All Things Ketones, How to Boost Cognition, Sardine Fasting, Diet Rules, & More — Dr. Dom D’Agostino

I know the current consensus on alcohol is that it's but I would I would push back because none of that is specifically studying wine. If you go to the studies on wine, it actually shows once the first one that came up is actually decreasing cancer risk. And then I noticed that when I take wine and measure my blood, it's less viscous. So wine also decreases platelet aggregation. >> So that it makes your blood less viscous and that is well known. I observed it and it was like something's going on here. And then I went to

PubMed and it's actually well known. I didn't know it at the time that it decreases platelet aggregation so less potential for clotting for stroke and things like that. >> Dom, nice to see you again. It's been a few years. Thanks for making the time. >> Yeah, it's great to see you, Tim. Yeah, We've stayed in contact here and there with text texting, but yeah, great to see >> lots of texts and why not? This is one of the text threads I could probably actually make public in my life without some type of mutually assured destruction

with many of my friends. I have been revisiting everything ketogenic and certainly looking at exogenous ketones for a number of reasons. And one of which we were Chatting a little bit before recording is that I have a number of relatives who are deteriorating from neurodeenerative disease including Alzheimer's. And one of them is APOE33. And my siblings and I are APOE34, which would seem to indicate we would have potentially a let's just call it 2 and 1/2x higher probability of developing something like Alzheimer's. Even though data might change, who knows? Nonetheless, I'm looking to throw As

much possible at this from a preventative perspective. Where can or what data do we have? And if there's a little bit of speculation involved, I'm fine with that too in terms of future directions for research and what might come up for applications of say the ketogenic diet and or exogenous ketones to something like Alzheimer's, whether it's from a preventative perspective, a mitigation of or slowing of progression of symptoms Or anything else. >> Mhm. Yeah, that's a a rapidly emerging area of research. And I think you're aware, we talked kind of previously of the case reports

that are out there. Yep. >> That kind of put this on everybody's radar. I would say the early adopters of this idea were the people who understood that brain energy metabolism was pretty central to Alzheimer's disease. >> Sometimes called type 3 diabetes, if I'm getting that right. >> Oh, sure. that was coined back in 2005 or six I think and that was brought to my attention actually by Dr. Mary Newport and her husband Steve Newport was the subject actually in the case report for the use of the beta hydroxybutyrate monoester for that and Dr. Richard

V of the NIH was also on that and Mary was near and dear to my heart. I actually coincidentally hosted Her for dinner last night at the house and had her over here and she's a close friend of mine. We co-e together at USF. She's a guest teacher. Interestingly, I saw Steve Newport in 2008 or nine and I I witnessed the observation. He is a 34. He has Alzheimer's. He was 34 for APO E4 and he also had he had Louisibody dementia but confirmed Alzheimer's disease 2 when they looked at the brain. I was questioning

this idea of of ketones rescuing the brain in The context of Alzheimer's disease. Symptomatically there was no doubt in my mind that it did because I witnessed him he wasn't using the ketoneester at the time but we quickly transitioned to that after a meeting. But he was taking coconut oil and MCT oil and he would bring these little shot glasses. Mary taught my class. We went out to dinner. He did the shot glass. >> His tremors stopped. He became animated and he talked. And after about 4 hours, He started to decline and started getting fine

tremors again. And then he would become reanimated upon increasing his ketones to about 1 to two, which we would give him like a 30 mill shot of MCT plus coconut oil that was mixed in there. So she was really and doing that three to four times a day with meals. >> So that was my first observation and it was clear to me that there was at least a metabolic within the Alzheimer's spectrum and I just like to Alzheimer's Is kind of a fuzzy, you know, diagnosis. >> Sure. Very fuzzy. >> I'd just kind of like

to call it dementia, cognitive dementia. There's vascular dementia and there's a beta and tao. When my wife was working on Tao at the Alzheimer's Center when we met, she was working under a guy who studied Tao. Then there was people at theirs who studied amaloid beta and there was like the towists and the beta and there was kind of like argument as to what was More profound. But a universal feature of Alzheimer's is amaloid plaque accumulation. But also now we know that glucose hypom metabolism is central to that. And as we age, our ability to

use glucose as an energy source decreases over time due to they thought maybe vascular reasons, but come to find out it's really it's a constellation of things including the glucose transporter, the glute 3 is on neurons, pyuvate dehydrogenase complex which is Like really the governor or the rate limiter of glucose metabolism in neurons. That's PDH pyuvate dehydrogenase complex. and the production if you look at that protein for that that decreases over time as does the sort of catalytic activity of that enzyme over time. So we know that and then there's neuroinflammation there's a vascular component

so all these things kind of contribute to metabolic dysregulation but also a big Driver is neuroinflammation and I do believe as does Dr. Mary Newport who is the author of that paper kind of with a case report and a number of other leaders in the field including I'm blanking on his name the chair of neurology at Harvard just gave an NIH seminar on infection as an ideological agent for Alzheimer's disease Epstein bar virus cytogallo virus herpes simplex virus HPV you know can contribute to things like cancer >> so we're probably talking about if I mean

50 60% of the population having one of these things. >> Steve Newport, the subject in that case report, had bouts of herpes, HSV around the eyes and got hit pretty hard with that. But also people who have shingles, >> you know, that I think they're at risk, too. We know like Epstein bar virus, you're four or five times more risk for things like MS >> is triggering the immune system. There's A renewed interest in looking at Alzheimer's disease, looking at the root cause. And I think metabolism is central, >> but the metabolic hit that may

be contributing to disregulated metabolism and neuroinflammation could be an infection and I think there's accumulating evidence for that. I was skeptical 10 years ago probably when we talked. However, this kept putting on my radar and then I was in a NIH sponsored Workshop on this looking at various aspects and the data presented by a number of different labs was very compelling >> for this. So, what does that mean? Our immune system is, you know, there's the four horsemen, right, that our friend Dr. Peter Tia talks about. >> I think the fifth horsemen is really the

immune system. Yeah, >> I like to add the six horsemen as our physical form, our skeletal structure. So, our bones, you know, and that that will give over time too. But the immune system is really central >> Mhm. >> to longevity. And the metabolic control of epigenetic regulation, metabolic control of immune system function is a very high interest. I know the Buck Institute has kind of refocused on that. >> Yeah. >> And many longevity clinics are now looking at that. What is your preferred Device for measuring ketones these days? >> For publications, we've used the

Abbott precision extra because historically we've used that. >> Yeah. >> And however, when I recommend >> a meter to people, I generally recommend the Keto Mojo device because that has the glucose ketone index in so the glucose ketone index is the millimar concentration of glucose over ketones. >> Yeah. And the strips are about nowadays Still less. I was going to say I don't know a few years ago they're about half the price. >> Yep. >> And we've tested the Keto Mojo. So we have a human clinical trial where we did we did breath, we did

urine, and we did precision extra and keto all together. And then subjects go into the chamber and we did metabolomics and everything else. But the keto mojo consistently gives us numbers that are more in line With our biological assays that we run in the lab like the Elias on that. >> Well, let me just tell you what I'm up to and you can tell me how ridiculous I am and off base or fact check as needed. Can you remind me of how to pronounce this? Dr. Thomas, is it safe? Am I getting that right? >>

Yeah, he's a good friend and colleague. Doc Tom Safe. Yeah man, >> Tom Safe. All right. So the in terms of fasting, we've talked quite a bit about Fasting. It still is very interesting to me and I'm wondering just in brief if if you could without getting too too much in the weeds, but I'm wondering what the ketogenic diet does that exogenous ketones do not achieve. And then I'm wondering what fasting does that the ketogenic diet does not do. But the way I want to get to that is to ask you because for a long

time I was doing a oneweek, we could call it a water only fast, but Let's call it a caloriefree fast, right? Black coffee and black tea and stuff I was consuming. But a week long waterl long fast a year and I was doing maybe a 3-day fast every quarter. I couldn't quite didn't really want to do like 3 to four week long fasts a year. Just didn't want to do it. But in terms of potentially purging precancerous cells and so on, I was like, you know what? I like the aesthetic practice. Seems like a bit

of Autophagy and cellular cleanup is a good thing. Why don't I do that? Do you do any fasting anymore or is that something that you have omitted from the current version of schedule? I do it situationally and I think there's situations where I think I'll benefit from fasting or from just inducing a state of an energy deficit. Right? So you could do caloric restriction, timerestricted feeding, dietary restriction. You could do a restricted Ketogenic diet, a cyclic ketogenic diet, modified a modified supplemented ketogenic diet, I guess, which is what I do. I like to do what

