Dom D'Agostino on Fasting, Ketosis, and the End of Cancer (#117)


“The FDA may see ketones as a drug. I see them as a fourth macronutrient. You have fats, proteins, and carbs. Ketones are an energy-containing molecule.” – Dom D’Agostino

Dr. Dominic “Dom” D’Agostino (@DominicDAgosti2) is an Assistant Professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida Morsani College of Medicine, and a Senior Research Scientist at the Institute for Human and Machine Cognition (IHMC).

He has also deadlifted 500 pounds for 10 reps after a seven-day fast.

He’s a beast and — no big surprise — he’s a good buddy of Dr. Peter Attia, my MD friend who drinks “jet fuel” in search of optimal athletic performance.

The primary focus of Dom’s laboratory is developing and testing metabolic therapies, including ketogenic diets, ketone esters and ketone supplements to induce nutritional/therapeutic ketosis. D’Agostino’s laboratory uses in vivo and in vitro techniques to understand the physiological, cellular and molecular mechanism of metabolic therapies and nutritional strategies for peak performance and resilience. His research is supported by the Office of Naval Research (ONR), Department of Defense (DoD), private organizations and foundations.

You can find the transcript of this episode here. Transcripts of all episodes can be found here.

#117: Dom D'Agostino on Fasting, Ketosis, and The End of Cancer

Want to hear another podcast discussing ketosis from a world class scientist? — Listen to my conversation with Dr. Peter Attia. In this episode, we discuss life-extension, drinking jet fuel, ultra-endurance, human foie gras, and more (stream below or right-click here to download):

Ep 50: Dr. Peter Attia on Ultra-Endurance, Drinking Jet Fuel, Human Foie Gras, and More

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QUESTION(S) OF THE DAY: What questions do you have about ketogenic diets that we didn’t discuss in this podcast? Please let me know in the comments.

Scroll below for links and show notes…

Selected Links from the Episode

Connect with Dom D’Agostino:

Facebook | TwitterUniversity of South Florida

Show Notes

  • How Dom D’Agostino responds when someone asks him, “what do you do?” [5:28]
  • Describing the Institutional Review Board (IRB) [9:53]
  • Research on advanced lifters in a state of ketosis [12:13]
  • Thoughts on getting big (hypertrophy) and strong while in a state of ketosis [15:53]
  • Defining ketones and ketosis [20:48]
  • The implications of fasting, nutritional ketosis and/or exogenous ketones for preventing/mitigating the onset of neurodegenerative diseases [28:23]
  • Defining cachexia, sarcopenia, anabolism, and catabolism [30:48]
  • Thoughts on the use of anabolic agents in cancer patients [34:48]
  • The advantage of SARMS instead of pre-existing low androgenic anabolic therapies [38:53]
  • To what extent is it possible to mimic the benefits of pre-chemo therapy fasting with exogenous ketones? [43:23]
  • How to accelerate the induction of ketone projection through use of exogenous ketones[49:18]
  • Ketone esters [56:13]
  • The benefits of eating exogenous ketones while in a carbohydrate attractive environment (for example, when traveling in Italy) [1:16:08]
  • What a traveling ketogenic breakfast looks like [1:20:43]
  • Reasons for using glutamine [1:25:08]
  • Thoughts on being considered a “nutritionist” [1:32:18]
  • The impact of Metformin on the survival rates of animals that have metastatic cancer [1:41:38]
  • If Dom D’Agostino learned that he had advanced cancer, what tools would he use to fight it? [1:46:18]
  • Thoughts on therapeutic fasting [2:03:03]
  • Observations of people who experiment with fasting [2:08:23]
  • Describing the risks and toxicities of consuming a cocktail of exogenous ketones [2:14:33]
  • Unusual foods or beverages that spike ketone levels [2:22:45]
  • Top resources for those seeking to learn about a ketogenic diet [2:41:33]
  • Most gifted books [2:43:13]
  • How to approach fighting Lyme Disease with the ketogenic diet [2:50:18]
  • The effect of ketosis on mitochondria [2:53:18]
  • Healing from use of antibiotics [2:55:53]

People Mentioned

The Tim Ferriss Show is one of the most popular podcasts in the world with more than 900 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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399 Replies to “Dom D'Agostino on Fasting, Ketosis, and the End of Cancer (#117)”

  1. Is there a way to reconcile the ketogenic diet and the use of the 4HBody cheat day? Clearly, a cheat day knocks one out of ketosis and it takes a few days to reenter. I think the inclusion of cheat days increases the possibility of long-term success , but wonder how it lines up with ketogenic thinking.

    1. If you look at the Cyclically Ketogenic Diet, that will give you a good understanding of how/why the ‘cheat’ day can be useful if you are on a keto diet and you are lifting heavy. There are a lot of technical reasons why it helps, so I’ll probably butcher the explanation without going back to the research, but it partially has to do with replenishing muscle glycogen stores, spiking insulin which is anabolic, and up-regulating/normalizing the metabolism via the T3 thyroid hormone.

      It’s important to note that the 4HB diet is the slow carb diet, which is not a Ketogenic Diet (still a great diet IMHO). There are a lot of places to get info/diet plans for strict keto diets – I like the diet plans/recipes on the site.

