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Dr. Dominic D’Agostino Ketosis Workshop Write-Up
The Keto Workshop
These are my notes from Dr. Dominic D’Agostino’s presentation on the therapeutic use of Ketosis at a Bioceutical’s workshop in Melbourne on October 28th, 2019.
It offers a deep dive into Ketosis, its uses and practicalities and contains many pearls of wisdom. Any errors, misrepresentations here are of course, solely my fault. I’ve tried to keep my words to purely what was said by Dominic.
Ketogenesis Intro
Ketone bodies are derived from fat either from our diets or from burning fat from our fat stores. It takes around 24 hours of fasting to enter into nutritional ketosis (intermittent fasting may be healthful but not long enough for ketosis). Ketosis is possible through diet, supplemental Keto Esters or salts, or fasting.
Switching the body’s pathways fully from glucose to ketone bodies usually takes two to three months (keto adaptation). Then fat oxidation enzymes, ketogenesis etc. are up-regulated. When in ketosis, people usually have a better control of appetite, and ketones give more energy per unit of input than sugar (glucose).
Diabetic keto acidosis is a consequence of insulin deficiency and results from high glucose and high ketones. It is very very rare in people who don’t have Type I diabetes as they have lowered blood glucose.
There are two main ketone bodies: acetone, and Beta-HydroxyButyrate (BHB). BHB is the most abundant (78% of all ketones in the body), and is the one measured by blood tests using handheld meters and is also available as a supplement. However, both of these ketone bodies are important.
The keto diet is unique in that the diet’s effectiveness to alter blood chemistry (ketone bodies) is directly measurable at home.
The ketogenic diet may not be recommended if you have liver issues. NASA were concerned about possible kidney stones, but this should not be an issue if you stay hydrated with electrolytes, particularly magnesium, potassium, and sodium.
Glut1, Alzheimer’s, Migraines, Neuro-Inflammation
Keto diet may be recommended for Glut1 deficiency and may also help (prevention, treatment?) Alzheimer’s disease (as Alzheimer’s is talked about as Type 3 diabetes). A keto diet also converts the excitory neuro-transmitter Glutamate (which may be elevated in Alzheimer’s) to the calming neuro-transmitter, Gaba. This may be way the diet can also reduce anxiety.
Dominic’s wife observed mice were less anxious when handled when on the ketogenic diet and investigated this phenomenon. When the rats were observed in a maze, they showed more exploratory behaviour and less fear in open spaces, indicating a reduction in anxiety on a ketogenic diet.
The diet may also help with traumatic brain injuries, headaches and migraines. It also decreases neuro-inflammation through multiple mechanisms: increasing GABA, decreasing Glutamine, adenosine signalling, reducing gut inflammation, decreasing Reactive Oxygen Species, and epigenetic effects. BHBs are almost drug like in their action as a histone deacetylase inhibitor, effecting DNA expression. Note, histone deaccetalaeze inhibitors are used as cancer-treatment drugs.
Electrolytes
When insulin is lowered, we excrete more sodium and therefore water and so taking in enough electrolytes is important. BHB Keto salts that are bound to Magnesium are good (such as Bioceuticals brand) as they also give you extra Magnesium which you are body be deficient in on a keto diet.
MCTs(Medium Chain Triglycerides)
Gradualy increase dose of MCT in teaspoon increments. It should be possible to increase four of five fold. Dominic has been able to consume 150ml before digestive discomfort by gradually increasing the dose. He’s also been able to get a reading for blood ketones of 1.0 mmol/L from MCT oil alone with a higher Carb diet. MCT powder is often better tolerated than MCT oil.
Supplemental Ketones
Ketone bodies can be consumed as a supplement and they increase blood ketone levels measurably. Most of Dominic’s lab’s work has been using Ketone Esters but Ketone Salts (BHB) are also effective.
When supplemental BHB is combined with MCT powder, it slows gastric emptying so that ketones are released slowler.
Dominic has observed that supplementing Ketone bodies can cause blood ketone bodies to drop below baseline for a short while after two or three hours as ketone production is downregulated. However, when they are consumed with food, they lower inflammation, lower blood glucose – demonstrating increased fat burning.
