Rejuvenation biotech is a new industry forming around the theme of life extension technologies. This episode provides a broad look at the state of the industry, its most promising life extension technologies and their potential timelines.

Life extension – this is something I’ve wanted to spend time on for a while.

In this episode, I interview 5 thought leaders from the life extension movement. Consider this an introduction to the current status of life extension tools and technologies, as we look at most areas with a broad first-look.

You will learn where things are and what the risk profile of those life extension tools and technologies is today.

All interviews took place at RAADfest in San Diego. This is one of the larger life extension technology conferences today. It stands for Revolution Against Aging And Death and then fest for the festival.

I would encourage you to skip around this episode. It’s long, and there might be a specific topic that you’re interested in. So check out the notes below and pick the area that you’re most interested in first and start there. If you get through the whole thing it will give you an overview of where things are currently at.

“At the moment we’ve got this burgeoning of the rejuvenation technology industry with more and more investors realizing that this is the next big thing”

-Aubrey de Grey, PhD

“Our life is code and I think that we can modify that. First, we’ll look for human health and then we’ll look to enhance your life for where you want to live, who you want to be and what you want to achieve.”

-Liz Parrish, CEO of BioViva

“Basically what we’re trying to do is reproduce the young physiology that you had when you were younger [by replacing your old plasma with younger plasma]”

-Dr. Howard Chipman

“It’s not entirely crazy to think that some point soon, we can turn some of these senescent cells back into healthy cells.”

-Brian M. Delaney

“Not all biohackers would call themselves quantifiers. […] In the quantification side, well instead of taking 20 things, if there are two or three I can do that I get 90% of the benefit from, I’ll do that. That’s efficiency.”

-Bob Troia, “Quantified Bob”

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

  • Start of the first interview at RAADfest with Aubrey de Grey. Presentation of SENS Research Foundation. (9:32).
  • The actual state of SENS Research Foundation. (12:22)
  • Therapies to target the seven types of aging damage. Some of the diseases linked to them. (14:18)
  • Companies associated with SENS and the variety of startups that have sprouted from it. (16:57)
  • Aubrey’s particular views and interests in life extension. (28:10)
  • Start of Liz Parrish’s section and the introduction of BioViva. (33:50)
  • The new focus of BioViva, using a meta-analysis of public data to find promising drugs and genes (38:30)
  • The scale and patients of BioViva’s potential gene therapy treatments. (41:30)
  • The biomarkers Liz and her group work with, where they come from and how they are detected. (44:00)
  • The process of receiving a specific gene therapy (1.0 vs 2.0 human) (46:00)
  • Self-experimentation, data collection and associated biomarkers (48:41)
  • What drove Liz Parrish to investigate riskier and more experimental medical areas. Her initial experiences in the area. (53:00)
  • The process and the legal loopholes that were necessary for Liz to be treated with gene therapy (56:00)
  • The current treatments and products BioViva offers. Future prospects for genomic counseling, new genes, and methylation testing. (59:48)
  • Ending of the interview and Liz’s conclusion on the potential of gene therapy (1:00:50)
  • Start of the interview with Howard Chipman, from Young Plasma (1:02:15)
  • The basis and origin of the Young Plasma Project. (1:05:08)
  • The positive and negative effects of using Young Plasma and the protocols associated. (1:07:21)
  • The Ambrosia study and the biomarkers that are generally used in Young Plasma (1:08:30)
  • The cost associated with participating in Young plasma and the mechanisms of the process. (1:11:34)
  • Howard’s own experiences in the area and ending (1:13;40)
  • Start of the interview with Brian M. Delaney. His experience with Young Plasma. (1:18:20)
  • The introduction of Brian M. Delaney and his work in the LEF (Life Extension Foundation) (1:22:37)
  • The repurposing of old drugs for new anti-aging purposes and new treatments and research. (1:24:20)
  • Brian’s objectives in LEF and life extension (1:30:00)
  • How Brian got involved in the area of life extension. (1:32:43)
  • The current state of Brian’s research. (1:36:00)
  • Brian’s health, tests, and biomarkers. His experiences with Calorie Restriction. (1:41.10)
  • Further experiences of Brian with CR, insomnia and other physiological parameters. (1:51:10)
  • Brian’s experience with Rapamycin, nicotinamide riboside. (2:02:01)
  • Brian’s experience with Metformin and senolytics. (Dasatinib and Quercetin). (2:08:32)
  • The effects of senescent cells in our body and the off-target effects of senolytics. Senomorphics. (2:13:59)
  • The DNA methylation testing at Zymo Research Program. (2:19:39)
  • End of the interview with Brian M. Delaney. (2:23:34)
  • Start of the interview with Bob Troia (Quantified Bob). Presentation and opinion of RAADfest. (2:24:44)
  • Bob’s activities, tracking during the last few years. Recent changes in the landscape of life extension. (2:28:39)
  • Which consistent data in Bob now regularly collecting about himself. (2:38:12)
  • Ketone testing and Bob’s experience with KetoneAid. (2:40:11)
  • Recent advancements and curiosities in the area of life extension and supplementation. (02:46:57)
  • End of the interview with Bob Troia. Invitation to contact him through social media and his web. (2:50:10)
  • Damien’s conclusion and some questions to take home about the main themes of the podcast. (2:51:13)

Thank the interviewees on Twitter for the information they shared and let them know you enjoyed the show.

Thank them here: Raadfest (the conference), Aubrey de Grey, Liz Parrish, Brian M. Delaney and Bob Troia (Quantified Bob).

Interviewees in Order of Appearance

Aubrey de Grey, PhD

Liz Parrish

  • Background: Parrish is the CEO of BioViva, an advanced life extension center. It aims to develop new gene therapy based health testing and analysis techniques for the betterment of your health.  They offer help navigating the details of genetics and family history. They can also assess how they impact your health and well-being.
  • Self-experimentation: She was the first person to undergo gene therapy. In particular, one targeting life extension. This took place three years ago. She’s known as patient zero in some circles for this reason. Check Liz’s journey as a test subject of gene therapy here.
  • Research: As CEO of BioViva, she recently presented the results from her telomere lab. Telomeres are DNA pieces we can look into to assess aging.
  • Follow Parrish on Twitter.

Dr. Howard Chipman

  • Background: Dr. Chipman is the medical director at Atlantis Clinic. He oversees the Young Plasma section. Their approach is to transfuse all the regenerative and healing factors present in young blood. This is done by transfusing the plasma (blood minus the cells) of young donors into an older patient. This was first tested in the 1920s in Russia. He is also involved in Aurora Aerospace. It is a space training company for jet fighters and zero-gravity flights.
  • Research and experience: He specializes in emergency medicine. He has treated patients with life-threatening conditions. These include heart attack, drug overdose, shock, or massive bleeding. You can check Dr. Chipman’s Pubmed articles here.
  • Find Dr. Chipman on Facebook.

 Brian M. Delaney

  • Background: Brian is an advisor for the Life Extension Foundation.  LEF is a nonprofit organization. Their long-range goal is to extend the healthy human lifespan. This will be done by discovering scientific methods to control aging. They have been proficient in the supplements area. They have produced many well formulated and effective supplements. Before his involvement in the LEF, he was a philosopher and translator. He is based in Stockholm, Sweden. He is also a founding member of theCalorie Restriction Society.
  • Books: The Longevity Diet is Mr. Delaney’s most popular book. In here he and Lisa Walford explain in practical terms the concept of calorie restriction. They consider CR “a life-extending eating strategy with profound and sustained beneficial effects”.

Bob Troia (Quantified Bob)

  • Background: Bob appeared in episode 22 way back in the Quantified Body. He quantifies a lot of n=1 experiments and publishes them on his blog.
  • You can find him on Twitter.

Tools & Tactics

Interventions

  • Stem cell treatments to combat cell loss. Stem cells are undifferentiated cells capable of generating many different cell types. They substitute the ones lost through aging1.
  • Mitochondrial mutation treatments to combat aging. Still in the early stages. Mitochondria are cellular organelles responsible for energy production. The accumulation of mutations throughout life can impair them. It can even stop their correct functioning. The reversal of these mutations might partially stop the aging process.
  • Telomerase induction therapy. Telomeres, the protective ends of linear chromosomes, shorten throughout an individual’s lifetime. Telomere shortening is a hallmark of molecular aging. It is associated with the appearance of age-related diseases. Several scientific articles, including María Blasco‘s 2 have been recently published. They suggest that telomere growth can reduce the phenotypes of aging.
  • Myostatin inhibition therapy. The inhibition of this protein can increase muscle mass and strength. These results apply to mice3 and possibly in humans. It is believed that it could be successfully employed in cases of muscular dystrophy.
  • Intravenous fluid therapy. Intravenous fluid therapy. It is the introduction of a fluid (plasma, serum, antibiotics) in the vein of a patient. It is generally for employed for purely medical purposes. In the case of Young Plasma, it is the method used to introduce the plasma in the patient’s system.

Tech & Devices

  • 10,000 Lux Lamp: Lamp that replicates strong sunlight. Damien has been using this in the morning to reset the circadian rhythm. this has the result of improving sleep quality. These lamps are designed for use by people with Seasonal Affective Disorder (SAD). They provide sunlight in dark months of the year.

Supplements & Drugs

Drugs (Typically More Potent/ Require Prescription)

  • Senolytics: They are small molecules capable of inducing the death of senescent cells. They are still under research. Senescent cells are non-functional ones. Dasatinib is a compound generally used in cases of leukemia. As of late, experts think it can be repurposed as a Senolytic along with Quercetin. Brian mentions taking 5.0mg of Dasatinib and 50 of Quercetin per kg of body weight.
  • Metformin: A drug used to improve blood sugar regulation in diabetes. Researchers are looking at its wider applications with cancer treatment. It can inhibit insulin secretion. Brian mentions taking up to 500mg.
  • StatinsThey are lipid-lowering medications. They can reduce illness and mortality in those who are at risk of cardiovascular disease.

Supplements

  • Rapamycin: A compound that has been researched for its life extension properties. According to Brian, it is potentially senomorphic (capable of restoring senescent cells). It is believed to work by stopping certain responses to nutrients that can accelerate aging.
  • Nicotinamide ribosideBrian mentions that it is useful for raising NAD+ levels. This happens in particular in the blood and in the cells. NAD+ is used in many redox reactions, including the ones needed to get energy. Brian mentions taking up to 500mg daily at some points of his fasting cycle.
  • Nootropics: They are drugs, supplements, and other substances.  They might improve cognitive function in healthy individuals. In particular, they may improve executive functions, memory, creativity, or motivation4.
  • KetoneAid: It is a series of ketone esters (beta-hydroxybutyrate). They possess a great energetic performance. Generally used by elite athletes to achieve great bursts of power.
  • Ketosports KetoForce: KetoForce contains the endogenous ketone body beta-hydroxybutyrate (BHB). It is 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). Damien expresses his preference for KetoCaNA.

Tracking

Biomarkers

Inflammation Markers

  • High Sensitivity C-Reactive Protein (hs-CRP): Elevated hs-CRP levels show inflammation. That is damaging to inner artery walls. If your level is below 1 mg/L then you do not have a cardiovascular disease risk. Liz mentions this as an example of a classical biomarker.
  • Homocysteine: High levels can be predictive of increased risk of inflammation of blood vessels. Low levels are generally not indicative of anything in particular. Anything over 150 μg/dL is generally considered an elevated concentration.

Blood Sugar Regulation Markers

  • Fasting Glucose Levels: A biomarker used to understand blood sugar regulation. Optimum levels are between 70 and 90 mg/dL. Higher ones show some level of blood sugar dysregulation. That lack of regulation increases the risk for diabetes II. Liz mentions this again as a classical biomarker.

Cholesterol Based

  • Low-Density Lipoprotein (LDL): The traditional measure of ‘bad cholesterol’. That is the type that causes heart disease. Less than 100 mg/dL is considered an optimal level. Levels between 160-189 mg/dL increase the risk of cardiovascular disease. Research has shown that LDL alone is not the best predictor for cardiovascular risk. LDL particles with the smallest sizes are most damaging to the cardiovascular system. Still, as Liz says, people with high LDL might never have a heart attack.
  • Testosterone: It is the primary male sex hormone and an anabolic steroid. Testosterone is used as a medication in several cases. Some of them are low testosterone levels in men and breast cancer in women. Normal levels are between 264 to 916 ng/dL from 19 to 39 years old males, and they decline after that.

Associated to neurodegenerative diseases

  • Amyloids: Amyloids are proteins that can arrange into fibers and plaques in the brain. They give origin to diseases like Alzheimer’s. The presence of visible aggregations has been associated with the origin of the disease. Still, recent studies might show that it is not the plaques that are responsible. Individual free proteins might cause the disease. Several complex methods that use specific ligands are used to detect them5.

Associated to cancer

  • Carcinoembryonic antigen (CEA): It is a set of proteins that are mainly present during the fetal stages of development. This is why their presence in normal blood is usually very low (about 20 ng/mL). Still, these levels increase in some types of cancer, which is why it is used as a tumor biomarker.

Lab Tests, Devices and Apps

  • Magnetic Resonance Imaging (MRI): Mainly used to provide information on the inner workings of the body. Liz used MRI throughout her gene therapy to view any changes in muscle mass and white fat.
  • Telomere length testing: Telomere shortening is associated with many health conditions. These lengths can be altered in response to social and environmental exposures. These two discoveries have underscored the need for methods to quantify telomere length. Terminal restriction fragmentation is one of the main methods used as of now for this purpose6.
  • Methylation testing: Methylation is a series of modifications that your DNA can be subject to. They play an important role in many chronic diseases. Through tests you can more effectively understand the diseases you might develop. BioViva aims to include this test to their list. This will enhance its predictive capabilities.
  • Ketone testing: The different approaches to measuring ketones provide different perspectives on your ketone metabolism. These can be looked at as the ‘window of snapshot’ that they represent. Some methods have a snapshot of a longer duration. These provide more of an average reading. Others might 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:
    • Measuring ketones via the urine (via the ketone body acetoacetate). They have the longest snapshot with it representing your ketone values over the last 5 to 6 hours.
    • Measuring via the breath (the ketone body acetone). It has a smaller snapshot window of the 2 hours leading up to the measurement.
    • Measuring via the blood (via the ketone body beta-hydroxybutyrate). It provides you a snapshot of your ketone level at that exact moment.

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

    • Urine Ketone Strips: Several parameters can interfere with the measurement values provided. They include both hydration status and becoming keto-adapted. They are the cheapest and starting with them is recommended.
    • Ketonix Breath Meter: Currently the only breath acetone meter. If you are moderate to high on this meter you are in ketosis (i.e. typically over 0.5 mmol/L). This device is recommended in epilepsy cases.

Other People, Books & Resources

People

  • William Faloon: The actual president of the Life Extension Foundation. Check his twitter here.
  • Dean Ornish: An American physician and researcher. He is the president and founder of the nonprofit PMRI. That stands for Preventive Medicine Research Institute in Sausalito, California. You can check his website here.
  • James Clement: The founder of Betterhumans, a transhumanist bio-medical research organization. They run open-label, non-randomized simple controlled trials

Organizations

  • SENS Research FoundationFoundation for the research of “Strategies for Engineered Negligible Senescence”. Founded by Dr. de Grey as an offshoot of The Methuselah Foundation. They work to develop, promote, and ensure widespread access to therapies. In particular, those that cure and prevent the diseases and disabilities of aging. This is done by repairing the damage that builds up in our bodies over time.
  • Ichor therapeutics: It is a vertically integrated pre-clinical contract research organization. They focus on the study of aging and aging pathways. It was set up to work on macular degeneration, which is the number one cause of blindness in the elderly.
  • Covalent Bioscience: It sprouted out of the work that SENS funded on amyloidosis. Amyloidosis involves waste products accumulating outside of the cell especially in the heart. They aim to develop and create affordable, better antibodies and vaccines. These will aim to solve a range of unmet medical needs.
  • Unity Biotechnology: Flagship company in the area of removal of senescent cells. Their mission is to extend human healthspan, the period in one’s life unburdened by the disease of aging.
  • Juvenescence: It is a drug development and artificial intelligence company. It focusses on aging and age-related diseases. It was created by Jim Mellon and his colleague Greg Bailey. Juvenescence AI combines advances in artificial intelligence with classical development expertise.
  • Andreeseen Horowitz: It is a venture capital firm in Silicon Valley, California. It backs bold entrepreneurs building the future through technology.
  • Y Combinator: It is an American seed accelerator, started in March 2005. They select and fund startups with great potential to allow them to grow as fast as possible.
  • BioAge: A company started by Christian Foley. It focuses on using a unique computational platform that explores a universe of proprietary and public data. The main aim is to identify and target molecular factors that influence longevity. Their target is to slow and stop aging.
  • Insilico Medicine: A company run by Alex Zhavoronkov. It specializes in the field of deep learning for drug discovery. It is also invested in personalized healthcare, and anti-aging interventions.
  • Integrated health systems (IHS): A company focused on advancing the healthcare industry. They do this through the latest Gene Therapy techniques used in longevity research. By pulling from public sets of biomarkers they aim to select some to identify patients. These patients will then receive the gene therapy treatments.
  • SpectraCell: A group of laboratories specializing in personalized disease prevention and management solutions. They were used by Liz Perrish for the MRI imaging and the telomere length testing.

Resource Links

Here are the links to each individual interview on our facebook page. On top of that, there are other interviews that weren’t included in the podcast:

Full Interview Transcript

Click Here to Read Transcript
[Damien Blenkinsopp]: Hey there! Damien with episode 52 of The Quantified Body podcast here. This one’s a bit of a test episode. It’s a little bit different in format. It is longer and it is taken from a conference that I went to on the topic of longevity, and more to the point, life extension and the now growing market, growing industry around the topic of life extension.

You may know that that’s been a personal interest of mine for quite a while. This podcast is basically looking at topics of life extension, longevity, performance and general wellness and how we can quantify and ensure that we’re getting those types of results.

So this is something I’ve wanted to spend some time on for a while and you could look at this as an introduction to the current status of life extension tools and technologies and where things are and what you could do an experiment with today and what the risk profile of those tools and technologies could be today. Or actually the potential quantified benefits, if any.

So this is a test episode because basically it’s based on some live videos that I recorded with people attending RAADfest 2018 which was held in October in San Diego. RAADfest is one of the larger life extension technology conferences today. RAADfest stands for Revolution Against Aging And Death and then fest for festival.

So pretty much everyone who is active in this new industry, companies like Life Extension Foundation, the hosts and the leaders of this conference, Coalition for Radical Life Extension, investors, biotechnology startups in this new industry which is called Rejuvenation Biotechnology. That’s the name it’s starting to get for itself. All of these people were here at this conference so you’ll see there are a number of different profiles that I interviewed and that you can find in this interview.

So I think it’s a good episode to get an introduction into these topics to start understanding where life extension is and start getting an idea of where you may want to look into more and learn more about one of these topics. If you want to go check out the live videos, those are all on the Facebook page. So you can go to Facebook and just search the Quantified Body and you’ll find all of these interviews in the live videos there.

I would encourage you to skip around this episode. It’s long, as I said. So if there’s a specific topic that you’re interested in, you may want to check out thequantifiedbody.net blog and check out as always, we have the highlights, the times, who’s talking about what subject at what time in the episode so you may want to just jump to one hour or two hours in. Pick the area that you’re most interested in first. However, going through the whole thing will give you an overview of where things are at.

So with that, just let me give you some brief introduction into the topics and the people who are going to appear in this episode.

The first one is Aubrey de Grey from SENS Research Foundation. I interviewed him in episode 14 of The Quantified Body podcast. Really in this episode, he gives us an update on how life extension has moved from the fringe, basically something that was looked at as a fringe science, to becoming a new biotechnology industry where you know have a lot of funding coming in and a lot of startups becoming active.

As I said before, this is now starting to become labeled, rejuvenation biotechnology. I just went to another conference on this in London just a few weeks ago where there were a lot of prominent people and investors. So you can really see that this is growing into an industry all of itself more credible. So that was a good discussion on the progress of the tools and the funding and everything that’s going to bring it alive and make it happen in the longer term.

The next person I interviewed here was Liz Parrish from BioViva. Liz runs a biotechnology company focused on life extension and she was the first person to undergo gene therapy targeting life extension and this took place three years ago. She’s known as patient zero in some circles for this reason. She just presented the results from her telomere lab. Telomeres are something that people are looking at to measure how we age.

The idea is that telomeres get shorter as we age so you can have an idea of someone’s biological age based on measuring the length of your telomeres. So hers were actually shorter than average when she first tested before her gene therapy and now they are longer than average three years down the line using the same test from SpectraCell Labs to measure that. So with Liz, we talked about plans for her company to support the development of life extension therapies and of course her own experience with gene therapy to extend life.

The next person we have on the show is Reason from Repair Biotechnologies. So this is one of the new biotechnology companies that has emerged and been funded in this area already and they’re working on life extending therapies. He’s also the author of the blog Fight Aging which has been around for a really long time.

I’ve known about this blog for a very long time and he’s constantly been covering the science, the updates and how things are progressing; the ideas, tools and so on. So it was interesting to talk with him about his own self-experiments with senolytics, which you’ll learn about is probably the newer term tools that people will be using to aim to extend or rejuvenate themselves and also just an overview of where he’s focused and the science he has covered and some of the more interesting things.

The next person is the episode is Brian M. Delaney from Life Extension Foundation. So Life Extension Foundation, you may know of, is a company that has been very active in the supplements area and they tend to have better formulated supplements than the average company and they’ve always written pretty good articles with in depth references and citations. So Brian is sort of chief guinea pig for the life extension which is his new role he has taken on. He has been an advocate and someone who has practiced caloric restriction for a long time.

So we talked a little bit about that and then we talked about his new job with Life Extension Foundation and the things and the tools he has been testing which include senolytics and Rapamycin; two potentially newer term tools that can be used for longevity purposes to try and extend your life. Also go into depth in both of those and his own experiments on what he has been up to.

Next person on the show is Quantified Bob, Bob Troia. So Bob appeared in episode 22 way back in the Quantified Body. He does a lot of n=1 experiments and he quantifies those so obviously he’s a good fit for this podcast so you might want to go back and check that. Basically, we had a chat about what he found interesting at the RAADfest, which of the life extension topics he’s most interested in and also his other recent quantified experiments that he has done since we last spoke to him.

And finally, the last person in this episode is Howard Chipman from Young Plasma. Now Young Plasma is providing transfusions today of young blood so blood from young adults to people who are older in order for them to benefit from rejuvenating properties. This was first tested in the 1920s in Russia in fact.

Since then, there have been mice experiments and there has also been some allozymes as human studies which have shown benefits from basically just transfusing younger blood into people with older blood. So he talks about that service, he talks about the latest study , Ambrosia, and how he got involved with it and what patients are doing and who’s using this currently. So that’s obviously interesting therapy right there also.

As per usual, there are extensive show notes for this episode. They may be more useful than usual. There’s links to everything mentioned in the show including the studies and easy listed takeaways. There are summaries of the biomarkers, the tracking, the tools and the tactics we discussed in this longer episode.

So please reference those especially if you’re not sure about anything. I know some of the topics get a little bit deep in this episode because some of the topics like senescent cells are actually complex. So I think you might find some of the show notes useful to get up to speed there.

Also if you want to receive in future, updates on episodes and so on, go to thequantifiedbody.net forward slash newsletter and from then on and henceforth, you will get an email from me in your inbox whenever a new episode comes out with all of the details of that episode. So you won’t even have to go to the blog.

That’s it for me. I’m now going to leave you to delve into these episodes and get a broad introduction into the topic of life extension.

[MAIN INTERVIEW TRANSCRIPT]

(00:09:32) [Damien Blenkinsopp]: There we go. We’re live again. We’re at RAADfest again and we have Aubrey de Grey sitting next to us which is fantastic. If you’ve been watching the podcast, you’ll probably know that we spoke to Aubrey de Grey in episode 14 which was about three years ago I think. So we’re not going to go over all of that stuff. If you want to get up to speed on the basics and what he’s doing, check that out later and then you can come back to this. That’s probably the best way to go about it.

We want to talk about what’s going on now, what you’ve been achieving and then how it’s all going. So first of all, we didn’t talk a lot about the SENS Research Foundation; how it’s structured and basically what the mission is and how it’s structured to achieve that. So I thought that would be a good place to start.

[Aubrey de Grey]: Yes it is. If you [check 10:12], first of all, just generically, but also because that has been changing over the past couple of years. So we are based in California and we’re a charity. We’re a 501c3 as it’s called in the U.S. and that means that people can give us money with tax advantages. We also incidentally have an affiliate charity in the U.K. so that U.K. taxpayers, ID taxpayers from most of Europe can do the same.

But our goal is not only to get work done internally on the basis of money given to us, but also to be the engine room of the industry. Of course you might think well what is this industry? There has been this thing called the Anti-Aging Industry for quite some time, but it doesn’t have a very good repute. That’s no surprise because it’s fundamentally based on things that don’t work or hardly work. We are creating. We’re the new industry; the Rejuvenation Biotechnology industry [unclear 11:05].

[Damien Blenkinsopp]: You renamed it.

[Aubrey de Grey]: Things that do work. That’s right. Now that has really only happened over the past couple of years. There have been investors coming to us saying, “What can I do? How can I get involved in this? But I don’t like giving money away so please give me an investment opportunity.” Historically, we would not have been able to help them because the projects that we were working on were too early a stage for us to be able to make a case that really joined the dots all the way to eventual profitability.

That is no longer the case. We’re now up to about half a dozen projects that we gestated for, in some cases several years, and that we eventually were able to spin out and to start up companies and every one of those companies is doing pretty well in terms of bringing in money. In some cases, money that is the equivalent of multiple years of our entire annual budget.

The foundation is still very small. We only survive on something like five million dollars per year. Some of these companies are getting twenty or more and that’s fantastic because it means the science can get done faster. It’s also fantastic in the sense that we can focus on the projects that are lagging behind and still have not reached the point where they can be spun out and made interesting to investors.

(00:12:22) [Damien Blenkinsopp]: Yeah. So is that transformed over the last three years?

[Aubrey de Grey]: Really, yes. Until, I’m going to say four years ago, we had never done this. Not only we had never done it, but at the moment we’re in a position where we’ve spun out six companies I believe now, but actually we’re also working closely with at least a dozen or more other companies.

They’re not spin-outs, but they’re doing very closely aligned work and the people are very much looking to me and the foundation as source of introductions to investors for example. So for me personally, it’s extremely gratifying. I’m able to maintain this position of influence in the emerging industry that I historically had in the non-profit world.

[Damien Blenkinsopp]: So this is fantastic. So you listed several companies, the twelve companies that you spun out yesterday and also the SENS aligned. How many are there in total now that you consider within the right parameters?

[Aubrey de Grey]: Yeah. It’s a continuum. It depends how much [unclear 13:19] but at least a couple of dozen.

(00:13:22) [Damien Blenkinsopp]: Wow. Wow. We’ll get into some of the specifics of that. So one of the things I wanted to talk about is when you published your book. Was that 2008? The first year?

[Aubrey de Grey]: 2007.

[Damien Blenkinsopp]: 2007 and you published the seven types of damage of aging?

[Aubrey de Grey]: That’s right. I had been talking about that for at least five years before that.

[Damien Blenkinsopp]: Yeah. Last night, you said that basically that hasn’t changed. That model has withstood time.

[Aubrey de Grey]: It has withstood the test of time, that’s right. Always though was the risk that there could be some new type of damage that had not been discovered.

[Damien Blenkinsopp]: Yeah.

[Aubrey de Grey]: Of course there still might be, but every year that goes by when it’s not discovered is increasing circumstantial evidence that it’s never going to be.

[Damien Blenkinsopp]: Yeah.

[Aubrey de Grey]: Similarly with regards to therapies, it’s very important also to recognize that we have not had any bad news of the form of this or that approach that we thought we would be able to take to succeed in repairing this particular type of damage is not going to work for some reason.

[Damien Blenkinsopp]: It’s not dead end.

[Aubrey de Grey]: That has not happened either.

(00:14:18) [Damien Blenkinsopp]: Excellent. Excellent. Ok so if you got these seven areas, where are we making progress with this portfolio of companies now? Are there specific areas where we’re making progress now?

[Aubrey de Grey]: So that’s a much better finding. Really all of them, the progress is really encouraging; much faster than it used to be. So there is a possible big spectrum in terms of how far along they are. In fact, there has always been that spectrum.

So one of the areas is stem cell therapy to repair cell loss; cells dying and not being able to be magically replaced by cell division. That’s an area which was already sufficently established when we began a decade ago, but we have always deprioritized it with just an occasional little thing in the stem cell area. But other people with good money and from other sources are doing it so that’s [check 15:04] there. But pretty much all the other areas we have worked in, we have done quite a lot and yes they’ve all moved forward.

So the only one that is entirely within the foundation still is mitochondrial mutation. Even there, it’s probably not going to be all that long before we can [check 15:23]. Because after maybe ten years of working on it without anything really to show for it even before we were publication, we started making breakthroughs. We had our first real groundbreaking breakthrough publication two years ago now and we’ve made massive progress since then. We are universally recognized in the field as the world leaders in that area now and we believe that it’s going to be ready for private sector prime time fairly soon.

Now, that doesn’t necessarily mean that we can shut up shop and declare victory at the foundation. Because first of all, we are obviously doing other stuff in addition the research. We have this very vibrant education arm and also we do regular outreach. But also, even though some examples within these seven things are already out there in the private sector, it’s been out, nevertheless there are other examples that still need to be gestated for a bit longer before they can really be of any proposition.

(00:16:16) [Damien Blenkinsopp]: So some aspects of that damage hasn’t been spun out yet. So you said some of the mitochondrial mutations are looked at internally. When you’re saying internally, does that mean that you’re funding internal research or you’re funding external researches that you think are appropriate, but it’s internally funded?

[Aubrey de Grey]: In that case, it’s actually literally internal. We do the work in our own facility in Mountain View, California. We have a couple of other projects in Mountain View, but most of our work I think will be [check 16:44] about two-thirds is funded extramurally. In other words, we support professors in laboratories and institutes and universities.

(00:16:52) [Damien Blenkinsopp]: Wow. Ok, cool. Ok so if we look at the timeline, this is the kind of stuff people are going to be really interested in. If we look at the timeline of where these companies are and where you think they’re going to get to some commercial or even clinical trials or something that people could actually get involved in, could you paint a rough picture or maybe something we can expect?

[Aubrey de Grey]: Sure, absolutely. Absolutely. So let’s take Ichor. I would say out of all the actual spin-outs that we’ve had, that’s probably the poster child in the sense that it’s the one that has attracted the most funding so far and it has also grown in terms of the diversity of things it works on. Ichor was set up to work on macular degeneration which is the number one cause of blindness in the elderly. It’s an example of what we call LysoSENS. It’s caused by the accumulation of waste products inside the cell in a particular part of the cell called the lysosome.

We developed a method to fix that in house in our Mountain View facility. For several years, we couldn’t quite get there. We ran into the sand for a long time and we were a bit frustrated and one of our employees decided that he wanted to run with it. He felt he had a solution to this last problem. He was right it turns out [check 18:02]. He formed his company; fine with us.

We only took a very small nominal percentage of the company in return for the intellectual property. The technology went forward, they’ve got good money and there and then, they’ll be doing clinical trials next year or possibly even by the end of this year. That’s just one example.

Another company Covalent Bioscience which is in Texas. It’s a company formed out of the work that we funded on amyloidosis which involves waste products accumulating outside of the cell especially in the heart. It’s a very important phenomenon in terms of mortality and the [check 18:38]. That went well enough that the two main academics who were spearheading that work have now quit and gone full-time with the spin-out company. They are again hoping to be in clinical trials in the very foreseeable future so it’s happening.

[Damien Blenkinsopp]: Yeah. It’s starting to get to meet the road. Which do you think is going to be, I guess it’s the mitochondrial mutation which is going to be the last thing.

[Aubrey de Grey]: I don’t like to say. At this point, I would say the mitochondrial mutation strand is probably moving as fast as for example, the extracelular crosslinking strand; the [check 19:14] problem. The [unclear 19:15] problem is being spun out right now. It will be out within the next month. It just came together a little bit more quickly.

But I wouldn’t necessarily go on a rant in terms of how far along they are or how soon they’re going to be in the clinic. It’s all neck and neck. That’s how it should be. We have always been very careful to prioritize the ones that are at the most difficult, most challenging, most neglected so that they’ll catch up.

(00:19:43) [Damien Blenkinsopp]: So I was thinking about the seven types of damage. Liz Parrish, she has done one type.

[Aubrey de Grey]: Well two really.

[Damien Blenkinsopp]: All right, two types of [check 19:52] so that covers two areas of damage?

[Aubrey de Grey]: Yeah.

[Damien Blenkinsopp]: Ok. Basically you’re going to have people which are covering some of the damage, but not some of the other damage and it’s a bit difficult to understand what that may look like.

[Aubrey de Grey]: We have to give our finger on the past [check 20:07] very carefully because you’re right, but the utility of this taxonomy, the seven-point plan that we have must never be lost sight of. The utility comes down to the fact that for each strand, even though there may be many examples of a problem within the strand, for each strand there is a generic therapy. So if you have cell loss, it’s just stem cell therapy.

Now, different organs have different cell types and they need different stem cell therapies. So if you get one working, that’s not the end of the story, but it is kind of halfway to the end of the story because the stem cell therapy, even though they’re different, they have an awful lot in common. That means that once you’ve got a couple of them working then getting the next one working is going to take much less effort and much less time. There’s much fewer unknowns so we can push that forward.

It also means that it’s easier to make a case whether to scientists or to investors that this is something that they can make money out of in a timeframe that they’re comfortable with.

[Damien Blenkinsopp]: So in a sense once you’ve made progress in one of these areas, you’ve gone to clinical trials and you prove that even if it’s one-tenth of the actual end-output you need for that area, you’re validated, you’ve got credibility and that will make it a lot easier.

[Aubrey de Grey]: Let me also emphasize that you don’t necessarily even need to get as far even as clinical trials. So the strand of SENS that has been most in the news in the past couple of years is definitely senescent cells; removal of senescent cells. In that case, the company that’s really the flagship in this area, Unity Biotechnology, which is somewhat associated.

We could not describe them as a spin-out from us, but some of the founders have worked with us and have been funded by us. That company was able to attract its first [check 21:48] respectable enough like mid seven digit money on the basis of ridiculously preliminary data. Not just that it wasn’t clinical. It was only in mice, but also it was genetic models of mice that gave no particular reason to expect that one would actually be able to create drugs. It was even accelerated aging model which are always unreliable and they still were able to make a lot of money.

Since that time, their data has improved. They’re now worth nearly a billion dollars so this is a big deal. They’re not going to start clinical trials until later this year.

(00:22:18) [Damien Blenkinsopp]: Wow! This kind of leads on to some of the names you have in terms of the investing companies were quite big. You’ve got Juvenescence and you’ve got Andreeseen Horowitz, some huge names in the BC world and also Y Combinator. Has that made a difference? Why did these companies or these funders come in?

[Aubrey de Grey]: It’s beginning to. So some of the, well really all of the really early investors when the industry just was starting to begin three or four years ago, were private individuals using essentially, well starting with their own money. Juvenescence is an example. Jim Mellon and his colleague Greg Bailey, both very successfully invested in other areas and decided to get really into this. Other just private individuals decided to start their own thing.

It wasn’t so much a movement at the investor side of things at that point. But then after a year or two of that, things started to change. So Andreessen Horowitz, obviously as you said an extremely established name in BC, doesn’t do much Biotechnology. They still don’t. They decided to get into this area just because they’re with this one company, BioAge. Which again is not technically a spin-out from us, but we work very closely with them, that was doing bioinformatics. So Andreessen Horowitz is very heavily involved in informatics in general.

So it was just something that they felt that they could understand really and do well. They felt a bit comfortable with it, it looked promising and of course, they were right. The company’s doing extremely well. Then Y Combinator has got into this whole field more recently, just really in the past year. They have again, not had much influence on Biotechnology until recently. They decided to do that and furthermore, they’ve done it in a proper way.

They’ve done in a way that recognizes that Biotechnology just takes longer to get going than IT. So the typical deals that they would have had for IT companies would be more like three months to get to demo stage and then we’re only going to give you a few hundred thousand to create.

[Damien Blenkinsopp]: More effective products.

[Aubrey de Grey]: Yeah. Whereas when you get to Biotechnology, they recognize the difference in its order of events to mobilize the time and the money.

Yes, they are very much very clear that aging is a major preoccupation of theirs. They want to get into a startup landing in the biology of aging as quickly as possible. They’ve already got a few companies which again of course we’re talking to. They are [check 24:34]. They’re literally on the same street of us. They’re literally two blocks away.

[Damien Blenkinsopp]: Well that’s useful.

[Aubrey de Grey]: Yes.

(00:24:41) [Damien Blenkinsopp]: Ok so you just mentioned bioinformatics and BioAge. I don’t know if you’re allowed to talk about BioAge. I heard they’re more of a stealth mode.

[Aubrey de Grey]: They’re not really stealth, no. In fact, they share about what they know quite a bit, but what they have done as a result though actually of successful fundraising is they have been able to go broaden beyond the bioinformatics side. So Christian Foley who started BioAge is… she made a name at Stanford in bioinformatics. But the predictive ability that she was able to demonstrate with her original very small team of people was so good.

It mainly focused on metabolomics, but now spreading out to other onyxes. It was so good that the funding came in that was sufficient to be able to do their own lab work as well as to validate some of the drug candidates that they were identifying in silico. So now I’ve heard that a number of very good lab scientists are working at BioAge as well; again, friends of us.

It’s an extremely mission-oriented company. They’re very, very strong on making sure that they don’t get diverted by short-term investors into doing the wrong thing. That’s not true only of BioAge. It’s true across the board of the companies we work with.

Lessons have really been learnt here. A decade ago, you had a few cases of very well meaning, very smart gerontologists going out and forming companies and getting investment to actually take things forward. Even though it was earlier days in terms of science. A great example would be elixir, a pharmaceutical study by Cynthia Kenyon and Lenny Guarente. Complete waste of time, but it became a waste of time because they got the wrong investors. Because they got people on board who were much more interested in short-term [check 26:13] than they were in actual long-term success and the whole thing ended up being a total clusterfuck. That’s not happening these days.

[Damien Blenkinsopp]: Is it because you’re advising?

[Aubrey de Grey]: It’s a bunch of reasons. Firstly, it’s because the founders of these companies recognized that risk and they’re very careful of what money they take. But secondly it’s because the opportunity exists to take money from people who are not going to do that; people who really are high-risk high-rewards type investor types who are very comfortable with long-term strategies and yet who also have sufficiently deep pockets to be able to be the major investors for a long time.

(00:26:54) [Damien Blenkinsopp]: Yeah. Great. So you mentioned bioinformatics and I was wondering how important is that to the overall strategy? Because we especially saw [check 27:01] some of the data and the stuff they’re doing and I’m hearing more about that data. It’s obviously something that we talk about here for validation. Does that also have to be an area of investment to push this forward by being able to validate the discovery you were talking about with BioAge?

[Aubrey de Grey]: It certainly does and it’s not just validation either. Well a lot of it is, but the sheer ability to make predictions so that you don’t have too many things to validate is the key really. Another great example in our space is Insilico Medicine who also received a load of money and mostly from Juvenescence in that case. Again, run by a longtime and very ardent mission-oriented guy, Alex Zhavoronkov; great friend.

They are usually state of the art machine learning techniques to achieve really fantastic results in terms of prediction of not only new drugs, but also new activities of old drugs that could be repurposed and their aftermarket is shorter in that case. Yeah and they’ve been able to get very good investment.

I believe that bioinformatics will never do everything You’re always going to have to do a lot of bench work and everybody knows it, but it definitely has its place.

(00:28:10) [Damien Blenkinsopp]: All right, great. So I’d like to pass a little bit on to you actually because we chatted last time just about what you do. Do you do any tracking for yourself? Are you interested in any of these life extension? One of the things I’ve heard about quite a bit here is senolytics because some people see this as something short-term they can do to enhance their health spans and they can get to these technologies. What’s your view to this for yourself? Are you doing anything or are you interested? Do you think it’s not really worth it because you’re just waiting for the big stuff?

[Aubrey de Grey]: Everybody’s different in this. I always tell people, “Don’t do as I do; do as I say.” The reason I say that is twofold. First of all, I’m just well-built. I’m a really lucky guy. Well first of all, I’m lucky in that because of my providence in the field, I’m able to get for free the kind of really top of the range analysis of my metabolic state that would normally cost ten thousand dollars and I’ve done that maybe five times over the past fifteen years.

(00:29:04) [Damien Blenkinsopp]: What kind of analysis?

[Aubrey de Grey]: They measure 150 different things in your blood and all manner of physiological and cognitive tests; you name it, they do it. I always come out insanely younger than I actually am like fifteen years younger. What that means in terms of what I should do is I have to be very conservative. Respecting how little we really understand about metabolism. It’s a case of if it isn’t broken, don’t fix it.

So the fact that I actually eat and drink what I like and I don’t even do much exercise, nothing happens. I’m doing fine and so I might as well, but that doesn’t mean that I’m going to do fine forever. I always have to pay close attention to any early signs of something going downhill.

The other way in which I recommend people not do what I do is because of my position and my advocacy role, I’m constantly on the road. I definitely don’t get nearly enough sleep and that’s definitely bad for me. But I figured it’s probably [check 29:57]. I’m hastening the defeat of aging, but I’m [check 30:00] in my life.

[Damien Blenkinsopp]: Absolutely. Yes it’s really interesting because I’ve spoken to a variety of people here and they have got very different strategies. One person I spoke to, he’s basically stacking everything that you’ve seen here. Some of his markers, he actually isn’t in such great shape so the higher risk is worth it to him. But if you’re starting from a great place then as you said, until they’re proven, it’s not worth taking these things.

[Aubrey de Grey]: Precisely. Senolytics, for an example, the [check 30:27] is definitely one of the things in my seven point list and so I’ll definitely be willing to do that at some point. But at the moment, it makes sense for me to wait and see and let these therapies become more effective and more, you know, more tested. That’s happening so fast now that in one or two years down the road would make more sense to me.

(00:30:50) [Damien Blenkinsopp]: Yeah. It’s a very strategic unit. It really fits with what you’ve done with SENS Research Foundation. So this is the last thing. Where can people, I mean two things. Have you got an ask for the audience? Anything that you’d like to tell them?

[Aubrey de Grey]: Sure, totally! At the moment, as I said we’ve got this burgeoning of the rejuvenation technology industry with more and more investors realizing that this is the next big thing and it’s starting to come in too. But there is still this residue of projects that absolutely vitally need to be taking fold as well and yet are not yet quite at the point of investability even from the visionary end of the spectrum of investors. That’s why the foundation still exists.

Now the unfortunate part is that your average investor is not totally keen on giving money away. They got wealthy by not giving money away indiscriminately. Therefore if anything, the burgeoning of the industry side actually makes that much harder for us to bring money in philanthropically.

As such, we are still way short of what we need in order to go as fast as the difficulty of the science allows. I think we could still at least double the rate at which we make progress on the hardest and therefore the most essential aspects of this work. Absolutely I haven’t asked. I say anything you can do to help. We have a nice friendly donate button on our website, sens.org and if you want to give us more than that then you know where and how to contact us.

Other than that, if you’re not wealthy, you can still give us ten dollars, a hundred dollars a month; these add up. But also advocacy; very, very important. People who are not billionaires and not scientists may feel that they can’t do anything, but that’s not true at all because the quality of debates, the quality of understanding and discussion of this area is still being unbelievably strongly held back by the desperate need for most people not to get their hopes up about this.

This is what drives what I’ve called [check 32:47]. They hear rationalizations that allow people to trick themselves into thinking that aging is some kind of blessing in disguise. I get so frustrated that people just refuse to open their eyes because it’s holding us back. That lack of enthusiasm is making people not support this work financially. When I say people here, I don’t mean just individuals, I also mean companies and governments.

So shunting the course of debates just as you’re doing right now by having me on camera, this is what needs to be done.

[Damien Blenkinsopp]: Perhaps more of these conferences. More people attending the conference, getting more involved, more engaged.

[Aubrey de Grey]: Totally. RAADfest is growing. Yeah it’s a fantastic event. We also have our own event in Berlin every year, every March. The emphasis is a bit different. It’s more exclusively science at that conference, but the crowd is the same. The kind of connections you have, it’s across the whole spectrum from the hardcore scientists who are getting the work done at the lab through to all the advocates, the investors.

[Damien Blenkinsopp]: Aubrey, thank you so much for your time.

[Aubrey de Grey]: My pleasure.

[Damien Blenkinsopp]: It’s great to have you again. Yeah.

[Aubrey de Grey]: Thank you.

[Damien Blenkinsopp]: Can you go first? We were just talking about how we we’re going to talk and it just failed.

[Britton Schneider]: I’m Britton Schneider. I work with Liz at BioViva.

[Liz Parrish]: My name’s Liz Parrish and I’m the CEO of BioViva.

(00:34:15) [Damien Blenkinsopp]: You know me or you should do by now so I’m not going to introduce myself. This is going to be a great little chat based on some of the stuff I learnt yesterday from your presentation. Just talk about what BioViva is doing and also what you personally have done yourself which is one of the highlights. So first of all, just for the audience because many of them probably don’t know who you are and what you do. What do you do? Who are you?

[Liz Parrish]: I’m the CEO of BioViva. I’m considered the woman who wants to genetically engineer you. I want to create humans that are healthy and don’t die of the diseases of aging and therefore bring treatments back to children who are dying of critical diseases now that will cure them of their diseases.

[Damien Blenkinsopp]: That’s a really good introduction.

[Liz Parrish]: I’ve been doing it for a few years.

(35:00) [Damien Blenkinsopp]: So Aubrey de Grey just called you patient zero so you apparently have several names. Are there any others?

[Liz Parrish]: Well depending on who you talk to.

[Damien Blenkinsopp]: Good ones! Well if you get any bad ones. Any bad ones?

[Liz Parrish]: I don’t know of any bad ones actually. I don’t think that I get too much right now.

[Damien Blenkinsopp]: That’s good. Does Brit call you something? Does she have a pet name for you?

[Liz Parrish]: She calls me “you’re late.”

[Damien Blenkinsopp]: Ok.

[Liz Parrish]: That’s how I know myself.

(00:35:21) [Damien Blenkinsopp]: That’s the main thing there. Ok so what does BioViva do and what is its mission?

[Liz Parrish]: BioViva is a bioinformatics platform now. We’ve changed our gears. For two years, we tried to be a program that actually treated patients directly with gene therapy. We’re looking at regenerative medicine gene therapies; gene therapies that reverse the biological clock, gene therapies that create upregulation of regeneration in the body, gene therapies that increase muscle mass for the aging population and therefore creating cheaper cures for kids with muscular dystrophy.

So every one of the therapies that we talk about today, there’s an aspect that can be used in childhood disease. But we wanted to do that. We wanted to treat patients correctly, but we found out we couldn’t do that. There was not a regulatory framework for us to be a U.S. company and do that, but the most important part of treating patients is the data; what happened when a patient was treated.

So we actually became in partnership with an exclusive partnership with a company that’s offshore of the U.S. It can broker deals between patients and doctors to do gene therapy and we get access to all the pre and post data. We find out exactly what’s been done to the patient and then we look at the biomarker panel that we’re developing with our bioinformatics program and we see where gene therapies work and where they don’t work.

In research and development, we are actually starting to design our first viral vector that will get multiple genes in at one time.

[Damien Blenkinsopp]: So you are doing R and D still?

[Liz Parrish]: Yeah, we are.

[Damien Blenkinsopp]: Then you license that out, but you just don’t clinically deliver it?

[Liz Parrish]: No. The thing is you never want to fall in love with your hypothesis. So we don’t want to be a telomerase inducing gene therapy. We don’t want to be just a [check 37:06] inducing gene therapy, PCG-1 alpha, FGF21, Folistat. If you fall in love with your hypothesis, you’re going to try to prove that it works.

We’re a testing platform to see what works. We’re going to bring other companies through that have therapeutics that we will actually give them their first human data. So why would we do this? Why would we do medical tourism? It’s a multi-pronged approach.

Number one, you give patients access to therapies they couldn’t get otherwise. Often, these patients are in dire need of something and the regulatory system and their doctors would just let them die rather than treat them, rather than take the risk because we’re very risk-averse. So number one, you’re helping patients.

Number two, you’re helping biotechnology companies get the first data on whether their drugs work in patients and where they work and where they don’t work.

Number three, de-risking investment in biotechnology. Right now, biotechnology has a 94% failure rate through phase studies. Investors don’t want to invest, but if you plop down the data on ten, twenty, a hundred patients and what happened, we’ll know what drugs will work before we start to run them.

Do we think that drugs should go through a regulatory service? Absolutely. They should go through a regulatory service so they can be sold widely to a wider audience and help more people, but people need access now. The human model is the best model organism to work in to find out if drugs work for humans.

(00:38:30) [Damien Blenkinsopp]: So you completely pivoted the company. So before you were actually developing them and now you’re, just to get it straight, you’re not doing any R and D and development at all? Or you’re doing a bit, but mostly you’re going to be sourcing the R and D from other companies?

[Liz Parrish]: Instead of actually trying to run one gene to find out how well it works, we use the meta-analysis so it’s called bench to bedside. Where we are doing the development and research and development is the driver, the vehicle; what gets the genes into the cell. So we’ll let other gene companies and research institutions run all that expensive pre-data, but then we want to see what happens in patients when we look like we do have a promising drug.

[Damien Blenkinsopp]: So you’re going to select the most promising ones?

[Liz Parrish]: Yeah, that’s right. So the reason we would look at telomerase induction is it actually has decades of research done on it. Nobel prizes have been given out and fantastic, very inclusive research papers have come out. Maria Blasco just put out an exhaustive scientific paper about how telomerase induction does not cause cancer, it may actually protect against cancer. These are the things that we need to see, but if we don’t apply them to humans, they have zero value.

(00:39:42) [Damien Blenkinsopp]: So basically what you’re doing is you’re saying the regulatory environment is not going to let us do any of this and it’s very expensive to do the clinical trials. So we’re going to let less risk-averse people or maybe they’re in a situation where they’re at high-risk of dying or they have a very damaging condition already and so it’s in their interest to reduce risk. So they can do it for medical tourism then you can get the data and then fast forward and validation.

[Liz Parrish]: Fast forward those drugs. Actually, I think that our platform in the next two years, we’d like to prove ourselves and then we’d like to have the regulatory service look at our platform. If we actually ran drugs like we’re designing to run drugs, this is actually what we want. Don’t hide any of the data, show the data; where does it work, where does it not work.

That way we have a clear picture of what’s going to happen. We already take drugs that aren’t necessarily safe, but we’re none the wiser. We get a pamphlet, you get a bottle of statins, you get a pamphlet, but if you look at the Cochrane Report, a statin will save one in 164 patients from getting a stroke, but one in ten will get Type 2 Diabetes and one in 50 will get dementia from taking the drug.

We don’t understand our risks to begin with, but we’re looking at gene and cell therapies, we’re looking at just upregulating a beneficial protein that has decades worth of data on it in the human body to push regeneration. Not only may these patients actually recover from their disease if we’re lucky, they will be spearheading the technology for the future.

Our risk aversion just has developed so many myths around living as if we’re not actually going to die, but how is anyone actually going to solve the problem. Taking a gene therapy is the type of people who want to buy an experience, but they are also health investors; they’re investing in their future.

(00:41:30) [Damien Blenkinsopp]: You probably are talking to a lot of people who are interested in taking gene therapies, what type of people is this? Just to get some on the ground information. i’m sure these kind of people contact you. What kind of population are interested in this?

[Liz Parrish]: We get thousands of people who contact us and are interested in taking a gene therapy and they really span the gamma and some of them were excruciatingly heartbreaking earlier on because we didn’t have ways to treat patients. We had people come through with sick kids who have probably died since then because there was no option. People with muscle disorders, heart disorders and various really sick people. But also we get some pioneers. Some people that hands down would take any therapy to be part of the experience of spearheading technology for the human race.

[Damien Blenkinsopp]: Like some healthy people?

[Liz Parrish]: Some healthy people.

[Damien Blenkinsopp]: Like you?

[Liz Parrish]: Yeah, some not so healthy. Well if you look at biological aging, by the time I was 40, I’m not very healthy. These therapies will be used in sick people. We’ll see if we can regenerate a kidney, we’ll see if we can regenerate a liver, we’ll see if we can create some more beneficial cognitive effect in patients with Alzheimer’s. But then we’ll work them back to people in less disease state and soon, we’ll be using them as immunizations. How soon that happens is how fast we start working towards that data.

(00:42:52) [Damien Blenkinsopp]: So what is the timeline for this model you’ve put in place? Is it just started? Is it 2019 you’re going to have some clinics in specific countries in the world that’s run by this organization called IHC?

[Liz Parrish]: IHS?

[Damien Blenkinsopp]: IHS.

[Liz Parrish]: Yeah, Integrated Health Systems. Yeah so we’re starting now and already patients are signing up to talk to doctors. They are very interested in therapeutics so we’re hoping to start generating our data in 2019, but how clean that data is and what that data means is going to take us a little bit of time to generate. So we’re looking at a huge biomarker set. We’re looking at a multi-comeback…

[Damien Blenkinsopp]: There are four monstrous slides. I think I’m a data geek. It was ridiculous.

[Liz Parrish]: Yeah. So we’re going to pull from publicly available data sets, but we’re going to be analyzing, the first company in the world that analyzes what happens when you do regenerative gene therapies in humans.

(00:43:44) [Damien Blenkinsopp]: So you’re going to ask the clinics to collect this data? Because it was a very extensive amount. So do you need equipment like special MRIs?

[Liz Parrish]: Well we actually work with the doctor. So the doctors who are exclusive to IHS are actually exclusive to giving all of the data to BioViva.

[Damien Blenkinsopp]: That’s the new agreement?

[Liz Parrish]: Right, and there is protocol. So to every gene therapy, there’s a protocol, there’s a list of markers that have to be taken before a patient can be treated.

[Damien Blenkinsopp]: Ok.

[Liz Parrish]: It is pretty broad.

[Damien Blenkinsopp]: It wasn’t all of those though, was it?

[Liz Parrish]: Remember a lot of it is done in blood work. So a lot of those biomarkers come from blood work, DNA testing, methylation testing. Other markers come from imaging. So imaging is really important when you’re talking about brain health, when you’re talking about muscle health. When we’re talking about whole body health, we want to visualize what’s happening.

(00:44:38) [Damien Blenkinsopp]: Are you going to basically standardize the definition of the type of data and also how to record it?

[Liz Parrish]: Yeah, absolutely.

[Damien Blenkinsopp]: But who’s going to actually collect the data? Are you going to collect the blood samples and send it to a U.S. lab or a centralized lab? Or are there going to be labs all over the place or just the local ones?

[Liz Parrish]: So that depends on what labs the doctors work with, but they’re all the big companies. We work with generally the standardized labs.

[Damien Blenkinsopp]: Like [check 45:01]?

[Liz Parrish]: Yeah. Exactly. But we also work with some smaller companies that have some protein discovery methods, proteostasis, demethylations.

[Damien Blenkinsopp]: This specific test is more advanced.

[Liz Parrish]: Yeah so we’re not only looking at the old biomarkers that we used to look at c-reactive proteins and a blood glucose level, but we’re looking at these markers that will be really important in five years that really will be more specific than the other biomarkers in the coming years. That’s how we’ll find the real true biomarkers of aging that can give us a close date to the biological age of what your due date might be on your body and how we could actually change that.

But by doing regenerative therapies, we might be able to reverse engineer some biomarkers of aging as well.

(00:45:50) [Damien Blenkinsopp]: What does that mean?

[Liz Parrish]: It will give us a new view, a new insight of reversing pathology in the body and regenerating certain [check 45:58]. So for instance, even when you’re young, you’re actually generating damage. Your cells are degenerating in a slow form way. This isn’t just something that happens as you get older. Your body is developing so we have the illusion that we’re not accumulating damage, but in fact we’re accumulating damage over our entire lifespan.

We’ll be looking at bodies hopefully with regenerative medicine in these gene therapies that actually start to restore damage. That’s a reverse process of damage. Therefore we’ll get the insights of what that actually means with biological age. First, we’ll start pinpointing it back to a healthy body. A healthy what I call 1.0 body with a 2.0 body may have different biomarkers that give us insight to how to adjust to what is happening with aging in the body right now in the 1.0 body.

[Damien Blenkinsopp]: I’m not 100% following with this.

[Liz Parrish]: Sorry.

[Damien Blenkinsopp]: Sorry guys.

[Liz Parrish]: It’s probably me.

[Damien Blenkinsopp]: So 1.0 is someone.

[Liz Parrish]: 1.0 is a human who has not been given the gene therapy.

[Damien Blenkinsopp]: Ok. All right. So you’re saying once you get a gene therapy, you may not be normal? You might be something different, but it’s also healthy?

[Britton Schneider]: Ideally, yes.

[Damien Blenkinsopp]: Or it might be healthier?

[Liz Parrish]: You’ll be regenerating, well that’s what we’re hoping, is to put the body into a homeostasis; stronger, smarter, faster, healthier.

[Damien Blenkinsopp]: So that’s the 2.0?

[Liz Parrish]: Yeah. That’s any person who has gone through a regenerative gene therapy who has an upregulation of a protein that is designed to actually reverse damage in the body.

[Damien Blenkinsopp]: Ok so I’m following you now I think.

[Liz Parrish]: I nerded out.

[Damien Blenkinsopp]: The same way we’re upregulated with many detoxifications.

[Liz Parrish]: I went too far.

[Damien Blenkinsopp]: You talk fast. Not as fast as Aubrey, but he’s hard to keep up with. So for instance, we have many detoxification processes and enzymes in our body, you could upregulate some of those and then you could drink alcohol all day and not worry about it for instance, like Aubrey does.

[Liz Parrish]: Yeah, that’s true. That’s one use of our time.

[Damien Blenkinsopp]: Well I’m not saying it’s the best, but basically that’s what you are saying. We would have these abilities.

[Liz Parrish]: Yes of course. I’m all for people enjoying their life and living the life that they want to live.

[Damien Blenkinsopp]: We’ll go to the gym less and be stronger.

[Liz Parrish]: Yeah exactly. Well that was one of the things with my therapy. I worked out five days a week, I ran about 25 miles a week and after my therapy, I got on plane after plane, I had jet lag, I wasn’t working out. When we did my second MRIs, I was really worried because I had not been exercising, but the muscle mass was bigger, the white fat was down and my insulin sensitivity was up.

[Damien Blenkinsopp]: Ok Liz.

[Liz Parrish]: So that’s fantastic!

(00:48:41) [Damien Blenkinsopp]: I did want to talk about this of course I did. So on this podcast, on this show, we’re into self-experimentation so you’re a good fit and tracking data on it so that’s one of the key things. But I wanted to make sure we covered all the business and what you’re up to there because we’re also excited about the data. Because my belief and probably most of the people following the show which includes BCs, entrepreneurs, software experimenters and biohackers, is that data is one of the keys to everything because it will stop us running around in circles.

[Liz Parrish]: Yes, exactly and boy did we learn a lot about data. When we started this company, I found an investor. He said I’ll invest in you taking this therapy to embark on this and show that we can reverse biological aging. We have really big plans, but we didn’t really have a list of things that we really needed to do. So all I did was a lot of blood work, I did MRI imaging then I did telomere length. But today what we know is there’s so much more that we could do.

[Damien Blenkinsopp]: So you wish you knew probably more?

[Liz Parrish]: Of course, but that’s how you get there.

(00:49:38) [Damien Blenkinsopp]: What exact baselines did you take?

[Liz Parrish]: That’s when you saw my biomarker list, it’s extensive; it’s exhaustive.

[Damien Blenkinsopp]: Well because we don’t know which ones it’s going to affect.

[Liz Parrish]: No, we really don’t and we actually still don’t know what biomarkers [check 49:48] that we look at now. We’ve hunted LDL cholesterol like a witch hunt and yet people with high LDLs sometimes never have heart attacks.

[Damien Blenkinsopp]: I have high LDL, but I’m not worried about it because my particle count is low.

[Liz Parrish]: There is the group in Italy that have a gene. They never develop atherosclerotic plaques, but amazingly they have really high LDLs and then people with high HDLs and low LDLs die of heart attacks.

[Damien Blenkinsopp]: So it’s a perfect example.

[Liz Parrish]: So we have a long ways to go.

[Damien Blenkinsopp]: Because this biomarker is used everywhere and we don’t even know what it is.

[Liz Parrish]: Everywhere. Yeah.

[Damien Blenkinsopp]: It’s called bad cholesterol, but we really don’t know what it is.

[Liz Parrish]: So we need more data. We need to look at phenotype, we need to look at anatomical, physiological data. We have a long, long ways to go. So even before BioViva came along and started throwing regenerative gene therapies into people, we had a problem with biomarkers and we’re just pointing out that problem.

(00:50:40) [Damien Blenkinsopp]: Ok. So you’re going to collect a lot of data, but how are you going to get the value right because there are a lot of biomarkers. Are you going to put AI on it or what are your plans for this leverage?

[Liz Parrish]: Yeah, right now we’re using machine learning algorithms so our computer scientists and the PhDs that are working on that are trying to collect all of the best data and they’ll do a little bit of light machine learning as the data goes in. The most important thing is that the data is clean because garbage in, garbage out, we’re screwed. AI can’t solve a problem if we have no data.

AI is really fantastic for old drugs because we have a lot of data on how those work and it’s helping us understanding protein to protein interaction because we have some data on that. But regenerative gene therapies, we need human data then we can plug that in then we can start to get some meaning.

The microbiome, very interesting; changes as you age. If we are actually able to regenerate parts of the body, will the microbiome change? But we still don’t know most of the microbiome and we have issues.

[Damien Blenkinsopp]: Well I can tell you that I’ve done 40 different microbiome tests and I’ve never gotten actual information because you have to combine it Liz to get the real picture and assay islands.

[Liz Parrish]: Well it changes with what you eat.

[Damien Blenkinsopp]: It’s up and down all the time.

[Liz Parrish]: Yeah.

[Britton Schnieder]: We still have to identify what’s good and what’s bad. It’s still so much we don’t know.

[Damien Blenkinsopp]: Yeah, but we don’t know. There is a lot of “don’t know” basically so I think bioinformatics, it’s interesting. I’m always like, “Wow!” That’s what bioinformatics, and I’ve been thinking for a long time, we need to focus more on that. Because the more I get into, I’ve got into data just from this show and really it’s not accurate. A lot of this stuff is inaccurate. The more I’ve tested, the more I’ve spent on it, I’m like is this useful?

[Britton Schneider]: It’s the results.

[Liz Parrish]: Actually the arguments within the field. So in 2015, I took the two gene therapies that we’ll talk about. I did the telomerase induction and I did the myostatin inhibitor. Immediately people flew up and they were like, “Telomerase induction!” or they were like no, you should have tried this other thing. Well we have to get out and try these things. Without the data, we can’t say something doesn’t work.

(00:52:44) [Damien Blenkinsopp]: Could you talk about, I’m interested why did you take that decision to do it? Was it because you were frustrated the company wasn’t making progress?

[Liz Parrish]: No, no. The company actually was just starting. So in 2013, my son was diagnosed with Type 1 Diabetes. I was thrown into children’s hospital. I had been volunteering my time for two years working with stem cells and that advocacy and trying to figure out why the funding for stem cell had dried up and people weren’t interested when it seemed to show such promise.

So I had this regenerative medicine education that I was going through, I’m thrown into this hospital situation and I started asking them can you do something with stem cells. Could you biobank some of his pancreas so we can use it later and they looked at me like, “Lady! That’s experimental medicine.” They said kids are dying here. Your son has a treatable disease and I looked around and I saw that kids were dying and it was so unacceptable to me.