I call I mean I kind of coined it. It's like sardine fasting. And I had a cancer patient a long time. One of the first that I sort of engaged with actually you might his name was Dr. Frederick Fred Hatfield. >> So he was like kind of a famous >> Dr. Squat. >> Yeah. Yeah. Dr. Squat >> back in the day. Wow. >> Yeah. We were good friends. He was a mentor to me in many ways. But he had advanced metastatic prostate cancer and it went to the bones where they did a PET and I

was just getting into this area of research and I was like here's what I would do and I would go to his house and I'd bring him things and he was testing things and he loved sardines. So he kind I think he steered me onto sardines in like maybe 2007 or eight or something like that. That was my love for sardines kind of was probably from him. But he would do low carb. He called it ketogenic, but I think it was just more of a low carb diet. And then he would do five days. He

would do a fasting mimicking diet that Walter Longo has advanced, but he has more of a plant-based approach. But Dr. Hatfield would do, Fred would do one or two cans of sardines, maybe one can of sardine per day for a Week. So we called it sardine fasting. And that was >> just as I was getting into this. And essentially what happened is that he went into rapid remission. and the doctors didn't really know. Huh. >> Fred ended up passing away maybe 8 years later of something completely unrelated to his cancer. >> As a non-oncologist, I

have to pause and just say I mean it seems like prostate for a lot of people they hear that they Think death sentence, metastasized prostate cancer. They think no way. You're done. Am I exaggerating? I mean, how frequent is it that people have complete remission of something like that? Maybe I'm exaggerating things. There's a lot of factors like the Gleon score and his was not good and and a number of factors. So he was given I think he told me like three months to live. I mean but he went years and years after that and

he was like no evidence Of disease. >> How often was he doing the sardine fasting? Was that once every month? What did his cadence look like? >> He stayed ketogenic and then I would go over there and encourage him to do that. And he loved to do it. He was like, "Okay, I do this and now I feel better when I'm doing >> Fred also surprisingly would smoke a little bit and I got him to maybe stop that too." So, we got him to dial back On some other behaviors and maybe he would drink a

little bit too, but not that much. But his health improved dramatically when he adopted a low carb and then ketogenic diet. And then for years he did the sardine fasting and we communicated and I just encourage, hey, keep sending me your medical reports. And you know I was like maybe there is something to this. So that actually steered me into just like the Alzheimer's we started Alzheimer's Research because of Dr. Mary Newport. I studied seizures because Mike Dancer just >> Google Mike Dancer epilepsy and you'll find some remarkable stories. I kind of steered him to

the ketogenic diet and it was a remarkable he got off all meds and it worked way better than the meds. So but that was prostate cancer. But then I started engaging with other patients and then connected with Thomas Safeereed soon after that. >> How frequently was Fred doing the week-long sardine fast if you had to guess? >> Once a month. Sorry. Yeah, I meant once a month. >> Yeah, it's analogous to the fasting mimicking diet. >> Yep. >> I think Vultra Longo can do that. You know, he advises patients based on situationally their situation, but

I encouraged Fred to do it every month. And his feedback to me was that he would do it once every month to two months. He enjoyed doing it, so it was something that he kind of >> like looked forward to doing. So, >> sorry Dean fast. I can't wait for that to become a thing. That's going to spread. I don't want to gloss over what you personally do. So, for you, for instance, I found out recently and everybody get your checkups, right? Do Not skip colonoscopies. Do not skip. In my case, I got an endoscopy

because I was having some trouble swallowing every once in a while. I thought it was like, ah, maybe it's just like I'm eating too quickly with dried chicken or something. And suffice to say, putting that aside, that was sort of the symptom that catalyzed it. But I ended up having very unexpectedly a hiatal hernia. hiatal I think also related to the word hiatus Edmologically but basically I'm going to get the definition wrong I'm sure but basically from your esophagus to your stomach typically there's a nice kind of sphincter or ring and basically the stomach is

kind of >> pushed out of that ring and there's actually a lot of scarring in my throat from acid and so I was told that you know maybe not this bluntly but that that puts me at um increased risk of throat cancer or esophageal cancer, some Type of cancer. And I was like, [ __ ] that's not typically what kills people in my family. Usually, it's the cardiac stuff. And I feel like I have that >> my lipid profile is very well under control. And which is why going back and doing research for this conversation

and I've also done fasting over the years, I've thought, okay, well, in addition to taking the proton pump inhibitors and everything so that I'm not accumulating more scarring, is there a place for Doing the fasting since I don't mind doing it anyway just to further hopefully decrease the risk? And you were saying you fast episodically. Was that the word that you used? >> Situationally. episodic >> situationally. Situationally, what does that mean? >> If my wife is traveling and I, you know, it prevents me from being antisocial and I have a lot of work to do

and I have to I have a grant deadline. It's 5 days Away. Okay, I'm starting fasting for 5 days until I get this grant submitted. >> If I'm traveling by myself, >> I'll do it. If I get for any reason, occasionally I'll get sort of an inflammatory flare up and I don't know what it's just I'll feel a little bit off like brain fog or my joints or something like that. It's pretty rare now cuz my HSCP is like non-detectable. Right. Before I did K it was always like one or two. >> So on a

higher carb diet. >> Yeah. So people might recognize CRP, right? I mean >> C reactive protein is a marker of inflammation. And I mean, if you get your your annual blood test or whatever, chances are it's on there somewhere. >> Yeah. I'd like to draw attention to that real quick because HSCP is a better indicator of cardiovascular disease than LDL cholesterol. We know that now. If you someone said that like 10 years ago, They like think you're crazy. But yeah, HSCP is what we call a cardio metabolic biomarker including, you know, >> triglycerides and insulin

and things that should be included. But that is a really important biioarker I think to keep low for Alzheimer's and for cancer and all the other I call six horsemen now. >> Yeah. >> So the things that I mentioned I'll use it situationally if I feel like Something is coming on like I'm getting a flu but >> the sardine fasting and I advise it for cancer patients too. I want them to avoid a water only fast in the context to prevent cancer cexia >> muscle loss or muscle wasting. >> Yeah. Right. >> And omega-3 fatty

acids are very potent mitigators of cancer cexia. And so you have the omega-3s and basically you have everything your body needs, especi But essentially it's like you have >> you have adequate nutrition and then you create a caloric deficit. You create caloric restriction and then with caloric restriction come a whole host of beneficial things. the protein's low enough that you're suppressing insulin mTor and probably activating AMP kynise and if you do that in a protracted way and you can achieve a glucose ketone index of 1 to two for about 3 to 5 days the constellation

of things that if you Measure that would sort of correlate with inducing and maximizing autophagy. So that was sort of the rationale for me to do that and a lot of people talk about autophagy and it's kind of a nebulous term. We measure it. We look at the auto faggosome. So we're like a lab that actually does kind of look at things like that. And there's p62 and other things that you can measure, but there's no commercially available. I think the best way to measure that Suggests you're in autophagy is a glucose ketone index after

period of fast, which Keto Mojo will do automatically. It'll do the calculation for you. I did have a quick question. When I compared my Keto Mojo to a oral glucose tolerance test where I was having blood drawn every 30 minutes, the glucose readings I got from the Keto Mojo were substantially higher than the blood test than the blood draw itself. And I was Wondering if that's something you've observed. I mean, who knows? Maybe it's a bad device. Maybe I had too much alcohol still on the finger and I didn't dry it properly. I mean, who

the hell knows? Maybe it doesn't matter so much, but it seems to matter, right? Because spikes above regular spikes above a certain kind of nanog per deciliter seem to be indicative of all sorts of things. Have you run into any issues with the device or any caveats related To specifically the glucometer side? What I do like that's nice about it is it does give you that glucose ketone index, the GKI as a readout right there on the device, right? or in the app at least that accompanies the device. >> Are you talking about measuring glucose

at the exact same time point that a phabotamist pulled blood? >> That's exactly what I'm talking about. >> Okay. What was the difference between what was measured there? >> Let's say the peak at 30 minutes out after drinking this dextrose delicious not so delicious dextrose water. It's something like this. I was bumped up to probably 140 on the phabotamist drawn blood and it was like 165 on the Keto Mojo. >> And the return was much faster and much better on the phabotamus drawn blood than it was on the Keto Mojo device, which is not to

throw them under the bus cuz it could be operator error or just a Single bad device. And I have friends who have used it very successfully on the ketogenic diet, which is why I ended up buying it because Precision Extra is kind of a pain in the ass to get a hold of and at least on Amazon. So that was my experience and I was like, "Okay, well tricky, tricky, tricky." Cuz I, you know, if if I'm really trying not to pop above a certain level, if the device I'm using dayto-day is 20 points above

where maybe it should be, then that's a Problem. >> What's your hemoglobin A1C? I'd have to go back and look. It's trending down, but I would have to go back and look. >> Okay. And if you wear a CGM, you're under >> maybe 100 like with the CGM. So, the the meters tend to trend a little bit high, like about 10% high. I think they were 10 to 20. The >> Keto Mojo was 10% higher than our assays and the precision extra was 20% higher Than the assays that we do when we've got blood from

the animal. So if that if that helps, >> but I think you want to look at like all you want to look at your insulin levels, your hemoglobin, A1C, >> HS. >> Yeah, we got it all. And just for people, public service announcement, do an oral glucose tolerance test. Ask your doctor, talk to them, get your insulin measured because my relatives metabolic Dysfunction was missed for a very long time. in part because they were looking at fasting glucose and you can get really lucky with fasting glucose depending on when you get that snapshot and I

mean the docs weren't great to begin with who were tracking these relatives but as soon as we looked at O GTT the oral glucose tolerance test and insulin oh my god it was like skyhigh out of range >> yeah or put a CGM on them that's what Motivated me to be I guess you know one of the first adviserss for levels and I've worked with them on a research front >> I think You've interviewed Sam. >> Yeah, Sam Corkos. >> I mean, that's the ultimate kind of metabolic optimization platform. I mean, there's others emerging, too,

but simply wearing I mean, now they have the Stella Stella device that came out. So, CGMs are over the counter >> now. But the analytics from that and also the biomarkers that if you're part of that program that you can measure which include many things that we could talk about >> but that would capture your relatives if your relatives put a CGM on. >> Yeah, >> that's really important but what you observed is pretty normal and not to probably be of concern. >> Okay, cool. Yeah, I just wanted to check It out just to tie

this up for me and I maybe just missed it. If someone is using exogenous ketones on a continual basis, are there longer term adaptations? And part of the reason I'm asking is that in the most recent kind of set of experiments, let's just say I was strict keto for 3 weeks. >> Mhm. >> And then frankly just got bored to death of the diet. It's hard. >> So I did like Yeah, I did 3 weeks of let's just call it kind of textbook protein also quite low 10 to 15% let's say. So maybe I bump