Carnivore Diet
Some people eat high fat cuts of meat to create a Keto Carnivore diet, and some demonstrate impressive blood work including cardio-metabolic markers, and claim auto immunity and gut issues have been cured. This may be due to avoiding anti-nutrients in vegetables such as oxalates. However, Dominic talked about hormesis – how these anti-nutrients can make us ‘stronger’. He commented the diet is unnecessarily restrictive.
Carb Cycling
Carb cycling is good in theory (unless you are using the diet to treat epilepsy in which case you always want ketosis). It may only take 24 hours of increased carbs to increase T3 hormones which may have been suppressed. Dominic prefers to increase Carbs for one meal only, rather than for whole refeeding days. He would cap Carbs on those days to 100-150g. Also, remember that if you are in Ketosis, your glucose transporters may be downregulated and you may be less able to deal with the carbs – so don’t overdo it!
Other Supplements
- Taurine (2-3g) day may enhance liver production of ketones
- Alpha lipoic acid may help glucose disposal
- Leucine is a purely ketogenic amino acid
- Carnitine supplementation can be good for fat utilisation
- Magnesium, sodium and potassium as electrolytes
LDL Cholesterol
LDL cholesterol in the first weeks of beginning a Ketogenic diet. LDL can be lowered by decreasing the amount of dairy fat in the diet, replacing some saturated fats with mono-unsaturated fats. Link between LDL as a single marker and heart disease risk is questioned.
Cancer
Dominic’s second presentation was on cancer prevention and treatment which I will include in a seperate post.
Stephen Ward is a qualified Nutritionist and Functional Medicine practitioner.
References
- Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention https://www.ncbi.nlm.nih.gov/pubmed/30974836
- Ketone Administration for Seizure Disorders: History and Rationale for Ketone Esters and Metabolic Alternatives https://www.frontiersin.org/articles/10.3389/fnins.2019.01041/full?sfns=mo
- The glucose ketone index calculator: A simple tool to monitor therapeutic efficacy for metabolic management of brain cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367849/
- ketonutrition.org
Grass-Fed Beef in Australia
If you Google “grass-fed beef”, you will find a bunch of essentially scare articles from the U.S. from wellness and paleo sites. So if you are eating red meat, what are the differences between grass-fed beef and organic beef and how does this apply to Australia, and where is the best place to buy it?
What is Grass-Fed Beef?
Grass-fed cattle must never have been fed grains their whole life. This has a variety of benefits on the nutrient profile of the meat they produce…
In a review of the research from the U.S., grass-fed beef has been found to contain 300 percent more Omega 3s than factory-farmed beef and contains less Omega-6s. Omega-3s and Omega-6s are two essential fatty acids in human nutrition. A healthy diet should consist of roughly 1:1 ratio of the two fatty acids, as we did in Paleolithic times, but the standard Western diet includes up to 30 times as many omega-6s than omega-3s. Omega-3s are anti-inflammatory, good for the gut, and are linked to heart, joint, and brain health.
However, remember to put that amount of Omega-3s in perspective… Grass-fed beef contains around 90 milligrams (0.09 grams) of Omega-3s per 100 grams, whereas salmon contains approximately 1.6-2.7g per 100g.
Grass-fed beef also contains less fat in total, may contain less cholesterol-raising fats, and more antioxidants. grass-fed meat also contains more essential nutrients such as iron, zinc, vitamin E, vitamin B12, and carotenoids. However, we need to remember the studies that show this are from the U.S. where the system of raising cattle is different.
Beef in Australia
Australian beef is highly regarded throughout the world, with high standards for the health and welfare of the cattle. In Australia, cattle spend around 85-90% of their time in pastures. No cattle in Australia spend their whole time in feedlots.
Cattle in Australia are also fed mainly on wheat, barley, and sorghum rather than corn (which can be GMO). Non-grass fed beef is therefore likely to be of a higher standard and have a better nutrient profile than beef from the U.S.
Grass-Fed Beef in Australia
In Australia, cattle can be certified grass-fed (never eaten grains), by the Pasturefed Cattle Assurance System (PCAS). If you want to be sure of grass-fed beef, that has never been fed grains, this is one to look out for.
PCAS certification also allows cattle to be certified as growth hormone and antibiotic-free.
Coles, somewhat controversially, introduced their own standard with their grass-fed range called Graze. They say their standard is based on PCAS and contains all the same requirements e.g. regarding not being fed grains, access to pasture, feed-lotting, traceability, and dietary supplementation.
