to carbohydrate restriction. So you do get some cancers that seem to use more glucose for energy, and you get some that actually use glutamine more for energy than glucose.

More or less they use both for energy, but because mine was so glowing up — lighting up like a Christmas tree I’d like to say, it showed that it was potentially more efficacious to just really cut down on the glucose, and see what was going to happen from that.

[Damien Blenkinsopp]: So these were all MRIs they were giving you?

[Andrew Scarborough]: Yeah, and interestingly even though it’s different from other cancers where you get a PET scan, and you can still see the enhancement there, on an MRI, that was interesting to me.

[Damien Blenkinsopp]: Do you know why that was? We spoke recently to Gene Fine who is talking about the PET scan, in the use of cancers. Do you know why you were able to see it quite clearly on the MRI in your case? Is that specific to brain cancers?

[Andrew Scarborough]: Yeah, I think from what I’ve seen in the literature it is, I don’t know exactly why that is. I guess it’s just you’re able to see the metabolic activity even with — I think it’s an iodine solution, not the good kind, the more radioactive iodine that they give you, rather than the supplemental iodine which you can get which is actually really good for hormonal control and certain cancers.

[Damien Blenkinsopp]: So, they give you an IV of that when you go to your MRI, so they can see more?

[Andrew Scarborough]: Yeah, that’s the contrast injection that they give you. Sometimes with PET scans, they do give you the — that shows up quite nicely with the contrast dye. I view my scan straight after I have them, so it’s interesting to view that.

[Damien Blenkinsopp]: Yeah. So I think its gadolinium, is that the contrast dye you’re talking about?

[Andrew Scarborough]: That’s one of them, but I don’t have that one from my scan, I have something else. I can’t remember exactly what it’s called, but I’ve had a few different kinds of scans. I’ve also had MRI spectroscopy which is a fascinating type of scan.

It works with lights, allowing you to see the microenvironment in the brain. And we’re looking at how the ketogenic diet is changing that environment within those biomarkers within the brain as I’m progressing. That’s really interesting to see.

(23:02) [Damien Blenkinsopp]: Yeah, so great. What kind of scans have you been having over time, and how frequently? And how have you seen the ketogenic diet impact that over time?

[Andrew Scarborough]: Well initially I had a standard MRI scans which were quite boring. The cancer cells, [unclear 23:19] was that wasn’t the best for brain cancer, even though it’s world-renowned for other cancers. At that time, I had the enhancement and significant scar tissue, and I had Hemosiderin, which is a blood staining, that was quite a lot of that showing on my scan.

Since then I’ve had progression in a way that I’ve been given a statement saying that I have a response, that I’ve achieved complete remission, and the enhancement is no longer present. I’ve also had significant healing of the scar tissue, and I’ve had vast improvement of my symptoms. So, I am completely off medication for epilepsy which I was told by five different neurologists — that I’d be crazy to even reduce the medication, and I should increase it because my seizure activity was so bad.

I’ve just had a linear progression of improvement in that respect, so I’m completely off medication for the epilepsy, and for that, I do a number of things which controls my seizure activity. And if I forget to do those things I instantly have seizures — it’s like being on a tightrope you have to keep up with doing all these things, I haven’t had a seizure in a long time. When I start to stop doing these things, or I slip up even a little bit I get an aura, which is a warning for me that I’m going to have a seizure.

I have emergency measures to reverse that, which I’ve devised myself largely. It’s interesting.

(25:07) [Damien Blenkinsopp]: Yeah, sounds very interesting, we’ll jump into that. So the epilepsy is a symptom, it’s driven by the hemorrhage that you had and some damage?

[Andrew Scarborough]: Yeah, and also it can provide these for an indicator of where you are with cancer with the brain. Particular with the temporal lobe epilepsy which is a typical response from a temporal lobe brain tumor. My tumor was between the temporal and frontal lobe, so I have three different types of seizures, which is fun.

Monitoring my symptoms and my seizure triggers, and my theories on what would resolve the seizures, not just the ketogenic diet but things I could do with the ketogenic diet to optimize it specifically for brain cancer management. I was able to work out what worked out most effectively for me personally and relate that to the literature as well. I was then able to go to my neurologist and say, “Well what do you think of this?”. And then when they said, “I think it’s absolutely ridiculous, there’re no science behind it.”

I was able to show the science behind it and my results. And then they could say, “Well that’s very interesting.” I’ve had success that they didn’t expect.

(26:42) [Damien Blenkinsopp]: That’s great. So when were you given the sign off, when they say, “Okay your scans are clear.” Did they say it’s in remission or do they say it’s clear?

[Andrew Scarborough]: With that kind of cancer it’s never deemed as curable and I don’t think it can be curable, but personally I think you can achieve and maintain complete remission, and maintain that status indefinitely. From close observation of the animal studies, when they come off the diet after they’ve achieved complete remission, same kind of cancers, that it comes back almost instantaneously. The unpublished human studies I know the same thing, the same occurrence.

I am very keen to stay on this very strict ketogenic diet, and I actually feel quite good on this. Internally, when I have my blood tests which I have a myriad of different blood tests just to see how I’m doing in terms of my general health. A number of markers for potential tumor progression. Internally I am actually much healthier than before I had cancer, which I find that kind of funny.

(28:08)[Damien Blenkinsopp]: So what kind of improvements have you seen, what are the biomarkers that stand out for you, the test results that have come back, and been useful?