[Damien Blenkinsopp]: But your point is if they’re dying, let’s do something riskier.

[Liz Parrish]: Let’s do everything. Let’s do everything. So I left the hospital and I never really went home. I started getting on every board that I could get on as far as information on the internet, looking up what was going on and I found a SENS conference happening in England. That was 2013 and I got on a plane and I went over there and I said, “Ok what is what you’re doing, how does that help kids?” Because I was looking for treatments for kids.

I got there, they said, “Look, we’ve got all this great technology, we just need funding.” So if you look, I went home and I created a funding company. It was called BioTrove Investments. I started BioTrove podcast thinking that people just needed education. I’d get a call on the phone, I’d get to go fly around with fancy people who have a lot of money asking me a lot of questions about the technology. They said, “If you prove it works, I’ll put money into it.”

[Damien Blenkinsopp]: The investors?

[Liz Parrish]: So I said well ok two of my favorite things were telomerase induction and myostatin inhibitors because myostatin inhibitors were already working in humans. So I thought they will like this. So I found an investor and I said, “Let’s start this company and if you want to, I would take these gene therapies.” It will be my contribution to the world, it will be my contribution to my children and it will be my contribution to a world that I hadn’t really given much back to. He said, “Let’s do it. I think this will work.”

Of course we hoped to cure aging in one therapy, but we didn’t, but we got some really interesting data. We found out ok now we have to build the platform to make this a reality. Test every gene therapy that we can and see what combination is needed to actually achieve what we originally started.

[Damien Blenkinsopp]: So they gave you your start?

[Liz Parrish]: Yeah.

[Damien Blenkinsopp]: So how long ago was this?

[Liz Parrish]: That was in 2015.

[Damien Blenkinsopp]: So we’re three years on.

[Liz Parrish]: Yeah.

[Britton Schneider]: September makes three years.

[Liz Parrish]: Yeah, I took the therapy in September.

[Damien Blenkinsopp]: So it’s exactly three years.

[Britton Schneider]: Exactly three years ago.

[Liz Parrish]: Yeah, but the company was started January eighth 2015. The investor came in right away and then it took a long time to get that gene therapy. Then the gene therapy was delayed twice. So here I was ready and anticipating ok we’ll do it. We had considered treating a patient with it, but we couldn’t find any legal way to do that.

(00:55:57) [Damien Blenkinsopp]: How were you allowed to do it? I don’t really understand the regulatory.

[Liz Parrish]: There are some loopholes in regulations where if you are educated, you understand the product of your company, you can participate in the product of your company

[Damien Blenkinsopp]: It’s your personal company, that’s the view.

[Liz Parrish]: It’s not an actual law, but it’s a bit of a loophole and so the FDA never sent us…

[Damien Blenkinsopp]: But you have to be the owner of the company. Is that the thing?

[Liz Parrish]: Yeah and actually people have looked at ways to use that in order to sell shares in their company for people who want to participate in what their company is doing. So yeah spoiler, some people do that. It’s called making an educated decision. I’m a major shareholder in a company, it’s developing technology that will treat patients.

[Damien Blenkinsopp]: You needed that credibility to move forward.

[Liz Parrish]: I don’t know if it offered us credibility, but it sure ignited the industry. We were the first company to treat a patient for, or a person, in this case myself, for biological aging.

(00:56:57) [Damien Blenkinsopp]: Ok. So what baseline labs did you take?

[Liz Parrish]: We did all of the standardized blood tests that you would get at your doctor when you’re doing one of your uber health exams. We did MRI imaging, we did the telomere length testing.

(00:57:11) [Damien Blenkinsopp]: Which company was that?

[Liz Parrish]: We used SpectraCell. We actually used both SpectraCell and Life Length, but the Life Length one that we sent, they said they got it on the wrong day so they couldn’t analyze it.

[Damien Blenkinsopp]: You know what? One of my friends has the same problem. He stopped using them.

[Liz Parrish]: Yeah I was really like, “You are kidding me.” Actually, they were our company of choice. So at the last minute, we had to do a SpectraCell because they would take a 24 hour delivery at that point and we had to get it in within 24 hours because I was about to embark on the test.

[Damien Blenkinsopp]: That’s a shame you didn’t know.

[Liz Parrish]: Well what is great is one year after I took another SpectraCell and I went ahead and did Life Length again because they sent me a free kit because the first one got messed up. Guess what? They had the same value.

[Damien Blenkinsopp]: Exactly?

[Liz Parrish]: They pegged me at about 45 years old.

[Damien Blenkinsopp]: So the same as the SpectraCell?

[Liz Parrish]: Yes.

[Damien Blenkinsopp]: So the two labs coincided; that’s good.

[Liz Parrish]: They totally coincided. So the third one that we did this year, we used SpectraCell because it was the one that we had consistency with and they showed that they lengthened a little bit again. We don’t know if they lengthened all within maybe an 18-month period and they’ve stopped or if they continue to lengthen. Remember, this is only my T-lymphocytes so I can’t tell you that my whole body has been changed by it.

[Damien Blenkinsopp]: The test only looks at one specific cell.

[Liz Parrish]: Yeah. So gene therapy has a lot of obstacles that we have to get over. One thing, what genes do we need to use to create really healthy humans. The other thing is how do we target a lot of cells in the body without creating a immune response. Those are two really big things.

So a lot of people, they either go one way or another. They’re like, “This is so great that you’re doing this” or “Why isn’t this working yet?” We have a ways to go and so by analyzing this data and patients, we’re not only going to learn what happens with gene therapies, but we’re going to learn about titration. That means the dose that you give.

Here’s a really interesting thing. Hemophilia B, they just found in studies if they give 20% of the dose, they had a better outcome in patients; completely unexpected. We don’t expect that with something like telomerase induction that’s not shared outside the cells, but we can expect that with other genes. That’s cost savings. What that means to you is a lot less cost.

[Damien Blenkinsopp]: There’s a lot of those U curves in dosage. I’ve seen that talked about in other areas as well.

[Liz Parrish]: But generally in gene therapy when we look at myostatin inhibitors with the primase, the more they got, the bigger they were, but all genes are not the same.

[Damien Blenkinsopp]: Yeah. Ok. The other one you did was the MRI for the muscle?

[Liz Parrish]: Yes.

[Damien Blenkinsopp]: The myostatin?

[Liz Parrish]: The myostatin inhibitor.

(00:59:48) [Damien Blenkinsopp]: Ok. Thank you very much. Where can people follow what you’re doing, stay in touch with you? Twitter, Facebook or the company?

[Liz Parrish]: Yeah. We are in several places. Actually Brit probably knows. We’re bioviva-science.com. That’s the website. You can see what we’re doing. In October, we’re going to be offering genomic testing, but more importantly, genomic counseling because a lot of people have already got their genes run, but what does that mean?

So we want you to be able to talk to live specialists. Then we will be working over the next year to turn that into longevity counseling. We’re looking at the 59 genes in the human body that drive longevity. We want to see if in people and their family lineage, if these are actually creating longer, healthier lives by the upregulation of these proteins.

[Damien Blenkinsopp]: So they will come to you for that?

[Liz Parrish]: Yeah.

[Damien Blenkinsopp]: So you’ve got a [check 1:00:38] just like a data service basically.

[Liz Parrish]: So the genomic counseling, the genomic products, we’re hoping to offer some of the methylation testing that you can get from other companies, but offering it through our platforms so you have the availability to share your data with our company so we can solve the problem sooner. Then other than that, we’re just analyzing data and doing research and development in BioViva research and development for the larger load viral vector in order to pump you up in one treatment.

[Damien Blenkinsopp]: Ok.

[Liz Parrish]: Fifteen years give us.

(01:01:11) [Damien Blenkinsopp]: Great. If you had one ask to the audience that would help your mission, what would it be?

[Liz Parrish]: I would ask you to go and read some scientific papers. I would ask you to go look at what we’ve achieved in science, look at model organisms and how we’ve extended lifespan. I’d ask you to look at organisms that are already in the planet that have specialized genomes. The extremophiles, they can handle hot, radiation, extreme cold. Axolotls, they can regenerate their limbs. The pentachromat species that can see in billions of colours and I want you to get really excited about your future.

Our life is code and I think that we can modify that. First, we’ll look for human health and then we’ll look to enhance your life for where you want to live, who you want to be and what you want to achieve.

[Damien Blenkinsopp]: Thank you so much both of you; Brit also. Bye.

[Liz Parrish]: Thanks. Bye.

[Damien Blenkinsopp]: See you guys.

(01:02:15) [Damien Blenkinsopp]: Ok we’ve still got the lovely background noise. We’ve been running away from it, but it’s here and it’s following us so we’re just going to persevere now. So I’ve got Dr. Howard Chipman from Young Plasma with me here. We’re at RAADfest 2018. There’s basically an exhibition here. It’s an exhibition hall with lots of companies doing interesting things.

So I’m going to be talking to a selection of these people that I find more interesting and Dr. Howard is one of the more interesting people we’ve met. So first of all, could you just introduce yourself. You just gave me some great highlights of your background so I think that’s a pretty cool way to introduce yourself to they guys.

[Howard Chipman]: My name is Dr. Howard Chipman. I’m the medical director at the Atlantis Clinic in Oldsmar here in Tampa, Florida. I’ve been an emergency physician for many years and also done family practice and walk-in clinic. But I saw a lot of my patients were getting older and needed some other type of anti-aging treatments so I started doing the young plasma treatments. That’s what I’m here for to promote and also to learn about other anti-aging things that we can add to our protocols to help our patients stay alive and healthier and myself too of course.

(01:03:25) [Damien Blenkinsopp]: Yeah. So in a nutshell, what is Young Plasma and how long have you been doing it?

[Howard Chipman]: Young plasma is basically the blood minus the cells which is the plasma from younger people 16 to 25 years old. The idea is to get the healing and growth factors that you had when you were younger and replenish your body with those for anti-aging and healing of degenerative processes.

[Damien Blenkinsopp]: So you’re actually giving people basically a transfusion?

[Howard Chipman]: Yes.

(1:05:00) [Damien Blenkinsopp]: Of how much blood?

[Howard Chipman]: We customize it for the patient, but typically patients get seven units of fresh frozen plasma. The plasma comes from a certified blood bank so it’s tested for all infectious diseases.

[Damien Blenkinsopp]: This is the stuff you would get if you had an accident in a hospital?

[Howard Chipman]: Yes, this is the exact same blood you’d get in a hospital.

[Damien Blenkinsopp]: It relates to your emergency medicine background.

[Howard Chipman]: Except the donors are young.

[Damien Blenkinsopp]: So you make sure they’re young. So yesterday you were telling me that you mix up seven units of blood.

[Howard Chipman]: Actually we just start an IV and we just run the units in like an IV fluid basically over about two hours and that’s it. It’s very simple and painless.

[Damien Blenkinsopp]: Great. Well it’s very interesting. You said you’ve got a few other things just in your background.

[Howard Chipman]: Well my goal is eventually to fly into space. I love airplanes so I have a space training company also called Aurora Aerospace and we take people out for military jet training flights and also zero gravity flights. We do have a microgravity research as well as. We’ve had artists go up and do zero-G painting.

[Damien Blenkinsopp]: Cool. You’ve got an eclectic mix of interests. I like that.

[Howard Chipman]: I just can’t decide what I want to do when I grow up. With the young plasma, hopefully I won’t grow up too fast.

(01:05:08) [Damien Blenkinsopp]: Exactly. All right with the young plasma, I like to give people a little bit of background where this came from if they haven’t been aware of it. It has been in the press for the few years. So could you start from [check 1:05:19] study and then [check 1:05:20] here?

[Howard Chipman]: Well I’ll go back a little bit further. Actually, there was a Russian physician called Bogdanov in the 1920s who started giving himself transfusions of blood from young people to see if it would have an anti-aging effect. He reported many beneficial effects from it, but unfortunately he died after a transfusion.

[Damien Blenkinsopp]: He did? Of what? A bad transfusion?

[Howard Chipman]: Well they’re not sure because back then they didn’t know about blood types. So he may have had a transfusion reaction, but the patient that he got transfused from had malaria and tuberculosis.

[Damien Blenkinsopp]: Ok that could have had something to do with it.

[Howard Chipman]: An interesting note, Dr. Bogdanov was actually a communist and he was highly involved with the communists of Russia. He actually treated Lenin’s sister with young blood. So that’s the first reported instance that we know of in modern times of people using young blood or young plasma.

After that, some experiments were done where they took mice and they interconnected their circulation system called parabiosis where they took an old mouse, young mouse, stitched their blood vessels together so that their blood circulated freely between them. What they found was that the old mouse, his health improved. He became younger and basically everything they could measure or dissect out of him improved.

[Damien Blenkinsopp]: Yeah and what happened to the young mouse?

[Howard Chipman]: The young mouse, he went downhill. Other studies have corroborated this that not only is there a lack of good stuff in your old blood, but there’s actually bad stuff in there as well that actually causes bad things to you. If you take out old plasma and inject it into a younger individual, it causes damage.

[Damien Blenkinsopp]: So don’t do that guys. If you do end up in the army, if you want to ask for younger blood, i don’t know if that’s possible.

[Howard Chipman]: I don’t think so. Typically if you’re getting blood in the ER due to hypovolemic blood loss, what you really need are those red cells to provide the oxygen so that doesn’t really matter. Of course if I was dying and needed blood, I’d rather have younger blood, but if you need those red cells, it doesn’t really, that’s doesn’t matter so much.

(1:07:21) [Damien Blenkinsopp]: All right, cool. So are there any downsides to this? You’ve done this yourself.

[Howard Chipman]: Yes. I’ve been doing it for two years and I feel the difference. I feel more energetic and more youthful. I find myself acting more in ways that I did when I was younger that I had kind of forgotten.

[Damien Blenkinsopp]: How old are you?

[Howard Chipman]: Fifty-six.

[Damien Blenkinsopp]: I don’t think you look 56.

[Howard Chipman]: I used to jump up two stairs at a time. Over time, you get older and you act differently. You don’t really realize it, but after doing these treatments for a couple of years, I find myself doing things that I did when I was younger.

(1:08:00) [Damien Blenkinsopp]: Ok. What is your protocol? How frequently are you doing it? What dose?

[Howard Chipman]: I’m taking seven units every three months.

[Damien Blenkinsopp]: Ok.

[Howard Chipman]: Again, that’s not based on any hard science. It’s based on the study that we performed; the Ambrosia trial where we used seven units.

[Damien Blenkinsopp]: You are mimicking the study?

[Howard Chipman]: Yes. That dose was come upon by a high dose of plasma because we use plasma for many other things in the hospital. Basically, we just took the high upper-level dose of that and do it every three months.

(1:08:30) [Damien Blenkinsopp]: Yeah. So you said you worked on the Ambrosia study. What was the Ambrosia study?

[Howard Chipman]: The Ambrosia study was a trial where we took a number of individuals and gave them one dose of seven units of plasma and then measured the biomarkers before and after to see if there was any change in there.

[Damien Blenkinsopp]: And?

[Howard Chipman]: The study is not published yet.

[Damien Blenkinsopp]: So you’re not allowed to talk about it.

[Howard Chipman]: I don’t have the data because I was a sub investigator, but my understanding is that the amylase and the CEA showed significant improvements and there were several other biomarkers that showed that as well.

[Damien Blenkinsopp]: So reduction in amylase. Is that amylase did you say?

[Howard Chipman]: Amyloids, sorry. Amyloid.

(01:09:07) [Damien Blenkinsopp]: Amyloid plaques in the brain. How do they measure the amyloid?

[Howard Chipman]: They weren’t measuring the plaques. They were measuring blood levels. They send off a huge panel of 100 different tests.

[Damien Blenkinsopp]: Ok. Those were the only things you know that came back with a difference?

[Howard Chipman]: Correct. Correct.

[Damien Blenkinsopp]: Because you might have expected more basic things like CRP. A lot of people get elevated as age goes on.

[Howard Chipman]: It’s possible. Like I said, I haven’t seen the data yet.

[Damien Blenkinsopp]: Do you know when it’s going to be published?

[Howard Chipman: No, I don’t.

[Damien Blenkinsopp]: Ok.

[Howard Chipman]: I keep asking, but I haven’t gotten a straight answer yet. Hopefully soon.

[Damien Blenkinsopp]: Ok. We’ll look forward to that.

[Howard Chipman]: But the patients that we treated in the study and the patients I have treated subsequently have all reported subjective significant improvements in their wellbeing and health.

(01:09:50) [Damien Blenkinsopp]: Ok. Great. So now you’re providing this as a service to other people?

[Howard Chipman]: Yes.

[Damien Blenkinsopp]: By the way, are you tracking any biomarkers yourself?

[Howard Chipman]: No.

[Damien Blenkinsopp]: Have you noticed anything personally?

[Howard Chipman]: I’m not checking any real biomarkers. I do routine labs upon myself and my glucose and cholesterol and all those things improved, but it might have been due to, I started going to the gym too. I figured if I’m doing this young plasma, I might as well make the best of it and do it as a regimen of improving your lifestyle.

[Damien Blenkinsopp]: So you see improvements. That often happens with me. I do two or three things at the same time.

[Howard Chipman]: It could be from something else.

[Damien Blenkinsopp]: I don’t know, in like, ten years. So I’m going to do several and then I’m like I don’t know which one did it, but it’s something.

[Howard Chipman]: The main thing I look at is, “Does it work?” The efficacy, and I think we’re eventually going to find the cure for aging, but that’s going to be a while off. So what we need to do now is to stay alive as long as we can with the best tools that we have now. That’s what my goal is, to try and find things that we have available now that we can use to keep ourselves.

[Damien Blenkinsopp]: Extend health span.

[Howard Chipman]: Yeah extend our lifespan until maybe something better comes along.

[Damien Blenkinsopp]: Cool. You’re doing this now as a service.

[Howard Chipman]: Yes.

(1:11:02) [Damien Blenkinsopp]: How many people have you had in your clinic?

[Howard Chipman]: We’ve treated over a hundred people with this so far.

[Damien Blenkinsopp]: Are they one-time users or are they frequent? What’s the way people have been using this?

[Howard Chipman]: About half of them were in the study and they came just for one-time; some of them. But many of them have since come back. I’d say probably 80% of the people that do one treatment continue to do them because they feel improvements.

[Damien Blenkinsopp]: Are they doing the similar protocol to you? The three months?

[Howard Chipman]: Some are, some aren’t. Some can afford it.

(01:11:34) [Damien Blenkinsopp]: Let’s talk about the cost. How much is one dose?

[Howard Chipman]: The treatments are eight thousand dollars and that’s for seven units. That includes everything. If people want less units, we have a prorated scale. We have a couple patients that come every month and get five units for example. We have a patient with dementia and we’re trying to see if it can help with that. Because there are some animal models and studies that show that it might be beneficial so we’re trying to help this woman. She comes every month and we give her five units, for example.

(01:12:05) [Damien Blenkinsopp]: Ok. All right. Cool. Do you have any idea of the mechanisms? It sounds like it’s probably way off for me to understand what might be going on.

[Howard Chipman]: There are many, many things going on and we’ll never know the details exactly. Basically what we’re trying to do is reproduce the young physiology that you had when you were younger by replacing all those healing and growth factors that are present in young blood and just basically replenishing the people who are older.

There are many different mechanisms going on. The body is very complex; the process. I think over time, we’ll be able to better understand these mechanisms, but I’m not a basic research guy. I don’t have a billion-dollar lab to figure all this stuff out. So what I’m trying to do is help people today and help myself with what we have right now until we figure it out.

(01:12:53) [Damien Blenkinsopp]: Great. So one of my first questions when I met you was how are you getting this blood? Is it legal? I’m sure that might be a question some people have in their heads. So what is the answer to that?

[Howard Chipman]: Of course. It comes from a certified blood bank so yes it’s completely legal. We’ve been using plasma treatments for over 50 years in hospitals. Every hospital in every country gives plasma every day pretty much. It’s usually given as a preventative or to treat bleeding disorders. It’s an FDA-approved treatment.

[Damien Blenkinsopp]: You’re just using it off-label.

[Howard Chipman]: We’re just using it off-label for something else.

[Damien Blenkinsopp]: So it’s quite straightforward really.

[Howard Chipman]: Absolutely straightforward; no problems at all.

[Damien Blenkinsopp]: You’re just saying basically you have to be a practicing doctor.

[Howard Chipman]: Yeah, you have to be a physician because it has to be ordered and administered by a physician. There you go.

(01:13:40) [Damien Blenkinsopp]: Ok, great. So that’s Young Plasma. The other thing I would just like to know a bit more broadly what you’re up to in terms of your activities. You said you’re going to the gym and you’re tracking markers. What are you doing in terms of your own health and life extension?

[Howard Chipman]: I’m using young plasma. I’m also taking Metformin as well. It’s a Diabetes drug. There seems to be pretty good evidence now showing that it’s helpful. They did a study where they took people who are diabetics and put them on Metformin and measured their insulin, heart attacks and strokes and they actually had lower incidence than non-diabetic people who were not on the medications. I think Metformin’s a no-brainer so it’s probably a good idea to take it.

[Damien Blenkinsopp]: Did you ever raised glucose or anything like that or you’re just taking it for the longevity?

[Howard Chipman]: My hemoglobin A1C was measured at the time was borderline. It wasn’t diabetic.

[Damien Blenkinsopp]: Was it six?

[Howard Chipman]: It was 5.7. I used to joke and tell people I was one doughnut away from being borderline, but it’s all back to normal now.

[Damien Blenkinsopp]: Where’s it at?

[Howard Chipman]: I don’t remember what it was last, but it dropped. It dropped. It was almost in the abnormal range and now it’s well in the normal range.

[Damien Blenkinsopp]: So do you think that might be the Metformin?

[Howard Chipman]: I tested it before I started the Metformin so I just started. I haven’t checked my blood. I just started on the Metformin recently.

[Damien Blenkinsopp]: It’s probably the young plasma and your exercise.

[Howard Chipman]: Yes. Yes, but the Metformin will bring it even lower. Sorry, what were you asking about?

[Damien Blenkinsopp]: I don’t know. It skipped my mind there. This is the problem with live. I got into what you were talking about.

[Howard Chipman]: You asked me what I do for other treatments. So firstly, I take Metformin, I do the young plasma, take an aspirin a day; that’s a no-brainer.

[Damien Blenkinsopp]: Ok aspirin.

[Howard Chipman]: I also take cholesterol medication. I take a statin.

(01:15:31) [Damien Blenkinsopp]: Are you concerned about the potential negatives of some of those?

[Howard Chipman]: I don’t see statins as a problem. It’s overblown. A lot of my patients are 400 pounds, their cholesterol are through the roof, “Oh they can’t take a statin.” I do not see many problems with statins. Rarely, people get some muscle pain and you have to stop it.

[Damien Blenkinsopp]: Like fibromyalgia.

[Howard Chipman]: In some people, it will raise their liver enzymes slightly.

[Damien Blenkinsopp]: The things I have seen are its potential interactions with mitochondria. I was thinking that might be the connection with the muscle pain and fibromyalgia.

[Howard Chipman]: It’s possible.

[Damien Blenkinsopp]: The connection there.

[Howard Chipman]: But I don’t see too many side effects from it. Most people don’t have any problems at all. So I take that because my cholesterol was a little bit high. There are studies suggesting that even normal people take statins significantly to reduce their risk of heart attacks and strokes. My father had coronary artery disease.

[Damien Blenkinsopp]: You’re focused on that one.

[Howard Chipman]: Yeah. My dad didn’t believe in eating vegetables. He lived to be 90.

[Damien Blenkinsopp]: He would’ve gotten along with, have you heard of th carnivores? The zero-carb? There’s a whole tribe of them on the internet now.

[Howard Chipman]: Really?

[Damien Blenkinsopp]: They just eat pure meat. That’s a thing, yeah. Great. So you’re exercising, you’re taking Metformin, baby aspirin; you’re doing quite a range of things.

[Howard Chipman]: And the statin.

[Damien Blenkinsopp]: And the statin, yeah. That’s quite a bit.

[Howard Chipman]: The other thing I’m looking into is Rapamycin as well. I’ve seen some potentially good studies and evidence on that. It is an immunosuppressant, but some studies show if you take it once a week, you don’t get the immunosuppression, but you still get the anti-aging effects. I have a couple of my young plasma patients that have dementia. I have them on Rapamycin.

[Damien Blenkinsopp]: Is it quite expensive?

[Howard Chipman]: It’s not cheap and it’s not very expensive either. You’re only taking it once a week.

[Damien Blenkinsopp]: How much does it cost on a monthly basis, for example?

[Howard Chipman]: Can I just throw a number out like 50 bucks, 100 bucks. It’s not cheap.

[Damien Blenkinsopp]: That’s pretty cheap.

[Howard Chipman]: I thought a four dollar Wal-mart prescription, but it’s not expensive. It’s not expensive. It has been out for a while. That’s something I’m not taking, but may consider taking soon because it looks like it does actually work.

(01:17:43) [Damien Blenkinsopp]: What will lead you to the decision to take that or not?

[Howard Chipman]: Maybe I’ll see how my patients do on it.

[Damien Blenkinsopp]: Ok guinea pig; the guinea pig approach.

[Howard Chipman]: Usually, I use myself as the first guinea pig.

[Damien Blenkinsopp]: That’s good to know. It has been great to chat with you about all of this. Is there anything we missed?

[Howard Chipman]: Not that I can think of. I think you asked me to give my contact information. Anybody has any questions, they can contact me at any time. I’m at the Atlantis Clinic in Oldsmar, Florida. That’s next to Tampa. Our website is young-plasma.com and if anybody wants to call me for a consultation, I’ll give you my cellphone number 813-476-2321. If you have any questions about Young Plasma or any other anti-aging, I’m glad to answer for you.

[Damien Blenkinsopp]: Thank you so much for your time. It has been great to have you here.

[Howard Chipman]: Nice talking with you.

(01:18:37) [Damien Blenkinsopp]: Hey! We’re here with our second interview. There’s a little segway here actually. We happen to have one of the guys who’s using

[Brian M. Delaney]: Young Plasma.

[Damien Blenkinsopp]: Young Plasma which I didn’t know.

[Brian M. Delaney]: From Dr. Howard Chipman. I got that six, seven, eight weeks ago and I didn’t know what to expect. I read some of the research results. There are actually many and there’s lot for umbilical cord plasma which is really young plasma, but for less young plasma, there aren’t a lot of results out there, but I wanted results. For theoretical reasons, I expect there to be some benefit because I’m 55 and the plasma comes from someone between the ages of 16 and 25.

I did some before and after biomarkers and saw small changes, but it’s hard to know because I’m always changing my diet and exercise routine so I can’t really say much about that. What was amazing was the subjective effect which sadly didn’t last too long, but for about 36 hours I was Superman. It was amazing.

(01:19:35) [Damien Blenkinsopp]: What did it feel like to be Superman?

[Brian M. Delaney]: I have sleep problems and I’m not as young as I used to be. I think I do have a lot of energy and I’m in pretty good shape, but I walked towards my car from the clinic after having plasma. During it I had, some get hives so I had some Benadryl so I was a little tired from the Benadryl, but that had worn off. I got in my car, turned on the radio and the music sounded more beautiful. It didn’t matter if it was Abba or Beethoven, the whole thing from the bass.

[Damien Blenkinsopp]: Life is more beautiful.

[Brian M. Delaney]: Yeah, it was amazing.

[Damien Blenkinsopp]: There were more colours in the world.

[Brian M. Delaney]: Yeah it was incredible. I’m driving across the Everglades and it’s just wow.

[Damien Blenkinsopp]: It was a bit psychedelic.

[Brian M. Delaney]: It was almost. I happen to be a birdwatcher. You can fool yourself into imagining and experiencing it better than it is. So I’m looking at all these passing raptors and identifying them really quickly as if my vision worked better. I knew obviously my vision is not better. Anyway so for about a day and a half, I really felt physically, I felt, you could even say I had more energy. That’s such a stupid marketing term, but I really did have more energy.

I slept better that night which is unusual for me. Normally I have to take sleep medications which is not good. The next day I woke up and I felt amazing. I did, this is one slightly more objective measure, I do decline pushups and I changed my diet and I tried to see if it would have an effect so I measured the height of my feet on the chair exactly, it’s 47 centimeters, arms are set a certain distance apart and I could do about 15% more that morning.

[Damien Blenkinsopp]: So how many?

[Brian M. Delaney]: Normally, it would be about low forties and it was somewhere around 50 I think.

[Damien Blenkinsopp]: It pushed you to the maximum?

[Brian M. Delaney]: That was just maximum, yeah. Next day, I was exhausted, yeah. Unfortunately, the subjective effects and partially objective.

[Damien Blenkinsopp]: Did they decline as well? That change during the week?.

[Brian M. Delaney]: It did start to go back to normal after about a week. So the 36 hours was just an amazing experience and then it started to fade and within five to seven days, I felt like I was back to normal.

(1:21:42) [Damien Blenkinsopp]: So when did you do that?

[Brian M. Delaney]: I can’t remember exactly. I think it was maybe two months ago. It was seven weeks.

[Damien Blenkinsopp]: You just did it once?

[Brian M. Delaney]: Just once although I’m going to do it again in a couple of weeks.

(01:21:50) [Damien Blenkinsopp]: So do you have a plan? Are you going to stick to it?

[Brian M. Delaney]: Here’s what I’m going to say. Money is an object for me, but if money were no object, I felt so good that I would do this every three or four days. That’s how good I felt, but it’s just too expensive. Dr. Chipman knows that and he would love to bring the cost down. He has a contract with the blood bank which is hard to get that enables him to buy small quantities of plasma.

[Damien Blenkinsopp]: I think he’s going to be limited. He was telling me it’s quite tricky at that place.

[Brian M. Delaney]: Yeah so I would love to do it every few days. That’s how good it felt, but it’s just impractical.

(1:22:37) [Damien Blenkinsopp]: Ok. Now Brian M. Delaney, let’s introduce you. Who are you? What do you do?

[Brian M. Delaney]: I am currently the president for the Society for Age Reversal. It’s a group that Bill Faloon founded.

[Damien Blenkinsopp]: Bill?

[Brian M. Delaney]: Bill Faloon of Life Extension.

[Damien Blenkinsopp]: One of the founders of Life Extension Foundation or supplement maker?

[Brian M. Delaney]: Exactly. He put me in charge of it. Lots of people, fortunately more and more all the time, are working on finding cures for aging or at least treatments to reverse parts of aging. It’s great that lots of money is coming in from increasingly conventional sources.

For example, Jim Mellon, the British millionaire was a very good, but more or less conventional investor. He slowly started turning towards Biology and then now he’s turning towards anti-aging. I’m sure it’s probably because he has charitable donations and he wants to save himself and his immediate family, but also because he has realized it’s a great investment.

So lots of money is going into anti-aging, but typically this is going to result in cures or effective treatments maybe a decade from now. The typical drug development path takes that long; maybe seven years, maybe fifteen years. What we’re trying to do is find what one could describe as the low-hanging fruit of age-reversal treatments. That’s not entirely accurate, it’s just easy to pluck. It’s not always easy to pluck, but you can pluck it soon.

So this involves things that have been investigationally orphaned because there’s no easy way to make a profit from it. For example, Metformin that has been studied for a long time for Diabetes, but now there are people trying to raise money during these trials to try to test it in humans as an anti-aging treatment, but how do you make a profit from a drug like Metformin? It’s not so easy. You can do it as a clinician, but that’s just patient fees so it’s not going to be too profitable.

[Damien Blenkinsopp]: [Check 1:24:39].

[Brian M. Delaney]: Yeah. Rapamycin is another example and of course senolytics. Senolytics are substances that will destroy senescent cells; these zombie cells that spew out injurious cyclin molecules.

[Damien Blenkinsopp]: The idea is we accumulate senescent cells as we age and it’s the signals they’re sending out or the metabolites or whatever they’re sending out which is damaging and accumulates over time.

[Brian M. Delaney]: That’s exactly right. Worse still, these senescent cells can turn other non-senescent cells into the senescent cells. So it almost is like The Walking Dead. So a TV show where zombies can turn non-zombies into zombies by just being near them and getting close and biting them metaphorically speaking. So it’s great tool to use if you can do it safely. Some would say that’s a big if. The category of senolytics spans both the traditional [check 1:25:37].

[Damien Blenkinsopp]: So senolytics are things that kill senescent cells?

[Brian M. Delaney]: Yeah. “Seno-” from the Greek “old” and “lytic” for “lysis” to split apart or break so yeah that’s what senolytics do. There are all kinds of them.

[Damien Blenkinsopp]: Are these compounds or molecules?

[Brian M. Delaney]: Yeah. Even now, there are new strategies using enzymes, but the standard approach that has existed upon not only Big Pharma, but also the stuff that we’re trying to find, involves either something like natural substances like fisetin or old cancer drugs that can be repurposed like Dasatinib.

So that has been tested in rodents several times now specifically a combination of Dasatinib and Quercetin. Synergistic is a word that is often abused, but it describes them correctly. You put them together and the effect is more than the sum of the individual effects of the two. I don’t think there has been a lifespan study done yet or even underway, but what we see in the rodents is regression of atherosclerotic plaques. for example.

[Damien Blenkinsopp]: Regression?

[Brian M. Delaney]: Yeah, actual regression which is astonishing which we normally think they can’t do. Dean Ornish I think has shown that a radically low-fat diet combined with other aspects of his program, meditation and exercise can regress them actually, but aside from that, it’s really hard.

[Damien Blenkinsopp]: How do they measure that?

[Brian M. Delaney]: I think it was just x-rays.

[Damien Blenkinsopp]: [Check 1:27:09]?

[Brian M. Delaney]: With the rodents, I think they actually just looked. They just x-rayed them, I think. I’m not sure. There are actually two studies I believe that showed that.

(1:27:19) [Damien Blenkinsopp]: So when you say you going about looking for these compounds, what does that actually mean? Are you looking for the research? Are you talking to people?

[Brian M. Delaney]: We’re talking about senolytics alone, but this is the same strategy for lots of other drugs.

[Damien Blenkinsopp]: You’re doing several areas. This is just one you’re focusing on at the moment?

[Brian M. Delaney]: I’m focusing on many, but it’s one that I’m particularly interested in. So I think we can actually save people’s lives now with senolytics. I’m convinced. I’m trying to get my mother to try this and she’s a little scared because Dasatinib is a cancer drug and if you Google it, you see the side effects. That’s from people taking it daily for months who are really sick because they have cancer and are taking other drugs.

My approach partly is I just read research. My formal academic training is in the Humanities, but I’ve gotten up to speed as fast as I can on research. I try to make executive decisions about what areas our group needs to focus on and then I contact the real experts which I’m not, and try to form collaborations and try to see if what they’re doing in researching Quercetin alone or in combination with something else is redundant. Then we try to find funding. We might fund it ourselves. Bill Faloon has funded lots of projects; he’s incredibly generous. And or we find other people who want to fund some of this research.

At conferences, the talks are always great, but you go to the poster presentations and you find some mad scientist graduate student at the University of Lund in Sweden. He has got some cool idea and it may be something that hasn’t even been published yet. That’s what I really want to do. I want to find these things that no one knows about.

(1:29:10) [Damien Blenkinsopp]: Yeah. So just for the people out there, posters at conferences are typically studies in progress or maybe just finished by PhD students. Maybe it’s part of their PhD so they’re not going to do a full talk on it, but they’ll have this poster explaining that whole study and what they found or they’re finding. So I actually have PhDs working for me who present this kind of stuff at conferences so it’s a way to fund the edgier, earlier stuff.

[Brian M. Delaney]: Exactly. Yeah. Then there are small startups or we call them pre-startups. Scientists with ideas who are sitting somewhere. There’s a guy Harold Catcher who’s actually an American, but he’s got a collaboration with some people in Mumbai and actually he’s spent about half a year.

At this point, unfortunately, I can’t talk about much of his research, but they have a polyherbal formulation that has got some amazing results. It can look like it does what this calorie-restriction diet does which apparently slows aging even in humans according to biomarkers. That research has been done for a century. They have some other amazing products and they’re forming a company.

[Damien Blenkinsopp]: So it’s like a calorie restriction mimetic?

[Brian M. Delaney]: Yeah, possibly even more. It’s not clear yet. So people like that I try to identify and then maybe that would be a case where if they’re forming a startup and they’re looking for investors as opposed to funding from charitable sources that just want to give away their money to help resources then I might connect them with investors who want to help actually found the company. If the company’s already started then I’ll help it grow.

(01:30:57) [Damien Blenkinsopp]: So your goal is basically to find opportunities and help push them on?

[Brian M. Delaney]: Yes.

[Damien Blenkinsopp]: You help give them what they need to grow and to make more progress faster?

[Brian M. Delaney]: Faster! That’s really the key. If you don’t have that part about the timescale, you’re really focused on the short-term. We had a group that was named previously “The Society for the Rescue of Our Elders.” A long and exotic name, but the concept was it was based on this group, the name itself, this group in Holland that existed two and a half centuries ago where people would fall into the canals and drown. If you did it quickly enough, you could pull them out and save them so it was a society for the rescue of drowned persons.
The idea was there are people like my parents who are about 83 who don’t have a lot of time left. My dad’s in good shape, but my mother is not. Jim Mellon is doing this amazing work, Juvenescence, but a lot of what he’s investing in is not going to come in time for my mother; probably not even my father who is still in good shape. So the idea with this society for the rescue of our elders, I thought of it internally as the society for the rescue of my mother. That is what really motivated me.

[Damien Blenkinsopp]: That gets you up in the morning.

[Brian M. Delaney]: Exactly. So it’s really trying to find treatments that can be made available in a very, very short timeframe. If you saw my mother sitting down, she’s sharp, but if you saw her walk, you’d realize she may not have a lot of time left. It actually does worry me so that’s part of why. I had a fine life teaching Philosophy in Sweden. I gave that up entirely to work with Bill because I really want to.

(1:32:43) [Damien Blenkinsopp]: Wow! I’m just really curious. How did you get involved in this?

[Brian M. Delaney]: Life Extension itself, I was involved in the Calorie Restriction Society and that goes way back.

[Damien Blenkinsopp]: I saw that, yeah.

[Brian M. Delaney]: I was making money doing other things. I was in graduate school as a philosopher.

(01:32:59) [Damien Blenkinsopp]: So you practiced calorie restriction?

[Brian M. Delaney]: For a long time. I’ve gone at least half of it which I’ll explain in a moment. What happened was a long time ago in 1992, I was diagnosed with Crohn’s Disease. It’s an inflammatory bowel disease. It was not clear at first. We thought it might have been food poisoning, but until that point, I really ate horribly. I exercised a lot. I had this notion like a lot of people do that the virtue of exercise can make up for the vice of bad eating no matter how badly you eat and that’s not true of course. It helps to exercise, but you have to eat well as well.

Back then, research online was useless so I went to the medical library when I was in graduate school in Phiolosophy, but I would go to the medical school and read about nutrition. That’s when I found what [check 1:33:45] were and calorie restriction. I called them up and said, “This looks miraculous! Why aren’t human beings trying this?” They said well I’ve written two books trying to get people to do it. A few people are, but let’s start a non-profit. That was my beginnings of my interest at Life Extension.

But back then, because I was so focused on things one can do now, then as now, and then it was only CLR. Vitamins couldn’t help with certain disease states, with aging cells so CLR was the only thing I wanted to do. So I did that, but meanwhile I’m in graduate school. That was my main way to make money; not much.

Then I accidentally moved to Sweden 18 years ago and continued making money teaching all the while trying to keep the CR Society going. But what happened about seven, eight, nine years ago was there really were better options or options other than CR (Calorie Restriction) that seemed promising; that seemed either available or soon to be available.

So that posed two challenges for me. One, do I even want to keep the CR Society going given it’s clear [unclear 1:34:53]?

[Damien Blenkinsopp]: It has less potential.

[Brian M. Delaney]: Exactly. But then secondly, do I want to shift gears and put more of my own energy into something else? So I oscillated for quite a while and then just by chance, I was in Florida a year ago only visiting my parents and helping them move actually and called up Bill Faloon thinking that I might maybe write an article for a magazine about CLR. I think what I wanted to pitch was, “Is it still worth it?” He said, “Where are you?” I said I’m in Florida. “Hey I’m in Florida, let’s have dinner.” We had dinner and we talked. We had another dinner and we talked.

He had already started this Society for the Rescue of Our Elders. He said if you want to become Project Manager, leave your life in Sweden and just really commit to this, I’ll bring you on retainer and we’ll be off and running and I said yes.

[Damien Blenkinsopp]: Excellent! I bet you were like man, this will be fun.

[Brian M. Delaney]: It was generous of Bill and great for me. Not that I minded teaching Philosophy to hungover Vikings.

[Damien Blenkinsopp]: So remind me. Is this now two years? How long?

[Brian M. Delaney]: One year.

[Damien Blenkinsopp]: One year.

[Brian M. Delaney]: A little bit more.

[Damien Blenkinsopp]: Where are you at with this? Are you basically working some leads or have you actually completed some funding?

[Brian M. Delaney]: Where we are now is what’s going to be announced here at RAADfest by Bill Faloon in a few hours and then in a little more detail in his second presentation on Sunday which is that we now have a pretty good idea of some concrete steps people can take today to slow aging.

[Damien Blenkinsopp]: This is under senolytics?

[Brian M. Delaney]: It involves a number of steps. I feel like I don’t want to go into it in too much detail because Bill wants to.

[Damien Blenkinsopp]: Yeah, open it to the world.

[Brian M. Delaney]: Yeah, be the one to present it. We have a little publication that you can grab where it’s laid out. None of this has been verified and done in phase three or even phase two trials. This is just stuff that we have either put together using other people’s research that others have funded or research that we have helped fund through this group called Better Humans. This guy, James Clement started a non-profit, Better Humans where he runs these open-label, non-randomized simple controlled trials. They call them phase zero trials; exploratory trials. So some of the data from his work.

[Damien Blenkinsopp]: So it’s on humans, but it’s non-randomized. So you basically just give ten people something and see what happens?

[Brian M. Delaney]: Yeah.

[Damien Blenkinsopp]: You take a baseline?

[Brian M. Delaney]: Exactly. In some cases, one can say well that doesn’t really say that much, but in this case he designs them very well. Give me a moment, I have to remember what I’m allowed to say. You know what? Wait until Bill gives his talk. I don’t want to screw this up. James doesn’t really care, but it’s all pre-publication and he has a whole bunch of papers that are about to be accepted I assume for publication. I am allowed to say that the results from most if not everything he has done look positive in two ways. They’re safe and at least a bit efficacious.

(1:38:07) [Damien Blenkinsopp]: So what could this mean? Would it mean there’s a supplement someone can take with these compounds?

[Brian M. Delaney]: It will mean yes supplement or drug in a particular order. Actually I should just back up. This has nothing to do with Better Humans.

[Damien Blenkinsopp]: This is a senolytics area?

[Brian M. Delaney]: That is part of it, but something that is important here to back up and note. It has nothing to do with Better Humans or any research that we’ve done recently, but it’s almost common sense. I’m going to to express broadly that the most fundamental first step that people should do is to get the body in basic shape using things like Vitamin D supplementation if your Vitamin D is too low or get out in the sun, exercise if you’re overweight, eat better. These things are actually more effective than a lot of people realize.

I’m still President of the CR Society and I still want to wear that hat occasionally and tell people even if they don’t want to do extreme CR like I did for years, that can help a lot. Then take these steps that involve some of these off-path drugs.

(1:39:16) [Damien Blenkinsopp]: So build your foundation first with the basics that we know. All right let’s talk about the structure though because that’s interesting and maybe it relates to what you do. I don’t know.

[Brian M. Delaney]: For my own personal health?

[Damien Blenkinsopp]: Have you implemented all of this stuff already?

[Brian M. Delaney]: Absolutely!

[Damien Blenkinsopp]: So let’s just talk about you as a case study. So what do you do?

[Brian M. Delaney]: What I did for a long time was calorie restriction as you know.

[Damien Blenkinsopp]: How many calories we’re talking per day?

[Brian M. Delaney]: I’ve got weird inefficient metabolism. This is going to sound like a lot, but I exercised a lot. At my most extreme, where I really looked like I shouldn’t have survived; it was really extreme.

[Damien Blenkinsopp]: Very thin.

[Brian M. Delaney]: Very thin. I looked in the mirror and I thought that’s not me even though I felt great. At that point, I exercised a lot. I was eating 1,900 calories per day and that doesn’t sound so little.

[Damien Blenkinsopp]: What is it? Like 10% now?

[Brian M. Delaney]: No, it was more like 35% to 40% below what I’m eating now. I’m still trim, but not like [unclear 1:40:18].

[Damien Blenkinsopp]: You’ve got quite a high metabolic rate.

[Brian M. Delaney]: Yeah which is actually bad because that tends to be one of the things correlated with rapid aging. It’s just burning through like stepping on a gas pedal and the engine is not quite in tune so that’s unfortunate. Anyway I did that for a long time and looked at my biomarkers which improved dramatically.

[Damien Blenkinsopp]: What kinds?

[Brian M. Delaney]: Just like HDL through the roof, LDL really bottom down. When I did the measuring particle count and size, the few LDL particles I had weren’t noticed.

[Damien Blenkinsopp]: Great. So that’s what you want basically. You probably don’t remember the numbers.

[Brian M. Delaney]: No.

(1:40:57) [Damien Blenkinsopp]: It would be well below 800 for the small particles. But based on what you’re saying well below 800 so really good. We’re talking about the nuclear magnetic resonance lipoprofile which is a test which looks at the particle size of your LDL and your HDL to really understand that versus just looking at LDL cholesterol total which is normally what people look at. The idea is that it’s a lot more accurate because if you’re looking at total LDL, you could have some really big particles which we don’t really care about because they’re not very atherosclerotic.

[Brian M. Delaney]: We think.

[Damien Blenkinsopp]: We think. It’s a better assumption than LDL is bad for you.

[Brian M. Delaney]: Absolutely.

[Damien Blenkinsopp]: It’s progressing slowly is what we’ll say. But if you combine that with a bunch of biomarkers then it starts to paint a realistic picture. So your homocysteine, your CRP, did you look at those?

[Brian M. Delaney]: Yeah. CRP was just perfect; it couldn’t be better. I do have genetically high homocysteine so I didn’t get below seven. Seven is very good.

[Damien Blenkinsopp]: Seven is actually good.

[Brian M. Delaney]: It’s good, but I a lot of people have below five. I have familial high blood pressure so mine never got without having orthostatic hypertension which is fainting when they stand up. They would have 85/57 and feel great. Mine was more like 102/60 which is great, but it’s not the typical extreme CR value. My fasting glucose was, my doctor would say, “Do you feel weak?”

[Damien Blenkinsopp]: How much was it?

[Brian M. Delaney]: It was like 60; usually sometimes even high fifties.

[Damien Blenkinsopp]: Yeah, that’s pretty low.

[Brian M. Delaney]: So it was great. I felt great. Unfortunately what happened was about three years ago, two and a half years ago I had hernia surgery and they screwed up so then it was three surgeries. I had to eat more to recover. You have to eat more. I don’t know if it had to do with mTOR signaling, but I had to get out of the famine stage which doesn’t make growth easy. But I have to confess when I started eating more, I felt good in a way that made me think wow.

[Damien Blenkinsopp]: Alive! Just some empty calories after all.

[Brian M. Delaney]: Leucine, the protein that makes the mTOR signaling go up and testosterone. Suddenly, I was a man again.

[Damien Blenkinsopp]: Did you test your testosterone? Because I thought it would go down while you’re fasting.

[Brian M. Delaney]: It did.

[Damien Blenkinsopp]: Which is similar to caloric restriction I would think.

[Brian M. Delaney]: It’s two things. People on really extreme CR have low serum total testosterone, but really low free testosterone because the sexual hormone binding is really high.

[Damien Blenkinsopp]: It does?

[Brian M. Delaney]: Yeah. On CR, that took place. We joke that men on CR, we are functional eunuchs. When I started eating more, I realized that there is perhaps more of a sacrifice to being on CR than I realized. Being hungry was not a problem for me. Feeling cold is not a problem; you put on a sweater.

[Damien Blenkinsopp]: You were starting to realize also that CR may not be as impactful compared to all these other things.

[Brian M. Delaney]: That too.

[Damien Blenkinsopp]: So you got double whammy.

[Brian M. Delaney]: Yeah. Exactly. So that got me thinking about alternatives. At that point, I started, well I had to recover from my surgeries. That took a while. So then I started going back to research in my off hours and then that’s when I started to realize how much else is out there. I looked into Rapamycin and some new [check 1:44:21] that appears to be a partial calorie restriction that I’m now on by the way.

[Damien Blenkinsopp]: You’re on Rapamycin?

[Brian M. Delaney]: Yeah.

[Damien Blenkinsopp]: Let’s get your stacks.

[Brian M. Delaney]: So to answer your question, I got off CR, had a bunch of testosterone and had fun with that. Then I realized ok I had to get serious about not dying.

[Damien Blenkinsopp]: How old are you by the way?

[Brian M. Delaney]: Fifty-five.

[Damien Blenkinsopp]: Fifty-five.

[Brian M. Delaney]: I was more knowledgeable about diet than anything else. What I started with was time-restricted eating. I didn’t want to go back on CR the way that I had been. I wanted some of the benefits of a CR-like diet so I was interested in Valter Longo’s work and I tried the Fasting Mimicking Diet for a while.

[Damien Blenkinsopp]: How many cycles did you do?

[Brian M. Delaney]: I did it once already for five or six weeks for about four months. It’s hard to know. You get these immediate benefits after and then they start to fade. It’s not clear. He hasn’t done the experiment which is really important which is to do daily CR with an amount that is the average amount that someone on fasting would have done would end up eating. If you eat 2,500 calories per day normally and then you ate 500 per day for five days of every month. You average that out and what is that per day for the month?

Then you do the study with normal daily CR eating the same total amount averaged over the month. He hasn’t done that.

[Damien Blenkinsopp]: So you want to compare?

[Brian M. Delaney]: Because we don’t know if it’s fasting per se.

[Damien Blenkinsopp]: You’re saying it might just be the calorie reduction because five days you reduce your calories?

[Brian M. Delaney]: We don’t know that. He needs to do the experiment.

[Damien Blenkinsopp]: I’ve done an experiment with fasting [check 1:46:02] last week. Your immune system goes down. It’s going to go down further because there’s more autophagy than with caloric restriction.

[Brian M. Delaney]: We don’t know that.

[Damien Blenkinsopp]: No?

[Brian M. Delaney]: We don’t know that actually. With mild CR, maybe not. But certainly daily CR, at least moderate CR, there is autophagy. There are all kinds of things that happen at slower levels than during a fast or a fasting on your diet.

[Damien Blenkinsopp]: What I do know is just your white blood cell count is halved on day five. Then you test again seven days later after refeeding and you’ll actually be higher than your baseline and that’s what I’ve seen several times now.

[Brian M. Delaney]: In yourself?

(01:46:43) [Damien Blenkinsopp]: Yeah. So I’m using as a proxy for autophagy which isn’t great, but it’s difficult to get autophagy and get a biomarker. So I’m continuing to look into that, but it gets me hopeful. I’ve also seen some effects in my mother who is now doing cycles of these to combat cancer. It looks promising from that. For her type of cancer, you have immunoglobulin M which grows over time. So the maximum reference [check 1:47:10] because basically over the years, it has grown.

What we’re trying to do is knock it down by doing a fasting mimicking diet once a month. We’ve seen it now two times in a row now boom boom. That suggests to me autophagy because that’s the idea behind why I wanted to implement it with her is that she’s getting that autophagy, it’s clearing up some of the senescent, well cancer cells in this case, not just senescent, but evil cancer cells. We’re hopefully replacing with some of the good cells. But I understand it’s hard to get that autophagy that’s actually going on.

[Brian M. Delaney]: I was trying to figure out do I want to keep doing this? I was confident I didn’t want to do daily CR because that was just horrible.

[Damien Blenkinsopp]: It seems like you’re taking some of the fun out of life. Your testosterones are always going to be low.

[Brian M. Delaney]: Although what I argued before I experienced this surge of testosterone after my surgery which doesn’t matter because I was able to have normal relations with women and I was able to fall in love.

[Damien Blenkinsopp]: For the first time in my life.

<b[Brian M. Delaney]: No I mean before.

[Damien Blenkinsopp]: Ok. No. Good.

[Brian M. Delaney]: Finally, at the age of 52, I fell in love and had sex.

[Damien Blenkinsopp]: I realized why.

[Brian M. Delaney]: Exactly. But on the other hand, love does have a component that is obviously physiological and a lot of it is lost. What we told ourselves was that we have a more sublime form of love like what Socrates describes in Plato’s Symposium. The character Socrates; I don’t know if everyone knows that. You start with the body and then Diotima is the character that Socrates himself talks about saying that we become more sublime as we love in a less corporeal way. We had all these notions of how we were in some ways still able to love and it was better. That’s absurd. It has to be sexual and plunge more directly.

Anyway so I knew I didn’t want to do daily CR. I experimented with it fasting mimicking diet before. I may still do that periodically. It’s not something you have to choose one way of doing and stick to it. Then I tried this restricted eating window daily, but that was too difficult because I exercised.

[Damien Blenkinsopp]: Which hours?

[Brian M. Delaney]: This is the problem. This very controversial, but there is some evidence to suggest that we do need to eat our first meal not too late in the day. That’s controversial.

[Damien Blenkinsopp]: Actually I have seen such in Panda’s work. He’s really pushing that we shouldn’t be eating late in the day. I have been using that template since seeing his work.

[Brian M. Delaney]: Now there’s also this, there’s a lot to work on, which genes turn on and off in the normal circadian cycle. A lot of it based on work with rodents which are nocturnal so it’s hard to know if you can flip that to the diurnal pattern for humans, but it seems clear that there are changes in genes. We don’t know in humans what they are, but there are these go, have sex during the day.

[Damien Blenkinsopp]: What you’re saying is we have a genetic clock basically? The circadian clock.

[Brian M. Delaney]: Then at night, you get into this repair mode that could be interfered with if you have a belly full of food. This is why we’re all different and we can’t come up with general rules that everybody follows. My problem, and some other people have this, is that I have horrible sleep problems. They got worse around seven or eight years ago. That’s another reason why I had to go off CR. Somehow the low blood glucose at night was causing an increased cortisol.

[Damien Blenkinsopp]: You get a cortisol spike, yeah.

[Brian M. Delaney]: Maybe that was happening all along and I became more sensitive because I got older or maybe the spike went higher. I don’t know, but something changed. That’s another reason why I just cannot be on CR unless I’m going to take really powerful probably brain-damaging sleep medications which I don’t want to do.

[Damien Blenkinsopp]: It defeats the purpose of the whole thing.

[Brian M. Delaney]: Yeah so I make it 80 and I’m just drooling and I don’t know my name unless I’m [check 1:51:16] before I become drooling. At first, I tried a time window that was late because of my sleep problems and I just was too scared that I’m screwing up this cycle of genetic changes. So then I tried an early window, but then I couldn’t sleep.

I was trying to find some safer sleep medications than the so-called “Z” drugs. They have these non-Z like names such as Ambien which is zolpidem, but there is one with a short half-life called Zaleplon which I think is Sonata. I always forget the easy to remember names. I think it’s Sonata that I would take because I have sleep maintenance insomnia. My head won’t go to sleep and I wake up after four hours and I can’t go back to sleep so I’ll take Zaleplon then, but that’s still not so safe so I gave up on that because I woke up too early.

[Damien Blenkinsopp]: So do you wake up early?

[Brian M. Delaney]: Yeah, I wake up too early and I can’t get back to sleep.

(1:52:06) [Damien Blenkinsopp]: I have problems with that too.

[Brian M. Delaney]: It’s horrible unless I stuff my face before I go to bed.

[Damien Blenkinsopp]: Have you tried CBD oil?

[Brian M. Delaney]: Yeah. I haven’t found really pure CBD oil is my problem.

[Damien Blenkinsopp]: I think that might be part of the problem. I managed to get a whole bottle from this person I knew and it did seem to help, but only if I took it once in a while. If I start taking it every night, it stops working. It doesn’t do the trick.

[Brian M. Delaney]: All right, but that’s a whole other topic; how to manage sleep. What I’m now doing is I’m suffering the different types of damage. I cycle through different things that are useful, but damaging in different ways. So I’ll eat late a couple times a week then I might get reflux which is another problem and I might screw up the genes that are supposed to turn on. That’s only couple times a week.

I’ll take the CBD oil. The reason I asked about the purity is not so much about the strength, but typically there will be a little bit of THC mixed in even though it’s illegal. I need a huge amount of CBD to have an effect, but this means a huge amount of THC. So I do that a couple times a week and wake up half-stoned I think. Maybe it’s the CBD that’s making me feel that way. Then a couple times a week, I’ll get [unclear 1:53:17].

[Damien Blenkinsopp]: It feels like it if I take more. I’m quite sensitive to it. I don’t need a lot.

[Brian M. Delaney]: You’re lucky.

[Damien Blenkinsopp]: I’ll wake up really drowsy in the morning and I need two coffees to wake up. It avoids the purpose.

[Brian M. Delaney]: I’ve tried this Suvorexant from Belsomra which works on this new system discovered; the orexin receptors. It works, but it feels like it has a long half-life.

[Damien Blenkinsopp]: I don’t know if this would be helpful, but one of the things that helped me a lot is I found a Parkinson’s study because I have the same night-waking problem. They did this experiment where basically they gave them a strong light source, 10,000 watts SAD lamps; the Seasonal Affective Disorder lamps, that are medical lamps. You put one of those in front of you and you expose yourself to that for an hour in the morning. I think it was actually half an hour, it wasn’t that long, but I’ll leave mine on for an hour sometimes.

I bought one of these and just put it next to my laptop when I’m working in the morning and you’re just given that stronger relative signal because we don’t get outside. I’m in London and it’s terrible. You actually don’t even know if it’s daytime sometimes when you look out the window.

[Brian M. Delaney]: It’s like that in Stockholm.

[Damien Blenkinsopp]: Whereas here we don’t have that problem at all. That has seemed to help. I do it every morning because it’s right next to my computer.

I knew it was working because at first what I tend to do is have my coffee and then I’ll feel alive and I would switch it on and just check the usual business stuff. Has anything blown up while I was asleep. So I’ll do that and really wanted to have my coffee, but I actually don’t need it. I’m already really awake. So I started to notice that and then on the other end of the spectrum, I was getting more sleepy in the evenings because now you’ve increased the relative distance. You have a strong light in the morning and now when it gets dark in the evening, I was starting to feel drugged and I’d start going to sleep at 9 o’ clock, no problem.

Then the other thing that has really made a difference is getting to bed earlier. If I can get to bed at 9:00, I’ll still wake up at 4:00, but I’ve had seven hours of sleep.

[Brian M. Delaney]: Your body is smarter than mine because if I go to bed early, the whole problem just shifts to the east. I’m in Florida, I’ll I go to bed at 9:00, I will wake up 1:00 and then I’ll try this other method of not taking a power nap so that you can have all your sleep compressed. I will fall asleep at 8:00 and I will wake up at midnight and then suddenly, I’m just back on Stockholm time living in Florida then I’m on Mumbai time. It just keeps going to the east or earlier.

[Damien Blenkinsopp]: Maybe it would be interesting if you do a CTM to see if there’s something going on; something that spikes or drops at a specific time.

[Brian M. Delaney]: That’s a good idea.

[Damien Blenkinsopp]: Then you can be like look I woke up at that time and it’s tanked like you say. Or maybe it’s not. Some people see spikes sometimes. I wonder if that’s an infection or activity during the night.

[Brian M. Delaney]: That’s a good idea.

[Damien Blenkinsopp]: Yeah.

[Brian M. Delaney]: That’s a really good idea.

(1:56:23) [Damien Blenkinsopp]: Anyway sorry. So getting back to your stack.

[Brian M. Delaney]: So I did this time-restricted, various forms of it and I’m going to keep doing that because I really do think that that can have a huge effect on health. I don’t know what my ultimate plan will be. I know I’ll do the periodic multi-day fasting or fasting periodically.

[Damien Blenkinsopp]: So just on the fast mimicking diet, you decided that you’re not sure about the research? Is that why you dropped that or is it just inconvenient?

[Brian M. Delaney]: I haven’t dropped it. To be honest, I haven’t decided yet. There’s going to be a huge conference in early November that Valter Longo is putting on at USC. November 9th and 10th that I’m going to be going to [check 1:57:00]

[Damien Blenkinsopp]: What’s that called?

[Brian M. Delaney]: Something like Fasting, CR, Longevity. It can be Googled. Valter Longo, Fasting, November, USC.

[Damien Blenkinsopp]: There we go.

[Brian M. Delaney]: I’m going to go to that and probably there will be some new results to be announced at the “Poster” sessions perhaps. So I haven’t given up on it. It’s just that I’m not convinced that it’s better than any of the other restricted eating diet. I do think it’s beneficial, but is it better than daily restriction, is it better than time-restricted window per day, is it better than every other day partial fasting? I don’t know. So that’s one thing

That was my thinking too about that up until a year ago. It was really until I met Bill and got this new amazing job. Now I can wake up and read research. That’s what I started doing and then traveling and going to conferences, talking to researches. So at that point, I realized that there were some senolytics worth looking into. How one combines that with a restricted eating is very complicated. Do you want to have two ways of getting these genes to be activated too much? Is that too much? Who knows? But Rapamycin became particularly intriguing to me. I only started it three months ago.

(01:58:15) [Damien Blenkinsopp]: Is that easy to get?

[Brian M. Delaney]: Yeah, it’s pretty easy to get. We have a relation with this group called International Aging Systems (IAS). They have a booth here and I think they’re based in London. So one can get Rapamycin of high quality source made in the EU for a reasonable price. The FDA here in the U.S or the DA, whichever it is, permits I think a three month personal supply. It’s a prescription drug.

[Damien Blenkinsopp]: So as a consumer, you can order it?

[Brian M. Delaney]: Yes and you can do it from any country. It’s just that the border controls might be tougher in some countries, but in the United States, it’s pretty open. Otherwise you can get a prescription. It’s not cheap, but it’s not like exaggerate that’s very expensive. So I’m taking now 7.5 milligrams once a week which is much higher or somewhat higher than what anyone else is taking. Typically, people take between 3.0 and 6.0.

[Damien Blenkinsopp]: Ok. Why are you taking more?

[Brian M. Delaney]: I decided it’s part of my job. I want to push the envelope a little bit. Not because it’s going to be scientific, but mostly when it comes to the side effects so that I can then report to people what I felt during that.

[Damien Blenkinsopp]: Have you noticed something?

[Brian M. Delaney]: Nothing negative.

[Damien Blenkinsopp]: How long have you been taking it?

[Brian M. Delaney]: I started at 4.0 milligrams per week about three months ago. Then I went up to 5.0 then 6.25 because I was scoring the tablets.

[Damien Blenkinsopp]: Are you taking labs or do you have a tracking routine? Or did you just take labs?

[Brian M. Delaney]: I am terribly embarrassed to say I’m sloppy on that front and it’s partly laziness, I have to confess. But mostly it’s that as part of my work, I really have to try a lot of these things and it would be so hard to isolate the relevant intermittent variable when I’m trying so many things all the time. It doesn’t add a lot of value to get labs done and to draw conclusion about any one treatment.

It’s not useless and I have done some labs and I will report on our blog at society for rescuetheelders.org. I’m going to report some results that I think I can attribute to one treatment and not some of the other ones I did a little bit earlier, but it’s complicated scientifically so I really do have to.

If I go to a conference and there’s an exhibit booth with someone I’m offering something, I feel like I have to try it. It is my job. Or if I’m traveling around the world and I meet some mad scientist who has got exosomes and I think they’re safe and he’s just, “Hey, you want some?” I’ll try it. It’s what it seems. That seems like part of what I need to do.

