Summary
Dr. Dominic D'Agostino joins Shawn Baker to discuss how ketogenic diets and exogenous ketones may benefit cancer treatment and traumatic brain injury. They cover the role of systemic inflammation and the blood-brain barrier, how ketones alter tumor metabolism, and the clinical research behind using nutritional ketosis as a therapeutic tool.
Key Points
- Ketogenic diets exploit the metabolic inflexibility of cancer cells, which rely heavily on glucose and cannot efficiently use ketones for energy.
- Exogenous ketones (beta-hydroxybutyrate salts or esters) can raise blood ketone levels without strict dietary carb restriction, offering a more accessible therapeutic option.
- Nutritional ketosis reduces systemic inflammation by lowering blood glucose and insulin, both of which fuel tumor growth pathways.
- For traumatic brain injury, ketones provide an alternative fuel source when glucose metabolism in the brain is impaired post-injury.
- Therapeutic ketone levels for cancer and brain injury protocols are typically 1.5-3.0 mmol/L, higher than what most casual keto dieters achieve.
- Combining ketogenic diets with standard cancer treatments (chemo, radiation) may enhance efficacy by starving cancer cells of glucose while protecting healthy tissue.
Key Moments
Therapeutic ketosis allows survival in extreme environments
Dom D'Agostino describes how animals in therapeutic ketosis can survive extreme environmental conditions that would otherwise kill them, a finding that drove his excitement for ketone research.
"When we put animals inside an environmental chambers, you know, and push them to with a protocol that would typically kill them, if they're in, if they're in therapeutic ketosis, they can survive extreme environments that would otherwise kill the animal."
Optimal ketone levels for health versus disease management
D'Agostino recommends mildly elevated ketones of 0.5 to 1.5 mmol/L for general health, with higher levels of 2 to 4 mmol/L for managing conditions like epilepsy or cancer.
"I think, I think the sweet spot for me is just getting ketones mildly elevated 0.5 to 1.5 in that range, you know, for the average person, you know, if you're, if you're using this to manage a metabolic condition or epilepsy or cancer or something like that, maybe two to three, or four would be better ketone levels."
Combining keto with intermittent fasting for metabolic switching
D'Agostino explains that combining a ketogenic diet with time-restricted feeding is synergistic for fat oxidation, especially as metabolic flexibility declines with aging.
"So if someone's doing a ketogenic diet, and they simultaneously, you know, do do intermittent fasting or time restricted feeding those two things are pretty synergistic and as we age, that may be a way to further augment our fat oxidation."
Ketogenic diet with exogenous ketones for traumatic brain injury
For penetrating traumatic brain injuries, about 80% of patients develop seizures, making the ketogenic diet supplemented with MCT or exogenous ketones near standard of care.
"If you have a penetrating traumatic brain injury about 80% of those guys have seizures. So in that context, the ketogenic diet is not only useful is almost a standard to care, it can be because some of those users are also drug resistant."