[Andrew Scarborough]: The first thing I looked at was my vitamin D. When I was first diagnosed it was in a severely deficient range, and now it’s in the suboptimal range. People would say it’s too high now, it’s 200, and previously was 20.

I also have my triglycerides tested, I have my cholesterol done, and all those fun markers. I have a full blood count, my white blood cell count was pretty good, I can’t remember the exact figures. It’s actually better than before I had cancer, which is not typical even years after you had cancer, immunity can be compromised, so your white blood cell count is typically quite low, and I found that quite interesting.

(29:13) [Damien Blenkinsopp]: It’s great to hear about that progression. Let’s talk about the actual things that you’ve done in terms of where you started in your ketogenic diet, because I know that people said they’re ketogenic. Have you been tracking your blood ketones and blood glucose since the start? And have you seen how that’s changed as you’ve changed your diet?

[Andrew Scarborough]: Yeah. The first thing I did I went out and got a glucometer to measure my blood ketones and blood glucose, and I was comparing that to book cancerous [unclear 29:45] disease, and the glucose-ketone index that Thomas Seyfried devised and came up with, with his colleagues. I had a number of conversations with him about it, just over email, and I was amazed that he got back to me.

I found it very interesting, I started with trying to do the fast, to start with, to get me in ketosis quite quickly. But I realized with epilepsy that’s not a great idea. I had quite a few bad breakthrough seizures attempting that.

I decided not to try it that way, I decided to do it gradually and over time I managed to get into the therapeutic range within just a few weeks.

[Damien Blenkinsopp]: When you say therapeutic range what is that?

[Andrew Scarborough]: I was using the glucose-ketone index, which you use a ratio where you divide your blood ketones by the blood glucose, and you come up with a number, and you try and make sure that number is — I think it’s above one. I don’t measure it anymore in that way because I’m consistently in very deep ketosis with very low blood glucose, so I don’t have to do it anymore.

[Damien Blenkinsopp]: Yeah, we actually covered the index with Thomas Seyfried before. I think it’s a glucose divided by ketones, and there’s a couple of other little things you have to do in there, it’s not super straight forward. I put a spreadsheet up for some people who are asking, when he was talking to us he said it was under one.

So I guess that’s what you are aiming for and you seem to be saying you’ve gone…

[Andrew Scarborough]: Yeah at that time, that’s what I was aiming for, but now I’m consistently above 3.5, so I don’t have to worry about that so much.

[Damien Blenkinsopp]: Oh, in the glucose-ketone index?

[Andrew Scarborough]: Well my ketones are typically above 3.5, and the blood glucose is typically hovering around 3.5 — at the very least one to one.

[Damien Blenkinsopp]: Okay, so for the people at home, because in the US the blood glucose measurement isn’t millimolar. So you’re talking around in between 54 and 72 mg/dl, like 3-4 millimolar. I’m guessing you’re hovering around with the Seyfried Index somewhere around 0.6, 0.8.

So it’s well below one that’s what you’re saying because your ketones are so high.

[Andrew Scarborough]: Yeah. In the evenings it goes sky high, well the ketones go sky high, the glucose goes really low.

[Damien Blenkinsopp]: Do you mean from 5 o’clock onwards — it’s interesting because I saw that in some of my fast and some of my earlier experiments also.

[Andrew Scarborough]: Yeah. I guess it’s a hormonal thing that happens, and also because there’s that period of time where I only have typically two meals a day, that’s the in-between period, I guess where it goes that high. So that’s where I’ve unintentionally fasted for that period of time even though the diet’s mimicking fasting itself.

(32:58) [Damien Blenkinsopp]: What is a typical day look? What are you doing now, what is your typical day look like? I’m assuming at the moment you’ve got the most extreme version of your own program for this, is that correct?

[Andrew Scarborough]: Yeah. Typically I have 85% of fat and 15% protein in my diet, but over the last few days, I’ve experimented with 90% fat and 10% protein, and negligible carbs. Typically on my 85% and 15% protocol that I follow which is very similar to the animal studies, and quite similar to very strict ketogenic diet for children with epilepsy.

I restrict my calorie intake to 1,600 calories — calorie restriction is extremely important for brain cancer management. You probably discussed that with other people I’m guessing. What’s also important I think is the other things that I’m doing.

Personally, I think it’s very important to make sure you have correct therapeutic ratio — I like to call it of omega 3 and 6 in the blood, and I have at home testing kit for that which I send off to the lab every few months.

[Damien Blenkinsopp]: Okay, that’s interesting, is that a dry spot test?

[Andrew Scarborough]: Yeah, it is. You just have to collect quite a significant amount of blood, and it gives you a report back just saying what you’re ratios of omega 3 and 6 are in your blood.

[Damien Blenkinsopp]: Which lab are you using for that?

[Andrew Scarborough]: Well, the testing kit is by — if you go on Omegasense.com it comes up. There’s a center called the NutriCentre in London, and I just get it from there. It’s a pretty good test, very accurate.

[Damien Blenkinsopp]: Have you seen that change? This is actually the current levels ratio, it’s not like it’s your diet of the day like we were talking about — the blood glucose and the ketones which are changing all the time. It’s a more stable marker which is evolving over time, so you’re choosing for a range you want to keep it within.

[Andrew Scarborough]: I’m just trying to get us close to 1:1 ratio as possible, and I’ve experimented with a 2:1 and a 3:1 ratio in favor of omega 3 which is quite hard to do, but it’s very interesting. We know that omega 3 fatty acids exhibit neuroprotective properties and can represent a potential treatment for a variety of neurodegenerative diseases. It’s really interesting, we know that they are shown to be cytotoxic to tumor cells themselves.