[Damien Blenkinsopp]: For sure, you’re training you. Every now and again, you’re using labs just to see what’s going on?

[Brian M. Delaney]: Yeah.

[Damien Blenkinsopp]: Just in case you sabotage your whole anti-aging plan?

[Brian M. Delaney]: Exactly. That I’m certainly doing. Another shift that I made in my diet aside from energy intake level was the foods that I eat. I want to radically high fat, low carb diet like almost 80% calories from fat; mostly nuts.

[Damien Blenkinsopp]: Macadamia?

[Brian M. Delaney]: No. I used to. I’m convinced that saturated fats of any chain length are probably not so great. Macadamia nuts have more saturated. It’s not like steak or lard. If I’m at a party, I’ll grab quite a few, They’re delicious, but no. I try to stick with walnuts, almonds, pistachios are really good. What else? Pecans; those are not so great, but I love them. A little bit of olive oil which also has a lot of saturated fat compared to some of these other nuts. That shift has led to higher LDL.

Just to speak, I generally track my biomarkers. The one thing I’m worried about that doesn’t look good is I haven’t done my NMR; this wave measure particle size of the LDLs. I haven’t done that in a while. The last time I did it, it looked good, not great, but good. I have to do it again so I’m eating even more nuts now. I wake up, I eat nuts and broccoli or kale. That’s pretty much it.

So now back to Rapamycin. I started increasing the amount I was taking and really I’ve had no side effects. I had cankers; a canker sore once which people get. Only once.

[Damien Blenkinsopp]: So one of the side effects of Rapamycin is immunosuppression so that’s one of the concerns. That’s why you’re not taking it every day because you’re going to get some immunosuppression, but you’re hoping that that’s just a momentary downside and possible canker sores.

[Brian M Delaney]: Yeah, almost everyone reports that. I would not recommend 7.5. That’s quite high. But on the other hand to be honest, if you scale up from the rodent studies that showed the maximum lifespan benefit, the equivalent would be something between 10.0 to 12.0 milligrams for a human once a week. That’s part of why I bumped it up to 7.5. I may even go higher. We’ll have to see.

It has a really long half-life. Usually some people say I think between 62 and 67 hours. So one can do 7.5 and maybe do it every eight days instead of every seven just to give some period for letting it to taper out.

It has probably, as you said, the immune risk, but also there seems to be a risk of glucoregulatory dysfunction. It’s not clear.

(2:04:05) [Damien Blenkinsopp]: In terms of it’s more variable?

[Brian M. Delaney: No. Actually glucose goes up.

[Damien Blenkinsopp]: That’s the general level trend?

[Brian M. Delaney]: Yeah it goes up in some studies, not all. But then there’s this other weird phenomenon where it seems to disappear after a while after a few months. That’s why there’s this problem. We’re pretty sure we have to pulse the dose, but is the pulsing done once a week or once a day? Or take it once a day for a few months, let the side effects taper off which they do, according to some studies and then stop it.

[Damien Blenkinsopp]: Then restart?

[Brian M. Delaney]: Then stop it. We don’t know.

[Damien Blenkinsopp]: So even pulsing once a week, you’d still get that rise? Is that a chronic dose?

[Brian M. Delaney]: We don’t know yet. We don’t know yet. Actually, here I do have some data. This is something that I can say it’s the Rapamycin. It’s a good [check 2:04:54]. Now I’m eating very early in the morning and a smaller amount fairly late in the evening. So my big gap is actually between breakfast. So I take my fasting glucose at 8:00 p.m. and it is typical these days, so not on extreme CR.

It’s in the mid-seventies. On Rapamycin, it has been typically 70 or 71 so it has not gone up, it has gone down. The margin of error is pretty large, but it certainly hasn’t skyrocketed upwards which is what some of the mice research indicated it would.

So I’m not worried about that effect, but I haven’t had my lipids measured recently, but I am going to do that soon. I’ll do a full NMR and see what it looks like. That’s part of my stack. We could go one for hours here.

[Damien Blenkinsopp]: So we have time-restricted eating?

[Brian M. Delaney]: Of various forms, yeah.

[Damien Blenkinsopp]: Of various forms. We have ketogenic diet?

[Brian M. Delaney]: Yeah.

[Damien Blenkinsopp]: We have Rapramycin.

[Brian M. Delaney]: 7.5 milligrams.

[Damien Blenkinsopp]: 7.5 milligrams.

[Brian M. Delaney]: Probably will go higher.

[Damien Blenkinsopp]: What else?

[Brian M. Delaney]: The next would be nicotinamide riboside; oral nicotinamide riboside.

[Damien Blenkinsopp]: Is that Niagen?

[Brian M. Delaney]: That’s one of the brands, yeah. This is to raise NAD levels in the blood and more importantly in the cells.

[Damien Blenkinsopp]: Have you done any testing of that? Because I saw people are doing more tests now. I haven’t seen any results

[Brian M. Delaney]: Of NAD levels?

[Damien Blenkinsopp]: Yeah.

[Brian M. Delaney]: No I haven’t yet. This is a complicated topic. Do blood levels matter so much or is it the levels in the cell?

[Damien Blenkinsopp]: Red blood cells. Yeah, exactly. Well, yeah.

[Brian M. Delaney]: So I’m not really sure, but we do know that nicotinamide riboside will raise blood levels. It will double blood levels. I’m not sure how much we know the extent to which it will raise levels in the cells, but it certainly does raise levels. This is something in the cells which is where it matters.

Because Rapamycin is a partial CR mimetic, it’s probably going to increase my own production of NAD to some degree. So I have this complicated weekly cycle of when I first take the Rapamycin, I’ll only take 250 milligrams of nicotinamide riboside those first two days per day and then I’ll go up to 500 and then towards day six or seven, I’m taking 750. Then when I’m doing a fasting mimicking diet, and by the way I may skip a week of Rapamycin, I may adapt that pattern. So once a week, four to six weeks, do a five day partially near fast and then don’t take Rapamycin because that would be too much; little bit too much going on at one time.

[Damien Blenkinsopp]: You’re doing the fast anyway.

[Brian M Delaney]: Then I wouldn’t take any nicotinamide riboside for a few days. So time-restricted eating, ketogenic diet, high-fat, low-carb, Rapamycin, nicotinamide riboside. Maybe I’ll do the occasional NAD patch or infusion. I don’t know. I’m not really sure about that. But then finally, of the big things exercise of course which you know of exercise.

(02:08:00) [Damien Blenkinsopp]: What kind of exercises do you do?

[Brian M. Delaney]: Strength training. I have so many old baseball injuries, there’s not a lot I can do. I do pushups. I have a chin-up bar. I certainly don’t have time to go to the gym so I’ve got my backpack with different sized rocks I put in it and do overhead pull-ups. I do everything at home so I just can’t think [unclear 2:08:21]. Then I run and walk briskly.

I always exercise after meals to knock down those blood glucose and lipids. People don’t realize postprandial lipids can be a problem too. So always. If I’m at a restaurant with a billionaire that I’m trying to get financing for a project, maybe I won’t exercise and I will take Metformin.

(02:08:46) [Damien Blenkinsopp]: Are you taking Metformin as well?

[Brian M. Delaney]: Only if I cannot exercise after eating and I’ve had more than a tiny amount of carbs.

[Damien Blenkinsopp]: Ok. Interesting.

[Brian M. Delaney]: Five hundred milligrams.

[Damien Blenkinsopp]: Is that based on any study or anything?

[Brian M. Delaney]: Well it’s based on what we know for Metformin and Type 2 diabetics. It will actually knock down those [unclear 2:09:04].

[Damien Blenkinsopp]: Some people are just taking it chronically.

[Brian M. Delaney]: Lots of people.

[Damien Blenkinsopp]: Yeah.

[Brian M. Delaney]: Lots of people.

[Damien Blenkinsopp]: More and more.

[Brian M. Delaney]: Tons of people. I’m actually an outlier here where I’m actually not convinced that for healthy, trim people who eat well and exercise that it really is worth it. I know some clinicians who have tried it. This is actually worth noting. Two clinicians who are anti-aging doctors, really smart people who have tried Metformin in elderly and the elderly say, “I feel like crap” because it lowers their energy levels. That’s part of how it works.

So now the next thing I have to talk about is the senolytics. A lot of people think that we shouldn’t try any of them; that we need more human research. Not that I can’t understand. It’s not strange for a physician to say let’s wait until phase one, phase two, phase three trials are out. That’s why we have not recommended that anyone tries these. I can just say that I personally want to and have tried them. I want to try them and have tried them and would like my mother to try them.

The combination of the Dasatinib and Quercetin, if one is going to try it, the conservative thing would be do it once every few years. You just take the dose, knock out a whole bunch of certain classes of senescent cells. It doesn’t target all. Each different type of senolytic agent has a different target. So this is mostly preemptive sites that it knocks out and a few other types of cells, but mostly senescent cells. Do it once every few years and then they go back.

I’m doing a much more aggressive approach where I’m taking it every four or five months. I should stick to a strict schedule, but I just get too busy. I’m traveling. There can be side effects for this during the 12 to 24 hours after you take it.

[Damien Blenkinsopp]: What’s the name of those?

[Brian M. Delaney]: This is Dasatinib which is cancer drug.

(02:11:10) [Damien Blenkinsopp]: How do you get your hands on that?

[Brian M. Delaney]: Metaphorically speaking, sometimes it’s a researcher pal in some way.

[Damien Blenkinsopp]: Some connections?

[Brian M. Delaney]: Yeah. You can get it various ways, but the proper way to get it which I’m now going to use is me to go to a doctor. I mean researchable. I’m not talking about anything illegal. You become part of the study and there are lots of studies now going on; not lots, but a few. But the standard way that I would recommend would be go to your doctor, your healthcare practitioner, say you want to do this, show the doctor the studies and get a prescription and then pay for it.

The ways to get this through various overseas sources where it’s a little bit less expensive, but still high-quality, usually through India. The amount you take is per round which you can divide in half and then take one week and then the next, but per round would be 5.0 milligrams per kilogram of body weight.

[Damien Blenkinsopp]: Ok.

[Brian M. Delaney]: So that would be 750 milligram tablets. It’s actually hard to get a bottle of 750 milligram tablets. So I usually have to buy too much and then give some to a friend or go halves on it.

Quercetin is a natural substance it is a supplement. You take ten times as much of that so it would be 50 milligrams per kilogram of body weight. So what we now think is that it’s better, and Bill Faloon will be describing this, we meet lots of people. It’s better to divide that in half per what you call round you do once every three years or once every four or five months.

[Damien Blenkinsopp]: So it’s not very frequent.

[Brian M. Delaney]: No, no.

(02:13:04) [Damien Blenkinsopp]: So what about all these vegans eating [check 2:13:05]?

[Brian M. Delaney]: They’re not eating as much.

[Damien Blenkinsopp]: Not as much as they need.

[Brian M. Delaney]: No, not even close to what you get from this protocol. So you take that and you might get muscle cramps. The one serious risk which is theoretical, never heard it happening to anybody, is anaphylactic shock

[Damien Blenkinsopp]: Ok.

[Brian M. Delaney]: The smart thing to do is to go to your healthcare practitioner and talk about it and if it’s ok, he or she will say no don’t do this because it’s crazy.

[Damien Blenkinsopp]: You would think a lot of cells are getting killed off.

[Brian M. Delaney]: So the theoretical risk of the dangerous side effect is anaphylactic shock. The more long-term theoretical potential downside is the off-target effects because the mechanism is such that it could kill some healthy stem cells.

(2:13:59) [Damien Blenkinsopp]: I’ve got a silly question. If we’re killing off all those senescent cells, let’s say they’re doing something, but they’re just not doing it very well and as stem cells are declining, are we able to rectify that? Do we end up with enough cells to do the job?

[Brian M. Delaney]: What the senescent cells are doing, mostly they’re doing really bad stuff, but there are some positive roles with tissue remodeling.

[Damien Blenkinsopp]: They’re trying to do their job.

[Brian M. Delaney]: No, it’s not that they’re trying to do their job and they’re kind of doing it, they’re not doing it at all except possibly the tissue remodeling and sending out these extracellular matrix proteins that some of them are dangerous, but some of them are actually useful. They’re useful in tissue remodeling. So I don’t think that’s the problem.

The theory behind why this helps with osteoarthritis in particular; that’s another thing seen in rodent studies and I think I can say there’s some human data. Yeah, I will say that we have some human data that it really helps in osteoarthritis. The way that it works is it actually frees up existing stem cells to do their job. But in theory, we really don’t know. I see the results in the humans and I see the results in the rodents.

I had a kidney stone a year ago; more than a year ago. It was diagnosed with a CT scan. I discovered I have calcification. Not much, very little, but that really shocked me.

[Damien Blenkinsopp]: So you had the calcium scroll?

[Brian M. Delaney]: No, I just discovered. They saw that in the CT scan. The guy asked me, “Do you smoke?” No. You have some calcification in here, not much. It was a shock. That’s one of the reasons why I was motivated to go on an aggressive Dasatinib and Quercetin treatment protocol because it seems I have some calcification. So theoretically I could be doing some harm.

So reason someone who is really young, I would say, “My God! Don’t be absurd to do this.” Having anyone under 40, certainly it seems foolish.

[Damien Blenkinsopp]: Something to do later.

[Brian M. Delaney]: Yeah, and that’s partly because the potential off-target effects. We really don’t know. We have to do those studies. Bu there’s another reason. It’s not entirely crazy to think that some point soon, we can turn some of these senescent cells back into healthy cells.

[Damien Blenkinsopp]: Turn them back; fix them.

[Brian M. Delaney]: Yeah. Exactly. People are now talking about senotherapy is this new term. Basically you deal with the senescent cells in various ways, not simply with senolytics which destroys them, but there is a new term that I think now rightfully could be applied to Rapamycin, called a senomorphic. It changes the senescent cell. It doesn’t make it perfectly healthy, but there is evidence that Rapamycin will lower the amount of these injurious paraben factors that the senescent cells are letting out. So they’re morphing; they’re changing.

[Damien Blenkinsopp]: They’re less antagonistic.

[Brian M. Delaney]: Yeah, basically. So Rapamycin actually has that effect. Presumably CR does as well.

[Damien Blenkinsopp]: Is that damaging them in some way maybe?

[Brian M. Delaney]: Damaging the senescent cells?

[Damien Blenkinsopp]: Yeah.

[Brian M. Delaney]: Probably not. Probably not. We don’t know, but I would imagine it’s more of an epigenetic change in the senescent cell itself that’s actually changing.

[Damien Blenkinsopp]: [Unclear 2:17:27]

[Brian M. Delaney]: Yeah. Have these injurious [check 2:17:31].

(2:23:00) [Damien Blenkinsopp]: Great.

[Brian M. Delaney]: That’s it.

[Damien Blenkinsopp]: That’s full stacks for you?

[Brian M. Delaney]: For now. We didn’t mention the biologics. We did; we opened with the biologics. The next categories would be the biologics. The newer “Living Medicine” as some people are calling it which doesn’t apply to plasma, but does to cells. If I had the money, I would get, people are now saying MSCs which used to stand for Mesenchymal Stem Cells, but now they’re saying let’s call them Medicinal Signaling Cells.

[Damien Blenkinsopp]: I heard that last night.

[Brian M. Delaney]: Because it’s not clear that they’re stem cells. [Check 2:17:59] mentioned that Mesenchymal Stromal Cells, but anyway MSCs from birth-associated tissue. I have not done that yet, but if I could afford it, that would be my next step.

[Damien Blenkinsopp]: It looks interesting.

[Brian M. Delaney]: And young plasma as young as possible from umbilical cords. Cord blood would be great. What Howard Chipman’s offering is also very good as I mentioned earlier. I felt like Superman for a day and a half; tragically short, but it was great. So that would be the thing that I would really want to put a lot of energy into for my own treatment next if I go forward.

(2:18:32) [Damien Blenkinsopp]: Great. Wow. So are you doing any consistent tracking? Is there a lab panel you do once a year or once every six months?

[Brian M. Delaney]: What I’m going to start doing is…

[Damien Blenkinsopp]: Or am I encouraging you?

[Brian M. Delaney]: You are and lots and lots of people think I’m being an idiot or lazy or both by not getting more blood work done. I track simple things like pulse and blood pressure and body temperature at home. Body weight obviously; I’m doing that for years. Bill Faloon and I and our team came up with this age management profile that you get at lifeextension.com. I think there’s a discount. Let me see. I will make this available.

[Damien Blenkinsopp]: It’s a set of panels?

[Brian M. Delaney]: A huge set of things. I am going to do that every six months and it has got a whole bunch of relevant markers. It has got a lot of inflammatory markers. The other thing I’m doing is DNA methylation testing; Zymo Research Program.

(2:19:43) [Damien Blenkinsopp]: DNA methylation?

[Brian M. Delaney]: Yeah.

[Damien Blenkinsopp]: So epigenetics.

[Brian M. Delaney]: That may be new to some of our viewers.

[Damien Blenkinsopp]: That’s really new. I’ve been talking to a couple companies doing that. There’s one in the U.K. It looked interesting, but I was like it’s the early stage. I got into the whole microbiome area. I’ve done so many tests from all the companies, nothing actual. The test results were varying between companies. I was like you know what this is too early stage so I don’t know if this is actually usable at all.

So now I take my time, talk to a lot of people, try to get into it. It’s easier if I take two labs and I put them together, am I going to get some similar results or what am I going to get here?

[Brian M. Delaney]: With epigenetic testing, you will get varying results sometimes.

[Damien Blenkinsopp]: They’re changing off.

[Brian M. Delaney]: Exactly. Steven Horvath at UCLA is the one who came up with this idea, I think. He’s the one that came up with it. He selected, they’re called CpG sites. They’re a particular area between a C and a G in a DNA chainwork. You’ve got potentially a methylation, you’ve got a group covering over the DNA so that it can’t be expressed. I think he based on actuarial data and or data from the [unclear 2:21:08] study, but they had tons of data and it is very accurate way of predicting someone’s chronological age.

[Damien Blenkinsopp]: Chronological or biological?

[Brian M. Delaney]: Chronological.

[Damien Blenkinsopp]: So no matter what you’ve done during your life.

[Brian M. Delaney]: Oddly enough.

[Damien Blenkinsopp]: It will still say you’re 50.

[Brian M. Delaney]: Well no, it will vary a little bit, but the goal is chronological age. Now, he has now come up with something called a phenoage. It’s the new selection of CpG sites. That’s going to measure biological age. That would be more useful. Zymo, this company that had a license with Horvath, they have a blood test, a urine test and I think a saliva test. For each one, I think it’s a slightly different selection of CpG sites.

[Damien Blenkinsopp]: So you have to do all of them?

[Brian M. Delaney]: One could do all of them. I am doing all of them. I am doing all of them.

[Damien Blenkinsopp]: That would give you a more complete picture? You plug this into an algorithm?

[Brian M. Delaney]: No, they don’t do that. Well they could, maybe they will, but this is off the books thing that we’re doing. They’re helping me and I’m helping them, I hope by giving them more data.

[Damien Blenkinsopp]: Are they early stage in this business?

[Brian M. Delaney]: I would say it would be somewhat early stage.

[Damien Blenkinsopp]: But it’s based on Horvath’s work?

[Brian M. Delaney]: It’s based on Horvath’s work and their own. They’re now doing their own research. So I think they’re going to eventually move towards their own selection of CpG sites that they think will be the most useful. They may have several different tests. One that may be useful for measuring chronological age license to insurance companies. One that would be a measure of phenotypical age; your actual biological age of people like you and me and a lot of people watching this.

That I’m doing. I believe in the idea. I agree with you that it’s somewhat early, but only somewhat. I had my last results when I was 54. Came out as 50 which is ok as a guy who started CR too late, kind of went off CR for a while because I enjoyed the testosterone. Ok that seems like four years. I’ve done strict CR earlier even though it’s supposed to be chronological and not biological, it does change with increased production and aging. So maybe it would’ve been 47 instead of 50. I don’t know. Yeah, but it was nice that it was younger than.

[Damien Blenkinsopp]: Validation that it wasn’t all a waste of time.

[Brian M. Delaney]: Exactly.

[Damien Blenkinsopp]: That’s what we’re trying to get out it. Some really good biomarkers to tell us that the stuff’s working.

[Brian M. Delaney]: Yeah.

[Damien Blenkinsopp]: Man, this has been a great chat.

[Brian M. Delaney]: Yeah it really has been. Thank you.

[Damien Blenkinsopp]: Thank you very much. We’ve covered so much stuff and it has been great to hear your personal experience and what you’re up to. Your personal journey really, you’re constantly modifying stuff and looking into new stuff. So where can people get in touch with you or reach out to you or learn more about what you do?

[Brian M. Delaney]: We have a new website with a tragically long URL, but it’s not too hard to remember. It’s scoietyforagereversal.org and there’s a blog there. If you click on that, I haven’t started it yet. I’m going to start it tonight.

[Damien Blenkinsopp]: So tomorrow there’s going to be an awesome post.

[Brian M. Delaney]: Yeah, I hope. I hope.

[Damien Blenkinsopp]: Depending on how long it goes on this evening.

[Brian M. Delaney]: Exactly. Excatly. It may be somewhat a little bit drunken depending on the party tonight. Actually alcohol is not something one should partake in too much if one wants to live a long life. That’s where I’m going to be updating people on what I’ve discovered and side effects of my own experimentation [check 2:24:31]

[Damien Blenkinsopp]: Great.

[Brain M. Delaney]:Thanks a lot.

[Damien Blenkinsopp]: Thank you so much for your time.

[Brian M. Delaney]: You bet. Thank you.

(2:24:44)[Damien Blenkinsopp]: Third time lucky. Hey guys! We’ve been messing around with the equipment here, but we’re now ready to chat. So right now, we’re at RAADfest. This is [check 2:24:53]. We’ve got today and tomorrow left and we’re going to be doing some more interviews. Right now we have Quantified Bob. You know Quantifed Bob if you’re a superfan of Quantified Body because he was in episode 22 talking about intermittent fasting and blood glucose dysregulation and his experiments in tracking around that.
So you met Bob and we had a great conversation before. So if you haven’t listened to that, you might want to go and listen to that before you relisten to this or rewatch this because we’ll just cover new ground basically. We’re not going to go over the old stuff. So Bob, how are you doing?

[Bob Troia]: I am doing great. This is the third day of this RAADfest event. So we’ve had so many conversations just over the last three days because to see some of the talks about some of these advancements and some of the therapeutic work that’s being done around stem cells. I think when I was on your podcast, it was three years ago.

[Damien Blenkinsopp]: It was a long time, yeah.

[Bob Troia]: We were talking about it on a very macro high level certain dietary things and interventions, getting into maybe some data around glucose tracking, but now we’re getting down to the cellular level and subcellular level and seeing how rapidly these advancements are happening. It’s really cool. Just in those past few years, I think we’ve gained so much additional knowledge and insights. I looked back on even when we spoke and I was like, “Wow” some of it is actually cool. It’s relevant.

[Damien Blenkinsopp]: It’s still relevant.

[Bob Troia]: We talked about [check 2:26:17] testing, but then there was a whole new wave of science and things that are coming out.

[Damien Blenkinsopp]: Yeah. What have you thought about the event so far? Are you enjoying it? Are there great points? Would you recommend people come here?

[Bob Troia]: Yeah! I haven’t been to this event before. That was my main curiosity about it. I wanted to come last year and I didn’t so I came this year. I didn’t know what to expect. I’m a long time subscriber of the Life Extension. You get the magazine and some of their supplements. It’s a really cool, interesting crowd.

There’s a real sense of community around this. We talked about longevity and even this conference is called Revolution Against Aging and Dying and I’m just like ok. I like to make it a little positive. Instead of saying revolution against, I would make it something for living longer and better and more productive lives.

But the talks have been great. I like conferences where the presentations get into some science, not being a sales pitch. So we’re getting to see some really cool talks. I’m actually learning some more. Often when I go and I see talks, it’s like I’ve read about this, I’ve already read that and read that. Yeah I’m coming away from these talks with notes and mental notes and things I can go follow up on because it really piques my interest.

(02:27:34) [Damien Blenkinsopp]: Yeah. So I’ve also found that the people we met here, I’ve met so many cool people here and talking with people. We hung out with people last night from some of the startups that are being funded in order to bring some of these anti-aging therapies eventually to market. So there are really interesting people here doing interesting stuff so I think that’s one of the great things. This is my first Life Extension conference. What about you?

[Bob Troia]: Yeah, same. The other thing I was going to say was that what we’re seeing is this general idea, in the general space of this whole wellness and longevity, the overlap because I’m running into friends and people. I was like, “What are you doing here?” From whether it’s a quantified self conference or a biohacking conference or a biohacking conference, all these worlds are just overlapping now. It’s really interesting.

[Damien Blenkinsopp]: You’re meeting the same people.

[Bob Troia]: Yeah. Well new people, but also you’re seeing everyone’s interests are cross-pollinating. It’s all becoming around this whole concept of overall self-optimization and figuring out all the different ways to make ourselves as best as we can be.

(02:28:39) [Damien Blenkinsopp]: Excellent. All right, let’s talk about what you’ve been up to since we last spoke. So it has been three years, what’s the most interesting tool or tactic you’ve tested or you’ve used consistently because you actually see it’s making a difference?

[Bob Troia]: Sure. If you want to talk about just insights, I feel I’ve gone from again that macro level of tweaking my diet, trying to heal my gut and those types of tactics. We talked about concepts like intermittent fasting and now you’re seeing proliferation of things like types of fasting protocols and fasting mimicking diets. So if we’ve both done a lot of experimentation around that which was really cool and digging even a little deeper.

Ultimately everything we’re doing boils down to, for me at least, I’m seeing it as mitochondrial efficiency. So I look at tools and tactics and be like how is that helping or injuring that. So whether I’m using modality that reduces oxidative stress in my body or [check 2:29:42] in my diet, it’s all how about I can make it as efficient as possible. So it’s going back to as you peel back every layer of the onion, you’re going, “Ok, what am I really honing in on there?” Yeah so for me, that’s a really big part of it.

Some of the tools, we talked about wearables and getting data off all that and we’ve seen the big ship to that whole landscape.

[Damien Blenkinsopp]: A lot of companies are gone.

[Bob Troia]: They’re gone. Or the ones that were really open about letting you access data and have open access to it, they’re siloing themselves off because they’re trying to monetize it on their own which has been frustrating. But three years ago, everybody was doing 23 and me testing for genetics, but now whole genome sequencing is affordable.

(02:30:24) [Damien Blenkinsopp]: So we’ve seen a few companies talking about this; the whole genome sequencing thing. Liz Parrish’s BioViva, I’m doing that, Health Nucleus is doing it, but there are other companies as well. I told someone yesterday. He was saying there’s a huge movement in China for this whole genome sequencing so it’s available now. It’s actually the whole thing rather than the 23 and me is just a small part of it. So we’re getting to that step where we actually have better data.

[Bob Troia]: Yeah and it’s one of those things where five years ago, that whole genome sequencing was a million dollars and now it’s down to under a thousand dollars and a year from now it will be what you’re paying for 23 tests a few years ago. It’s pretty amazing. I think the fact that other people are doing this, that’s going to help bring this cost down because they’re all competing in a way now.

(02:31:09) [Damien Blenkinsopp]: I guess the other thing I liked about this here is this community. You see these companies, they’re competing against each other. Like stem cell companies, they’re in the same area so they’re competitors, but what you see here is everyone has a common objective which is to defeat aging and to defeat the damage of aging.

They’re working together a lot of the time in networks and in partnerships even though they’re actually competitors. So it’s really nice to see that because they’re so much focused on the objective, they’re like I don’t care who makes it. It’s like Elon Musk. He’s like I just want to let electronic cars be in the world so I’m going to open source the info.

[Bob Troia]: Even seeing the Life Extension Foundation, they fund a lot of research and they’re funding companies that are essentially viewed as competitors, but they’re going to get some innovation over here and we’re going to get some innovation over here and eventually it all will start coming together. Yeah it’s pretty cool to see. I’m also seeing companies are getting funded.

[Damien Blenkinsopp]: Yeah. It’s a lot of funding.

[Bob Troia]: Institutional money, big money and I was like wow.

(02:32:14) [Damien Blenkinsopp]: So we saw the SENS Research Foundation. Yesterday they had Y Combinator, part of Y Combinator had invested in one of their companies targeting aging. Andreeseen Horowitz so these are huge names in the BC incubator world.

[Bob Troia]: Yeah. I think they all see where this stuff is going and they’re putting their bets down now on some of these players. I come at it from I have technology background, I’m an entrepreneur as a UN so it’s interesting to watch how it all plays out because some of these are areas that maybe were more risk-averse to a few years ago. Now they’re seeing our studies and they’re seeing some glimmers of hope there in terms of wow they’re really on to something so there’s money going in there. For me, it’s about ok I want this company to be be successful and funded so they can make these things available to me at an affordable cost.

Yeah that’s pretty exciting, but back to your original questions about what I’ve been up to the last few years, I’ve gone through a lot.

(02:33:12) [Damien Blenkinsopp]: So what are you doing in a typical week now? You get up in the morning, what does a typical week look like now in terms of the tools and tactics and the tracking?

[Bob Troia]: So I look at it from the standpoint of no matter if one person’s data is more optimized than the other, it really comes down to we all have 24 hours in the day and how am I going to make the most of that time. I’ve been fortunate in that I’ve done a lot of this light work in terms of collecting some of my data, looking at data. I’m not doing it all the time.

There are moments where I might do continuous glucose monitoring for a period of two weeks, but I’m not always wearing that sensor because I got my insights for those two weeks. I maximize the time I’m wearing it to get my insights. Maybe six months from now or a year, I’ll use it again. So that’s not a burden on me.

I try to possibly collect as much data as possible. So even if I might not be using it today, but if I want to go back and look at what I was doing six months ago what actually happened back then, the data is there. It would require no effort on my part. I spent a lot of time in the few years back setting up some systems and tools and now it’s very much like a set it and forget it kind of thing where it can be on autopilot to some degree.

What I’m seeing now even on the consumer side is the frustrations where they’re getting access to their data and tools, but the insights they’re getting are not. You might say how your sleep is terrible, but hey your sleep is bad. I know my sleep is bad so what should I do and they’re not really being given that next step above what tactics and tools and what they could be implementing. There could be a whole slew of issues related to why their sleep is poor and really digging into that.

Things like training and recovery. I’ve been really big on exploring some of these devices and tools and modalities that help us. Instead of going to the gym six days a week for three hours a day, literally just 30 minutes here and 30 minutes there and be on with your day and you’re going to get just as much result out of this. It’s not about who can work out the longest and who can push the most weight. There are more efficient ways to do it.

In terms of supplementation and experimenting with different things whether it’s nootropics or just making sure I’m getting proper nutrient balance in my diet, I definitely cycled on and off things. Right now, I’m three months into taking this nicotinamide riboside product that’s basically a precursor to NAD. The body should be able to convert this into that. I’ll be getting some blood drawn shortly to see has it shifted. Has it increased my levels? Compared to what someone my biological age would have.

In terms of is it something I’ll be taking long term? I may not need it. It may be the result is actually your body doesn’t need that additional supplementation. Maybe if you were a different state or condition or older then it would be ok. Maybe ten years from now, you should consider starting to take it. But I’m seeing just other observations with it. It has a slight shift to my circadian rhythm. I was waking up about 30 minutes earlier a day, but not exhausted. It just seems it made me want to wake up earlier. Recovery from workouts and training definitely were a noticeable effect of it. That’s just one experiment.

I’ve been doing a lot of stuff around cognitive testing and understanding how to find tools that can help measure and assess whether you’ve got acute trauma or past trauma in your brain or fatigue, et cetera and then what can you do or take, what helps or hinders that. Because I had actually thought, I assumed from playing sports for years, getting hit in the head repeatedly, I’d have some issues. But it turns out some of the tactics I guess I have been doing over the past few years have kept my brain state at a good level.

When I did the assessments, it was actually I’m not saying disappointed, but everything was really good. There were like you don’t really need to make any changes or just keep doing what you’re doing.

So we’re seeing these cool assessment tools and devices are coming out of these labs and maybe they’re used by professional sports teams or the military and they’re being made accessible to basically anybody. Part of what I’ve done is I have all these different types of training and recovery tools.

About six months ago, myself and another person set up a facility in New York City because I was realizing friends were coming over to use a lot of the things I had. So instead of me just eating the cost of one of these devices, I was letting people get some benefit out of it so I said why not just put it into a space and let people come and share it without having to come to my home.

So it has been fun. It’s almost a little part-gym, part-lab, part-playground and so that for me is really exciting. From a business standpoint, really I just use it more as a place where I’m collecting data and I can do some really cool experiments around training and recovery and figure out how I can use these tools to effect based on biomarkers.

(02:38:12) [Damien Blenkinsopp]: Yeah. Is there anything consistently you collect and do daily or at least weekly, over time?

[Bob Troia]: Yeah. Daily, my routine would be as soon as I wake up in the morning before I even get out of bed, I do a hurry variability check. So about a two-minute check.

[Damien Blenkinsopp]: Are you correlating it with the aura?

[Bob Troia]: Yes, they do correlate. This is the new aura ring. So overnight while you’re sleeping, it’s taking heart rate variability readings throughout the evening and then it gives you an average number.

[Damien Blenkinsopp]: For the night?

[Bob Troia]: Yeah and it will vary.

[Damien Blenkinsopp]: It gives you the peak as well?

[Bob Troia]: Yes. So you might go from really low sympathetic state to a parasympathetic, but it’s just going to average it all out. So you may have had a really poor night’s sleep, but there might have been a part where you had really high HRD, good HRD so it hides the fact that you had a poor. Otherwise when you wake up in the morning, if you had trained really hard the day before or you’re jet lagged, you might see it’s suppressed today. They’re different, but they’re both important. They both give you a different insight into your physiological state.

If you go from that, you’re obviously sleep tracking. You can then start looking at the effects of that and I wear that with other types of data. If I’m home, I kind of understand my environment, my bedroom so air quality, temperature, humidity, light, sound and then things like body composition. The scales are not the super most exact body scales.

You can’t miss 4% body fat in a day, but if you just blur your eyes and stand back and look at the trend over six months, you will see the trend and you can point out where, “Yeah I changed my workout. I was lifting a lot more heavy weights during that month” and you can see the changes there.

Glucose tracking, I’ll do spot checks with a finger stick. You do a fasting reading so before you have any food or drink. Ketones as well, you can do that. Then I’ll play around throughout the week maybe if I actually want to see glycemic response to different foods. I can do spot checks with the finger stick. From the ketone measurement, for a while I was doing testing with the strips. I think if someone is more keto-adapted, actually it might make you look like you’re not in ketosis; you’re not doing it.

[Damien Blenkinsopp]: Blood ketones?

[Bob Troia]: Urine with the strips.

[Damien Blenkinsopp]: [Unclear 2:40:41] urine.

[Bob Troia]: Yeah because your body won’t be excreting it. Your body is keto-adaptive. You know this.

[Damien Blenkinsopp]: Some guys won’t know it.

[Bob Troia]: Yeah. Sure. Well basically with ketones, there are three ways to measure them. You can do blood, breath or these strips if you use urine. There are different proxies to basically the levels of ketones in your body, but blood is the best way to really measure them. I think you probably use the same meter. There’s a meter that you can use for the glucose measurements and the ketone measurements. Breath is an interesting one because it’s using acetone from your breath, but I can’t get it to get consistent readings.

[Damien Blenkinsopp]: I’ve got PhDs looking into this at the moment and it’s really tricky. The devices we have for tracking breath ketones at the moment, very, very tricky to use so we’re re-evaluating whether we should continue or not, but yeah we’ll find out. We keep on digging to try and find out. Because it appears that the meter actually measures other things and that can interfere. Basically you’re getting a combined reading of acetone and something else.

[Bob Troia]: Yes.

[Damien Blenkinsopp]: Depending on what you’ve eaten or your gut bacteria, potentially you get a signal and you think you’re in ketosis.

[Bob Troia]: Even if the force of your breath is not super consistent.

[Damien Blenkinsopp]: It’s really hard to control, yeah. The blood ketones actually go down over time as you get more keto-adaptive. So mine have gone down, not hugely, by about 1.0 millimolar. So I used to be nearly 4.0 sometimes in the afternoon. Now I’m being more 3.0 or even 2.5.

[Bob Troia]: Wow! That’s really good. I’m not going to say my diet is a keto-diet, but through just my normal diet and periods of intermittent fasting, I always wake up in the morning in a state of at least mild nutritional ketosis. So it’s fairly low, mild, but I can shift really easily into a higher state if I just fast for a day without taking exogenous sources of ketones.

So I don’t know if I mentioned that. I had done some experimentation with pure ketone esters. But most people, like athletes, Tour de France cyclists, are using these super big energy boosts.

[Damien Blenkinsopp]: Use the KetoneAid ones?

[Bob Troia]: There’s a product called KetoneAid that was pure beta-hydroxybutyrate. It is the worst-tasting. It is like rocket fuel so you have to chase it with a little bit or mineral water. It’s really crazy.

[Damien Blenkinsopp]: To wash your mouth out.

[Bob Troia]: Yeah. I approached it from all these athletes are doing it and reporting on benefits from athletic performance, I was like I want to see what it does to cognitive performance. So I did an experiment around just a whole battery of cognitive tests where I established, for two weeks, I just got my baselines. I got rid of any learning effects so the scores that couldn’t get any higher, I leveled out. I’m not getting any smarter, better or faster, my reflexes.

I took this product, it was a very small amount, but it was super, super powerful. Within 15 minutes, I used a blood ketone meter. They only go up to 8 milliomolars, the upper limit. I went, it had an error message. We were through it. So basically the dosage, I should have taken maybe half the amount.

[Damien Blenkinsopp]: How ddid you feel?

[Bob Troia]: It’s just a weird experience. Everything is brighter, your mind is lit up. I was nervous for a millisecond because I feel the gears shifting like an engine’s revving up, but then you’re just like whoa this is amazing. Your brain is never getting that sort of just flood. I mean it is pure beta-hydroxybutyrate getting right into your brain. You’re just like wow.

[Damien Blenkinsopp]: So what were the reults on that?

[Bob Troia]: We waited an hour before I did the tests. So I took it, went off the charts in the meter. Then we waited an hour so it got back down into the range of 6.0 to 7.0 millimolars as soon as it was therapeutic kind of zone and redid all the tests. The battery of every single one, I immediately increased in my scores over those baselines. These test everything from working memory to speed and reflex. It’s a battery of things, but all the scores across the board went up as high as 35, 40%. I was just like this is crazy. Then I go, “This can’t be.” Maybe I have adrenaline going.

The ketones didn’t last. The window of time is four hours.

[Damien Blenkinsopp]: For the ester?

[Bob Troia]: Yeah they tail off and you’re back to normal. So the next day, I was like let me go back and do them again with no esters, my scores were my baseline scores. So it was a temporary bump.

[Damien Blenkinsopp]: Ok. That’s interesting because one of my friends in the U.K., he got the DeltaG one which is the one that humans use. He did a weeklong test taking it every day and it was similar. The first day had all the anecdotal I feel different and the other days, it didn’t seem to make as much of an impact. He seemed tolerant.

[Bob Troia]: Oh really?

[Damien Blenkinsopp]: Yeah.

[Bob Troia]: I wasn’t taking any of the esters. I took them once. So it was almost I was going from zero.

[Damien Blenkinsopp]: I mistook you. I thought you were taking it the next day as well.

[Bob Troia]: No. I never took the esters.

[Damien Blenkinsopp]: So it’s not building your brain better. It’s temporary.

[Bob Troia]: It’s a performance enhancer I would call it. It’s very expensive so I think for athletes who they’re going to use it more often for performance, but if I’m going to go on Jeopardy, maybe I’ll pop it before I go on the show because I’ll be a little bit more on top of it.

[Damien Blenkinsopp]: First of all, if I’m going to do some speaking or some sort of cognitive task, I’ll take a ketone. KetoCaNa is my favourite from KetoSports. Those are the original makers. I get these kind of benefits I really think it is [check 2:46:20]. I haven’t done the battery of testing like you, but I should do that because just like anecdotally I’ve heard other people talk about it as well.

[Bob Troia]: You can even compare. There’s other tropics, you can probably stack them against each other and see how your performance compared.

[Damien Blenkinsopp]: It’s the best thing I’ve taken. A lot of the nootropics, I really don’t find they impact me and often they start affecting sleep if I take them so that destroys all values right away.

[Bob Troia]: It’s not a one size fits all. I know I don’t respond to or may respond to and you’re going to be very different.

(02:46:57) [Damien Blenkinsopp]: Yeah. Everyone has got a different brain chemistry so you have to be really careful about that. So we’re going to wind down because we’ve got other stuff coming. Is there anything you haven’t spoken about that’s really cool? Or anything you want to say?

[Bob Troia]: Anything cool? I think from the quantified aspect of things, I do think there are some cool advancements happening and some of what we can measuring today. I was just inside this event and I was getting my face thermal-imaged. It’s interesting to see how technology is always getting married with Chinese medicine. So we’re really going back to these things that have been around and they seem new because you couldn’t quantify them.

So imagine getting a thermal image like Predator. That movie Predator, you look like.

[Damien Blenkinsopp]: Predator?

[Damien Blenkinsopp]: Yeah and you’re lit up so you see hot spots and cold spots. So they did my face and they could tell I had just arrived off the plane and they could see that my throat was all irritated. They saw my nasal passages were [check 2:47:43]. Then they can map the Chinese acupuncture points and actually show you right here you have some poor digestion happening just by looking at the thermal camera. Now you can actually put this to data. These are things that are quick slot. It took literally 15 seconds to do this scan. You stand in front of the thermal imaging camera, it provides the data.

I’m experimenting with other modalities that are coming from Europe or maybe the Soviet Union that they’ve used for athletes for years. It’s cool to experiment on some of these things. Things are getting exciting. It’s all about being able to learn even more about ourselves in the least intrusive ways and getting actual insights on this stuff.

So for me, I’ve definitely gone and tested lots of things, there has been lot of dead ends and things that are cool, but is the benefit worth it? There might be things where it’s a hassle and I’m not getting enough out of it.

[Damien Blenkinsopp]: A lot of it’s you do projects, you add stuff, you retest it for a while and then you eliminate, you start cutting stuff. It’s this constant process of push forward, add some things, remove more things to get to the stuff that actually is worthwhile.

[Bob Troia]: So the analogy I made with biohacking and quantified self not all biohackers would call themselves quantifiers. I’ll try 20 things and I feel amazing and I don’t really care about isolating what worked. Maybe it was only one of those things that really contributed to it, but they’re not really interested in isolating it. They’re just like I’ll just do everything. Whereas the quantification side, well instead of taking 20 things or doing 20 different things, if there are two or three I can do that I get 90% of the benefit from, I’ll do that. Because 90% of the benefit with the least effort. That’s efficiency.

[Damien Blenkinsopp]: Yeah. It’s a more [check 2:49:34].

[Bob Troia]: Yeah absolutely. In structured experiments, you always do like a ABA test .

[Damien Blenkinsopp]: It’s repeat. I really find value in the repetition. You cycle on, you cycle off, you cycle on, you cycle off, you cycle on; you do that those four times and you can have a clear signal.

[Bob Troia]: Absolutely, yeah. We’re all seeing a subject experiment so you don’t have to worry about the scientific rigor.

[Damien Blenkinsopp]: As long as it works for you, who cares? It’s like in n=1 If ultimately that’s what we’re out for. So we’re not doing science for everyone. It may be useful as a case study for someone else, but then go and do some science, but there are more important things that actually just work for us.

[Bob Troia]: Yes. I agree 100%.

(2:50:20) [Damien Blenkinsopp]: Ok so where can people find you? Just a reminder where are you most active? Where would you tell people to go?

[Bob Troia]: Sure. So Quantified Bob, you can go to quantifiedbob.com. Any social media, Instagram, Twitter, Facebook, Quantified Bob. You can email me, [email protected],com. If you’re ever in New York City or you want to start playing around with some cool tools and training and recovery tools, if you go to Optml O-P-T-M-L optml.co, you can see some of the things that I’m doing up there with the oxygen training and recovery tools and that will be built out over the next month or so.

[Damien Blenkinsopp]: Excellent. Thanks very much for your time and I’m sure I’ll be seeing you at another event soon.

[Bob Troia]: Yeah, it has been great. It has been so great hanging out with you and reconnecting and looking forward to the rest of the event.

[Damien Blenkinsopp]: Yeah, me too.

[Bob Troia]: Thanks.

[Damien Blenkinsopp]: Turning you guys off. See you later.

Hey there! Congratulations on getting to the end of a Quantified Body marathon episode. I don’t know about you, but I had a lot of questions coming out of this conference and on the discussions I had. It was a good introduction to get the lay of the land, but I have a lot of questions particularly before I would consider actually experimenting with any of these tools that were discussed.

So here are some of my first questions. I’m bringing them out there so that if you have any thoughts yourself, you can perhaps add your comments or your questions to the blog and we can have a bit of a discussion around this because I think there is a lot of uncertainty. There is a lot of different things to tackle and topics to explore in this area and it’s really for me, this is like a first episode of many future episodes. This is an important topic to me and I think an important topic to everyone and it’s going to be more and more interesting in the next years.

So here are some of my questions that I have after this episode. The first area is really understanding the risk profile of some of these tools. To make sure that there is no huge downside basically to the use of any of these tools that we are completely unaware of or some blind spots there. In particular, there are a couple of ones that I’m interested in trying to understand that risk profile better.

So that would be senolytics is number one. My questions are: How can we evaluate the risk profile of some of these different senolytics? Who should take them, who should not? At what age should you be? At what age does the upside become more useful than the potential downside? What is the track record in the use of some of these? Do we really understand them? Even the ones like some of the antibiotics or the chemo-based drugs that have been used for a while, potentially we don’t understand all of the long-term effects of these.

On my journey in the Quantified Body, I’ve learnt that we are still learning a lot about the body and we are learning our ability to quantify and get data on aspects of our biology is still very limited. I expect this area to be transformed in the next 50 years with just the amount of data and understanding that we can actually process. So for now, I consider that most of our biology is not being tracked. We don’t have data on it and it’s just a big black hole that we don’t know anything about.

My concern for these things are is there something going on which could present some long-term damage that we’re not aware of. How can we ensure that we are preferentially killing just senescent cells and not doing some other kind of damage? So that’s the topic I’m interested in understanding more before I potentially experiment with this myself.

The second one would be in the area of young plasma. I think this is very, very similar in my concerns. My main concern here is with blood transfusions in general. If you’re not in a critical state so if you haven’t just had a car accident and it’s really life or death, you need a blood transfusion to survive, then what is the risk profile of having a blood transfusion?

I believe that we aren’t able to screen for all of the pathogens in the blood currently. If you look at some of the more advanced labs which are trying to look into this area like Aperiomics which I discussed in the last episode, episode 51 for microbiome, Aperiomics does analysis against its database of pathogens which it’s still building for all types of samples; urine, blood and stool. They’re finding things that they didn’t expect.

So I do believe that the blood samples we have today, they are screened for some of the most important infections we know of such as HIV. But there are potentially many that we are not aware of that could lead to chronic disease later in life or chronic issues in the long-term and we’re just not aware of them.

So I feel like there is a risk profile there to establish on blood. If you’re going to have a transfusion of younger blood, then how do you ascertain that there’s nothing in there that could present some issues in the longer term and thus negate those young healing benefits from young blood? So that’s understanding the risk profile better in particular separating out any larger downsides rather that we may be exposing ourselves to and are unaware of.

The second area is really trying to understand the benefits and the upside of making an effort investing money in these treatments or these tools. So really understanding it area-wise. Is it worth our time?

The two which would fit more into that category now I think are Rapamycin because this is available now. You can get this. What kind of protocol could you put in place? What kind of experiment could you do? What biomarkers could you be testing in order to understand over a year, over two years, does this have any benefit to you? Is it worthwhile from a cost and effort perspective? Or potentially some of the side effect downsides? Also we have to take those into account. So would it be worth it to you?

Then the other one is NAD which has received a lot of press over the last couple of years because there has been nicotinamide riboside (NR) which have been on the market and popularized a lot by the company Elysium Health in the form of its supplement basis which you may have heard of. But how worthwhile is NAD supplementation really? There is a little bit of conflict around this in terms of the scientific discussion around it. How interesting is it? How beneficial is it given the cost of these supplements currently?

So someone who I did meet at the conference and I interviewed for the video live, but isn’t in this audio episode is Maria Entregus. Her grandson has worked with SENS Research Foundation a long time and has also just brought out a test for NAD levels which is a biomarker to help establish if taking nicotinamide riboside is having an impact on your NAD+ levels.

You could get a baseline an you could get some other tests down the line just to see if the value of that has actually changed. The name of that test is Life Bridge Test. By the time this episode is out, that could be out so that could be something worth looking at. Getting a baseline and then tracking that if you’re going to invest in taking NAD and trying to raise your NAD+ levels.

Those are some of the questions I have and some of the bigger questions I’m going to spend a little bit of time looking more into to understand if it’s worth doing any of these in the shorter term. I’ll be going to some other conferences in the near future. One in Berlin in March 2019 is “Undoing Aging” which I’m going to.

There are some others, some events, more events that are taking place so you can expect some more updates on these technologies and potentially some self-experiments if I decide one of them has a reasonable risk profile and I can track some of the upside benefits there.

So I’d love to hear your thoughts on these questions if you have any or if you have ideas, any clear ideas on them or references of course. We like references. Or if you have your own questions about these, please post them in the comments of this episode on the blog. I’d love to hear from you. So you can do that by going to thequantifiedbody.net and then pick out the episode there and comment on it. That’s it for me for this episode. I’ll talk to you again soon in Episode 53.

 

Research Study References

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Microbiome testing can be confusing: many companies, different technologies and a lack of standards make it hard to get actionable insights from the data. Find out how technologies and labs differ and what information is actionable from today’s microbiome tests.

In this episode we continue our discussion of the microbiome that we started in Episode 9 and continued with Episode 37. Today we try to help you navigate the confusing field of microbiome testing companies and discuss the pros and cons of different technologies.

Examples and lessons learned from our own testing will give you an idea of how a microbiome test can help you make decisions about your health. Finally, we discuss what we think the future of microbiome testing holds.

[Why microbiome testing is important] is that unlike genomics and genetics and your human DNA, which I find very fascinating, but there’s not a whole lot you can do to change it. Despite the fact that there are a lot of genes that are involved, there’s not a whole lot you can do if you find out that you’ve got the gene for this or that. Whereas with the microbiome you’ve got way more genes and you can change them. And I think those two things are part of the reason that I’m very excited about the microbiome.”
– Richard Sprague

Long-time software executive Richard Sprague discovered his love for science through microbiome self-experimentation, studying questions like “Can I improve sleep by feeding certain gut microbes?” or “What is the impact of a gut cleanse on my gut bacteria?”

Formerly “Citizen Science in Residence” at uBiome, a biotech company, microbiomics is of particular interest to Richard because it is easy to get access to a lot of raw data that let non-specialists like him make interesting discoveries at the cutting edge of medicine and science. Richard shares his experiments and insights on his Medium Publication called Personal Science and the Microbiome and his blog.

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

  • Why is the microbiome interesting (5:40).
  • Microbiome testing is now more accessible to the public (7:45).
  • Different technologies for trying to understand your gut and what’s going on there and the pros and cons of these technologies. Technologies discussed include: Cell culture, PCR, 16S sequencing, metagenomic sequencing (9:02).
  • What is the different between a different bacterial strain and a different species and why this distinction is important when analyzing your microbiome (17:40).
  • Cutting edge new technologies to understand your microbiome better: transcriptomics, which looks at what genes are active, proteinomics which looks at the actual proteins and metabolomics, which analyzes metabolites (20:10).
  • The reasons why the results from different labs are different (27:30).
  • The different labs doing microbiome testing and compare notes on the ones they used (33:13).
  • How glucose response and the microbiome are interdependent and knowing more about your microbiome might allow you to predict your body’s glucose response to different foods (51:26).
  • The labs at the bleeding edge of transcriptonomics (57:29).
  • N=2 experiences with the labs used and how they interpret and compare the data they received (59:24).
  • The effects of his ketogenic diet on his microbiome (1:02:44).
  • Discussion of gut microbiome diversity, day-to-day variability and individual difference in the microbiome (1:15:54).
  • A self-experiment he has done to try and change is microbiome taking a probiotic and the effects of traveling and eating different foods on the microbiome (1:20:15).
  • A way to change the nose microbiome using kimchi (1:22:01).
  • Advantages of a varied diet over taking probiotic pills to change the microbiome (1:24:06.)
  • High-level thoughts and recommendations about using different microbiome tests (1:28:34).
  • Why everybody doing lab tests should try to get the raw data from the lab (1:36:30).
  • Discussion of what future technologies and applications will useful to get even more information out of the body’s microbiomes (1:38:23).
  • Improvements that would provide better data and insights from microbiome testing (1:41:44).
  • How travel impacts the microbiome (1:47:03).
  • Where to learn more about the microbiome (1:55:42).
  • Information about what Richard is tracking and his interest in traditional foods and medicine (1:57:37).
Thank Richard on Twitter for this interview.
Click here to let him know you enjoyed the show!

Richard Sprague

Recommended Self-Experiment

Use Kefir to Change Your Microbiome

  1. Tool/ Tactic: Richard found a real noticeable difference in the microbiome after drinking kefir, in particular a couple of microbes that he did not have before he started drinking kefir and that he has now. Interestingly, one is associated with recovery from Crohn’s Disease. See Richard’s academic pre-print paper.
  2. Tracking: to track the effects of adding fermented food like kefir to your diet you need to get your gut microbiome tested before the start of the diet and several weeks or months later.

Kimchi for Sinusitis Treatment

In sinusitis sufferers the sinus microbiome is out-of-whack and the probiotic Lactobacillus Sakei is missing. L. Sakei can work as a sinusitis treatment if put into the nostrils. Kimchi is a natural source of L. Sakei. To experiment with kimchi to treat sinusitis Damien recommends the following:

  • Put a teaspoon in a container with kimchi and scoop up some of the juice.
  • Dip your finger into the liquid and put your fingers up both nostrils spreading the liquid.

More information on how to apply kimchi juice to treat sinusitis can be found here. The scientific paper underlying this approach is also available.

Tools & Tactics

Diet & Nutrition

  • Fasting: Fasting interventions can potentially change the microbiome. In this episode it was discussed as a tool or experiment in particular for any chronic issues/ unidentified health issues that no one knows how to solve.

Sleep

  • Good sleep is essential for the body. Richard experimented with potato starch to boost his bifidobacterium levels. The result of his self-experimentation can be found in his blog. Although this approach did not work for him, other people have seen positive effects and he recommends that people with problems sleeping try potato starch.
  • Damien is experimenting with three different approaches to improve his sleep:
    1. 10,000Lux SAD (seasonal affective disorder) light. Using this light for two hours every morning simulates strong daylight. This approach has worked for him and his theory is, that the strong light in the morning is a way of resetting his sleep cycle. SAD light use to improve sleep and prevent daytime sleepiness is discussed in this study.
    2. Going to bed really early also helps him to maintain a solid 7 to 7.5 hours of sleep per night. He now goes to bed by 9 pm.
    3. Taking a glycine supplement to reduce night wakings.1,2

Tech & Devices

  • 10,000 Lux Lamp: Lamp that replicate strong sunlight. Damien has been using this in the morning to reset the circadian rhythm and as a result improve sleep quality. These lamps are designed to be used with Seasonal Affective Disorder, by providing sunlight in dark months of the year.
  • Sleep Tracking Devices mentioned include:
    • Zeo: A popular fitness tracker that went bankrupt due to issues with its business model.
    • Fitbit: This version of the FitBit integrates sleep tracking.
    • Oura Ring: OURA is a convenient wearable ring that has become popular over the last year. The company is currently participating in studies to understand the accuracy of its sleep tracking. Damien uses it to track sleep duration only – the base metric.(Note: If you’re looking at buying this discount code gives you 75 Euros off “TNBBJDQX49J”).

Tracking

Biomarkers

The biomarkers discussed in this episodes are strains or species of gut bacteria that are part of the microbiome. Tracking these biomarkers require a microbiome test.

A good best practice is to get a baseline test followed by tests over time, especially if you make changes to your diet, travel or experience health issues, to see how the microbiome tracks.

The four major groups of bacteria are Firmicutes, Actinobacteria, Proteobacteria and Bacteriodetes. Changes in the abundances of each of these groups often associate with many health conditions.

  • Firmicutes and Bacteroidetes: are both key players in regulating gut metabolism, and are critical in understanding metabolism dysfunctions. See: “Diet–microbiota interactions as moderators of human metabolism” Nature 2016. The ratio of firmicutes to bacteroidetes from different lab tests was discussed, and has been discussed in the literature, but Richard is wary of relying on a single test, noting that his own ratio is highly variable day-to-day.
  • Bifidobacterium also known as Lactobacillus bifidus are ubiquitous inhabitants of the gut, vagina and mouth of humans. They are found in fermented foods like yoghurt and cheese. Bifidobacteria are used in treatment as so-called probiotics, defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”. This scientific paper published in Frontiers in Microbiology summarized the current understanding of the health benefits of Bifidobacterium.
  • Spirochaete is a phylum of bacteria that contains many pathogenic species, including Borrelia species that cause Lyme disease. Testing for these pathogenic bacteria can reveal important information about one’s health. Damien put together a paper describing how one could use uBiome’s 16S rRNA microbiome sequencing as a pre-screen tool for Borrelia.

Lab Tests

Microbiome Labs Overview

With a number of different labs out there offering microbiome tests it can be difficult to decide which company to use or what the upsides and downsides may be. The table below provides an overview comparison of the different characteristics of each of the labs including.

uBiomeAmericanGutAtlasBiomedDayTwoAperiomicsViome
OFFER Cost $89 per test $99 per test £274 ($379) per test $329 per test $781 per test $399/ year
Breadth of Testing Gut, Mouth, Nose, Skin, Genitals Gut Gut + DNA (+ Metabolomics/ Blood Markers) Gut Gut, Blood, Urine and Oral Swabs Gut + Metabolism (blood glucose regulation) + Body dimensions
Service N/A N/A N/A Nutritionist consultation included N/A N/A
Geographies Served International International UK & Russia US Only International US, UK & Canada
Year Started 2012 2012 2017 2017 2017 2017
TECHNOLOGY PLATFORM Sequencing Type 16S 16S 16S Shotgun Shotgun RNA
Information Depth From Phylum to Genus From Phylum to Genus From Phylum to Genus From Phylum to Species and Strain From Phylum to Species and Strain From Phylum to Species and Strain
Type of Information Metagenomics
(What genes are there)
Metagenomics
(What genes are there)
Metagenomics
(What genes are there)
Metagenomics
(What genes are there)
Metagenomics
(What genes are there)
Transcriptomics
(What genes are expressed/ active)
DATABASE SCOPE Coverage Bacteria Bacteria Bacteria Bacteria Bacteria, Viruses, Parasites and Fungi. Bacteria, Virus, Parasite and Fungi
BENCHMARKING DATA QUALITY Benchmark Data Quality/ Scope Likely largest database currently N/A N/A The Weizmann Institute studies included over 1000 Israeli participants on glucose regulation and the biome. Currently have study underway in U.S. Large whole genome database covering over 37,000 microorganisms, 7500+ of which are known pathogens. Very early stage - likely most limited currently
OUTPUT YOU RECEIVE Actionable vs. Informational? Informational Informational: Detailed reporting. Informational: Limited information (only family/ genus level reported)

Actionable:
Many specific recommendations
Recommends Actions:
Rates each food according to your glycemic response
Highest level of granularity of species reported. Recommends Actions:
Rates each food
Transparency of Recommendations N/A N/A HIGH: Includes reasing and study references for most recommendations MEDIUM: Doesn't Explain Recommendations, but can assume comes from Weisman work HIGH: Discussion with researchers. LOW: No information given on which various inputs explain outputs or why
Raw Data Yes Yes No (planning to add?) No
(but planning to add)
Yes No
(No plans to add)

Note: This is a high level analysis of the current technologies and labs on the market which are primarily focused on metagenomics. There are others that have yet to emerge commercially but will eventually create a broader and more complete landscape and understanding of the biome. These include metatranscriptomics, proteomics, metabolomics, and other meta data.3

Microbiome Lab Tests

  • uBiome Explorer test: Richard used to work for uBiome as a citizen scientist. They use machine learning, artificial intelligence, statistical techniques, and a patented precision sequencing process based on 16S rDNA sequencing to analyze the microbes in a sample.
  • American Gut: this project is run out of Rob Knight’s lab at UCSD and is one of the largest microbiome research labs in the world and the world’s largest crowd-funded citizen science project in existence. Anybody can join the project by making a donation.
  • Atlas BioMed: a UK based company does DNA and microbiome testing based on 16s rDNA sequencing.
  • Doctor’s Data Microbiome Testing: a clinical lab performing specialized testing.
  • BioHealth GI Screens: a company providing functional laboratory testing, including testing of the gut microflora.
  • Aperiomics: identifies every known bacteria, virus, parasite, and fungus in samples. Specializing in identifying pathogens and solving complex clinical infections.
  • Diagnostic Solutions GI Map: microbiome testing based on PCR technology.
  • Gencove: offers DNA testing to explore ancestry and tests the microbiome of the mouth.
  • Arivale: tests the genome, blood, saliva, gut microbiome and is taking lifestyle into consideration.
  • Viome: Analyzes the gut microbiome to help improve health, weight loss and wellbeing. Viome offers an annual plan that includes a microbiome test.
  • DayTwo Microbiome Analysis: provides personalized nutrition based on the to maintain normal blood sugar levels. The company studies individual metrics and gut microbiome and translates their findings into actionable insights. Richard’s review of DayTwo can be found on Medium.
  • Thryve Gut Health Test: assess gut health using 16S sequencing and provides personalized probiotics kits.
  • GI Effects Comprehensive Stool Test and GI Effects Microbial Ecology Profile Test: these are tests available via Genova.

Analysis of the Different Labs

Granularity of Output from the Labs

This graph shows the level of granularity of information different labs provide to the customer in terms of number of species and genus. Some labs like Atlas Biomed only report genus level. The comparison shows that Aperiomics is able to identify more species due to the higher depth of sequencing the lab uses.

Source: Damien’s lab samples

Analysis and Graphs from Richard Sprague

Results from different microbiome testing labs can vary by quite a bit and therefore be confusing. Some of the variety in tests results can be explained when samples are taken at different times. This graph shows gut microbiome diversity over a period of one year.

microbiome labs


Changes in the gut microbiome over a one year period (Richard Sprague)

But variations can even be observed during the course of one day as the following chart shows.

microbime labs

Daily variations in the gut microbiome (Richard Sprague)

But even having the same sample tested by different labs can lead to different results based on the different methods they use. To interpret data from different labs it is important to focus on the bigger picture, do the lab tests find the same type of bacteria in the same order of abundance. A chart that Richard shared emphasizes that point. The results shown in the table are from the same day, swabbed from the same tube submitted to both companies. The results are different but not extremely different. The top phyla are the same and the abundances are in the same order.

Microbiome labs

Comparison of gut bacteria phyla and relative abundance in a sample tested by Day Two and uBiome (twice) (Richard Sprague)

 

Other People, Books & Resources

People

  • Elizabeth Bik (@MicrobiomDigest): Richard recommends following Elizabeth on Twitter. She is one of the smartest microbiome scientists he knows, and is very prolific on Twitter. She reads all the publications, and will let you know the ones that matter.
  • Rob Knight (@KnightLabNews): Rob Knight is a Professor in the Department of Pediatrics at the University of California at San Diego, among many other things he is a member of the Steering Committee of the Earth Microbiome Project and a co-founder of the American Gut Project. This article in the science magazine Nature gives an overview of his work.
  • Eran Segal (@segal_eran): is a computational biologist at the Weizmann Institute of Science. He has shown that there is no “One size fits all” diet, and that the very same foods can be good for some and bad for others. He is also one of the founders of the company behind the DayTwo microbiome labs. Eran was interviewed on Quantified Body with another founder of DayTwo, Lihi Segal, here.
  • Chris Kresser: A functional medicine practitioner and founder of the California Center of Functional Medicine, a group of doctors that treat patients with a wide range of chronic health problems, from digestive disorders, to chronic infections, to autoimmune disease, to hypothyroidism.

