Dom D'Agostino — The Power of the Ketogenic Diet (#172)

Dom D'Agostino

“If medicine wants to focus on prevention, there’s no better tool than nutrition.” – Dominic 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.

Many of you sent enthusiastic follow-up questions after the last conversation we had, so Dom took the time to answer your most popular questions. In particular, he focused on ketosis, ketones, and the ketogenic diet — so you can consider this a ketosis master class (especially if you combine both episodes, though this one does stand alone).

It takes a few minutes for Dom to warm up — so be patient! If you have an interest in these types of metabolic therapies, whether for performance enhancement, endurance, weight loss, or fighting cancer, diabetes, or any number of other maladies, you will find a gem within this episode.

If you only have 5 minutes, listen to Dom’s thoughts on how much protein you should eat on a ketogenic diet.


#172: Dom D'Agostino -- The Power of the Ketogenic Diet

Want to hear my first interview with Dom D’Agostino? — Listen to our in-depth conversation here. In this episode, we discuss fasting, heavy deadlifts, and the end of cancer (stream below or right-click here to download):

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

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QUESTION(S) OF THE DAY: What was your favorite quote or lesson from this episode? 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

  • Why is there so much resistance among dieticians and researchers toward ketosis despite evidence in its favor? [07:12]
  • Can you gain muscle size and strength on a ketogenic diet? [15:20]
  • How much protein should you take in with a ketogenic diet? [16:21]
  • What is the impact of the ketogenic diet on Type 1 diabetes? [19:16]
  • Is it better to analyze ketone production by breath or blood? [27:42]
  • How does ketosis affect performance at altitude? [30:53]
  • Are there any differences females need to be aware of when considering a ketogenic diet? [35:53]
  • Can a female obtain a sub-10 percent body fat with a ketogenic diet? [40:43]
  • How does ketosis affect the microbiota? [44:53]
  • Is counting calories just as important as tracking fat intake and carb restriction if you want to avoid weight gain? [52:00]
  • What are Dom’s nutritional tricks to surviving scientific conferences where the food is often less than healthy? [55:36]
  • What stimulants aid in ketosis? [58:53]
  • Can a vegetarian or vegan follow a ketogenic diet? [1:05:01]
  • Should you be concerned if a ketogenic diet increases your LDL or LDL-P (bad cholesterol)? [1:08:55]
  • Elevated triglycerides? A ketogenic diet isn’t for everyone. [1:14:17]
  • Is it dangerous to use ketone salts? [1:15:29]
  • What’s Dom’s advice for people suffering from fatty acid oxidation disorders? [1:24:39]
  • Does Dom really support Kegenix? [1:29:40]
  • What are Dom’s go-to products? [1:37:21]
  • Are exogenous ketones only useful in a state of ketosis, or would they benefit someone who is not keto-adapted? [1:45:28]
  • Can exogenous ketones combined with a low-carb diet (but not a ketogenic diet) still give some or all of the benefits of a strict ketogenic diet? [1:48:38]

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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118 Replies to “Dom D'Agostino — The Power of the Ketogenic Diet (#172)”

  1. very excited to listen to this! just wanted to say that if ever there was a picture of a scientist who was secretly trying to hide that he was in fact a super hero it is the one above… #worstdisguiseever #definitelywearingpurpleunderwear


    1. Right? Reminded me of Hulk. He was a scientist too. Plus, as we can see in his computer screen, Mr. D’Agostino is messing with some green stuff. He better watch out. 😛

  2. Hi,

    I always thought that Ketosis would be a beneficial metabolic state to achieve for a certain time/period until I read the following statement in The Food Hourglass… “Ketosis is a state whereby the body makes large amounts of ‘sugar’ itself. But this is no ordinary sugar, this is a ‘super sugar’, called methylglyoxal. Methylglyoxal is 40,000 times more reactive than normal sugar and makes proteins stick together like a mad Pritt stick.”

    The author – Dr Kris Verburgh – being a medical doctor and gerontologist, I have always taken his advice seriously. Also, the fact that high protein intake accelerates ageing is something that kind of messes with my head since I have been following (s)low carb for ages now…

    Can you please advise… I am confused :-S



  3. Thank you for sharing this. I’m always looking for ideas about ketogenic diet. I keep falling off the protocol.

  4. Tim, ever try allowing water to surround your breathing channels (nose, mouth) in the shower to activate the stress response and adjust with your comfort levels?

  5. So love everything ketogenic 🙂 Love the science and all the details!

    Thank you Dominic and Tim for this episode! I’m a ketogenic diet fan – absolutely love this hunger free lean lifestyle – never felt better physically, emotionally, mentally. I tried most diet practices out there – atkins, vegan, raw vegan, low cal, paleo, frequent meals, IF etc.

    Ketogenic + IF so far is my favorite protocol. It’s actually liberating for me. I don’t feel that I restrict myself or suffer socially plus I don’t feel dependent on food anymore.

    I prefer cycling ketogenic diet though. Sometimes (especially after periods of intense training) I feel my body needs more carbs to recover. But those carbs always come from fresh fruits, non-starchy vegetables, nuts and seeds.