Ideally, an optimal ketogenic diet for brain cancer should have, in my view a better ratio than omega 3 and 6. I think the standard ketogenic diets that are applied to humans at the moment are way to high in omega 6 which is inflammatory. I struggled when I was doing a standard ketogenic diet because of that.

[Damien Blenkinsopp]: What are you taking in order to raise your omega 3 levels? What are you doing in diet specifically?

[Andrew Scarborough]: Well, initially I was eating lots of brains because they are the best source of omega 3 that you could get, and that’s high in DHA, and one of the main fatty acids in the brain is DHA. The brain is 70% fat, and the rest is mostly water, it just makes sense to me to have in my diet mostly fat and water, that was my main reason for doing that.

We also know that the fatty acid composition of gliomas differs from that founding non-malignant brain tissue quite significantly. The reduction of glioma DHA content is really interesting to view — we know that in gliomas which is what my tumor was, and what a glioblastoma is as well. We know that they have significantly less DHA in and around them.

If we can increase that — the literature shows that it can have a very potent effect, particularly when on a ketogenic diet, in shrinking these tumors.

[Damien Blenkinsopp]: That’s great so you’re still eating brains today, is this a large part of your diet? What types of brains?

[Andrew Scarborough]: I was eating lamb’s brains, but, unfortunately, I’ve stopped eating them because of the very, very low risk of Scrapie which is like a CJD, a Mad Cow disease but the lamb form. Even though it’s a very small risk, and you probably have that same risk if you were to eat any infected tissue of that same animal, I just thought it would be a good idea to avoid it, which is a shame because it’s my favorite type of food on the ketogenic diet.

It’s a perfect ketogenic food, but my second most therapeutic ketogenic food that I found is sweetbreads which is the pancreas and the thymus gland of — in my case I get them from lambs again. I’ve done an experiment which is on YouTube, on my YouTube channel, just look at Andrew Scarborough, and look at my sweetbreads experiment, I’m testing the myoglobin of sweetbreads and it comes up very high on the glucometer for ketones.

When I test my blood after my postprandial blood glucose and my blood ketones after eating, my ketones shoot up very high, and the blood glucose stays more or less the same as before I started eating.

[Damien Blenkinsopp]: That’s interesting. Out of interest, how much do sweetbreads cost? Are they relatively cheap or expensive?

[Andrew Scarborough]: Well I mostly get them for free, sometimes I have to pay a pound for them.

[Damien Blenkinsopp]: Okay, so they are very cheap.

[Andrew Scarborough]: Yeah, because no one wants them.

[Damien Blenkinsopp]: Right that’s what I was thinking.

[Andrew Scarborough]: They’re incredibly nutrient dense, rich in trace minerals such as zinc and selenium, and they’re rich in protein, and omega 3 fatty acids. Like the brain, and like all the fish — the great source of omega 3. They also raise ketones very high.

[Damien Blenkinsopp]: Yeah, that’s very surprising. I don’t know if you’ve heard new supplement ranges which I’ve been playing around with it, exogenous ketones.

[Andrew Scarborough]: Yeah, I take those as well. I take KetoForce, mostly when I’m trying to do exercise because exercise is a huge seizure trigger for me. So yeah I play around with that.

[Damien Blenkinsopp]: It sounds like the sweetbreads are more effective than the KetoForce, KetoCaNa and the other ones.

[Andrew Scarborough]: Yeah. I actually made a supplement, a sludgy juice that the sweetbreads come in because I have them completely fresh straight after the animals are being slaughtered, well not straight after, but not long after, because they have to do a number of things just to make sure they are safe to eat. I made a supplement out of that and tested it, and it was very interesting the results, but it tasted absolutely foul.

[Damien Blenkinsopp]: Is that a downside of sweetbreads, they’re really awesome except they taste bad.

[Andrew Scarborough]: Yeah.

[Damien Blenkinsopp]: Okay.

[Andrew Scarborough]: It’s not the best tasting, you have to boil them for a long period of time, but they’re very nutrient dense and very effective.

[Damien Blenkinsopp]: How do you eat them? Have you got a quick recipe for the people at home, and they’re like, “Oh like a great thing to try out.” But if it tastes horrible is there some way to mask it.

[Andrew Scarborough]: The best thing to do is boil them for about an hour, that’s actually a short period of time typically for sweetbreads. Normally, it’s a lot longer. And then if you add tarragon to it, it actually compliments the flavor, and it actually tastes a lot nicer.

That’s one of the things I do, it goes well with tarragon. I just consume every bit of the animal, and I don’t have any carbohydrate so that’s how I get around possible nutrient deficiencies from not having any fruits and vegetables. And it allows me to not count carbohydrates, so it’s a Paleo-Ketogenic diet.

[Damien Blenkinsopp]: It’s a pure meat diet, right? Basically a pure carnivore?

[Andrew Scarborough]: Meat and fish, and fat, and that’s it.

(41:37) [Damien Blenkinsopp]: I do know there’s a little bit of story behind the reason — first you were on a ketogenic diet and you were doing more of a straight forward one with the coconut oil, and all of these kinds of things, what happened?