      In my experience, when I am on a strict keto diet – turning the ketostix purple, and do a huge carb up day, all the glucose/glycogen fills up the muscles and liver, and I’m back in ketosis the next day or the day after – so it’s definitely possible to have a ‘cheat’ day and quickly return to ketosis.

      I think it really comes down to objectives and commitment level. If you are on a Ketogenic diet and in ketosis, you can have periodic cheat days and get back into ketosis pretty quickly. If it’s taking you longer than you would like, maybe do intermittent fasting the days after the cheat day. If you are on the slow carb diet, chances are you will not be in ketosis. Get some ketostix and play around with it.

      For me personally, the longer I’m eating a clean, Ketogenic diet, the less I want to get really sloppy on a cheat day – it makes me feel awful.

  2. Tim, great podcast. I love Dom’s demeanor. He’s such an intelligent guy without an air of arrogance. Now how does he feel about strength training or HIIT during these long fasts of 5-14 days? Avoid these workouts entirely or can you do them with some post workout supplementation without breaking the fast? I’m looking at implementing these fasts quarterly like Dom suggested but I wasn’t sure if I should back off training during these periods. I lift 2x per week and do HIIT 2x per week (all workouts on their own dedicated day).

  3. with all the talk about fasting would you recommend doing a fast during the geek to freak workout routine? If so at what time and for how long?

    I am considering doing an additional week of the program along with a 5-7 day fast to push into a ultra fat burning start.

  4. Very interesting podcast. Way over my head, but there’s a lot of great stuff in here. Question: I currently follow Slow Carb more or less, with a cheat day on Saturdays. If I tried a Ketogenic diet, would I abandon the cheat day or keep it. If I kept it, how & when would I incorporate it into the week? When would it be best scheduled around intermittent fasting?

  5. Tim-LOVE this episode, love all your episodes but really ate this one up (yes, bad pun intended…)!

    Re: Lyme disease: have you ensured through testing you don’t also have any of the commonly co-occurring diseases? I’m sure you know that most testing stinks. IGeneX is the only lab to use for higher sensitivity testing. (I have no affiliation). Your reference to the neuro systems made me wonder about Bartonella.

    Current theory between me and one of my talented practitioners is that ketosis starves the little bugs and that this is a direct positive healing impact where no other treatment has been fully effective. I wanted to add that in to the additional functions discussed at end of episode in this area. Also, note that we are looking at a ketogenic diet in which protein stays a bit lower than typical in order to avoid the bugs aggressively converting protein over into a glucose form to feed them.

    Also look at Dr. Alan MacDonald’s work connecting Lyme and Alzheimer’s. A pathologist, he has found Lyme spirochetes in 7 out of 10 post mortem Alzheimer brains. That’s crazy, right?? Scary stuff. In an interview I heard him reference Alzheimer’s as a possibly a sort of late stage chronic Lyme form, in part. Zoinks…

    Keep these helpful and informative podcasts coming, thank you so much!

    Also, love 5 Bullet Friday!

  6. What a fascinating episode. I just finished listening to it all in one sitting, literally,as I am a State Trooper and was doing an escort detail listening to the podcast. I am psyched to try a fast, with some exogenous ketones to kick start the effects, before switching into a ketogenic diet. It was great to listen to Dom’s wealth of knowledge. I would be very interested in knowing what his and your input would be as to best start on such a path. A follow-up edisode with Dom would be awesome. Keep up the great work.

  7. Hi Tim,

    Another great one. Thank you for speaking with Dominic about the ketogenic diet. I know you have been playing with this for a while and it’s great to see two podcasts on the subject to expose us to the new information.

  8. De Novo also has sucralose and artificial dyes and flavorings. Those are not microbial friendly. What would be the benefit of takin it? Is it worth the risk?

  9. Tim, this is one of the best episodes so far! I am going to listen to it two or three times as there a many gems. I have to say, I found some of the potential options in relation to cancer treatment and even prevention to be jaw dropping. And am definitely going to do some N=1 experiments with a Ketogenic diet and some further reading. A follow-up episode would be great!

  10. Question: I currently follow Slow Carb more or less, with a cheat day on Saturdays. If I tried a Ketogenic diet, would I abandon the cheat day or keep it? If I kept it, how & when would I incorporate it into the week? When would it be best scheduled around intermittent fasting?

  11. Hi Tim, I am just finishing this episode and I think this one has a potential to change peoples lives in a massive way. I would pay to get it translated into czech and/or Slovak language if there was a transcript. Is there? I know this one is long, but hey, this is worth it.

  12. Round 2 with Dom D’Agostino? YES PLEASE! It took me 3 days to get through Round 1 but I want more. Dom is funny, smart and excited about his fascinating work. Thanks to both Dom and Tim for investing the time and sharing the fruits with me.

  13. Great episode!! I love them all but am an MD and very interested in this one in particular. I would like to know if the leto diet can help or cure RA??

  14. Hi Tim

    Thanks very much for these posts and podcasts on Ketosis – the people you’ve brought on and the stuff you’ve said got me down the rabbit hole, and purchased myself a blood glucose/ketone monitor

    My goal’s to shed a little excess BF – I’m quite lean and athletic but could do with losing a few pounds. Ketosis interwebs information says to stay within 1.5mmol/l – 3mmol/l but, strangely, I’ve found that hasn’t really accelerated fat loss. Instead, I’ve found that around 0.5 mmol/l-1.5 mmol/l in the morning first thing has produced the greatest results in terms of thinking clarity and weight loss. Would you know why that might be? No keto interwebs pages I’ve seen can explain it so was interested in your take on it

    Also what do you think’s a good range for blood glucose readings for fat loss? Again, the interwebs says, on average, that anything between 85-110 is a good range, but I’d be interested to hear what range worked best for you? Is lower better?