    One thought about research of ketogenic diet protocols.

    Have you thought of getting volunteers-enthusiasts who are willing to try different protocols and do necessary tests etc.? There are many people like myself willing to be a part of some experiment, getting necessary equipment, doing tests etc. Might be an option instead of waiting for funding.

    Anyway. Thanks a lot! Loved it! Loved the one with Rhonda Patrick too!

    1. Totally! Food doesn’t rule my life anymore – it’s just an enjoyable part when I “want” it 🙂

  6. It would seem Four Sigmatic is not set up to support the offer of your European listeners as it bounce us off the /Tim page to their normal landing page?

    1. Hi Ian-

      Thanks for the comment! Tim’s offer is also valid for International customers, and many have already taken advantage of this discount. You can go to

      Just add the code TIM at checkout.

      You’re right on the redirect from the US landing page though. The reason being that we have two completely different webstores; one for North America and another one for Europe/International. There are complex legislative and operational reasons for this. I understand that it’s not optimal, and we hope one day there’s a solution to fix it.

      But thanks again for commenting and sorry for any hassle we might have caused you.

  7. Hi,

    I always thought that Ketosis would be a beneficial metabolic state to achieve for a certain time/period until I read the following statement in The Food Hourglass… “Ketosis is a state whereby the body makes large amounts of ‘sugar’ itself. But this is no ordinary sugar, this is a ‘super sugar’, called methylglyoxal. Methylglyoxal is 40,000 times more reactive than normal sugar and makes proteins stick together like a mad Pritt stick.”

    The author – Dr Kris Verburgh – being a medical doctor and gerontologist I have always taken his advice seriously. Also, the fact that high protein intake accelerates ageing is something that kind of messes with my head since I have been following (s)low carb for ages now…

    Can you please advise… I am confused :-S



    1. The Ketogenic diet is not a high protein diet, not sure if you are practicing keto or if you are practicing some form of high protein low carb diet. I believe that the thought is that excess protein can increase IGF1 production which may be responsible for the acceleration of aging. ( animals with reduced IGF1 production tend to live longer) It would be worth noting that elevated insulin ( higher carb diet) also plays a role on IGF1 production, so a ketogenic diet inherently limits IGF 1 production across multiple pathways. I would also consider that IGF1 is also responsible for a plethora of beneficial functions so you would want to weight the benefits vs risks of elevated (naturally elevated) IGF1.

      1. Hi Jerald,

        Many thanks for your feedback…

        I do realise that the Ketogenic diet is not per se a high protein diet, but just wanted to throw two concerns of mine out there… hoping for some feedback 🙂

        Correct, it is the Growth Factor production (amongst other things that might be correlated) that is indeed linked to accelerated ageing. Since I have been cutting out more carbs (strongly based on Paleo and 4HB), these have been replaced by foods that have a higher protein content… which admittedly works well on the weight loss – or weight control – front. I am just worried that I am creating other potential long term issues… too much protein is not too kind on the kidneys neither for example.

        The Food Hourglass recommends a less extreme approach whereby carbs are strongly reduced and the focus is more on the Glycaemic Load… insulin peaks are obviously to be avoided for a multitude of reasons, but oats for example can still be part of the mix (while being rather starchy).

        Now, I am not a biochemist and don’t pretend to have in-depth knowledge of the subject… hence the reason I enjoy listening to different opinions and perspectives, as long as these are based on solid scientific evidence obviously.

        Have a great day


      2. For anti-aging, aiming for the lower but still acceptable levels of igf-1 might be a good goal, animal protein increases ifg-1 and dairy raises it even more than meat.

    2. Greg, I’m very comfortable with keto given my many years of experience with it. I believe that if methylglyoxal was that extreme a problem for people following the diet, we’d have seen some evidence of it by now…

      High protein intake over a lifetime, particularly in the latter half of life, might accelerate aging but ketogenic diets are not high in protein, even in the amounts Dr. D’Agostino is recommending for athletes, or they wouldn’t be ketogenic.

      1. Hi Miriam,

        Many thanks for your feedback 🙂

        I might not have formulated my Comment very well initially… I do realise there is a difference between Ketogenic and high protein diets but just wanted to throw two separate concerns of mine out there.

        Just out of curiosity, do you tend to stick to a certain pattern of eating (Ketogenic) for very long periods of time or do you tend to alternate things?

        Thank you

        Have a great day


      2. Greg, I stay about 30-40 g with protein at approximately 1 g/kg LBM. I basically eat the same foods most days while I’m home but may eat more carbs when I’m dining out. I would guess that there are even some sugars hidden in restaurant meals but this is never enough to inadvertently throw me out of ketosis.

  8. Tim I do and listen and agree with lots of your shows but this guy, although intelligent was so “tone-stiff” I had to switch off and put Baldwins podcast on. You got to cut into those long winded answers before your listeners tune out!! #engage

      1. Agreed, the more technical and complete the better. I am listening to learn, not for entertainment.

    1. Uhh…you get that this episode was just Dom sitting down with a microphone and going through listener submitted questions? Tim wasn’t even in the conversation.