[Andrew Scarborough]: I noticed that with certain people with certain types of brain injury, your brain can be more sensitive to salicylates which are found in coconut oil, various vegetables and fruits, especially ones that have seeds. I wasn’t able to have avocados or any of the staple ketogenic foods that you have. I also couldn’t have dairy because I had a reaction to that, and I wouldn’t advise dairy anyway on a ketogenic diet for anyone with cancer let alone — brain cancer, because of IGF-1.

It just doesn’t make sense to me that there’re so many ketogenic diets for cancer management that have been based around dairy.

[Damien Blenkinsopp]: Right. There’s a lot of cheese, cheese is pushed quite hard…

[Andrew Scarborough]: Yeah, loads of cheese and double cream, and it’s not efficacious for me, even though I’m astounded that they get any results with these trans fat. And they do get some results, that’s encouraging for me on my — what I would call a more beneficial and effective ketogenic diet for this circumstance.

(43:06)[Damien Blenkinsopp]: Could you explain quickly the IGF-1, because there are people at home that are not quite up to speed on the IGF-1 and the dairy aspect of it. What’s the problem there?

[Andrew Scarborough]: It activates insulin-like growth factor and that can cause cancer cells to proliferate faster. One of the ways I get around that — I used to eat lots of butter, but because it’s more insulinogenic and it has milk proteins and casein. What I do is I have Ghee, which is clarified butter so the milk solids and the casein have been removed, and it’s much less insulinogenic and I actually get a much better blood ketone readings as a result as well compared to butter.

I find that interesting in itself, and we also know that compared to coconut oil, Ghee has much more omega 3 fatty acids, and coconut oil only has omega 6. If you’re basing a ketogenic diet around — just loads and loads of coconut oil which is just omega 6. Even though coconut oil is fantastic for achieving ketosis, I would advise it in moderate amounts if you can tolerate it because it’s really good.

I would say that making sure that you have enough omega 3 by having more animal fats is more beneficial in terms of the overall nutrient profile than just consuming tons of coconut oil.

(44:44) [Damien Blenkinsopp]: Right. You mentioned you eat all the parts of the animal, I’m guessing you mean all of the organs…

[Andrew Scarborough]: Yep.

[Damien Blenkinsopp]: Do you consume what you would call a variety of these? Do you try to cycle them, and the widest spectrum possible? So what other organs are you eating, are you literally eating all of the different organs on a rotation each week?

[Andrew Scarborough]: Yeah. Literally everything but mostly heart, because it’s very very cheap, it would cost me 60 pence at a time, and you get quite a substantial portion— because lamb hearts are quite fatty, there’s a huge chunk of fat on them. I can just eat them as they are, and I don’t need to add extra fat.

It’s a fantastic source of iron, zinc, selenium, B vitamins, folate, and it’s the best food source of coenzyme Q10. It’s funny how people pay an absolute fortune to get pills that have a coenzyme Q10, and I just get the best source that you could possibly get for 60 pence at a time.

[Damien Blenkinsopp]: There’s a psychological barrier about the taste, and it’s just what we’ve become used to really. I’m definitely nowhere near as far as you — I’ve been eating more organ meats and I’m trying to push it up, I just made another order today from a new company actually. I’m slowly building my way up, and it’s a taste I’m struggling with, recipes I think help with that, learning how to cook and deal with the different tastes, and just getting used to them.

[Andrew Scarborough]: Yeah. I actually did quite well to start with brains, they’re actually the most tolerable in terms of tastes because they just taste like creamy eggs.

[Damien Blenkinsopp]: Oh, I would’ve never thought that.

[Andrew Scarborough]: They taste like creamy salty eggs.

[Damien Blenkinsopp]: You just don’t look at them while you’re eating them.

[Andrew Scarborough]: No. And a number of things I do are just for entertainment, to keep the diet interesting, to make sure I have enough trace minerals. That’s why I added insects to my diet quite early on because anytime you eat the whole animal you’re getting a variety of nutrients. When you eat insects you’re consuming the whole animal — it just makes sense that it would be a beneficial thing to have.

[Damien Blenkinsopp]: How do you consume those? Because I know there are cricket bars out there in the US, how are you consuming insects?

[Andrew Scarborough]: What I do is I get the fattiest insects that are ketogenic, I get waxworms and super worms. Mostly insects that reptiles eat, I get them from a pet shop that sells them for reptiles now, I used to get them online.

[Damien Blenkinsopp]: Oh, man. Okay did you used to buy from [check 47:31 – Bug Grow], was that the specific brand — was that the only place you bought from?

[Andrew Scarborough]: Yeah, I tried a few, I tried silk worm, pupa as well — a few different insects have different medicinal properties, they’re in Chinese medicine. They’re really interesting in terms of the properties that they have. But we largely ignore that, mainly what I do now is I get them from the pet shop.

I just stick them in the freezer to kill them, and then I’ll give them a gentle wash and eat them …

[Damien Blenkinsopp]: You just eat them straight?

[Andrew Scarborough]: The problem, if you get them online is that they’ve been dehydrated and cooked so much that the nutrient profile isn’t as good as if you have them fresh after they’ve been wiggling about. I also grind them up and make my own flour after I’ve frozen them. That makes quite nice breads, I make a zero carb ketogenic bread which is very useful. People actually think it’s proper bread…

[Damien Blenkinsopp]: You don’t tell them right?

[Andrew Scarborough]: I’ve actually offered it to people without telling them, and they quite like it, and then I tell them what it is, and they want to punch me. But it’s actually surprisingly quite nice.