    Just wanted to add a big thank you for all the other stuff you do too, I’m a big fan and look out for your stuff because I know it’s going to be well researched and proper – thanks Tim!



  15. Awesome episode.

    Curious to hear thoughts on ethanol consumption – AKA and how this is a different animal than nutritional ketosis. Ultimately, beta-hydroxybuturate accumulates however, the redox shifts and associated vomiting may garner a worse milieu than nutritional ketosis perhaps? Interestingly, ethanol is metabolized to acetic acid and was touted to increase insulin sensitivity by Charles Polaquin on a previous episode. Which further peaks my interest as to where ethanol fits into all of this.

    The movie was Gymkata by the way, not GymCaNa. One of my favorite horrible movies to watch on WPIX in the 80’s.

  16. Loved this podcast! I hope you do a second part that goes into workouts and a modified keto diet plan for hypertropy. Thanks!

  17. It is sickening that his go to resource for keto diet info is the website of a woman making outrageous claims about the diet, with distance learning degree in “human nutrition” from an unaccredited diploma mill chiropractic college. It’s not like he doesn’t know who is behind that wealth of unsubstantiated medical claims as he sat on a panel with her at AHS 2014. [FWIW, Chef Rachel Albert, the woman on that panel with cancer, has sadly since passed away. I mention this because she talks about how her cancer got away from her and spread because she initially treated it with alternative — read: UNPROVEN — therapies, and it was likely too late by the time she tried anything conventional.]

    Keto for cancer sounds good until you look past the irresponsible hype. Its track record is nothing short of impressively underwhelming in any of the handful of actual studies on humans with cancer. Keto for epilepsy and rare neuro disorders, check. Exogenous ketones for people eating high refined fat diets in desperate need of quick empty calories, check … but why? Keto for cancer? Not so much. Not yet anyway.

    PS Apologies if this edited/expanded comment is a repeat. WP doesn’t like my WP account so I used Twitter.

    1. Thank you for being the voice of reason here. It’s like the keto telephone game, everyone hears the part they agree with, few are willing to do some research and find quite the opposite information.

  18. phenomenal episode, Tim!

    Curious how you handle alcohol when you are deep into ketosis. I find it makes me a light weight! I get really drunk really quick, could be dangerous if I don’t take care. Do you experience this too?

  19. LOVED this podcast. Thanks Tim & Dom

    One question I’m not sure you got to the bottom of, which I was thinking throughout the interview, was this: “what is the effect if someone takes dietary ketones but does not follow a strict ketogenic diet? ie – if you are in Italy and have a week on the pasta, is taking dietary ketones helpful or unhelpful?

    That’s an extreme example but I imagine that a lot of people might not be disciplined enough to stay in ketosis all the time, so it would be good to know if taking a supplement can help keep us there and if there’s any downside to taking it, if we fall off the carb wagon!

    Thanks a lot,


    1. I’m interested in this same thing. I can’t seem to find it again but I’m listening to the podcast again.

      I’m at 2:24 and he’s talking about artichokes and foods to raise ketones.

      1. I tried it too with awful results, but I just had a thought…do you think he meant to say cream cheese??

  20. I love, love this podcast! I have been following you for over a year now and just can’t get enough!

    I have a question about IF on the keto diet. While fasting can you still have fat i.e. Butter cream, mct oil?

    And should you take BCAA’s during your fast to prevent muscle loss?

  21. I have listened to this podcast three times now and it’s starting to sink in. I thoroughly enjoyed this episode and am excited to learn more and do my best to get friends and family to consider updating their eating habits. The bacon grease comment will probably help.

    In the podcast, Dom was trying an experiment and I think xTend(?) was mentioned but without the glutamine, to err on the side of caution, regarding slowing cancer growth. Is that formulation available to the public or is there an alternative? Maybe I’m getting mixed up -there’s so much info in the podcast it’s hard to keep up…

    Sincere thanks Tim- I’ve been following since reading 4hww, Vagabonding and immediately selling all my stuff for my first of many mini retirements. THANK YOU SIR.

  22. Awesome, thanks Tim! I’ve been struggling to stay in ketosis but started testing out the MCT oil a few days ago. Got some nasty carb-flu going on now which I’m gonna try fix with a small bucket of sour-cream keto pudding! I’ve learned more from the TFS this year than all my schooling combined!

    Looking forward to the Alain de Botton episode. Read his book, Status Anxiety at the beginning of the year. Extremely interesting dude.

  23. Great podcast – some questions for a follow up with Dom that I hear conflicting opinions on related to fasting.

    1. Will I break the benefits of the fast by having Butter/MCT(aka Bulletproof coffee) with my coffee in the morning?

    2. Will I break the benefits of the fast by drinking bone or other kinds of meat based broths during a prolonged fast?


  24. I absolutely loved this episode and learned so much more about the keto diet. I’ve been keto for years now and hearing Dom talk about the many benefits of the diet just confirmed my beliefs even more! Thanks Tim!