  9. Incredible round #2. one more brain busting question that would be amazing if someone knew the answer. Dom mentions that LC diet can affect hormone production including T3. Millions of Americans have thyroid disorders, should this diet be avoided? My personal results in ketosis while having autoimmune thyroiditis have been a roller coaster so far but I still feel great! If anyone has information id be grateful!

  10. I want to ask if anyone has has success on a ketogenic diet while also having no gallbladder. I had mine removed several years ago. Also I am on PPIs for my stomach and effector for anxiety and panic issues. I know it sounds complicated but I want to try a ketogenic diet to lose fat. I’m over 200lbs and I’m just under 5 foot 3.

    1. Weight loss is a great side effect of the diet! Keep in mind what Dr. D’Agostino said about gradually dropping the carbs. That was about 36 minutes into the interview. Because of your height and gender, you won’t need to eat much unbound fat so my guess is that this will be easier than you think. All the best!

      1. Thanks for responding. This is first time someone has responded to my inquiry. I have read both your responses. I know now 100% that foods such as donuts, cream filled anything, high fat dairy can cause me to have great pain (in what i think is my pancreas, doctors have not helped demystify it for me either.) in what seems to be my upper right abdomen, just to the right of my belly. Due to ppis I have poor digestion but without them I’m in major pain. I’m trying to find diet based help through many avenues. I’ll re listen to Dom.

    2. I might start with slo-carb diet first, then add intermittent fasting into the mix before trying the ketogenic diet. Seems to be an easier transition than going straight into NKD.

      1. Yes, thanks jsnoshima. Compugirl, you can start with that commitment- no food after dinner. Sticking to it will give you a sense of accomplishment. Aim for these kind of goals and let weight loss be the side effect.

  11. Thanks, Dr. D’Agostino, for your comments on “cholesterol”.

    I liked your personal story on the impact that keto had on driving down inflammatory markers. Everyone should be asking for the high sensitivity CRP.

    I wish that all HCP’s were more on top of interpretation of lipid test results. LDL is overemphasized and “normal” triglyceride ranges are higher than optimal.

    Guess I’ll make sure that I’m healthy and well-rested next time I have my lipids levels tested!

  12. I’ve tried this in the past, but I always feel absolutely terrible. I honestly think people respond to different macros differently. I personally do a lot better with more carbohydrates and I’m able to stay lean because I need them.

    Do you feel terrible? I’m guessing not if you do this.

  13. Thanks Dom and Tim, very interesting and information episode.

    I have lost 20 lbs over the last 4 months by first beginning with the slow carb diet and then transitioning to Ketogenic. I believe I added some muscle mass along the way too. This is all without any additional exercise up until a week ago, when I started the fundamentals gymnastic bodies program.

    Talk about drinking Tim’s Koolaid, I know! Whatever, the principles and programs to success are there and have helped me progress and stay on track.

    Thanks to you both, I feel great!

  14. Tim, in terms of overall health and wellbeing; focus sing on mega-trends such as CV health, obesity/diabetes; inflammatory/autoimmune disease, and Cancer – have you heard of Synergy Worldwide.

    Their flagship product, ProArgi9+, enhances Nitric Oxide production and longevity in the blood, which improves the CV system and therefore the transport system to all other major organs. This has the potential to help the body heal wherever it needs most urgently. I, for example, had a 3.5 day turnaround in pain from hip osteoarthritis, having been suffering for 2.5 years and considering giving up being a PT.

  15. I’ve been using the ketogenic approach to mitigate (perhaps reverse) damage done to my brain by parkinson’s disease (I refuse to dignify this pernicious plague by capitalizing it). I was diagnosed in late 2011. Been keto for about a year now. Results = amazing. BP – down. A1c – down. Weight – down. Cholesterol – down. Inflammation markers -down. Liver enzymes – down. parkinson’s meds (levodopa) dosage – down. My neurologist during my most recent visit: “You seem better. I don’t ever see that. People don’t GET better. Can you meet with all my patients?”

    1. Thank you for sharing this story! I am currently getting a PhD in Clinical Psychology, with an emphasis in Neuropsychology, and my career goals include using nutrition and lifestyle factors (along with well-supported traditional measures) to help treat neurodegenerative diseases. It is astonishing to me just how little the top experts in the field of neuroscience/neuropsychology/neurology etc. know about how nutrition impacts cognition and brain health. Rarely do I hear nutrition recommendations given to patients, and when I do it is usually a side remark about eating a heart-healthy diet, but never anything remotely related to a ketogenic approach. I am happy to hear about your current successes and will keep your story in mind as I progress in this field.

  16. Most in depth keto stuff ever! I was a little freaked out after hearing Dr. Veech trash talk the exogenous ketones and opted to go MCT powder instead as a cheat cure. Glad you cleared that up.

    If only the medical and nutritional community would get a clue about keto being right for some people who have the dicipline and desperation to try it fit 90 days.

    Well done!