[Damien Blenkinsopp]: A quick story here, I was in Mexico 15 years ago and I went to Taxco. Anyway you go up into the mountains, into this old city and they were selling plastic bags full of live insects for eating. It’s something that we used to do — we don’t do in modern society. . .

[Andrew Scarborough]: If you look at anthropology, and how we evolved, it’s largely ignored especially with these Paleo diets — we evolved primarily eating a variety of insects, and in quite a large amount. It suggested that the man would go out and go hunting — would only about a 20% success rate catching these larger animals.

The woman would be mainly collecting insects for food. Seasonally they would collect nuts and berries, but it’s a fact in anthropological studies that we did consume a large amount of insects before we moved closer to the coast to eat fish, and that’s how our brains developed more. It’s an ignored fact.

(50:16)[Damien Blenkinsopp]: It’s really interesting, we’ll get there. There’ll be people writing books — maybe you, about the missing parts of the Paleo diet, Paleo upgraded. You did mention that, when you exercise you’re taking exogenous ketones, because of your epilepsy, why is that?

[Andrew Scarborough]: When I exercise my blood ketones go down, lower than my individual therapeutic reading for seizure control for me personally. I have to do that, and I also have to take another experimental treatment of mine which is proved effective, which I learned from the literature on epilepsy. It’s a magnesium chloride solution that I mix into water, and I have a specific amount that reverses auras.

An aura for me is when you have all symptoms that you’re about to have a more serious type of seizure. An aura is a partial seizure in itself.

[Damien Blenkinsopp]: Okay. Maybe you would loose your words a little bit?

[Andrew Scarborough]: I would get pins and needles in my mouth and throat, and I would feel very dizzy, and faint. I have this horrible feeling like I’m going to collapse and have a tonic-clonic seizure. When I take the magnesium solution that I take three times a day, it actually reverses that aura, it is a potent preventative measure that I found to control seizure activity extremely effectively.

People with any kind of epilepsy, their levels of magnesium drop very low, and there are certain types of the day that magnesium is at its lowest, and typically that’s when seizure threshold is also at its lowest. If we can control that, we can control seizures very effectively. Also, on a ketogenic diet, supplemental magnesium — particularly magnesium chloride are found most effective.

It acts as a natural statin, it has a beneficial effect not only on cholesterol, in a natural way not like a typical statin where it’s actually destroying that process, it’s working with your body to do it naturally. I find that it also controls blood glucose — it regulates blood glucose very effectively too. I see it as my replacement for my medication that I was on previously, and the medication interestingly actually causes magnesium deficiency as well as calcium deficiency, deficiency in vitamin B-12 and vitamin D.

[Damien Blenkinsopp]: Which medication where you on?

[Andrew Scarborough]: I was on the maximum dose of Levetiracetam, which the brand name is Keppra and Sodium Valproate the brand name for that is, Epilim. I was both on those and the highest possible amount that you could be on. You can imagine the side effects of that, and the nutrient deficiencies that caused were just quite substantial.

When you’re withdrawing from those drugs you could actually get breakthrough seizures if you don’t address those nutritional deficiencies, and those seizures can actually cause SUDEP — it’s shorthand for sudden unexpected death in epilepsy. I was told consistently that I was highly likely to have that if I was to — not only come off my medication which is what I eventually did but reduced the medication. I have to reduce that medication for a period of almost two years.

I had to do it very slowly, and adding these nutrients and trace elements so that I was not having these breakthrough seizures that were life-threatening. It was a difficult balance, but I achieved it.

(54:50) [Damien Blenkinsopp]: It makes it easier when you titrate down slowly, but still you’ve been courageous in pushing for all of these things when you’re getting this pushback which is saying it’s really dangerous. Just in terms of the exercise, how do you bump your ketones up – is it the KetoForce?

[Andrew Scarborough]: Yeah. I consume that throughout my workout but I tend to mostly just do quite a light bodyweight exercise because I don’t want to stress my body too much. Thomas Seyfried himself recommends that cancer patients don’t push themselves too much with exercise, because it just puts too much stress on the body and on the brain. Mostly I just go for long walks, in an area with lots of oxygen, and I’m actually going to start having hyperbaric oxygen therapy fairly soon.

I’m in discussions with a number of facilities about that, and I’m going to start doing case studies on patients. I’m actually working part-time at the moment with Imperial College London in Charing Cross Hospital, to start-up clinical trials hopefully next year with brain cancer patients using — what I would call an optimal ketogenic diet.

We’re looking at magnesium for these brain cancer patients, we’re looking at the omega 3 and 6 ratios in the blood, we’re looking at C-reactive protein as a marker for a systemic inflammation, and we’re able to measure that for over a period of time to see how that changes while on a ketogenic diet.

[Damien Blenkinsopp]: With cancer is that typically high the hs-CRP because of the inflammation, or is that just a. . .

[Andrew Scarborough]: Yeah. It’s typically higher than normal, but one of the main ideas of measuring that is to have a marker that you can measure over time. I’m a huge fan of testing and I know that even if these things have no effect on cancer, they have an effect on epilepsy and blood glucose management.

We know that these are prognostic factors and they’re also effective at managing epilepsy which many brain cancer patients have as a result. I’m very keen to start doing this in patients more, and I’m working very hard to do that.

[Damien Blenkinsopp]: It’s very exciting that you’re able to work in hospitals. This is starting next year you said, potentially?