  25. What a great episode! Glad you ventured “into the weeds.” I’ve definitely got some research to do on ketosis as I’ll be breast-feeding my third child for another year or so.

    My husband and I started the slow-carb diet (saw amazing results) and transitioned to the “Primal Blueprint”/paleo diet. We are the healthiest we’ve ever been! Our children are thriving as well. We’re planning to take that next step for our health and enter into the world of ketosis. My mom has MS, so she’s been right alongside us in our attempts to attain ultimate health.

    I’d love a Part 2 with Dom. Get out in those weeds, heck, venture into the woods! The physiological explanations and laboratory findings are so interesting! Perhaps you could go more into ketosis and the effets on the immune system (I’d love to see more studies done on autoimmune diseases- is there anything happening there???).

    Thanks Tim!

    Also, I’d love to know where I can ship you some treats for your Molly (my husband makes high-end meat treats).

  26. Wow, awesome podcast! I have a lot more questions I’d love help with if anyone knows the answer or if there is a followup podcast:

    -What is Dr. Dom’s recommendation around doing carb ups? I’d love more in depth details around his diet plan.

    -How do I do and how should I prepare for my first fast? I’ve done 24 hour fasts but nothing beyond that.

    -Does he have any recommendations around not getting constipated on keto?

    -Other sites discuss keto being bad for gut bacteria. How does one prevent this and why is it that keto causes this to happen? This seems a bit concerning that the healthiest diet for someone would be hazardous to gut health.

  27. Hello Tim, I get that these factors are important. It would be awesome if you were to key into one of the very most important ones…the kind of light exposure we receive every day! Not enough during the day and way too much at night and of the wrong type. Talk about macro nutrient.

  28. did they give a protein:fat:carb ratio that one should strive for in a ketogenic diet? it sounded like they were about to and then they got caught up in the weeds and then shifted focus

  29. does anyone know what ratio of protein:fat:carbs Dom recommends. it sounded like they were about to give that but then they got caught in the weeds and then shifted gears

  30. Fascinating and extensive interview.

    BCAA product by Scivation contains sucralose and a load of artificial colors (most banned in Europe). There are better products out there.

  31. Tim, given the focus on maximum performance in life, would you consider doing an episode on structural/orthopedic issues and the ways to deal with those? I’ve had 1/3 of my foot bone removed, had a bone graft and a stem cell procedure to attempt to get back to a place where I can do some of the fun and healthy things I want to do. I have used PDTR and various other spooky sciences to help myself get more out of life. I would love to hear you tackle the issues that are not diet related that most of us encounter during a life well lived.

  32. Tim, Please have your friend Ray Cronise on the show soon. He just completed a 23 day fast, has helped many find health through plant based diet along with Dr. Fuhrman and is writing a book about the science of it all which is on Kickstarter for next year.

  33. This interview inspired me to try incorporating a ketogenic diet. I was previously on a diet that mirrored that in the 4 hour body and was heavy on legumes. It seems that legume consumption would be difficult on a ketogenic diet based in its carb content.

    Can anyone explain if it is ok to eat legumes on a ketogenic diet and if so, why those are ok as opposed to other carbs?


  34. A diet and non-technical listener…sticking with the podcast paid off. Learnt some fascinating things, and enjoyed the technical aspects even when really over my head! Kevin

  35. As a long time listener, this was one of my favorite podcasts. Wanted to thank Tim / Dominic for the awesome show. Made me want to hop on the ketogenic diet ASAP. Used to be on a low carb diet a couple years ago, then felt as if it wasn’t really necessary for my health or performance.

    So right now I aim for simply the highest quality foods and a balanced diet – mostly protein based. I engage in powerlifting 4 days per week, and usually do a lot of walking – I find that carbs are enjoyable and don’t seem to compromise my performance. However, in regards to cancer prevention, the carbs may be a good idea to minimize (after hearing this episode).

    Am very interested in testing some of those exogenous ketones for rapid induction of ketosis. Would be interested to hear Tim/Dom’s thoughts on Oxaloacetate as a supplement. On a side note, a related podcast episode you may want to check out featuring Dr. Thomas N. Seyfried of Boston College (he was referenced in this podcast) is here: http://smartdrugsmarts (Dot) com/ketosis-vs-cancer/.

    Tim, if you’re reading this comment – I’d especially dig a round #2!

  36. I really loved this interview. I have been experimenting with a keto/ modified atkins and low carb diets and have felt great. I want to get pregnant soon and am curious to find actual data and research pertaining to ketosis and low carb eating and pregnancy. I have read that a lot of people say this is not good, but they don’t seem to have much to back it up. Have there been any studies as to the amount of carbs needed during pregnancy and breastfeeding?

  37. Tim – can you please recommend a program for safe fasting (5-7 day fasts) including consumption of exogenous ketones, as well as metrics which must be monitored during this period? Thanks!

  38. I absolutely loved this episode. Thank you so much Tim for getting Dom on the show, and thank you Dom for all the interesting and valuable insight! I look forward to the follow up episode! I have listened to this one more than once already and still can’t get enough.

    All I know my whole life is that I crave chocolates and biscuits and never felt satisfied. I was constantly thinking about my next meal. Since I heard this, I only adjusted my diet by cutting sugar and refined starch, and adding coconut oil to my tea in the morning (I normally take Green Mate, Russian blend, which if I recall correctly is a black tea or Pomegranate White) and already after one week I noticed that I am not hungry all the time. I am going to order a few books to read more how to fully implement a Ketogenic diet.