Books

  • The Personalized Diet: The Pioneering Program to Lose Weight and Prevent Disease: a diet book by Eran Segal and Eran Elinav that explains why one-size-fits-all diets don’t work and helps readers customize their diet to lose weight and improve health. Robert recommend it specifically because it gives suggestions for how you can test yourself using just a cheap glucose meter.
  • Wired to Eat: Damien recommended this book by Robb Wolf which starts with the 30-Day Reset to help people restore normalized blood sugar levels, repair appetite regulation, and reverse insulin resistance. You can also listen to Episode 49 of this podcast for more information. This book also features standard Paleo – based recipes and meal plans for people who suffer from autoimmune diseases, as well as advice on eating a ketogenic diet.
  • The Longevity Diet: Discover the New Science Behind Stem Cell Activation and Regeneration to Slow Aging, Fight Disease, and Optimize Weight: book by Valter Longo. Valter is the director of the Longevity Institute at USC in Los Angeles, and of the Program on Longevity and Cancer at IFOM (Molecular Oncology FIRC Institute) in Milan. The book describes the 5 Day Fasting Mimicking Diet which promotes longevity, overall health, and reduce excess fat.

Other

Full Interview Transcript

Click Here to Read Transcript

(0:04:43) [Damien Blenkinsopp]: Richard, thanks so much for joining the show. It’s great to have you here.

[Richard Sprague]:My pleasure, I’m a big fan of your podcast. I’m actually a little bit humbled that you’ve asked me to come here and talk today.

[Damien Blenkinsopp]: Well you shouldn’t really be humble because you’re a real data geek when it comes to some of this stuff. So we’ve known each other for a long time because of that.

I can’t remember how we connected? Do you remember how we first connected?

[Richard Sprague]: I’m not sure either. It’s probably some quantified self thing. But I’ve been listening to your podcast since the beginning.

[Damien Blenkinsopp]: It wasn’t in person anyway, it was online. I think you must have posted you know what, I think you posted some uBiome analysis, one of the first blog posts, trying to analyze it or something and I found you on Twitter. It might be something like that.

[Richard Sprague]: It could be.

[Damien Blenkinsopp]: Okay great, so we’re going to talk about the microbiome because Richard, as I just mentioned in the intro, has been looking into this a lot. And really the first thing is just to get you guys up to speed on all of this, because it’s starting to become quite a complex question.

(0:05:40) We hear a lot about this in podcasts and health podcasts all the time. I think it’s quite a lot more complex than we generally hear. So, Richard, what do you think? What’s going on with all of this? Why is it important, and why are the labs important right now to try and quantify it?

[Richard Sprague]: You’ve had several podcast interviews with people who’ve been working in the microbiome science, but to me the way I would summarize it is that unlike genomics and genetics and your human DNA, which I find very fascinating, but there’s not a whole lot you can do to change it. Despite the fact that there are a lot of genes that are involved, there’s not a whole lot you can do if you find out that you’ve got the gene for this or that. Whereas with the microbiome you’ve got way more genes and you can change them. And I think those two things are part of the reason that I’m very excited about the microbiome.

The other thing is that partly because of that scientists are finding out all kinds of new relationships and associations between the microbiome and just about any human condition you can imagine. Everything from allergies and obesity to Alzheimer’s disease, to mental health issues like depression or schizophrenia.

There’s a relationship with the microbiome there; we don’t understand what they are, but in the last couple of years some really awesome new technology has come online that makes it possible not just to be able to go and see what the microbiome is in an individual person, but now it’s coming to the point where it’s at consumer level pricing. So that you and I can go and figure that out as well and not just wait for some scientist to go and figure it out.

[Damien Blenkinsopp]: Right. It’s actually interesting because basically since 2014 there’s been quite a few different labs coming out and these are really some of the firsts.

I mean, genetics was the first with 23andMe and players like that, but it’s one of the first areas where it’s consumer driven testing rather than coming from the medical world, and coming from physicians where they control all that stuff. But really uBiome, which was one of the first commercial players, came out and said this is going to be a consumer driven model at first.

[Richard Sprague]: Yeah.

[Damien Blenkinsopp]: Yeah. So it’s, I mean I think that’s the other reason there’s a lot of chat about it as well, because it’s more accessible to the general population.

(0:07:45) [Richard Sprague]: Yeah, that’s right. And in particular I think the 16S, I call it the Hack, made it possible to do something that people weren’t expecting to happen technologically so quickly.

Because if you think about how long and how much money it took to sequence the first human genome back in 2000. You know, that was billions of dollars and involved the cooperation of hundreds, maybe thousands, of scientists around the world.

Well, now we’re talking about at least 10 times, maybe 100 times more genes in a single human being for microbes, and they’re from thousands, maybe tens of thousands of different species. Well, how in the world would you ever sequence all of those genes? It just seems like an impossible problem.

But somebody discovered this trick several years ago that let’s you just look at 200 base pairs on one partial gene, and you can get a rough idea of what’s going on. And that just revolutionized things, because it made it possible now for people to get a hint of what all those microbes are doing.

And that just revolutionized the field. And what’s cool is like you say, since about 2014 it’s been possible for the rest of us to go and access that same kind of technology for basically under 100 dollars.

And that’s just opened up all kinds of new, interesting discoveries.

[Damien Blenkinsopp]: Yeah, yeah. So, we’ll get into why the 16S works, and how it works, in a bit.

(0:09:02) Let’s take a step back because obviously there’s quite a few different technologies out there. When you go to see physicians, when you’re using these technologies, when you’re trying to understand your gut and what’s going on, there’s a fair amount of options. And there’s different options that are being used.

So, Richard could you just give us a quick overview of what kind of technologies are being used currently?

[Richard Sprague]: The first one is culturing. And that’s been around for hundreds, arguably thousands of years, because you essentially, if you know that there’s a microbe involved and if you know which one you want, it’s well understood what kind of things they eat.

So you just take a little bit of a sample, and you put it into a Petri dish and you wait to see what happens. And, scientists know how to culture a lot of the microbes that are important, in particular the pathogens. And that’s kind of the classic way to do it; even today it’s still the gold standard. If you have some kind of medical issue where a doctor wants to confirm for certain that you have such-and-such pathogen, everybody will trust the culturing results.

So that’s kind of the first thing. The problem with culturing is that it only works on certain organisms. And they have to be alive, and it takes a while. It might take several days, or weeks in the case of some microbes.

So the next step was the development of PCR, which is if you know which microbe you’re looking for, you can put into a special machine, polymerase chain reaction, which is well understood technology that’s been around since the early 1990’s.

And they will confirm or deny whether a particular sequence of DNA base pairs are in there or not, which is another way of saying a particular microbe. And that works very quickly; that’s a few hours in some cases. And you can find out for certain whether a particular microbe is there. So the big advantage there is speed.

[Damien Blenkinsopp]: And also the accuracy, because you can really pinpoint something and if it does show up in the test, you can be sure it’s there.

Whereas even with the cultures, I think one of the issues is contamination. Because you’ve got these Petri dishes growing stuff, who knows sometimes. I’ve done some cultures in the past for different things, and I’ve been very suspect about the actual results that came out in the end. I was like, I think…

[Richard Sprague]: Yeah, you have that contamination problem with everything. The bigger issue with culturing and contamination, I think, is that sort of by definition you’re just sitting there waiting for something to happen. And sometimes it happens, sometimes it doesn’t. And, for example, if the pathogen of interest, if it somehow died on the way to the Petri dish, for no good reason, you’re not going to find it

And vice versa if the lab technician somehow exposed something or other to this or that on the way to the Petri dish then you’re going to see something you weren’t expecting.

So the next step up is, we were talking about 16S sequencing. It’s called 16S because there’s a line on the centrifuge when you take a sample and you spin it around enough, there’s a like that’s called the 16S line, which is if you skim off the goop that you find there, you will get one particular gene called the ribosomal rRNA gene. That is part of the genome that’s responsible for building the ribosome, which is an essential part of the way that all cells work.

Well, in bacteria it turns out that all bacteria use a very similar gene. We call it the 16S, the ribosomal gene. And because bacteria are all going to have that same one, in evolutionary terms it’s called conserved, throughout evolution, that it becomes possible to be able to tell the differences in bacteria based on slight variations in that gene.

The gene itself a couple thousand base pairs. But it’s one particular part of that gene called the B4 subunit that’s only, I think it’s 200 base pairs. And so if you just sequence those 200 base pairs, you got a pretty good idea of which microbe it is. Because all the different bacteria that have ever been found on Earth will have that 16S gene, and they will differ just slightly.

And if you’ve got a reference database to be able to see which one is which, and especially if you know that this came from a human gut, right there you’ve suddenly been able to eliminate having to do a gazillions of sequences. Because, sequencing something for only 200 base pairs is pretty cheap, you’re able to get the whole cost down to less than 100 dollars.

[Damien Blenkinsopp]: Yeah. So they called this hyper-variable because, I mean the interesting thing about this is that that region just varies greatly. So that’s why you’re able to identify these different genus of these sometimes species, if it happens to be a species that has more variation on that. But that’s really the key to it; it just varies so much that you’re able to identify the different things in it.

[Richard Sprague]: Yeah, and it’s pretty cool. It’s a really amazing shortcut, when you think about it.

[Damien Blenkinsopp]: Right

[Richard Sprague]: That you’re able to go from literally millions of genes, down to exactly which biome species it is. That’s pretty cool.

(0:13:44) [Damien Blenkinsopp]: And so those were the first tests that came out with the uBiome, the American Gut and some others. There’s Atlas BioMed now in Russia and the UK as well, but I’d say most of the labs are using it, the 16S. Is that the one you’ve seen because you’ve seen some others in their states, and new ones that I hadn’t come across.

[Richard Sprague]: That’s right. I mean there are lots. It’s not that hard for a lab to do 16S sequencing. In fact probably most universities do this routinely. So anybody who’s got an Illumina gene sequencer can do 16S sequencing. It’s not, the basic ideas are pretty well understood.

Also the pipeline, the software pipeline where you go from the output of the gene sequencer to actually telling you which part of the taxonomy it is. All of that stuff is available on Open Source software. Just about anyone, any feasible lab can go do it.

[Damien Blenkinsopp]: For me, when I was first getting my uBiome stuff I was trying to understand it better and I just accessed the Open Source stuff. And actually, you think it’s going to be super complicated. I didn’t do a degree in bioinformatics or anything, but actually it wasn’t that complicated.

I managed to look into, and you’ve been doing a lot of that and posting your results up online as well. That’s how you got into it. So it’s actually very accessible, which is great as well.

[Richard Sprague]: That’s right. And it’s pretty easy if you have questions to find bioinformatics experts around who will answer your questions. Because like I said, this whole technology and the basics behind it pretty well understood.

(0:15:04) So, that’s 16S. The next step up requires a lot more detail and a lot more sequencing. People call it metagenomic sequencing. And essentially what you’re doing is you’re taking the entire sample, you blow it up people say you shoot a shotgun at it and you get all these little parts flying out.

And then a computer takes, it’s almost like a big jigsaw puzzle and reassembles it. And the advantage of metagenomic sequencing is that now you’re not just looking at that one 16S rRNA gene, you’re looking at all the genes. And so it’s a lot more comprehensive.

[Damien Blenkinsopp]: And then you can get species, strain level identification.

[Richard Sprague]: That’s right.

[Damien Blenkinsopp]: Because the one thing I struggled with when I was doing a few little projects on this was sometimes if you’re unlucky and you’re trying to identify some certain species or definitely strains or even genus in some cases the 16S can’t work. It’s very difficult to get that type of level of granularity of information out of it sometimes.

[Richard Sprague]: Yeah, that’s right. And unfortunately that matters. So one of the reasons why something turns into a pathogen, it turns into a pathogen and your body isn’t able to fight it off because it may be only off one or two base pairs.

So there are versions of E-coli that are only a couple of base pairs different than the ones that are highly pathogenic. And that’s because the bacteria are able to mutate much faster than a human can. Obviously it takes us a whole lifetime before you pass on a genetic mutation.

Whereas the bacteria do this all the time. So, unfortunately most of the pathogens that you’ll see out there are just a couple of base pairs different, and you can’t tell them apart with 16S.

[Damien Blenkinsopp]: So when you say a couple of base pairs, that’s the strain level? Is that the level of strain difference?

[Richard Sprague]: That could be the strain level or the species level, it depends where on the gene the mutation happened.

(0:16:50) [Damien Blenkinsopp]: So strain for the guys at home is the absolutely tiniest, basically if you think of a human mutation, that’s kind of a strain. Do you say that’s correct Richard?

[Richard Sprague]: Yeah, the way I would describe it is that you take a dog or a wolf, both are part of the genus canine. Okay? It would matter a lot to to whether it’s a dog or a wolf at your door, it matters a lot.

So just knowing the genus didn’t help you a whole lot. The species will tell you now that it’s a dog versus a wolf. The strain would tell you that it’s a poodle or a bulldog.

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

[Richard Sprague]: Now, there are lots of cases where it might make a big difference whether it’s a Rottweiler or…

[Damien Blenkinsopp]: A poodle, yeah.

[Richard Sprague]: Yeah. So you’ll need this kind of metagenomic sequencing to be able to tell that level of difference. And unfortunately a lot of times it matters.

(0:17:40) [Damien Blenkinsopp]: Yeah. So I had on a PCR test, just in November, fibrocholera. In other words, cholera turned up in my test. And I was looking at it like, this can’t be.

You start looking into it and you’re like, wow. I had diarrhea, stool problems, for about a week, which was very unusual, liquid diarrhea. And so I looked into this and thought, I can’t have had cholera.

And when you look into it, there’s only two specific strains of that with small modifications which cause the epidemics. The other ones, they’re dangerous, they’re not nice, they give you diarrhea for a week and it’s not nice. But it’s actually some very rare strains that come out, those are the only ones that cause the really lethal epidemics that we’ve seen in the past.

[Richard Sprague]: Could be. And in fact, and this is where it gets really complicated, it could be that the particular strain that you have will out-compete the bad guy. So having it will actually help prevent you from getting cholera.

That’s the sort of thing that happens. That’s why it’s really hard to look at the presence or absence of a particular microbe and say in isolation whether this is good or bad.

Usually it will turn out that something that’s pathogenic will have one other characteristic, which is that it is super hyper-competitive, and it will just eat up everything else and take over. And you’ll know within days, maybe hours, whether it’s bad or not.

[Damien Blenkinsopp]: Yeah.

[Richard Sprague]: So a lot of times if you just see a little bit of this or that in there, that’s just life.

[Damien Blenkinsopp]: Yeah. But I think this is really, really important because I think a lot of the people who are finding species and I think we’ve both been guilty of it too, Richard. We find a species in one of our microbiome tests, so we dig into it and we research it. Especially with the 16S lab, where it’s maybe at a higher level that it’s been identified, I think it can lead to a lot of work with no outcome there, because you’re not as sure what you’re actually dealing with.

And the best thing there is probably to escalate it, basically. If you found something in a 16S you could escalate it to a shotgun, or better PCR for the specific one that may be a concern.

[Richard Sprague]: Yeah, that’s right. And the other kind of thing to always keep in mind with all those sort of testing is that we do have a lot of data. And that’s dangerous because now suddenly you’re being flooded with a whole bunch of data, and it’s easy to overreact. Because you’ll find all kinds of things, and it takes a long time to be able to sit back and look at it a little bit more objectively and say you know what, this is just the nature of the technology. We’re at the cutting edge; we’re going to find some stuff, don’t get too excited.

(0:20:10) So, going back to the list of different ways you can measure the microbiome. One of the other areas that’s been very exciting, this is kind of where the real cutting edge is now. It’s called transcriptomics, and that’s based on the observation that just because a gene or a microbe is there, it doesn’t mean anything in and of itself.

What you really care about is whether that gene is producing the proteins that are the building blocks of life. And the way that you tell that is by the RNA that it’s producing while it’s doing all of it’s copying and transcribing these genes. So people call it transcriptomics because you’re transcribing this gene into RNA.

And there are some new tests that are coming on that let you be able to look at that. Now, that has been extremely expensive. Like I said, it’s the cutting edge and you’re talking about RNA, which is a very difficult to handle molecule; it takes special kinds of labs to be able to do that.

And what’s very exiting is that now that is becoming possible to do at consumer level pricing as well. But that’s definitly, I think most of us would agree that that’s where the future is going to be.

[Damien Blenkinsopp]: Yeah, and then after that you have proteinomics, actually looking at the proteins. Because basically what we’re talking about is the chain of events in order to create the different molecules in your body.

[Richard Sprague]: Yeah.

[Damien Blenkinsopp]: And it goes all the way down the line from genetics, transcriptomics, proteinomics, to metabolomics.

[Richard Sprague]: Metabolomics, yeah.

[Damien Blenkinsopp]: And it’s all great stuff.

[Richard Sprague]: Yeah

[Damien Blenkinsopp]: The beauty of it is one day we’ll probably have all them and actually understand what’s going on in the body.

[Richard Sprague]: Yeah, that’s right, yeah. I should also mention there are lots and lots of different tricks along the way to try to mimic what you get out of metabolomics or transcriptomics without having to do a full blood panel and that sort of stuff. One of them is called functional genomics.

For example, uBiome you can get this thing called a KEGG analysis. And that’s fairly common. That’s kind of a way to guess what sort of metabolites might be produced by this particular gene.

I don’t think it’s of super huge value. A lot of people will point to that as being evidence that such-and-such type of metabolite is present in my body. And you’ll hear that every now and then, it’s called KEGG analysis, another way to talk about it. But what I’m excited about is that now I think we’re able to move beyond that to looking more directly at what the specific thing going on in your body is.

[Damien Blenkinsopp]:With the transcriptome?

[Richard Sprague]: That’s right, yeah.

[Damien Blenkinsopp]:Yeah, I mean you can see that on uBiome, right. If anyone has a uBiome test at home they have the functional part that is displayed. Do they still have those charts, I haven’t checked for a while.

[Richard Sprague]: That’s right, yeah.

[Damien Blenkinsopp]: So that would be your KEGG analysis you’re talking about, correct?

[Richard Sprague]: That’s right, yeah.

[Damien Blenkinsopp]: And it’s things like, they’ll say you have caffeine metabolism and other things going on.

[Richard Sprague]: Or yeah, Vitamin D or this or that, yeah.

[Damien Blenkinsopp]: Yeah, yeah. I thought it was interesting because you told the story of where that came from and why we should be maybe a little conservative in thinking that that’s accurate.

[Richard Sprague]: Well it’s based on some experimental studies that were done a long time ago in Kyoto actually that’s why it’s called KEGG. It’s Kyoto something or other, EGG.

They essentially took a lot of genetic samples and they looked to see what kind of metabolites were produced. Well based on those experiments and they were carefully done experiments people are estimating when you’ve got a particular set of genes in your sample what kind of metabolites they might produce as well.

And that’s arguably better than knowing nothing at all, but I wouldn’t rely on it to be able to tell exactly how much caffeine I’m metabolizing or Vitamin D, etc.

You find a lot of this kind of stuff with genomics where somebody’s got some kind of tool, and it’s experimental. They’re just trying it out, and we’ll see how it works. And this is one of those cases. So I wouldn’t put a whole lot of stock in it.

(0:17:40) [Damien Blenkinsopp]: Yeah. Right. Great. I think another important question is why use genomics lab to understand the microbiome versus the other ones? The cultures, for example. They’re all genomics, right? The PCR, the…

[Richard Sprague]: Yeah. The biggest advantages of the genomic approaches are that it works on all of the microbes that are in the sample.

Remember with culturing, unfortunately, unless you reproduce the exact environment of your gut, which means anaerobic, no oxygen there, it’s got all the different microbes in combination and some of them are producing things that the other ones eat and need. There’s this whole community, so unless you’ve got that whole thing you can’t necessarily culture what you’re looking for.

Whereas the genomics which just says, you know what, we’re just going to look at every single gene in the whole thing. As a result, people have found that it’s well over 90 percent of all the microbes in your body can’t be cultured. We find brand new ones all the time.

[Damien Blenkinsopp]: Right. So that’s what’s going on, and that’s only been enabled by the genomics approach.

Because as you’re explaining, it’s super complicated; all the interactions between the bacteria and they rely on each other to survive.

As soon as you remove them and you’re trying to culture them or something, you remove that whole environment that they’ve been able to survive and breed in. And they need the metabolites, the things coming from the other bacteria and they’re just not there, potentially, because you kill them off.

The way that culturing works is basically you’re trying to separate out the things you’re trying to grow so that they show up in color and stuff. But by separating out and killing off the other stuff and not letting it grow, you’re basically killing off the ones that you want to grow anyway, in some cases, because they need the other bacteria.

[Richard Sprague]: Yup, that’s right. And it turns out that in a lot of interesting cases like some of the pathogens, maybe that’s good enough. But if you’re really trying to understand the whole richness of the microbiome, you’ll have to go to the genomics approaches.

[Damien Blenkinsopp]: Excellent.

[Richard Sprague]: So, now I will say, and I think we should put a big caveat in here. The genomics approach is nice to be able to get a look at all the genes that are there.

When I first started studying this, I thought, wow this is awesome, I’ll finally know what’s going on in my body. But I discovered that it’s actually much, much more complicated than it looks. As you can imagine, if you’ve got millions of organisms in a sample and you want to turn that into some useful data summary, there are a lot of steps that the lab has to go through.

And the steps are everything from the way that you happen to insert the sample into the vial, and it goes through the mail, and then how the lab tech handles it. All the way up to the bioinformatics pipeline where they’re going to process all of these numbers that come out of the sequencer and turn that into whatever taxonomy.

There are dozens of steps involved, and in any of those steps if the lab does it slightly differently than the other lab, you’re going to get different results.

[Damien Blenkinsopp]: Correct me if I’m wrong, because Richard has been at uBiome for quite a while so he’s had a closer experience with all of this. It seems like the bioinformatics pipeline, which is basically a series of calculations you’re going to make based on a database you have of references.

[Richard Sprague]: Yeah

[Damien Blenkinsopp]: And that comes from research of things saying that this piece of code means that this species, genus, exists, and so on. So you’re using a database of references in order, and you’re pushing it through this pipeline of algorithms, basically, that looks at the database checks and categorizes things. So that’s what that bioinformatics pipeline is actually doing.

And it turns out that everyone’s creating their own bioinformatics pipeline, and they’re using different databases, different reference databases

[Richard Sprague]: That’s right.

(0:27:30) [Damien Blenkinsopp]: And then we get quite different results, which is the next question I wanted to bring up. Why are we getting different results from different labs?

[Richard Sprague]: Yeah. And this is a little scary for me when I started digging into this, because I had spent a lot of time getting to know the different papers and the different labs and the different conclusions that people had come up with.

And you can put it in the show notes, but there’s a chart that I like to see that was from a publication in Science a couple of years ago where somebody actually went through and compared all the different big microbiome categorization projects and looked at just some of the common genus level microbes that they found in there. (publication referenced by Richard)

And it’s a little scary, because you look at it and you see that oh, the Human Microbiome Project says that such-and-such genus is dominant, and this one big study of like 4,000 individuals in the Netherlands found that no, that’s not the one that’s dominant, it’s a different one. And we’re talking about hundreds of thousands of individuals, so you’d think that they would all kind of average out, but that’s not the case.

And even American Gut and uBiome, if you look at their overall pictures, when they look at firmicutes versus bacteroidetes, or some of the other common ones, the results are just different. And you could say that, well maybe that’s because the type of people who send samples to uBiome are different than the ones who don’t.

But you’re talking about enough people that that’s a little bit harder to swallow. So what’s really going on is that a lab makes just one little change in, for example, how many times they PCR something before they submitted the sequencer, just one little change like that will express different levels of DNA, and then poof, you’ve got a different result.

And each of the labs if they use different reference databases, like you were saying, those references could be slightly different. If they find that a particular gene, they look it up in one reference database and it says that, oh this is bifidobacterium such-and-such. Well another lab might have called it something else.

So you just have to be a little careful. The good news is, and this is the way I look at this, if you’re going through the same lab most labs, I give them the benefit of doubt that they’re usually pretty careful. And the scientists behind this are usually pretty cautious about how they do protocols.

So you could usually trust when you submit a sample to one lab that it’s comparable to the sample the next time you submit it to the same lab. It’s just you have to be a little bit careful if you see a paper that says that they found that such-and-such microbe is associated with such-and-such condition, don’t just automatically assume that, oh my uBiome results says I have that microbe then that must mean I have such-and-such association.

[Damien Blenkinsopp]: Yeah, you could look at which lab did they use. Basically. And it’s a shame that there isn’t a standardized reference database, but it’s also the nature of the technology and the way it’s developing really.

[Richard Sprague]: That’s right, yeah.

[Damien Blenkinsopp]: Because it’s been opened up, and we have this commercial model. Which is actually enabling really the explosion of data gathering.

I don’t know how many samples, but basically there weren’t enough samples out there being collected and so on to advance science, right? So you have these commercial companies, like uBiome and so on, and they’ve made it feasible to get a large number of samples. I don’t know if you know how many samples uBiome has now, or if that’s disclosable.

[Richard Sprague]: I think the last announcement they’ve made is it’s well over a quarter million. I don’t know the exact number what they’ve announced, but it’s a lot of samples.

[Damien Blenkinsopp]: Right. And then you learn a lot from that massive data, you start the see the correlations. All the labs have, I think, questionnaires filled in as well so that they can start to see if there are some things that are related to Paleo diets, Keto diets, to antibiotics abuse. Not that many people like to abuse antibiotics in particular, but it has been done.

So I think it’s really interesting that all this data is being collected. And the nice thing, also, is that they keep the sequences, correct? This is definitely an area you’ll know more about than me, but if we wanted to run this through a different bioinformatics pipeline later, could we do that?

[Richard Sprague]: It would be tricky. Are you saying like if I submitted the same sample to uBiome and later on to someone else?

[Damien Blenkinsopp]: No I’m saying uBiome has a million samples, for example. And they have a particular bioinformatics pipeline today which says that, for example, I have a species we’ll talk about the cholera species that came up in my PCR test recently. But maybe in the five years time they’ll improve their reference database.

[Richard Sprague]:Yeah, that’s right. So, in fact, they could just go back to the shelf and look up and see your old sample and then run it through something else, and they might find something new. That’s right, yeah.

[Damien Blenkinsopp]: Right, so if they ever do decide that it’s important to change their bioinformatics pipeline, they could…just run it again.

[Richard Sprague]: Yup, you could run it again. And in fact, if you have the fast Q file, the raw output from the sequencer, it’s possible to run it through a different pipeline there as well. And if in the future somebody comes up with a better reference database, for example, it’s possible to take that same exact fast Q file and come up with a different answer.

(0:32:28) [Damien Blenkinsopp]: Well exactly. So they have all these fast Q files on a server somewhere, I’m guessing. Right? So these are the things you could run through a bioinformatics pipeline and get different answers. So that data is going to be invaluable, incredibly valuable.

[Richard Sprague]: Yeah, you’ll be able to find new insights from the old data in the future.

[Damien Blenkinsopp]: Right. Richard and I were just talking before we started this episode, some of this stuff may be challenging to get without visuals.

Whenever we’re mentioning something and it sounds complicated, we’ll probably throw a chart in there because we’ll realize that, and we’ll be like yeah, that one deserves a visual chart. So we might go over the concept relatively quickly, because we realize we’re not going to get there on audio but try and provide some visual aides in the show notes.

(0:33:13) Let’s talk about the actual labs now. What are all these labs? We’ve just kind of bounced around a few of them already, but what’s the landscape look like? It looks like it’s kind of exploding in the last few years, right? So I think uBiome and American Gut were around in 2014, and since then there’s quite a few different labs that have come out.

[Richard Sprague]: Yeah, that’s right. I’m actually curious also about you, because you’ve done more of the culturing than I have. And what kind of labs you’ve had experience with on the culturing side.

[Damien Blenkinsopp]: Yeah, so there’s basically a lot of functional medicine practitioners and hospitals in general will use the culture approach.

So I’ve done many, many different cultures over time and eventually this led me to running two different cultures; this was quite a few years after having started the Doctors Data and the BioHealth lab side-by-side, because they have different strengths and weaknesses. They’re both culture based test, and pretty consistently some things would turn up, but not necessarily on both of them.

I was working with Chris Kresser’s California Center of Functional Medicine there. And I like those guys because they’re very conservative about tests; you may have come across them as well Richard, I know they were talking to uBiome.

And they’re very conservative about their tests. They look for the studies, they look and they have a very large population of clients as well. And they’ve been running for many years. So I like the fact that they’ve been doing that for a while, and they have changed their tests over time.

And they, I think they may have moved on a little bit from these tests, but a couple of years ago when I was doing a lot of this with them they were running both of those side-by-side. That’s a little bit expensive, but it did tend to give us pretty clear…

[Richard Sprague]: So, did you submit the same exact sample to two different labs?

[Damien Blenkinsopp]: Yeah. Each time. Yeah, that was their protocol. Basically they…

[Richard Sprague]: And can I ask you, those culturing labs were they, did you have to poop in a box or did you just send a swab?

[Damien Blenkinsopp]: We used these kind of tiny vials for the uBiome, right? Where you put this really little vial, I mean basically the size of the end of your thumb. The culture labs, they’re larger; kind of three times a test tube size. They’re like a big test tube.

[Richard Sprague]: So a couple of tablespoons?

[Damien Blenkinsopp]: Yeah. And normally, actually, you have four of those for each kit. So there’s a lot of spooning and scooping that goes on for a little while into these different containers because they’ve got different assays they’re running there and they’re trying to preserve and do different things in each of those vials so they can look for different things, parasites and so on.

So it was quite a time consuming process when you’re doing that.

[Richard Sprague]: Yeah. And did you have to go to the hospital or the doctors office to do it?

[Damien Blenkinsopp]: Yeah, you do these from home. They send you the kits, and you sit on the floor scooping. I would lock myself in there for half an hour and scoop away.

[Richard Sprague]: And did the tests agree with each other? You said you submitted from the same sample.

[Damien Blenkinsopp]: Sometimes, sometimes they didn’t.

The reason they were using those in particular was because they felt they had different strengths as well. The last I heard some people feel BioHealth was a little more useful and picked up more stuff.

And again it comes back to our discussion of sensitivity, whether it’s picking up stuff. And that is the concern with a lot of physicians that it’s not picking up stuff, and it doesn’t do it reliably.

So I actually experienced this because I did many of these, over time. We were doing them every couple of months or so to see if the treatments we were doing against parasites like blastocystis hominis I had that for a while, and it’s quite a common thing but it can be a bit of an annoyance in the gut.

And we would do a protocol to get rid of it; we would retest it, it’d be gone. And we’d wait. You have to wait after your treatment, obviously, in order to let things settle down and then see if they grow back. And it would be gone for maybe two tests, and then it would come back again; it would just pop up on one of the tests.

So there’s a bit of inconsistency, and it’s a little bit worrying. For that reason you end up doing a lot of these, and they can be expensive.

[Richard Sprague]: Yeah, interesting.

I don’t know too much about Doctors Data or Biohealth.

I talked to functional medicine practitioner who used GI Effects. And that seems to be, at least in the Seattle area where I am and a lot of naturopaths, that seems to be kind of the one that most people use. The functional medicine people that I talk to are pretty positive about it, and they say that it actually produces very actionable results for treatment.

[Damien Blenkinsopp]: Yeah.

[Richard Sprague]: It seems the one to beat.

[Damien Blenkinsopp]: That was actually the first one I ever did, I think back in 2011 or something. It was MetaMetics previously and Genoma acquired that company. And MetaMetrics was very well respected as a company, so it was a good acquisition.

It came up with some stuff. And that is a combination of the culturing approach and PCR which we were talking about later, which is a genome sequencing but quite accurate. If you see something with PCR, it’s there. That’s a high probability.

[Richard Sprague]: Yeah, and I would say I’m not a doctor and please don’t trust my advice but if I did have some kind of gut issue I would want the functional doctor to use what he or she is familiar with and comfortable with, and they seem to be comfortable with this. And I would trust those results because they’ve been used for years and years and doctors have learned what work or don’t work about them.

I look at the other genomic results like the 16S and metagenomic results as being kind of cool for someone like me, and definitely worth watching for future potential. But if I were really sick, I would want to stick with what the doctors trust.

[Damien Blenkinsopp]: Yeah, exactly. And so I know some functional medicine practices have evaluated 16S based testing, and have done trials with it. But so far they’re like, this isn’t going to be good enough in terms of diagnostics, and also just the cost. Maybe it would pull out some things sometimes and be a little bit indicative of something, or just help you to explore doing a PCR with something. But they felt like the cost benefit and just the kind of time involved in getting a patient to do it wasn’t worth it at this point.

(0:39:10) [Richard Sprague]: Yeah, maybe. Now, on the other hand, there are a lot of conditions where the traditional culturing, or even the PCR approaches, can’t find out what’s wrong, and they don’t know what’s going on.

And that, I think, that’s where the place is for a little bit more experimental and you want to look at a bigger picture. And that’s where you get the 16S and metagenomic approaches because you will see a lot more.

[Damien Blenkinsopp]: Absolutely.

[Richard Sprague]: And after you’ve looked at zillions of samples the way that I have, you do start to see patterns. And you start to see when something looks anomalous, and you say, hmm. And those are the kind of things that if you’re just relying on culturing approaches you probably wouldn’t be able to see

[Damien Blenkinsopp]: Absolutely.

I’ve been really interested in the shotgun approach in particular for this, to pick up things that, as we said before, with PCR basically you have to say I want to find a poodle. You know? Or I want to find a dog in the mass of everything in the world. So you have to really know what you’re looking for, otherwise you’ll just get a negative and it costs money.

Whereas the shotgun, if you don’t know what you’re looking for but you think there’s something there it’s a good idea to do a shotgun to give you an indication. So I did a recent one, Richard and I were talking about the shotgun approach which is looking for pathogens and things like this, which is the Aperiomics, the lab test.

And I did a shotgun sample of my poop and, you know, there were a few different pathogens and some others that came up which were unknowns. A lot of them were unknowns, actually, because it’s a relatively new service; and this is where you see the bioinformatics pipeline, their reference database and so on.

They told me the benchmarks they have so far. They don’t have enough data, so there’s some interesting stuff, but there’s a lot of unknowns; we don’t know if its pathogenic or not because a lot of people have this and they’re going fine.

But I think that for me was an interesting test because it was using shotgun just to potentially pick up something interesting, and then go after it with PCR.

[Richard Sprague]: Yeah, that’s interesting. And I would love to see results that people do side-by-side if you submit the same sample to two different labs. It would be really interesting to compare that.

(0:41:12) [Damien Blenkinsopp]: Yeah, so I did that with the GI Map from Diagnostic Laboratories. Also uBiome, but unfortunately somehow that was lost, either in the post or I don’t know what happened with it. And I did Free Labs.

GI Map, we haven’t discussed, is a PCR based test. And that’s from Diagnostic Laboratories. And there’s a lot of functional medicine practitioners who are now looking at that one. Because it is PCR based, so again if you pick something up and it’s looking for quite a number of problematic bacteria, parasites, and so on, then it can be pretty useful. It’s a little bit more expensive, but that’s a good one.

So I ran that next to the Aperiomics, and I had that back. And I was trying to cross them, but nothing crossed actually.

[Richard Sprague]: Oh you didn’t find any, there was no consistency between the two?

[Damien Blenkinsopp]: No, I didn’t find the same. So I found the cholera in the GI Map. So I trust that because it’s PCR based. It didn’t turn up in the shotgun, which could be the reference database that they haven’t put that species in, or that specific strain in even. Or it could be the bioinformatics pipeline that they haven’t built out yet.

There’s so many different reasons that that might not be. But it goes back to what Richard was saying earlier, is that if you’re using different labs it’s not necessarily going to pick up the same stuff at this stage.

[Richard Sprague]: That’s interesting if they couldn’t find cholera in two different samples.

Part of it also could be if we’re talking about minute amounts, even the metagenomic approaches you’re only looking at a certain number of, you’re not looking at every single gene in there. You’re still looking at a subset of all the different genes, because you can’t sequence all gazillion of them.

The PCR approach though, you’re looking for a particular one. So you stick in some primers that will cut every single copy of DNA that has that one in there. You’d have to ask somebody who’s more knowledgeable about lab science than I am to state this more unequivocally, but when you do that you will know that the following DNA snippets came from that microbe.

Whereas with the shotgun approach, you’re going to know at a broad level, because you’ve looked at as many as you could, but you haven’t looked at every single one of them

[Damien Blenkinsopp]: Yeah.

[Richard Sprague]: And when you’re talking about minute amounts, that might make the difference.

[Damien Blenkinsopp]: Yeah, I think the nice thing about, going back to genomics, is that it will get better over time, as these databases, these bioinformatics pipelines, as each company basically gathers data and experience. And eventually, hopefully, there will be some type of collaboration. I don’t know what would be up in the future, but it would be nice if there was a way to match these together and get…

[Richard Sprague]: That would be neat, yeah. That would be neat to have a bunch of people all comparing our results from the different labs.

[Damien Blenkinsopp]: Yeah, and trying to build conversion tables or something. Something like a pool where you can convert your uBiome into your American Gut, or whatever you wanted. And it would be more comparable.

(0:44:07) [Richard Sprague]: And see how you compare, yeah. In fact, actually it’s funny because American Gut is one of the few labs that you submit the sample dry. In other words, you just put it on a Q-tip and you send it in dry. You don’t put it in a special upright vial.

[Damien Blenkinsopp]: Nothing? Okay, interesting.

[Richard Sprague]: And I asked the lab about that, because that’s kind of odd. And they know that there are certain species that when they are dry they continue to multiply. Because it’s not dead when it comes out of your body. And some of them when they’re exposed to oxygen immediately die, but some of them don’t. In fact, some of the thrive, and you get a bloom actually in some species.

And what American Gut does and they’ve written a paper about this, they’re very upfront about it they run, in their bioinformatics pipeline, they’ve already tested which species are thriving in an oxygen environment, and they filter those out. And they say oh well you collected a sample on such-and-such date, that means that this much time has passed which means that likely this much of this species has bloomed. And we’re just going to go and adjust the final result that way.

[Damien Blenkinsopp]: Whereas basically uBiome’s test and others, they’re killing all the bacteria straight away to preserve them in the state they were in the stool.

[Richard Sprague]: Yeah. And again, that’s going to be a difference in the pipeline. You’re going to get different results.

[Damien Blenkinsopp]: I mean, I can imagine. I mean that introduces basically another variable. I wonder why they didn’t decide to eliminate that.

[Richard Sprague]: Well the reason they didn’t do that is because the people at American Gut are super careful scientists, and what they care mostly about is consistency across all their different samples. They want to make sure that every single sample is conducted under the same conditions.

And they also at least in the beginning were working a lot in environments like outside the United States where maybe the collection procedure was maybe a little bit more erratic. And they just wanted it so that they could take all the different samples and treat them exactly the same way.

They’ve got a paper on this where they show, you know, that it doesn’t matter as much as you might think, but still. Yeah, it’s another area where the pipeline is going to be different.

(0:45:55) For you guys at home, just a quick reference there. I spoke to Rob Knight from the American Gut a while back, so if you wanted to know more about what he was doing there. He talks about where they got the first data and so on for that project.

(0:46:10) Okay, great. How about the 16S labs? Because you know all the 16S labs really well.

[Richard Sprague]: Yeah, well let’s talk about the 16S.

Now, first of all, I want to repeat in full transparency, I am a friend of uBiome. I’m a former employee. I’ve been a happy user of them for a long time. But I have spent time with their scientists; I trust their scientists. I think they’re pretty careful about how they put stuff in the lab.

Now that said, there are lots of other labs that I’ve worked with as well, and I’ll just go through the differences.

We talked about American Gut. I think that American Gut is scientifically they’re the most sound lab. You’ve had Rob Knight on this show, you know he’s a very smart guy, well published, extremely careful scientist, and knows everybody.

They have published a lot of results based on their American Gut cohorts, and they’ll continue publishing. They take their science very seriously. The other thing about them is they’re ultra transparent.

Every single one of their software tools that they use are all Open Source. They anonymize, and then anybody who wants to can go look at their data and reproduce their results. In fact, they even have Python notebooks where if you don’t trust something that they publish in a paper you can go run it yourself down your own Python and see.

So it’s very transparent from that point of view.

The other company that I would call out is a newer company called Thryve in Santa Clara. They’re focusing on personalized probiotics, but the CEO Richard Lin is an example of the kind of person I like to see running one of these companies because he cares a lot.

He’s been trying to solve some of his own issues, and so he founded a company, essentially, to go and help resolve that. So he cares a lot and he’s especially focused on actionable results. So I like them.

There are lots of other labs; I won’t go into all the names, I haven’t tried a lot of them.

One that I will bring up though is a company called Gencove that focuses mostly on genomics. So they’ll take a mouth sample. But what’s cool about them is that they’ll run their mouth sample, the swab that you give from your mouth, you get the DNA results just like with 23andMe; it’s very comparable to 23andMe. But they also give you the microbiome breakdown.

So there’s that company. And there are lots of other companies that are doing 16S in one form or another.

(0:48:20) [Damien Blenkinsopp]: So that’s very similar to the Atlas Biomed guys, who actually came from Russia. So they were doing studies in Russia, and now they’re in the UK as well, so they got the two populations. So they’ve combined in their interface the DNA and the microbiome.

So it’s quite interesting. I would say they’ve got a lot of recommendations. We’ll get into this in a little bit but they got a lot of recommendations in there, and study references and stuff like that. It’s quite interesting; they’re quite strong on the recommendations from the data.

[Richard Sprague]: Interesting. Do they, what kind of sample do you give them? Is it a mouth swab, or both, or blood? What do you give them?

[Damien Blenkinsopp]: Sorry, this is for the gut, right?

[Richard Sprague]: So it’s just gut, okay.

[Damien Blenkinsopp]: Oh, for the DNA it’s saliva, you’re correct.

[Richard Sprague]: Yes.

[Damien Blenkinsopp]: And then for the gut it’s the usual poop thing.

[Richard Sprague]: Yes, okay.

[Damien Blenkinsopp]: So you do the test and the same time. Or you can send the DNA whenever you wanted.

[Richard Sprague]: So they’re two separate samples?

[Damien Blenkinsopp]: Yeah, that’s right.

They’re trying to combine to get more information, to see correlations, things like that.

[Richard Sprague]: That’s real interesting.

 

[Damien Blenkinsopp]: And their plan is, I think this will get more interesting. I went to see them last week and so I was talking to them a lot.

And basically their plan is now to get into blood tests as well. And to bring this kind of information to clinicians, where you combine DNA microbiome and blood tests results, metabolomics. And some of the standard stuff as well, like information whatever it is that doctors have been using for a long time. And you can give a bit more context.

So they haven’t figured how they’re going to do that, but the idea is to provide more context around these blood tests to try and make the links and stuff like that to provide a better tool, basically, for looking at patients.

And I think if it’s done that way, led by blood tests which have been used for a very long time in diagnostics anyway, and you add information and context with the DNA and the microbiome, then that actually sound quite useful.

(0:50:11) [Richard Sprague]:That’s right. There’s another company in the US called Arivale, based here in Seattle, and they are now available in the West Coast, California and here. They might be nationwide at this point. But it’s a very similar kind of thing.

I think it’s 1000 dollars, for a one year program. They do a 30x genomic sequence. They test your microbiome, they do your blood test, and there are a couple of other things. They give you a FitBit and measure activity.

And then they assign you a personal nutritionist and you have once a month meetings with them, and you can ask them email questions, and that sort of stuff. And they work with you on whatever issue you want.

And I think that is the direction that I think if you’re seriously trying to solve a problem, that’s what you should be doing. Because it’s this holistic look at the blood results, the microbiome, the genetics and all that stuff together.

[Damien Blenkinsopp]: And consultation. And experts who actually help you work through it.

Because right now, frankly, a lot of these services had to start a consumer facing in order to get the volume of data and build up their databases, right? Because that was the only way that you were going to get enough data to be able to start seeing patterns and start getting past this first hurdle.

And I think it was always sold like that anyway; this is informational, it’s not diagnostic, it’s not supposed to be used like that. That’s really the idea.

[Richard Sprague]: Yup.

(0:51:26) [Damien Blenkinsopp]: Okay. So that’s 16S, and like I said Atlas Biomed that was a 16S as well. And then we have the metagenomic shotgun ones, which I was quite excited about.

I spoke to Eran Segal and Lihi Segal in a previous episode about their work, and that resulted in Day Two. So I was kind of looking forward to that, because it was the first shotgun service to come out that was a reasonable cost. I think at that time it was like 200 or 300 dollars.

[Richard Sprague]: Yeah, that’s right.

[Damien Blenkinsopp]: Yeah. So there’s that one. And you’ve done that as well, and you published a review about it. So what did you think of Day Two?

[Richard Sprague]: I thought Day Two is very cool. You submit the sample, it took a while to get back, but they’re just getting started.

What’s neat about it is Eran Segal, as you mentioned, did a lot of really cool research where they were able to identify, I guess, glucose response levels and it’s dependence on what’s going on in the microbiome. And so by looking just at the microbiome they’re able to tell, oh your insulin levels are likely to respond to what’s in your diet.

And they ran this big machine learning algorithm against all the different kinds of food types. And they had, I think 1000 volunteers and they did a whole bunch of studies.

And now Day Two gives you an app that goes through the food groups and tells you how likely you are to respond, well or poorly, to a particular type of food. It’s very well done.

[Damien Blenkinsopp]: In terms of glucose response, right? It’s just glucose response. So we know that.

It’s been pretty cool. And they had large studies; they had a pretty large population, over 1000 people.

[Richard Sprague]: Yeah. It was, and they’re careful scientists and they published their results.

And kind of the interesting take-away from Eran Segal’s work was that there are some people who, your standard diet advice says you should always eat the whole grain version instead of the white bread version. But there are some people who it’s the exact opposite advice. And this algorithm seems to be pretty good at telling which one you are.

So in my case, for example, with Day Two it’s showing that I should be eating things with more fat in them.

So yeah, there you go Mr. Ketogenic guy. And it was pretty accurate for me. It showed, for example, I’m not lactose intolerant; I can handle dairy and it recommends that I have dairy. And I found most of the suggestions to be reasonable.

The other nice thing about them is they’re not based just on a particular food, but they recognize that food is in context. So having a slice of toast is not the same as having a slice of toast with some butter on it; the way that your body is going to respond is totally different. And they have a lot of recommendations for that.

[Damien Blenkinsopp]: Absolutely.

[Richard Sprague]: So I’m pretty impressed. I’m waiting to see how they do. A lot of the initial research was all done in Israel. So they’re running a study now I guess in the United States. And I think actually when you had them on your podcast I think one thing they mentioned, they’re doing something with Mayo Clinic, I think.

[Damien Blenkinsopp]: Yeah, exactly. Yeah.

[Richard Sprague]: So I’m looking forward to seeing how that turns out in the next couple of years.

[Damien Blenkinsopp]: Yeah, that would be pretty cool when they get more data. Because I think, personally, glucose response is one of the highest impact things you can do relatively simply by changing your diet. Sometimes sleep and other factors as well, but it’s really important.

So going back to this personalized…

[Richard Sprague]: Just one quick thing, did you see the new book that Eran Segal and his co-author put out?

[Damien Blenkinsopp]: No, I didn’t.

[Richard Sprague]: It’s called The Personalized Diet. That’s worth reading. Yeah, that’s worth reading. It’s called The Personalized Diet.

[Damien Blenkinsopp]: Okay, great.

[Richard Sprague]: Go check it. It just came out, and I just read it it’s a wonderful book.

[Damien Blenkinsopp]: Oh, awesome.

[Richard Sprague]: It goes into a lot of… And what’s cool is in the end, he gives suggestions for how you can test yourself using just a cheap glucose meter, and gives suggestions as part of it. It’s kind of cool.

[Damien Blenkinsopp]: Excellent. That sounds a little bit like the Rob Wolf test that was in Wired to Eat.

I put some charts up on that. It’s a standard actually glucose tolerance test to different foods. But you learn a hell of a lot. I don’t know if it’s the same, but it can be done; just a blood meter can tell you a lot of information.

[0:55:22] So I’ve been doing this a lot. One of my other pastimes, currently I’ve been developing a food which uses different fibers because I don’t want it to by glycemic, because I’m not a fan of high glycemic responses. So, similar to the Eran Segal guys.

So I’ve looked at a lot of different fibers and I can tell you that there is definitely a lot of variation between. Because when I go to a company and I ask them for a fiber, there’s many of these. There are a lot of different fibers that are created by companies now in different ways.

Basically fibers are carbohydrate which is resistant to getting broken down in the body. So that’s the way you’ve got to look at it. So there’s a potential high glycemic response from a fiber because your biome may be able to digest it and turn it into glucose, whereas someone else’s maybe not. And it’s going to pass through them and they get no glycemic response.

So I’ve had quite a fun time testing a lot of different fibers and collecting a lot of data on that and seeing the different responses. And I plan to now do that on a population, because I understand that just because I get these particular responses doesn’t mean that everyone’s going to get that response.

But it’s actually tricky with these fibers and everything. There’s a lot of products that state low-carb or whatever, but they often have different fibers in them. And it’s just not that simple, unfortunately.

[Richard Sprague]: That’s very interesting. It would be especially interesting if you could trace it to which microbe is involved.

[Damien Blenkinsopp]: Oh yeah. I know, right.

[Richard Sprague]: There might be a simple little change to the formula, where you add a particular microbe or you add something that that microbe likes to eat and suddenly now that fiber that caused the bad glucose response is suddenly just fine.

[Damien Blenkinsopp]: Yeah, exactly. It’s people like Day Two are going to have the best information because they’ve collected it. I always think about all this whole area and everything, I’ve been thinking about this for quite a whole in terms of us trying to get ahead.

It’s like, who has the data? If you want an answer to something, go find the people with the most quality data it has to be quality data and you’re going to be the closest to the answer at that point. You know, if you can get talking to those guys and what they’re doing with that.

(0:57:29) [Richard Sprague]: Yeah, that’s true. That’s right. So we should also talk about Viome, which is the other metagenomics company. They’re the transcriptomics one that we talked about.

They just came out, and I just got my results back a month or so ago. And again, they give you this big, it’s an app where they’ll give you a big breakdown of the different microbes that you have. Actually, it’s the different, they try to stress that it’s not the microbes themselves it’s the activity of the microbes.

And then they break it down and tell you what kind of foods that you should eat or not. And it’s a pretty impressive list of people backing the company; if you look at their board of advisers it includes people like Ray Kurzweil and Aubrey de Grey, the Life Extension guy, and the bulletproof empire, Dave Asprey is a big fan them. And you’ll see a lot of, Ben Greenfield Fitness, etc.

[Damien Blenkinsopp]: They’ve got their name out in the media more than most companies quicker.

[Richard Sprague]: Yeah, that’s right.

And they’re founder, Naveen Jain, one of the things I respect about him is he really genuinely believes in it himself. So he’s out there himself personally pitching the product, and he’ll talk about his own results. He’s got a private Facebook group where they talk about it, and he’s one of the active participants answering questions about it. So they’re very serious, and they’re hiring a lot of people.

They claim that they’re based on some lab science that was developed out of the Los Almos lab in New Mexico over many years. I’ve had a hard time figuring out from a scientific point of view exactly how they’re doing the work.

One of the things they, if you go to their website they say specifically that they’re not going to release the raw data. So it’s a little hard to tell exactly what’s going on, and how they’re coming up with the recommendations.

And it’s something that I hope that they’ll be a little bit more transparent about.

[Damien Blenkinsopp]: Yeah, and this is something, you know we wanted to talk about, is basically if you’re thinking about doing some labs what kind of things do you want to take into account.

(0:59:24) Let’s talk a little bit about what we’ve actually run. Like what labs have we both used? Because I don’t know you Richard like, what labs have you run over the last, is it four years?

[Richard Sprague]: Well, okay. So, I’m a little crazy. I’ve done well over 500 samples from uBiome, another several dozen from other different labs. Probably all told I’m up at close to say 600 samples.

[Damien Blenkinsopp]: And at uBiome you were doing daily ones, right?

[Richard Sprague]: That’s right. Yes. So I had daily samples for more than a year.

[Damien Blenkinsopp]: Which means you were pooping every day. At least once.

[Richard Sprague]: Yeah, that’s right.

Well actually I should say, I should be more precise. No, not every single day. That’s right. There are a couple of gaps in it, but generally speaking I had near daily samples for more than a year. And then I have other fairly regular samples going back through to 2014.

What’s also cool about it is I tracked all of the food that I ate the whole time, and my exercise and my sleep and that sort of stuff. So I’m able to run all these cool correlations to figure out what I learned. So that’s really cool.

I’ve done also Viome testing, Day Two, Thrive, I mentioned Gencove. Let’s see, who else. I’ve not done any of the culturing tests. But what’s also cool is I’ve done a lot of these side-by-side just to see, to cross-compare them among themselves, which has been interesting.

[Damien Blenkinsopp]: A lot of these labs have interfaces where you have to access the data. So I can’t do it for all of them, but I’ll put up samples of any that I’ve done that are basically PDFs or something that you can actually see.

[Richard Sprague]: Yeah, I’m happy to show mine as well.

[Damien Blenkinsopp]: Yeah, so we’ll combine our things to try and give you a picture of what most of these look like. Can’t be all of them just because some don’t actually deliver the information in that approach, but it should give you a good idea of what all these things look like, and the kind of microbes they’re looking at and stuff like that.

From my side, I started with uBiome when they launched and that’s when Richard also go into it, I believe. And they were one of these Kickstarter campaigns, or that was Indiegogo, because…

[Richard Sprague]: Indiegogo, yeah.

[Damien Blenkinsopp]: Kickstarter and all that kind of stuff…

[Richard Sprague]: Back in 2013.

[Damien Blenkinsopp]: Yeah. This is kind of amazing that it was already that long ago.

So I’ve just done seven uBiome tests. Quite a bunch of those were the five I don’t know if you’re doing the five…

[Richard Sprague]: That’s the five sites, yeah. I’ve done it, it’s gut, mouth, skin, nose, genitals. I’ve done them all.

[Damien Blenkinsopp]: Yeah, I’ve done semen as well, because I was curious. [Laughter] I was like playing around with different stuff. Which they don’t normally do, and they haven’t got a lot of benchmark data on that.

So the standard ones that you said are the mouth, the genitals, and the skin. And they did teeth as well, actually. They did the dental one.

[Richard Sprague]: That’s right, yup.

[Damien Blenkinsopp]: Yeah, so they have quite a bit of data on those.

[Richard Sprague]: Yeah, and we could talk forever about some of the things that I’ve learned from all of my studies. And I’ll give you a link to my, I’ve been writing some of my results up. But don’t forget, the microbiome is more than just the gut and you can learn a lot of things from skin and from mouth and nose as well.

[Damien Blenkinsopp]: Right, exactly. And there’s actually a little hack, we’ll talk about some hacks we’ve done on things that have actually potentially done something in a little bit.

[Richard Sprague]: Yeah.

[Damien Blenkinsopp]: So the other ones I’ve done is the Viome one as well, Day Two, so both of us have done that. I’ve done the Atlas Biomed one, because I’m based in the UK. And I’ve done quite a few of those culture and PCR based tests, so it’s a little bit different there.

(1:02:44) Alright, let’s just dive in to see what kind of things we found from this. First of all, what can we say about comparison of data? We were talking about how they’re not necessarily comparable.

[Richard Sprague]:Yeah. That’s an interesting thing. So I have done comparing my 16S results with both Viome and Day Two, and I find that at the high level, they’re actually fairly different.

I shouldn’t say, you know it’s sort of like you can see the chart here. For example, in Day Two it says that my furmicidies level is about 50 percent. When I tested it on uBiome, one of my uBiome tests shows it’s like 59 percent. My bactorides in Day Two is like 45 percent, uBiome tested it out as more like 30 percent.

There are, that sounds like a fairly significant difference, but if you’ve seen a lot of samples you realize that it’s probably not as significant as it might sound, because there’s a lot of variability in day-to-day anyway.

The one thing that I did notice was that, however, the ordering, in other words which was the most dominant, the second dominant, etc, was pretty consistent. Which is nice to know. That means at least at the biome level you can kind of trust that if it says that you’ve got higher furmicidues than bactroidides then maybe you really do.

The other part is that if it says that you’ve got verrucomicrobia, which is the phylum that includes akkermansia, which is an important one for eating the musilin level and is considered important for health. If Day Two shows that you have it, it’s likely that uBiome will show that you have it as well. Which it’s nice to see a little bit of consistency there.

[Damien Blenkinsopp]: Alright we were talking about this a little bit earlier, because I was comparing all the species that I’ve picked up in different ones. And, you know, obviously they don’t correlate all the time.

So Richard was saying that probably the way to look at it is that if it turns up in two tests, and it’s not in one test, then it could be just that it’s likely it’s there. And it might be worth doing a PCR or whatever, but it’s likely it’s there. And it’s the bioinformatics library of the other one maybe doesn’t include that species, right? They haven’t got the references in their database or something.

But that’s kind of like a starting assumption you can start with in your exploration to try and nail it down, whether it’s there or not.

[Richard Sprague]: Yeah, that’s right. It could be and the other thing, again I would emphasize look at presence versus absence, and be a little bit less concerned about the abundance, and that’s going to vary a lot.

[Damien Blenkinsopp]: Well that’s, on your Viome you’ve got this spirochaete of…

[Richard Sprague]: Yeah, the Viome one is interesting. And I don’t know how to interpret that, because it shows that I have 79 percent spirochaete…

Damien Blenkinsopp]: It’s off the charts compared to the others, yeah.

[Richard Sprague]: It’s off the charts, yeah. And now what they’ll say is that that’s the one that we’re after, those are the microbes that are active.

[Damien Blenkinsopp]: What level is that? Is that the family or the genus?

[Richard Sprague]: It says, my test result says 80 percent spirochaetes at the phylum level, and then it shows at the genus level, the genus spirochaete is 46 percent.

[Damien Blenkinsopp]: So it’s missing one.

[Richard Sprague]: Yeah, there’s just something that doesn’t add up about it, and I don’t really understand how to interpret the results. And I’ve asked them and

[Damien Blenkinsopp]: Right. It sounds like their library isn’t quite there yet, and maybe there is…

For people who don’t know at home, spirochaetes get a bad rep because Lyme Borrelia, which is of course quite a bit of a problem for some people, is a spirochaete. That’s the family it’s in.

So when people see spirochaetes, typically, and when they’re talking about them they’re talking about pathogens. So when you see it in your samples and I’ve seen it in my Ubiome as well. It’s something, I actually did a little project on it, which I’ll, in the show notes we’ll put up anything we talk about, all that usual stuff.

But yeah, I bet you were interested when such a high amount of spirochaetes turned up, and you were like woah okay, but what kind of species is there.

[Richard Sprague]: Yeah, and the results show it broken down by phylum, genus and species. And what was odd is that at the phyulum level it said 80 percent spirochaetes, at the genus level it said only 46 percent, and there were no spirochaetes at the species level.

And the genus level, all of the different genera added up to, I think it was something like 90 percent. In other words, so they think they identified all the genera that were in there, but it didn’t add up. So I’m not sure exactly how that works.

[Damien Blenkinsopp]: Yeah. So I had a little problem as well. When I got my results, I had 30 bacteria in the total, which was showing up, which I felt was relatively low. And so I talked to them a bit about that, and at the time they felt that was correct.

That was when Viome first came out sometime last year. I got my results relatively early. So things may have moved on since then. I would expect as they’re working on the databases and all that kind of stuff that I’ll have more. And I think I haven’t counted them recently, but I need to count them up again but I think I now have more that have turned up.

[Richard Sprague]: Yeah, and they’re pretty clear about, they’re selling a subscription. So right now it’s like 400 dollars a year, or something like that, and so they claim it’s a subscription because they keep updating your results as they learn more information.

So, anyway, so I don’t know how to interpret that.

The other part about it, Viome, like Day Two, has a list of foods that you should eat or not eat. And what I found was there was some consistency between the Day Two algorithm and the Viome algorithm.

For example, both agreed that I can handle dairy products, lactose. Both agreed that I should stay away from grains, although Viome thought that whole grains were okay in a lot of cases. And then there were just some odd ones, like for example Viome says that I shouldn’t eat pork.

[Damien Blenkinsopp]: I think I may have had that too. I had some quite odd things in there.

The issue I had with it was that there’s no reasoning. For the Viome we don’t really know what they’re looking at and why they’re making these decisions. We discussed Day Two, basically we know what it’s based on. It’s based on the glycemic response.

[Richard Sprague]: And there’s an academic paper where they showed the reasoning behind it, and you can, all the caveats that you would see, normally, in any kind of academic study, but at least you kind of know what direction they’re coming from

[Damien Blenkinsopp]: And they’re very focused just on the glycemic response. So you know where that recommendations coming from and they give the A, B, C, D grades.

I would have loved if they showed the average glucose response for someone with mine. That’s what, I actually sent in a support email or something like that in to them for that, because I would be like wow that would be much cooler, rather than these A, B, C, D categories.

[Richard Sprague]: You know they changed it recently, right? They’ve changed it; now it’s not A, B, C, D it’s, they give you a number from 1-10 I think now.

[Damien Blenkinsopp]: Okay. So that’s a bit better, that sounds better. Yeah, that’s good.

Alright, cool. But the problem with Viome is you have no rationale, no methodoloy, and it says you shouldn’t eat something that you love. I think it told me I shouldn’t eat chocolate. So, it’s like, you know I kind of like chocolate and I don’t have any reason.

[Richard Sprague]: Give me a reason, yeah. Give me some kind of…

[Damien Blenkinsopp]: Give me a reason, give me a study. I need something to give up chocolate, you’ve got to give me… Because I don’t even know, maybe you think I’m allergic to it. I don’t know, I don’t know what you’re trying to get at.

So Atlas Biomed has a lot of recommendations as well in their interface, but what I did like is wherever there’s a recommendation there’s always papers, study papers, left there. And there’s always the reasoning.

And you can argue that with 16S and some of the other limitations they have, maybe they’re pushing the edge in terms of their recommendations, but at least they’re trying to give, you know, a reasoning and structure. And there’s a transparency.

So, with Viome, the thing for me is it’s not transparent, so you can’t, you don’t know what you’re getting, what the output is. So it’s like, how can you do anything with it really. At the moment.

[Richard Sprague]: Yeah, you kind of have to trust their scientists, or whatever the results is of this thing. Yeah.

And the other part of it is, remember also it might say, eat apples. Well, there’s lots of different ways you can eat apples. There’s a Fuji apple that’s different than a this kind of apple, there’s an apple that was just picked versus one that has been sitting in a truck for a while.

There’s lots of different kinds of things. And to just say a blanket statement, eat more apples, is, you know, I don’t find that as scientifically satisfying as it could be.

That’s why I like the Day Two approach more to talk about, well we’re not going to say apple versus not apple; we’re going to say apple with cheese versus a meal made out of apple pie, or something like that.

[Damien Blenkinsopp]: Yeah. I was talking with a guy who runs another bioinformatings company just the other day about this, and basically a lot of people have a religion about food. It’s not like everyone’s really objective about this.

Vegans are vegans, and ketogenic people are ketos I’m guilty of that one. And it tends to be an emotional thing. I try to be more objective and numbers driven, but, you know…

The problem is also, when we’re doing these tests, if you tell me not to eat my favorite vegan food and I’m a vegan, you’ve really got to and the argument is, say, glycemic response, and a lot of vegans don’t care about glycemic response, right? I think.

So if you actually gave us the reasoning, then different types of people with different approaches and thinking towards their eating style will be able to choose. They can be like, but I don’t care about that. I don’t care about glycemic response, or I don’t care about the other factor, or I don’t care about allergies. Or whatever the reasoning is. And at least that would give you a better framework in order to make a decision.

[Richard Sprague]: That’s a good idea, yeah. Have you used Inside Tracker? The blood testing company, Inside Tracker?

[Damien Blenkinsopp]: I haven’t. I know they were on a show a while back.

[Richard Sprague]: That’s another company I have a lot of respect for. It’s not the microbiome, but they have, it’s all about blood testing. And they’ll do exactly that. You can type in, you could say, I’m a vegan. Now give me your suggestions. Or, I’m a carnivore, now give me your suggestions.

And it’ll be tailor-made for you, because they recognize, like you say, that you may have another framework that you’re thinking about. And if your diet suggestions can’t fit in my framework, I may have to either give up my framework, or maybe I’ll give up you.

[Damien Blenkinsopp]: And this is something I’m seeing more in my results. When their recommendations come up and when I’m looking at them, I’m like oh, you know, that doesn’t fit with the ketogenic diet. That’s where I am currently.

[Richard Sprague]: Yeah.

[Damien Blenkinsopp]: So you want me to eat more of that, but I’m just not interested.

[Richard Sprague]: Yeah.

[Damien Blenkinsopp]: So there you go, even if I’m being objective. But if I had more information I might reconsider it a bit more.

[Richard Sprague]: Yeah, exactly.

(1:12:55) [Damien Blenkinsopp]: Okay, so what other kind of interesting stuff have we discovered here?

The other contrast, like I was referring to, I was trying to do earlier, was the Aperiomics, which is a shotgun sequence as well. And I was trying to compare it with the PCR to identify similar things. But that didn’t quite go as well, either.

So I think the shotgun technology, although it’s more detailed than the 16S, it’s going to take time for those databases and bioinformatics pipelines to evolve so that it’s picking up everything.

[Richard Sprague]: Yeah, I think you’re right. And like I said, I think you probably can trust a single lab over time. So if you’re doing A/B testing on a particular kind of intervention, and you follow the same lab both times, you may be able to trust that. But looking at the results from different labs, I just don’t know how useful that is a lot of times.

Especially when you get down to the species level, or down to something very, very particular. There’s just too many ways that they can be different.

(1:13:51) [Damien Blenkinsopp]: So because I’ve mentioned the ketogenic diet, one interesting thing is that if you look at some of the studies they suggest that if you’re on a ketogenic diet so I’ve been on a ketogenic diet for something like, since 2011, and then really seriously since January 2016. I was actually blood testing and stuff to make sure.

What they say is you should see increased microbes of the genus bacteroides and decreased firmicutes. And if you look at all my early uBiome tests, 2014, 2015, 2016, a lot of the time it’s the opposite.

[Richard Sprague]: Hmm.

[Damien Blenkinsopp]: Yeah, and I’m firmicutes dominant. I remember looking at this when I was first, I was like that doesn’t really sound like me.

And I think this goes back to the papers sometimes, as well. The studies when they’re looking at these things. I’ve got a team working looking at them, ketogenic studies and stuff like that.

When you look at a lot of the ketogenic studies, they have very different diets in them, unfortunately. You know, 40 grams carbs, 5 grams carbs, 50 grams carbs and doing different things. So a lot of things, when you look at these studies, even, you have to kind of look at the details of the studies. What they were actually doing, and then the diet.

So, you know I complained, I think. And I would bet that the reason I’m getting a different result there is because I have a, what I would call, a well-formulated ketogenic diet. Which means that I eat a lot of vegetables and, you know, fibers and things like that.

Because I think the main hypothesis there is that someone on a ketogenic diet is eating less fiber, basically, to feed his gut biome, and therefore you’re seeing that inversion.

[Richard Sprague]: Oh, I see.

[Damien Blenkinsopp]: But I’m not seeing it, so I think its because the type of ketogenic diet I’m running is different to that. So even when you’re looking at some of these studies, you have to be careful to look at the details of them as well, and does it exactly resemble you.

[Richard Sprague]: That’s true, yeah that’s true because not all ketogenic diets are going to affect the microbiome the same way. Yeah, that’s right. And then you get into the whole definition issues, of some people say that this or that is ketogenic and other people would dispute it. Yeah, that’s all tricky.

(1:15:54) Let’s talk about some of the things that we’ve done. In your show notes, I hope we can put some of these images that I’ve put up here, but there’s one in particular I guess if you’re asking me my take-aways. I think people need to recongize that a broad measure, something like diversity, which is something a lot of people care about, it’s real hard to tell what that means. And it’s very hard to just put a single number on the concept of musilin.

We all sort of intuitively understand that having a diverse microbiome is a good thing because you’ll be able to respond better to different challenges that might come up in your environment. But if you have a diversity of pathogens that’s not necessarily a good thing. It sort of depends on what’s in there.

And the other part is, and this is true of generally I find through daily microbiome testing is that there’s a lot of variabilty day-to-day.

So one of the charts that you can look at in here is just showing the diversity that if you tested me on a Monday you would say I have low diversity. In this case I have like 1.8. But if you tested me on Tuesday I was all the way up 2.3. And then if you wanted until the weekend, by Saturday I was at, maybe, it was still hovering around 2.1, but then suddenly on Sunday I plunged to under 1.8 again.

[Damien Blenkinsopp]: So we understand, with these diversity algorithms, right, that they’re running, is that looking at species diversity?

[Richard Sprague]: No it’s looking at the family level, which makes sense because the family level is kind of a good level to look at because you still have a lot of coverage. You’ll get close to 100 percent of all the different things that are there, unlike say genus or species where there are lot of ones that just won’t show up in the 16S.

[Damien Blenkinsopp]: In the 16S, yeah they won’t show up so you wouldn’t be — yeah that’s what I was getting at.

[Richard Sprague]: So they test it at the family level. And there are a couple of different ways to measure, but one way to measure it is, you can think of it as the probability that if I grabbed two things at random, two microbes at random from my gut, the probability they would be the same,

And in the case of if you, for example, if you’re firmicutes dominant and a lot of people would have 70 percent firmicutes, it’s pretty likely that if you grabbed two random microbes that both of them will end up being firmicutes. But it’s very unlikely that two of them would be something else, and that’s the way you measure diversity.

There are a couple other different measurements for diversity, but they all rely on the this idea that in aggregate we’re looking at, like how much information is in this signal. And that’s a little difficult to be able to really pin down.

Now that said, the other thing that I pointed out is that although it’s variable day-to-day, if you look at my picture and we can put this in the show notes too if you look at my diversity across the year, yeah there’s a lot of day-to-day variabilty but there’s a trend. There’s kind of an average there.

And I’ve looked at this with other people as well, and it’s unique to me. So there’s something different, something special about my gut that is different than your gut. And even though there’s a lot of day-to-day variability in how that works, I think there really is something there. There’s some kind of signal, we just have to understand better what that signal is.

[Damien Blenkinsopp]: Right. So you’re saying diversity is interesting but we don’t understand why it oscillates.

[Richard Sprague]: Yeah, and it’s partly because we don’t understand diversity, or know what that really means.

[Damien Blenkinsopp]: Well I think it would be really interesting. You’re saying it works at the family level, and that’s because…

[Richard Sprague]: That’s how we measure it, at the family level usually.

[Damien Blenkinsopp]: Right. So that’s what we’re measuring currently. And it’s not the ideal, right. I mean, ideally, maybe with the shotgun. And I don’t know if there’s studies actually on this. Because I’m assuming that the studies were all done on a 16S for diversity.

[Richard Sprague]: Oh no, people do diversity metrics for any sort of sequencing.

[Damien Blenkinsopp]: Okay. So they’ve done it on shotgun as well, but they still do it at the family level?

[Richard Sprague]: No, just generally speaking, if you want to be able to compare two different samples that were done on 16S, you’ll probably want to compare at the family level.

[Damien Blenkinsopp]: Yeah.

[Richard Sprague]: But there are other ways to measure diversity too that might be useful. Like just counting up the total different number of species that were found in your sample versus my sample. And you might find that you had 150, I had 130. And that’s kind of interesting to know that you have some microbes that I don’t have, and maybe vice versa.

[Damien Blenkinsopp]: Yeah.

[Richard Sprague]: But that’s hard to capture in a single number, and a lot of people, like the Viome test wants to be able to say in one chart, what is your diversity. People sort of care about that.

I’m just, in my experience that’s hard to pin down.

[Damien Blenkinsopp]: Right, and it’s hard to say it’s actionable or you can even say, okay I’m diverse, I’m well. It seems too abstract in terms of a biomarker.

[Richard Sprague]: People who complain about having low diversity, I’d say why don’t you test yourself tomorrow and see. You might like the test results you get better tomorrow, I don’t know.

(1:20:15)The other, just to quickly show you one more of my charts that I think is fun.

So I tested myself doing a probiotic, taking a pill, to see what would happen. And in this chart you’ll see there’s a little red splotch on there that shows there’s about a nine or ten day period that I was taking this pill daily to try to improve my levels of bifidobacterium.

And on this chart you’ll see that it’s hard to see there’s much difference in the level of bifidobacterium, but there’s another huge spike in my bifidobacterium that happened several months before I took that.

[Damien Blenkinsopp]: And we are talking huge, guys. You’ve got to look at the chart.

[Richard Sprague]: It’s totally, totally different. And the fact is that that month of September I happened to be traveling in New Orleans and eating a lot of red beans and rice, which apparently affects my bifidobacterium levels. And that’s kind of the take-away lesson for me is that often the best interventions you’re going to have are going to be some kind of food that you eat.

[Damien Blenkinsopp]: Probiotic.

[Richard Sprague]: Like a prebiotic, yeah. Because I think what’s going on is these microbes all interact with one another. And so just increasing one is sort of like poking on one little thing hoping that that’s going to improve it, but really that’s going to create a cascade effect of a whole bunch of other things.

[Damien Blenkinsopp]: Absolutely.

[Richard Sprague]: And the only way to really improve things is probably holistically.

[Damien Blenkinsopp]: Yeah, yeah, absolutely. It comes back to the whole foods approach and everything, right? That we can’t approximate, we can’t invent a food with our food science because we don’t fully understand what’s in a whole food. Right?

That was one of the concepts out there. And so we should just eat whole foods and then we’re going to get everything that we need. And one day when science has really understood all of the tiny details we can maybe mimic it. But for now it’s probably just not a good bet to be able to do that. So, really interesting.

[Richard Sprague]:Yeah, that’s right.

(1:22:01) [Damien Blenkinsopp]: One of the things I came across in terms of a test was putting kimchi up your nose.

[Richard Sprague]: Yes, I’ve heard about that, yes.

[Damien Blenkinsopp]: Right. Because I think we discussed it before on a past call. So this was something recommended to me by a physician, because I had experienced some sinus headaches.

And people have been experimenting on this we’ll put up the links on the internet and blogs about this approach to reducing the incident, or eliminating, sinus headaches. And basically there’s certain types of kimchi that contain cayenne, which is in all of them today because there’s a lot of different kimchis on the market.

And they have to be unpasteurized. And basically you take, you don’t put kimchi up your nose literally. Thankfully, you take some of the liquid in that, so you put a teaspoon in, pull it out, then you dip your finger in it and you put your fingers up your nose, both nostrils, to get some of that in there.

So you’re snorting the juice, basically. And the idea is you get lactobacillus sakei up there, and that helps to populate the nose if you’re doing that every day. And that helps to counter some of the microbes that are potentially causing the sinus headaches by their overgrowth. So it’s countering their growth, basically.

It did seem to have a positive effect for me, but unfortunately I wasn’t doing any biome test or anything like that at the time, so there’s no data on that. It’s just an idea that someone might want to test. And I’d love to see some biome or something else results on it if you do do it.

[Richard Sprague]: It would be interesting, yeah. So my daughter suffers from sinus headaches now and then, and I told her about what you had suggested. We have this big jar of kimchi still in the refrigerator, but she just wasn’t interested.

[Damien Blenkinsopp]: It’s kind of a weird sensation at first, I have to say.

[Richard Sprague]: It’s like the other advice that I got on the internet was you should simulate, what is it called, the brain burn that you get if you have some very cold ice cream or something. And she doesn’t mind doing that, eating a lot of ice cream when you have a headache. But kimchi up the nose thing was a little bit hard for her to try.

(1:24:06) [Damien Blenkinsopp]: So obviously there’s a lot of probiotics on the market right now. A lot of them, and I think going back to what you were talking about, when you introduced one of those into this environment and we have been talking about that there’s a homeostasis of that environment.

They work together, they feed each other, and you just throw one in there, he’s basically getting thrown into an alien population. Because if you’re adding them, it’s probably because you don’t have them, so it doesn’t really fit in with that environment right now. And that’s my assumption why they’re not growing, not sticking in a lot of results like yours that you’ve seen.

Because it’s probably, he depends on some other guys, some other bacteria. That would be interesting studies. Like, bifidobacterium, everyone knows that these are beneficial, what other species do we need in there to support them, and then concoct basically a probiotic which maybe allows that. And maybe adds prebiotics as well. I mean, that sounds good to me.

[Richard Sprague]: Yeah, and people tried doing that. And I’ve looked at a lot of people who’ve done A/B testing, where they test their microbiome before and after, and I have yet to see convincing evidence that any of them makes any difference. Yeah.

[Damien Blenkinsopp]: Right. And they’re quite expensive, some of them, right now.

[Richard Sprague]:Yeah, that’s right.

Now, that doesn’t mean that it doesn’t work. And there have been studies like BSL-4, I think, is the one that people talk about. They’ve done randomized controlled trials and they show that such-and-such marker is actually improved, or such-and-such disease state is improved after taking the probiotic. I just haven’t seen that demonstrated…

[Damien Blenkinsopp]: In the data. But that’s also like, okay, so maybe it’s something that’s not being picked up in that particular sequence, the bioinformatics pipeline, or whatever. And it will turn up in two years when we’re finally tracking it. That’s the problem with where we are right now; something could be happening and could be beneficial, and we’re just not finding it in the data is all.

[Richard Sprague]: Yeah, who knows. Or it could be that they way they do the testing, these randomized trials, maybe they all drink a glass of orange juice after they take… Who knows.

Yeah but I do think in general, a lot of people ask me after all my testing, What do you think about taking probiotics pills?

And my general, I just have not seen any good evidence that any kind of pill really helps. If you want to make a difference to your microbiome, do something involving food.

[Damien Blenkinsopp]: And a variety. I think a wide variety makes sense. If you’re trying to get diversity, a variety of vegetables which is supposedly a good rule of thumb for micronutrients and other reasons as well it can’t be a bad thing to do.

[Richard Sprague]: Yeah. You can have, you can put up a link to the, I’ve got a medium place where, medium.com, where I posted a bunch of my microbiome experiments. But a few of the things I’ve tried are like, kombucha, soy lint, makes a difference in the microbiome.

[Damien Blenkinsopp]: Oh right, that’s an interesting one. Yeah, so the whole, whole…what do they call it. Nutritionally complete food.

[Richard Sprague]: Yes, right.

[Damien Blenkinsopp]: Yeah. There’s like 60 companies that have started those now. I didn’t realize until I looked into it the other day. Didn’t you do a colonic at one point? Was that you?

[Richard Sprague]: I did, I did that as well. Again, my take-away was that I was hoping that there would be some ability to make a major change afterwards, by feeding myself the right kind of things. But it just bounced right back to the way it was. Two weeks later I was right exactly where I was before.

[Damien Blenkinsopp]: But that’s actually, that was good feedback for me because I spoke to one physician who’s been working in environmental medicine for a very long time about something that I had.

And he suggested six colonics within two weeks. And he didn’t know why, but he’d been doing it for 30 years. And he said, I don’t understand completely the mechanism, but it really helps with this specific thing.

So, I did it. But I was concerned about my biome, obviously, doing that and colonics and stuff. So when I heard your story I was like, okay.

[Richard Sprague]: Yeah, and who knows. I’m just one guy, so.

[Damien Blenkinsopp]: Right. N=1.

[Richard Sprague]: The other thing that people should realize based on my experiments that I don’t have an appendix. It was removed when I was five years old. And the appendix is known to include, that’s where the bacteria gets stored when you…

[Damien Blenkinsopp]: It gets stored. Yeah.

[Richard Sprague]: Yeah. So who knows what’s going on in my gut.

[Damien Blenkinsopp]: But that’s a good test though, because then you don’t have that storage device, basically.

[Richard Sprague]: You’d think, yeah, but who knows.

[Damien Blenkinsopp]: Yeah but that is a pretty important N=1 difference there.

[Richard Sprague]: But nevertheless, for me at least, everything just seemed to bounce back. And I’ve found that my microbiome is pretty resilient to just about any kind of change.

[Damien Blenkinsopp]: Yeah, hard to change.

[Richard Sprague]: Yeah, that’s kind of the bottom line.

(1:28:22) [Damien Blenkinsopp]: Alright, so we’ve dived through some of our own personal experiences there, trying to change it. And as you’ve kind of heard it’s not easy to change your microbiome, it seems. But it doesn’t mean it’s not worth experimenting with.

(1:28:34) So the thing I’d thought we’d do now is kind of take a step back and look at the big picture of all of these labs and everything. To see where they are and what kind of, you know, thoughts we have about using them, I guess, right now. What’s valuable to you, you the guys at home, to be doing with these right now and potentially in the future.

Richard, what are your overall thoughts?

[Richard Sprague]: Well, so, it’s hard to beat the price of 16S. And it is something that’s also pretty easy to do; you don’t have to poop in a box, you don’t have to put tablespoons, laying on the floor kind of thing like this. It’s relatively easy to do. And for that reason alone, I think it’s worth doing a 16S test. Do a couple over time, or if you’re trying to check out the effect that it has on one particular thing, it’s cheap and easy.

[Damien Blenkinsopp]: If I can just jump in there, I think that’s interesting also because of what we’ve said about the bioinformatics pipelines and the databases will be evolving and getting better over time. And that sample is part of your history, which could be useful if and this is actually Jessica, she came on the show way, way, way back and she suggested it was good.

Say you get sick in the future, it could be gut related, and you have that sample. As the bioinformatics and the database evolves, you could then look back at that and be able to see what the difference is. And you would be able to formulate some kind of plan to try and get back there, at least.

So just for that reason, for this historic storing your sample if you ever need it in the future, it’s a reasonable idea.

[Richard Sprague]: Yup. I think that’s something everybody should do. And we talked about the other tests.

I told you about Day Two, I like the science behind them. It’s like 300 something dollars, I guess. Little bit expensive, I think, but a lot of people would find it would probably be useful for you if you were looking at a particular condition, particularly any of the metabolic diseases like diabetes, I would think that you would want to do this.

Because it’s going to tell you based on these peer-reviewed studies, it’s going to tell you something about your glucose response to different kinds of foods.

[Damien Blenkinsopp]: Yeah. If you’re overweight, if you’re really overweight, it’s probably interesting.

[Richard Sprague]: Yeah.

[Damien Blenkinsopp]: Because it might just pick out one of those foods that is your main go-to every day.

What I like to think about these kinds of tests, because we’re saying it’s not 100 percent, but it’s a good broad picture. And if some of these foods that you’re eating every day come up as red in their algorithm, you can then go and test them properly. And you’ve saved a lot of time and effort because it gave you that broad look at all of the foods.

And it gave you some way of basically strategically focusing on like five different foods that you’re eating a lot and turned up red there. And then you could do a proper glucose test with a meter on each of those. Whereas obviously you couldn’t do that on the thousands of different foods you’re eating, or hundreds, that you’re eating each week.

[Richard Sprague]: Yeah, that’s right. And like the example I give is I have always eaten a lot of bananas. Now, I’m aware of the carbs, and the sweetness, and everything else. Bananas I always thought were nutritious; it’s a fruit, it’s healthy and it’s easy to eat.

But both my tests Day Two and Viome results came back saying that I should avoid bananas. Which I thought that’s kind of interesting evidence. And so that’s the kind of thing I probably wouldn’t have thought about.

[Damien Blenkinsopp]: Have you, my first question, have you tested your glucose response to that? I’d really like to see.

[Richard Sprague]: I mean I test my glucose response, but I haven’t noticed any major differences. I have not tested my glucose response after eating a banana, I should do that. It would be interesting.

[Damien Blenkinsopp]: Right, that’s what I would love to see, to marry that up. Yeah.

[Richard Sprague]: Yeah that’s a good idea, I’ll try that.

[Damien Blenkinsopp]: Please do, and we’ll chat about it later.

 

[Richard Sprague]: Yeah. And I guess those are the big commercially available ones in the US. You mentioned Atlas Biomed and Aperiomics is that what you said?

(1:32:11) [Damien Blenkinsopp]: So Aperiomics is designed, their whole thing is focusing on pathogens. They mostly work with physicians , and they mostly get people who have strange illnesses and haven’t been able to figure anything out. I mean, she’s got some interesting stories.

I’ll tell you, because I’ve been talking to the girl that runs the lab. And I figure I’m going to use it a little bit more, because it appears like a lot of us and I’ve been talking with other scientists about this a lot of us carry a bunch of pathogens around with us all the time.

Depending on where your immune system is and everything else, you could be fine. But that doesn’t actually mean you want to harbor these things for the rest of your life. Because they do see some correlation later in life to certain neurological diseases and stuff to some of these pathogens.

And so I think it’s a preemptive. Because I’m a bit anal, I’m quite interested in that to screen for certain things that I might decide to try and remove for the long-term benefits of removing those things.

So I’m actually going to run a blood sample through her as well. But she’s got some interesting stories. Like she had some patient come in with some sample and they couldn’t figure out what the problem was. And it was a species of leprosy.

[Richard Sprague]: Ooo, okay.

[Damien Blenkinsopp]: Yeah. And apparently this specific one isn’t supposed to be around anymore. So they’re picking up stuff that is kind of presumed dead or gone in the past.

So I think her lab will be interesting. I’m not sure how fast she’s accumulating data. But if anyone’s got something, some really strange medical condition out there it might be an option to just try and get some ideas on the table.

[Richard Sprague]: Yeah, I think that’s a good point that especially for people who have some kind of misdiagnosed chronic condition, where your doctor and maybe doctors, and you’ve consulted lots of people and they don’t know what’s going on. And they’re just, can’t figure it out.

I do think that any of these tests is going to be valuable as an additional data point. Now whether it’s going to produce something actionable for you or not, I don’t know. But I’m really glad that we have the technology available for us to better ourselves.

[Damien Blenkinsopp]: Yeah, it’s exciting. It’s starting to give us ways to try and decipher these mysteries. Or at least get us closer to the results more quickly. And often it’s kind of leads.

Obviously it’s not, that’s why they’re not being used by physicians that much is because they can’t give you a diagnosis. But they can give you leads and patterns, and eventually someone can figure something out from that.

[Richard Sprague]: Yeah, yeah. And like my example of bananas, I think that a lot of times just doing a different test like this will maybe point out something that you had not been focusing on; you had sort of taken it for granted that this was just the way things are.

This is the way that I live. And sometimes they’ll kind of shake you up a little bit and say, well wait a minute. Have you tried rethinking this previous assumption? And I think that’s valuable too.

(1:34:52) [Damien Blenkinsopp]: So what did you think on the 16S versus shotgun? I mean, they’re not that far apart now in terms of price.

[Richard Sprague]: Yeah, I mean again. Well, I mean.

[Damien Blenkinsopp]: It depends on your budget, right?

[Richard Sprague]: Depends on your budget, yeah. And I know a lot of people who would say 400 dollars, or 300 dollars, is a lot of money to spend on something that’s not quite that well understood. And I understand that argument. I think that if you can, I think it’s definitely worth it. I think you’re getting some new insights that you wouldn’t have had otherwise.

We talked about the question that we have about the transparency of the results of Viome and where they got their…

[Damien Blenkinsopp]: I think transparency is key because, it’s also, I think it’s a little bit about the ethos of the company. Like the ones that are already transparent, you can see, as we were saying, these samples they have them, they’re going to evolve over time. So it’s going to become more valuable provided that it’s transparent.

[Richard Sprague]: That’s right, yeah. Yeah. I do want to know why it is that you gave that recommendation, and then I want to know and trust that if someday you discover new science that makes you retract your recommendation then I’m going to hear about it. And you’re going to be honest and up-front about it.

[Damien Blenkinsopp]: Right.

[Richard Sprague]: Because here’s the thing about science. Real scientists, they want to be proven wrong. They’re constantly working, it’s why their…

[Damien Blenkinsopp]: Exactly. The search for truth. Yeah, exactly.

[Richard Sprague]: Exactly. And I always get a little suspicious when I’m talking to one of these companies where they act like, What do you mean, are you questioning my science? Are you questioning my results?

You know what, yeah. They should be glad for that.

[Damien Blenkinsopp]: Well they don’t give you full access to the data. If you don’t give me my raw data, I get nervous.

[Richard Sprague]: That’s a red flag right there, yeah.

[Damien Blenkinsopp]: Yeah. So, Richard just brought that up. We’ve got a little table here we’re going to throw up. He was like, oh yeah raw data, and I was like damn I forgot that one.

(1:36:30) When you can, raw data is going to be really helpful. And it just proves that they’re transparent as well. I think that’s a really important thing when you’re going for one of these services, to ask about.

[Richard Sprague]: Yeah.

[Damien Blenkinsopp]: And I think most of them are going to provide that. We spoke a bit about, some of them haven’t done it quite yet but they say they’re going to do it soon.

[Richard Sprague]: Yeah. I look at it as a reputable lab will be happy to give you the data because their real value that they had is in the interpretation side. And they have access to additional, maybe proprietary data or insights that you don’t have.

Which is fine, that’s where they’re going to be differentiating themselves. But the raw data itself, it’s just data. It just comes right out of, it’s your data; it’s about your health. You should be able to look at it. That’s my attitude.

Plus, in the case of something like uBiome, one of the reasons I’m very, very excited about uBiome’s raw data is that we’re able to go and take that data and do things with it that uBiome just doesn’t have the time or the, maybe just the bandwidth to go and pursue. And so a lot of these charts that uBiome sent me, I did that because I had access to the raw data. I wouldn’t have been able to do that otherwise.

[Damien Blenkinsopp]: Yeah. I actually had, anyway. That’s a long story. I had a little project to identify a species which I thought would be useful to the 16S. Basically like a strategic screen for pathogens using some tools. So I actually got that sent to uBiome, and they were like, ìThis is really interesting, but we have a lot of other projects that are taking up all our time right now.î

So there’s a lot of stuff these technologies could be used for in the future. And I think that’s one of them. A very cheap method for some doctor to get a strategic screen, and then for pathogens, for a list of pathogens. And if something comes up, you then do the PCR, which is more expensive. But you’ve done it really cheaply. So I think that’s going to be, hopefully, a really interesting application in the future.

[Richard Sprague]: Yeah, that’s right.

(1:38:23) [Damien Blenkinsopp]: What other things do you think might be cool in the future? Or what applications do you think these are going to turn out to be pretty useful for? Or, what do you think you would use it for today, if you’re going to use it for something?

[Richard Sprague]: Like I said, I think that most people talk about gut microbiome, but there’s a lot of interesting things you can learn in the other microbiomes as well. And I think we’re going to see a lot, in the future I think we’re going to see more emphasis on, say the mouth and the skin. And there’s just these very intriguing associations.

For example, one of the things about Alzheimer’s disease, one of the early symptoms of Alzheimer’s disease is a lack of smell. And there is some evidence that the nasal microbiomes of people with Alzheimer’s are different than those who are not. And could it be that there’s a microbe that just sits in the nose for years and years, decades and decades, and finally migrates into the brain and that’s what triggers the disease?

And we’re going to find all kinds of associations like that.

[Damien Blenkinsopp]: Yeah. And I think it’s often going to be multi-factorial as well. And that’s why data from all of these places is going to be so invaluable, because we’re going to be like, oh look, when you get these 20 factors together.

I mean this is why we haven’t been able to figure this stuff out yet because we focus on one factor, and we just can’t see the big picture. Which is way more complicated.

(1:39:39) [Richard Sprague]: And talking about AI is becoming kind of a buzzword, but I do think that the ability to be able to go and look at all these different tests all holistically and be able to look at all this different data and then see patterns, that is one thing that AI is good for.

[Damien Blenkinsopp]: Yeah.

[Richard Sprague]: And we may be surprising ourselves in the kinds of insights that are possible.

Damien Blenkinsopp]: I know, right. It’s going to be really interesting what comes out. And some people are going to get really annoyed by some of the stuff AI brings out. It’s going to trash some stuff we’ve been doing for a long time.

[Richard Sprague]: It probably will.

(1:40:05) [Damien Blenkinsopp]: One cool thing that’s actually going on is, and Richard eluded to this with another company before, but Day Two, what’s interesting about these companies is they’re evolving pretty quickly as well.

So Day Two when I did it, was just a test. But now when you buy it, you actually get a nutritionist consultation. So they’re embedding that with it.

[Richard Sprague]: Yeah, that’s right.

[Damien Blenkinsopp]: Did you get that when you signed up for it?

[Richard Sprague]: I just, I never talked to the person. I probably should at some point.

[Damien Blenkinsopp]: You, follow up. I’d love to know what they talk about.

[Richard Sprague]: Yeah, well the frustration I was having is because I want to know a lot more technical details about stuff, and they usually don’t know the answer.

[Damien Blenkinsopp]: Well, you find out. You never know, you might hit the jackpot.

[Richard Sprague]: Yeah. In the case of both Day Two and Viome I was very impressed that they reached out to me. I got a call out of the blue from someone from Day Two, and they just said, We wanted to talk to you about your test and what you thought about it.

[Damien Blenkinsopp]: Wow.

[Richard Sprague]: It was like, how did you get my phone number? And they said, ìWell you put it down when you registered for the product, and that’s what we’re calling it for, because we wanted to know what you really think.î And I chatted at length with somebody and told her exactly what I thought about the product.

So I’m encouraged that they are going out of their way to do this. Similar with Viome, I know; they are calling people up and saying…

[Damien Blenkinsopp]: Are you saying uBiome, or is there another company?

[Richard Sprague]: No, Viome.

[Damien Blenkinsopp]: Oh, Viome. Okay, got ya.

[Richard Sprague]: They’ve been very proactive about making sure that people send their samples in, and find out why it is that you’re not sending the samples. So I’m encouraged that the whole industry is undergoing this kind of push to be more customer centric. And maybe really trying to solve people’s problems as opposed to just a fast way to make money.

[Damien Blenkinsopp]: Yeah, exactly. Solving results, giving people results is where it’s at.

[Richard Sprague]: Yeah.

(1:41:44) [Damien Blenkinsopp]: Okay, so what do we think are the things that have to be improved? I mean, we kind of touched on this already, but to get to something that’s going to be far more valuable, like all of these services, so that we’d be saying everyone should be getting these done and really using them.

What has to happen with the technology? What has to happen, and do we have any kind of reasonable timelines?

[Richard Sprague]: So there’s kind of a movement. A lot of these companies are trying to add better access to the literature.

So for example Thrive now, they’re proud of the fact that they did some kind of machine learning thing, where they went through all the literature and looked at all the references to different microbes, and they’re going to tell you this and that about it. So there’s some activity around that. I think that’s helpful.

I think it’s nice to be able to have some way other than just googling the name of a microbe to find out what it is. If we can get more into, more vetting of the literature that would be good. Even if you spend any time with this area you’ll notice that there are thousands of new articles coming out, new journal articles, new peer-reviewed journal articles coming out every day.

You can’t keep up with them all. And a lot of them are self-contradictory. It’s just very hard to tell.

So if maybe there was a little bit more emphasis on curating the results a little bit better, that might be useful.

[Damien Blenkinsopp]: Standardization. Somehow.

[Richard Sprague]: Right. The way the labs really report the results, the way that they publish the results. That kind of standardization I think would be great.

[Damien Blenkinsopp]: So I was talking with a bioinformatist who’s working in the nutrition area. He’s got one of these apps similar to, that tracks food. Food intake and all of that. And he was telling me that the databases that all of the companies with these apps, all of them, are using are really low quality.

So then it’s a very similar instance, and I’m sure it’s similar in most of these areas where the quality of data is actually very poor. And we’re just talking very basics here, like the macro content of a food, which is being put in their database. Then you take the photo, or you enter, you pick it from their library, and you think you’re getting that macro content but you’re not because the data is quite bad.

So they’ve personally just been building a very low volume database. So it has less in it, but it’s high quality. And they’re thinking about just throwing it out there as Open Source to try and bring the industry up a bit. To try and get people using that and building on it. And improving on it.

But I think what’s happened is a lot of people have been conscious that their databases aren’t broad enough, or don’t have enough volume in it. So it can be very frustrating for customers and all of this stuff. So they’ve chosen other approaches like just get customers to add the information in, or whatever. And these are low-quality approaches, and then you end up with a lot of garbage, unfortunately.

So, this is a very important topic for quantification in general, and getting actionable information out of it at the end of the day.

[Richard Sprague]: Yeah, and everybody kind of wishes there was Wikipedia of knowledge about the microbes and about the food benefits and all that kind of stuff where anybody can go and add their results. I guess that’s Wikipedia.

[Damien Blenkinsopp]: There is value in crowd sourcing, but it’s those processes and things that you have to put in so that you get a volume, but then it’s filtered, and filtered, and filtered. So that you maximize the benefits of building volume through crowd, but at the same time there’s that mechanism to ensure that quality eventually ends up there.

[Richard Sprague]: Yeah, and it works for things like, MyFitnessPal has any kind of food you can possibly imagine in any culture, any language, anything and they’ve got it in there. Because they’ve got this crowd sourced thing figured out to a science.

And in fact they were telling me that when Nabisco put out some new packaged good, they had the calorie information in their database before Nabisco.

[Damien Blenkinsopp]: That’s ridiculous.

[Richard Sprague]: It’s like somebody just immediately.

Yeah, but you know it’s of unclear quality. And in a lot of cases, particularly with foods, and with the microbiome, like we were talking about apples; there’s a lot of difference between what was tested in a lab somewhere and what you’re actually putting on your plate.

[Damien Blenkinsopp]: Yeah, and I can tell you, because I’ve been digging into food science and stuff for one of my companies, and when you see an ingredient on a label, there are 20, 30, 40, 50, 60 different versions of that that would fit into that name. And they have quite different properties in some instances.

We’re picking three different ones, and we’d go through ten of them until we get to one that does what we want to. So there can be a lot of variation on this. So when you’ve got these ingredients and they’re using these ingredients as well to pull the macros and everything. It’s just not the same.

[Richard Sprague]: Yeah, and I think with labelling, in some ways it may be a dis-service that governments around the world force companies to put the labels on because it gives this false sense of security on your part. That you think, of it’s got sugar in it. Well, what kind of sugar.

[Damien Blenkinsopp]: Exactly.

[Richard Sprague]: And the reality is just way more complicated than they can summarize in a label. And I almost wish that there was instead like a competition among lots of private companies that will compete on the best label that they supply for a particular food.

[Damien Blenkinsopp]: Yeah, because right now everyone hides behind it, basically.

[Richard Sprague]: Exactly, yeah. And in the US it’s particularly bad because we don’t give, it’s not per 100 grams, it’s per serving, whatever that means.

[Damien Blenkinsopp]: I was actually looking at that the other day, and I was like this makes it really hard to do the calculations in my head. Because you always have to have it working on the 100 otherwise you can’t compare.

[Richard Sprague]: And, you know, smarter companies know how to manipulate that. For example, what is it, the little sugar packets that you get for coffee? I guess they’ve arranged it so that they make the size exactly at the cut-off, where now they can say it’s zero calories because it’s like 4.9 calories, but it’s under 5 so they can report it as zero calories.

[Damien Blenkinsopp]: Yeah. There are so many tricks in the food industry. They have mastered the game; they’ve had a while to do it. And I think regulators are never going to be able to solve that, it really has to be transparency coming through because companies want to do it to please their customers. Because regulators, it’s just not their job. You can’t fit a structure that forces people to do it.

[Richard Sprague]: Yeah, and that’s where for the microbiome stuff, as we get more and more companies involved in it and more and more labs that are doing this sort of thing, I do hope that there emerges some sort of independent verification lab, or something.

And I think, was it LabDoor I think that you had on your podcast a while ago is an example of that company that, I love that. They go out and they specifically go and evaluate these things. And it’s independent, and they’re just looking to see kind of, on behalf of consumers, whether you can trust what you’ve got or not.

It’d be neat if there was a similar kind of thing with the microbiome world, wouldn’t it?

[Damien Blenkinsopp]: This is happening, you know the software world has made itself, has been very good at this.

When I think of telecoms, and software, and these IT industries compared to the health industry where it is, there’s a lot of silos in health. And everyone’s got their own lab, and you don’t know if they interrelate, and they don’t, I mean even in the big labs that hospitals have been using for a long time and so long.

And what we really need is a similar structure to what they’ve done in telecoms and software, where you have these big open standards of organization, and everyone gets together and says, we know it’s going to be more valuable for the industry; we know we’re going to make faster progress, and the economics are going to be better, so we’re going to make this.

And maybe it just needs a few people to stand up. So if you’re listening out there, and you’ve got a role in this, go for it please. Because you could add so much value to this industry. People need to start putting things together.

And then I think the other analogy is a lot of integrator kind of companies in software area and the internet now, where things like Zapier and IFFT and all these other apps are relying on all of the rest of them in the ecosystem. And maybe like a conversion app or other ones would add so much value to all of the other things out there.

So I think there’s ways to better integrate these things over time, and it’s going to happen. And there’s plenty of business ideas out there, potentially as well.

[Richard Sprague]: That’s right, yeah. You know, it’d be interesting to look maybe at the history of how, even say like blood testing for standardized.

Because I’m sure they had the same kind of problems in the beginning. Like, how do you decide how to measure Vitamin D, or how do you decide to measure all of this stuff? And it looks like they’ve kind of figured that out. I wonder if some of those same lessons could be applied…

[Damien Blenkinsopp]: Largely, however, I’ve had problems with blood tests in terms of variants. In particular between different countries.

So I was in Spain at one time trying to get labs, and I actually left the country because I gave up completely. Because the data wasn’t correlating with stuff I’d seen in the US and the UK and stuff. So I think there’s still, there is interlab…

[Richard Sprague]: Maybe it’s more complicated than I think.

[Damien Blenkinsopp]: I think there’s still…

[Richard Sprague]: Yeah, a lot of these things, the more you dig into the details the more you realize how messy it all is.

[Damien Blenkinsopp]: Yeah. It’s a crazy world we live in. And this is something you’re constantly working on. You still work on this stuff, do you? Or have you kind of moved on a bit?

[Richard Sprague]: I do. I mean, [most of my situation] right now is I’ve got so much data that I’m spending a little bit more time trying to do the analysis of the data. It is kind of cool though, because every time, lots of people send me their samples and ask me what I think, and every time that somebody sends me a new sample, I get more information.

[Damien Blenkinsopp]: Yeah. Are you offering…

[Richard Sprague]: Yeah. I mean, anybody who wants to, you can send me your uBiome data. I’m happy to look at it and tell you what I think.

I’ll find out little things like, the other day there was a New York Times article about heart disease or something I read this every single day and they’ll mention the particular microbe that was involved. And so I’ll just go look it up and I’ll see, oh, huh. And I log into my computer and I see, okay how does that microbe look in me and what was I doing at the time.

And I’ll find all kinds of interesting correlations. I’ve found things like during travel there are particular microbes that bloom in me. And just we need to understand why, and what is that thing doing, and is it a good thing, a bad thing? I don’t know.

[Damien Blenkinsopp]: I was just also thinking that you’ve travelled a lot, right? You lived in China.

[Richard Sprague]: Yeah, I spent two years in Asia.

[Damien Blenkinsopp]: Right, so we both did that. We both traveled a lot. And I think that influenced our biome a little bit. You found some stuff in there.

[Richard Sprague]: Yeah. One of the things, I mean one of the things I think is really cool is there’s a particular microbe that was identified a few years ago as letting Japanese people, so their digestive systems can handle seaweed, and metabolize seaweed better.

[Damien Blenkinsopp]: And you have it.

[Richard Sprague]: And the study that did this was comparing a lab in Japan versus a lab, I think it was in Saint Louis. And they concluded that North Americans don’t have this, and Japanese people do. And I thought that was pretty cool, but when I looked at my own results I found out I have it too. And that was kind of cool.

In fact, that’s the reason that got me excited about the microbiome, is that it does appear that there are ways that you can change your microbiome.

[Damien Blenkinsopp]: Like living in another country for a while.

[Richard Sprague]: That’s a big one, yeah.

In fact, actually speaking of probiotics. So a lot of people have sent me A/B testing of their probiotics, and one guy sent me, he had three samples. One when he’d been living in the UK, another when he had moved to California and started taking probiotic, and then a month or so later he did another sample. And guess what, you can’t really tell the difference between the two samples taken on the probiotic, but you can tell the difference the sample when he was living in the UK.

(1:52:18) [Damien Blenkinsopp]: Yeah, so if you really want to change your biome, move. So I wonder, I have lived in countless countries. I think my microbiome might be confused, potentially

[Richard Sprague]: Yeah, maybe. But you know what, the microbiome is pretty resilient too. I like looking at, so I compare my father who lives in the Midwest in the United States. And he has kind of stayed in the same place, and that’s where I grew up.

But it’s interesting to look at our microbiomes. I’m essentially a superset of his. So, whatever microbiome I inherited as a result of living in his household for the first however many years of my life, and eating kind of, we have similar tastes in food, and similar diets to this day. But yet I have a superset of his microbiome, because I’ve lived all over the place and he hasn’t.

[Damien Blenkinsopp]: Yeah, exactly.

[Richard Sprague]: And again, that’s kind of a neat thing to know that we do have some influence over how this whole thing turns out.

I run into a lot of people who ask me questions about, like what can I do to change something. And that’s a big one, geography. But there are a lot of things that people don’t necessarily think about, either.

And a big one that I always tell people is about fasting. That’s a fast and easy way to change your microbiome that a lot of people just don’t do. It’s surprising how often you’ll run into somebody who, if you ask them when’s the last time you went a full 24 hours without eating food?

[Damien Blenkinsopp]: Have you seen samples before and after from fasting? I mean, I’m into a lot of fasting so I’d be interested to [know].

[Richard Sprague]: No, I haven’t. And I would like to be able to see that. I would like to see somebody doing a serious job at fasting.

[Damien Blenkinsopp]: I can tell you you need to nurture it back to life after a 10 day fast with fibers. Actually with fibers and stuff, I tried to eat other things, but I was like, it just doesn’t work. So you have to kind of feed it, like I juiced fibers, basically, like vegetables, and actually added some fibers in order to kind of get myself back to normal.

[Richard Sprague]: Yeah. The reason why it’s been hard for me to test this, I mean I do fast occasionally, but it’s hard to test it because when you don’t eat anything, usually you don’t produce anything either. And so.

[Damien Blenkinsopp]: Well, I can tell you a way after a fast to generate poop, just liquid poop, very fast. If you just take fats, that’s not a good idea after fast of five days or so. So that would generate a result quite quickly, but I don’t know what you’d get. It might be completed biased. Yeah, it would be completely biased.

[Richard Sprague]: It would be biased. Yeah.

[Damien Blenkinsopp]: But the other things is, so the solution I found is actually juicing. So if you juice fibers in plants and stuff, and have that as your first couple of drinks, you should after the fast be able to poop quite quickly.

[Richard Sprague]: Yeah, it’s just, you’ll poop something differently than, we don’t know what’s going on in your microbiome before that happens.

I mean, I have tested my skin microbiome extensively like before and after going camping, let’s say. Where I’ll go for several days without a shower to see what happens. And there’s a difference; it’s noticeable. I assume the same thing is happening in the gut microbiome.

[Damien Blenkinsopp]: Yeah. Okay.

[Richard Sprague]: But when I run into people who have some kind of gut issue, that’s one of the first things I suggest is just give it a shot. Because I have talked to people who will say that, you yourself can comment on how fasting does make a difference.

[Damien Blenkinsopp]: Yeah, and that goes back, I always like to quote Valter Longo’s work, where he’s actually got a book out now. But I had my episode on the fast-mimicking diet. Anyone who’s got some weird, chronic issue and that no one knows how to solve it, the cycling of fasting just could be an interesting tool.

[Richard Sprague]: That’s right, and it’s worth tying.

(1:55:42) [Damien Blenkinsopp]: Yeah. Okay, so let’s learn a bit more. Where could someone learn more if they wanted to go an investigate this stuff? Where would you tell people to go and learn more about the microbiome? If they found this whole discussion really fascinating and they want to learn more about the labs and everything.

[Richard Sprague]: Yeah. Where I would start with is, and you can put up a link to it, is I’ve written a post on Medium where I’ve listed my favorite ten books about the microbiome. And that’s what I would look at.

But the number one book I think is Rob Knight’s book about, it’s written a couple of years ago but it’s a great summary; it’s relatively easy and quick to read. It will tell you a lot of the different things that you need to look at. But I do try to read just about every mainstream book that comes out about the microbiome.

And I’ve selected the 10 that I think

[Damien Blenkinsopp]: There’s quite a few coming out now.

[Richard Sprague]: There are a lot of them, yeah. And a lot of them are really excellent. So take a look at my top 10 list. And I’ve tried to keep that up-to-date of the ones that I think are particularly good.

(1:56:32) [Damien Blenkinsopp]: Excellent, excellent. What are the best ways for people to connect with you and learn more about what you’re up to and your work?

[Richard Sprague]: Well the best way is to look at my Twitter handle, just @Sprague. I try to post something pretty regularly. And people are welcome to contact me there. You can also look at my website, richardsprague.com, just my personal website where I kind of post things as they come along.

[Damien Blenkinsopp]: Right. You’ve got your blog over there, right.

[Richard Sprague]: Yeah.

(1:56:57) [Damien Blenkinsopp]: Right, now who besides yourself would you recommend to learn more about the microbiome? Who would be your go to, like your favorite people…

[Richard Sprague]: The favorite person I have is Elizabeth Bik, who on Twitter is @microbiomedigest. And she’s one of the smartest microbiome scientists I know, and she’s very prolific on twitter. She reads all these publications, and she will let you know the ones that matter. So that’s the one I would recommend for that.

[Damien Blenkinsopp]: Wow. Excellent. Is there anyone else?

[Richard Sprague]: A lot of them are the ones that you’ve already featured on your program. Obviously Rob Knight, Eran Segal from Day Two. Those are all good people, that I trust their science and always eager to hear what next thing they’re going to come out with.

(1:57:37) [Damien Blenkinsopp]: Excellent, awesome. Thank you for that. Okay, let’s talk a bit about you. What is your personal approach to improving your body and user tracking? And this is not just microbiome but really anything? Including microbiome.

[Richard Sprague]: Yeah, I’ve been a quantified self-tracker for a long time.

I track my daily amounts of sleep. I track a lot of the main foods that I eat. I don’t do it as rigorously as I’ve done in the past; so like a lot of us there have been times in the past where I rigorously checked. I used to have a Zeo device that I slept with, and I could tell you for years exactly how much REM sleep I had.

And I tracked my activity. Not so much now, I don’t carry a Fitbit or anything, but from time to time I’ll look at just… Because I’ve got such food baselines in the past. If I’m going to make a major change I’ll track myself again.

But the number one thing, I mean I hate to keep on harping on this, but I track my microbiome. I think that’s really fascinating. And it’s something I recommend people, even if you’re not going to track it every day track it once. Get a baseline, and see how it is, and I think you’ll learn a lot.

[Damien Blenkinsopp]: And so what are the things you’ve stuck with now? What are you going to do the next month, or the next three months?

[Richard Sprague]: Well I am interested now in, I’ve been interested in fermented food. One of the things that I discovered from tracking my amount [unclear], power of kefir, because it’s one of the few things that I’ve noticed makes a real, noticeable difference in the microbiome.

And I’m doing a couple of experiments on myself just to see… I’ve noticed a couple of microbes that I did not have when I was before I started drinking kefir and that I have now. One of which is associated with recovery from Crohn’s Disease. So it seems like it’s probably an important microbe.

And I’d like to find out more ones like that. So I’m constantly on the lookout for new kinds of…

[Damien Blenkinsopp]: That’s interesting, and I may be able to help you with that one because I went for a kefir about a year of kefir daily, and I was doing the uBiome test during that period. So there might be in there.

[Richard Sprague]: Oh, interesting. So the data that’s, your uBiome data would include the kefir drink?

[Damien Blenkinsopp]: It would be around it. I think it would be either side of it.

[Richard Sprague]: No, I’ll take a look, because it would be interesting to look to see if you’ve got the microbes that I found in mine.

[Damien Blenkinsopp]: Yeah, that’s what would be interesting, because the first test probably wouldn’t have anything, and then maybe the last test would.

[Richard Sprague]: Yeah. I’m especially interested in traditional, both traditional foods and traditional medicines, because I think that’s an under explored area for finding new interesting microbial solutions to things.

Chinese medicine and Indian Ayurvedic medicine, they have a lot of things that to Western eyes look kind of weird. But if you look at it from the point of the microbiome, suddenly you have a vocabulary now to talk about something in more scientific terms. And I’m really interested in that.

Somebody told me about this, there’s some droplets that apparently Indian mothers give their babies when the babies have colic. And I bet that’s a microbial thing; it probably affects the microbiome.

You know, there’s just little things like that that happen all the time.

[Damien Blenkinsopp]: Right. And before we used to say, there’s no way they can do anything. But as we add these new layers of science on, we start saying actually there’s a potential mechanism there.

[Richard Sprague]: Yeah. And when people have tested some of this stuff, ìscientificallyî, when you look at the details of how they test it, a lot of the times it’ll be something where they, there was some kind of Chinese medicine and somebody will say well let’s bring some people into the lab here in California and let’s give some of them this and some of them that.

Well it’s different conditions than it is when it was administered by a barefoot doctor in rural China, where there are microbes all over the place that are affecting the results. You’re not necessarily comparing apples to apples.

So I think there’s probably a lot of things like that in traditional medicine or food that have a bigger, positive effect than we know. And it’s the kind of thing I wish I knew more about.

[Damien Blenkinsopp]: Cool, very interesting. What I realized now actually is, what kind of insights have you got about your biology from your quantification? And have they led to any changes in behaviors or any actions that you’ve taken? So actually, you know, changes in your life you’ve made.

[Richard Sprague]: Yeah. I would say that I’m pretty healthy. So I’ve not had any real issues that I’ve been concerned about. And so that makes me a little bit, I’m kind of odd. A lot of people who are involved in the microbiome, they have some kind of story about their journey trying to recover from something.

So I don’t really have that. But that also makes me, I think, an interesting case because I’m able to look and see over time how my health as shifted as I get older, and how different things. One of the things that I’m intrigued right now about in particular is sleep.

I’ve always been a reasonably good sleeper, but I get less sleep than a lot of people; I average at around 6.5 hours, and I have for decades. I’m interested in getting better and deeper sleep.

I have found a relationship with potato starch, is one thing that we’ve talked about before, that some people use that as a way to increase the amount of bifidobacterium in their body. It’s something that I would try, if you know somebody who’s having trouble sleeping, that’s one thing to look at.

[Damien Blenkinsopp]: Yeah. Okay, so this is a bit random, but I’ve been working on my sleep for quite a while. I’ve really got to do a full episode on this kind of stuff. And I’ve, like you, had actually worse. At times I get 4 hours sleep, 4.5 hours sleep, and it was very difficult to stay asleep; I can get to sleep, but I can’t basically stay asleep.

So there’s two things that I’ve done that, among all the others, which I think… actually three things. The first is get one of these. So I’m showing Richard a SAD light, 10,000 LUX. SAD Light.

And you put it on and I got this from a Parkinson’s study, because they have problems with sleep as well. And when they showed this, they basically put this on for two hours in the morning.

So it’s basically simulating strong sunlight, right? And you put it next to your desk or something, and you get that. And I’ve found that helps. I think, potentially what’s going on in the mechanism is it’s resetting your sleep cycle. Because we’re not getting enough light; we’re indoors all day, we’re not getting enough light and stuff.

So that seemed to make quite a bit of difference. And the other thing is, which

[Richard Sprague]: So you just turn this light on in the morning?

[Damien Blenkinsopp]: As soon as I get up, I walk into the… I find it’s actually to wake me up as well, better than coffee. Sometimes I’ve forgotten to have my coffee because it’s already done the job, basically.

[Richard Sprague]: Yeah, interesting.

[Damien Blenkinsopp]: So I really

[Richard Sprague]: You just turn it on in the morning, and the rest of the day you turn it off and just live your day?

[Damien Blenkinsopp]:Yeah. And I love this thing.

And I’ve tracked the data and stuff, but I still, I’m still tracking. I got the Oura, which isn’t the best. But I think duration’s not so bad. So I’ve been tracking that over [a longtime]. I’m still kind of waiting to see the results on it.

The other thing is, and this is most people aren’t going to like this, is going to bed really early. And so I started to go to bed, I now, like first of all I said I’m going to get to bed by 11pm. Right?

Because I noticed it seemed that in my Oura data and everything I was like sleeping a longer duration if I got to bed earlier. So that worked a bit. I pulled it back to 10. Worked a bit better. Pulled it back to 9, I’m having 7 hours, 7.5 hours consistently every night, which I’ve never done in my whole life.

And I don’t know why it is. But I can give you like reference of celebrities and people who do this. There’s a lot of people out there that go to bed at 9 and get up at 4. I get a lot more work done as well, now. And I feel much better, but it is a bit of a lifestyle. Most people don’t want to fit in with it.

[Richard Sprague]: Yeah. And that’s interesting that you say that. So are you taking supplements or doing anything special to improve sleep, or just

[Damien Blenkinsopp]: I’ve taken lots of supplements. The only one I still take is glycerin. There’s some studies showing that that helps to reduce night wakings, which is…. So that I do stick with.

In another one of my companies we actually recommend it to anyone, and have them doing it when they have sleep issues and sleep interruptions and that. And it seems to be working consistently across those people.

[Richard Sprague]: Interesting. Yeah, interesting. Yeah, I really miss my Zeo, because before they went out of business that was far and beyond the best way to track your sleep.

[Damien Blenkinsopp]:Everyone misses them.

Well I’m hoping the Next Door is going to be more accurate as well. So that’s coming out, due for delivery in April I think.

[Richard Sprague]: Yeah, it’s hard to see how anything’s going to beat looking at the brain waves, which is what Zeo did.

(2:05:41) [Damien Blenkinsopp]: Okay, right. This is quite an important thing. If you were to recommend one experiment someone should try to improve their body, health, performance, longevity, anything like that, with the biggest payoff, what would that be and how should they track it so they can understand that payoff, and that it’s actually happening for them?

[Richard Sprague]: Yeah. Again, I would look at the microbiome. And probably the number one thing that I see that people could improve with their microbiome is their bifidobacterium levels.

And that’s the thing that, I know you know, it’s associated with sleep, and with serotonin levels. And so just an overall mental stability, all those sorts of things. And what I found in my, looking at lots and lots of samples is that people who don’t have any bifidobacterium, they almost always have some kind of problem.

So the number one thing that I would say for people who are interested in this is to test yourself, see what your bifidobacterium levels are, and then look at different ways to be able to increase it and improve it.

[Damien Blenkinsopp]: Have you got any ideas on what might work?

[Richard Sprague]: Unfortunately, I don’t have really good ideas that work for everyone, but I would start with things like, you can try potato starch which is, if you eat it raw it is known that it’s a particular type of resistant starch that feeds bifidobacterium and it’ll make it through your digestive system. You can try that.

For some people beans work, as I’ve said with my example of going to New Orleans. And then I would test myself in a couple weeks and see if I got any bifidobacterium in me. And I think that’s like the number one thing that I would recommend for people to look at is the bifidobacterium levels, and see what works for changing that in you.

[Damien Blenkinsopp]: Yeah, so that’s a good one. I had non-existent bifidobacterium when I started doing uBiome, but now it pops up in all my tests. So, unfortunately, I can’t say what I did, because I did many different things over that period. But it’s definitely possible.

[Richard Sprague]: Yeah, that’s good news.

[Damien Blenkinsopp]: So that’s good news.

Well, Richard this has been a great discussion. We’ve gone all over the topic, and it’s really great to catch up with you and talk about all this stuff. So thank you for your time.

[Richard Sprague]: No, thank you. It’s always a pleasure talking to you. Damien, you have so many things that you know about, and we’re kind of kindred spirits on this whole quantified journey. So, thanks a lot, it was great talking to you.

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Looking at an example of Machine Learning applied to functional medicine with the goal of helping athletes optimize performance. The question – with the help of artificial intelligence, can a 7-minute questionnaire identify physiological weaknesses and bypass the need to spend money on expensive lab tests?

This episode focuses on Machine Learning and Artificial Intelligence. These topics are massively discussed in investor and entrepreneurial circles, as well as the media in general. There is a trickle of that starting to move into areas of health tech and health data. There is a lot of potential and discussion around what that could mean.

It was about time that we tackled this subject to see what potential it has to help make better use of all the data that we are collecting on health. I have been spending more time on the conference circuit around this topic looking for technology that is adding value in this area. This means helping us make better decisions with less error and less effort.

This is a health data podcast, and as you will have understood through listening to previous episodes, there are a lot of challenges to getting actionable information and value out of today’s health data. So machine learning looks promising to potentially help us bridge that gap.

This will be the first of many episodes where we look into the subject, and today is a bit of an intro into the subject.

Where modern medicine really falls down is with (chronic) diseases of modernity, like diabetes or obesity. Medicine is just not designed to solve those types of problem…. We’ve got a machine learning algorithm that will identify the problem sooner and more easily. But the solution remains the same: you need to move your body, you need to eat appropriately, you need to handle stress appropriately.”
– Christopher Kelly

This episode’s guests are the Nourish Balance Thrive team, Christopher Kelly and Tommy Wood. Chris and Tommy are friends of mine whom I bump into often on the functional medicine conference circuit. Chris and Tommy run the Nourish Balance Thrive podcast and are constantly digging into functional medicine and related areas to see what they can extract to help athletes perform better.

They’ve used the data they’ve collected over the last three years that they’ve been working with athletes – as an input to a machine learning tool, to cheaply predict what an athlete should prioritize working on to improve his or her performance. This is, to my knowledge, the first time that machine learning has been applied to the area of functional medicine.

We have an output from the algorithm; for each individual prediction, we have a sensitivity and specificity. Our H. pylori prediction has 100% sensitivity and a 98% specificity. That’s basically a gold standard test. That’s as good as doing the real test.”

– Tommy Wood

You can run the test yourself to understand what we’re talking about better by going to TheQuantifiedBody.net/machinetest. That will take you through a series of questions before predicting the issues that blood, urine, and stool tests would uncover for you, without actually investing in those tests.

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

  • Mutual respect between guests and host for their work (4:23).
  • Using machine learning to determine patterns in very large data sets (4:33).
  • Artificial intelligence is on the rise in the health market – will be the topic in future podcasts (7:29).
  • Machine learning is useful in functional medicine because of the ability to produce simplifying algorithms for detecting complex physiological processes (8:06).
  • The process of developing the Nourish Balance Thrive (NBT) questionnaire for assessing five major performance issues (10:47).
  • The basic and advanced biomarkers tested on individuals during the development of the NBT algorithm (13:36).
  • In some cases, machine learning algorithms determine health issues with more precisions compared to the judgment of individual medical practitioners (15:47).
  • Power output in athletic performance depends on oxygen deliverability  – in large part, determined by levels of oxygen-binding protein (hemoglobin) in red blood cells (19:04).
  • The importance of choosing the right study – population of people based on whose results machine learning algorithms are developed (20:28).
  • How algorithms are re-validated and the reasons Chris is confident in the predictive power of the developed model (22:47).
  • The NBT questionnaire retains high sensitivity and specificity in predicting results which individual athletes would obtain when actually testing the algorithm’s predictions (25:31).
  • The logic behind how algorithms make predictions in answering input questions (28:05).
  • Combining small decision trees into an overall big algorithm with real-life predictive power (29:36).
  • The background leading Chris to journey into artificial intelligence and machine learning fields of study (30:12).
  • A practical walk-through into how the NBT machine test works and how they interpret results (33:17).
  • The NBT machine test provides test clients with rankings of where each person stands in terms of 5 main performance issues and determines which issue to focus on the most (34:59).
  • Based on algorithm results predictions, clients are usually asked to come to the US for getting specific follow-up tests done (37:49).
  • Tommy hopes to accumulate success stories of tackling athletes’ performance issues, thus prove the actionability of the developed algorithm (39:49).
  • After detecting weak points in athlete performance, the used interventions have a base in low-risk diet and lifestyle modifications (41:12).
  • The potential of machine learning to revolutionize important aspects of life, including human health (42:29).
  • Compared to traditional medicine, functional medicine considers the multi-complexity of factors influencing health (45:48).
  • Developing useful applications in health doesn’t always require really big data – ex. NBT uses data from a relatively small study population of 1000 athletes (48:15).
  • The amount of data necessary for machine learning application in health depends on the artificial intelligence tool used for computing patterns (49:09).
  • Machine learning applied to detecting specific root causes of chronic illness (50:52).
  • Modern medicine solves acute health conditions but there is a strong need to utilize proactive approaches in chronic illness prevention (52:49).
  • Resources for learning more about the complexities and applicability of machine learning (56:50).
  • Picking up machine learning is accessible and available, even for beginners with no programming skills (58:00).
  • How best to connect with Chris and Tommy and learn more about their work (58:50).
  • Influential people in the field of functional medicine (59:52).
  • The biomarkers Chris regularly tracks to uncover and solve underlying causes of health issues (1:01:45).
  • The importance of optimizing both mind and body towards better health – including diet, exercise and meaningful relationships with others (1:03:56).
  • Monitoring blood glucose is an effective self-experiment which has a big payoff for health, performance, and longevity (1:05:35).
  • Using the Wim Hof method towards improved management of blood glucose metabolism (1:09:11).
  • Ketogenic dieting and why aiming for overall stability in blood glucose regulation is among the most important health strategies (1:11:01).

Thank Chris and Tommy on Twitter for this interview.
Click here to let them know you enjoyed the show!

Christopher Kelly & Tommy Wood, Nourish Balance Thrive

Machine Learning Applied in Functional Medicine

  • Nourish Balance Thrive Test: This recently developed 7 minutes questionnaire-based test is able to detect performance issues in athletes. It serves as a filter for which aspect of optimizing performance an individual should focus on improving the most. Give it a try!
  • Short Explanation Video: How the Machine Learning test uncovers underlying root causes of physiological weak-points which are holding athletes back from their peak performance.

Recommended Self-Experiments

Monitoring Blood Glucose

This experiment involves tracking measurements of glucose (blood sugar molecules) concentration in your system. It reflects the body’s ability to properly metabolize food and feed cells with essential energy in the form of glucose molecules. Fasting glucose means testing first thing in the morning before eating anything. As such people are enabled to follow overall functioning of the body’s energy metabolism – whether glucose levels are used up in a stable way.

By making use of continuous glucose monitoring (see below), more specific information about glucose metabolism can be derived. For example, Chris has detected that elevated levels of blood glucose after a meal (post-meal glucose spikes) are sufficiently reduced when he takes a walk after eating. He has also discovered that intense exercise drives his glucose levels up to 180 milligrams/deciliter meaning that eating food is not the only reason for elevated glucose concentrations.

Tracking

Biomarkers

  • Glucose Tolerance Tests
    • Fasting Glucose: One of the most researched biomarkers in human health. Optimal fasting glucose levels are between 83 to 88 milligrams/deciliter.
    • Fasting Insulin: The cells in the pancreas release insulin into the bloodstream in response to increases in blood glucose concentrations. Insulin functions to enable the intake of glucose from the bloodstream into the cells of your body. Optimal fasting insulin is above 5 microunits per milliliter.
    • Hemoglobin A1C: One of the most useful markers in testing for glucose intolerance. Its interpretative power comes from the connection between glucose and hemoglobin – the protein in red blood cells (RBCs) which carries oxygen. Because RBCs live approximately 3 months, Hemoglobin A1C reflects the average blood glucose levels over this period. Higher levels of hemoglobin A1C indicate poorer control of blood glucose levels with optimum HbA1c levels being below 5%.
  • Lipid Profile Panel
    • High – Density Lipoprotein (HDL): The traditional measure of ‘good cholesterol’ used by doctors and healthcare. For example, levels above 60 mg/dL are protective of cardiovascular disease.
    • Low-Density Lipoprotein (LDL): The traditional measure of ‘bad cholesterol’. Less than 100 mg/dL is an optimal level, while levels between 160-189 mg/dL increase the risk for cardiovascular disease.
    • Lipoprotein(a): Lipoprotein molecules carry cholesterol and similar substances through the blood. Tests can measure a specific type of lipoprotein called lipoprotein-a. Higher levels of this marker imply risk of artery damage. Dr. Kahn states that in most labs normal reference ranges for lipoprotein(a) should be under 30 mg/dL.
  • Thyroid Functional Test Panel: This panel of tests typically includes testing for circulating levels of thyroid hormones such as Thyroid Stimulating Hormone as well as the thyroid hormones triiodothyronine (T3) and thyroxine (T4). Proper functioning of the thyroid gland is key to athletic performance. The thyroid serves as a regulator for speeding up or slowing down human metabolic processes (conserving vs. using up energy, based on energy availability).
  • Liver Function Tests: When liver functioning is physiologically stressed, the blood levels of liver enzymes Alanine Transaminase (ALT)Aspartate Transaminase (AST), and Alkaline Phosphatase (ALP) get to a higher level.
  • Hemoglobin: The protein in red blood cells that carries oxygen throughout your body and is usually known for its role in diagnosing anemia – a sometimes serious health condition characterized by low oxygen delivery throughout the body. Because the Nourish Balance Thrive team strives to enable athletes to perform optimally, the team sets hemoglobin ranges higher than the standard upper ranges for eliminating anemia. As such, ranges are above 13 grams/deciliter in females and above 14.5 in males aiming for peak athletic level oxygen deliverability throughout the body.
  • The 25-hydroxy Vitamin D Blood Test: The most accurate way to measure how much vitamin D is bioavailable to your body is the 25-hydroxy vitamin D blood test. Optimum vitamin D levels range between 50-70 ng/ml.

Lab Tests, Devices and Apps

  • Differential Blood Cell Counts: includes measuring concentrations and important ratios between different types of cells found in blood including white and red blood cells, platelets, or immune system specific cells such as neutrophils or basophils. This is a very common test and differential diagnosis uses it – seeing whether particular aspects of a person’s physiology are functioning more strongly than others or if there is a need for follow-up medical tests.
  • Blood Chemistry Panel: This test includes measuring of blood chemistry parameters including sodium, potassium,  glucose, urea nitrogen, creatinine, total protein, albumin, globulin, cholesterol, triglycerides, total iron and other markers. This is also a very common test which serves to examine the overall physiological functioning of organ systems which are most important in human health.
  • Dried Urine Test for Comprehensive Hormones (DUTCH): A lab test which uses mass spectrometry analytical methods. These methods are significantly more precise in measuring hormone levels compared to blood or saliva tests – most of which use antibody-based immunoassay analytical methods. Mass-spectrometry also allows for comprehensive analysis of metabolites of hormones and thus provides a more – comprehensive physiological picture. For athletes, the Nourish Balance Thrive team suggests that optimal scores are above 4 points, considering the test’s internal reference ranges for providing scores on hormonal balance in a person’s body.
  • Organic Acid Test: This test provides an accurate evaluation of gut yeast and bacteria functioning, thus offering a snapshot of an individual’s nutritional and metabolic profile.
  • GI-Map Test: Stool testing which uses DNA sequence analytical detection techniques of gut microorganisms including opportunistic organisms, normal gut bacteria flora, parasites, and fungi. The strong confidence in results stems from the ability to quantify the amounts of specific individual microorganisms instead of merely detecting their presence in the gut.
  • Comprehensive Stool Analysis: A test which measures key markers of digestion, nutrient absorption (intake into the bloodstream after digestion), and inflammation in the gut.

Tools & Tactics

Diet & Nutrition

  • Ketogenic Diet:1 A high fat, moderate protein and low carbohydrate diet. This diet is particular in that it changes the metabolism so that it burns ketones instead of glucose for fuel. 2 A ketogenic diet usually leads to elevated fasting glucose levels but it would be a mistake to apply standard fasting glucose reference ranges for long-term ketogenic dieters. This is because fasting glucose epidemiological studies do not consider special ranges for subpopulations of people who make use of a ketogenic diet.

Supplements

  • Matula Tea: A type of herbal tea which is potentially effective in removing H. Pylory – related gut dysbalances causing health and performance issues. This is a relatively low-risk intervention compared to taking antibiotics as first treatment.
  • Sulforaphane: A chemical found in abundance in broccoli sprouts that people can either grow at home or grind up the seeds. Sulforaphane can potentially eradicate H. pylori infections.

Interventions

Tech & Devices

  • Measuring Blood Glucose6
    • Pin-Prick Glucose Tracking Devices: The most popular and easily accessible devices for checking blood glucose. The most popular devices, and ones we’ve discussed before, are the Precision Xtra Blood Glucose and Ketone Monitoring System in the U.S. and the Freestyle Optium Neo Glucose/ Ketone meter in the UK.
    • Continous Glucose Monitoring (CGM): A device containing a small sensor just underneath the skin that measures glucose continuously (ex. every 5 min). A transmitter then sends wireless data to a receiver which displays glucose trends. One of the most popular CGMs on the market is the Dexcom G4.
  • FitBitThis company offers wearable devices which include cardiovascular fitness tracking. The Fitbit Surge is a fitness watch that offers GPS tracking, heart rate monitor, all-day tracking, and sleep tracking. The Fitbit Charge HR monitors physical activity and sleep quality.

Other People, Books & Resources

Organizations

  • Quest Diagnostics: A company in the United States offering easy access to most of the basic lab tests, ex. blood cell counts or lipid profile panels.
  • Great Plains: A company which offers an Organic Acids Test (OAT) featuring testing of more than 70 markers from a urine sample.
  • Genova Organix: While the NBT team mainly utilize data from the company Great Plains, they sometimes also use data from Genova Organix because this company also offers organic acid testing and some clients have already done it.
  • Diagnostics Solutions: This company offers the (Gastro Intestinal) GI-Map Test and are among leaders in the field of precision genetic profiling of gut microbiome.
  • Doctor’s Data: A company which offers stool sample test featuring testing of microorganisms functioning in the gut flora.
  • 23andMe genetic testing: The largest personalized genetics company offering direct to customers testing. Analogous to the Nourish Balance Thrive test serving as a strategic filter, 23andMe genetic testing also does not lead to diagnostic results but focuses on guiding individuals to focus on specific aspects of their health and performance.
  • Regenerus Labs: This company is in the United Kingdom and focuses their services in the area of functional medicine. The company is discussed in the context of there currently being difficulties in obtaining functional medicine – relevant tests in countries other than the US.
  • Doctor’s Data: A laboratory testing company which offers heavy metal burden, nutritional deficiencies, gastrointestinal function, cardiovascular risk, liver and metabolic abnormalities testing profiles.

People

  • Dale Bredesen: An expert in the mechanisms of neurodegenerative diseases including Alzheimer’s disease. He offers courses in his approach to treating this health condition.
  • Ben Greenfield:7 A professional competitor and endurance-training athlete. Previously Chris has discussed the story of his health decline and recovery on Ben Greenfield’s podcast and this story has strongly resonated with listeners who are athletes.
  • Robb Wolf:8 A former research biochemist who is quite influential in bringing Paleo to the mainstream.
  • Jeremy Howard: Offers courses for people who have basic coding skills but are beginners in the machine learning field. Compared to Chris, Jeremy uses a different sub-branch of machine learning known as Deep Learning which is currently very popular. Tommy discusses how Deep Learning can help to detect lung cancer from Computer Assisted Tomography (CAT) scans of people’s lungs.
  • Bryan Walsh: A naturopathic doctor who produces a youtube video series on interpreting blood chemistry results, as part of the Wellness FX company. Brian has previously participated in Robb Wolf’s podcast discussing adrenal fatigue and the effects of low cortisol.
  • Chris Kresser: Works in ancestral health, Paleo nutrition, and functional and integrative medicine.
  • Mark Hyman: A doctor in the field of functional medicine who works to tackle the root causes of chronic disease.

Books

  • The Master Algorithm: A book written by Pedro Domingos in which he discusses the applicability and future potential of machine learning. Previously he has been on the Nourish Balance Thrive podcast to discuss how machines can learn. 

Other

  • NIH PROMISThe National Institute of Health has sponsored the development of the Patient-Reported Outcomes Measurement Information System. This is a set of person-centered measures that evaluates and monitors physical, mental, and social health in adults and children. Based on personal experience with athletic performance and informed intuition about health, Chris selected the questions which are part of the Nourish Balance Thrive machine test from this free NIH PROMIS database of questions.
  • XGBoost: The algorithm used by Nourish Balnce Thrive to develop their test in the field of functional medicine. This algorithm is most popular among the Kaggle community. Kaggle is a place where the world’s leading practitioners complete (usually, but always, for a prize) to solve machine learning problems. The particular model of this algorithm used by Chris does not require much computing resources in order to train the models.
  • fast.ai: Jeremy Howard’s website where he teaching online courses in Deep Learning. While Deep Learning turned out not to be the algorithm applied in the Nourish Balance Thrive project, fast.ai DeepLearning courses are useful for machine learning practitioners of any type. Most Deep Learning applications are computationally expensive and require more than only your laptop to perform. For example, you might have to sign up to Amazon S3 data storage services and purchase computer hardware (likely from the company Nvidia) in order to be able to train models using Deep Learning algorithms.
  • IBM Watson Health: Overview of healthcare applicability of the IBM Watson’ artificial intelligence platform. Functional medicine differs from traditional medicine in that it focused more on personalized, integrative and preventative health. It might be argued that IBM Watson’s program is, in fact, using traditional medicine approaches while adding machine learning as another layer of understanding patterns in health.
  • Artificial Intelligence in Medicine Conference: Chris attended this AI conference, focused on using Deep Learning to uncover the root causes of chronic disease. One main argument discussed was that root causes may be less important compared to being able to diagnose health issues and apply treatment solutions. However, while machine learning is powerful in diagnosing health issues, it remains a tool which requires an understanding of the process.
  • Google Deep Mind: By analyzing million hand-labeled images of diabetic retinopathies (damage in the eye caused by high blood glucose levels), the team created a learning algorithm that predicts diabetic retinopathies better than a human could9 The same potential science can also be applied in preventative medicine measures – by integrating diet, exercise and lifestyle factors to study, for example, prevention of diabetic retinopathies.
  • Python: The programming language Chris uses which is a language that is readable and non-obscured in any way – thus offering user-friendly access to programming.
  • AmazonYahoo: Chris has worked in these companies which use machine learning to optimize their business in analytical ways.

Full Interview Transcript

Click Here to Read Transcript

(0:04:23) [Damien Blenkinsopp]: Hey Chris and Tommy, welcome to the show.

[Christopher Kelly]: Thank you for having us. I am delighted to be here. It’s a privilege and an honor. I’m a long time listener, so it’s very exciting to be here.

[Tommy Wood]: Yeah, likewise.

(0:04:33) [Damien Blenkinsopp]: It’s awesome. Yeah, having seen you guys at various conferences over time and obviously having many discussions, it’s about time.

So today we’re going to dive a little bit into machine learning, because you guys have been playing around with that. Chris and Tommy, what is machine learning? Is it the same as artificial intelligence?

I think, first of all, we’d better just give a bit of background. I think what people are looking at in the news and everything you could think it’s anything, and maybe nothing, and maybe it’s the end of the world, Terminator style, pretty soon. So what is it really, and what is it today?

[Christopher Kelly]: That’s a really good question.

I get the sense that people are starting to use the term ‘Machine Learning’ like people used the term ‘Internet’ in 1999. There were internet companies popping up all over the place. And there are machine learning companies popping up all over the place now and I think that maybe is a bit of a warning sign that maybe there’s some hype going on here.

Like anything else, machine learning is just a tool and really what you care about is the application. So I think that’s maybe an important point to note.

I should make it clear that I’m a practitioner of machine learning, and not necessarily an expert of the academic sort. And this may be important for people listening because I want to encourage people to take part in this activity, especially if you’re already a code or computer programmer of some sort.

I would say that you need to know how the controls work.

Imagine you’re driving a car. It’s important that you understand what happens when you turn the wheel, and it’s important to know what happens when you press the pedals but you don’t necessarily need to know how internal combustion works in order to drive the car. And I think the same is true of machine learning; it really doesn’t need to be very, very complex unless you’re going to be researching and developing new algorithms.

So to answer your question specifically, machine learning, in my mind, is a sub-branch of artificial intelligence.

And I spent most of my life writing computer programs, very carefully, by hand coding algorithms. IF-THEN-ELSE, that type of construct that some people will be familiar with. In machine learning, I’m doing something different.

Over the last three years, we’ve collected lots and lots of data–about 100,000 total features–from about 1,000 athletes. And then I’ve used that data to train an algorithm. So I’ve shown an algorithm many, many examples of the pattern that I would like to identify in the future, and then the machine–it’s kind of a funny thing to say–learned how to predict the patterns that I was interested in.

At no point did I ever hand code an algorithm, and I think that’s what makes machine learning different from regular programming.

(0:07:29) [Damien Blenkinsopp]: Thanks for that overview, Chris.

So what is artificial intelligence?

I’ve seen a lot of the hype. I can tell you, I go to conferences now and a lot of start-ups are talking about adding machine learning and AI to their apps just to be a bit cooler and to attract investment and so on. So there’s definitely a bit of hype around it, which I think is why it’s worth talking about.

In contrast to machine learning, which is what you’ve been doing, what is artificial intelligence?

[Christopher Kelly]: Yeah, that’s a good question I would rather not answer.

[Damien Blenkinsopp]: Okay, yeah it’s fine. We can explore it in a later podcast.

This is a topic I’ve been fascinated with and digging into. And I know it’s pretty complex. So, let’s just skip that one, shall we?

[Christopher Kelly]: Yeah.

(0:08:06) [Damien Blenkinsopp]: Right. So one of the unique things about what you’ve done is you’ve applied it in the area of functional medicine, which I don’t think I’ve seen done before. We’ve started to see a few applications for health.

But what do you think, if you’re looking at the area of health, where do you think it could be applied usefully just from how you’ve got to it? So you’ve done it for prediction of results. Is that the main area you see it as useful? Or are there other areas which you see that it could be applicable?

[Christopher Kelly]: Oh no, so yeah. Our application is just one tiny thing.

So to give people a bit more background, we’ve worked with about 1,000 athletes over the past three years, and the way that we’ve helped those people is we’ve uncovered the underlying root causes of the things which are holding them back from their peak performance.

We’ve used blood chemistry, and urinary organic acids, and urinary hormone testing, and then also stool microbiology, and then also PCR DNA analysis. And obviously it’s quite difficult to get some of these tests done. Blood chemistry is ubiquitous, obviously, but the other tests I talked about are quite difficult to get done. And they’re also quite expensive.

So the thing that I would like to achieve is first to make it much easier to do our program. See, you know, can I predict the results of these tests without you doing them. And then of course potentially it could bring the costs down in the long-run.

So when someone does one of our tests, somebody in a lab somewhere is putting a sample into a machine. And they’re doing some mass spectrometry, obviously that’s an expensive machine that is taking somebody’s time, and that costs money.

So one of the things I think that machine learning will be able to do in medicine is reduce the cost in the long term. And then it will provide greater access to people who perhaps might not otherwise be able to get a hold of these fancy tests.

[Damien Blenkinsopp]: Right, so it’s like a filter, so that people don’t necessarily have to do all of the tests.

Because when we look at the functional medicine process today, basically a functional medicine practitioner takes your history, right. He talks to you, and then he decides on an array of tests. As you said, this can be pretty expensive depending on how many you’re going to run.

And I think that’s one of the biggest issues for functional medicine right now, for it’s greater acceptance. Some people basically can’t afford the tests that they’re being told to do.

So what you’re saying is you’ve used a questionnaire that you give people, and you’re using the data from that to predict what the results would be in the tests.

(0:10:47) [Christopher Kelly]: Yes, exactly.

So we have 53 questions which form part of our standardized health assessment questionnaire. Those questions I chose personally from a large data bank of questions that are available online for free. It’s the NIH Promis data bank of questions.

And it’s a whole other story that I won’t get into now, but I was not feeling good in 2014. I chose these questions based on the way that I felt. Some of them were very relevant to me, and then others that I saw in the data bank I thought, well now that’s not really right.

They’ll ask you things like, ‘I was so tired I couldn’t get out of the bath.’ Or, ‘I couldn’t even leave the house, I didn’t have enough [energy].’ So this sort of chronic fatigue type questions. And I was definitely feeling bad, but not that bad. So I selectively cherry-picked these questions from this data bank.

Then we had 1,000 athletes go through our program. It almost became a standing joke that we would see the same person and the same problems over, and over, and over again.

So that’s what got us thinking. Is there some way that we could predict the results of these fancy tests using just these 53 close-ended questions that you could answer in seven minutes by clicking on radio buttons.

[Damien Blenkinsopp]: Right, so you’ve been giving that selection, your cherry-picked selection of questions, to everyone that you’ve worked with over the last three years.

[Christopher Kelly]: Exactly right.

So, everybody that’s been through the program, they’ve done [it]. We’ve worked a bit differently maybe from some other functional medicine providers that you’ve met in the past in that we always do the same set of tests.

Obviously, each person is unique. They have their unique history, situation, and goals. But the tools that we use to identify the underlying root causes don’t vary much from person to person. We use the same set of tests on everyone. And then at the same time they do the tests, we have them do the health assessment questionnaire.

I always have that data for every single person that goes through our program. So that’s how I was able to train the machine. I had the 53 close-ended questions and then alongside that, I have all the blood chemistry, the urinary organic acids, the DUTCH test, the stool culture, the stool PCR test.

So if you can imagine a great big spreadsheet with all of these things in columns. Then the final thing I’m trying to predict is do you have circadian dysregulation, or do you have gut dysbiosis, or do you have a glucose tolerance problem, or do you have an oxygen deliverability problem?

So that’s a higher order function that I’ve calculated using some of the other biomakers which form the columns of the spreadsheet.

(0:13:36) [Damien Blenkinsopp]: Okay, excellent.

Could you just go through the lists of tests you used? Because we talk about tests all the time on this show, so people will have run into them in past ones, and so on. So what’s the blood chemistry you’re running specifically?

[Christopher Kelly]: Sure. Do you want to talk about the blood chemistry, Tommy, because it was largely you that designed that panel.

[Tommy Wood]: Yeah. So we’re obviously based in the United States, and most of the blood panels are run through Ulta. So you do the tests at Quest Laboratory. And it’s stuff that people will be very familiar with.

I’m a big fan of doing the basics, because we know the basics work, and that include doing the history. So everybody comes in and does the history; that’s really important and sort of gave us the basis for how we could predict some of the results, like Chris was talking about.

And then the blood tests are a basic blood count, an extensive thyroid panel, a liver function test, a kidney function test, there’s calcium and [unclear 0:14:32], vitamin D, insulin, HbA 1 c, fasting glucose, and basic lipids test.

All the things that people will be familiar with that they can get from their doctor. And it’s also something that even if somebody is not in the United States it’s usually something they can get locally as well.

So those are the real… We cover those basics just because we know what they mean and how they apply to the physiology. Then it gives us some grounding to then expand into the newer tests.

[Damien Blenkinsopp]: Excellent. And so the newer tests you’re talking about, is that The Great Plains?

[Tommy Wood]: Generally. We do have some data from the Genova Organix, because some people have done that too, but it’s mainly The Great Plains organic acids test.

Then, like Chris mentioned, we do the urinary hormones, the DUTCH. The stool tests that we’re currently using are the Doctor’s Data–a comprehensive stool analysis with parasitology–and the Diagnostics Solutions GI-Map with the PCR. That’s the whole panel.

[Damien Blenkinsopp]: Right, great. So you’ve taken this data for everyone, and what you’re saying is you’ve seen correlations which will lead to five different outcomes that you’re looking for. Five problems to target.

(0:15:47) [Tommy Wood]: Yeah, so what the machine learning particularly–and Chris knows more about this than I do, definitely–what it’s really good at doing is predicting patterns. There’s the well-known example of the algorithm that was trained to identify lung cancer on X-rays, and it was able to do that better than the best radiologist in the world.

So if you give it enough X-rays which say this X-ray shows lung cancer then it learns what that looks like. And then you give it future X-rays and then it says okay this is lung cancer, this isn’t lung cancer. And it can do that more or better, more accurately, than a human radiologist can.

So, this makes me think of a time Chris and I went to Dale Bredesen’s training course last year to learn about how he treats Alzheimer’s disease. And Chris stands up and tells Dale Bredesen’s personal radiologist that at some point machine learning is going to make radiologists completely irrelevant because the machines are going to be able to do all the radiology for us.

That’s what machine learning is really good at. So if we give it specific patterns we want to look for, and the ones that Chris mentioned were low oxygen deliverability – that’s basically just another word to describe lower than optimal hemoglobin, which people probably will have heard of.

Then we talked about glucose intolerance. That is three different predictions in one group; so it’s high fasting blood glucose, high HbA 1 c, and high fasting insulin.

We obviously have tighter levels than most people would probably think of. We’re talking above 88 milligrams/deciliter blood glucose or a fasting insulin above 5. So that’s kind of our level of where we’d like to see things.

Then, if we talk about the dysbiosis we’re predicting things like H pylori, or clostridium, or a general bacteria overgrowth, yeast overgrowth on the OAT, something like that. That’s based on the lab values that you get from, say, The Great Plains Organic Acid Test.

And then hormonal balances, so that’s low estrogen in females, low testosterone in males, again based on the DUTCH references ranges. And then circadian dysregulation, which is basically having a cortisol marker outside of the normal range at a given time point during the day. Again on the DUTCH you need at least a 4 point. Now it can be a 5 point if you take a sample in the middle of the night.

So based on all of those things, we can kind of drill down, and the machine will tell you what the ranking of those different problems is for you. So maybe glucose intolerance is the most likely issue that you have, and then it will rank the other ones too.

Then sort of the back-end we can look at the percentages, and we know how accurate the machine is at predicting each individual thing. Have like a sensitivity and specificity for each individual one, so we know how accurate it is, and what the likely issue is. And that means we can get people started very quickly.

Because we know if someone’s going to come to us with blood glucose dysregulation. We take a little bit more of a history and we know exactly what we need to do. We don’t need to do any blood tests first because we know what issues there are going to be. We can start people very quickly without them having to do all the tests first.

(0:19:04) [Damien Blenkinsopp]: Yeah, excellent.

The only one I don’t think we’ve come across before is low oxygen deliverability. Could you give us a little bit more background on that? Where does it come from, and what type of people have it?

[Tommy Wood]: Yeah, basically it’s based on hemoglobin.

People will have heard of hemoglobin when it comes to anemia. So if you have low hemoglobin–that’s the protein in your red blood cells that carries oxygen–then you’re considered to be anemic. It’s one of the markers of anemia. So people may have heard of that.

We have ours slightly higher. We know what levels athletes need to be at in order to perform optimally; so it’s above 14.5 grams/deciliter in males, above 13 in females. So those are higher cutoffs. Those don’t define anemia, but it defines what we’d like to get an athlete to if we can so they can perform optimally.

So we don’t call it anemia because we’re not detecting anemia. We’re detecting low oxygen deliverable, which is basically your blood doesn’t have as much hemoglobin as it could hopefully have. This means that you’re not delivering as much oxygen. You don’t have the capacity to deliver as much oxygen as you’d quite like to.

So the phrasing is important because we’re not detecting frank anemia. We’re detecting something else that we know is important for athletic performance because power output tracks very nicely with hemoglobin. So if you can increase that, you’ll definitely increase somebody’s athletic performance.

(0:20:28) [Damien Blenkinsopp]: Right, excellent.

And that brings us to a very important point of where your data comes from, and what the focus of it is.

I understand that data set of people that you have is quite important. You have to be quite careful of the selection and use of it. Why is it that important?

[Christopher Kelly]: So I’ll take that. I think it’s really, really important.

I went on to the Ben Greenfield podcast in 2014 with another one of my doctors – Jamie, my founding medical doctor, she’s a pro mountain biker. And I told this story of my health decline and then recovery and the use of some of the testing that we’ve talked about so far in that recovery.

And that story resonated with a particular type of athlete that listens to then Ben Greenfield podcast. And they were the people that came forward to work with us. I also talked on the Robb Wolf podcast and from my perspective, it was difficult to identify the two different types of people.

They seem to be very similar in their personality and their problems and their goals. All completely wonderful people and I’ve had a fantastic time over the past three years. But I already mentioned that I cherry-picked those questions out of this huge data bank of questions that were supposed to be for all people and all things.

So I think that the algorithms would not be particular good at predicting the results of these tests of people who didn’t fall into that same category. I don’t know, I haven’t tested this. But that is my suspicion because remember we said that machine learning was teaching a machine how to learn based on labeled examples.

So when Tommy talked about the X-rays there, a real radiologist had labeled this X-ray as this one is a malignant tumor, this one is not. And in my data set, we’ve said this one has low hemoglobin, this one does not. And we’ve taught the machine how to learn to identify this pattern using examples.

If I then went into a completely different population of people, let’s say people who only had chronic fatigue syndrome, well they might answer something completely different to my health assessment questionnaire. And so I don’t know whether I would be able to predict with the same accuracy.

I think this is something that we should experiment with.

(0:22:47) [Damien Blenkinsopp]:And when you’re going into this, how can you re-validate it for the other populations? Is that something you’re going to be doing on a long range basis, or how does that work? I imagine for some people you’re going to be collecting test data as well, rather than simply relying on the questionnaire for everyone.

So how do you see this going forward? How do you think it might work on insuring that it’s continuing to be valid? Is it going to be continuing to machine learn, or have you basically done a cut-off based on the training it’s already had?

[Christopher Kelly]: Sure. The analysis is already live on my website, and so I’m collecting some data already through people who are just visiting my website and seeing the analysis there, and taking it.

And then I’ve also spoken on a few different podcasts about the analysis. For each podcast that I’ve spoken on – and I should do the same for this one – I will provide a custom link that you can find in the show notes and that custom link allows me to identify the source of the traffic.

By definition, you are a particular sort of person if you listen to The Quantified Body podcast, and I think that might be important in the predictions. So the custom link, I think, is going to be really important. And it’s only once I’ve collected a certain amount of data will I be able to say this is a very strong prediction and maybe this is not so good.

And of course some of the people that do the analysis will go on to do the real tests. You can get started more quickly when you do the analysis, but for now we’re still doing all of the tests. So once I get back the real data – the real blood chemistry, the real urinary organic acids, all of that – I’ll be able to compare what the machine predicted versus what we actually tested.

Now, I’m not really expecting any surprises for some groups of people because when I was training these models, I deliberately held out 20% of our data. So I said we had data from 1,000 athletes. I held out 20% of that, set it to one side and then I only used that data once I had finished training the models. So I used that to test the models, and so that’s how we know how accurate they are.

I wouldn’t be here talking about it if I didn’t think the models were any good. And the reason I know they’re so good is because of this held out data set.

[Damien Blenkinsopp]: Great. And so, does it give back a correlation or something like that? Did you get a number like this is 90% accurate with the last 20% you used, or something like that, to give you that confidence?

[Christopher Kelly]: Yeah. So, Tommy, do you want to talk about the sensitivity and the specificity of the tests?

(0:25:31) [Tommy Wood]: So people maybe have heard of sensitivity and specificity, which is basically something we often use or calculate in medicine if we’re comparing a new test to a gold standard test. This is exactly what we want to do.

And basically the sensitivity tells you the likelihood that a positive result is truly positive. And the specificity tells you the likelihood that a negative result is truly negative. So you want both sides of that coin.

You could say that if you have 100% sensitivity, you’ll pick up everybody who is going to be truly positive about one thing. But if you don’t have any specificity then you’ll have loads of false negatives. There are lots of ways to balance that out. So you want both to be, essentially, as high as possible.

We have an output from the algorithm; for each individual prediction we have a sensitivity and specificity. So I’m looking at one right now. Our H pylori prediction has 100% sensitivity and a 98% specificity. That’s basically gold standard test. That’s as good as doing the real test.

Some of the other things are not going to be as accurate. Bacterial overgrowth has a 94% specificity. So they’re up there; I think the lowest one is maybe in the 80% in terms of specificity. If somebody has a negative prediction there’s a small chance they might still have a yeast overgrowth on the actual test results.

So it’s really close. It’s at the level where you could say that we’re close to being able to predict something as well as the test would be able to.

[Damien Blenkinsopp]: Wow. That’s pretty impressive. Just through 53 questions.

[Tommy Wood]: I just have to say that I actually couldn’t believe how good this was. And Chris has run it multiple times.

So originally we were going to do tests or predict urine results and stool results from blood test results. Then eventually we sort of worked our way back, and we got to the point where we were just using the questions. And it’s almost too good to be true, but I promise you it is actually true.

[Christopher Kelly]: That was my original idea. I thought blood chemistry is ubiquitous; anyone in the world – or that’s not true, but most people have access to blood chemistry. If you give me your CBC, for example, can I then predict the arabinose, which is a marker of candida overgrowth on the urinary organic acid test? Because that would still be quite cool.

And it turns out that does work, but what works even better is just me asking you these 53 close-ended questions.

(0:28:05) [Christopher Kelly]:But one thing I’d like to point out is there are five different answers, 53 different questions. So I believe that is 5 to the power 53… It’s 1 times 10 to the power 37 different permutations. So that’s a lot of different ways to answer this health assessment questionnaire It’s really a lot.

[Damien Blenkinsopp]: Right. It’s like this huge tree of permutations that’s going on there.

[Christopher Kelly]: Exactly.

[Damien Blenkinsopp]: So you’re getting people to take a lot of different paths, and eventually they’re coming to one outcome. So that’s where that specificity is coming from, from all of those permutations you’re driving them through.

[Christopher Kelly]: Right, exactly.

And that’s exactly how this particular algorithm works. We’ve used this algorithm called XGBoost, which is very popular from the machine learning website I would encourage people to visit called Kaggle.

Kaggle is a place where you could launch a competition and have the world’s leading practitioners compete – usually for prize money but not always – to solve your machine learning problem. And XGBoost, the algorithm that we used, has been a constant winner in the Kaggle space. And that is exactly how it works; it’s a boosted decision tree.

So, think about what happens when you call up the electricity board; you get presented with all these different options. You have to press one for customer service, two for sales, and all of that. So you can see that pans out into a decision tree, and that’s exactly how our XGBoost algorithm works. It’s a large number of these small decision trees.

(0:29:36) [Christopher Kelly]: And another really interesting thing that’s so simple it’s almost worth not talking about, and you can’t believe how well it works.

Each one of these small decision trees, they’re slightly better than chance. So if I’m trying to predict the results of a coin flip, then it gets it slightly better than chance. And it turns out that when you have thousands, or even millions, of these small decision trees that are slightly better than chance. And you combine them all together amd get a really strong learner that’s very good at predicting things.

So that’s how this algorithm XGBoost works.

(0:30:12) [Damien Blenkinsopp]: Great.

Chris, I know you’ve been going through artificial intelligence and machine learning for a few years now. I was just wondering if you could talk a little bit about your experience in this. You ended up choosing this particular approach to it.

Was it easy when you jumped into it and you wanted to learn it? I myself have been looking at it, also, because it’s this whole new world with all this potential. How have you found it? How has your journey been through it?

[Christopher Kelly]: I’m glad you asked that question, that’s a great question.

I have an undergraduate degree in computer science, and I’ve worked my whole life for big tech companies. I’m 41 years old now, and I’ve worked for Yahoo – they were the company that brought me from London to Sunnyvale to their headquarters. I’ve worked for Amazon. And I’ve worked for a search company within Amazon, and I’ve worked for two hedge funds.

All of those companies make heavy use of machine learning, but somehow the technology evaded me for the longest time. And the reason was, every time I tried to get into it I just found the subject matter so incredibly dry.

So if you go and read some academic papers on some machine learning algorithm, typically what you encounter is an abstract, or a small amount of text at the beginning of the paper that makes a lot of sense. Then you turn to page two and there’s this wall of equations, and you’re like, okay. And then you just put page one back on top of page two, move it to one side, and carry on hand coding your algorithm.

And that’s just been the way with the academic computer science community. It seems to be dominated by people who are very strong in mathematics and mathematics is the language that they use to communicate. But it’s not necessarily the best language for all computer scientists.

And so I’ve found some other resources very, very helpful. In particular, Jeremy Howard has been running some classes in San Francisco designed exactly for people like me. Luckily, those classes are now available online. And those were wonderfully helpful.

And it turns out that Jeremy Howard is using a different sub-branch of machine learning. He’s using something called Deep Learning, which is very, very popular at the moment. I had tons and tons of fun.

So Tommy mentioned the trend to identify the malignant tumor on an X-Ray; it’s a Deep Learning algorithm that’s doing that. So it’s different from what we’re using. We’re using XGBoost.

So Jeremy is arguably more state of the art, but he’s solving different types of problems. Deep Learning is better at solving these computer vision problems, and other things too.

So those courses, I think, were absolutely fantastic. That was what allowed me to get past this wall of mathematics and become a machine learning practitioner.

[Damien Blenkinsopp]: Excellent, thank you for going into that, because I think it would be amazing if more people started to apply this to health and functional medicine. And there’s a lot of listeners on this show – entrepreneurs, venture capitalists, and all sorts of types – who might find it a little bit easier and approachable knowing that there are ways around that.

(0:33:17) [Damien Blenkinsopp]: Another thing I wanted to do on this podcast is take the people listening through a practical walk-though of how it’s being used. So people are going to click on this link and go to the page where it is, and then what happens?

[Christopher Kelly]: Sure.

I’m a very visual person; I like to learn with audio and visual stuff. So I’ve paid someone to make some whiteboard explainer videos, because obviously this stuff is complex. So there’s a video, if you come to the show notes you can see the video. It’s the whiteboard explainer video that hopefully summarizes things that we’ve been talking about and explains how these things work.

And then as you go through the analysis, it’s really quite simple to do. All you do is you click on radio buttons and answer the questions. I’m going to ask you things like: ‘In the past seven days I’ve felt tired.’ And then the answers will be something like always, sometimes, never. I can’t remember the five different permutations, but you just answer the questions honestly.

They’re grouped into sub-categories that you’ll recognize, and anyone who has spent any amount of time not feeling good will recognize these questions intimately, I’m sure. And that’s it really.

Just walk through for seven minutes, and then at the end you’re presented with the results, which, as Tommy alluded to slightly earlier, we don’t give you the output of the model because it’s kind of confusing. You need to know quite a lot about how the model is made in order to interpret the output. It’s actually talking in probabilities, which are quite difficult to understand.

So the model is going to say whether it thinks you probably do match the criteria or you probably don’t. It’s mostly a binary classification.

(0:34:59) [Damien Blenkinsopp]: So to just highlight that point.

Basically as Tommy was saying earlier, it’s going to highlight whether you’re in a specific range in one of the tests. Is that the output for you guys? It’s going to say there’s this risk of H pylori, for example?

[Christopher Kelly]: Yeah, that’s exactly right.

The gut dysbiosis model, for example, is a composite of the H pylori prediction, the bacterial overgrowth, and yeast overgrowth. So we just lump all of those things together and call it gut dysbiosis. And so if the model thinks that any one of those things is true, then it’s going to predict a binary classification for the most part.

So we kind of argued about it–not argued but debated it–for a while about what we should show the user. In the end what we went for was just a rank. What you see on the results page are the things that the model thinks are most important for you. Because it’s kind of hard to interpret the output of the model, this probability as a percentage.

[Damien Blenkinsopp]: Right. So, I went through it myself, and you have the display of the five areas. And then it looks like a percentage, basically, right?

[Christopher Kelly]: Yes, that’s the number that in the end we decided to hide from the user, because it was confusing.

And so we can still see on the back-end, but for the user now what they’re seeing is just the rank of things. So these are like the order of importance of the five different categories.

[Tommy Wood]: Damien you used a slightly earlier version where you could still see the percentages.

It eventually turned out that that was becoming kind of confusing. So we thought that people could just focus on what the most important thing is, and that’s how people would then follow up through the system. But we have obviously all of the data to help.

[Damien Blenkinsopp]: I see. So it’s just going to highlight one of the items that is the most important to look into, for example if low oxygen deliverability is the thing you should focus on. Is that the point?

[Tommy Wood]: Yeah, well, you’ll get your ranking for all five. The order of importance for all five. So you’ll get some follow up, that Chris can tell you about, and that will be based on whatever was ranked number one.

[Damien Blenkinsopp]: Okay, got it.

And that’s the use of the tool, really, helping people to focus on the area. I mean, I used to talk about DNA tests like 23andMe as something useful to help you focus on things.

It’s not entirely accurate, it doesn’t give you a diagnosis or anything, but using it as a strategic filter to say: ‘There’s a lot of things popping up in lung cancer risk in my genetics, I should probably have a deeper look into that.’

So it sounds like you’re kind of proposing this to be used in the same way. Basically it’s a strategic device to look at where should I focus my efforts and have a look more into it.

[Tommy Wood]: Yeah.

(0:37:49) [Damien Blenkinsopp]: Great.

Have you got any case studies of people who have used it already? Anything that’s come out of it since you’ve been playing around with it?

[Christopher Kelly]: No. It’s totally brand new. In fact, just this morning I just signed up our first client who is a British guy living in Spain. So he could do it; it’s still possible to get the tests done, but it’s not easy. So…

[Damien Blenkinsopp]: It’s impossible in Spain. It’s really, really hard.

When I lived in Spain, I ended up moving to the United States because I got so frustrated. I was getting an MRI done and they gave me just the completely wrong results, and I thought, I’m done, I’m out of here. And I left, it was the end.

[Christopher Kelly]: Yeah, so that’s what we normally do. We do have clients from all over the world, and that’s what we normally say, ‘Can you come to the United States?’

And for most of the athletes that we work with, they can. So if you’re an IronMan Triathlete, for example, there’s a good chance you’re going to want to come to the United States for a race. And when you do the race, you can just stay in a hotel or an AirBnB, whatever it is. And then you can do all of the tests either at home or you can take a trip to Quest and get the blood drawn there.

So for this guy in Spain, I didn’t show him the exact output of the models, as we discussed previously. But when I looked on the back-ends, the models were really, really confident about several things which I know how to fix right away.

[Damien Blenkinsopp]: So it’ll be interesting to see how that goes.

[Christopher Kelly]: Exactly.

[Damien Blenkinsopp]: It’s incredibly good use case because so many people struggle with tests outside of the United States.

[Christopher Kelly]: Right.

[Damien Blenkinsopp]: It’s getting a little bit better in the United Kingdom now. There are some guys called Regenerus Labs who are doing a fair number of the functional medicine and other tests now by post and they handle that. But overall, it’s still really, really complicated, and I’m constantly getting questions about it.

This sounds like a really useful use case for it, for people who are also in Europe or even in places like this where they can’t get their hands on the tests in the first place.

(0:39:49) [Tommy Wood]: This is a really important part of the process. We think we can predict things with a very high degree of accuracy, but how well can we treat those things when we don’t have the full set of data. And we’re very confident that we can, but the only way you can find out is to actually do it.

Particularly with people who fit very nicely into the group that we used to train the data. So just more of the same kind of client that we’re used to working with and we get very good results with, that’s the ideal test bed. And then we can show that we can really do what we think we can.

[Damien Blenkinsopp]: Yeah. It would be really interesting to have you guys a few months or whatever down the line, once you’ve run it for a while and got some test results and some experience and so on.

And maybe it sounds like basically trial and error. You’ll just put someone through a program, say they’re living in Spain, and if it fixes him you’ll be like, okay, that worked. That’s a good data point for the model.

[Tommy Wood]: And maybe we’re just doing what Voltaire said, which is that we’re just entertaining the patient enough while nature cures the disease.

[Damien Blenkinsopp]: It would be great.

[Tommy Wood]: But in reality, I think we know how we would approach each of those different things. So if we’ve got a model that predicts something with a very high degree of certainty, then the likelihood that this person will see benefits based on what we suggest based on the algorithm is really, really good.

(0:41:12) [Christopher Kelly]: And we should talk about some of the interventions as well, because I think that’s important. It’s not like we’re predicting things and then asking people to take drugs that may have unwanted effects. We’re talking about lifestyle medicine here.

So let’s say the model predicted that you had a glucose intolerance problem. Well I can coach you, my wife can coach you, and any one of my coaches can coach you with how you can improve your glucose tolerance.

So you could do things like time-restricted eating where you only eat during daylight hours. That could improve glucose tolerance. Or you could move your body more. Maybe you could do some whole body resistance training that’s going to create an intracellular glucose deficit and make the glucose that’s in your blood go into cells more easily. And maybe that would improve your glucose tolerance.

Do you see what I’m saying? It’s mostly diet and lifestyle interventions.

[Tommy Wood]: Really low risk.

[Christopher Kelly]: Very low risk.

[Damien Blenkinsopp]: I’m guessing the ones where we get closest to actually some kind of medicine are gut dysbiosis, where you guys are using herbals and probiotics and things like that, primarily, aren’t you?

[Christopher Kelly]: Exactly. For example, this tea, there’s a Matula Tea. There’s a company on the internet that guarantees you that it gets rid of H pylori. And it’s very expensive, but they give you your money back if you send them a test and you’ve still got the bug.

And there’s other things like broccoli sprouts, sulforaphane, that people can either grow at home or just grind up the seeds. That may help with eradicating an H pylori infection. So fairly low risk compared to taking antibiotics, I would say.

(0:42:49) [Damien Blenkinsopp]: I thought we would take a little bit of the big picture look at this machine learning.

Having gone through this experience for yourselves, how transformative do you think machine learning could be? Or will not be, for that matter, for health over the next 10 years, given the examples you’ve seen? I know Chris, you’ve been to conferences and stuff and seen some examples as well.

What do you think the power of this is? Or isn’t?

[Christopher Kelly]: Oh yeah, I mean it’s going to completely revolutionize everything, I think. Almost everything. And it’s interesting that some of the jobs that I think are going to go are the white collar jobs.

So I know this from talking to Pedro Domingos, he’s been on my podcast. And I would highly recommend his book, The Master Algorithm, where he talks obviously in detail about this.

But it’s the white collar jobs, so anything where you’re doing something over and over again that doesn’t really require any manual movement. So some people I think mistakenly believe it’s the workers that are going to go, that they’re all going to be replaced by robots. But that’s not true.

When you look at, say, the skills of somebody building a house, those motor skills they’re using and their dexterity took millions of years to evolve. Computers haven’t got there yet. Whereas, identifying a malignant tumor on an X-ray, that’s just a pattern recognition thing that computers have already learned how to do.

So, if you’re laying bricks and mortar for a living, I think your job is safe. If you’re a lawyer or a radiologist, or somebody who issues patents, then I’m not so sure your job is safe. It’s very interesting.

[Damien Blenkinsopp]: I was reading a case study on J.P. Morgan and they were talking about deals, like mergers and acquisitions, and it was taking hundreds of thousands of hours of lawyer work before. Now it’s being done by a computer in a day.

[Tommy Wood]: There’s one thing we discuss a lot, sort of on the back-end. We’re basically it’s like we’re discussing things pretty much continuously. And one thing that comes up a lot, particularly as it relates to health, is the machine is only going to be as good as the person who is training it and the way that they train it.

So if you think about, I was reading something recently about how IBM’s Watson in health hasn’t produced as much or as fast as they thought it would. We wonder if part of the problem is the fact that you’re taking traditional medicine approaches and then just trying to add machine learning on top.

And as we know, the current approaches we have to chronic diseases or cancer aren’t necessarily the right ones. And these aren’t getting us anywhere as fast as we originally hoped. Because we’re still working around an acute care system for chronic diseases.

So there’s definitely the possibility that until we keep trying and failing this in various different arenas we’re just going to get the same wrong answers, but we’re just going to get them faster.

(0:45:48) [Damien Blenkinsopp]: Right. And I think Chris you brought this up in an email that sometimes the system we have is focusing on one marker, or is focusing on one diagnosis driven by one single input to that. There’s one reason why you get sick.

Whereas in the world of functional medicine we’re looking at a multifactorial, multicomplex, everyone is kind of different with different inputs, sort of problem situations. And from what I’ve seen with machine learning is it could be the answer to this because it will just look at all of the data and it will say if you look at these five things and how they vary, you get these different situations.

Whereas I guess the limitation of our human brain is we tend to focus on one thing and we’re just trying to say this leads to that, and it’s a linear fashion.

[Christopher Kelly]: Yeah, absolutely. So that’s a really good example, actually.

If you think about my analysis, most people could hold it in their working memory that maybe gas, bloating, and diarrhea might be related to gut dysbiosis. And a practitioner can hold that in their working memory.

But what about these 50 other questions? Maybe you can’t go for very long without eating, and that is a sign of gut dysbiosis. How many of these things can you hold in working memory at once? It’s really, really complex.

When I went to a conference last autumn, the Artificial Intelligence in Medicine Conference down at Dana Point, which overall was very good, I enjoyed my experience there. They where taking questions at one point and I asked the question, ‘Could we use Deep Learning to uncover the root causes of chronic disease?’

And the commentator, he turned to the panel and he said: ‘What do you think? Do you think we really need to understand the root causes, or is it just enough to be able to diagnosis the problem? Because once we have the diagnosis, then there’s the treatment, right? So do we really need to understand the root causes?’ And I just like put my head in my hands.

So it’s frightening because machine learning, obviously it’s so very powerful, but like Tommy said, it’s just a tool. You still have to understand how to use the tool in the most effective way in order to get the result that you’re looking for.

[Damien Blenkinsopp]: Absolutely.

A lot is going on in the world of health, right? Conventional medicine is starting to use big data and train algorithms and so on. But there’s not a lot going on in functional medicine, which is the area and the conferences which we explore more because it’s related to the origins of problems and so on.

(0:48:15) [Damien Blenkinsopp]: Have you seen any other examples of people trying to apply some kind of machine learning? It would be something I’d really love to see more of. I’ve been thinking about it for a little while, that’s why when you guys told me about this I was like, yes!

[Christopher Kelly]: Yeah, so, maybe part of the problem is that everybody thinks that they need big data.

When I was listening to some of these talks that were presented at this conference last year, there were hospitals there who were doing 16,000,000 blood tests per month. That’s probably more than Nourish Balance Thirve will ever do in our lifetime, I think. That truly is big data.

But I think we’ve been able to do something really good without actually having big data. We’ve only had data from 1,000 athletes. So maybe this idea of big data needs to go away. Perhaps we don’t need big data; each individual practitioner already has enough data in order to do something useful.

(0:49:09) [Damien Blenkinsopp]: Well yeah, and especially the ones that have been practicing for 10 years. There’s many of those, and they’ve got a ton of data. I think that’s one of their biggest attributes there, this asset of data they’re sitting on from past patients.

How much data is necessary then? Did you just try this and it worked out?

Or do you think it’s because you were focusing on a niche and there was a tight correlation between the people and that’s why it worked out? Whereas if we do these population studies, I think the view is it can be a bit all over the place, so it can be harder to see those patterns potentially.

[Christopher Kelly]: Yeah. We only had 100,000 total features, which is really quite a small data set. But, there’s no reason why we can’t keep these data sets separate for specific populations.

So let’s say Mark Hyman wants to train models based on his data set. And then Chris Kresser is over here and he sees a lot of thyroid patients so maybe he wants to train on his specific data set. You could still use the same code base, and you could still use the same algorithms.

With the particular model that I’ve used, XGBoost, it doesn’t take that much compute resources in order to train the models. So this is in stark contrast to Deep Learning, for example, where really it’s not possible to do much on your laptop.

You really have to spin up an S3 instance, a Cloud computer with lots of fancy hardware probably made by Nvidia that will allow you to do the training of these algorithms. So computationally it’s very expensive.

That’s not true of the algorithms I’ve used. There’s no reason why people couldn’t just run separate instances of the algorithms on their own personal data sets.

(0:50:52) [Damien Blenkinsopp]: Great. That’s great to hear. I hope this episode inspires a few more people to look into this.

Are there any specific areas you think it should be applied to beyond, or at, or where you think it’s going to be more exciting?

[Christopher Kelly]: That’s a good question. It’s a question I don’t know if I’ve got any good answers [for].

Yeah, so we talked about how there’s so much complexity in the root causes that are causing chronic illness. Tommy has a really good talk that he did on the underlying root causes of insulin resistance.

It’s tempting to believe that the only thing that causes that are refined carbohydrates. And that’s technically true, they maybe do cause insulin resistance. But then there’s endotoxins in the gut, and there’s circadian dysregulation, and there’s loneliness, and there’s other types of stress. There are all these different things, and I feel like it’s going to be almost infinitely complex.

What we really need is some kind of algorithm that could really uncover all of these root causes. Keep everything in working memory at once, and figure this out in a way that no human ever could. I think that Tommy has done a better job on insulin resistance than any other human I’ve met so far. And that includes all the people I’ve interviewed on my podcast. But I have a feeling that a computer might do even better, should someone choose to sit down and apply one in that area.

[Damien Blenkinsopp]: Yeah, that’s great, thanks for that feedback.

I think functional medicine is actually an area where they’re dealing with some of the most complex problems. If you look at things like Lyme disease, where there’s of course a ton of controversy because it’s so complex; people say it doesn’t exist or it exists.

I’d love to see this kind of thing applied to those areas to finally bring some clarity to it and say this is what the machine is coming up with, based on just data. To get past all the opinion and everything which seems to kind of cloud these types of areas.

And chronic fatigue syndrome, you brought that up earlier, that’s another one of these dubious areas where…

[Christopher Kelly]: Yes, that’s death by a thousand cuts, I’m sure.

(0:52:52) [Damien Blenkinsopp]: Yes, excellent.

So is there anything we’ve missed that’s important about your thinking on this subject, or your application and what it’s doing currently?

[Christopher Kelly]: The only thing I wanted to say, another example I saw which I thought was a bad use of this technology, was there’s a paper that came out of the Deep Mind group, which is now part of Google. They did something astonishingly clever, it’s absolutely amazing.

They took a million – a million – hand labeled images of diabetic retinopathies, this is damage done to the eye through high blood glucose. And they created a learning algorithm that would predict diabetic retinopathies better than a human could. And so it’s kind of all amazing, that’s absolutely brilliant.

But then you realize that had the person who’s retina was being scanned done an oral glucose tolerance test with insulin 20 years previous. They maybe could have altered their eating patterns, the food they’re eating and when they’re eating it, and their movement patterns, exercise. Then potentially we could have saved their eyesight, which I think is a much greater win than being able to diagnose them with diabetic retinopathy 20 years later.

So I really wanted people to know about some of the uses and abuses of this type of technology.

[Damien Blenkinsopp]: Yeah so it’s a question of thinking about where they greatest impact is going to be had. And also there’s this question of trying to diagnose the end conditions rather than trying to proactively trying to tackle a problem for the future.

It’s just that mindset, which I don’t know if it’s a lobbying philosophy or how eventually that mindset switch is going to take hold. It seems to just be engrained in the education system, I guess. The systems and everything and the process people are taught on how to approach problems.

[Christopher Kelly]: Yeah, medicine is a really funny beast.

Initially when I started Nourish Balance Thrive, I thought medicine was broken. And then more recently I’ve come to understand that medicine is not broken at all. It’s doing exactly what we designed it to do, which is treat acute and episodic illness.

So if you get hit by a bus or you get an infection, then medicine is really, really good at treating that, for the most part. Where it really falls down is with these diseases of modernity, like diabetes or obesity. Medicine is just not designed to solve those types of problem.

And so we need something completely different, and that is what the Nourish Balance Thrive program is. Now we’ve got a machine learning algorithm that will identify the problem sooner and more easily, but the solution remains the same; you need to move your body, you need to eat appropriately, you need to handle stress appropriately. All of those things.

So, I’m hoping that by doing the cheap and easy diagnosis sooner, it’s going to bring people’s attention to the real problems more easily and sooner so they can rectify them before it really becomes a chronic disease.

[Damien Blenkinsopp]: Yeah, it’s interesting. As you were talking about the system there, I was thinking basically the same problem we have with machine learning we have on a society level, right?

If medicine’s focus, or any organization’s focus, is on something else, it doesn’t matter what you put into it it’s not going to get the ideal outcome. Just like with the machine learning programs; if you set it on the wrong task or the wrong focus, it’ll get the wrong result. And the more money you put into it, the worse it will get.

So it’s interesting like that. Maybe it’s just mimicking humans.

[Christopher Kelly]: Well that’s exactly right. That’s a really good point that you bring up.

Especially with the Deep Learning algorithms, it’s a deep convolutional neural network. It is a model of what happens inside the human skull, literally. That’s how it works. So if you set it on the wrong task, it’s going to get the same wrong answer that humans did.

(0:56:49) [Damien Blenkinsopp]: Yeah, exactly.

OK, so where should someone look first to learn more about this? Are there any good books or presentations on the subject? You’ve mentioned a couple of resources already. Are there any others?

[Christopher Kelly]: No, I don’t think so.

Definitely my two favorite things are, The Master Algorithm by Pedro Domingos–and it was Pedro, when he came on my podcast he said: ‘Oh you should use XGBoost for that.’ And I said, ‘Okay.’

Until then I had been trying to use Deep Learning to solve my problem, not really getting very far. And then Pedro said that one word and he was right. Absolutely amazing book; I absolutely love that book, The Master Algorithm.

And then check out fast.ai, which is Jeremy Howard’s website where he’s teaching these online courses in Deep Learning. And even though I just said that Deep Learning turned out to not be the algorithm that was best for me, Jeremy is an amazing practitioner that will teach you all of the skills that you need in order to become a machine learning practitioner of any type.

So even if you end up using XGBoost or some other algorithm, you’re still going to need all of these other tools that sit around the periphery that will be very valuable no matter what algorithm you use. So that’s fast.ai.

(0:58:00) [Damien Blenkinsopp]: Excellent.

Just to clarify there, if you have no programming background is this still something you can look into and learn more about it and it would be useful, do you think?

[Christopher Kelly]: I would like to say yes, that learning how to program shouldn’t be much more difficult than learning how to speak. It’s really getting that easy.

Python is the programming language that I use and I really don’t think it’s that hard. You can read it just like you can read English. It’s not obfuscated in any way.

Having said that, Jeremy Howard’s course is designed to teach machine learning to people who can already code. I know that some of the people on his classes were coming from a background that was completely different, like mathematics, for example. So maybe they didn’t have any ability to code.

But if you’re smart, you’re going to be able to solve this. Learning is the only skill that really matters.

(0:58:50) [Damien Blenkinsopp]: Cool.

What are the best ways for people to connect with you and learn more about you and your work, you and Tommy’s work at Nourish Balance Thrive? Are you on Twitter, have you got a podcast, or Facebook? Where are you most active?

[Christopher Kelly]: Sure. So what I would really like people to do is come to Damien’s show notes and use the custom link and do the seven minute analysis. Then once you’ve done the analysis, I’m going to follow up on email and send you links to my best podcast episodes on some of the problems that we found.

Tommy has done some fantastic interviews all over the internet–even I have trouble keeping track of them all. So we sat down and thought okay, which are the best things on glucose intolerance? So you’re going to get an email with links to our very best stuff.

I do have my own podcast, a Nourish Balance Thrive podcast, but yeah I would encourage people–you do fantastic show notes, Damien. You do the best show notes I’ve ever seen on the Internet. They’re amazing. So if people are listening and they’ve never seen Damien’s show notes, they should definitely come and check those out.

(0:59:52) [Damien Blenkinsopp]: Thanks, I appreciate it. Of course everything you’ve mentioned in the whole show will be in the show notes, as usual. So, thanks.

Who besides yourself would you recommend to learn about machine learning, or just functional medicine? On your journey, because I know we’ve been to the same space, who do you recommend to check out their work?

[Christopher Kelly]: That’s a really good question. I think my favorite person, the guy that’s been most influential to me, is Bryan Walsh.

Bryan Walsh is a naturopathic doctor from Maryland. If you search online, this is like a hidden gem on the internet. Nobody knows about this. His videos on Youtube, some of them still only have a 1000 views, and I swear most of them are me.

So if you search for Bryan Walsh WellnessFX, which is the blood testing company you’ve probably heard of, you’ll find these videos on Youtube and they are amazing. No one teaches blood chemistry interpretation like Bryan Walsh.

Bryan also has a biochemistry training course for health and fitness professionals called Metabolic Fitness Pro. By the way, I have no financial affiliation with any of this stuff. This is just someone that’s been really, really helpful to me in learning over the years.

Bryan is now on the road teaching weekend seminars on how to do blood chemistry interpretation. I’ve done a whole bunch of training courses. I’ve done FDN, I’ve done Kalish, I’ve done other things, and really Bryan’s stuff is by far the best for me.

[Damien Blenkinsopp]: Excellent. I’ve seen some great stuff of him looking at cortisol dysregulation and adrenal fatigue, if it exists or not.

[Christopher Kelly]: Yeah, exactly, The Artist Formerly Known as Adrenal Fatigue. Bryan has been talking about how that’s nonsense for at least five years, probably longer.

He did a really good interview with Rob Wolfe about this. Really, really good. I love Bryan. He’s been really helpful to me.

(1:01:45) [Damien Blenkinsopp]: Great. Thanks for that.

So I’d love to get to know you a bit more, as well, just in terms of what you actually do to improve your body, and how you use tracking today.

Do you track any metrics or biomakers for your own body on a routine basis? And if you do, why?

[Christopher Kelly]: Well, I still do all of the testing that we talked about. I was at the lab yesterday getting the blood panel that Tommy designed done. I still do urinary organic acid, I still do stool testing.

Already, I said that I ran into some health problems a few year ago. When I did the stool testing, I found a pinworm infection, I found a raging yeast overgrowth. I had almost certainly what most people would call SIBO, although I never did the breath test. I had a belly like a basketball, where I’m still quite lean but for some reason I look like I’m six months pregnant.

So those tests, they were really helpful in uncovering the root causes of my health problems. I took a whole bunch of botanical herbs to solve those issues and that worked really well. So I still do all of that type of testing.

In terms of tracking things on a daily basis, in the end I found it more helpful to track the behavior that leads to the desired outcome. And I can explain that with an example.

So I know that I don’t walk enough–that was one of my problems. I’m a mountain biker, so I pedal lots and lots, and I sit lots and lots when I’m working, but I don’t really walk around too much. The reason I didn’t use to walk around too much was because I found it really, really boring.

So I first thought I would get a FitBit and track the number of steps I’m taking each day. And that was horrifying. I was doing 400 steps a day or something on some days, working from home. Really, really low. And in the end, the solution was not FitBit, it was to get a dog.

A few months ago we got a dog – and I apologize, he barked earlier and I had to kick it out of the room. So not so great for podcasting but great for walking. Now I walk at least an hour a day, and I really enjoy it. It’s really fun.

So maybe sometimes the answer is not to track the number of steps or track whatever it is you’re interested in, but instead insert some interrupt into your life that’s going to lead to the behavior change that gets the desired outcome.

(1:03:56) [Damien Blenkinsopp]: Yeah, that’s really clever, changing your environment like that. Definitely one of the most effective things I’ve found is changing your environment.

So, you’ve had a lot of insight, and it sounds like you’ve made a lot of changes over time. Are there any other more recent changes or things you’re thinking about based on any of these things that you’ve tracked or that have come up? Or are you basically optimized now and you’re quite happy?

[Christopher Kelly]: I am very happy, actually, but I am worried.

One of the reasons I’ve been so good at doing–I say so good. People have told me I’m quite good at doing the podcast, and then also the client calls. It’s because I was so able to relate to the other person’s specific situation, because I had also been through that same situation. I’m worried that I’m losing that now.

But, I do continue to think about it, and maybe there’s something I’m missing, but one of the things I advocate is that it really isn’t that hard. There aren’t that many things to think about.

Diet, which we talked a lot about on the podcast. There’s appropriate management of stress; you’re never going to get away from stress, but you need some way to appropriately manage it. Whatever you do, don’t be lonely. That’s like smoking 15 cigarettes a day. Just because you live in London doesn’t mean you’re not lonely; it’s perfectly easy to be lonely even though…

[Damien Blenkinsopp]: Well especially with all of our devices these days. I think a lot of people choose that route rather than…

[Christopher Kelly]: Exactly. Yeah. So these real relationships are being replaced by Facebook and Twitter and all the rest of this stuff.

And then what else is there, there’s movement, appropriate movement. You need to walk, I think, and you need to occasionally lift heavy things and maybe sprint. And that’s really all there is to it. It’s not that complicated. Or at least it didn’t take me long to say it.

(1:05:35) [Damien Blenkinsopp]: Yeah, excellent.

If you were to recommend just one experiment that someone should try to improve their body – and it could be to improve health, performance, longevity, whatever they’re after or whatever you think is most important – with the biggest payoff, what would that be?

[Christopher Kelly]: Definitely monitoring blood glucose, without a question.

[Damien Blenkinsopp]: Okay. Is that with the CGM or a blood meter? How should they do that, and how…

[Christopher Kelly]: I think most people are not going to have access to the CGM.

I have worn one, personally. Somebody sent me one from New Zealand. So I’m in Santa Cruz in California and I believe that you still need a prescription from a doctor to get one, which is unfortunate, and I’m sure that will change in the future. Somebody sent me one from New Zealand and I did learn a couple of things.

The first was that when I walk, my blood glucose goes down quite surprisingly rapidly, even walking with a three year old girl. So most people would think that’s nothing, that’s not enough exercise to have any impact on anything. But it turns out that it is.

So I can prevent postprandial glucose spikes just by going for a walk with my three year old daughter. And I never would have known that without the continuous monitor. You just wouldn’t know to stick your finger to see that it’s happening.

And then the other thing I found out from the CGM was that intense exercise really, really raises my blood glucose. I don’t know whether its cortisol or what, I haven’t done continuous cortisol monitoring. But when I do intense exercise I can get my blood glucose up to 180 milligrams/deciliter, no trouble at all. So, that kind of makes you aware of the fact that it’s not just the food you put into your mouth that can raise blood glucose.

The place to start is with the finger stick test that everybody has access to. You can go to your local drug store, anywhere in the world, and pick up one of these finger stick tests that I know you’ve talked about on the podcast before. Then just check your blood glucose first thing in the morning.

Optimal evidence based reference range for fasting blood glucose is 83 to 88 milligrams/deciliter. So that’s what one of our models is trying to predict, being out of range. So that’s where I think you should be, and that’s where I am now. It took me a while to get there, but I am in that optimal range.

[Damien Blenkinsopp]: Is that throughout the day? So they can check it at any time away from food or…

[Christopher Kelly]: I’m not sure.

I wouldn’t want to see excursions too far out of that reference range. Once you go above 120 it becomes questionable whether you’re doing yourself any good. Obviously there’s going to be some excursions. If you’re eating any carbohydrate at all then it’s going to go above 100, I would expect.

But I think the fasting value is really interesting because we have some epidemiological data that shows hazard ratios go up significantly once you get above – or below actually – that 83 to 88 milligrams/deciliter in fasting blood glucose.

[Damien Blenkinsopp]: Right. So is that first thing in the morning then?

[Christopher Kelly]: Exactly. As soon as you get up, you stick your finger before you’ve had a chance to move around too much or eat anything.

[Damien Blenkinsopp]: Yeah. I do think sometimes that’s a tricky one for some people, like me, because with my CGM I’ve seen over time really quickly after I wake up I start to get a rise from cortisol.

[Christopher Kelly]: Okay.

[Damien Blenkinsopp]: And so it’s always made me wonder.

I’ve been going to get my blood’s fasting glucose for years, and it didn’t necessarily come back ideal. But then if I look at the whole day, I’m basically in the optimum range all the time. And it’s just this one little spike when I wake up in the morning.

I think I do have some cortisol dysregulation, but I think it’s relatively common as well.

(1:09:11) [Damien Blenkinsopp]: Just on your exercise thing you were talking about. I maybe have a little bit of information for you there. I’ve been testing the Wim Hof method recently.

[Christopher Kelly]: Oh yeah. I am familiar, I’ve tried it.

[Damien Blenkinsopp]: Have you? Oh cool. Well how are you finding it?

[Christopher Kelly]: It’s hyperventilating, and it made my face tingle, and I felt kind of funny. I could see that it was doing something. But yeah I’m not sure what else to say about it.

[Damien Blenkinsopp]: I’ve been through the whole program and taking it pretty seriously. It’s actually helping me with some things which I’ll cover in a later episode.

But I’ve tracked it extensively as well with CGM and things like that, and the breathing, the hyperventilation, whacks up your blood sugar every single time.

Yeah, with a cortisol response. So it makes you wonder if when we get an exercise response, is that due to the breathing? Because when we’re exercising hard, we’re actually breathing really hard as well. Or is it the actual exercise as the actual trigger?

[Christopher Kelly]: It’s a hormetic stressor, is what it is. It has to be.

So some part of your brain thinks that you’re being chased by a tiger, so it’s trying to liberate energy. It’s trying to liquidate your assets. Let’s just get some glucose moving. I bet if you were to measure blood levels of fatty acids, you’d see the same thing; that energy is going up too.

So you’re just liberating your assets so that you can escape from whatever this danger is. But your brain doesn’t know that it’s not really a tiger that’s chasing you, your just doing the Wim Hof thing.

But eventually it leads to you getting stronger. So the same thing happens when I do kettle bell swings, or if I go in the sauna, or if I ride my mountain bike for long enough. And so it’s a hormetic stressor; eventually, hopefully, you get stronger.

[Damien Blenkinsopp]: You do feel it as well, when you first start. You feel this slight anxiety when you’re doing the hyperventilation, and over time that goes away, which fits with your explanation there as well.

(1:11:01) [Damien Blenkinsopp]: But anyway just to come back to your fasting glucose thing, there is that slight variation you have to be aware of, but overall the morning is probably the best time. Is that what you’d advise?

[Christopher Kelly]: Yeah, I think so. It’s overall stability that you’re probably shooting for.

Just because you see, maybe you’re eating a ketogenic diet. And we nearly always see elevated fasting blood glucose with someone who’s been eating a ketogenic diet for a while. But does it mean anything anymore based on my evidence based reference range, because that’s epidemiological data and you can bet your bottom dollar that those people that were in that data set were not eating a ketogenic diet.

So at that point, all bets are off. But for the ketogenic dieter, they’re still achieving overall stability, which may be the most important thing.

[Damien Blenkinsopp]: Right.

Chris, it’s been a really interesting episode. Thanks for all your thoughts and for building your little tool here, which is a great first in functional medicine, I think. So congrats on that, and of course I’ll give the link and everything in the show notes for everyone to follow up with. It’ll be interesting to see what everyone gets from it.

[Christopher Kelly]: Yeah. I’m very excited to know what people think. If you think I’m an idiot and I should stop doing this, please tell me, because otherwise I won’t know.

[Damien Blenkinsopp]: Great Chris. Talk to you again soon.

[Christopher Kelly]: Thanks Damien.

References:

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What is carbohydrate intolerance? Do each of us have a personal tolerance or intolerance of carbohydrates? Does this also vary by source of carbohydrate? Learn how evolutionary tools may explain appetite regulation and carbohydrate metabolism and offer ways to regain carb tolerance through diet and lifestyle modifications.

In this episode, we explore how carbohydrate intolerance works. We look at the evolutionary template (basically the Paleo template), neuroregulation of appetite, carbohydrate tolerance, insulin resistance and sensitivity, and the factors that drive all of these.

Once the person is insulin resistant, particularly when they are heading down this road towards prediabetes and potentially diabetes, there is without a doubt one intervention that seems to work remarkably well. That’s reducing carbohydrate level to a point where it’s no longer toxic to the individual.”
– Robb Wolf

Robb Wolf (@RobbWolf) is basically the man responsible for bringing Paleo to the mainstream, in part via his New York Times Bestseller, The Paleo Solution. He also has a new book out, Wired to Eat, which covers many of the topics discussed in this episode.

Robb is a former researcher biochemist and review editor for the Journal of Nutrition and Metabolism, and the Journal of Evolutionary Health. He is a consultant for the Naval Special Warfare Resilience Program and has provided seminars in Nutrition and Strength to organizations such as NASA, the Canadian Light Infantry, and the United States Marine Corps.

One of the takeaways from Robb’s new book, Wired to Eat, is using a 7-Day Carb Test. That’s testing a different type of carb seven days in one week to see what these do to you, and what your personal tolerance is to different carbs, because not every one of them affects you the same way, or like it would any other person.

I ran that test myself and the results are further down this page. This gives you a concrete example of what Robb is talking about when he talks about the 7 Day Test, how to measure blood glucose and how to understand how these carbs are affecting you differently.

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

  • Damien extends his gratitude to Robb for getting him back to eating meat in the year 2010, which greatly improved Damien’s health (03:45).
  • Robb’s book Wired to Eat approaches health from an evolutionary neuroregulation of appetite as starting point and progresses with dieting self-experiments (04:01).
  • The insulin resistance theory and how the 7 Day Carb Test is useful in coming up with personalized diet plans aimed at improving health (10:46).
  • The potential for low-carb / paleo diet and intermittent fasting to improve carbohydrate tolerance (18:50).
  • Robb’s plans for experimenting with donating blood to reduce potential iron overload inflammation (19:58).
  • The value of lipoprotein insulin resistance (LPIR) panel in determining ‘hidden’ insulin resistance, otherwise not detected by fasting glucose levels alone (21:05).
  • Anthropometric measures, such as the waist to hip ratio, are only somewhat reliable markers of insulin resistance (24:28).
  • Making use of the 7 Day Carb Test to track the process of recovering carb tolerance over time (24:53).
  • Why sleep is the most important health parameter and how HRV is useful for tracking sleep quality and overall health (29:39).
  • Integrating physical exercise into a busy life and optimizing exercise intensity (36:41).
  • The ketogenic diet offers numerous therapeutic and health maintaining benefits (41:35).
  • The role of the circadian rhythm in tuning meal consumption with the body’ demands throughout the day (45:35).
  • People to follow & material for learning more about this episode’s topics (51:39).
  • The best ways to connect with Robb Wolf and learn more about his work (53:14).
  • The biomarkers Robb Wolf tracks on a routine basis to monitor and improve his health, longevity, and performance (53:45).
  • The labs using NMR spectra technology to detect LPIR components with high precision (57:58).
  • Robb’s one biggest recommendation on using body data to improve your health, longevity, and performance (58:28).

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

Robb Wolf

  • Main Website: Short life & career summaries of Robb Wolf and his team.
  • Paleo Diet: An introduction on the Paleo Diet written by Robb.
  • Robb’s Instagram: Where he spends most of his social media time and answers almost all posed questions.
  • The Paleo Solution Podcast: Robb’s long running podcast exploring every area of evolutionary and paleo based lifestyles as well as many of today’s chronic health challenges.

Recommended Self-Experiments

7-Day Carb Test

  1. Tool/ Tactic: This test is described in detail in Robb’s Wired to Eat book and on his blog here. It consists of consuming 50g of carbohydrate from different carbohydrate sources (e.g. rice, lentils etc.) each day for one week.The goal is to identify which carbohydrate sources have the biggest impact on blood glucose levels, and thereby identifying which ones you are least carbohydrate tolerant for.In creating this test, Robb was inspired by the Weizmann Institute of Science’s Personalized Nutrition Project. We discussed personalized nutrition and interviewed the lead researcher, Eran Segal, from this project in Episode 48.The test entails preparing 50g of effective carbs, or another carb source, and eating only one type of this meal first thing in the morning (with the exception of coffee and water).
  2. Tracking: Track the food types, your blood glucose level before you consume the food and the time at which you eat. Exactly two hours later, test and record your blood glucose reading again.Is your blood glucose at the 2 hour mark over 115mg/dl? This can indicate carbohydrate intolerance with respect to that specific food.By understanding the carbohydrates you are personally intolerant of you can reduce your blood glucose variability significantly by just removing these from your diet (while still enjoying other carbs that your body is tolerant of).

    Robb recommends that the 7-Day Carb Test is repeated approximately every 3 months, such that the time intervals are close enough to track improvements in particular carb foods insulin sensitivity, as well as tracking the body’s overall insulin sensitivity.

Damien’s 7-Day Carb Test Results

Before recording the interview with Robb I followed his carbohydrate testing protocol for some of the carbohydrates that appeal to me more.

I made a couple of modifications of the protocol to fit my profile better.

  • First, as I’m on a ketogenic diet, I also tracked blood ketones to understand the impact of each carbohydrate source on my levels of ketosis.Did a particular carb drop me below the performance ketosis threshold (1.5 mmol/L)1? Or did it drop be below the nutritional ketosis threshold (0.5 mmmol/L)?
  • Second, from my using a Continuous Glucose Monitor for the last 3 months I know that my blood glucose readings in the mornings are not stable. They rise and fall after waking very predictably, but to greater or lesser amounts depending on sleep, stress and possibly other factors.On the other hand, since I only eat once a day typically, at my evening meal, I know that my blood glucose in the afternoons is always flatline. So I ran my experiments in the afternoon knowing that the variables were better controlled. This is not the situation for most people as Robb describes in his book, so you are most likely better off running the test in the morning as he advises.

In my case the takeaways from this self-experiment were:

  • Lentils had the least impact on my blood glucose levels and ketone levels. My blood glucose had dropped back to near baseline, below 90 mg/dl, within 90 minutes.
  • White rice had the largest relative impact on my glucose levels, but didn’t necessarily have the largest impact on my blood ketone levels. It was the only carb for which I found myself ‘carbohydrate intolerant’, as it failed to return below the 115 mg/dl cut off mark. It also had potentially not even peaked at the 2-hour mark. It was still rising as of last reading, and was just over 130 mg/dl.
Blood Glucose Response to 50g of Effective Carbohydrate

carbohydrate-tolerance-glucose2

Blood Ketone Response to 50g of Effective Carbohydrate

carbohydrate-tolerance-ketones-2

Notes for Context & Additional Observations
  • Average readings of two or three blood glucose readings were taken for each blood glucose data point. From discussions with blood meter manufacturers I’ve learned that blood glucose meters have a high variance in their readings, so when you want accurate results you need to take several readings depending on the variance of the readings (two readings if the first two readings are < 0.5 mmol apart, or three readings if they are over 0.5 mmol apart). Researchers I’ve spoken to also follow this protocol to normalize readings.
  • Unfortunately I ran out of ketone strips for the last experiment which was the black beans. This was particularly annoying since the ketone response looked pretty unique for these – so I will likely rerun this particular test in future (especially as I dabble in black beans at Chipotle every once in a while).
  • I experienced some gut intolerance/ some negative symptoms from the lentils. This was the only carb that I experienced this with and seems to go against some assumptions that autoimmune/ auto-inflammatory responses are behind the largest glycemic responses to foods. The glycemic response in my case, was the lowest for lentils while it was the only one I experienced gut intolerance with.

Sleep

  1. Tool/ Tactic: Sleep is the most important physiological parameter, and poor sleep or inadequate sleep is excessively damaging to the body. Robb argues that if one feels good when going to sleep and waking up, then this is a reasonable indication that the body is performing in healthy shape. Tactics for improving sleep quality from Robb’s blog include: reducing light saturation, reducing noise in the environment, doing intense exercise earlier in the day (due to potential shift in circadian rhythm with late evening exercise), stopping all work a few hours before sleep and making a list of your thoughts before going to sleep – then agreeing with yourself that you are best able to take care of this list after a good night sleep.
  2. Tracking: In Robb’s opinion, it is key to subjectively track physiological concepts in our bodies and to make use of understanding these perceptions. For example, this entails paying attention to feeling tired before or rested after sleeping, or feeling background symptoms of inflammation (eg. in the joints). Robb discusses the use of Heart Rate Variability (HRV) for tracking sleep quality in his blog.

Tracking

Biomarkers

  • Waist to Hip RatioAnthropomorphic body markers, such as waist to hip ratio, body weight, or Body Mass Index (BMI) are useful for understanding carbohydrate tolerance, ex. as a complement to evaluating 7 Day Carb Test after a diet intervention. However, anthropomorphic markers are not very specific measures of insulin resistance. For example, people who are lean still face carb toxicity. Alternatively, people also sometimes face inflammation caused by the immune responses to other specific food types, ex. eggs or soy.
  • Fasting Blood Glucose: Elevated fasting glucose levels indicate a progression toward diabetes. Fasting glucose is usually taken first thing in the morning after an 8 hour fasting period and optimum levels range between 70 and 90 mg/dL.
  • Hemoglobin A1C: Used to identify the average plasma glucose concentration over prolonged periods. Higher levels of hemoglobin (A1C) indicate poorer control of blood glucose levels. Normal levels are less than 5.7%, pre-diabetes levels range between 5.7 to 6.4%, while higher than 6.4% is indicative of diabetes. Both fasting glucose levels and hemoglobin A1C are useful in identifying a level of blood sugar dysregulation, but cannot be used to quantify insulin resistance at an individual level.
  • HDL & LDL CholesterolHigh – Density Lipoprotein (HDL) is the traditional measure of ‘good cholesterol’ used by doctors and healthcare. Levels above 60 mg/dL are considered protective of cardiovascular disease. Low – Density Lipoprotein (LDL)) is the traditional measure of ‘bad cholesterol’ – the type which causes cardiovascular disease. Less than 100 mg/dL is considered an optimal level, while levels between 160-189 mg/dL increase the risk for cardiovascular disease. While both measures are important biomarkers, these are not indicative of insulin resistance status.
  • LPIR (Lipoprotein Insulin Resistance) Score: The LPIR Score is constructed as a weighted combination of 6 lipoprotein subclass measures and reflects the concentrations of each into one score. The final result ranges from 0 (most insulin sensitive) to 100 (most insulin resistant). Recent studies have been using the LPIR as a more accurate approach to assessing insulin resistance improvements via interventions.2
  • GlycA: A novel biomarker useful for predicting predisposition to insulin resistance and Type 2 diabetes3, cardiovascular diseses4 and inflammation-driven diseases including cancer5. Normal GlycA levels are below 400 μmol/L. Concentrations tested above this cut-off value are considered high and indicate the need to take steps towards preventing health issues.
  • FerritinSerum ferritin acts as a buffer against iron deficiency and iron overload. Levels are measured in medical laboratories as part of the workup for detecting iron-deficiency anemia. The ferritin levels measured usually have a direct correlation with the total amount of iron stored in the body. Female normal reference range is 12-150 ng/mL and for males it is 12-300 ng/mL.
  • HematocritThe hematocrit (Ht) is the volume percentage (vol%) of red blood cells in the blood. It is normally 45% for men and 40% for women. Robb checks ferriting and hematocrit as markers for tracking iron saturation which he plans to tackle by experimenting with donating blood and because these are useful in determining iron saturation which he suspects is the potential cause of some inflammation.

Lab Tests, Devices and Apps

  • NMR Lipoprofile: The LPIR score is part of the NMR Lipoprofile run by Labcorp (example report output here). It is an additional biomarker that was added to the panel more recently. The NMR Lipoprofile was originally run by the company LipoScience, which was acquired by Labcorp. As a result, Labcorp is now the company that runs the most advanced labs using NMR Lipoprotein analysis.
  • GlycA Test: The GlycA test is also offered by the company LabCorp.
  • BioForce HRV Set: BioForce HRV is a for tracking HRV which allows users to include their choice of sensors. There is a standard Bluetooth heart rate strap or a newly developed and finger sensor. Both sensors are compatible with all iOS and most Android devices and are constructed to deliver the precision necessary for accurate HRV measurements.

Tools & Tactics

Diet & Nutrition

  • 30 Day Diet Reset: A diet scheme based largely on a Paleo diet type template, aimed at healing the gut and re-normalizing the neuroregulation of appetite. Following Robb’s guidance in Wired to Eat, the 30 Day Diet Reset should be done before the 7 Day Carb Test such that the results of the test can be objective.
  • Fasting: Damien has seen improvements in his carb tolerance with the use of fasting as a tool in various formats. Having tracked his glucose and ketone levels, he concludes that the switching point of burning ketones, instead of glucose, occurs at approximately the 72-hour mark. Over several fasts, it becomes easier on the body to switch to ketogenic (therapeutic) ranges with the switch occurring quicker (e.g. 48-hour mark). The glucose/ketone ratio charts look flatter indicating a more controlled physiological response to fasting.6
  • Ketogenic Diet: A diet which restricts carbohydrate intake, over time causing the body to switch from using glucose to burning ketones as the main fuel. There are many potential benefits from ketogenic dieting. For most people who are overweight and insulin resistant, a lower carb intervention wins out as an approach to solving these health issues. A therapeutic state of ketosis is determined by reading fasting blood glucose levels (which should be below 80 mg/dL in the morning after 8h of no food intake), while β-hydroxybutyrate (blood ketones) should be higher than 0.8 mmol/L. See Episode 7 with Jimmy Moore on optimizing ketogenic diets.

Interventions

  • Donating Blood: Robb plans to experiment with donating blood, with the aim to reduce some potential low-grade inflammation caused by iron overload. He plans to track iron saturation before and after 3 months of donating blood on a consistent basis and reach conclusions based on the data. Robb compares his case to Chris Masterjohn who personally controls an iron toxicity predisposition by optimizing his blood donation schedule. Chris discusses this topic in Episode 46 of this show, an episode focused on micronutrient status optimization.

Tech & Devices

  • Blue Light Blocking Glasses: FDA registered blue light blocking glasses used for digital light eye strain prevention. These glasses are a useful way to reduce light saturation for a few hours a night before going to sleep.

Other People, Books & Resources

People

  • Christopher Kelly: An athlete and founder of Nourish Balance Thrive which is a service offering a science-based, personalized support program to help people regain optimal performance.
  • Marty KendallAn engineer with an interest in nutrition who seeks things numerically who founded Optimizing Nutrition. Marty aims to consolidate a range of paleo and ketogenic ideas into an algorithm that will enable an individual to tailor their diet and bring about health goals.
  • Tim Ferriss: An all-round successful man, who runs a podcast focused on deconstructing world-class performers – other successful people in various niches or businesses. His podcast is often ranked #1 across all of iTunes and is also selected for “Best of iTunes” for three years and running. Robb interviewed Tim in an episode of his podcast.
  • Joel JamiesonJoel Jamieson is considered among authority figures on strength and conditioning for combat sports and has trained many athletes since 2004. Joel stands behind the BioForceHRV project, aimed at tracking HRV and implementing it in optimizing exercise to the condition of your body. Joel introduced Robb to the BioForce tracking platform which he has used ever since.
  • Alessandro Ferretti: An optimum nutrition researcher who formed Equilibria Health Ltd, which is now recognized as one of the leading providers of nutrition education in the UK. Alessandro actively does Judo and Karate and has discovered that he performs efficiently with a ketogenic diet – meaning feeling energetic, being able to undertake fasts, and remain lean.
  • Bill Lagakos: A biochemistry professor focused on circadian rhythms and nutrition. Following on Bill’s work, Robb has adjusted his diet to time-restricted eating, meaning that shortened feeding windows are assumed to be beneficial for a variety of physiological reasons. Moreover, based on his research in biological (circadian) rhythms, Bill Lagos advocates the idea that more carbohydrates should be eaten earlier in the day, such that carbohydrate backloading can be avoided. Because of these reasons, Robb has adjusted his fasts to approximately 14-16h, whereas before he would 18h fasts. Following a fast Robb eats a robust full meal, but he usually times this with jiu-jitsu exercise 2-3 hours later. This is an example of optimizing both how diet volume and the intensity of exercise.
  • Chris Masterjohn: Robb appreciates Chris’s ability to dive into the biochemistry and pathophysiology of when things are right and wrong in the body, as well as to develop whole food and supplement solutions based on his research. Chris was a guest on our show in Episode 46.
  • William Cromwell: A physical chemist who studied NMR spectra technology lipoproteins, serving as Director of Cardiovascular Disease at LabCorp.

Books

  • The Paleo Solution: A book by Robb Wolf following his perspective as both scientist and coach on the benefits of Paleo dieting, and this along with exercise and lifestyle changes can change one’s appearance and health for the better.
  • Wired to Eat: A book written by Robb which starts with the 30-Day Reset to help people restore normalized blood sugar levels, repair appetite regulation, and reverse insulin resistance. This book also features standard Paleo – based recipes and meal plans for people who suffer from autoimmune diseases, as well as advice on eating a ketogenic diet.
  • Myth of Stress: A book explaining how much of what we perceive as stressful in day-to-day life is actually generated by our brain’s anxiety response, but is not actually a legitimate stressor in terms of evolutionary times scenarios, when our brains evolved the stress response. Robb interviewed author Andrew Bernstein in an episode of his podcast.

Other

  • I, Caveman Show: Robb took part in this Discovery Channel reality show where they had to live mimicking the stone – age hunters and gatherers. It took place at 8,500 feet in the Colorado Mountains.

Full Interview Transcript

Click Here to Read Transcript
(0:03:45) [Damien Blenkinsopp]: Robb, thank you so much for joining the show.

[Robb Wolf]: Hey, huge honor to be here, thanks.

[Damien Blenkinsopp]: Yeah, it’s a huge honor on my side, because you got me back into eating meat back in 2010, just as we discussed a few minutes ago. That was great and that vastly improved my health, so thank you for that.

[Robb Wolf]: Awesome, awesome.

(0:04:01) [Damien Blenkinsopp]: Yeah.  So you just released this book, Wired to Eat, which I went through, and it’s building on what you’ve done in the past, and also looking at some of the things you’ve learned over time with all the practical experience you’ve had implementing this.

What would you say is basically the crux behind this book? Is it the neuroregulation of appetite, or how would you think about it?

[Robb Wolf]: Yeah, it’s kind of two pieces. So the front of the book is really starting this conversation from the perspective of the neuroregulation of appetite.

So I’m kind of known as being one of the Paleo guys, and I definitely use that evolutionary biology, evolutionary medicine framework to inform the question and answer process that I bring to strength and conditioning and nutrition, and what have you, but it’s a starting place. It’s not the endpoint.

And I think that’s where, in some ways, the efficacy of that whole methodology has been lost. People assume that that’s where you start and stop. Whereas for me it’s always been this is the starting place.

We’re not yet able to take a Star Trek type scanner and run it from toenails to earlobes and then say okay you need to eat this and train this way. Stuff like that may happen eventually, but we’re still very much in this empirical process.

So then if we’re in this empirical experimentation process, where the heck do you start? And I throw out this really insane, over-the-top, greasy used-car salesman notion that maybe evolutionary biology can inform some of where we start this health and performance story from.

There’s this model in evolutionary biology called the Discordance Theory. That’s basically you have an organism that is pretty well matched for it’s environment. The environment can be the weather, the food, it can be a ton of different factors, it could be bacterial or parasitical. But if things change, it could be beneficial, negative, or it could be neutral.

But if we start seeing disease processes prop up that we don’t see in the natural free-living environment, or in the pre-environmental change story, then maybe there’s something to be learned from that. That’s my crazy suggestion is that possibly our genetics are wired up for a life way and a time that no longer exists, and that as great as so many of the elements of modern civilization are, there might be downsides to it.

For example, antibiotics are amazing for preventing septic illness and death, but there might be some downsides related to mitochondrial function in our own bodies, and then changes in our gut microbiome, which we’re now understanding may have huge implications for our overall health.

Again, I use this as an orientation tool. And at the beginning of Wired to Eat I’m laying that foundation with the neuoregulation of appetite. Really trying to understand if we looked at high carb diets or low carb diets, what are the things that allow people to eat in a way that they support their activity level, support a healthy body composition but tend not to overeat.

And there are some commonalities there. The efficacy of some of these nutritional approaches becomes really obvious why they work when we better understand the neuroregulation of appetite.

And the goal on the front end of this – and it’s kind of funny because it’s fairly touchy feeling stuff – but my real goal is to help people understand that it’s not your fault if you find it difficult living in the modern world and navigating the snack aisle of the supermarket. It’s totally reasonable and understandable.

Now I’m not one of the fat accepting guys either. I do recognize that overweight and metabolic issues are damaging to our health. They are a huge cost to society.

So I’m not recommending that we just roll over and die and let life have it’s way with us, but I’m suggesting that if we can unpack all that emotional baggage and understand that this process might be hard but it’s doable, then we’re starting off at a good footing.

And then the implementation part of the book is where we get really granular in a more progressive fashion. We start things off with a triage process where we do some subjective elements, such as asking how do you feel between meals, what’s your cognitive function like, how long can you go between meals and still maintain good physical and cognitive performance.

And then we get more specific. We look at things like the waist to hip ratio, we look at fasting blood glucose. We really lean heavily on this thing called the LPIR score, the lipoprotein insulin resistance score, because for me it’s kind of the most powerful direct means for understanding where we are on this insulin sensitivity insulin resistance spectrum.

And if we are more insulin resistance then we tend to do better on a lower carb intake. And there’s a lot of variability with that. But we also have people that are overweight or experiencing some other health related issues but they are actually insulin sensitive, and these are the people that tend to do better on that moderate to high protein, high carb, low fat diet. So there are examples of both ends of this spectrum working pretty well.

But we use this triage process to get a handle on where we are in that insulin sensitivity insulin resistance spectrum. We use a 30 day reset, based largely around a Paleo diet type template, to heal the gut, re-normalize the neuroregulation of appetite. And then from there we use the 7 Day Carb Test.

There we pick a battery of different carb foods and we eat an allotted amount, which is 50 grams of effective carbohydrate. We check our blood glucose at a two hour mark. If your blood glucose is at or below a certain level, that’s usually an indicator that’s a good amount and type of carb for you.

If it’s above that, then we start asking some questions about should we reduce the portion size or is this really a good food for you. Because sometimes our elevated blood glucose level is not just from the carbohydrate content of the food but it’s from the immunogentic properties of the food.

If someone is reactive to wheat or eggs or soy, they may actually get a significantly elevated blood glucose response. And it’s not from carbohydrate, it’s from the stress response that occurs when we eat a food that we have an immunogenic response.

[Damien Blenkinsopp]: Thanks Robb. A real big download there.

[Robb Wolf]: Yeah, that was… (laughter)

(0:10:46) [Damien Blenkinsopp]: Let’s talk about a couple of the things you mentioned that stood out.

First of all you were talking about insulin resistance.

Do you see this as one of the cruxes of the issues? Is this one of the main factors? I know you’ve had a lot of practical experience in clinics and studies, and so on. So what have you seen in the populations out there in terms of how important the insulin resistant piece is?

[Robb Wolf]: Yeah. And this is a really contentious topis because people are still in pissing and squabbling matches about what brings about insulin resistance. Is it just in response to elevated insulin levels?

I think it was an interesting theory but over the course of time that has not borne out to be the best theory. It still seems to relate to an overabundance of energy causing systemic inflammatory responses within the cells that then tends to up-regulate this insulin resistant response.

But once the person is insulin resistant, particularly when they are heading down this road towards prediabetes and potentially diabetes, there is without a doubt one intervention that seems to work remarkably well. That’s reducing carbohydrate level to a point where it’s no longer toxic to the individual.

My analogy to this is basically photo exposure in getting a sunburn. Depending on what type of skin pigmentation you have you will be able to handle greater or lesser amounts of UV radiation before you get a sunburn. And if you do have a sunburn, there’s really only one intervention that makes sense, and that’s to reduce your exposure to the toxic levels of UV radiation.

And so that insulin resistance and the resulting metabolic derangement, which includes but definitely isn’t limited to elevated blood glucose levels, you can tackle that in a variety of ways. You can starve people down on a high carb low fat diet, and it can work. But in that insulin resistant state we tend to have a really serious dysregulation of the appetite and the tendency to want to eat a lot of carbohydrate.

And so this is where for most people who are overweight and insulin resistant that lower carb approach seems to work pretty magically. Even in these free-living populations where people can make a variety of choices, the lower carb intervention tends to win out.

[Damien Blenkinsopp]: I guess that refers to the saying carb-cravings, that we often hear.

I don’t know if you’ve seen this, but some people have a lot of difficulty with fasting. They’ll have dreams about food if they fast for 24 hours. I know friends who have fasted with me [for whom] it was a bit difficult. Or they get ‘hangry’ – I know that’s a term you coined in your book as well.

Have you found that that correlates with some of the lab tests? Is that kind of a symptom of potential insulin resistance?

[Robb Wolf]: Yeah. So here’s a good example of this.

My wife and I did this 7 Day Carb Test, and we’ve known empirically that I just don’t do as well with carbs.

I remain 100 percent gluten free because if I get a gluten dose, the first bathroom I hit will require a priest, an exorcism, and probably needs to be bricked over and never used again. So there’s no upside to consuming gluten such that I willingly do it. I get some cross-contamination stuff occasionally.

But I’ll have a little rice, or some corn, here and there. We’ll go to Mexican food or Thai food and I’ll kick my heels up once in a while. And I usually feel pretty rough. And I may feel rough for a day or two afterward.

Whereas my wife, I’ll ask her, “Hey are you feeling kind of carb headed from that?” And she says, “Yeah, it lasted for 20 minutes.” I wonder what’s going on with that.

And so we dug into that deeper, using this 7 Day Carb Test. And we ate the same amount of carbs – 50 grams of effective carbohydrate — and we picked the same foods. It was, white rice, white potatoes, sweet potatoes, applesauce, gluten-free bread, and a couple other items. And it was really interesting.

So with the white rice, at two hours post-meal my blood glucose was still in the 180s, damn near diabetic levels. Terrible. And I felt terrible. And Nicki at two hours was a 121, 122 or something like that. Just across the board, she had remarkably better blood glucose levels than I did.

So that was interesting, and it was kind of validative of what we had seen previously. So then kind of out of nowhere she said, “Hey, I’m going to do a dinner to dinner fast.” I was like, okay, that sounds good. We’ll check that out. And it was interesting.

So she did her dinner, and didn’t eat again the following morning. She worked out. We have a 10 month old Rhodesian ridgeback puppy that requires a ton of training, and she’s really diligent in training the dog, but it’s active. So she did her workout and then she’s running the dog around.

And we have two daughters under the age of five. So it’s a really active life that we both live, and particularly my wife being at home in that scene most of the time. By 23 hours she was getting hungry, but she was still totally cognitively on point. She felt good.

Right at that 24 hour mark we checked her blood glucose level, which was 71. That’s low, but a good low, particularly for a fasting scenario. And her ketones were at a 0.8. So she was already in a therapeutic ketosis range. And she was effectively just right at that 24 hour mark.

This is something that we just don’t see all that often in Westernized populations. This exact type of study hasn’t really been done specifically in hunter-gatherers and pre-Westernized societies, but what we see in those situations is these folks may go a day or two without eating.

They are hungry, they are definitely wanting to eat, but they don’t have a decrease in physical performance or cognitive function. You aren’t a very effective hunter-gatherer or horticulturalist if you are leaning against a tree drooling on yourself because you are in metabolic shutdown because you have to eat every two hours to keep yourself going.

So your question was — and I know that this is the longest answer to the shortest question in history. I seem to be good for that. But the question, was do we see specific lab values that tie into this?

What I’ve noticed is a tendency towards, if you are more insulin sensitive – and that will be determined by your total choleric load, your stress load, your sleep, your gut microbiome. There are lots of factors that go into that.

But if you tend to be more insulin sensitive, we tend to see more metabolic flexibility. If you have a higher carb meal, it doesn’t really knock you out and you don’t get super high blood glucose levels. You don’t have hypoglycemic crashes. And on the flip-side of that, if you need to go 6, 10, 12, 24 hours without eating, you may be hungry but you are still functional.

Whereas that insulin resistant individual, they do a piss poor job of dealing with large carbohydrate boluses. They get a super high blood glucose level, they get a rebound hypoglycemic response. And then when they have carbohydrates restricted significantly, the first couple of days – usually 72 hours – they’re in hell, because they have neither adequate glucose to fuel what’s going on and they’ve not yet kicked over to converting fats into ketone bodies in an effective way.

There are hormonally driven elements to this, and then there are also possibly mitochondrial considerations, where the mitochondria themselves may be damaged to a degree. It’s like taking a lawnmower that’s been out in the garage for two years, and it’s got some water in the carburetor and you just have to really rip the cord on that thing to get it to turn over and start using the fuel that you want it to use.

So let me know if I answered that. I know it was a long, rambly story.

(0:18:50) [Damien Blenkinsopp]: Yeah, I think you really did. Out of interest, because you noted that your blood sugar spiked to 180, how long have you been low carb for?

In a sense it seems like it’s not therapeutic, even if you’ve been low carb and Paleo for a long time, it doesn’t necessarily mean it’s going to mend these type of things, this dysregulation when you eat some rice.

[Robb Wolf]: Yeah, it’s interesting. Over the course of time, I’ve been able to push that carb tolerance up.

So now on my heavier Brazilian jiu-jitsu days I’ll be somewhere between 120-150 grams of carbs, and I do fine with that. But I also keep an eye on the types, and then I tend to put more of the carbs in the post-workout period, and similar to that. Whereas before 120 grams of carbs would have just crushed me.

So I’ve definitely recovered a lot, relative to where I was previously. And I’m still tinkering. I’m not sure if there’s still some gut health considerations. I’m actually just getting ready to start donating blood on a consistent fashion, because of some thoughts around some potential low-grade inflammation from iron overload.

So I’m going to play with that, and what I’ll do with that is I’ll probably go through three months of consistently donating blood, check the before and after numbers with regards to ferritin and iron saturation, hematocrit. And if we get to whatever delta we get from the start and the finish with that, then I’m going to revisit this 7 Day Carb Test and see if we get some improvements on that.

So that might be one final stone that I need to turn over and explore. I know Chris Masterjohn had talked about really reversing some significant insulin resistance. He had no idea what was going on, and he felt it was largely driven by that iron overload status.

(0:21:05) [Damien Blenkinsopp]: Wow, that’s interesting.

I have iron overload as well, and many other things like infections. So for me it’s a bit difficult to pinpoint what it is. But my carb tolerance has got a lot better with fasts.

So I’ve tracked with fasts, and I’ve seen that switching point you were just talking about, the 72 hours. It gets a lot easier and would happen a lot quicker as well. My ketones would go up faster, and glucose would go down quicker. And it’s been flatter over time. So it’s really, really interesting.

So you mentioned another panel just a bit earlier, a lipoprotein insulin resistance panel. What’s that?

[Robb Wolf]: So people are usually familiar with HDL cholesterol and LDL cholesterol. The cholesterol is a fat soluble, not water soluble, substance. So it would be like trying to mix oil and water together; it just doesn’t work that well.

But we need to move these substances around the body, so there are these things called lipoproteins, which actually are the vehicle that carries the cholesterol passenger around the body. And triglycerides are also, to some degree, carried around [by these], although they have their own carrier molecule as well. But these lipoproteins usually correlate pretty directly with the amount of cholesterol that we have, both HDL and LDL cholesterol, but not always.

There are certain folks that exhibit this phenomena called discordance, where you may have lots and lots of small dense lipoprotein particles and then a relatively low cholesterol level. And these are the folks that often, like a 35 year old triathlete and they work out all the time but they’re also a shift working firefighter or something and they suffer a heart attack at age 35 or 40.

And it’s like, wow, we never saw that coming. Their triglyceride to HDL ratio looks pretty good, which is a decent correlate or indicator of insulin sensitivity. And then their total cholesterol levels didn’t look that high, but under the hood looking deeper the lipoprotein numbers were super high.

And so there’s also a way that we can look at the lipoprotein numbers and their relative ratios. And there have been some really phenomenal correlation studies to tie this link together so that we can tie that lipoprotein insulin resistant score to the real world.

And there are some other methods for tracking that. There’s looking at fasting blood glucose, but there are limitations to that. There are ways that that can be misinterpreted both on the up and the downside. Fasting insulin is similar, it’s helpful but there are ways that can be circumvented. A1C [is another].

So we do like looking at several of these numbers, in the beginning in particular, and then checking back on them periodically, because it provides a lens. In particular a lens to help us better understand that 7 Day Carb Test. Because those carbohydrate numbers just in isolation can also be a little bit confusing.

But with that lipoprotein insulin resistant score, what we found in the police and fire populations that we work with – I’m on the Board of Directors of the Medical Clinic here in Reno, Nevada – we found that with the other methods for tracking insulin resistance we were missing people, particularly folks that were sleep-deprived and/or hyper-vigilante.

So they had consistent adrenal cortical response, some HPT axis dysregulation. Those people were insulin resistant, and often times significantly so, but we didn’t see it in fasting insulin levels. Specifically blood glucose levels may not have been that bad at that point, but we were seeing some really consistent long term insulin resistance when we looked at that LPIR score.

(0:24:28) [Damien Blenkinsopp]: So it sounds like it could be uncovering people that we normally miss.

How about the waist to hip ratio? That’s a nice easy thing that anyone can do at home. Did you also find the same thing, that it doesn’t necessarily capture people? Like you can be pretty thin and slim and have these same issues.

(0:24:53) [Robb Wolf]: Absolutely, and that’s where again we use it to build a case, but you can’t hang your hat 100 percent on anthropometric measures like that.

[Damien Blenkinsopp]: Great. Have you looked at how people can basically recover carb tolerance? Or have you seen that kind of period, the timeline?

Any indication of, say they did a 7 Day Carb Test now, when would it be useful to retest? Maybe 6 months after following a clear Paleo diet and all of your proscriptions. You talk about all of them.

[Robb Wolf]: That’s a really good question. Part of the inspiration for even doing the 7 Day Carb Test came out of research from the Weizmann Institute in Israel, and it was looking at personalized nutrition by tracking the individual glycemic response.

And what they did in these folks is they had them wear a CGM, a continuous blood glucose monitor – just a little disk that gets slapped on the back of your arm – and it measures your blood glucose levels once a minute, every minute for the duration of the test. I forget, but it was two or three weeks and they had 800 people signed up on the study.

So it was a massive amount of data; they had over a million blood glucose samples. They then did a gut microbiome sequencing on these folks, they did a full genetic analysis, and the standard kind of lipidology based blood work. And then they started feeding these people different meals. And the blood glucose responses were all over the map.

It was similar to myself and my wife, where one person would eat white rice and [their] blood glucose would go to the moon, [whereas] another person would eat white rice and they had a barely perceptible increase in their blood glucose response.

And then there were wacky things like hummus. Even though I’m the Paleo guy and legumes are theoretically problematic, hummus is protein and fat and fiber. There’s hardly any carbohydrate to it, but hummus was about a coin toss as to whether or not you had a good or a bad blood glucose response.

And the one thing that they did figure out with this was that if you determine the amounts and types of food that kept your blood glucose within lower bound levels, then your gut microbiome tended to improve and your inflammation and insulin sensitivity tended to improve over time.

So I don’t know that I have an exact timeline on this that I could relate, but what appears to happen is if you eat in a way where you’re not consistently deranging your blood glucose, which seems to have knock-on effects with the gut microbiome. There are some interesting theories around how acellular or processed carbohydrate can shift the way that our gut microbiome is existing. It’s a pretty interesting and elegant model.

But if you keep things within good bounds, then things tend to improve in kind of a virtuous cycle, and then conversely if you are consistently driving blood glucose out of what we would consider to be healthy bound, the gut microbiome tends to shift towards a more pro-inflammatory state. We see elevated inflammatory cytokines on circulation, we tend to see elevations in insulin resistance.

And in the book I make a recommendation that maybe quarterly. We don’t necessarily need to do a full reset as far as a 7 Day Carb Test, but I really recommend sitting down and just paying attention.

“Hey, how long can I go between meals and still feel good? If I do a little bit of fasting training, how do I feel with that? How’s my sleep? What’s my creakiness in my joints, what’s my subjective measures of inflammation?”

I am fairly geeked-out on the quantified self stuff, and I find a lot of it valuable, but I still like to get people back in their own skin so they can get a sense of where things are going right or potentially going wrong.

And a quarterly recheck, at least on the subjective level, seems to be frequent enough that if things are sliding sideways we haven’t slid so far that it’s terribly hard to get things back on a good track. But it’s also not so frequent that you just throw your hands up in disgust and you’re just done with the whole process and don’t pay attention to anything anymore.

(0:29:39) [Damien Blenkinsopp]: Yeah, absolutely. On my own journey I’ve quantified so much stuff, but at the end of the day it’s how you feel that matters. And you can even improve a whole bunch of biomarkers, but if you don’t feel better or feel less inflammation it’s not that helpful. It can be insightful and give you clues, but we’re still at quite a rudimentary level yet.

I actually interviewed Eran Segal in just the last episode of this podcast, actually. He inspired me to get into CGM, amongst some other people. So ever since I’ve been playing around that and have found it very instructive.

And not just for the food intake, but also sleep, which you talk about a lot in your book, and stress.

How important do you think those are in your experience, compared to the food? Because we always talk about the carbs and the food.

[Robb Wolf]: Even though I’m the food guy and we used to run a gym, so you would think that I would say that exercise is most important, or exercise and nutrition, but sleep is it. I mean, sleep is it. And here’s my argument for that.

You could eat the most wretched diet imaginable, and it’s going to be hard for you to kill yourself in anything short of a couple of decades. Some people can do it, but it takes a pretty Herculean effort to do yourself in with even the worst dietary practices you can imagine.

But sleep-deprivation is so injurious to our physiology that the Guinness Book of World Records, they will let you jump a rocket motorcycle across the Grand Canyon, they’ll let you juggle chainsaws that are lit on fire, but they will no longer entertain people trying to do unbroken longer periods of sleep-deprivation. The last two people that have tried it, they got right around that 9 to 11 day mark and they just died. And they don’t know why, but they are dead rather quickly.

So the sleep piece is just so incredibly important. The stress piece is important too, but there was a great book that I read and I interviewed the author, it’s called the Myth of Stress. It was really a fascinating reframing of this whole stress story. And so much of what we experience in day-to-day life that we perceive to be stress is completely generated between our own ears.

It’s anxiety about finances, it’s anxiety about how this meeting is going to go with our boss. It’s all these different things that really at the end of the day, we have an opportunity to either let this stuff eat us alive, or we can reframe it and just say that’s not actually a real threat, and so I don’t have anything to be worried about. So there’s actually comparatively little in the modern world that is in fact a legit stressor.

Now the caveat with that, we do a lot of work with police, military and fire, and those folks legitimately live in hyper-vigilant states a lot, because they have life-or-death scenarios that they’re dealing with every day all the time. So there are caveats to that.

But a shlep like me, where I live out on a small farm, we have some animals, I have two kids, I do the business stuff that I do, I can let myself get spun up and feel stressed out. Like, oh my god, one of the goats got bit by the neighbor’s dog.

This did happen this time last year, and the poor goat it’s eat got peeled off. But it was fine, we had a vet come out and gave it some antibiotics. We had to catch the little bugger and wrap it’s ear up for about a week, and then he was totally fine.

But when it first went down, I was like, why did we ever move out here, what are we doing, this is a waste of my time. And all this just internal dialogue and stress. Then I stopped and I was like, well I love living here. The kids love the animals.

There’s sometimes pain in the ass elements to this, but I’ve turned this from an acute event into what is now for me a long-term stressor, but I did it to myself. So I would throw out there that a lot of what we perceive to be stress is mainly self-generated.

And again, circling back to the sleep part, I just can’t think of a greater return on investment than trying to go to bed a little earlier, sleep a little longer, within the boundaries of what’s normal for you. Just blackout your room, have a really solid sleep hygiene process where you go to the bed at the same time each night.

It may not do wonders for your social life, but then again maybe it will because you may not be a cranky cantankerous prick because you’re actually well rested. So it’s hard to tell. And it’s liable to pull 5 years of aging off of you in just a matter of a week.

[Damien Blenkinsopp]: Yeah. Sleep is the hardest part.

Just curious, do you use anything to track your sleep? To try and keep a bit more responsible, or have you seen anything that works for people?

[Robb Wolf]: Really HRV is kind of the best thing that I’ve seen. Some of these actigraphy things are interesting. It is interesting, again, even though I’m a biochemist, I don’t know if I’ve weighed and measured so many things that I’m just like, oh my god I don’t want to do it anymore.

But I’ve just gotten into a point now, and it’s interesting. Folks like Tim Ferriss and some other folks I’ve interviewed with, they were like, “What’s your morning ritual?” And because I have kids, the morning ritual is super variable. I don’t know if somebody pooped their pants, and they’ve got poop from their earlobes to their toenails. That’s a way different morning than if that doesn’t happen.

But what I have found is I tend to have really good control over my go-to-bed ritual. So when the sun goes down – and this varies with the seasons, our days get longer so we stay up later – but when the sun goes down then, we installed dimmer switches in our house when we did our remodel last year and we drop the lights down to a super low level. We put on some blue blocker Swannie sunglasses.

Usually not too long after that I do a little bit of reading and I just fall asleep. And it’s like a ninja blow dart hits me. And when I’m consistent with that, and if I also happen to be tracking my HRV pretty consistently, I just see that HRV score improve. And then if I do have an off-night of sleep, we see some pretty immediate impact on that.

But the actigraphy, I haven’t found to be super helpful. If we had someone that was waking up in the middle of the night or something like that and we had some HRV score feedback. The thing about HRV is it tells you something is up, but it doesn’t tell you what that thing is.

It could be that we’re having a low blood sugar response in the middle of the night, so we get some cortisol release, and that suppresses melatonin production, so it pops us up out of sleep. So maybe we need more calories overall, maybe we need more carbs near dinner. Maybe we need fewer carbs near dinner, because some people are experiencing that rebound hypoglycemic event.

There’s not a one size fits all answer with it, but in general I just kind of gauge [when] I wake up in the morning, I stand up [and see] do I feel clear headed, do my joints ache because of jiu-jitsu and being 45, or do I feel good? And if all of that stuff feels good, then I’m pretty good to go. And particularly if that HRV score just stays nice and consistent.

(0:36:41) [Damien Blenkinsopp]: Yeah. I’ve been a fan of HRV also for a long time. I’ve been tracking it.

I also find it difficult, the same way you do. It captures everything, and if you’re someone who’s got some kind of chronic health or some issue like that on top of potentially not sleeping correctly, over-training. You’re doing Brazilian jiu-jitsu, so I’m sure that’s happened a few times.

And there are these different factors and you have to kind of piece the story together. But it can give you that overall number.

I’m just curious, what do you use, do you use a sort of an app or is there something specific you like because of convenience or something?

[Robb Wolf]: Yeah, I’m just kind of old school. Joel Jamieson hooked me up with the BioForce platform and I’ve pretty much just like hung out on that.

I know there are a lot of cool stuff out there and I do have a few others but I’m again, a little busy and kind of lazy with that stuff. I’ll check in on it occasionally, but it’s generally a deal where once I get a baseline established, and it’s a thing again that I know if I’m getting into bed, falling asleep, and waking up feeling good, everything else is fine.

And then on my training side I do a little strength and conditioning, a little bit of weight work, gymnastics, and also some low level cardio to support the Brazilian jiu-jitsu. I just keep my volume and intensity really modest on that. 80 percent of my rolling is more in a drilling and aerobic fashion, and about 20 percent is that white buffalo in the sky.

Like the 20 year old three stripe white belt is trying to take my head off my shoulders, and so it’s a battle for survival. But I don’t do too many of those. Maybe one day a week that there’s some pretty hard training that goes on.

And so long as I do that, everything is good. Everything is really, really good. I just try to make very small, incremental progress, in mainly the jiu-jitsu side, and so all of my strength work, all my conditioning work, all of that is of a remarkably low volume and intensity for the most part. Just to support jiu-jitsu.

If I feel the least bit knackered after a cardio session or something, I went too hard. Because I need to save that energy for rolling, and not for getting better at the Airdyne or something like that.

[Damien Blenkinsopp]: Yeah.

So when you’re talking about volume, how many hours are you doing of exercise, jiu-jitsu, and all kind of mixed together?

[Robb Wolf]: So jiu-jitsu is between three to five days a week, and usually an hour to two. Shorter classes if I’m time pressured, then I get the one hour class which is a mix of drilling and then a little bit of live rolling.

A couple days a week I usually will stay for a half hour to an hour of just continuous live rolling. I try to grab partners where we don’t set a timer and we just try to roll. We just try to keep moving, and it forces a pace that you could maintain for about an hour straight. And I really, really like that. You get lots of repetitions in in that regard.

And then as far as the weights and gymnastics stuff, I just drop in a little bit of gymnastics bodies, mobility and strength work during the course of my work day. Usually once a week I either squat or deadlift. Once a week I might do some heavier weighted press and pull weight room style stuff for the upper body.

But those weight room workouts, I warm up and I’m done in less than 20 minutes. Occasionally a little longer than that if I’m doing a lot of mobility work in between, but even then it’s not like I’m doing a CrossFit work out.

I have two minutes of rest between sets. I’ll do a set of weighted chins, a set of weighted dips, and then some weighted shoulder dislocates to work on my thoracic mobility in between those sets. So it’s not a frenetic pace.

And then the recovery cardio, I will go longer on that if I can. It may be 40 or 60 minutes occasionally, but a lot of those – my oldest daughter now is five years old and has gotten pretty good on her little dirt bike. So I will drive her and and myself over to a park right next to our house that has some dirt trails and she’ll ride her bike and I’ll run at a nice easy pace. So I’m outside and I’m spending time with my kids.

So there’s like somewhere between three and maybe eight hours a week of jiu-jitsu, there’s maybe two more hours total a week of weights and cardio. But I do try to do a ton of stuff. I’ll stick the younger kid in a backpack and go for a hike for as long as she will put up with it. We have a three acre farm where we have animals to deal with, and we just run around playing hide and seek, and stuff like that.

So I do a lot of physical activity running around with the kids, but in the gym stuff between jiu-jitsu and strength and conditioning and all that is less than 10 hours a week, for sure.

[Damien Blenkinsopp]: Yeah, so you keep the intensity monitored.

I just looked up the Myth of Stress. Was that Andrew Bernstein?

[Robb Wolf]: Yeah, Andrew Bernstein.

[Damien Blenkinsopp]: Okay. Bernstein. Cool. That sounds really, really interesting.

Does that tie in with the gratitude stuff? We hear a lot about gratitude and I’ve been practicing it for a little while. I think a lot of people have. Did he mention that at all?

[Robb Wolf]: Yeah. He would be a great interview. He’s a solid guy, a really, really good guy.

(00:41:35) [Damien Blenkinsopp]: Yeah. Excellent.

Okay. So I thought we’d also jump into a little bit of ketones, ketosis, and fasting, because I know you’ve played around with this yourself and your levels of carb. And it’s such a big topic at the moment.

You’ve spoken a bit about you can’t really do the really low carb and the Brazilian jiu-jitsu and that you can’t get away with it. What’s you overall feeling on the whole ketones and ketodiet?

[Robb Wolf]: Yeah, the last chapter of the book is called Hammers, Drills, and Ketosis: the one tool your doctor will never use. Fortunately, that story is changing. Therapeutic fasting and ketogenic diets are incredibly powerful as potential adjuvants or adjuncts to things like epileptic treatments, potentially working in synergy with conventional cancer therapeutics.

Just huge potential there, but it’s crazy because you don’t see people get into huge pissing matches about whether or not you should use a hammer, a screwdriver, or a handsaw to get something done. If you’ve got a 2×4 and you want to cut it cleanly into two pieces, a hammer and a screwdriver are terrible options, the handsaw is a great option. There’s just not a lot of drama around that.

But then whether or not you should be higher carb or lower carb becomes this religious doctrine thing. And there is a little more nuance to it, there is a little more depth. But just empirically we’ve seen people do pretty well at the power athlete end of the spectrum, the real short time indexing end of the spectrum, and quite low carb.

And we’ve also seen some people doing this ultra-endurance work at a pretty good level going very low carb. And interestingly that looks like catering to the ATP creatine phosphate pathway and also mainly the aerobic pathway.

Where we have a kind of deadzone, a no-man’s land, appears to be these really glycalitically demanding sports like soccer and MMA and CrossFit and jiu-jitsu. And there’s just, man you don’t see a lot of just empirical success there. You see people like me that try, and try, and try.

There are a few examples, there are a few people out there that are figuring out how to do it. Probably the highest level, most sophisticated person I’ve seen looking at this problem is Alessandro Ferretti. He’s in the UK. Man, that guy is smart.

And he is just doing some shockingly interesting work looking at [it]. And he does Judo and Karate, so not exactly the same as Brazilian jiu-jitsu but he’s found he runs great on a ketogenic diet, he has great energy, he can fast, and he’s lean. All the stuff is great, but then he will get kind of adrenalized and burned out in the process of doing too much high-intensity activity.

And what he’s done is just try to map out the volume and the intensity of the training he will be doing, and then match that with a maltodextrin solution or maybe a maltodextrin plus fructose, because there are some arguments for repleting some of the hepatic glycogen preferentially. And he does some really amazing work.

Now, for me, because I’m kind of lazy, it also looks a little bit like a calculus problem. Alessandro is like six times smarter than I am, and he runs a really well done clinical intervention, where they’re just collecting tons of data on people.

I’m kind of a knuckle-dragger. So where I’ve arrived out with all the stuff is I just tend to eat between 75 to 120 grams of carbs a day. Higher end on training days, lower end on non-training days.

But the overall story I think is ketosis and fasting hold enormous therapeutic potential. Potentially some great performance enhancement under certain circumstances, but it’s also a powerful tool. And like any other powerful tool it can be misused, or inappropriately used.

[Damien Blenkinsopp]: Yeah, Absolutely. I know Alessandro, I talk to him quite often too. He’s a great guy. I have to get him on this show soon.

[Robb Wolf]: Yeah.

(0:45:35) [Damien Blenkinsopp]: So thanks for all of this. Last thing on this carb thing is it doesn’t sound like you time your carbs at all before or after training, or anything like that. It sounds like you’re very much focused on the practical, which is probably 80 percent of society who aren’t super self-disciplined and robotic about this.

[Robb Wolf]: Yeah, I do time it a fair amount, in following a guy Bill Lagakos. He’s a professor of Biochemistry, I believe, in the East Coast, and really super sharp on circadian rhythms. And he kind of alerted me to this idea that time restricted feeding, the shortened feeding windows, seem to be quite beneficial for a variety of reasons.

But he made a really strong case for this idea that we would do better to eat more of the calories and more of the carbs earlier in the day. And I know there’s carb backloading. This becomes, again, if you want to get a contentious pissing match on the internet, just throw one of these concepts out there.

But Bill made a really interesting case that there’s an argument based off of circadian biology that we should eat more carbs, more calories earlier. And that is one thing that I’ve focused on.

So I will do, whereas before I might do an 18 hour fast, I’ll just do 14 and 16 hours now. And I will do a really robust meal, and then maybe 2 to 3 hours after that I have a Jiu-jitsu session. And then that meal ends up being much higher in carbohydrate. And I again kind of base it off the volume and intensity.

But then usually my dinner… I do two to three meals a day. Probably 80 percent of the days it’s three meals, 20 percent of the days it’s two meals, and that tends to be more the weekends when I’m just hanging out with family and I just want to be lazy and I don’t want to cook yet another meal for myself and all that.

I do partition closer to the pre-workout period but I’m not like taking a maltodextrine drink right before and one right after, and all that type of stuff. There might be some upside to that, but I have noticed for my digestion that the digestive process, for me, does much better with less frequent feedings, and less refined foods and all that type of stuff.

So I’ve had a pretty darn good degree of success with that so far. And I mean it is dead simple. I would be hard-pressed to think of a more simplistic way of eating and fueling. It is really, really simple.

But at 45 years old, I just got my purple belt last Saturday and I’m doing great on that. And body composition is good. My wife is still willing to sleep with me with the lights on most nights. So life’s pretty good in that regard.

[Damien Blenkinsopp]: Congrats, I saw that purple belt. It’s quite an achievement.

[Robb Wolf]: Thank you.

[Damien Blenkinsopp]: So is there anything we’ve missed that’s important about your most recent thinking on this subject?

[Robb Wolf]: No, I don’t think so. You did a great and thorough job asking this stuff.

Again, I would just encourage people to think about, if they feel off-put by this idea of Paleo diet type stuff, just give some thought to this. Is there any merit looking at biology and thinking about the evolutionary underpinnings, particularly when we see things go south?

If we don’t see health or other parameters that we would ideally like to have, if something significant is changed in that organism’s environment, do we have any insight from looking at what the environment preceding that event? So that’s kind of the totality of my greasy used-car salesman pitch on this stuff. Is there anything we can learn from that?

And it’s not just around food. It’s around sleep, and photoperiod, community, gut microbiome. All of these things really, when we see problems popping up, it’s this discordance model again. And modern medicine is shockingly well-suited for dealing with acute injuries and infections, and it has been an appalling failure with regards to chronic, degenerative disease.

And people may get their back up about that and say we work very hard. I don’t doubt that people do, but if you simply look at disease rates and incidence – Type II diabetes, Parkinson’s, Alzheimer’s – they’re increasing at exponential rates, yet we know more about the disease process than we’ve ever known in history.

Our iPhones, iPads and computers get cheaper and better every single year, and it’s because we properly apply the technology and knowledge that we have around that topic to improving the product and the outcome. We do not do that in health and medicine, and it’s because we do not start the story from this evolutionary biology perspective, and start having the conversation from there. Because if you do that, chasing symptoms no longer works, and filing people into these arbitrary buckets of disease or not-disease doesn’t really work anymore.

In the 1900s, the previous century, was the century of eradicating infectious disease, for the most part. This century is going to be about dealing with chronic, degenerative disease due to affluence. And it is not going to be solved by a pill or a potion. It’s not going to be solved by telling people to eat less and move more, everything in moderation. Because all of that completely ignores every element of our fundamental evolutionary biology.

[Damien Blenkinsopp]: Thanks, so much for that roundup.

To learn more about this, they can go and get your book. That’s available at Amazon. There were some bonuses or stuff. Is there anything like that still available?

[Robb Wolf]: The bonuses might pop back up again, but most of that was for saying thank you for people who were early adopters on it. But we’ll see. Maybe a couple of months down the road we might pop the bonuses back up.

(0:51:39) [Damien Blenkinsopp]: Okay, cool. Are there any other good books or presentations on this subject that you’d recommend?

[Robb Wolf]: Oh, man, if people are not following Chris Masterjohn, they’re really missing out. That guy is brilliant.

And he’s been doing a deep dive on kind of a series of different nutrients that you need to pay attention to. And he kicked the whole thing off, actually, with iron. Both the iron deficiency, anemia, stories and also the iron overload stories.

So he gets into the biochemistry and the pathophysiology of when things are right and wrong. And then he also starts off at whole food solutions and also makes supplement solutions, and man he is just doing brilliant work.

Who else is doing great work? The folks at Nourish Balance Thrive are doing phenomenal work. Marty Kendall over at Optimizing Nutrition. They’re just some brilliant people.

It’s funny a lot of them had an engineering background and either they got sick or spouse got sick, and then they got in and started looking at this stuff. And it’s interesting. They come in with no medical training biases, and after they start retro-engineering, literally, the disease process, they arrive at something that looks like kind of an appropriate carb, Paleoesque looking nutritional intervention with a focus on sleep and gut microbiome and all that.

I don’t know if that’s just confirmation bias, or really smart people applying their training to figuring out a process. But it certainly caters to my confirmation bias, so I tend to like that stuff.

(0:53:14) [Damien Blenkinsopp]: Cool.

What are the best ways for people to connect with you, and learn more about you and what you’re up to? Twitter or Facebook?

[Robb Wolf]: The blog and podcast live over at Robbwolf.com. The bulk of my social media time I spend on Instagram these days. My handle there is @dasrobbwolf, and I answer just about every single question that is shot across the bow there. So I do the best job I can to stay on top of that.

(0:53:45) [Damien Blenkinsopp]: Excellent.

Just a few more details maybe on our personal approach through using any tracking. I know we’ve already spoke about them, so just really to see if there’s anything else.

I was wondering if there’s anything you track yearly, or every six months, or anything like that that we haven’t already spoken about.

[Robb Wolf]: So, I do check-in on my lipoproteins, that LPIR score, or LDLP, LPPLA2. There’s kind of a suite of somewhat obscure lipoproteins which I keep an eye on about once a year.

And part of that is because at the end of my last book, I was pretty beat up from that. Then I went on a Discovery Channel reality show, called I, Caveman. And we had to live like Stone Age hunter-gatherers. We had stone tools, we lived at 8,500 feet in the Colorado Mountains while there was still snow on the ground.

We basically starved for 10 days until I killed an elk with a hand-thrown spear, and that was the first food we ate. But the long and short of that is I lost 18 pounds in 10 days, and was super beat up. And I ended up with some HPTA axis dysregulation. My thyroid was super low, I had adrenal issues, testosterone was kind of tanked out.

And so an interesting sideline with that was that my lipoprotein numbers were sky-high. My LDLP was 2,800 or something like that. Really, really high. And the clinic that I’m on the Board of Directors of here, we do tons of lipidology work. And the doctors were freaking out, you need a statin. And I said no I don’t, I’ve got other stuff going on.

So we did some poking around, and I actually went on some Nature Throid, which is kind of like armor but a T3/T4 thyroid deal. And I did kind of a classic adrenal restoration story, high dose Vitamin C, some licorice, some adaptin. And I quit traveling, and I started really paying attention to my sleep.

And within three months I was off the thyroid medication, testosterone had more than doubled, both free and total. And I felt remarkably better after that, shockingly. And my lipoprotein number, my LDLP, had gone from 2,800 to, I want to say, 1,100. And eventually it settled out at 800 or 900.

I do check back in on that every once in a while though, because that combination of super low testosterone and disordered thyroid. The low circulating T3 that really down-regulates your LDL receptors in the liver. So you just don’t clear LDL particles, so they accumulate in circulation. And once they start accumulating, then the potential for them to oxidize is much greater.

And then I also potentially have a little bit of iron overload going on. So I had a really kind of nasty situation brewing there. So I do check in on that, just to make sure everything is bumping along good. So I do a really thorough thyroid assessment, which is TSH, T3, T4, reverse T3, thyroid uptake, and then some of the just kind of background iodine status. And that gives me a pretty good benchmark about where that is.

And then I’ll check testosterone, estrogen, estrodiol, DHT, to kind of see where that part of the hormonal axis is. Because again, based off inflammation, fatty acid ratios and what not, you can start pushing more testosterone towards the DHT pathway, which can be problematic for the prostate under certain circumstances.

So I pay attention to those things, but it’s usually about once a year. But again, I’m a lazy cuss when it comes to that stuff. I know some people test it like once a month. I’m more of a once a year, maybe once every six months on some things. But more of a once a year deal.

(0:57:58) [Damien Blenkinsopp]: Thanks for that, very, very interesting. And the fact that you recovered, and you obviously see that as an actionable metric that you can keep up with.

I’m just wondering, which labs were there? If there’s any specific place, or are these just standard Quests, or something like that?

[Robb Wolf]: We tend to go through LabCore because LabCore ended up purchasing LipoScience, which is the [unclear 58:09] that developed the NMR technology around looking at lipoproteins. There’s other ways of looking at it, and they have pluses and minuses to them, but in my opinion that NMR spectra that looks at the LPIR score and lipoprotein count is head and shoulders above everything else out there.

The guy that largely developed it, William Cromwell, he was a physical chemist, a believe a PhD, which is basically a physicist who studies chemistry. And then he went to medical school, and he got into this NMR spectra jockeying type stuff, and developed this whole technology around looking at these lipoproteins. They have some really interesting correlation studies that they’re doing.

There’s a biomolecule called glycA, and by looking at glycA in relationship to some other lipoprotein fractions, they’re claiming that they can see things like Parkinson’s, Alzheimer’s, and insulin resistance decades ahead. And they’re still awaiting FDA approval on that. But it’s really interesting. So I tend to really put some pretty heavy weight on that lipidology side with regards to that LPIR score and that whole NMA spectra technology.

(0:58:28) [Damien Blenkinsopp]: Thanks very much, that’s very, very interesting stuff.

I think I know what you’re going to say here. If you were to recommend one experiment someone should try to improve their body health, performance, longevity, chronic health issues, whatever, with the biggest payoff, what would it be?

[Robb Wolf]: Sleep.

[Damien Blenkinsopp]: Okay.

[Robb Wolf]: Sleep. I mean, maybe a blood sugar deal I can make an argument for, but if we improve your sleep, there is nothing else that you could do that’s going to improve everything else more.

And the one caveat with that, if we have say a shift work population – police, military, firefighter, new parents, medical caregivers – who can’t control their sleep, then they really need to get a handle on the glycemic load of their diet and get it to a level that’s non-toxic for them.

But even then, the shift-workers, they need to pay even double attention to the sleep. When they do sleep, they need to sleep well. When there is sunlight, they need to get out into the sunlight at appropriate times. It becomes doubley important for them.

But the greatest return on investment anybody’s going to get on any of this health and wellness stuff is putting more emphasis on their sleep.

[Damien Blenkinsopp]: And should they just track hours slept, something simple like that?

[Robb Wolf]: Hours slept is good, but it’s more the ritualized process. When the sun goes down, then you dim the lights. And if you’re still on the computer, you flip on the f.lux, and you put on some Blue Blockers, and you set up a ritual.

To the degree that we set our lives up that we have to live and die by self-control, we’re mainly going to die. We’re going to fail. And so we have to set up a kind of a habituated process so it really takes the thinking out of it; it’s just what we do. So I would tend to focus more on that.

And then certainly if you want to keep an eye on approximate duration in bed, but that’s a whole other interesting feature too, is when you start paying an over the amount of attention to those things, then you start getting anxious about it. And I just see this damnable downward spiral in the quantified self space, where I just want to put a black bag over these people’s heads, drag them out into the woods and stick them in a tent.

And it’s like, there’s a creek full of fish. We’ve got them trapped behind a fish weir, you need to get them out by hand and gut them and cook them. Here’s the kit to make a fire. We don’t make it ridiculously hard, but you’re going to have to work to get your dinner, work to stay warm. And when the sun goes down you’re going to make a decision, do I want to sit up in the dark, feeding this fire on the limited firewood I have, or am I going to go crawl into my sleeping bag and go to bed.

They’re not quantifying a goddamn thing under those circumstances. And all of a sudden, all of the digestive issues disappear, and the sleep disturbances disappear, and they’re three body fat percentage point is lower after a week and it’s not because they’re hypocaloric, it’s just because they’re not inflamed and insulin resistant.

And so again, I try to get people to just live. I’ve really been harping on this thing of track what matters. And the longer that time goes along, I’m just finding fewer and fewer things that matter, relative to the experiential process. Be in your body, experience what is going on. Be in contact with what your emotions are, and develop a little bit of a zen and stoic process, where you can see these things occurring, and then you can choose to how you respond to it.

Whereas if we’re so tied to external devices for every little bit of feedback, then we’re essentially dependent on that. And I hate dependency of any variety.

[Damien Blenkinsopp]: Thanks so much for that, this is really, really interesting. It’s been a fantastic episode. And thanks for being so open, just giving all these details of your own experiences and your life. It’s a great, great show. Thank you.

[Robb Wolf]: My pleasure. It’s a huge honor being on. Thank you.

References:

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Is your glucose metabolism driven by your personal microbiome? Recent research reveals how the microbiome influences blood glucose, weight gain and weight loss. And how the new company, “Day Two”, is using microbiome sequencing data to provide personalized nutrition recommendations.

In this episode we discuss how personal your blood glucose response and regulation is. We look at how glucose metabolism can differ from one person to another, and how it differs based on typical measures, such as the hypoglycemic index. Most research studies try to understand what a diet or food does to an average person. But the question is whether you or any of us is an average person? Will your body respond to inputs in the same way as it will for an average person?

I found out that collecting personal data for myself is more useful than following the recommendations that come out of the studies that are looking at a statistical human person, rather than a real individual person. Data which is unique and personalized is usually most helpful to act on, especially when the derived conclusions differ from the mainstream nutrition studies proposals.

In the past, we have covered several aspects related to this episode. You may find it helpful to do some background listening on previous episodes before digging into this one. These include the blood glucose metabolism episodes, Episode 43 on Continuous Glucose Measurement and Episode 26 on Biomarkers of Aging – in which we discussed blood glucose as a biomarker of aging.

On microbiome testing and its use, we have had episodes that are relevant to this one. There is Episode 9 on Quantifying the Microbiome with uBiome and Episode 37 on Health Impacts of the Microbiome with Robert Knight, a well-known researcher.

“We study many different aspects of the microbiome as it relates to our health. This is another study where we studied another very basic phenomena, the yo-yo diet. What we showed there is actually that even after you complete a diet and lose weight, your microbiome doesn’t go back to what it was.
– Eran Segal

This is a two part episode with two guests. We have Eran Segal who heads up the Segal lab, which undertakes research in computational and systems biology focusing on nutrition, genetics, microbiome and gene regulation, and their effects on health and disease. This lab has released a series of studies over the last years on microbiomes and how they may be impacting blood-glucose regulation.

These studies have been heavily featured in the mainstream press because they put into question lots of our assumptions of how diets and food work, and how they impact blood glucose. Eran Segal earned his Ph.D. from Stanford in 2004, and in 2011 he was made a professor at the Weizmann Institute of Science, which is very well-known in Israel.

“What we do is give you a mobile application. So you get a personalized mobile app that you download, and it’s tailored just for you. It gives you a microbiome report, because we did it and we have it… We’re giving you your top food and meal recommendations. You have your top breakfast, your top lunch, your top dinner, your top fast food, because even when you eat fast food once in a while, you can still choose healthier fast food than others.”
– Lihi Segal

Our second guest is Lihi Segal – same last name but, no relation. She is the CEO and Co-Founder of DayTwo, which is the new microbiome lab-testing and personalized diet and recommendation service that has licensed, and is applying the research from the Segal lab, on the microbiome. Lihi has held a series of CFO and COO positions in start-ups over the years. Previously, she was COO and CFO of Sisense Limited, a provider of business intelligence and analytic software. She holds an MBA from Northwestern University.

itunes quantified body

What You’ll Learn

  • Studying the glucose response as a quantifiable effect food has on our bodies (05:43).
  • Post-meal glucose levels represent direct tracking of response to different foods (13:00).
  • Tracking glucose spikes and quantifying the body’s post-meal blood glucose regulation (14:17).
  • The accuracy and usefulness of continuous glucose monitoring – new devices and helping research (14:55).
  • Constructing multifactorial algorithms for personalized prediction of blood glucose response (18:53).
  • Using high-resolution microbiome sequencing to detect specific strains of microbiome bacteria (20:31).
  • Compared to BMI or blood tests, the microbiome is a more significant factor in predicting glucose metabolism in a personalized way (22:55).
  • Different microbiome features contribute to the overall prediction of response (22:56).
  • The propensity to gain weight and the effects of artificial sweeteners (26:11).
  • The microbiome’s acquired ‘memory’ regulates weight gain mechanisms (26:53).
  • Relapsing weight-gain is regulated by the microbiome, including by regulating genes involved in energy expenditure (26:53).
  • The microbiome remains stable over time, such that consistent long-term diet changes are required for profound health effects (30:20).
  • Unlike micronutrients, small fibers are digested solely by gut bacteria – but consumption of either has sustained effects on glucose metabolism (33:38).
  • Artificial sweeteners currently being examined by Segal Lab (34:52).
  • What DayTwo does as a company and personalized services to expect in near future (35:20).
  • Providing actionable information for glucose management (42:00).
  • The basic data inputs for using the DayTwo service and integrating lifestyle into personalized diet feedback (43:26).
  • Instead of being a diagnostic company, DayTwo offers recommendations under a predictive model (45:52).
  • Where DayTwo microbiome testing and output to users stands out – comparison with competition companies (46:38).
  • DayTwo collaborates with the Mayo Clinic to replicate the Israeli microbiome study on US population – calibrating the algorithm for American foods (50:59).
  • DayTwo’s success story in Israel, public recognition, service available for pre-order in the US (53:15).
  • Plans for bringing DayTwo to the UK and European markets after first tackling the US market (55:24).
  • DayTwo US release is not dependent on the Mayo Clinic trial, but more data means continuous predictive algorithm improvement (57:34).
  • Reasons why numerous lab testing companies operate in Arizona (58:53).
  • Pricing of DayTwo services and a lower US pre-order price (59:42).
  • DayTwo takes a direct to consumer approach – offering customizable nutrition advice delivery for different individuals (1:01:51).

Thank Eran Segal and Lihi Segal on Twitter for this interview.
Click Here to let them know you enjoyed the show!

Prof. Eran Segal, Segal Lab

Lihi Segal, DayTwo

  • DayTwo: A microbiome lab-testing company and personalized diet recommendation service. Lehi co-founded DayTwo where she currently serves a CEO function.
  • MyNetDiary: LabTwo’s database for the American market is on this network’s nutrition database featuring 400,000 different US-based foods.

Tools & Tactics

Diet & Nutrition

We discussed the studies that reveal several tactics with respect to weight loss and weight gain, as well as optimizing blood glucose metabolism towards health impacts. Important aspects from Prof. Eran’s team’s research include:

  • Predicting Diet Response: We discussed the health effects and potential benefits of various diet types. A key takeaway is that nutrition can be personalized based on predicting post-meal blood glucose responses.
  • The Microbiome & Artificial Sweeteners: Segal Lab has tested for the effects of non-caloric artificial sweeteners (NAS) – namely saccharin, sucralose and aspartame compounds. They determined that artificial sweeteners induce glucose intolerance by altering the gut microbiome. Xylitol and stevia are chemical formulations currently being examined by Segal Lab.
  • Post-Diet Weight Regain: Eran’s team have shown that persistent microbiome alterations modulate the rate of post-dieting weight re-gain. As a general rule, a low carbohydrate diet is most beneficial for weight loss because this diet prevents post-meal blood glucose spikes. Compared to a meal which spikes blood glucose levels, low response meals are associated with more fat burning and with losing weight over time.

Tracking

Lab Tests

  • DayTwo: This test offers analysis of your blood glucose metabolism as a response to particular food types or complex meals.
    • The most novel feature is microbiome sequencing with the greatest resolution offered on the market – known as ‘shotgun sequencing’. This method covers the entire genetic content found in a stool sample.
    • Current price in the US is $299 pre-order, but will later cost $399 as a standard price for the US market. This is cheaper compared to Israel, where the price is $500. In Israel, DayTwo incorporates continuous glucose monitoring for all users, thus requiring more for the glucose monitor everyone receives.
  • uBiome: A company which offers microbiome testing services, using 16S sequencing technology for microbiome analysis. We covered the applicability of uBiome’s service in Episode 9.
    • While it is cheaper than DayTwo sequencing, 16S sequencing does not allow looking below the genus level of bacteria. 16s sequencing looks only at one small region of RNA rather than the whole sample and for this reason does not provide the same resolution or ability to differentiate between different species for lack of information. 16S sequencing is the most popular today for cost reasons.
    • Differentiating between specific species of pathogenic vs. benign E. Coli is not possible with 16S sequencing, but is a standard with shotgun sequencing (DayTwo testing).

Devices & Apps

  • DayTwo Food & Activity Logger: A mobile application providing personalized day-to-day nutrition and diet recommendations.
    • The app offers analysis of your microbiome in report format, based on the required LabTwo testing.
    • Additionally, it features your top breakfast or lunch food components, allows searching through a food database, and makes recommendations on alterations – e.g. substituting rice for pasta whenever fit for your body’s blood glucose response.
    • Over time, the impact of using this app should be improved health by consuming food with the aim to optimize your blood glucose metabolism.
  • Freestyle LibreThis device is used for continuous glucose monitoring and the obtained data is used to determine trends in glucose metabolism. The FDA approved this product for the US market in 2016.
    • Contains a glucose sensor and a reader displaying the glucose data collected by the sensor.
    • Segal Lab is switching to this device partly because it offers greater user convenience by avoiding the finger pricking technique for obtaining analysis-blood.
    • Eran claims the device is at least as accurate as the company states, possibly even more accurate.
  • Fit Bit Charge: A device from the FitBit company was used in Segal Lab research to track and integrate lifestyle (sleep, meditation, exercise) into predictive algorithms for personalized nutrition recommendations.

Biomarkers

  • Post-Meal Glucose Response: Measuring blood glucose levels for the two hours following a meal.
    • The most important measured phenomena by Segal Lab and subsequently used by LabTwo for making nutrition predictions – are glucose spikes following a meal.
    • Glucose spikes are sudden rapid increases in blood glucose concentrations as a result from particular meal types, or more broadly a result of your diet.
    • Glucose spikes are associated with disease (e.g. diabetes and types of cancer). Thus, avoiding such responses is important for optimizing blood glucose metabolism.
    • Other times we have discussed post-meal glucose response is Episode 7 on optimizing ketogenic dieting and Episode 43 on continuous glucose monitoring.
  • Hemoglobin A1C: This is the most used marker for diagnosing diabetes. Its interpretative power is derived from the connection between glucose and hemoglobin – the protein in red blood cells (RBCs) which carries oxygen. Because RBCs live approximately 3 months, Hemoglobin A1C reflects the average blood glucose levels over this period.
    • The results are reported in percent (%). Higher levels of hemoglobin A1C indicate poorer control of blood glucose levels.
    • Prediabetic states range between 5.7 – 6.4% and diabetes is diagnosed above 6.5%. Optimum HbA1c levels are likely below 5%.
    • A caveat: Depending on your diet, your RBCs can have a shorter or longer lifetime. Since HbA1C measures glucose accumulation having RBCs with a longer lifetime than average leads to higher HbA1C readings despite average blood glucose being low. For example, Damien’s blood glucose is typically under 100mg/dL at any time point even after many meals due to his ketogenic diet. His HbA1C has ranged between 5.1% and 5.3% during this time however low carb diets are assumed to lead to longer RBC lifetimes. Higher carb diets are typically assumed to have average RBC lifetime.
    • Both guests share the opinion that collecting HbA1C and other blood marker data is not useful for making nutrition predictions once you have microbiome sequencing data. This is because sequencing provides sufficient data when combined with an algorithm to predict an individual’s glucose metabolism and provide personalized nutrition recommendations.

Other People, Books & Resources

Organizations

  • DNA Genotek: A Canadian company supplying microbiome collection kits for DayTwo analysis. After extensive testing, DayTwo concluded that DNA Genotek offers the best state of the art technology requiring no freezing or timing. The end result is the ability to preserve stool sample in the Day0 condition for greatest result objectivity.
  • Mayo Clinic: LabTwo cooperates with the Mayo Clinic aimed at repeating the trial in Israel at the Weizmann Institute on an American population. The aim is to obtain more data and to optimize the predictive algorithm for blood sugar response to the US population. While the trial will last for a while, LabTwo is currently able to make precise predictions for US users and the data from the trial will be used to work on similar targeted future goals.
  • FDA: The US Food and Drug Administration has placed a diabetic label on CGM technology. Thus experimenting using CGM devices with individuals is not allowed, unless diabetes diagnosis has been previously established in the test participants. LabTwo partnered with the Mayo Clinic and have successfully designed a trial including CGM devices which was approved by the Mayo Clinic institutional review board (IRB) – essentially an internal ethics committee.

People

  • Dr. Saleyha Ahsan: She traveled to Israel to take part in the study on personalized nutrition at the Weizmann Institute. Afterward, this was covered in an episode of the BBC Two Trust me I’m a Doctor show.

Other

Full Interview Transcript

Click Here to Read Transcript

(00:05:43) [Damien Blenkinsopp]: Welcome to both Eran and Lihi Segal onto the call. Thank you both very much for joining us.

So I just wanted to jump straight into your research on the glucose response, and all of the other stuff you’ve been doing in the last couple of years really because it’s all kind of related. Why did you focus on the blood glucose topic in particular?

[Eran Segal]: That’s a really good question. When we started a few years ago, we wanted to take a science-based approach to nutrition.

We thought very hard about that problem, and what we should examine. And if you think of the most common approaches in most studies in nutrition they usually consist of some dietary intervention, and then they look at weight loss, or they look at a change in some marker of a disease. And that’s great because ultimately these are the parameters that we’d like to have an effect on.

But, the challenge we found with this approach is that it then takes weeks or months for these parameters to change. You know, a parameter that measures your diabetes level, or weight. And at the end of this, you get a single measure. It takes weeks or months to change, and that measure is affected by multiple things that happen to you during those weeks or months. Both the diet intervention that you give, but also many other factors unrelated, which can be then confounding to what you’re measuring.

So, we thought that maybe one of the reasons that it’s very hard to do nutritional research, and why many researchers are failing, is because they’re looking at this single measure effected by many things. So we didn’t want to go that way. Even if we see an effect, you’re not sure you can attribute it to the diet, and if you don’t see an effect it’s very hard to troubleshoot what went wrong.

So we thought very hard about this, and that led us to look at glucose levels. More specifically, the glucose levels after a meal, what’s called the postprandial glucose response, or post-meal glucose response.

So by that, what I mean is what your blood glucose levels look like in the two hours after you eat a meal, which we can also quantify using the area under the glucose curve into a single measure representing the response that you had to that meal.

[Damien Blenkinsopp]: Right, so that’s like the total area under the curve is the total amount of glucose that was in your bloodstream during that area of time.

[Eran Segal]: Yeah, you can think of that as an approximation. I’ll tell you in a moment what we really are hoping that this is actually measuring, but that’s quantifiable into a single measure. But now we have to think about three aspects, or three features of this that really led us to conclude that this is what we want to follow.

So in a nutshell, what they are is that we were convinced by all the existing literature that this post-meal glucose response is really key to weight management. It’s really key to disease – diabetes, but not only diabetes, I’ll talk about those.

Finally, and not least importantly, that it’s very easy to measure and it’s something that, not within weeks or months but within a week, we can obtain not one, but even 50 quantitative measures of healthy nutrition in a single individual.

So first, why is it important for weight loss and weight management? This is very basic, and there’s been a lot of literature on this.

When we eat – and I’m talking about healthy people, even people who are glucose intolerant, but let’s say not insulin dependent Type I diabetics. When we eat, our body digests carbohydrates in the meal and releases them into the bloodstream.

After that, there is a response of the body by secretion of insulin, whose job is to lower the glucose levels. But in addition, what insulin signals, also, is it signals the cells to uptake the sugar that’s floating around in our blood.

And then excess sugar is converted into fat for storage because it initially is converted into storage of glycogen, but our stores of glycogen are highly limited. So very fast the remainder will be stored as fat. And this is actually known as one of the primary mechanisms by which we gain weight. In other words, this action of insulin.

So, in a sense, we would have liked to even measure directly at a continuous rate insulin, but that’s technically not possible. But in healthy people – and there’s been lots of research – by measuring glucose levels you’re actually looking at a proxy for a measurement of insulin.

And there’s been work showing, for example, that if you eat a meal that spikes your glucose levels compared to a meal that does not, then after a meal that does not you have more oxidation of fat, more burning of fat.

So the connection to weight loss is very well established. There’s also a lot of literature looking at very low-carb diets, which I think as a dietary regiment it’s incompatible with life for most people. But if you look at some of the studies when you eat a low-carb diet your glucose levels are low, and in general, those have the most beneficial effect on weight loss.

So that’s item number one why we focused on blood glucose levels because it’s very important for weight loss and management. The second is disease, and the most obvious is, of course, diabetes.

In fact, diabetes is diagnosed and defined by glucose levels. It’s defined in two or three different measures; either by the hemoglobin A1C, which measures your average glucose over a period of three months or by the glucose levels that you have two hours after you eat a meal. So something very similar to what we’re measuring.

And so, of course, you directly are playing with and improving the measures by which you diagnose diabetes. By that we can manage better the disease; manage it better in pre-diabetics, even possibly reverse it in this population. And, of course, for all the people with normal glycemic levels, we can prevent or delay the onset of diabetes.

So that’s one area where it’s important, but then separate from diabetes there’s been a lot of links to cardiovascular disease, to cancer. So in cancer, this is known as the Warburg effect. We know this for 90 years that cancer cells have a very different metabolism that much more heavily relies on glucose.

And so the thought is that by limiting the amount of glucose that you provide, you deferentially affect the growth of cancer cells compared to normal cells. And there’s been associations in the literature between blood glucose levels and cancer.

There are also been associations to overall mortality. There’s one paper that tracked over 2000 people for 30 years showing that if you responded more highly to a glucose challenge 30 years ago, you’ll live longer, basically. So there’s been links to many diseases, and so we’re very confident that it also has a strong association to disease.

And the final point is what I made before that because of the technologies with continuous glucose monitors we can now really in a single week measure 50 quantitative measures of healthy nutrition. And they’re quantitative of health nutrition because of the two points I made before.

[Damien Blenkinsopp]: So you felt that it was basically the continuous glucose monitor was a game changer because you’d be able to gather a lot more data quickly, and eliminate somebody’s potential variables coming in from the longer term studies which you can avoid.

[Eran Segal]: Absolutely. So if you think about it, we actually focused on examining the direct effect, one of the ways by which food directly affects you, and this is your glucose levels.

And from everything I mentioned before, we also believed that this is really a very critical clinical marker for weight loss and disease.

(00:13:30) [Damien Blenkinsopp]: Right. Okay, great. So you focused on the post glucose response to meals specifically, but you did mention Hemoglobin A1C. Is that something else you tracked and you found useful in these studies?

[Eran Segal]: So that’s something that we measured. We found it useful for predicting how different people respond to different foods, but it’s nothing something that you measure as a direct effect of a meal.

It’s one of those single parameters that takes many weeks to change that, again, would be very hard to develop a dietary regiment that would affect that directly because of all the confounders that I mentioned before.

So in fact, glucose levels is, as far as we know, the only reliable quantitative measure that is really super relevant that we could track, and that’s why we focused on it.

(00:14:17) [Damien Blenkinsopp]: Right. And you mentioned the area under the curve is the part that you’re interested in. So I’m guessing that you’re looking at a benchmark to what’s okay, and what goes too high in terms of that area.

You said to me when I tried to give an analogy to explain that to the audience that it wasn’t quite right. How would you explain the utility of that?

[Eran Segal]: We can just say that it’s basically looking at your glucose response and it’s quantifying how much you had spikes for glucose levels after the meal. And these spikes, as I mentioned before, is what is strongly linked to everything else.

(00:14:53) [Damien Blenkinsopp]: Right. Thank you very much. How did you find the continuous monitoring technology? Did you use a specific device, and how sensitive or accurate did you find it? There’s various monitors out.

We’ve spoken about these before, and I know people that have been using them for diabetes management and so on. So I’m just interested in your opinion on where that technology is right now, if research can be improved maybe later as it advances, or is it already as good as it’s going to get.

[Eran Segal]: So I think it was very good for our purposes. Not without problems, but I think even finger pricking is problematic, and can be variable. But, there’s also progress.

There’s a recent device by Abbot that we are now shifting to using because it’s more convenient, mainly. It’s probably as accurate, possibly even with higher accuracy – that’s what the company claims. But it’s just much more convenient, and it doesn’t require the finger pricking anymore.

But overall, they definitely capture the trends. I will say that when we measure responses to 50,000 meals you really have a very large data set, and you can afford to have some inaccuracies here and there, which all the technologies have. And still you correct for that in the algorithms.

(00:16:10) [Damien Blenkinsopp]: Great, thank you for that. Moving on a bit to what you discovered is actually driving these blood sugar regulation changes. What are the examples of the most unexpected things that you saw in the data?

[Eran Segal]: Are you talking about the factors that affect it, or even just before the surprising responses that people had?

[Damien Blenkinsopp]: I’m interested in both. If we start with what you saw that maybe you weren’t expecting, and then what you think drove that, or what you discovered drove that.

[Eran Segal]: So the first key result of the study was – and this was initially very surprising – we saw that when you give different people the exact same meal, they have very, very different responses. And this is in contrast if you eat the same meal on two different days, which is what we’ve tested on an unprecedented scale of 1000 people. This is 7000 different meals standardized that we provided.

When you eat the same meal on two different days your response is going to be very similar, but when you and I will eat the same food, our responses will be dramatically different. You can eat bread and have zero response, and I can eat bread and have a higher response than what I would have if I even ate pure sugar. So it was really all over the place.

And this was even before talking about our solution, this was very surprising. And we realized also that it has a lot of implications.

Because if we realize, again, the importance of blood glucose levels to our health and weight, then what it directly means is that general dietary recommendations are always, no matter what they are, going to have limited utility. Because for any single food that we tested, we had people who had a high response and others that had a low response.

So you can’t really make a general recommendation about food. Now there are trends. There are foods that lower glucose levels on average, for some people. And that is known; it’s what’s called the glycemic index.

I think you even touched upon that in your questions. And we also saw that in the data. So whatever foods have been reported with lower glycemic index on average they have lower responses also in our data. But if you look at all those numbers that go into making that average, they’re all over the place.

[Damien Blenkinsopp]: So there isn’t a cluster around the mean, it’s widespread.

[Eran Segal]: Exactly. It’s very spread across it. And when you measure enough people the means will be significantly different, but there is a wide spread across the means.

Meaning that we can take ice cream, for example, which on average induced relatively low glucose levels, and we can take rice, which on average, induced high glucose levels, but you will still find people that respond more highly to ice cream than to rice.

(00:18:49) [Damien Blenkinsopp]: So it’s quite surprising in those terms. So, in terms of what you’ve found or discovered that drove that. I know you tested for a lot of different things. What sort of things did you also test for in order to try and find the pattern of what was driving this?

[Eran Segal]: So we looked at many different things. We looked at body measures, anthropometries, height, weight, waist for instance and so on. We looked at several metabolic parameters in blood. We looked at questionnaires.

So we had a medical background in food frequency and lifestyle questionnaires. And the most novel component that we integrated into the study is the microbiome. So we measured all of those. In fact I will say that we found an association, a strong correlation, between variability and the response to food in all of these different groups of parameters that we measure.

And then the next step was to take all of these parameters and integrate them into rules, or an algorithm, that basically given your inputs to all of these factors, which vary from person to person, we would be able to predict how you would respond to each and every single food or food combination or complex meals.

And we showed that that actually works very well, and predicts personalized responses with very high accuracy. In fact, the accuracy that we think is even feasible because, even when you eat the same meal on different days, I mentioned your response is going to be very similar, but it’s not going to be identical.

So there is some inherent biological variability, and our predictive power is approaching that variability.

(00:20:30) [Damien Blenkinsopp]: Okay, great. The microbiome was the novel part of this. What exactly did you look at? Because there’s a few different approaches to looking at the microbiome right now.

What were you looking at and trying to map with it?

[Eran Segal]: So we looked at the most comprehensive in terms of resolution, which is just doing shotgun sequencing. So that’s basically sequencing the entire content of what we find in a stool sample. That mostly consists of bacteria, but this type of sequencing is really the highest resolution.

It allows us to identify individual genes in the bacterial composition, of which there are several millions in each and every one of us. It allows us to identify not just species, but also specific strains of bacteria.

And so there are many of these different factors that we integrated together, and used them in the algorithm.

[Damien Blenkinsopp]: Great. Is that cost prohibitive verses some of the other technologies that are used out there?

So you have the 16S, which is just looking at one part which some of the projects like uBiome are using right now to enable them to serve many consumers and make it a lower cost so people can afford it right now. Are the costs much higher for what you were doing?

[Eran Segal]: So first of all, for 16S, I will say that we didn’t want to go in that direction because science-wise I don’t think we would have gotten as predictive power.

And in fact we even showed that to ourselves in the study because it doesn’t have the resolution, and in many cases it doesn’t allow you to go below even the genus level of bacteria. So you can have the pathogenic E. coli or non-pathogenic E. coli will have identical 16S; you won’t know what’s in there. Just to give an example.

So we went for the shotgun sequencing. It is indeed much more expensive. If you talk to researchers they’ll tell you that it’s way more expensive.

I will say that what we have been working on in our labs for many years prior to this study, and then as part of the study, is to optimize this process very extensively using automation and using robotics.

We’ve substantially reduced the cost; it is still significantly more expensive than 16S. But I think our margins of error are much smaller than other researchers, and this is probably also why we were able to profile at that level.

(00:22:53) [Damien Blenkinsopp]: Okay, great. So, in terms of the microbiome – because we’re talking a lot about the microbiome and the other factors – is there a stronger weighting of the variability? Are there variants associated more with the microbiome, or are there some other factors that are really important?

The other thing that is interesting is the microbiome actually does change, and we’re trying to change it and improve it and so on in many clinical situations now. Whereas your height, age aren’t changeable.

So if you could give me a bit of background on what you found is the biggest weighting there, and maybe which is most actionable?

[Eran Segal]: Those are two very good questions.

Related to what is most important, every component that I mentioned before we can show has significant predictive power. Now of course, in terms of predictive power, some of these components are somewhat redundant with each other.

So for example we found that when you add the microbiome and some other components, then we can do without all of the blood tests, and in fact we don’t need them at all for the predictive power. They add really something negligible.

Of course we think that blood parameters are predictive; it’s just that in the context of many other parameters, they’re somewhat redundant because they can be explained and correlated with several other parameters. And so likewise with the microbiome we found that actually unlike blood, in every context that we apply the algorithm, the microbiome always had a significant contribution to the prediction.

I will say though, that of course the microbiome has the most significant contribution when you add it by itself. As soon as you add more and more parameters, this is expected. It’s marginal contribution. And also, I believe this is an area where with additional research we can dramatically improve in the future.

We already have started this process because we have a lot more information and a lot of smarter ways by which we can handle this data, which is not true for BMI, weight, blood parameters, which are very limited in the amount of information they have.

[Damien Blenkinsopp]: Right, because there is basically truckloads of data we’re going to be taking out of our microbiomes, because there’s so much in there.

[Eran Segal]: And when we and others continue to research and identify key genes in the microbiomes that are helping in the breakdown of certain products, production of different metabolites that affect us, and we know better how to zoom in on different features, we’ll be able to improve the predictive power from it.

(00:25:25) [Damien Blenkinsopp]: Great. So in terms of the level, you mentioned that the technology that you’re using goes right down to the strain level, and the species, and genus, and so on. But where do you see the patterns?

Is it on the genus level, the species level? Is it just one species that can completely change how we respond? Or is it at a very high level like bacteroides, or something like that?

[Eran Segal]: So there are significant associations on all levels.

And I can say that it’s not a single species that is really dominating. We actually have this in our paper; we have many different features from the microbiome each make a contribution to the overall prediction, but together there’s dozens of these features. Together they make a significant contribution.

[Damien Blenkinsopp]: Right. It’s really a multifactorial analysis.

[Eran Segal]: Yeah.

(00:26:10) [Damien Blenkinsopp]: Okay. You did a paper before 2014 on the artificial sweeteners, which also got a lot of coverage. That was interesting also.

And in that one I believe it was the high bacteroides and the lower clostridiales which showed that you had a higher propensity to gain weight, wasn’t it? Rather than just blood glucose regulation.

[Eran Segal]: Yeah. So yes, we did see an overall effect there. But also there we developed an algorithm that could predict susceptibility, in that case, to consumption of artificial sweeteners. And that was also multifactorial basically using dimensionality reduction of essentially all the species that we had in the sample.

(00:26:53) [Damien Blenkinsopp]: So the most recent paper you are looking at is also looking at regaining weight after dieting.

For example, if you go on a diet and there’s this typical yo-yo effect where someone goes on a diet and they just regain it all back. I’m wondering is that related to the microbiome or what’s going on? So if you could relate what you’ve been looking at there and what you found?

[Eran Segal]: Yeah.

So we study many different aspects of the microbiome as it relates to our health. And this is another study where we studied another very basic phenomena, the yo-yo diet that you mentioned. And what we showed there is actually that even after you complete a diet and you lose weight, your microbiome doesn’t go back to what it was.

So it’s very well known that as you gain weight your microbiome changes, and what we showed is after you lose weight your microbiome doesn’t revert back to the original state. And that memory, if you will, of the microbiome is in fact sufficient to induce and enhance weight gain once you stop the diet.

So I would say it’s another work further establishing the causal link, and providing more insights into mechanisms by which the microbiome plays a key role in our health, and specifically with respect to metabolic states and diseases; in this case relapsing obesity.

[Damien Blenkinsopp]: In that study did you find any mechanisms? Is it specific species? I think you were talking about metabolites in there as well.

[Eran Segal]: Yes. So this work was in fact work in animal models; this was work in mice. And the advantage of is that we can really go deeper into mechanisms, unlike in humans where it’s much harder.

And so there, we also did a metabolomic profiling, and we identified metabolites that were missing after you lose the weight. And when we administered these molecules back, we in fact were able to cure the mice of the phenomena of relapsing obesity.

[Damien Blenkinsopp]: Wow.

[Eran Segal]: And more important we actually showed that these metabolites in fact regulate genes in the host, in the mouse, and they regulate genes that affect energy expenditure. So these mice, when they have less of these metabolites which are broken down by bacteria, when the bacteria break them down, these mice are going to have less energy expenditure and therefore more weight gain.

[Damien Blenkinsopp]: Wow. So I guess you don’t understand why that energy expenditure is going on. There’s probably quite a complex downstream process that follows.

[Eran Segal]: Right. That’s quite complex, but we also had some insights in the paper as to that as well, and we found some genes that regulate that process in brown fat tissue that are directly affected by these molecules. And these molecules are made less available because the bacteria in mice that had a previous history of obesity, in fact, were breaking down and taking away these molecules more.

[Damien Blenkinsopp]: Wow, so it’s actually the introduction of new bacteria for the weight gainers, which is taking away these substrates.

[Eran Segal]: So in this case, it was metabolites. So there are specific metabolites that are broken down by bacteria, which we showed here, we call that post-biotics as opposed to pre-biotics.

[Damien Blenkinsopp]: Right, by adding the bacteria that’s missing or making taking away the ones that are causing the problem.

(00:30:17) [Eran Segal]: Yeah. Those can be technically more challenging in some cases, but in general yes.

I also want to relate to, you asked me before about the stability, or how much the microbiome changes. And we have several studies on that; in fact, some are not even published. What we find is in fact the microbiome is actually much more stable, perhaps, than most people think.

So in fact your microbiome, unless there is very dramatic change in health or weight, is probably going to be very stable even across many years. We have data on that. And what I mean by stable, it means you will still look more similar to yourself even after following some dietary interventions, at least in the short term, than you will to other people.

Now, having said that, we also found that short term dietary interventions in fact do change the microbiome, also in consistent ways, across different people. So while you’ll still remain in the neighborhood of what your microbiome is, still some functions will go up, some will go down. Those can be consistent across multiple people who consume the same type of dietary intervention.

[Damien Blenkinsopp]: Right.

Just as a takeaway from that, do you think the microbiome is going to be an important area of work? Basically learning how to modify it, push it in another direction in order to solve things like weight gain, blood glucose regulation. Is that your hope?

[Eran Segal]: Absolutely.

So the more we find causal effects for the microbiome on our health and weight the more this should be a target for intervention. But of course that will require further studies to understand what is casual and also how to change it.

And I do believe that with – and this has also been shown – that with long-term changes in diet, you will in fact achieve changes in the microbiome. But with short term dietary intervention the changes will be consistent, but they will be more subtle and you’ll still remain in your own neighborhood.

And what that means in terms of the research that we did, it means the algorithm is going to give you essentially the same predictions, even in a very stable fashion, across even some small, short term dietary interventions because your microbiome is essentially going to be very much the same.

[Damien Blenkinsopp]: Right. So if I test one month, and then I test six months later after doing a series of interventions – maybe not too intense, something like courses of antibiotics, things like that might be more intense.

[Eran Segal]: Antibiotics is probably a different story. That can have a dramatic effect.

I’m talking about even if you change your diet for a few months, your microbiome is not going to change a lot. If you maintain a very different diet after a prolonged period of time – I can’t give you exact numbers, but a long time – then you will see change.

And at some point, those changes may be large enough you may want to test yourself to make some modifications to the diet. But, for a very long period of time, without dramatic interventions it should stay pretty much the same.

[Damien Blenkinsopp]: It might be interesting if you do a course of antibiotics, because people have to from time to time, to redo the test and see what it predicts afterwords. Maybe some of the food responses are going to be different.

[Eran Segal]: Absolutely. And I think after antibiotics you will have very significant changes, and those could affect the prediction.

(00:33:37) [Damien Blenkinsopp]: Yeah. So the last thing, just going back to the artificial sweeteners we spoke about. Because they did see that those had an impact on the microbiome over time.

Do you think smaller things like that, basically micronutrients or small fibers, not necessarily macronutrient profiles, but those kind of things could have longer term impacts on the diet?

[Eran Segal]: Absolutely. I would say some of them could even have bigger effects than macronutrients. So fiber, for example, is something that is digested solely by our gut bacteria, so definitely could, and this is known, have alternations and will overtime have sustained effects. So yeah, absolutely.

I think the way we think about it now, and even drugs. We and others have shown that the drugs that you take actually also affect your microbiome. Any substance that you intake, although depending on the substance, might just go through your gastrointestinal track, meet the trillions of bacteria that are there.

They have 100 times more genes than we do. They could definitely break down these products, they could convert it into other products. I would think of it right now, anything that you intake could definitely affect your microbiome.

(00:34:50) [Damien Blenkinsopp]: Yeah. Alright. Thank you very much for that. Just a last few things.

A lot of people take xylitol and stevia. It wasn’t in your original study, and I was just wondering if you knew anything about that. Because the other ones, aspartame, saccharine, and there was another.

[Eran Segal]: Sucralose.

[Damien Blenkinsopp]: Sucralose. Yeah. It was a bit of a negative view on them in terms of what they were doing to the microbiome. Have you got any information or did you see anything on the other two?

[Eran Segal]: We are studying those now.

[Damien Blenkinsopp]: Great.

Eran thank you so much for your time. It was really useful.

[Eran Segal]: Okay, great.

(00:35:19) [Damien Blenkinsopp]: Excellent. Okay, Lihi, let’s talk about DayTwo and what you’re doing there.

So basically you’re taking the work done by Eran and his co-researchers and you’ve been turning that into this algorithm service to help optimize people’s diets. Could you give me a bit of an overview, how you look at it? What the company’s doing and how you see it going forward over the next year or so?

[Lihi Segal]: Yeah, so we licensed the technology in an exclusive way about a year ago, in the summer of 2015.

And then what we’ve been doing since then with the help of both scientists, because our founders are scientists and they’re on the management team and very deeply involved in the company. And so there’s a lot of hand-holding in that sense on the scientific level as well.

But what we’ve been doing, we built a team up of machine learning experts in DayTwo and also developers, and we really dove into the algorithm.

As you heard, on the research level the first thing they took 30 metrics in the blood, they did the microbiome, both 16S and the full shotgun. What we really tried to do is once we have all the results is really look into the algorithm and see what is that minimum set of features that we need, and write it to consumer. We don’t want to send them to get anything that is redundant.

So looking into that features into the algorithm, and looking to see what we really need, how to commercialize this. So we went through a kind of learning period when we’re looking to see how we define the product, what do we need. Do we need to freeze your stool? Do we need to send you to a doctor to get blood tests, yes or no?

And where we ended up is by looking at a really minimum set; because as you heard Professor Segal say, the microbiome was very significant in any constellation that they took, and made other things redundant. So really where we ended up with on the product side is that it’s all online, almost.

So you come online and you fill in a lot of questions – not a lot, I think a 10 minute questionnaire. But, of course it has to do with your anthropometrics and your food preferences and your medical history. Any information you just fill in your questionnaire. And then we mail home a kit; just a box. In that box there is a small tube and you take a stool sample at home.

So we use DNA Genotek as our supplier of the kit. If you know them, they’re out of Canada. This is really kind of state of the art microbiome collection kit. You don’t have to freeze it, you literally just take it when you can, when it fits you. You don’t have to time it. It’s there, you take it, and then you just mail it back to us by regular mail.

[Damien Blenkinsopp]: Is it a quick swab, or are you actually taking a sample?

[Lihi Segal]: We tested a bunch of other alternatives as well, but this company really gave us the most stabilized microbiome in extreme temperatures.

It’s really important for us to stabilize it and then send it through the mail. And you don’t have to freeze it and all that. So it made it much easier on the consumer side, and it’s also very important scientifically to get the microbiome at the state it was as it was collected in Day Zero.

So we did a lot of trial specifically on that to see that what the company claims is actually right. And so we send you this kit, you mail it back to us, and then we sequence it.

We chose to sequence, as Eran said, on a full shotgun basis because we found that that resolution rate gets us the prediction into a higher level and a very good level. So we decided to do that despite the higher costs that it has.

But again, we try to put a product on the market that is very good; it’s good scientifically, we don’t really cut the corners there. So although the cost is still higher, we do expect it to go down a scale, both on the full shotgun basis and the kits.

And then what we do is give you a mobile application. So you get a personalized mobile app that you download, and it’s tailored just for you. And it gives you three things initially.

It gives you a microbiome report, because we did it and we have it. Not all our users are going to love it, but a lot of them may be curious to open it up and see. And so there’s a lot of information there.

We’re giving you your top food and meal recommendations. So what that means is that we really look into different categories. You have your top breakfast, your top lunch, your top dinner, your top fast food, because even when you eat fast food once in a while you can still choose healthier fast food than others.

We’re really trying to bring this into your day-to-day and make little changes and not turn your world upside down. And then there’s whatever alternatives with pasta, alternatives with rice. That’s really general.

And we’re really giving you your top A+ meals and scores all the way to your worst list, which has up to C-. So we’re trying to educate you through that stage. You could always go to see what your top breakfast is, what your top lunch, and all that, but then you also have the ability to search.

If we didn’t say something that you eat and you want to know what your score is, you just search for it in our database. In the US we are based on a database of MyNetDiary. So we have 400,000 different foods that are US based foods.

In Israel we are have a different database that has Israeli foods in it. So people can really find what they eat in there.

[Damien Blenkinsopp]: Right, so these are actually branded products you can buy. Is that what you’re saying?

[Lihi Segal]: Yeah, there are a lot of branded there as well, but there’s also, for example, an apple without skin.

[Damien Blenkinsopp]: Okay.

[Lihi Segal]: You also get your just general food as well, but you would find your specific brand of whatever, yogurt, that you’re eating in the specific territory. And then, so that’s the second thing. The third thing is the search and also a build your own meal kind of possibility.

So the whole point here is that we’re not scoring nutrients. We’re not saying carbs or proteins, and we’re not even going into a family of pasta versus rice. It’s very different if you eat a pasta with cream sauce or a pasta with meatballs, or you eat a pasta with macaroni and cheese.

You have to be able to score complex meals, and that is where our kind of secret sauce is, we’re really looking at your personalized response to these complex meals. And so you can just search for those meals if you want. If you’re cooking or if you’re sitting in a restaurant and you’re able to get your scores on the foods that you’re eating.

(00:42:00)[Damien Blenkinsopp]: Yeah. So just to clarify, this is just focusing on glucose management? So lowering…

[Lihi Segal]: Right. So what we aim to do is balance your blood sugar levels. So when you go on and you eat your A+ or A- foods and you eat that on a consistent basis, and you keep portion control.

So it’s not a kind of blank check to eat as much ice cream or drink as much beer as you want, unfortunately. But it does allow you some flexibility with foods that are surprising. Things you thought were unhealthy, all the sudden you understand you can eat them. And vice versa, so it’s surprising in both ways.

And then if you eat that consistently then yes, you’re going to see that we’re helping you balance your blood sugar levels.

And as Eran mentioned, balancing your blood sugar levels has an importance both in minimizing the risk for diseases of all kinds. Even as a healthy person, you don’t have diabetes but it is really important to keep your stable blood sugar levels. And also the whole thing about weight loss.

It helps you, it encourages weight loss in that sense. So you need to have a restrictive diet; you can’t eat whatever you want and think that you’re going to lose weight with this. But it does help you lose weight, it helps control your hunger, it helps control your cravings. And so it really helps you to plan and choose your foods right. That’s what we’re aiming to do.

(00:43:25) [Damien Blenkinsopp]: Okay, great. So, just to be clear. In terms of the inputs, it’s mostly filling in a questionnaire. Is there any other test apart from the microbiome sample? Or is that just the only one that they need to do?

[Lihi Segal]: No, the basic thing is that we need the microbiome and we need your questionnaire.

Now if you do have addition information, if you have your HBA1C levels then we’ll be happy to take them in. If you have more blood tests it’s always good to take in. But it’s not as significant enough so we’ll say you have to do it.

[Damien Blenkinsopp]: Yeah.

[Lihi Segal]: But on a general level, as much information as you’re willing to give us, it will always help, yes.

[Damien Blenkinsopp]: So in your algorithm, it will just take that into account as well?

[Lihi Segal]: Yes.

[Damien Blenkinsopp]: It’s just that in terms of the cost, you don’t want to add to the cost or be inconvenient.

[Lihi Segal]: Again, as Eran mentioned, it becomes redundant at some point.

And so if you have it, great, but we don’t want to get people – the cost is not that much for an HBA1C, it costs like 20 dollars in the US today. So that’s not really the issue.

It’s more just this is the basic package; you send it home, you send it back. But as we’re looking at our future products and as we interact with you throughout your day, the app is going to allow you in future versions to report to us what you ate.

And we have a lot of insight on your sleep and on your exercise. That was not published, but we have it in the data, and they haven’t published that data. He didn’t mention it, but in the research they actually had people logging in their foods, but also their sleep and also their meditations and their exercise. They had a Fitbit on everyone.

So there’s a lot of insight that we’re going to be able to give you. And when to eat your biggest meal, because people have a certain rhythm and that’s personalized as well. So when would be preferred to have a large meal of the day. In the US usually it’s dinner. In Israel sometimes it’s lunch, sometimes it’s dinner.

Certain foods that you should eat at certain times of day. So we can really interact with you over time if we have more information on how you slept last night and how much fiber you had in the past 24 hours. There’s a lot of things that go into the algorithm that, if we don’t have them, fine, but if we do it can even help us give you better results.

[Damien Blenkinsopp]: So you’re integrating these lifestyle factors as well into the computations to tell people when to eat. That’s great.

[Lihi Segal]: Your stress levels, all that.

(00:45:52) [Damien Blenkinsopp]: So I was wondering, are you able to tell the status of someone?

Say I’m glucose intolerant to an extent already, when you get the data from people without getting the HBA1C, for example, are you going to be able to know this person’s going to have to be more careful? Is any of that kind of information coming out?

[Lihi Segal]: We’re not at any point a diagnostic company, so whatever we see we will not tell you.

[Damien Blenkinsopp]: Oh, okay.

[Lihi Segal]: We don’t do health assessments on you. We’re giving you your recommendations under a predictive model.

And for example if we find things that we think you should know, then we would probably say maybe you should see your doctor, or take these results to your doctor or something like that. We would never go into actually giving you any medical advice.

(00:46:35) [Damien Blenkinsopp]: Right. The same usual thing. There’s a lot of blood glucose dis-regulation that goes on way before you get to diabetes, as Eran was saying.

So I’m just sort of interested from an algorithm perspective. I know you’re not going to publish it because there’s a medical borderline there that you don’t want to go near, but I was just interested from an algorithm perspective – can it tell how far you are along that line? Because everyone’s got a little intolerance. I’m just curious, does it offer any information?

[Lihi Segal]: I can’t.

[Damien Blenkinsopp]: Okay, fine.

[Lihi Segal]: I can’t answer that question.

But as Eran mentioned, we’re looking into on the road map for DayTwo that’s not just for the people who want to buy it right now but we are looking into various things we can do with the data that we have, the data we collect, and the things that we learn. And of course diagnostics and therapeutics are a part of that whole agenda.

And so there’s insight that we’re looking into and collecting, and can very well come out with additional products that are related.

[Damien Blenkinsopp]: So as a first stage it’s basically a food recommendation engine as the output, and of course your microbiome data.

Do you have an idea of what type of microbiome data is going to be given? I know we talked about uBiome, for instance, in the past. We had Rob Knight from some of the other tests.

We’ve looked at a few different ones in the past. Have you got an idea yet, or are there pictures or anything of what it’s going to look like in terms of the data you provide for the microbiome?

[Lihi Segal]: I can definitely go back and send you some information about how it’s going to look, more or less.

[Damien Blenkinsopp]: Alright, cool.

[Lihi Segal]: But we’re trying to go into a lot of detail. Again, we’re doing full shotgun so we have additional insight. We’re not at just a very high level; we are looking into specific types of bacteria and trying to link them. We’re looking at studies and just general information about them.

Again, we have to be a little bit careful and not tell you anything that you may be alarmed with, or if you think that you have this and you’re going to be Type II or anything like that. So of course we’re being careful in the way that we present it. But there’s a lot of interesting information.

We’re also looking to do this in a very cool way that’s going to be, at least on the web – on the mobile it’s going to be a little flatter – when you sign into your web, there’s a report that’s going to be very interactive. You can dive in and go all the way down to the strain level, and then come up. So it’s going to be really cool in that sense.

[Damien Blenkinsopp]: So is there going to be, basically are you going to give all of that data?

My audience tends to be on the high quantitative side, so some of them tend to be people who download the data and start playing around with it in Excel. So will you have that kind of data?

With uBiome, for example, they have two aspects of that. They have the raw data they provide for you to download, and then you can put it into software to actually interpret yourself, like biometrician software.

And then they give you graphs which are basically summarized. So there’s not all of that information there, it’s a bit different, and it’s according to their perspective. So in comparison, what will you provide?

[Lihi Segal]: No, I don’t know to tell you that we’re going to give you all of the raw data. We probably could, but we haven’t finalized that down to the core of it. But again, we have it.

We’re going to have, as I said, the report and the very interactive tool so you can explore it. And the infographics is really cool. People are just playing here with it when they’re too tired to code. So they go and start planning that. But we could also provide the raw data, for sure.

Again, I think our users as opposed to uBiome users, uBiome users are mainly people who purchased it because they were curious about the microbiome. Our users, most of them, if I need to kind of guess or what I see, the microbiome is what gets them to say, oh this is really interesting.

This is personalized for me, I have my personalized microbiome; these people are scientific based, it’s not just that somebody came up with a diet based on my blood type, there’s science here. I don’t think that a lot of them are going to be very interested in downloading the file of the microbiome and things with it.

But we could definitely allow that, or be able to do that, if we see that there’s a need for that from our users.

(00:50:58) [Damien Blenkinsopp]: Yeah, cool. Alright. I saw there was a mention of a Mayo study on your site?

[Lihi Segal]: Where did you see that mentioned, by the way? I’m trying to figure out how did that get to you. We didn’t publish…

[Damien Blenkinsopp]: Well I don’t know, I think it was just mentioned. Oh, I know where I found it.

I was looking through your FAQ and there were some directions for Mayo study people on how to find the information.

There’s a leak there.

[Lihi Segal]:L: No, it’s not a secret by far.

We are recruiting people in the Mayo clinic now, and DayTwo is all over it. We just didn’t issue the press release saying that yet. But that’s been approved and it’s on it’s way as well.

So, what we’re doing, I’m happy to share, it’s no secret. But what we’re doing with the Mayo clinic is a clinical trial that is very similar to the clinical trial that The Weizmann Institute has done in Israel.

And so we’re recruiting 500 people and going through the same process of putting exactly the same device that was used in the trial in Israel and giving them test foods that are American foods, like a bagel and cereal, and really having them log their foods and providing all that information, and a lot of blood tests. So we’re really replicating the trial.

We’re just going to do that because we wanted to make sure we’re providing relevant recommendations after we have a basic cohort of US people. It doesn’t have to be the entire 500 completed, but we just, as the Israeli one was all Israeli, with Israeli microbiome and Israeli food, we just wanted to make sure that we’re able to calibrate the algorithm and it also works on a US based population with US foods and all that.

So we’ve already kicked that off. It’s a great collaboration for us to do this with the Mayo clinic, obviously. So we’ve already connected people. If any of your users are Rochester or Minnesota based people they can go and be part of that clinical trial.

[Damien Blenkinsopp]: Right. And it will be literally a copy of the other study so they could look at the other study to see what it would entail as well.

[Lihi Segal]: Right. There’s a bit of new information there as well. So that’s the reason we’re doing that. And also to start a collaboration with the Mayo clinic for other things as well.

(00:53:14) [Damien Blenkinsopp]: Great. Do you have a timeline for that? In terms of when you might get results eventually?

[Lihi Segal]: The timeline for US, it’s opened for pre-order. I know you probably entered through the UK, so you didn’t see that, because it’s IP based.

But if you were in the US you would see a pre-order. If you were in Israel, you could also buy and start getting it. So we started selling in Israel already.

The US is open on a pre-order basis, and we’re going to start shipping kits out to people in the beginning of 2017.

[Damien Blenkinsopp]: Okay.

[Lihi Segal]: It’s just around the corner.

[Damien Blenkinsopp]: Okay. So there are people already using this service in Israel, and it’s functioning.

[Lihi Segal]: In Israel we started the whole process of getting the evaluation, the kits, out to people and getting them back and sequencing them. We’re just starting to get, we’re in the final stage of getting the application finalized, and then getting the recommendations for people.

But there are a lot of people already who are using it because they got recommendations, whether from the Weizmann Institute Study or through us.

They’re not using the fancy application with the ‘Build Your Own Meal’, but the results and all of that have been around and have been used. Actually the BBC had a great show – I don’t know if you’ve seen it.

[Damien Blenkinsopp]: No.

[Lihi Segal]: The BBC has a show called ‘Trust Me, I’m A Doctor’.

[Damien Blenkinsopp]: I don’t watch TV here, unfortunately.

[Lihi Segal]: Oh, okay. So anyway, ‘Trust Me, I’m a Doctor’, it’s a doctor that has a show and she features clinical trials. And so she actually participates in the clinical trials that she features on her show.

So after the publication itself, she approached the scientists. She came to Israel with her colleague and was profiled and went though it, got food recommendations. Then she went back home and only ate what she was supposed to eat, lost weight and felt great, her energy levels [were up].

She was all psyched about it, and featured it on the BBC in a great show. I’ll send you the links so if you want you can see them.

[Damien Blenkinsopp]: Yes, please.

[Lihi Segal]: So there’s a lot of people who are using it, but outside of the clinical trial setting as well.

[Damien Blenkinsopp]: Okay, great. So it’s already getting around.

[Lihi Segal]: It’s getting contracts. Yes, we see the results are there.

(00:55:23) [Damien Blenkinsopp]: Yeah. Okay, so in terms of just how it’s going to be available, you’re only shipping to the US. So is no one in Europe is going to be able to do this?

[Lihi Segal]: Well, soon. We get a lot of approach on our support.

After the show was aired there was like 10,000 people hitting the website. So we know that there’s a lot of people interested. And we really want to go into selling in the UK as well. We’re just trying to be [safe], being a start up and not to jump too far ahead.

[Damien Blenkinsopp]: One thing at a time.

[Lihi Segal]: Right. So we did Israel because otherwise people will kill us here if we don’t bring it home. But we didn’t even translate it into Hebrew, it sold in English.

And we’re opening in the US because it’s an important market to start in. But we have concrete plans to get into Europe in 2017. So, soon. At least in the English speaking countries.

Really, logistically it just means that we need to get this box to people, but it’s not that simple. We will need a local database of food. So there’s some work on the server side to give you your foods and the database that fits you. We don’t think we’re probably going to need a trial to do that.

So in terms of the microbiome what we see is that the changes are not that [significant]. So there’s changes in the territories in the microbiome, but they’re probably not that apart compared to where the recommendations are. So you and I are very different in the way the algorithm predicts for us.

The microbiome is different, but it’s not that different. Anyway, it works on people. It could work on the US even without the Mayo trial.

[Damien Blenkinsopp]: So it sounds like that’s a validation effort.

[Lihi Segal]: Right, exactly.

[Damien Blenkinsopp]: I haven’t looked at studies of comparison of different countries and their microbiomes. There are some?

[Lihi Segal]: There are, if you look at the [57:12 check, unclear] that they have their graph there. So these show the US and there’s overlaps between the US, Europe, and Israel.

There are differences as well, but the differences, the way it reflects it in the algorithm is not that significant. So it works.

(00:57:33) [Damien Blenkinsopp]: Do you know when the Mayo trial, how long that’s going on for?

[Lihi Segal]: Oh, the Mayo trial will take a while. But we don’t need to complete the trial before we’re able to give recommendations. So we just need to validate it in a smaller group. But we’re there collecting data.

It’s more, you know in the US you can’t put a continuous glucose monitor on people at all if you’re not diabetic. Except under IRB kind of trial setting. So on a consumer level we couldn’t find any provider that would allow us to put continuous glucose monitors on healthy human beings without prescriptions. It’s a diabetic label from the FDA.

So we don’t have the device, and in order to really collect that data in the US we need to have a clinical trial set up and get the appropriate IRB and all that. So part of the whole doing of the Mayo clinic is because we just want more data, relevant data with glucose monitors and logging of food.

So we don’t need that to continue to start operating. I don’t even want to stop it after 500, so we’re talking about opening Arizona as a site, and Florida as a site. It’s really good just for our internal research purposes to continue to get more data.

(00:58:53) [Damien Blenkinsopp]: One quick question. I’ve noticed that Arizona comes up a lot in lab testing. I’m just wondering, as you brought it up just then, is there any reason?

[Lihi Segal]: Because Mayo has a site there. So when I’m collaborating with Mayo clinic, they have additional sites other than Rochester, Minnesota. So they’re thinking of expanding this to there and I’m more than happy to get more data.

[Damien Blenkinsopp]: I was just on holiday in Arizona and I just noticed that there are a lot of lab testing companies there.

[Lihi Segal]: It’s probably due to relevant man power and cheap, and something like that.

[Damien Blenkinsopp]: I think there’s maybe some state regulations or something that make it a little bit easier. Something like that also.

[Lihi Segal]: But again, when you sell outside of Arizona then you’re going to have to comply with the state laws anyway. So I’m not sure if that’s going to help you. But I don’t really know.

(00:59:41) [Damien Blenkinsopp]: So right now for the US is it $299 for the pre-order?

[Lihi Segal]: The price is going to be $399 but we’re opening up at $299, that’s a pre-order discount. But once we stop reordering, we’re probably going to go up to $399.

In Israel it’s 500 dollars, but we’re also doing a premium product in Israel; we’re giving continuous glucose monitors to people in Israel. So we’re giving them a fancy report on their blood sugar levels and all kinds of other stuff. We can because the device that I talked about in Israel you can put it on humans that are not sick.

[Damien Blenkinsopp]: Right, wow. That sounds like quite a service. If someone would pay 1000 dollars or more…

[Lihi Segal]: No, no, 500.

[Damien Blenkinsopp]: Oh, and they’re getting that premium service with the glucose monitor?

[Lihi Segal]: Yeah. It’s a lot, 500 dollars. It’s just more expensive than the US because of the continuous glucose monitor that we’re putting on.

[Damien Blenkinsopp]: They’re quite expensive, those things.

[Lihi Segal]: Well, they cost a few hundred. I guess in the UK it’s about 80 Euros. And then the reader and then the patch cost a little bit more.

[Damien Blenkinsopp]: I looked into getting one for myself; not for medical reasons, just to play around with.

[Lihi Segal]: Abbott Freestyle. Just take the Abbott Freestyle Libre. Just look for it. Freestyle Libre and then just order it online. And I think it costs 100 Euros or something.

[Damien Blenkinsopp]: Okay. And it’s got consumables on it too.

[Lihi Segal]: And then you have a patch. You get a round patch that you put on for two weeks. It’s good for two weeks. And then you have a reader.

[Damien Blenkinsopp]: And this is the one that Eran was talking about earlier that they’ve started using.

[Lihi Segal]: Right. So you can get that online.

We bought a bunch of them online ourselves in the UK before we found it in Israel. And once we found it here in Israel we decided to go with this product that we can also collect from people their blood sugar managements and give them all the fancy reports on all that. So it’s cool.

[Damien Blenkinsopp]: Yeah, it sounds quite exciting what you’re doing in Israel, because you’ve got more flexibility there. Are you publishing anything, maybe a bit later, about that on your customer base?

[Lihi Segal]: Not yet.

[Damien Blenkinsopp]: Okay.

(1:01:51) Is there anything we haven’t covered about the service, that we’ve missed?

[Lihi Segal]: Yeah. I think that this is kind of our direct to consumer approach. So we’re selling to you directly, but what we’re really working on is partnerships. Because what we really believe is that the way you’re going to use this is also very personalized.

Some people, the fact that we give them a fancy application that’s really cool and has a report on it and teaches them what to eat and what not to eat. There’s going to be a diet planner at some point on this. So you can really be independent in the way you manage your food.

For some people that’s going to be great, but some people really need more support. So maybe they go to Weight Watchers or they use other weight management services. And once you know as a user that there’s specific recommendations for you that are personalized for you, you really can’t tolerate generalized information anymore.

I’m saying this for myself. I go to this Weight Watchers group – it’s not Weight Watchers, it’s a local Israeli group. But I can’t hear her say to me, you should eat pretzels as a snack. 100 calories of pretzels are your snack. I’ve been doing that for 15 years, and then I found that it was my number 1 spiking snack.

And I moved to a different, totally different corn-based snack that was much better for me if I’m eating that 100 calorie snack already. So I’m snacking on that.

And what we’re thinking of doing is really opening an API with a lot of services. And so you as a user can share your information with your doctor, or with your nutritionist, or with your weight management group. Or when you take out food you want to be able to get a score. You want to log in, connect to…

[Damien Blenkinsopp]: So you could plug into a meal delivery site.

[Lihi Segal]: Think of this. Let’s say you’re ordering take-out of your food. We do this every day at lunch, just because in Israel is how it works.

And so I want to log in and connect with my DayTwo account, into that service, then get a menu and my score, A, or B. I’m already in a great restaurant, I’m eating food or I’m taking it out, I want to be able to get a score and choose right.

In the US specifically there’s a lot of employer wellness programs. All of those wellness programs provide nutritional advice, but it’s generalized. I, as a user, want my personalized advice to go with me.

So, that’s kind of the partnerships that we’re doing. Some will bring us customers, some we will bring our customers to them. And we’re building a marketplace around this.

So literally, think of that that we’re not competing with anyone. That’s the strategy that we built. We want to enable anyone who wants to use this personalized service to use it in their application and services.

[Damien Blenkinsopp]: Great, to make the information more widely available.

Lihi, it sounds great. I’m sure there are insurance companies and so on who would be interested in that as well. I know they’re getting more interested in these wellness programs.

[Lihi Segal]: Of course.

[Damien Blenkinsopp]: Okay well thank you very much for your time today. I really appreciated it.

[Lihi Segal]: Sure. Thank you so much.

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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

Click Here to Read Transcript

[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