[Andrew Scarborough]: Yes. It would also be featured in, New Scientist magazine early next year. My story and my approach will be featured, and that’s very exciting as well because it’s getting the message out there and we can then have the actual data on humans which is missing. It would be — as I’ve said before it will be efficacious.

We’ll be able to not just translate the diets that have been used for children with epilepsy which I don’t believe …

[Damien Blenkinsopp]: As good, as they could be?

[Andrew Scarborough]: I don’t think that they’re translatable for brain cancer patients because I think it’s just very different. For example, when I was on the standard type of ketogenic diet, they did include those ingredients. I developed symptoms that were similar to Temporal Arteritis, where my temporal arteries became so inflamed that I nearly went blind and I was prescribed steroids for it.

But instead of taking the steroids what I did is I looked at how much omega 6 I was taking in my diet, and even though my blood glucose and ketones looked fantastic, and the ketogenic diet is anti-inflammatory in itself. I was having these inflammatory responses which were only controlled and reversed when I re-addressed the balance of omega 3 and 6 ratios. That in itself is quite powerful.

(59:15)[Damien Blenkinsopp]: Interesting. Where did your omega 6 ratio start? We read studies where the standard American diet, for example, is you can get ratios of 20:1, 10:1 — quite far off.

[Andrew Scarborough]: I’ve read up to 40:1.

[Damien Blenkinsopp]: Were you not so bad because you said you had a reasonable — you were trying to have a reasonably healthy diet before. I wouldn’t expect you’d have the sad numbers.

[Andrew Scarborough]: Yes, prior to initiation of the diet, I would say I was most likely about a 10:1 ratio. But, on the ketogenic diet, it was probably quite similar actually because it was including lots of nuts, coconut oil, coconut milk, coconut cream, lots of vegetables that were high in omega 6. I just thought it could be done better — then I transferred on to what I like to call a, fishogenic diet.

I was consuming a lot more fish, and I felt instantly much better and then as I cut down on the vegetables – cut them out completely. I had an instant response where I can’t even remember the last time I had a headache, even a mild headache.

(60:32)[Damien Blenkinsopp]: Great to hear. I’m conscious of your time I know that you’re really busy currently. But there’re a couple of things — I do want to make sure we cover before you go. We didn’t speak about glutamine and I know that an important part you mentioned up front that’s something you had to restrict quite sharply. But how did you do that practically?

[Andrew Scarborough]: Well, the first thing I did was limit protein quite significantly, and I did a number of therapeutic fasts, and it wasn’t until then that I actually saw the greatest response in my MRI scans, in terms of the complete remission. One of the other things that’s quite effective is with the magnesium it has an effect on that as well. I need to find the study for that, but I can send it to you if you’re interested in reading it.

Another thing that I’m actually looking into for the long term is Metformin, because Metformin on a ketogenic diet has quite a potent effect. It has a number of mechanisms which I can’t remember all of them off the top of my head, but that’s one thing that I’m playing around at the moment. It gets an effect on MAMP and a few other things.

It’s quite hard to explain, it’s quite technical.

[Damien Blenkinsopp]: In terms of the fast, you said that’s when you really started seeing the effects, so that would mirror — we had Thomas Seyfried on here and he was talking about the importance of the fast. How many days — was that a pure water fast? Was it a seven or five day fast?

[Andrew Scarborough]: It’s interesting because I think that — when these researchers are talking about fasting for brain cancer patients particularly if they have epilepsy, what they fail to note is that there’s ionic changes that are happening in the brain when you’re doing these fasts. A patient with epilepsy can’t — especially if they have brain cancer in my opinion shouldn’t just do water-only fast.

I think that they need to do what I call, a ’magnesium fast’. When I fast I have my magnesium water solution that I make up myself, and that prevents me from having breakthrough seizures while I’m fasting because I have such low body fat percentage. My longest fast has only been nine days. I aimed for 10 but I couldn’t do more, I’ve done that a few times but I need to have my magnesium-chloride solution or I instantly have breakthrough seizures, not the good kind either.

I found out the hard way initially, but now it’s just the easiest thing that I do.

[Damien Blenkinsopp]: You’re taking specifically magnesium chloride, is that because it’s a spray kind or is it actually the magnesium chloride specifically — there’s something about the chloride which is helping?

[Andrew Scarborough]: It has something to do with hydrochloric acid and how you digest it. I’d say it’s more bioavailable and it seems to me to be just in my personal experiences that it seems to get the brain very quickly. The literature doesn’t actually say that, but personally, I found that — even though there is not much in the literature about that.

[Damien Blenkinsopp]: Are you buying a specific brand? We’ve talked about using magnesium spray transdermally, but I’m just wondering if you’re using one of those sprays? How much you’re taking of it?

[Andrew Scarborough]: It’s designed to be primarily used transdermally this particular type, and I just get it from a health food shop, it’s mainly people who do sports who take it, which is interesting and funny. I typically take about five sprays three times a day. I can’t remember exactly how much that is, for 10 sprays it’s 150 milligrams of magnesium.

It’s variable depending on how mixed up the solution is — typically around 230 milligrams in a day that I would take. If you consider our water is too high in calcium and not high enough in magnesium. It’s addressing that imbalance that we have, we know that we should have at least a 2:1 ratio of magnesium to calcium, that addresses that imbalance.

We know that in the mornings after we wake up, magnesium levels are lowest. Primarily take it in the morning, after waking up in the afternoon, and before I go to bed.

[Damien Blenkinsopp]: Have you checked your RBC magnesium levels?