    Second to this I am interested in the effects that Ketones might have on anxiety combined with extremely low Gamma waves and extremely elevated Alpha 2 waves (QEEG test was performed), if any. Especially after the short discussion of how being on a ketogenic diet helps the GABBA Glutamate balance.

    Am I correct in assuming that being in a state of ketosis will also promote Seritonin / 5HTP levels as Ketones has not only the ability to bridge the blood-brain barrier but also has restorative effects in the brain and neurotransmitters. (Apologies if I do not get it completely right, I am not a doctor or anything of the sorts).

    Lastly I was interested to test the effects of a Ketogenic diet on my trigger finger (ring finger), which is a secondary complication to my primary injury (Ruptured FDP and FDS of my index finger). The reason for this is that surgery was planned to cut the A1 pulley after I failed 2 cortisone injections and oral anti-inflammatory drugs. I do manage the trigger currently by restricting sugar which makes me wonder how many patients can potentially benefit from following a ketogenic diet struggling with inflammatory diseases. I even wondered if Crohn’s Disease, Ulcerative Colitis and rheumatoid patients might benefit being in a state of ketosis.

    This was so insightful and inspiring and I definitely want to hear more.

    Thanks for the great work and bringing it to us!

  39. Thanks Tim, an interesting episode. I would like to know more about ketogenic diets in relation to endurance athletes. I’m going to +1 the comments about wanting more information regarding plant based nutrition. I understand that the general consensus is that it is not optimal for athletic performance however I have concerns regarding the diets being used/tested in that many vegan/vegetarian diets can be high carb through things like breads, fruit, rice etc. instead of a focus on leafy greens, avocados etc (I guess similar to what they encourage in the ketogenic diet resources page). I also have increasing concern over the environmental effects of supplying all the animal products to our increasing world population. So I guess I’m looking for what would be best for an athletic body but has the least impact to the planet.

  40. Outstanding podcast (which is pretty normal for you!). This is near the center of my interests and I would love to extend the interview with Dr. D’Agostino. A particular question I would like discussed is nutritional ketosis and gut health: effects, maintaining….

    On a more general note, what I particularly like about your podcast is that it stretches me. I hear ideas and speakers that I would otherwise have to knowledge (or interest) in. Keep it up.

  41. Tim,

    I love that you’re using your resources for a greater good. Thanks for making them so accessible.

    Quick question – do you, or anyone here have a good coconut cream that you recommend? So many of them are runny, or rock solid.


    1. Rick, I am nuts about the Unsweetened Organic Coconut Cream Premium from Native Forest. I buy in the 5.4 oz cans & add 20 drops of liquid stevia per can. For a special evening treat also add a jigger of Jack Daniels.

  42. Hi All! Great podcast. I find that both work and my hobby, ultra-running, benefit from being in ketosis, and I actually really love the food. I have not measured bio-markers, but have not seen any negative effects after spending much of the last two years in ketosis (certainly no mucus problems that seem to be the focus of scaremongering). I do worry though whether there would be any deleterious effects of “over-using” gluconeogenesis in the long-term. Any thoughts?

  43. Looking at the comments there is definitely a desire for a part 2 interview. Even if I don’t have a specific question I too would like more with Don.

    The part that I found most interesting in this episode was that cows are ketogenic by nature and that there are certain vegetables that helps retaining ketosis. I am fasting from time to time and believe that the science supports a ketogenic diet but before listening to this episode I were conflicted about this. Because lately there has been a large amount of research showing the importance of the microbiome. Dr. Perlmutter (I think he would be an excellent guest for your show) who previously wrote the Grain Brain came out with a new book named Brainmakers were he cites the latest research showing how the Microbiome can be used to reverse and/or cure all kinds of modern diseases. The problem has just been that if you should develop a healthy microbiome then you need to eat vegetables to fuel the good gut bacteria. And before this episode I avoided vegetables since they contain carbs and would break the ketosis. Now I can see a way how to eat so I can develop a healthy Microbiome at the same time as I keep my ketosis. Thank you Tim, this really changed my thinking. If you have the possibility I would love to know more in a later post or podcast about which vegetables to use, how to use them etc. from a ketogenic and microbiome point of view combined.

    Lots of love from Sweden, you are doing an amazing job. Keep up the good work.

  44. I’m trying to find anyone who can shed light on this situation … I’ve always been interested in LCHF diets, dabbled on and off with them. About a month ago, I ran across Dr. Fung’s fasting work and at the same time, an exogenous ketone drink. The ketone drink made it easy to slip into a 7 day fast (water, salt, a little bit of bone broth, and some vitamins) and I felt stronger and more energetic than I had in years. I stopped the fast and for about a week, stuck to an LCHF/IF regimen (no ketone drink). I went out of town and had a typical fast food meal for lunch (one meal won’t hurt, right?)–chicken sandwich, french fries, coke. Thirty minutes later, I had a full-on tonic-clonic seizure. I was taken to the ER, stabilized, and put on an anti-epileptic drug which is making me crazy. I am now dealing with the side-effects of the drug (exhaustion, psychosis, brain fog, depression, anger), trying to take care of my four little kids without driving for six months (thank goodness I wasn’t driving when it happened), and trying to get into a neurologist in the small town I live in–the wait is currently over 3 months.

    Of course everyone who knows I fasted for a week blames the fasting, but it doesn’t make sense to me since fasting and ketogenic diets were used as the treatment for seizures before drugs were available. It’s hard to not think there was a link though. I do have a history of seizures–one tonic-clonic 25 years ago as a freshman in college during finals after pulling an all-nighter and one after 18 hours of hard labor with no food, no sleep, and no pain medication during the birth of my first child. I’ve had 3 children since then with no problems, and multiple EEGs with no findings. I have one or two deja vu experiences a year that may be mild simple partial seizures–so mild that I’ve been speaking to a large audience and no one in the audience knew that anything was happening, even though I did. These have been going on since I was 13.

    Does anyone have any ideas? I would like to continue fasting/LCHF/IF, but am nervous about triggering another seizure.

  45. This was one of my favorite episodes. I need to study Dom’s go-to resource to make sense of it all, though. This is a great addition to all of your 4 Hour Body and Slow Carb resources.

    Additionally, I want to point out that the Keto Pet link appears to be dead.

  46. Great podcast-thanks for the tip from Dr Newport (5bullet Friday) I am very interested in nutrition and optimizing health through nutrition (am an RN). I listen to your podcast while driving from home to work (2.5hr). It is amazing how many people are basically saying the same things-but nice to have the research to back it (i.e. Dom, Hof,) You have been having amazing guests. Keep it up! Regards Linda P

  47. Tim – I just finished this podcast, which kind of overwhelmed me with all the fancy terminology and acronyms you guys kept throwing around. “Fasting” was probably the most often mentioned word in the entire 3-hour conversation, so I wonder what kind of fasting you really meant? I’m assuming this was pure fasting, with water only (not fruit fasting, lemon water fasting, or any other kind of fasting)? Have you ever done any research on dry fasting? I just completed a 9 + 3 day dry fast (no contact with or intake of water or any other liquid) in September in the Altai mountains of Russia, and the healer supervising the fast there (Dr. Filonov) kept mentioning ketosis as well. What are your thoughts on dry fasting, and have you ever discussed it with the likes of Dom D’Agostino?

  48. i think dom mentions at one point that he’s consuming something like 300g of fat? i’m 200lbs and trying to consume ~185g of fat. 300g seems like it would be a real lot.

    1. The urine strips only work for awhile, and then the urine concentration of acetoacetate levels off. There are breath testers (for acetone), if you are blood averse, but the Precision Xtra blood meter is my preference and very easy to use. The test strips for ketones can be pricey, but they are available from Canada online.

    2. The blood strips were pricey and the ones I had were also unreliable. I like the Ketonix breath tester. You can sign up for a free one-month membership with and get a coupon for a certain percent off under his “special offers”.

  49. Wow! SOOO enjoyed this episode! What are your thoughts about early morning (5am) HIIT/CrossFit workouts while on a ketogenic diet? I’ve struggled with energy during the workout and attributed it to a lack of fast acting glycogen. As well as recovery post workout that I attributed to a drop in blood sugar.

    Thoughts? Suggestions?

  50. As usual, this podcast was fun and exciting to listen to. Great nourishment for the head! Like Dr. Attia, Dr. D’Agostino is articulate, interesting and knowledgeable, and I like the N=1 personal experience too.

    At his website I ran into his interview with Dr. Mercola. I’m just not sure what to think about this guy. Science Based Medicine has a very low opinion of him (AIDs denialist, anti vacc?).

    While at SBM I looked up the ketogenic diet and there is an entry there (focusing on Dr.Seyfried). It’s basically just a bit of restraint, as I (feebly) read it. One thing I like about Dr. D’Agostino’s view is that puts things in context – for example the keto diet can complement other more traditional approaches and even though some chemo is in fact carcinogenic, it can have its place.

    But sheesh, it can be hard for a layman to know who to believe sometimes on nutrition. I know I know, swim at your own risk. I guess what I’m running into is how to assess risk (in terms of quackery or not).

  51. Hey guys, recently listened to 4-Hour Work Week, loved it. Was wondering where I could find all the templates and reading recommendations mentioned in the book?

    1. Tim provides show notes on every episode with links to books and other resources. They are located directly below the podcast summary.

  52. Great show…..keep it up and would love a part 2!!! In regards to the mct powder. There’s a product called pruv-it and they have a powder they suggest to take once or twice a day. Does Dom recommend this product for the ketogenic diet. Thanks in advance for the response.

  53. Dom briefly covered what supplements he takes in the morning but I’m having a tough time finding the spot in the podcast where he covers that. Tim, can you please list out what supplements Dom is taking and at what dosage? Thanks! I’m looking to start my Keto diet AFTER thanksgiving!

  54. Dom mentioned what supplements he takes every morning in addition to taking ketone powder. I am having a tough time finding where in the podcast he mentions this. Tim, could you list out all of his supplements and the dosages he takes? I’m looking to start my Keto diet and am also interested in these additional supplements. starting my diet AFTER thanksgiving, of course. Thanks Tim!

  55. Would love to hear some feedback from the community: After hearing this podcast and in light of Stan McChrystal podcast (,I’m ready to take a guinea pig leap and try doing one meal a day for 30 days. I love to work, like to eat, and have some stuff I want to do get done.

    I’m thinking of going down to about one meal a day for a while. Lots of water until about 2:00, then a shake made of Amazing Grass, PB Fit, Strawberries and Blueberries, more water then a “normal meal” (protein, carbs, veg, etc.) for dinner.

    Would love to hear any feedback the group might offer.



  56. Amazing podcast. I listened to the entire thing twice and will be going back for a third time so I can understand it all. I have also gone to the recommended website (keto diet resource) and it is very helpful. I know that Dom does not specifically recommend or sell supplements, etc, but I am interested in decent resources for exogenic ketones and a good dried MCT oil. In the podcast, Dom said that he used a dried MCT oil sprayed with a probiotic and it was not available for purchase yet however when I search for dried MCT oil, I can find a couple and I wonder if they are decent quality or not?

    I would really like to see a follow up with Dom and it would be great to speak about the specifics of how to determine the amount of protein and fat needed on a daily basis and how to deal with “cheat days” effectively.

    Personally, I am interested in 1) ketosis for weight loss in the short term and 2) ketosis for brain health in the long term.

    Again, thanks for an amazing podcast, can’t wait for the follow up interview!

  57. Far out – so much new information to take on board, thanks a lot guys! Will need to listen again for sure. Mum has metastatic breast/bone cancer and the oral chemo tablets seem to be mostly only maintaining a low cancer cell count. So while they may be inhibiting cancer cell growth, pretty sure they are taking out a bunch of healthy cells too… Will be looking into modifying her diet further and mine – we mostly follow the Blood O diet as a general guiding principle on food we eat.

    Pivoting again to Ketogenic diet appears to be mostly moving around quantities of what we already eat and cutting the remaining things we still indulge in 😛 Have a feeling though as we take up the Ketogenic diet the cravings for these sugary & salty foods will go down/away anyway…

    Looking forward to part 2 Tim & Dom 😉

  58. This was your most interesting podcast yet! I would love to hear more like this. I’m planning on starting the Ketogenic diet and would love to know the brand of ketones you take to help me get into ketosis sooner rather than later. I’ve been following the Slow Carb Diet for a little over a month, so I don’t expect it to take me very long as my carb ingestion is already minimal. Thanks for all of your research on so many levels. You’re one of the most interesting people I follow!

  59. I’ve been guinea pigging myself with ketosis for a bit over a year now. And on my second listen through with this podcast. Dang, it goes by in hurry. Great stuff here.

    One of the issues I have with the ketogenic diet is that it is quite restrictive. I enjoy the superpowers it bestows, such as higher tolerance to hunger, a certain clarity of mind and long sustained energy between meals. But a bit too much carb, and the wheels come off.

    So it is with great interest I listen to Dom talking about the use of exogenous ketones and a modified Atkins diet. Just the ticket as far as I’m concerned. But, there is one thing I’m not quite grasping here. From listening to the podcast it sounds like exogenous ketones both keep the ketone bodies high enough to stay in ketosis, and reduce blood glucose. But I don’t understand HOW they reduce blood glucose.

    As I understand it, once glucose hits the blood stream it either needs to be taken up by cells and burned for energy, or converted in the liver to either glycogen or fat.

    Just how do exogenous ketones reduce blood sugar? This one is a real puzzle to me.

    One other annoying question– In addition to being interested in the various benefits of a ketogenic diet, I’m also thinking that a diverse and health gut biome is essential to wellbeing. But, the ketogenic diet is (as I understand it) is pretty low in fiber and the kind of carb that can make its way into the large intestine for the bacteria there to do their thing.

    It raises the question in my mind of how to both nourish the bugs in the gut, and keep the blood stream percolating along with enough millimolars of ketone bodies to derive the benefits of powering our mitochondria with ketones instead of glucose.

    Tim, again, thanks for this podcast. I’ve enjoyed all the ones I’ve listened to, and this one in particular dials down on some questions that I’m currently noodling on.

  60. Around 2:00:00 Dom says that pure protein (chicken breast) spikes insulin which knocks you out of ketosis, but doesn’t he also take BCAA regularly which also increases insulin?

  61. Tim,

    It amazing how fast you have progressed into such a professional interviewer. Thank you very much for providing amazing content from so many different people. It would be great to have a part 2 with Dom.

  62. Ketosis positive impact on post-surgical recovery?

    Based on this audio interview. I decided to (and did) eat / fast prior to my full knee replacement surgery on November 23rd in order to achieve Ketosis, which I believe I accomplished, though I did not do any blood testing to verify this. My results, based on feedback from the nurses and physical therapists, seem to be sufficiently unusual that I am referencing those here in case this might be of interest to others. Within two days of surgery I was walking without any aid (walker, crutch or cane) with the approval of my physical therapist. My flexion was measured at 105% and and extension was measured at < 10%. If you are having surgery, such as this, perhaps entering a state of Ketosis could be beneficial.

  63. Wow! What an episode! Very informative and exciting.

    If you ever do a follow-up, I’d be curious to know what are Mr. D’Agostino’s thoughts on artificial sweeteners in a ketogenic diet. He mentioned Stevia, which is a natural “fake” sweetener, but what about all the more industrial ones?

    Oh, and in a potential cancer therapy, how would CoQ10 (or its apparently much stronger relative, MitoQ) fit, considering the beneficial effects it has on mitochondria?

  64. WOW. Really enlightening podcast Tim.

    My question has to do with the ketogenic diet and health risks. With an 80% fat diet, aren’t cholesterol and LDL elevations a major concern? I know Dom mentioned a little that his LDL has spiked from time to time, but my first thought is “Man, there is gonna be a lot more fat floating around in those arteries” What about long term cardiovascular risks?


  65. Great episode, they touched on severe lower back pain on fasting, every time I fast this hits me on day 3 and I can’t sleep, I usually give up pushing through at this point. I would like to do a quarterly 7 day fast. Does anyone know how to negate this back pain? Would eating Keto before the fast help? Or is there anything else I could do? Also I use water Kefir, as this is made from sugar water (although most gets eaten by the Kefir grains) i’m guessing this will be no good for a Keto diet. Does anyone know if milk Kefir would be better, or am I just opening the bad ass door of adding dairy in my diet that I could really do without.

  66. Awesome Podcast. Your link led me to “Tripping Over the Truth” which is an amazing book. Any chance you could get either Pedersen or Ko on the show to talk about 3BP how it appears to be the cure to cancer by attacking the metabolic effects of cancer? At least the author of the book – Travis Christofferson. Can’t believe that the results of their treatments haven’t been more mainstream. Any attention to getting 3BP to market could save millions of lives.

  67. I’ve been doing the ketosis thing about 90% and have noticed my skin is no longer dry like it always gets in PA about this time of the year. And it’s crazy, but I no longer crave food of any sort. First time in my life I have no weaknesses for pizza, or anything else. It’s not that I can resist it, it’s that it’s just…gone. Crazy

  68. First off love the podcasts!

    Couple of thoughts:

    1) Could you do something about fasting, I do a version of the 5:2 diet meets the 4 hour body and would be really interested in anything that makes my fasting more effective.

    2) From what he said would a 5 day fast four times a year taking Dichloroacetic acid clear out from your system pre-cancer cells? Get them out of your system before they cause trouble.

    Couple of people to interview:

    Dan Harris – 10% happier

    Todd Sampson – Hack My Brain

    Enjoying 5 bullet Friday by the way.

  69. Hey, at about what point in the episode was he talking about his “fat bomb” dessert? Or does anyone here remember the simple recipe?

    I don’t mind listening to the whole episode again… but if someone could tell me now, that would be hugely helpful!

  70. Hi Tim,

    I have been doing some reading on fasting. There is a book by Upton Sinclair called “the fasting cure”. I wanted to get your thoughts on the following in connection with fasting; bad breath, enemas and breaking fast.


  71. Hi Tim & Dr. Dom, Long time podcast listener, but first comment/question. I heard Dr. Dom start talking about keto diet and efficacy for anxiety, before Tim pivoted with another question, and would love to hear the rest of that thought… has Keto shown signs of being effective for anxiety treatment? Cheers, Chuck

  72. For those fighting cancer, I think that green tea can lower glutamine levels. Google it and read up on it. I am absolutely no expert on this, but maybe someone can elaborate.

  73. Would anyone know where exogenous ketones can be purchased? Also any recommendations for brands?

    I am looking into getting into ketosis, but as I understand the transition period can be hard if not supplemented with exogenous ketones.

    Thank you.

  74. This was full of great information and great conversation. Tim or Dom, do you think there would be much benefit to taking a well rounded western diet and adding in some exogenous ketones? I ask because I feel good on my nutrition plan and meet my athletic goals, but I am interested in the benefits of ketones. It makes me wonder if one could take the caloric value of a certain amount of ketones and add them in the place of some of the current carbohydrate or fat intake. If so, would there be a threshold dose you need to take in order to achieve any meaningful health benefits?

  75. I absolutely loved this show and look forward to more please!!! I am in ketosis and never want to go back!! This was one of the most educational interviews I have ever listened to 🙂 Thank you so much!

  76. In this world of dumbed down, bullet point, 5 ways to… it’s so great to listen to something that I will happily listen to again with a pen in my hand. Thank you, Tim and Dom.

    I’m preparing (mentally) for my first at home 5 day fast. I have NOT prepared physically for this at all since it’s Dec 26th. Clearly I am a lunatic, but a lunatic with pluck and a sense of adventure. I’m excited…

  77. You should interview Atom Bergstrom. Been in the health food game for a long time and he is a regular on one radio network and has a blog. Might be a little out there but I know him personally and he is the smartest person I know. He is you 40 years ago. [Moderator: link removed]

  78. Thank you for your podcasts! Having read “Tripping over the Truth” after learning of it on your podcast, I would be delighted to hear you interview Travis Thristofferson and/or thomas Seyfried. Specifically it seems that 3BP could be a “magic bullet” for cancer therapy but progress seems stymied by the NCI/NIH bureaucracy and the fac that 3BP cannot be patented. You have enough wealthy listeners who care about this that you could help drive funding for this research. (I would make a donation if I had confidence in the recipient.)

  79. Question: Loves the talk, thanks for this interview and all interviews. My question/request if that when you are talking with your guest especially about the body, is it possible to add in to the conversation/questions to your guests about how it would effect women? I love the articles and I know you interview based on your own curiosity but was hoping to get a bit more info if the topic has a slightly different take for women.

    Thank you Tim! Love it!

    Lasca Weiss