it up next time, but just got so bored of it after 3 weeks. But I wanted to do enough that there might be some upgrade of the metabolic machinery. And we could talk about that cuz I know for athletes it might be like 6 months to 12 months. But went from that to then 168 intermittent fasting, still in ketosis for maybe a Week, so 16 hours off, eating between, let's say, 2:00 p.m. and 10 p.m. And then I went to a more paleoish diet, let's just call it, within that feeding window. And then I'd say

did that for a few weeks and then started layering in exogenous ketones in my fasting state. typically 11:00 a.m. 100 p.m. if I'm doing podcast recordings and things like that. And part of what I'm trying to figure out is given I'm APOE34, scared to death of Alzheimer's and maybe there's nothing to be done about it, but if there is something to be done in addition to exercise, right, and kicking out the cloth and EDNF and all that good stuff from a dietary perspective, trying to figure out like, okay, how long does keto memory last? if

there is a expiration date and if you were in my shoes, how you would think about not just the exogenous Ketones but fasting and ketogenic diet. Do you have any any thoughts on that? Well, yeah, you're you're doing a lot of stuff there. And I would recommend following a protocol that you could do kind of day in and day out that should ideally almost be effortless and kind of mesh with your schedule, which may be variable if you have podcasts and things like that. But I also I'm of the opinion that you could follow a

baseline diet, which is a lowcarb Mediterranean-like Diet. Mediterranean is kind of a fuzzy term. I hate it. But low carb Mediterranean style diet that essentially keeps biomarkers in check and then situationally go into ketosis now and then to just >> optimize it. But you want to follow an approach therapeutically that keeps your GKI into that 1 to4 range. Tom Seafood is very adamant about 1 to2 but the normal GKI of a a person in the US is like 50, right? Or 25 to 50. living in a State of having a GKI of even five would

be I think trending towards being more metabolically flexible and having greater fat oxidation and then you want to as it sounds like you're doing just keeping check of your metabolic biomarkers so comprehensive metabolic panel CBC of course if you're using you know different agents on that but insulin HSCP hemoglobin A1C triglyceride provides APOB that you want to measure to LP little A is good to know. Unfortunately, 30% of people and this is probably important when navigating what protocol to use. >> I have a mutation I did GB health watch which looked at my genetics for

dysipidemia. So GB Health Watch Dr. Spencer Nadulski reached out to me because I was posting my numbers online and he was like hey you need to do this test. So he's a very smart, aggressive or proactive kind of guy and suggested this test. He's like, I think you're a Hyperabsorber. And I was like, isn't like 1% of the population a hyperabsor? But come to find out, about 30% >> of the population hyperabsorb cholesterol. >> That's me, too. I'm in the same boat. >> Okay. I have an MPC1 L1 receptor mutation. That's a gain of function

mutation. So I use a zettoide monotherapy y >> for that. So a zettoide was sold as zedia and I can get by with half of a Tablet which is 5 milligrams and it half my apo. It put my apo it cut it in half and also half my LDL. So I can follow a ketogenic diet and I had the skyrocketing LDL apo but then I put that back in check. I am of the opinion that I need more data to come out. There's a group of people that think, you know, LDL in the context of

optimal metabolic biomarkers that it's not to be concerned about, but that data is emerging. And there's groups of people that I believe Are credible and then working on that front looking at the lipid energy model. >> With the lipid energy model, LDL and APOB is sort of a carrier for fat to peripheral tissues. But we don't have to go there. But I think >> Yeah. >> The balance of the data. Yeah. >> Dodge it for now. Yeah. >> Yeah. Yeah. If your LDL pops up, then a pescatarian Mediterranean-like diet that's low carb That ideally under

a 100 grams of carbohydrates per day and that's no sugar, no starch, fibrous vegetables and fruits. So my rule of thumb is 25% of what carbohydrate you consume should be fiber and then that'll essentially kind of make it non- glycemic. Right. >> What percentage did you say? What I do personally is about 50 to 100 grams of carbs a day and ensuring that the carbohydrates that you're consuming about 25% of that carbohydrate is fiber. So for example, >> broccoli, asparagus, of course, you know, cauliflower, green leafy vegetables, but even fruits like I trend towards wild

blackberries, raspberries, blueberries, and buy them like in combination. And then wild blueberries are about half the size and they have more fiber, less sugar. So I have like a cup of that per day. That's probably my carbs come from mostly broccoli, wild berries, dark Chocolate, and maybe a few other odds and >> Where do you get wild berries? Is that something you can buy or do you have to go out and steal from your neighbor's patch? >> Well, yeah, we have a blueberry. Surprisingly, blueberries grow great in Florida, but we have a blueberry farm right

by us and they make it's a winery, so they make grow blueberries and then make blueberry wines and things like That and have huge festivals. But we get from there, but yeah, you can go to Walmart and get, you know, the Walmart blueberries, which are like the size of grapes. And then next to that now, Costco and Sam's and and even Walmart now have the wild blueberries and they're about a third of the size. So, just because you mentioned LDL, I might be hallucinating this, so please correct me if I am, but >> didn't you

at one point dramatically cut Down your LDL labs by swapping dairy out, I think maybe heavy cream and using coconut cream or something else in its place. Or am I making that up? >> I took out heavy cream, but put sour cream back in, but maybe about half of the sour cream, but also just switched out >> the eggs. I think the eggs were getting to me cuz eggs have a lot of cholesterol and I was eating like a dozen a day. So When I prepare my food in the morning, my dogs get my food.

So I I'll make 10 eggs, but I will do I'll have like three yolks and then I divide the other yolks between my two dogs and then instead of ground meat, which I was eating a lot of, I get chub mackerel. I do sardines, occasionally tuna fish, but I get cases of chub. Chub like the insurance company. C H U BB. No. How do you spell that? >> A C H U B. Unlike a king mackerel, which Are bigger, chub mackerel are a small fish. >> Yeah, they don't bioaccumulate as much garbage. >> Yeah, they're

really low on the heavy metal list, which I I tend to check because I eat so much of it. So, one can is almost a pound, and there's three fish in each. >> I take a fish and give my two dogs each of fish. Then, I pour It's got a lot of fatty water in it full of omega-3s. And I pour that on their food and they love it. >> Where do I sign up to be reincarnated as one of your dogs? >> Yeah. Yeah. Yeah. This morning they got My wife Audacious has an Audacious

K9 supplement and that's got spirulina ketones and a few other things. We give them that creatine monohydrate. >> Hold on, I can't skip over that. Why give ketones to your dogs? >> Well, the brain boosting effects, the Anti-inflammatory effects, the neuroprotective effects, and the anti-cancer effects. So these are all things >> I worry about with my dogs. They are fixed. I do give them a SARM surprisingly after they got injured. >> This is an anabolic, right? >> I do. Yeah. I transitioned. They got attacked by a big pitbull and they you know kind of immobilized

for a while. So I was like we had some I was going to Use it for a cancer cexia study >> and it's ostin. Yeah. started giving it to them and it seems like yeah they are leaner, stronger. We have a great Dane that's 12 years old that makes him like 90 to 100 human years and he runs 35 mph. He has like no sign of slowing down. Yeah, he's a great Dane that should have passed away years ago and he's just like a machine. >> You mentioned Audacious Nutrition just For the purposes of transparency.

You do have family in the business involved with Audacious, right? Just to confirm. >> Yeah, I can't have any company. I don't sell anything personally but yeah my wife decided to create a product that sort of used the ketones that we actually used in research. >> So evolved out of that was various salts and the idea was that if that product was created then we can use it for for research. So and that was the initial Yeah part and that's kind of what I I was using it anyway. I was like well why don't you

just make a product out of this? I can't do it. But it actually was an I corpse NSF program through the university that got that started. >> Question. Do you give Rapamy to your dogs or would you or to yourself? Do you currently take or give your dogs rapy? >> I've went back and forth. I follow Matt Camell's work, you know, pretty close and go back and forth and I've decided Not to just because of the immune suppression. And I know I got about a handful of people that use it and I would say half

of them get sores in the mouth. Like that can't be a good thing. >> That's super common. The mouth sores. >> Yeah. The data is too early for that. And I think the same thing can be achieved in a greater a bigger lever would be sardine fasting for one thing and just beta hydroxybutyrate and a Well- formulated low carb supplemented ketogenic diet. high definition diet that elevates ketones and exercise, right? So, exercise and a whole host of other >> lifestyle things. I'm not ready to pull the rapamy trigger >> on my I would do anything

I do with my dogs excluding the SARM. I haven't used that, but seeing the effects and looking at their blood work, it looks perfect. So, there are no no side effects with That and it seems to be helping, you know, with their advanced age. >> Just a paragraph explain what this sarm refers to for people. There's a specific androgen receptor modulator that is sort of hits the androgen receptor but doesn't have the androgenic like qualities. >> It's not going to give you a third Adam's apple, but it'll help with muscle growth. >> It helps to

stimulate skeletal muscle Protein synthesis in the context of this drug also bone metabolism. And both of our male dogs are fixed too. So, we have discussions with various vets that are of the opinion they're more progressive that your dog should be on like TRT or testosterone if they're fixed because that will increase the quality of their life, especially as they age. You know, our dogs look I can't detect any loss of skeletal muscle mass even when I look at pictures. >> And for clarity, your dogs are all male. Yeah, we have two male dogs and

both of them are considered advanced age and the black lab is showing it a little bit. He has hardware in his two back legs. We had we had two knees put in with him, but he was a little bit heavier and now we've dropped his weight with what I feed him now, which is essentially fish, meat, eggs, ketones, and we give him a mushroom supplement. That's a mushroom kind of a lion's mane and a reishi maybe Cortiseps and a few other things. And then I give them creatine monohydrate. Yeah, they're pretty optimized as dogs. >>

And I think the big thing is that we live on a farm and they get a lot of activity too. They get two non-negotiable walks every day. I do that for for me too. That's part of like my you know creative downtime is to do a non-negotiable walk like morning and night. So, and they get a lot of that and they chase the they chase our Animals around too. So, >> what are your current feelings? Let's just say on the sardine fast when you're doing a weekl long sardine fast and maybe you're so adapted at

this point that you don't experience this, but certainly when I've done water fasts and even if I'm doing lower calorie ketogenic following a lower calorie ketogenic diet, I can have a really tough time sleeping at least for a handful of days, right? Have just kind Of rapid heart rate. I don't know if that's trying to compensate for lower blood pressure because I'm just losing so much water and electrolytes. Who knows? I have found supplemental electrolytes to help a bit with that. But what type of supplementation do you take or advise people take if they are

trying a ketogenic diet for the first time or fasting? Maybe the answers are different. >> Let's just say it's a sardine fast. like A man falter longo coming for you with the sardine fast. What supplementation makes this easier or more productive? Just from an adaptation perspective, >> I will use sardines and also ketoart which is essentially the electro sodium, potassium, calcium, magnesium, beta hydroxybutyrate and that is will be used like two to three times per day. >> At night time, yeah, when you go with a caloric deficit, your sympathetic Nervous system is activated a little

bit, especially with a water only fast. So you get a little bit hyper or dysphoric even for some people. >> Yeah. feel like you just ran up three flights of stairs when you're trying to go to sleep. Yeah, it's unpleasant. >> Yeah, that's less with a sardine fasting instead of like zero calories. So, the sardines would then be eaten at nighttime typically. And I remember doing this repeatedly. And what I would Do is take a little bit of GABA at night. And on one or two fasts, I took just >> 25 milligrams of dyen hydramine.

I think that's the exact or close to the exact dose of one or two benadryil, right? I'd have to look at it. But isn't dyenhydramine? >> Yeah, dyenhydramine is histamine. It tends to be lipopilic, which means when you take dyenhydramine, it quickly crosses the blood brain barrier. You Could be a little bit groggy the next morning. The studies show that 50 milligrams of dyen hydramine can decrease you know memory recall if taken acutely but 25 milligrams there's no effect of that. So I'm comfortable with taking 25 milligs of dyen hydramine at night and then giving

a lecture the next day in the morning. I feel razor sharp and because also it enhances it reduces sleep latency so I get better sleep but I would not use it more than once a month or something. And I do think dyenhydramine and these over-the-counter sleep aids used every night by various people that are emailing me. I mean it's creating dementia. I think >> I think I mean there's the data is pretty clear on that. you have an older person getting 50 milligrams every night, every week is bad. So, so melatonin, magnesium, a small dose,

I guess for my size it would be a half Dose of dyen hydramine and then GABA. So, you could take GABA in the form of GABA that you can get over the counter or there's also fenibbute GABA. So, which I have but tend to haven't used in a while. Fenib, I just want to put out there can be a really nasty drug for people. It could be addictive. you build a tolerance real fast and coming off a fenibute can be very problematic for people. I mean it's like coming off their GHB I think but it

could be a tool In the toolbox because I mean we're talking about taking like two three grams of fenibute can give you euphoria and have it's like a benzoazipene kind of but if you take 250 millig or 200 milligs of fenibute which is a small dose I mean theoretically you could take that two or three times per week and never really build a tolerance or get but I would not advise people do that but if you're going to fast like say once a month. One way to avert that and I get the same exact thing.

I get super hyper and my brain just goes on fire when I the first day of fasting. >> Yeah. A little bit of GABA or fenibute, dyenhydramine, >> magnesium, and then I also do I've always done melatonin. 5 to 10 milligs of melatonin. >> That's a solid dose. >> Yeah. We went on vacation and I forgot it. >> Do you still use melatonin continually? because I remember there was some conversation floating around the ether and never looked too closely into it because I don't use melatonin all the time about some some possibility of endocrine disruption.

Can you speak to that? >> Yeah, I've been using melatonin probably when I started using creatine in 1993, the old phosphaggen when I was in high School. >> Oh man, back in the day. >> Yeah. Yeah. >> EAS. Is that like way back? >> I was a beta tester for that. Yeah, I was a beta tester and then phosphaggen came out and then I 1993 I think I started using creatine. I was like an early adopter of creatine. >> But yeah, to get to your question in melatonin, I've studied melatonin on the hippocampus on brain

slices. You can Slice the brain like a piece of bread and you know applied melatonin looked at reactive oxygen species and things like that. We use it for oxygen toxicity. It wasn't good for that because it did make the the rats sleepy. Melatonin doesn't really make me sleepy. It kind of makes me more calm than anything else. >> So, I went on a vacation where I forgot melatonin and I slept like a baby. Probably because I was up every morning. Sun is the ultimate circadian Synchronizer. So, I got off of melatonin to check my indogenous

melatonin and there was no suppression. >> Melatonin in animals that are hibernating like little gerbles and things like that, if you give them melatonin, it can suppress endocrine function including testosterone production. Huberman talked about I love Huberman. So I was following him and he was talking about melatonin and so I went to the primary literature and I was Like man he's right it is an endocrine disruptor and suppressor but then I dug into the literature more and it was not the case for humans. So there was no evidence in and I think when he talks

about it I don't think he references like a human study but he does reference legit studies. Yeah, Andrew Huberman is an amazing scientist and he puts out awesome information out there. So but it did get me concerned about it. So, I got off of melatonin and then I confirmed That my body does make normal amounts of melatonin. So, I measured that. I also confirmed that 5 milligs of melatonin, if I go and measure the next day, my melatonin is off the charts. Meaning that I take 5 milligrams at night, the next day in the morning

at 9:00 or 10:00 in the morning, my melatonin is super physiological. >> Is that good or bad? >> I think it's good. So I take melatonin not to sleep but as a neuroprotective Agent that has a whole host of beneficial effects for the brain also Alzheimer's disease also cancer especially breast cancer. >> So use it for that. I also megaosed 20 or 30 milligrams and then checked my LH and FSH >> milligrams. Yeah. Okay. Yeah. 20 to 30 milligrams. >> 10 milligram tablets are like the gorilla tablets for melatonin. Right. So, I I chewed a

bunch of them and then Held it under my tongue and I didn't really feel any more sleepy. I just slept like normal. My aura ring was like normal. But then I went and I got lab work done and I did testosterone LH FSH and there was no suppression. Actually, my LH and FSH were trending like high end of normal, which is another topic that I can get into. But the thing is that it did not trigger an endocrine response in me. And I do not think there's any data in humans, Although specific animals are very

sensitive to melatonin. And if you give it to them, it can cause endocrine suppression of some sex hormones. >> Okay. >> It is a hormone. >> Well, that's good to know cuz I actually benefit from taking melatonin, but I I've largely cut it out because of some of the the murmurss, but it does help me sleep. Is this a true statement that you do not do any fasting Currently like pure water fasting but instead do this situational sardine fasting? I mean, is that sort of 99% of the bang for the buck and there isn't really

any reason to go beyond something like that as a fast mimicking diet? Or are there benefits that you think are compelling of doing a more restrictive, say, water only fast where you're allowed black coffee and a few other things perhaps, but are otherwise really not consuming calories? For me Personally, it's very context dependent. I was talking to someone the other day that was getting shingles. As soon as the first sign of tingling, which is like the precursor of getting shingles, they start fasting and it never actually surfaces. So only when they situationally pull the trigger

and start water only fasting does it completely mitigate. It's a massively effective countermeasure for herpes simplex flares or things like that. >> Yeah, I was going to ask I don't know anything about shingles. So what's happening there? do like endogenous ketones and therefore could you just take a bunch of shots of exogenous ketones or like what's what's actually happening to to have that suppression? >> I think we're augmenting metabolic control of immune regulation in the context. So you have the innate immune system which is always kind of running around and Then research work we're doing

now with the Mafet Cancer Center is basically using ketone metabolic therapy to augment the adaptive immune system. So the adaptive immune system is more specific. It's kind of like you know that B cell and T- cell augmenting the B cell and T- cell things where it's like the adaptive immune system is like the Navy Seals. And there was a human study that used a vegan diet versus a ketogenic diet. And this got put on my Radar by numerous people who then wanted to research this. A vegan diet actually augments and enhances the innate immune system.

And a two-week ketogenic diet, and this was published in Nature Medicine, augmented the adaptive immune system and partly through the gut and partly just through changing metabolic physiology. This happens when we fast. When if we're fasting, our gut is relaxing. I think it's restoring or preventing. When we eat Something, we have things going into circulation that's keeping our immune system kind of active, right? So, if we're not eating anything, our immune system becomes hypervigilant and then in a way that it becomes hypervigilant to attack things, but at the same time, it's suppressed. So, inflammatory markers

go down. The immune system is like an army. you have like a hundred thousand guys in an army and the immune system and they're all working. If you're eating and you're stressed and environmental toxins and things like that, when we fast, we allocate more of that immune system to be more vigilant to attack things, but at the same time, our general inflammation state goes down, right? It just becomes more vigilant, but inflammatory cytoines, chemocines kind of go down. So I think that's part of it in that it's stimulating I think cancer specific immunity but also

just generally Suppressing inflammation and that's happening for a number of different reasons in part due to elevating beta hydroxybutyrate which is an indogenous metabolite that plays a role in inflammosome suppression. Mhm. >> I know guys like maybe Eric Verden and like the guys at the Buck Institute, they had kind of looking at that and then our colleagues Dr. Deepix at Yale sort of formulated a diet to Specifically elevate BHB because he had showed previously that fasting suppresses the NLRP3 inflammosome and the metabolite that's off the charts with beta hydroxybutyrate. So the next study was giving

that as a supplement with a normal diet to see if that could then also suppress the inflammosome and it did and that was published in nature medicine 2015. >> So I formulated the diet like for that study and I'm kind like a middle author On that. So I think that plays a role in that. But I think it's multiffactorial and I think it's just one of these things that needs to be studied because it's kind of universally accepted. >> Yeah. >> That it's kind of happening. But you also have to be in a good healthy

state. If your if your nutritional status is low, it depends on kind of your baseline characteristics, your therapeutic response to fasting. And I think that's Really important especially for people who have cancer, maybe getting chemotherapy where they have compromised nutritional state in some ways. They have to approach it very cautiously. >> How many meals per day do you eat now? How old are you, Dom, at this point? >> 50s. >> In my 50s. Yeah. >> All right. Well, congrats. What does your diet look like now? Just like a kind of the set it and forget

it version Of Dom's diet. What does that look like? It's situational, but always probably three meals per day that I do. >> And you weigh about how much at this point? >> I just did a DEXA this weekend. Actually, I did a DEXA two weeks ago and I did another one after I got off creatin and then did another one. So, I just hover right at 218 to 220 >> and yeah, body fat last was 9.4. >> You got some muscle to feed. All right. So, so three meals a day. What What does it look

like >> this morning? It was eggs and chub mackerel and Yeah. Yeah. And that's it. So, basically just like protein and fat. And then for lunch, I typically have beef, chicken, or fish. Usually fish. Lately, I've been eating a David bar. Peter sent me some of those, and I've kind of like mixed opinions about it. It pops up on the CGM a little bit, but I think it's kind of an interesting Direction to go into. I enjoy them. They taste really good. >> Yeah, >> I've been doing that. And then for dinner, we went out

for Mexican. the other night and last night hosted Mary Newport and usually have like beef, chicken or fish with a vegetable like always broccoli. I'm a huge fan of broccoli. I could eat like three lbs of broccoli has no gas or Bloating effect for me at all. >> My body loves broccoli. Our dogs do too. So I give them a little bit of that salads. But >> usually about a pound of beef, chicken or fish at dinner. So that's my big meal. And over the years we have done transition. Instead of eating at 7, we

eat at like 5. >> Okay. >> 5 or 5:30. So we eat earlier and then I do physical activity after that. >> So if it's squats or deadlifts, I have to do it before I eat. But for like pressing movements and activity I do after that. And I do farm work for like an hour or two in the evening after that. And I typically have like every other night wine. So yeah, I do have a bit of wine, lower alcohol, non sugar, dry farm wines, which has like less than one gram of sugar per. >>

I would never drink wine without doing like some kind of activity after like Wine at 9:00 and then try to go to bed. I would never do that cuz I see that on my aura. But if I do a glass of wine and some form of physical activity, we always do an evening walk, I think I sleep better. I think I don't do two glasses, but I just do one glass. So, I know the current consensus on alcohol is that it's but I would I would push back because none of that is specifically studying wine.

If you go to the studies on wine, it actually shows once the First one that came up is actually decreasing cancer risk. And then I noticed that when I take wine and measure my blood, it's less viscous. So wine also decreases platelet aggregation. >> So that it makes your blood less viscous and that is well known. I observed it and it was like something's going on here. And then I went to PubMed and it's actually well known. I didn't know it at the time that it decreases platelet Aggregation so less potential for clotting for stroke

and things like that. So I think that may factor into we just got back from Greece >> and they had the UO and everything and just all the we went to then we went Sardinia. So we went to these blue zones and they just at night after their dinner the males will do a shot of alcohol usually wine but sometimes uzo and and they're all like in their 90s and like hundreds right they're in the Blue zone so it's a universal characteristic. >> Well that's my protocol. There may be a genetic component too. I remember

there was this book that was like why French women don't get fat or something and way back in the day I remember before his passing I was talking to Charles Polluin he's like yeah mthfr he's like that's why it's none of the other stuff in the book >> and he mentioned a couple of other Things like who knows but yeah I mean I I think yeah living by the water activity and social >> so the social interaction is probably the biggest lever I mean I just see them they're all out and about walking around and

yeah that's probably the biggest lever and getting sun So they're outside in the sun, everybody, you know, it's multiffactorial, but it doesn't seem to be hurting them. Let's put it that way. >> If someone is, let's just say they want To test out the ketogenic diet, and certainly they will note, they'll be like, "Wow, Dom doesn't eat a lot of vegetables except for a pound of broccoli at dinner. I can tolerate that. But I have probably like it comes out to 30 to 40 grams of fiber a day, which is pretty pretty high. But that's

broccoli and I usually have a small apple too. Sometimes we have apples and then like a cup of wild blueberries. So it comes out to >> Oh, right. Okay. >> about 30 grams. That's maybe a higher sometimes 10 or 20, but I try to shoot for about 30 grams of fiber. >> Yeah. Got it. Okay. If people want to kickstart the ketogenic diet, any any tips for kind of getting over the hump in the beginning? People can sometimes have a bit of a hard time before they kind of click over. I'm not sure. For me,

it's like once I'm above 1.2 millmers, I feel totally fine. That's Just me on a precision extra. But for people who are looking to give it a shot and maybe haven't given it a shot, any tips for noviceses, >> I would do fasted lowintensity cardio. For me, that would just be going for a long walk, waking up in the morning, and if you're going to start your ketosis experiment or whatever you're doing that morning, getting out in the sun, staying well hydrated, you could take MCT and also ketone Electrolytes like ketoart or something like that.

And then that will ease the transition because it takes a little while for your ketogenesis to ramp up due to you got to deplete liver glycogen and ramp up beta oxidation fat enzymes. And then you have as ketones get into circulation over the period of a couple weeks. You're going to upregulate the ketoytic enzymes which are basically the enzymes and the tissues that are able to you know utilize and leverage those Ketones for for energy over time. How long does that adaptation take, would you say? >> I don't know if anyone has unambiguously answered this

question in humans, but in rodent models, you could see the MCT transporter, not to be confused with MCT oil, but the monocaroxyic acid transporter, and now there's one, two, three, and four. That protein is 50% higher after two weeks, like in a rat, for example. I think the point is for Most people is that if you start fasting or ketogenic diet and to avert the keto flu, you want to hydrate, get in electrolytes and also elevate ketones as much as possible. And to do that with MCT if you can tolerate it or ketone electrolytes. I

would not be guzzling a ketone esester because you're going to spike ketones up. You're going to inhibit your own ketone production. It's a dose dependent thing. But my advice would be low inensity cardio hydrate Electrolytes and then small amounts of ketone electrolytes with MCT. So MCT will stimulate your own ketone production too. So it kind of >> Now are you just taking tablespoons of liquid MCT? Are you using a powder and mixing it in? What do you personally do or what would you recommend >> for the liquid? Sometimes what I do if I'm eating tuna

fish, which is packed in water, I'll pour the MCT on the tuna fish and stir it up and then deliver it That way. If I'm having coffee, I can put in the MCT powder in the coffee and mix that up and that would be, you know, 10, 20, upwards of 30 grams. And work by Steven Kunain actually showed that if you take MCT in the context of caffeine or coffee, you can boost your ketone production by like 20 or 30%. So there's a bit of a ketogenic synergy. When you deliver caffeine with MCT, it's stimulating

lipolysis and also fat oxidation in the liver. So you're Ramping that up. >> What type of powder do you like to use? >> People send me things, but I actually the powder that I have is actually it's Keto Brains. It's MCT powder output GPC theanine and it has lion's mane mushroom in it. So it goes under the brand name of keto brains and that's the MCT powder that I use. The base of it is MCT but then it has sprinkled onto that theanine which has a nice calming effect which probably good to use like on

the first Day of fasting. Alpha GPC if I take too much of it it gives me a headache so I only do like one or two. >> I got to be careful with alpha GPC. I also get a headache. >> Oh, really? Okay. So, you're like the first one. I don't know if I was creep, but yeah. When I first got Keto Brains, I did like six scoops and I was like, "Oh my god, I got a had a bad headache, but but one or two scoops is okay." >> I love that your first go

was six Scoops. >> If I just wanted offtheshelf MCT oil, cuz I just like >> Yeah, >> I feel like there's there's only so many medicinal mushrooms that I can cram into my diet also. But, no offense to the mushrooms, but actually have some interesting thought on some of the medicinal mushrooms. Some of them are very strongly antiviral and immunom modulatory. And so when I've talked to a Number of very credible micologists, they're like, "Yeah, it's probably best not to take that stuff every day." >> Yep. >> Like you should cycle on and off. >>