  17. Dom, has anyone from the Air Force ever asked you what effect the Ketogenic Diet would have on Fighter Pilots under high G forces? Would it help with G tolerance/endurance? Just wondering as I have heard mention of other military experiments with Navy SEALs and increased endurance underwater via ketosis.

  18. Someone please help me with this…

    I understand that on the ketogenic diet eating fruit would make it difficult if not impossible to reach ketosis. But I eat 2 servings of fruit a day, one at 8:30 am (either, mango, or orange or banana, or apple etc) and one at 10:30 (always blueberries) on an empty stomach.

    How can you justify not eating any fruit at all on this dietary approach when fruit has so many health benefits? I am open to conversation on this thread and interested on your thoughts Tim, Dom or any others!


    Jonathan A

    1. With regards to fruit- On a ketogenic diet your body shifts to utilizing ketone bodies as its primary fuel source. This is important because this process is a more oxygen efficient way of generating cellular energy, therefore while in a ketogenic state ROS is reduced. So without getting overly technical, your mitochondria are running more efficiently, and less ROS generation means that you do not need all of the exogenous anti oxidants from fruit. In addition recent research is showing that ketones themselves are cellular signaling meleciles that up regulate expression of anti aging and longevity genes like foxo3. So many of the health benefits of fruit you re already getting from the ketones, but without the insulin elevations. With that being said you can eat blueberries and still be in ketosis.

    2. I eat berries every few days on this diet and ocassionally some bites of melon and can stay in ketosis. Blueberries are pretty low in carbs. Just stay away from the really high sugar fruit like bananas and especially juices.

    3. In a ketogenic state you burn ketones as your primary fuel source instead of glucose. This is key as this is a more oxygen efficient use of fuel and therefore less ROS are generated. Because you have less free radical damage to attenuate you don’t need the exogenous antioxidant compounds found in fruit. In addition ketones themselves are cellular messenging molecules which have been shown to upregulate longevity genes such as foxo3. Also yiu can certainly eat berries as part of a keto diet. I eat about 3 or 4 oz berries a day and stay in ketosis.

      Ketones are responsible for many of the health benefits of fasting so a keto diet provides these benefits without having to actually fast.

    4. I had the same question as you. High carb foods (ie. virtually all fruits and most vegetables) are some of the most nutrient-dense and fiber-dense foods on the planet. Outside of epilepsy and possible DM type I, I don’t see how one can justify to eliminate these demonstrably healthy foods. But, I am all ears and want someone to prove me wrong.

  19. The link to the glucose/ketone meter goes to a discontinued product. Any chance of updating to something available, like the NEO he mentioned on the ‘cast — is that the Optium or the Precision?

    And great episode! Love hearing Dr. Dom.

    1. I have looked at Amazon and Abbott’s websites. To clarify, it is the Freestyle Precision Pro (which I believe DD said he uses) that is being phased out. You can buy it at as a “sale” item but there are no test strips available to be found anywhere for ordering, just the control solution. Would not buy this.

      At the Abbott store, the Precision Xtra meter is $27.50 v. $25.72 on Amazon. Ten ketone sticks at Abbott are $49.99 v. ~$67.55 Amazon. Amazon also has another seller offering less expensive unboxed ketone strips from Abbott that some reviewers state are Freestyle Optimum, not Xtra.

      If someone has additional findings, please share.

      1. There is also an established Italian pharmaceutical company that has become international and now sells in the U.S. a glucose/ketone kit called MD6. It is similar to the others but uses a 30g needle instead of the larger 28g.

  20. Dom,

    I’m certain you’ve been asked many times about the recent NuSi study by Dr. Kevin Hall who’s preliminary interpretations show no benefit of a ketogenic diet for fat loss and, per Dr. Hall, refutes the carbohydrate-insulin hypothesis. As this was one of the more robust studies done thus far, what’s your take on this study as it pertains to the current body of literature?

    Thanks in advance!

  21. You’re one of my personal heroes. I find a lot of inspiration in both how and what you are trying to accomplish with teaching people to learn. I’d really like to help contribute to what you are doing. I’m currently a manager at Celestial Seaonings in Boulder, CO. I’m not looking for a job, but would love to be of help.

  22. I Have successfully managed my type 1 diabetes insulin free for the past 18 months through being in ketosis and weightlifting. Building Strength has been enhanced massively for myself, I went from deadlifting 140kg (308 Pound) to 200kg (440 Pound) in a 3 month period. My bodyweight is 68kg (150 Pound)

  23. Hi Tim – it was great to hear Dom again & to have him go in depth on some subjects.

    I have been your listener for about a 9 months. On another note, I attempted to reach Dr. Dan Engle about another topic that was not addressed in your podcast with Dr. Dan & Dr. Martin. I had 2 ischemic strokes over 6 years ago. I wonder if the psychedelics could be useful with strokes? Have you heard this talked about in your travels? I attempted to reach Dr. Dan with twitter. Do you have another email or phone I can reach him?

    Thanks in advance,


    1. Instead of replying on drugs, why not try something that is well established in the literature to prevent ischemic strokes and reverse atherosclerosis and arteriosclerosis? Try a vegan diet. Vegans demonstrably get FAR less ischemic and hemorrhagic strokes than non-vegans. I know Tim and Dom are not a fan of this diet, but you already had 2 strokes! Something to think about.