Like PCAS, their beef can also be certified antibiotic and hormone-free, but it is not guaranteed. Their standards are upheld through the use of independent auditors.
Cleaver’s also produce a range which is organic and grass-fed and certified by their own Cleaver’s Certified Organic Grass Fed Assurance (CCOGA) scheme. It’s available in both Coles and Woolworths. Their standard also enforces grass-fed feeding and finishing but unlike Graze, all their meat is organic, growth hormone and antibiotic-free.
Woolworths stock grass-fed beef in their Grasslands range. This beef is accredited by Teys (Australia’s second-largest beef producer) to their own standard.
This standard is potentially less reliable than the PCAS and Coles grass-fed standards in that it requires only an initial self-assessment, and then twice yearly random samples of producers. Under the PCAS scheme, producers are required to undergo an initial on-farm audit and then yearly self-funded audits.
Like the other standards, Woolworth’s standard also dictates cattle must never have been fed grain. Unlike Coles’s Graze range, the cattle must always be antibiotic and growth hormone-free.
Aldi grass-fed beef may not be truly grass-fed at all and maybe supplemented with grain if pastures are poor. As reported in the media, this makes it essentially the same as standard beef in Australia, despite the premium price.
Organic Beef
Organic beef is the best choice when it comes to ethical standards and supplementation. Certified organic meat is free from growth hormones and antibiotics, synthetic pesticides and herbicides and is free-range. Organic beef doesn’t use antibiotics to promote livestock growth.
However, unless organic beef is certified as grass-fed, it may not provide the same nutritional benefits.
In Australia, anyone can claim their meat is organic, so look out for the certified organic logos, such as the Australian Certified Organic logo.
What about the environment?
Reports of the green-house gas production of livestock fail to differentiate the impact of grass-fed animals. A study by the National Trust in the UK found that grass-fed beef production actually reduced greenhouse gas emissions when the locking up of carbon by grassland pasture was considered. Of course, this is specific to the UK, rather Australia, and we need more Australian research in this area.
Summary
If your budget allows, organic beef that is grass-fed may be the best choice… But if you’re on more of a budget, then buying organic beef over grass-fed may not be a priority, but buying grass-fed may have some nutritional and environmental benefits. We are lucky that all beef in Australia is high quality and mostly grass-fed.
The supermarkets’ standards for grass-fed beef are similar, although they aren’t all antibiotic and growth hormone-free as standard (check the label!). Although the PCAS standard is more reliable, it probably doesn’t matter which of the supermarkets you buy your grass-fed beef from (apart from Aldi, where it’s not guaranteed to have not been fed grains). Just lookout for the best looking meat and deals!
Buying meat from a local butcher or market is also always a good option as you can ask about the conditions the cattle were raised in..
Eight little known super foods to heal your gut
When you think of gut health, and supporting the trillions of bacteria that live down there, you may immediately think of fibre, probiotics, and fermented foods. And yes, these are some of the best ways to support our gut bacteria.
But if you are suffering from bloating, gut discomfort, diarrhea, constipation or other gut symptoms, you will also want to address the fire in your gut, that is inflammation. These super foods can help:
Cruciferous vegetables: Such as cauliflower, cabbage, garden cress, watercress, bok choy, broccoli, kale, turnip, radishes, brussels sprouts, and similar green leafy vegetables. The polyphenols in these vegetables act as messages to your body that can move the needle away from inflammation and disease and toward health and vitality. But remember, these may not be a good idea if you have reactions to high FODMAP foods.
Curcumin (Turmeric): Curcumin is the supplement extracted from the spice Tumeric. Curcumin is a powerful compound that scavenges free radicals and prevents damage to the intestinal tract. Add turmeric to meat marinades, homemade stews, sauces and even your coffee and smoothies for added free radical protection. Try this yummy turmeric latte.
Carotenoids: from carrots, yams, sweet potatoes, papaya, watermelon, cantaloupe, mangos, spinach, kale, tomatoes, bell peppers and oranges
Stewed Apples: Stewed apples make the immune system in our gut smarter. Find out more here
Oily Fish: Such as salmon, mackerel, herring, anchovies or from walnuts, chia seeds, flax seeds provide the anti-inflammatory omega-3s which reduce gut inflammation.
Dark coloured vegetables and fruits: such as cherries, berries, red pepper, beetroot, red onions, red cabbage contain a higher concentration of polyphenols
Ginger: Ginger eases as gastrointestinal upset, stimulating saliva and bile production. It reduces intestinal inflammation and nausea. It is also a powerful anti-microbial which may benefit you if you have an unhealthy balance of bacteria in your gut
Garlic: When garlic is crushed it releases allicin, the phytonutrient thought to be responsible for garlic’s anti-microbial, anti-viral and anti-fungal properties.
Cooking stops the enzyme forming though, so if you crush your garlic and immediately throw it in a hot pan, you’ll receive little allicin. Instead, leave the chopped garlic for 10 minutes before cooking to allow the allicin to form, and then you should still receive the benefits.
Remember though, to fix a gut discomfort such as IBS, you will benefit from finding the root causes of your problems and also follow a plan to heal your gut.
What does the science tell us about gluten and leaky gut?
Catchy headlines poke fun at the gluten-free ‘fad’, and many GPs still do not believe non-celiac gluten sensitivity could be affecting their patients. But many people are finding that they feel better when they avoid gluten. So what does the research tell us?
In case you didn’t know, gluten is a family of proteins found in most cereals including wheat, rye, spelt, and barley. It gives dough a glue like consistency which holds it together. Gluten is not only found in obvious foods such as bread, pasta, and beer but also soy sauce, sweats, chips, hot dogs and battered fish!
Celiac Disease
In people with celiac disease, gliadin is a powerful trigger of zonulin release. Zonulin increases intestinal permeability by opening the tight junctions in the epithelial lining, and in people with celiac disease, an auto-immune response follows. This is a serious condition, and full-blown celiac disease is associated with complete atrophy of the villi which line the small intestine and absorb your nutrients. If you suspect celiac disease, particularly if you have a family history of celiac disease, please speak to your GP about testing.
Non-Celiac Gluten Sensitivity
Whilst increased intestinal permeability in response to dietary gluten is most severe in those with celiac disease, zonulin, a marker for intestinal permeability, is also increased in people with what is called non-celiac gluten sensitivity (NCGS) and also irritable bowel syndrome with diarrhea.
NCGS is a term applied to people who experience symptoms in response to consumed to gluten consumption but do not have celiac disease. They may feel gastro-intestinal discomfort, fatigue or neurological symptoms. These people tend to improve on a gluten-free diet. Unfortunately, these people can be mocked for avoiding wheat and told that it’s all in their head.
But researchers have found that people with NCGS have increased intestinal permeability compared to healthy subjects. This should not be surprising as we know gliadin increases the release of zonulin, which can affect tight junctions. The opening of these tight junctions, our gateways. allows macromolecules to come into contact with our immune system and our bloodstream and explains why the group with NCGS also had a systemic immune activation on eating gluten.
Gluten increases Intestinal Permeability in All Human Tissue
In a 2015 study, researchers found tissue taken from the duodenum of humans became permeable, and there was increased inflammation when exposed to gliadin (i.e. leaky gut). As this study is in tissue taken from people rather than directly in people themselves, we have to be careful extrapolating the results. However, this backs up the experiences of many people .. they feel better when they don’t consume gluten.
In people with gluten sensitivity and NCGS, the damage did not clear after 36 hours, and what is most surprising, is that after five hours the tissue taken from ‘healthy’ people without celiac of NCGS, still had increased permeability.
Now, the epithelial lining of the small intestine is made up of the fastest growing cells in the body, creating a new lining every 3 to 7 days, and the gut lining would heal itself after exposure to gluten. But, if you have toast for breakfast, a sandwich for lunch, and pasta for dinner, it is never getting a chance to heal. Remember, I’m talking about people who aren’t celiac or don’t have NCGS here. If you consume gluten for breakfast, lunch, and dinner, your gut lining never has a chance to repair and you leaky gut will develop.
Researchers refer to this as the loss of oral tolerance. Now, your body can not deal with the toxins you are exposed to, and it may also start reacting to foods you didn’t react to both, as your immune system fights to defend itself. You have pathogenic intestinal permeability or a leaky gut and this can lead to inflammation in the body and autoimmunity.
Although lab tests do exist to look at your sensitivity to gluten, it’s widely accepted that an elimination diet is the best way to test for gluten intolerance. If you have a chronic health condition, it may be a good idea to remove gluten from your diet and see if that is of benefit. If you want to go further with the elimination diet, a Low FODMAP diet may be the next logical step to improve gut health.