Y >> but if I just wanted MCT for purposes of travel, right? Cuz MCT liquid can create such a goddamn mess when you're traveling >> and in your pants too. Yeah. >> And in your pants, too. Yeah. And for People who are noviceses, do not do creatine, caffeine, and MCT oil out of the gate. You gotta prove to yourself that you can handle that unless you're >> unless you're going to depends on the airplane. Yeah. What other just MCT oil powders might you recommend or have you used? >> Quest MCT powder. I think you can

get that in like CVS and Walgreens now too. And Amazon just the Neutriost. So I Bought just straight up MCT. They also have like a C8 powder and I've tested both both of them wearing a continuous ketone monitor >> and I saw a nice elevation over time. And then I combined that MCT powder with keto start and basically I was in ketosis for half the day. So just do a day with that. >> I mean I'm going to break my own rules here but I've done enough test drives. I'm about to go to not super

high Altitude, but I'll be coming from sea level to about 8,000 feet on average. And we're going to be doing a lot of intense exercise. Y >> So maybe my my morning dose of coffee, which I'm sure will be some shitty instant coffee, but it's going to taste delicious when you've been freezing your balls off all night. Maybe I'll add some keto start and MCT powder to that because those would be easy to easy to travel with, I would imagine. >> Super easy. Yep. >> I'm not sure how Keto Start tastes in coffee. >> No,

no, don't do that. No, they have Keto Spike coffee. So, Audacious Nutrition has keto spike cocoa, coffee, and tea. So, in the afternoon, I don't do caffeine after 12. So, I will brew I'll just boil hot water and just put And the keto spike coffee is like a good Colombian coffee and it just has, you know, the BHB electrolytes in it. So, I've been doing that. >> Cool. I'll check that. Let's see here. I'm just trying to figure out because I went back through all of our conversations which covers a lot of technical detail as

you would imagine and I'm just wondering what you are most excited about and right now I mean just to volunteer this I'm very interested in neuroinflammation and the inflammosome the interplay with the microbiome and how the microbiome Can seemingly influence or mediate some of, for instance, the anti-seizure effects of the ketogenic diet, right? If you get rid of acromancia or a few other strains, >> lo and behold, doesn't really work. And I'm wondering if that applies to other, say, conditions that >> metabolic psychiatry might be applied for like schizophrenia and others. I don't know, but

seems interesting as a question. What types of questions or Projects or realizations, findings, anything have captured your interest or excitement these days? Just quickly go down the list. Ketone metabolic therapy for cancer. So is one. And we have a pretty comprehensive review that describes the framework for ketone metabolic therapy for glyobblasto, which is a cancer that's largely resistant to the standard of care. So way too much to talk about. It was actually like a 200 plus page paper that was going to be Submitted and we had to like basically put a lot of data and

things as supplementary figures. I think there's like six supplementary figures that tell specifically all the different metabolic drugs that target glucose, glutamine, GKI calculator and a lot of things. So yeah, just Google ketone metabolic therapy framework for glyobblasto and it's open access. So that has stimulated research at different places. But I'm excited about research that we're doing With the MafI cancer center which is the largest cancer center or one of the largest in Florida tier one cancer center where we've got various projects glyobblasto maybe a breast cancer but also a lung cancer. So was specifically

using ketone metabolic therapy to augment immune therapy, specifically the checkpoint inhibitors. And that has to do with what I described about ketone metabolic therapy, specifically beta hydroxybutyrate Activating the adaptive immune system and making checkpoint inhibitors, which is a class of drug that's and CARTT therapy. So now they actually have a study with CARTT therapy and checkpoint inhibitors. So ketones tend to expand the tea cells that are associated with CARTT therapy. So just kind of enhancing that therapy. And with the checkpoint inhibitors, it tends to just enhance cancer specific immunity that is augmented by PD1 inhibitors.

So they're Specifically studying that. So I'm I'm excited about that. So that's on the cancer front. and then we can jump if you have no questions I could jump to other the Alzheimer's the metabolic psychiatry and >> yeah let's talk about those let's hop to the the Alzheimer's and metabolic psychiatry would love to dive into that cuz that's front of mind for me and I'm not sure if I made this clear doing the couple weeks Of strict ketosis segueing to a sort of 168 ketogenic diet and then moving to kind of a paleo ish diet

has produced some of the best labs I've ever had and also the the best oral glucose tolerance test that I've ever logged and from a mood stability standpoint and I am also for at least the last few weeks supplementing with the monoester and a diester the sort of q but all of those things combined I got To say psychologically from a standpoint of sustained focus and mood has been just kind of mind-blowing to be honest. So yeah, I'd love to hear any and all thoughts on the Alzheimer's metabolic psychiatry front. >> So metabolic psychiatry, I

would encourage people to listen to Chris Palmer who I kind of put on your radar. I don't know if you remember I sent you the link to your metabolic >> you got to watch this Tim. It's it's Going to change sort of the landscape of psychiatry. Yeah, I remember that was a recording from a conference I believe where he was interviewing one of his patients on stage. >> The metabolic health summit. >> Yeah, exactly. >> Which is part of metabolic health institute which you can get educational credits through that. So yeah, we brought Chris in

and it was such a compelling story. He treated Matt Bazooki. So Matt Bazooki is the son of Jan and David Bazooki and they because he quickly went into durable remission >> who are well known from Roblox. >> Well known from Roblox. Yeah. Sort of billionaire philanthropists that are changing actually what ultimately may be the standard of care for psychiatry. And I think they kind of single-handedly are funding metabolic psychiatry with Sabani Sethy, she's at Stanford, Chris Palmer at Harvard, and I work with them closely As an adviser. There's at least a dozen other institutes that

are doing metabolic psychiatry research for schizophrenia, bipolar, major depression, anorexia, nervosa, which is a psychiatric disorder that kills more people than any other disorder, and a range of different things, and anxiety disorders and alcohol use disorders, alcohol withdrawal syndrome. So, they're doing research on that. So with metabolic psychiatry there's a lot of Pilot studies mostly bipolar looking at a range of different things ADHD2 and then there's apps that are emerging like metsai metsai.com that's a collaboration with Dr. Alli Houston, he's at Oxford and Georgia Eid, who might be good to have on the show. She's

from Harvard psychiatrist. So, that app is more of a comprehensive app that incorporates ketogenic therapy, but also lifestyle stuff and then coaching. So, metabolic therapy, coaching for mental Health. >> How do you spell the name of the app? >> Metsai is me tsy, right? Me t I'm trying to think Met better at the size than the branding. >> Yeah, I guess me tpsy.com. Met size. So, I think they have their website up. So, they're basically in their onboarding phase. So, they should go live pretty soon. But, I'd like to add that the Bazookis I remembered

that they are funding a big study at Oxford Right now. And the bazookis will match dollar for dollar any donation and spearheading sort of that using the app and using ketogenic therapies in combination with lifestyle therapies too. So metabolic psychiatry is rapidly emerging in a number and this ties into work we did I guess my wife did I was on the paper but she ran the study. We were doing seizure studies with exogenous ketones and the most efficacious one for this application was the recemic ketone Salts in the MCT. So we were gavaging them. >>

What does gavage mean? >> It's basically like tube feeding the animal. So instead of >> mixing the ketones in with the rat chow, they eat it. And so it's taking a syringe and based on the weight of the animal, you pull in the amount of ketone esther or this case it was MCT and ketone salts. We did the esters too and it it did have an anxolytic effect, Anxiety reducing effect. And then you administer that to the animal and what we were doing is we do seizure studies, put them inside a hyperbaric chamber and we

go two to three times more normal and it induces a seizure. But what we observed when we put the animals in ketosis is that instead of them trying to bite us and kill us and not wanting to be held, they were very chill and calm. It was just, well, this is great. We can handle the animals easier and get Them into the chamber without them trying to bite us. And my wife's a behavioral neuroscientist and she was like, well, we should do some behavioral studies because I think there's something here. So, we did elevated plus

maze. So in this case, the animals can go inside a closed little cave or it can come out into the open arm in the elevated plus maze which is exploratory behavior. They're more extroverted if they come out and more introverted and Kind of like their fear response if they go into the cave. So we got results that we published the title is anxolytic effect of ketone supplementation. We published I think three papers and showed like the mechanisms and stuff too. So that was an early paper in over 10 years ago just basically showing that inducing

acute ketosis with this formulation and doing the elevated plus maze produces an effect that was analogous to a dose of Benzoazipene. If you look at I don't know Xanax or other things in elevated plus maze it was like yeah 20 or 30% more time in the open arm so they're less fearful to be in environment and making them more like a social lubricant maybe like benzo or something. So it had that effect in the animals. And when we look at the blood work and even take out the hippocampus in the brain, the levels of GABA

to glutamate are higher. And then in Another study we did with Angelman syndrome, we looked at the mechanism of that and there's an enzyme called glutamic acid decarboxilles and a lot of anti-seizure drugs kind of target that. the protein levels were higher. Essentially showing that your brain converts more glutamate which is anxiety evoking like wakefulness enzyme. It's converting more glutamate which is excitatory to GABA which is brain stabilizing. That's like your chill or You know like alcohol. >> It's what you take before bed. >> Yeah. Yeah. >> Yeah. >> In a variety of different studies.

We also looked at adenosin receptor signaling. That's a little bit more complicated to describe but there's a number of different effects contributing to that. So there's a clear rationale I think for depression. If you do an FTG PET scan on someone that's depressed, it Shows glucose hypom metabolism. One thing to mention, I think an important thing to mention in the context of bipolar, you can have a hyperglycolytic effect and Dr. Ian Cample from Edinburgh University has published some elegant reviews and is doing some work on that front and sort of describing the research there. But

I think it's important because some of the feedback coming out and I think you even mentioned too when ketones get really High what we observe if ketones get too high that can cause an anxiogenic effect but there seem to be sweet spot maybe one to two I wouldn't go above three probably 1.5 to 2 millmer range that seems to be >> a level of ketones that safely does not produce a metabolic acidosis. So what we do see that when you get above three it starts to change blood pH. >> So it seems to maybe overwhelm

the respiratory and renal compensation and Your kidneys put out by carb and then there's respiratory and renal compensation that regulates your blood pH. But the animals that succumb to ketoacidosis and died from the ketone esters that we gave them in early studies had to do with acidification of the blood. So it was just an overwhelming because ketones are acidic. Yeah. >> And when you deliver it into an esther form, there's nothing to buffer that. When you give a ketone salt, the electrolytes are kind of like a buffer for that, right? >> So you have the

metabolic effect, you have the changing of the brain neuropharmacology, and in bipolar, you you throw anti-epileptic drugs at bipolar patients, and it's largely ineffective. So it makes sense that a ketogenic therapy would kind of work for that. And the neuroinflammation, too. So things That trigger neuroinflammation and that could be that could be an infectious agent that could be a virus that could be te Gandhi I mean it could be like a bacteria there various things that could cause psychiatric disorders various infectious agents create that neuroinflammation so I think neuroinflammation and then when someone has a

seizure too the inflammatory state of the brain gets much higher so I think ketogenic therapies are working Through multiple mechanisms more or less like in synergy to produce that it's not one mechanism when we published the NLRP3 I got requests from gen and various pharmaceutical companies to go there and give a talk on the mechanism so they could drugify and I would throw up a big flowchart of all these mechanisms and I think they would get frustrated and was like well what tell us the mechanism so we can make a drug out of this but

I think the beauty of Ketogenic therapies is that it's pleotropic Right. So, which means it's many mechanisms working in synergy. You could say metformin, GLP-1 drugs are working through metabolism and they're kind of pleotropic. Also, >> do you use either of those? >> I have experimented with metformin and that is a way for some patients to increase their ketone levels. So, we've published on metformin >> from the context that it increases Mitochondrial oxidative stress. So it's a weak toxin to the liver. Most people didn't know that when we were studying that. And I think metformin

can enhance increase kinase, maybe increase insulin sensitivity, and has a very weak effect at reducing blood glucose if you have a normal glucose, but it does tend to increase ketones a little bit. And I think there's about 150 studies on clinical trials.gov of right now on metformin as a means to augment cancer Therapy. So I think that could be a tool in the toolbox for some people. When I take it and I do really intense if I do an intense workout, I felt sick. An issue with metformin is it could produce lactic acidosis. It's producing

lactic acidosis because it's a weak. It is a toxin to the liver. So it's sort of deenergizing the liver. But also when I took it up to two grams per day, I had a photosensitivity. So when I went outside, the sun gave me a rash. >> You mentioned on your wrists. Am I making that up? >> It tend to correlated with that and then I got off of it and then I experimented with it again and it tended to be at the beginning. I'm in Florida and it was May. It's like when the sun's really

starting to crank and then I just go outside all day and it's like where is this rash coming from? So it's a photosensitivity reaction that I got and that kind of concerns me. So I never I Have it but I don't use it. May I ask you a quick question just related to metformin for a second? >> Mhm. >> I was looking back on notes on prior conversations and I think you mentioned Dr. Dale Bredson. >> Yeah. >> On an episodes of STEM talk, but specifically for folks with the APOE4 genotype like yours truly. >>

Do you think metformin may be more Interesting? >> But let's assume in my case, let's call me metabolically healthy. Maybe yes, maybe no. I remember a long time ago having a chat with Nav Chandal. I want to say I might be getting the name slightly wrong from Northwestern and he was like if you're doing a bunch of exercise and getting your diet straight. He's like I don't think that you're going to see a lot of benefit but he didn't have the APOE4 Information right on me. And then bourberine I have written down for some reason.

I'm just wondering if there's anything to either of those for APOE4 specifically. >> Yeah, bourberine is pretty similar to metformin's glucose lowering effect. So that's something that you can consider if you don't want to take metformin. I'm of the opinion that for the general population eating a standard American diet that is kind of averse to like Working out and just trying to really modify their diet. Metformin I think is a very potentially effective drug for longevity. It's going to reduce blood glucose since most people are pre-diabetic or you know have type two diabetes that are

in their 40s, 50s and 60s. And it will reduce your incidence of cancer, specific kinds of cancers like pancreatic cancer. I think the data is kind of good on that. And I think it'll Shift metabolic biomarkers that we have historically good data on in the right direction. Does Betformin do anything that taking a GLP1 like Tzepide or something doesn't do? I mean, I guess I'm just wondering if >> Yeah, >> there's an additive effect. Well, they're totally different drugs, but people who take metformin and one gram to two gram dose, two grams is kind of

high, but when they do that, they tend To eat less calories. So, it does create like a little bit of for me a GI issues, maybe a little bit loose stools in the beginning, and that could, you know, be factoring in there. So, it does tend to improve metabolic biomarkers across the board if you're trending towards like metabolic dysregulation or metabolic syndrome, >> right? A GLP-1 works essentially through caloric restriction and just decreasing appetite through in part a mild Gastroparesis and decreasing gastric emptying time but also works on the brain and I think has a

wide range of beneficial effects. I think it's a gamechanging drug that's going to change the whole landscape of metabolic therapies. >> Seems to have a from what I've read and maybe I don't want to over interpret here but potential neuroprotective effects, right? So that's the main reason I would be looking at potentially Lowdose GLP1. >> I like the low dose. I like that you preface it with low dose because I think higher doses are not studied enough long term to avert potential side effects that we don't know about. >> Do you take bourberine or is

it superfluous because of the diet? You don't really need anything to lower glucose. I've experimented with it and it did decrease my glucose in response to a meal. I did dihydroourberine which Is a more potent version of bourberine but interestingly after about a week I started to get a headache and then I got off I don't know if it has a vaso dilate or maybe it impacts liver metabolism in a way that was who knows maybe making decreasing my caffeine metabolism. I mean that these are things that come to mind. I don't I I'm a

fast metabolizer of caffeine. >> You still consume quite a bit of coffee. Yeah, >> I do. Yeah, I fill this up. So, this is Metabolic Mind. >> So, yeah. Actually, Metabolic Mind is part of the Bazooki's group, Metabolic Psychiatry. So, they they have a >> So, I do one of these per day. >> What is that? That's like 16 to 20 ounces. >> 24 I think. About 24 ounces. Okay. It's metal. It looks like a thermos basically. >> Yeah. >> Okay. Got it. >> Relatively strong coffee. I do that and pour one cup and I

usually finish it about now. And no caffeine. Caffeine at 4:00 or 5 p.m. is probably going to disrupt sleep latency and >> sleep timing. But yeah, GLP1, amazing class of drug. We're covering that now with med school in metabolic in our nutrition courses we're teaching. And then the SGLT2 inhibitors are also a pretty interesting class of drug that I Think has a lot of potential. So someone trying to bring their glucose levels down, for example, trying to get that, you know, these are prescription drugs. So of course, go to your doctor, but that's that's a

pretty good lever to pull, especially if someone's resistant to dropping their carbs, if they're eating some carbs. >> Yeah, GLP1 and SGLT2 are great. Well, this is also a tool in the toolkit with let's just say elderly patients who are Even if they wanted to comply may not have the mental faculty. >> Yeah. To comply with ongoing >> and you can't have necessarily 24/7 supervision to prevent them from eating bagels. >> Yeah. >> But maybe you can do just like all the meds in the morning and then one injection a week or whatever it might

be. Do you take any supplements or medications with the explicit goal of Mitochondrial health or maybe just the side effect of mitochondrial health? >> Yeah. Well, I think ketones shine there. The D both the D and the L beta hydroxybutyrate. So that's like first and foremost. And >> we are doing research with NAD. So NAD supplements >> these injectables. >> Well, I can't talk about the research that we're doing in depth, but we're working with Metro International Biotech. So they have phase two and phase three trials for like Alzheimer's and there's NR right nicotenomide ribosine

nicotenomide monucleotide. So the problem with those is that they're kind of the liver is pretty greedy and takes a lot of that and then the muscles are kind of brea so a lot of it's maybe not getting to the brain but if people just Google MIB626 so that's one of their drug forms of NAD that's a stabilized form of NAD and then They have a whole suite of NAD molecules that most people don't know about but are in experimental trials and we're doing some of those >> preclinical animal model work in our lab. So I

do think for certain applications we didn't see an effect but at the same time they are for applications like non-alcoholic fatty liver disease maybe Alzheimer's maybe inflammatory disorders improving if used for a long period of Time markers of mitochondrial health I think improve >> NAD people may know NAD is basically like a substrate for like the certuins right and various enzymes there's like 500 different enzymes a class of proteins that are called certuins rely heavily on NAD >> so this is like an important thing to consider and as we age just for folks who are

like have I heard that before I want to say back in the Day when resveratrol was everywhere in the news and super mouse and >> all you have to do is drink wine but maybe 20 cases of wine I mean all of that stuff with transferrol That's where the certuins popped up. >> Yeah, the certuins are really heavily reliant on NAD and NAD is involved in everything that we study, right? So like 5 to 600 metabolic enzymes need NAD for fuel. So that's important to consider. And DNA repair is exclusively tied to NAD levels. So

remember I mentioned reductive stress with D beta hydroxybutyrate. Yeah. So reductive stress means that the NAD to NADH ratio would drop. So you get more NADH relative to NAD and that could be problematic because the availability for NAD may not be there for certuins and other. So that you know a redux balance formulation. >> I see. So that kind of feeds back I don't want to get too far into that but I think it is impacting the redux balance which is getting us to revisit the various ketogenic formulations and to study this in cellbased systems

animal models. It's hard to do in humans. You could do like 31 phosphorus MRS if you have a four or seven Tesla system like Harvard has. So this is one way to look at like phosphocreatin, ATP, pH, and also NAD to NADH ratios. So this is one way. Actually, we do have that at our Alzheimer's center, and that's on The list of to-dos to look at this reductive kind of stress thing. >> So NAD, I'm just throwing that out there because I think there's a lot of criticism towards NAD. Now, that happens from time to

time because moving science from cellbased systems to animal models to humans, there's a massive learning curve there. We're learning that with some of the ketogenic agents, we're >> we're just at the cusp of really understanding the dosage, timing, Scheduling, and form of exogenous ketones. That's optimal. And it's going to vary dependent upon the situation that you're trying to treat. And also individually, I think people are going to have that opens up this whole personalized precision ketogenic metabolic therapy or the NIH is throwing a lot of money on personalized medicine based on genetic markers and based

on biomarkers that some of them that you can measure in real time like continuous Ketone monitoring, continuous glucose, and maybe lactate monitoring. >> That's very cool. One last supplement question because I'm looking back at past notes and I'm probably going to mispronounce this, buton sort of more absorbable version of CoQ10. Maybe that's a fair description, maybe it isn't. Do you still take that or no longer? I think CoQ10 is on the short list of five supplements that I would recommend to people. Although I Don't take it. I do get quite a bit from the foods

that I eat. I eat a lot of heart, liver, animal products that have kind of CoQ10 in it, but if you're on a statin, if you're on metformin and other drugs, >> they they could potentially deplete you. And then CoQ10 has a solid track record for cardiovascular health. So, idbinone is kind of a drug stabilized form of that. And then when I discussed that on your podcast, that was in the context of Something called the Deanna protocol. The Deanna protocol is after Deanna Toadon. >> She has ALS. She was diagnosed well over a decade ago,

was given two or three years to live. She's alive and well today. We were just emailing yesterday. So Deanna had advanced ALS and then has been stabilized using the Deanna protocol which included at the time Ibnone, but I think it became a drug. So Ibenone became >> the standard of care for Friedrixia and then you couldn't get it on Amazon. But I think ubiquininal or CoQ10, it would be a good substitute for that. And I don't use it myself, but I think that's if you're older in age and you have cardiovascular heart problems like in

your family. However, with that said, we actually did >> ubiquininal. We did high doses in our animal models and we saw some kidney toxicity. We had some animals die and we Didn't know. But that was in rodent models and we use again we use like really high dose for oxygen toxicity. We've looked at everything under the sun, but it was this unexpected side effect. And then I went to the literature >> and showed that it's such a powerful antioxidant in some ways >> and it maybe was concentrating in the kidneys. So there was a couple

papers came up and then we think that that's Why the animals may have died. We were using a mito like various forms that are like more mitochondrial specific. >> We're using more potent forms of of the CoQ10. So it may not be similar to the commercially available forms. What are the other supplements on that short list? You said four or five supplements. What are the other ones >> that I take? Yeah. So, creatine monohydrate would be kind of the staple thing that I've used since I was I don't Know a teenager first and foremost. Exogenous

ketones and the data is emerging on that. I think that's going to be the next creatine for that. But creatine for Alzheimer's disease, we didn't talk about it, but a dosage of 10 to even if you're larger, 20 grams. And that's not a misspeak there. 20 grams of creatine spread out, you know, maybe five grams three to four times a day for advanced Alzheimer's if you can tolerate it. Micronized form. >> I'm taking 20 grams today just because I didn't get very good sleep last night. I just find it to help with recovering from let's

call it sleep deprivation. But yeah, got to watch the split dosing. >> Yeah, vitamin D. But you have to measure that in your lab. So you want that to be you don't want it like over a 100red, right? So, you want vitamin D levels that are probably like 60 to 80 would be a good level of vitamin D and getting That checked. But I think you should check it first. It's weird. I live in Florida. I get tons of sun, but if I'm not supplementing vitamin D, I trend to be low 30s. It could be

trend, but so when I supplement it, I basically stay in the mid60s to 70s. Mhm. >> So, vitamin D and melatonin I think is a great neuroprotective antioxidant supplement to take at nighttime. And I don't take omega-3 supplements just Because I did Rhonda Patrick connected me with the omega-3 guy and I tried the omega quant and my DHA levels and EPA levels were off the charts. Out of curiosity, I got off of fish for like a month or so and it went down to normal ranges and then I tried Nordic Naturals, which it was a

company that reached out to me. I was like, "Okay, well, I'll remove omega-3s from my diet and then add it back in with a dose and it popped me back up to a level similar to if I'm Eating like tons of sardines per day." So, if you don't like sardines and you don't like eating a lot of fish, I think Nordic Naturals is probably like one of the go-to brands. >> Mhm. I'm not paid to say that or anything, but they're a legit. But you could do the omega quant test, and I think >> there's

so much data on EPA and DHA that I think ultimately the omega-3 levels will be part of standard blood work. There's so much data emerging on that that I think probably within the next 10 years, like when you get comprehensive metabolic panel, CBC, like that, you know, DHA and EPA will probably be added to that. >> All right, Dom. Well, we could go for many more hours, I am sure. But let's start to land the plan for this round. And I do want to ask, of course, if there's anything else that you'd like to mention

or point people to, anything You'd like to recommend, formal complaints you'd like to lodge, people you'd like to skewer in front of a large audience. No, I'm kidding. But anything that you would like to say or point people to any resources, anything that you're up to, where they can find you, anything at all? >> Yeah, I just want to, you know, mention Keto Nutrition. That's ourformational website, ketoonutrition.org. And we've hosted a conference where many People, you know, Dr. Walter Longo, Rhonda Patrick, who's been the keynote speakers, that's the metabolic health summit. That's been the conference

and that is run by metabolic health initiative. So I direct people to Metabolic Health Initiative and it's kind of run by three of us. My my colleagues Dr. Angela Poff and Victoria Field sort of run that show. I kind of tag on for the ride. But that's an ACCME accredited medical education platform. So everything that we're talking about here, we have speakers and we create a medical education platform so people can learn about metabolic psychiatry. people can learn about metabolic based therapies and metabolic drugs like GLP-1 drugs and and hormone optimization and things like that.

So I'd mention that the brand of ketones that I use that I often get asked is audacious nutrition keto starch. So that evolved out of our work with cancer neurodeeneration and Seizures. We're doing work at, you know, bird Alzheimer's center on probably 20 or more ketogenic compounds in development that are mostly alcohol free. So I think all of them are actually and we have some really interesting studies on Alzheimer's and a lot of other so hopefully in the next year be be able to share some of that pre-clinical animal model work. Hyperaric oxygen. So we

have a $28 million study. That's huge. Yeah. At the University of South Florida. I am just peripherilally involved in that. Just know the people running that and it's essentially evolved out of the DoD work that looked at the muddy waters of hyperbaric oxygen therapy for that. >> It's a good way to put it, the muddy waters. >> Yeah, I have been part of reviewing grants and also manuscripts and I think there's a lot of interesting studies that's going to emerge by the time this Airs. I think they will be on PubMed essentially showing that hyperbaric

oxygen therapy protocols, more mild hyperbaric oxygen 40 to 60 sessions in people that had traumatic brain injury a decade ago can enhance cognitive function, reaction time, and a wide variety of metrics associated with brain function. So I think this work coming out of Israel, I'd like to see it replicated. I would like to see the work that's different at the University of South Florida is that it's very innovative in that it's using a sham instead of using hyperbaric air as the control. They're using they basically pulse pressure in the beginning to make people think they're

being pressurized and at the end so their ears pop a little bit and I don't know every it's blinded. You know, people don't know even what they're getting. if you question them, they don't know if they're getting hyperbaric oxygen or But I do think that oxygen is a powerful drug and I'm excited about that research if you ask me. I'm excited if it proves it or disproves it. You know, I think we're going to get an unambiguous answer to this question about hyperaric oxygen for traumatic brain injury in people with and without post-traumatic stress syndrome.

>> Mhm. My thing is that if they put patients on ketone metabolic therapy, that would augment and enhance Hyperbaric oxygen therapy and decrease the potential for risk of an oxygen toxicity seizure, which goes up. Right? If you've had a traumatic brain injury, your risk of oxygen toxicity seizure would increase. >> Now, this is pretty specific to military or what are we talking about? They're all vets and if they do find out that they get a beneficial effect from that then after the the experiment they'll be able to get that for free service. So There's six

you know quarter to half a million dollar hyperbaric chambers. So the hard shell chambers there's six of them in this facility and it's a very it's the most elaborate hyperbaric oxygen therapy study that has ever been done. So and it'll answer the question about the efficacy. So that's ongoing now >> and I'm excited about that. I'm also excited about potentially using that facility >> because it's next to the Moffett Cancer Center for patients that are undergoing >> various cancer treatments that could be enhanced with hyperbaric oxygen therapy because it augments the immune system and it's

actually an FDA approved application for radiation necrosis. So if you've had radiation then your insurance would actually cover it but it can enhance certain therapies that we're working on now. So >> amazing. All right. Well, we will link To all of those things, >> okay, >> in the show notes as always, and I encourage people to check all of those out. I'm going to check all of them out. And Dom, thanks so much for the time as always. Took a ton of notes. >> I have even maybe even more questions on top of that for

more text messages. Sorry in advance. >> And so nice to see you again. >> Yeah, you too, Tim. Yeah, thank you for having me on. I appreciate it. >> Absolutely. And folks, show notes can be found at tim.blog/mpodcast. Just search Dom or Dominic and a lot of them will pop up. Just look for the most recent. And until next time, be a bit kinder than is necessary. It matters. It helps to others and to yourself. And as always, thanks for tuning in.