  24. Great discussion. Would like to hear an episode on Lyme. Also coinfections like babesia. Appreciate your perspective.

  25. Hi Tim and Dom. I’d like to hear your thoughts/comments on the recent Kevin Hall study results that question the potential benefits of the ketogenic diet. He might be a good guest to have on the podcast to provide an alternative perspective. Love the podcast – keep it up!

    1. It’s important to note that Hall is only addressing the potential fat loss benefit over other diets and not other health related benefits. A ketogenic diet does much more from an anti aging and optimal health standpoint vs fat loss, so the context is important. Up regulation of longevity genes ( foxo3 ) reduction in systemic ROS etc from a ketogenic diet are to me much more important than weather or not it confers any additional fat loss benefit over other diets. The conversation often is relegated to which diet is best for fat loss, but how you eat does so much more than just influence girth. A ketogenic diet provides many of the benefits of fasting while still being able to eat. It’s the ketones themselves that are providing many of the health benefits of fasting.

  26. Thanks Dr. D’Agostino (and thanks Tim for the show as always!),

    Magnesium question…you mention a number of different kinds.

    Any thoughts on Magnesium Malate? (magnesium malate dehydrate; each capsule in a common brand is 793mg)

    *I’ve had excellent results with Magnesium Bisglycinate (200-400mg before bed) but was recommended the Mag Malate recently.

    Not a lot of comparisons online…any comments?



  27. Another anecdote for you and Dom…I’m 64 y.o. and before the keto diet I could play basketball a couple times a week but be just wrecked afterwards and head straight to the bathtub and bed.

    Now, after 6 months on Keto diet, I play for two hours, four or five days a week, have very little fatigue after…I go home, do a couple hours homework (Masters degree student at Portland State) clean the kitchen, have a glass of wine and am reading to go the next day! I know it’s a cliche, but the Ketogenic Diet has absolutely given me a “new lease on life!”…Thanks so much to you Tim, Dom & Peter, for bringing this precious, life-giving knowledge to me!

    1. Sorry if I am a bit fixated, but . . . I am interested in trying the broccoli soup plus coconut milk. I have tried to find a suitable soup, but . . . no dice. I found a mix from Bear Creek, but a serving has 19g of net carbohydrates (not to mention modified corn starch, MSG, etc.) Campbell’s looks predictably unhealthy. I wondered if anyone knew of a good brand?

  28. Fascinating! Thank you Dom and thank you Tim. I made tons of notes, I can’t wait to follow-up, I appreciate the show notes as well 🙂

    Dom, any correlation between PMS and a Modified Ketogenic Diet?

  29. I’m about half-way thru this podcast, and I have renewed interest in ketosis again! I took some of Dom’s advice to task after round 1, and starting using BCAA’s for the first time (long time protein shake user here), especially once I found that Scivation has raw products (i.e. w/o artificial flavors). But this is where things get tricky, and I’m hoping someone can help.

    I find the use of a protein/BCAA drink just prior & during my workout boost recovery between sets (mostly swings & get-ups these days), but do nothing for me afterwards. I suppose that’s to be expected. I usually workout in the mornings before I see patients, and BP coffee with a mix of butter & coconut oil and collagen protein, and then add the protein/BCAA for while I’m working out (I know, I’m out of IF). Lunch has been 4 eggs & black beans or can of sardines with guacamole on either a teff wrap or a slice of GF bread. When I get to about 4:30-5, I’m crashing, and sometimes to the point of exhaustion that doesn’t recover from a quick round of BCAA’s (protein bar is usually my savior at this point).

    Looking for some thoughts/insights into what may be going wrong here, too much carbs overall? I know this is somewhere between slow-carb & keto, but I would think there is some middle ground where the BCAA’s could fill the gap.

    1. The bcaa aren’t going to have an effect on a mid to late afternoon crash. The bcaa is actually to stimulate mtor within skeletal muscle tissue during training. It sounds to me like what may be happening is you are not generating adequate Ketones in the afternoon to meet your Brian’s energy demand. Concurrently your glucose levels are likely not high enough to provide adequate energy either since your body is preferentially refilling muscle glycogen with the carbs you are eating. The carbs you are eating may be just enough to suppress ketone production later in the day. Without you checking blood glucose or ketone levels around when you are having this crash it’s difficult to be certain, however you I would try eliminating the beans and keeping cabs below 50 for the day for a few days in addition to adding additional fats to the mid day meal and then see how that does. Maybe even add a little mct oil to some tea with the afternoon meal.

      1. Also, might try eliminating coffee altogether for 1-2 weeks. Might be the cause of your crash around late afternoon. To stifle carb cravings try drinking a glass or two of water with a pinch of salt during the day.

      2. Side note on all of this, I switched away from a slow carb meal to a salad, and haven’t had any trouble with the crash. In fact, dinner time gets extended to much later w/o trouble. Of course there’s the whole IF issue to implement, but one step at a time!!

      3. I thought about this Ethan prior to switching to full keto. I haven’t found a need for anything to address the mid-day lull, b/c I haven’t really had one. I have been finding that a mid-day coffee/tea is enjoyable, but more for the warmth on these cold winter days!

  30. For those of you out there looking for a weight loss solution, then there is nothing easier or more effective than ketosis. I’m 6’0 and 33 years old and have been following the ketogenic protocol for the past 11 weeks. All told I’m down 25 lbs, from 215 to 190 and I couldn’t be happier about it. Many, many Kudos to Tim for promoting this, it is a life changer.

    I’d like to share some of my story with Tim’s readers, especially those who may be skeptical about keto. 11 weeks ago I was in the worst shape of my life. Pants were too tight, mid section was too lumpy and after another late night binge on carbs, I new things had to change. Fortunately for me, my wife had already started a low carb lifestyle, so I told her that I was in. My goal was / is to get a sixpack (still about 20 lbs away from that based on my body fat %). Bottom line is that ketosis rocks for fat loss.

    Before I couldn’t walk through my kitchen wothout sneaking a sugary or startchy snack, once in ketosis those carb cravings seem to disappear. It’s not like when you eat some bread and then are hungry again an hour later. Eating higher fat means less hunger signals and certainly less need for willpower to succeed. If I can do it, anyone can, because there is no one on this planet who liked bread as much as I did.

    Here are 4 things that have helped me along and could help you too:

    1. Ketogenic diet is much, much easier to follow if your significant other/roommate is aligned. If I was trying to eat low carb and my wife was ordering pizza or baking cookies, then it would obviosly be an uphill battle. This was a very, very, very important factor leading to our success (she is also down ~ 20 lbs, but didn’t need to lose as much as I did). I can’t overestimate how important this is, having someone to share your success with is HUGE, so try to find someone else doing keto, it will motivate you.

    2. Before I would try to lose weight through a combo of diet and exercise. Pretty standard advice, but it rarely works. I think Tim has written about this before, if you want to lose fat it is 99% diet. So this time I purposely chose not to add any new exercise routine and focus solely on diet. I am moderately active anyways, but I wanted to see what the diet could do by itself. Plus I’m positive that being able to focus solely on one big lifestyle change, as opposed to trying to build multiple habits at the same time, increased my probability of succees. While I want to also build some muscle, but I’m happy to defer lifting until I’ve got one habit locked up.

    3. To stay motivated I weigh myself every morning. I know that this goes against so-called “best practice”, but I do it anyways. If I’ve lost weight from the day before it affirms that what I’m doing is working and I feel great and motivated to eat clean for the upcoming day. Conversely if I’m up from the day before, I tell myself that I’m going to eat extra clean today. Basically I use the “failure” as motivation all day, knowing perfectly well that it isn’t a failure at all. Doing this everyday makes it feel like I’m on a streak and puts me in a confident frame of mind for the day. But I do this knowing full well that weight loss is never perfectly linear. And I don’t really have any expectations each morning, the morning weigh-in is just a trigger for setting myself up psychologically to have a good day, no matter what the scale says. The funny thing about ketosis and weight loss, at least for me, is that the weight seems to come off in spurts, a couple of pounds in say 2-3 days and then a week of plateau. Keep this in mind and be patient.

    4. I’ve found that I can be around 40 g of carbs and stay in keto, but I don’t track macros that closely. Some days I may go a bit over, but I don’t worry too much about it because I know the next day I will be back on keto.

    Hope that this helps those of you looking at keto for fat loss. I am living proof that it works.

    * Important Note: I still drink a few beers or glasses of wine each week and stay safely in keto, though I’ve found that my tolerance and corresponding desire for alcohol is WAY lower now. So take care.

  31. Hi Tim,

    I am loving all of the interesting morsels from Dom D’Agostino! I would also really enjoy hearing you have a conversation with Esther Perel, Michael Pawlyn, Michael Pollan, Amy Cuddy, Rob Dyrdek, David Blaine, and Bill Maher.


  32. Regarding the Dom D’Agostino podcast… I have a two-word request Tim: “Layman’s Terms”. I tried sooo hard to hang in there, but after 35 minutes of medical Chinese with no dumbing down for non-medical professionals, I had to give up. Other than that, I enjoy some of your podcasts greatly and appreciate what you do. Thanks.

    1. As a medical doctor, I was not comfortable with a good 10-15% of the terms/research. To tell you the truth, there is no other way to present the concepts Dom discussed. My advice is to listen to it all and delve deeper into the research when something sounds foreign 🙂 Enjoy!

  33. You need to interview this amazing human. I met him when he brought a team of young men to the US to play some American baseball. His life story is amazing. It all started when he was diagnosed with cancer at the age of 3. He was one of 25 children in an experimental test group. Everyone else died but him.

  34. Did Dom provide a recommendation for the best exogenous ketone product for a newbie to try out?

    He clearly commented on a few products but I wasn’t sure if there was one that he spoke to as an ideal starter product.

  35. For those practicing a ketogenic or intermittent ketogenic diet, how do you get the fiber in? In my experience when I eat a vegan-near vegan diet, I have 2-3 very smooth and fast BMs per day (not to be graphic), when I eat any excess of meat I have a struggling BM every 1-3 days.

    Fiber-rich foods, which incidentally are some of the most nutrient-dense, have demonstrable benefits to the GI and vascular systems, and in preventing certain cancers. I would imagine it would be difficult to mitigate this issue when trying a ketogenic diet.

  36. This is a great insight into the value of the Ketogenic Diet.. I have been experimenting with Intermittent Fasting for 4 months now ( 7 days per week ). Since I am a full time Personal Trainer.. my first objective was for fat loss and muscle gain.. besides gaining 3 lbs. of muscle while losing 9 lbs. of fat and over 3 inches of fat off my stomach… I felt amazing health benefits.. like more real energy and focus in the morning… joints feeling better… I actually skipped a hip replacement surgery.. Because of these amazing benefits that I realized as a drug, hormone, and ped free for life athlete attempting to role model the fountain of youth.. I started to personalize Intermittent Fasting nutrition plans for my Fat loss clients.. men and woman.. The results are very assuring that a personalized Intermittent Fasting nutrition plan is the fountain of youth.. and can be tweaked to gain muscle while losing fat while still realizing the obvious enhanced cognitive / brain health, health and longevity benefits of fasting..

  37. Tim: You have the greatest blogs on the net and I am spreading that message. The Dom answers were great. Thank you.

  38. Hello Dom, Great round 2! Any thoughts and/or evidence on what type of ketogenic diet and/or supplements will help lower high blood pressure? I lost weight, taken supplements (fish oil, CoQ10, magnesium), taken meds, and just started TM, all with no results. Thanks! John R.

  39. Love the deep dive science Dom.

    Have you seen anything on the potential benefits of a keto diet or exogenous ketones and the prevention or slowing of lymphomas or pre-lymphoma with permanently hard/enlarged nodes of the jaw?



  40. I wonder if you could have gotten the same results or better on a raw food diet. I would be interested in knowing your average ph levels but suspect you are eating a lot of greens??

  41. Dom’s cancer research is very interesting but like most Doctors, he seems more interested in treatment rather than prevention; that’s where the money is after all. However there may be some preventative’s in the Ketogenic diet especially if it reduces CRP. However even mindfulness meditation is shown to reduce that. IGF-1 levels are also important, you want to get those down to the low level of the acceptable continuum. You do this with plant protein; dairy and Meat raise it. Pea protein is especially good. So if you could do a Ketogenic vegan diet, which should also sustain slightly alkaline blood that might just work as a Cancer preventative. Again as I have in mentioned on the Charles Poliquin interview comments, the Mount Athos monks are one of the longest lived, lowest level of Cancer peoples on the planet. They seldom eat meat and when they do its fish. In the book Healing Cancer from the Inside out by Mike Anderson (RAVE Diet) he explains the cause of Cancer as pollutants, stress, alcohol, tobacco etc as the seeds of Cancer and that Meat is the fertilizer. Many people have CURED there cancer with his vegan, fat free diet. You never hear Dom talking about cures. So Tim, I ask you do you think this is a LONGEVITY Diet??? I would love you do find some Longevity experts and interview them on here, now if they come on here and say that studies of the longest lived, least disease ridden people are eating a ton of Fat and Animal protein then I will start eating beef like SOB. Thanks for the awesome podcasts and I would love to hear more of Poliquin not because of what he is talking about, just because he is so damn entertaining!

  42. Does anyone know a source for a product that Dom mentioned – he said Phenybute? Phenylbute? I may not have it spelled right. He said he takes it with melatonin for a sleep-enhancing stack when he travels and it gives him weird dreams. I didn’t see it in the links above and in doing a search I don’t think I have the right thing. Thanks for this episode – it was fantastic!

    1. Phenibut is (±)-4-Amino-3-phenyl-butyric acid. It has a variety of other spellings under which it is sold. It appears to be a GABA analogue. It’s fairly easy to buy if you search by name. It is not FDA approved, like most nootropics.

  43. Dom/Tim,

    Was wondering if either of you would mind answering the following questions I have regarding multi-day fasts?

    1. Should only water be consumed? Is coffee okay?

    2. Are there any supplements you recommend for during the fast?

    3. Should all exercise (i.e., yoga, strength training, etc.) be avoided during the fast?

    4. For optimal effectiveness, what’s the minimum amount of time the fast should last?

    5. What are the best foods for breaking the fast?

    6. How slowly and in what amounts should these foods be reintroduced?


  44. Tim,

    Dom IS financially affiliated with several of the ketone salt products he is promoting. He very craftily dodged that part of the question twice. Claimed no interest in the University of South Florida patent which is most likely not true. Very dishonest, especially as he implied that Dr. Veech has his own commercial interests. Absolutely imperative that you get full disclosures from your guests when they promote their own and trash others’ technologies, especially when peoples’ health is at stake.

  45. Traveling in SFO and looking for a local source of ketone test strips for a Precision Xtra. Anyone have a recommendation for a local source? Much obliged.

  46. After listening to this (and then everything else I can find by Dr. Dom), I’m left with one nagging problem. He mentioned roughly 1/3 of people can’t process a ketogenic diet. It just doesn’t work for them. Realizing you’re not a doctor and don’t play one on TV, I’m still going to ask how one would know which group they fall into. Is giving it a try the only way to know for sure, or is there some kind of screening or indicator?

  47. Hey Tim I was wondering if you know whether its possible to use exogenous ketones as an alternate energy source to preserve your carbohydrate intake to further facilitate muscle growth?

  48. Dr. Veech is very vocal concerning the use of ketogenic breath strips, From the audio I have listened to he does NOT recommend them whatsoever. FYI.

  49. Hi

    Just listened to the interview – #117: Dom D’Agostino on Fasting, Ketosis, and The End of Cancer

    My wife has Metastatic cancer so we are researching alternative treatments / therapies. The Ketogenic diet sounds great especially as she is also undergoing Chemotherapy

    One question I have is around the amount of fats from Dairy, given there are reports of cows being fed with growth hormones to increase milk yields and these hormones are passed into the milk and can be caner causing (not sure of actual research into this) so I was wondering how much fact is in this and if on the ketogenic diet you are eating more dairy products what are the risks?

    Great site and articles keep them coming

  50. I’ve heard this interview a couple of times and it never sunk in. Once I read Tools of Titans, it finally set in. I jumped into Ketosis after a 3 day fast and I haven’t looked back. Excited to see the results after my first 3 months is over.

  51. Hi Tim, is there a non fishy substitute to sardines or oysters you would recommend for that quick snack or breakfast when on the ketogenic diet?

  52. Hi Tim and Dom, what are your thoughts on the Pruvit Now ketone products? I guess it’s like the new Mary Kay of ketone diets. I’ve always been fit and interested in nutritional research and people keep approaching me about selling this stuff. I’ve always found that there’s no short cut to any place worth going but I wanted to see if y’all have any information on this new product.

  53. First, this comment is not at all about bashing any diet type, keto, cico, HCG, or, any person who is on these diets and are proponents of these diets. – I am always concerned first and foremost with HEALTHY – and a good healthy plan will ultimately lead to weight loss and to keeping that weight off forever.

    But whether it’s losing weight, trying to be healthy, or both – we need to do it safely – that is key to what I am about and what I will strive to research for and push for. Safety.

    So here we have in america and around the world maybe a hundred different diet types from atkins to Paleo and so on and so forth – most of them are variations on the same few diet themes we all are familiar with- eat less exercise more, less sugar, less carbs etc etc etc.

    Every once in a while we come across a diet that may appear to be extreme – but is rather docile and ends up being one of those variations on the themes I just mentioned. But we don’t and wont know that always – unless we investigate.

    More than any other diet it seems that people have had quite serious questions about the KETO diet. And for good reason – and not the reason you think at first. At first, i am sure that everyone reads the words High Fat and raises and eyebrow – a collective What you Talkin bout Willis!? It is that HF in HFLC that has many highly curious and cautious and needing to get some answers.

    The problem is – on many websites, the answers are not quite clear, somewhat contradictory, and all over the place as far as science is concerned. Again, I’m not mocking when i say this next part; it could be in the best interest for whomever of the keto folk, to regroup among yourselves and come up with a better mission statement if you will for the keto evangelism that exists on the internet.

    And this mission statement should have all manner of clear and precise bullet points, including windows for modifications which is fine, and including most if not all of the potential health issues related with this type of diet – a “diet” which had it’s origins in trying to treat people with medical conditions – seizures in particular. A diet which was and is largely done under hyper medical care – at least in the early stages.

    Extending on the mission statement, we can eliminate any what may seem like huge contradictory statements – like when some keto people say “eat fat, it triggers appetite suppression and makes the body lose weight.”

    So to that we have the “fat” thing to consider. This fat molecule many speak of that will do the triggering, that will cause you to lose weight – and thus we need a lot of it – “HIGH FAT DIET”. That needs to be made absolutely clear, honed down, and mentioned in the mission statement exactly which fat molecule (s) are you talking about – just like when we speak about vitamins – we say C will prevent colds and scurvy, or A will prevent blindness…list the fat molecule(s) that will do the trick or do what ever it is keto is saying it will do and thus we need copious amounts in our diets – or else we can’t achieve weight loss or some state of ketosis (more on that later).

    But the problem with identifying this fat molecule might require some basic chemistry – or not – but it will get tricky as we push further into trying to understand how eating a lot of this molecule has some effect on anything; Basic chem or not – a triglyceride can be considered – that for the most part is what fat is.

    Triglycerides are the main constituents of body fat in animals, vegetables (plants) and, this is key – humans – remember that later – that we already have tryglycerides (I always say “so you want us to eat fat from something else, to lose our fat?).

    Anyhoo – so lets start with being clear about what type or types of fat are we talking about here, what types of fats do you want us to consume in high amounts – or is it all of them? How about the MCT ones – which some say is the safer way to go? