Yeah, sodium-potassium pump.

Yeah, sodium-potassium pump.

So that needs to-- That maintains the membrane potential, and that sucks up a lot of ATP.

And if that membrane potential reduces, becomes depolarized, that activates neurons.

They become excitable, and that can trigger a seizure.

So if you get dehydrated, uh, a, a cell that is not-- A c- a cell that's dehydrated is less energetic, and it basically can trigger a seizure.

So if you are, you know, i- if y- you have any lack-- The-- your brain is extremely sensitive to the energetic state, and, uh, and ketones can preserve brain energy metabolism in the context of low glucose, glucose hypometabolism.

Mm-hmm.

Mm-hmm.

So we use the term ketone metabolic therapy or ketogenic metabolic therapy to describe, uh, a ketogenic diet and different versions of that, but also exogenous ketone supplementation, which there are many forms of that in the form of exogenous electrolyte salts, ketone salts, uh, ketone esters, the diols, 1,3-butanediol is a precursor.

MCT is considered, uh, a ketogenic, uh, supplement and, you know, we've kind of, um, I mean on paper we have like 30 different compounds, right? That are very ketogenic that kind of will be bioactive in some way when they're orally consumed.

So that's a pretty big category that's emerging in sort of the innovative aspect of a ketone, and these things are not mutually exclusive.

So you have ketogenic diets, and then you have ketone supplementation and things like intermittent fasting which can produce ketosis.

So these things can be used situationally, you know, in combination or as a standalone kind of therapy, right?

Mm-hmm.

So that was very apparent in cell-based systems and also like brain slices and tissue slices and things like that.

Now, again, as your role as an educator and your just extensive research with ketone supplements, what are you teaching your medical students about the potential role for ketone supplements in health in general or in specific disease conditions?

Yeah, well, I would say I loosely add that to some of the talks that I give because ketone supplementation, there are over 100 clinical trials now and a number, a few randomized controlled trials on cardiovascular health, on brain health and things like that.

But the science is still ongoing.

But we do have a lot of science on ketogenic metabolic therapies or the ketogenic diet.

I think there's at least five randomized controlled trials on this therapy.

So for nutrition, which we do have a mandatory nutrition course at USF College of Medicine, we do everything from dietary guidelines, which is I don't teach that, but we have talks on GLP-1s.

and also nutritional protocols with GLP-1s.

And what are some of the things you really want to explore in that channel to help educate people about?

Can you talk about Ben's study a little bit and its findings, and how it relates to the study we just discussed?

Yeah.

Uh, Ben reached out to me when he started the study, and he had some questions about dosing.

And he actually used, uh, lower doses than I used in my study, and he, he only did it over a week's time.

And what was really interesting about Ben's study is that it validated the work that we did [sighs] in our lab in an independent lab, and he used mice, and we used rats.

Essentially, what he found is that a one-week administration, which is not chronic, it'd be like subchronic for sure, he saw some very significant findings in regard to the, uh, looking specifically at the liver cells.

And he showed very convincingly that administration of one, three-butanediol, unlike just giving beta-hydroxybutyrate in the pure form, the D enantiomer and the L enantiomer.

It's all about carb, carb loading and, and maintaining carbs, right? So can you please discuss this paper and its findings and implications?

uh pay the extra 20 bucks and stay at the uh elite holiday inn yes

that uh that clean and jerk event at copasura i think was like probably the defining moment for the weekend for her because and i always kind of try to look for those as a coach like i kind of sit there and i wait like all right what's the moment where like we can try to really like make the push if we're in the race for it um And the reason I had talked to her about not looking at the leaderboard for the rest of the weekend, like I would kind of do that and let her know, like, OK, this is the girl you got to race.

Like, we're still going to do that.

So we're not just going in blind.

But instead of her looking at it and panicking out of placing was because I want to say she PR that clean and jerk ladder by about 38 seconds from training.

So that was like massive.

And she did it because she took a bigger risk on the 190, the last bar by just like immediately switching to a squat clean and not taking any rest.

Do you, do you have any thoughts on that? Like with, with kids and people who are training these people who are going through this huge, you know, hormonal life

This is an area quite interestingly where a ketogenic diet can help with cancer and Um, not to say that it is a treatment for cancer, but if you want to lead with the story of Dr. Fred Hatfield, who used a ketogenic diet in his own story, what happened with him?

Yeah, Fred was maybe one of the first, I just started getting interested in ketogenic diets and not formally doing research, but Fred was a dear friend and mentor of mine.

And I think, uh, around, we connected face-to-face personally around 2008, I believe.

And, uh, He was diagnosed with advanced metastatic prostate cancer that had spread to the hips and had metastatic bone cancer.

And he was undergoing different treatments that weren't really working at all.

And I had just like this, you know, I was studying ketogenic therapies for a military application, which is central nervous system oxygen toxicity, which is like something Navy SEALs get if they use a closed circuit rebreather.

But in the process of researching that, I had various cells and some of the cells were cancer cells.

Why is that?

Yeah, and the OGT for folks is just that oral glucose tolerance test where you drink a bunch of dextrose water and then they take your blood every 30 minutes for two hours to see how you're responding to it.

The biggest metabolic lever would be you have enhanced insulin sensitivity, and I think that has been the focus.

For example, Ben Bickman wrote a book on this and so, you know, doing hundreds of podcasts on insulin resistance, reversing insulin resistance, and low carb ketogenic, you know, being effective for that.

So that, first and foremost, your insulin sensitivity is very high, your fat oxidation is really high, and your glucose disposal is high.

And if you're in a caloric deficit, your ketone uptake is very high.

We see this quite convincingly, you know, in older rats where we, like, gavage, where we, like, tube feed the rats, and they're older, the ketones get to toxic levels, whereas, like, a younger, metabolically fit rodent will dispose of it very quickly.

Same with a couch potato human, same with an elite level athlete.

Is there a way to, whether it's on paper or otherwise, account for the increased ketone utilization? I mean, it'd be great for me just to verify that somehow, but then whether I can verify it or not, if I wanted to try to determine during that week, like, if I'm hitting my target GKI, how would you suggest that someone like me do that if I'm just not getting the numbers necessary to make the regular math work?

So if mistake number one is you're not measuring your actual ketone levels and you're not tracking what you're eating so you can see the association of, "Hey, when I ate this, it went down, when I ate this, it went up," what are some other mistakes people make with their diet formulation? Is that they typically err on the side of too much protein, not enough protein? Are they not realizing where carbs are sneaking into their diet? And what kinda guidance do you give people? How many grams of carbs a day do you tell somebody, or do you vary that based on their activity level?

Yeah.

Taking a step back, so I view, unlike many people out there, I view a ketogenic diet as a prescription metabolic therapy.

So that's the world that I come from.

There's clinical keto and then there's internet keto.

And which a lot of people are following a low-carb diet, which has a plethora of metabolic benefits, just have to be up on your blood work and you have to be very vigilant with tracking your biomarkers.

But a clinical ketogenic diet is typically done with consulting or advice or even following the framework, for example, a lot of books out there by Eric Kossoff.

So patient selection is gonna matter.