[Andrew Scarborough]: I haven’t because I don’t think it’s an accurate measure. I just go by how I feel, and sometimes — I see the epilepsy as a blessing because everything to do with epilepsy with brain cancer is typically very similar to what would work for treating the cancer. If something is working for the epilepsy, you’ve got a pretty good idea that it’s beneficial for the cancer, and most of the things that I actually research about what helps in terms of my epilepsy, experimentally and otherwise.

I found incidentally that it has quite potent anti-cancer benefits as well. It’s really interesting the relationship. It’s quite empowering as well. What I would call spectacular results because I still can’t believe I’m not having these horrific seizures all the time without medication. It’s quite empowering to know that it’s potentially having the same benefit on the cancer.

(1:06:44)[Damien Blenkinsopp]: Yes, it’s pretty amazing your journey. I don’t know if you’ve come into contact with other people with similar stories to tell — I know that some other people who had cancer, you said, unfortunately, they’ve passed away — the ones you were relating to. But if you come across any other people who have been experimenting like yourself.

[Andrew Scarborough]: Yeah. I actually have a group of friends now who I came into contact with just through seeking out long-term survivors, and I have a group of long-term survivor friends who had glioblastoma many years ago, and now have no sign of disease. I have a group of friends with various other cancers who are still here now. They’ve mostly done a drug cocktail treatment on themselves, which is very interesting.

Personally, I wanted to try and copy that drug cocktail treatment but do it in a natural way just using diet.

[Damien Blenkinsopp]: When you say drug cocktail, is that chemo or is that more Metformin and things like that?

[Andrew Scarborough]: It’s more Metformin and statins, and phosphates, and various other DCA, and other very interesting drugs. Personally, the only one I’m considering is Metformin, and potentially a few others, but mainly Metformin and Curcumin which I take in tablet form with DHA because they work synergistically. Curcumin actually increases uptake of DHA to the brain.

Because we know that around these tumors, or where the tumor was – DHA is very low. We know that if you have Curcumin and DHA that’s a powerful combination. Curcumin is cytotoxic to the cells. We know that DHA is, and is essential for brain functioning.

[Damien Blenkinsopp]: You really have built a whole lot of armory against this — it sounds like you’re doing really well. On the Curcumin – there’s many forms available on the market today, you’re taking one of the bioavailable forms…

[Andrew Scarborough]: Yeah, it has piperine in it as well.

[Damien Blenkinsopp]: Okay.

[Andrew Scarborough]: It’s a component of black pepper. I have a number of strategies that I use, and I’m constantly optimizing my metabolic formula.

(1:09:14)[Damien Blenkinsopp]: Do you feel constant improvement? I don’t know if there are any symptoms because it seems like you’ve got most of it under control. Do you think you’re going to be able to repair your body, do you feel any signs of that in terms of potentially resolving the epilepsy?

Do you think this is more likely something that you’re just going to optimize and maintain so that it never bothers you, so you never get the actual symptoms?

[Andrew Scarborough]: As my brain has been visibly healing at a very fast rate on these scans while I’ve been utilizing this protocol, I’ve also found my symptoms have improved with that quite substantially as well. I had facial paresthesia constantly all throughout the day, everyday, and a number of other debilitating symptoms I couldn’t even go out and walk a few steps. The fatigue was horrendous as well.

Being able to do what I am now and this non-stop activity, and just doing so many different things, and having my seizure activity controlled in such a great way that’s much better than before — even before when I was doing all these things I was still getting more activity. I haven’t actually done that many more things if I compare to even just a few months ago. Definitely improving in quite a dramatic way, despite having to keep up with all these things.

It’s getting easier to control, to the point where I have days now that I have no symptoms at all, but if I get overconfident and I forget to have my magnesium drink or do something that’s just out of my routine, I’d definitely have more seizure activity coming. Even though it’s not to the degree that I used to have.

[Damien Blenkinsopp]: I guess really say why you’re saying epilepsy is a bit of a bonus for you because it’s early warning detection system for you…

[Andrew Scarborough]: Yeah.

[Damien Blenkinsopp]: — Whereas cancers can creep up on you and you won’t know unless you’re watching the scans and even the scans aren’t showing a small progression. So right now you can still have a small amount of cancer left, but you can’t see it. It does seem like a pretty nice little tool, even though it’s not nice to have it, in the longer term it sounds like it’s a beneficial thing for you.

[Andrew Scarborough]: Yeah, I can see it as beneficial now, I couldn’t before but it definitely is.

(1:11:47) [Damien Blenkinsopp]: Well Andrew this has been an amazing — it’s very inspiring episode today. I can really say that — I’m totally going to take some of the things that you have been trying and start testing them out myself. I would like to ask you — where to look first if they would like to learn about this topic if they’re facing cancer or epilepsy?

Are there good books or presentations on the subject, the first places to go to, to start learning themselves about this?

[Andrew Scarborough]: I would thoroughly recommend the book, Cancer as a Metabolic Disease by Thomas Seyfried. I think that’s a great starting point. For anyone starting a ketogenic diet I would recommend, Keto Clarity, that’s a good resource to use. I would also go to www.ketogenic-diet-resource.com — that has answers to just about all the questions that you could have.

For help to a dietician, if you live in the UK I would recommend the charity, Matthew’s Friends. In the US, I would recommend the Charlie Foundation which is the sister organization of Matthew’s Friends in the UK. It has recently started to see — it’s mainly brain cancer patients that they see because they get around with that by saying that they’re treating the epilepsy.

I would also go on Clinicaltrials.gov to see what clinical trials are happening globally to do with the ketogenic diet and different cancers.

[Damien Blenkinsopp]: Right, so if they’ll just search for a ketogenic diet on there…

[Andrew Scarborough]: Yeah, if they search for ketogenic diet and cancer on Clinicaltrials.gov they can see all of the clinical trials that are currently happening in terms of ketogenic diets for different cancers. It’s very exciting that more and more of these are popping up, and I hope to — I have a meeting on Thursday to discuss having proper official ketogenic diets, using the right approach in this country, and that’s really exciting new development.

[Damien Blenkinsopp]: Is that with the government, NHS or some other body that’s going to help promote it.

[Andrew Scarborough]: This is in conjunction with brain tumor research, they’re one of the very few cancer charities that actually are going all at it with this metabolic research, and they’re doing that with Imperial College London. It’s a small charity that’s doing this, it’s quite incredible what they are able to do being such a small organization.

[Damien Blenkinsopp]: It’s great they’re starting to be – some grounds building from the bottom and up.

[Andrew Scarborough]: Yeah, and I’m going to start-up my own individual research with a few of my lecturers at my university because I want to get these things happening much faster than if it’s going through clinical trial protocol. I want to do this myself with lower grade gliomas, so that we can see a long-term response to try and shrink these tumors hopefully, because they are not as aggressive, but, they still are incurable.

I want to see what effect that we can have on them rather than having to go through all the standard treatment to go through clinical trials. I think that’s very exciting going forward.

(1:15:25) [Damien Blenkinsopp]: That sounds really exciting, and I’m sure anyone who – maybe affected would be very interested to know more. What are the best ways for people to connect with you and learn about you, and keep up with you when you’re doing these things, they can stay up to date on them. Are you on Twitter, you mentioned you had a YouTube channel?

[Andrew Scarborough]: Yeah, my Twitter name is @ascarbs, and I’m on Facebook if people want to add me on there, Andrew Scarborough. I also am working on a website at the moment which is www.metabolictherapy.co.uk, and that has a holding page at the moment, but it should be live shortly. I have a YouTube channel, Andrew Scarborough, and I have a blog, My Brain Cancer Story that’s the title of it.

People search for Andrew Scarborough and My Brain Cancer Story, they should find it.

[Damien Blenkinsopp]: Excellent. We’ll put all those links on the show notes of course also, make sure all of that is there. Is there anyone besides yourself you’d recommend to learn more about the stuff that you mentioned, Thomas Seyfried, is there anyone else that people should look to?

[Andrew Scarborough]: I would look at the research by Dominic D’Agostino, also I would recommend Dr. Colin Champ, I’ve had various discussions with him online which are very interesting. He’s very interested in my approach and he is very unique, he’s a radiation oncologist who is very supportive of this metabolic treatment. Very similar to my oncologist who – it’s quite a rare thing to find – but it’s very encouraging.

There’s Dr. Adrienne Scheck, who I’m having a meeting with on Thursday she’s coming overseas from the Barrow Neurological Institute in the US, and she’s the one that does the rodent studies using the ketogenic diet. It’s great to be able to discuss with her.

(1:17:29) [Damien Blenkinsopp]: Great, great, thank you for those. Some quick items on your – just a personal approach on what you would advise people to get started with – are you still tracking any biomarkers, on a routine basis?

[Andrew Scarborough]: Only occasionally with MRI spectroscopy but we’ve stopped doing that now just because it looks a bit boring and nothing’s really changing. It all looks really good, that’s why we’re not monitoring it anymore.

[Damien Blenkinsopp]: So maybe once in every six months or once a year?

[Andrew Scarborough]: Yeah, just to keep an eye on it, but everything that you would expect to be elevated but would be a bad thing isn’t showing up – it sounds like a good thing. It’s very new research, we don’t know too much about it, but it’s very promising for the future.

Because if we can see these things before they show on the scan, in terms of enhancement or just showing in an obvious way then it’s – that can only be good for the patient really. Then we can intervene in a non-toxic way.

[Damien Blenkinsopp]: So if you were to recommend one experiment, basically you’ve done many experiments to get to this point – they’re not proven recommendations by doctors and so on. What would you recommend that someone with brain cancer or potential other cancer – what would be the first thing they should try, the biggest payoff from all of the things that you’ve mentioned, what should their first step be?

[Andrew Scarborough]: The first step should definitely be reducing carbohydrate intake. The second step would be reducing protein intake to maintenance levels, and therapeutic fasts are very important. But the main thing, I would say is the omega 3 to 6 ratio, I believe that they should be an omega 3 to 6 index, just like with the glucose-ketone index, and they should work together, as a synergistic therapy.

Because you could even argue the ratio of omega 3 to 6 is even more important than the ketones. I would also say, the magnesium is very important with that too, those three things. Therapeutic ketosis, the omega 3 to 6 ratio and the magnesium I would say are very important for brain cancer patients.

[Damien Blenkinsopp]: Great, thank you, that’s some great takeaways for people at home. Andrew, I’ve got to say this has been really amazing interview – it’s amazing all of the different avenues you’ve run-down and all of these different aspects that you found to improve your situation. I know it’s going to be an inspiring story for the audience.

Thank you very much for being on the show.

[Andrew Scarborough]: No problem, we did cover a lot but we got there in the end.

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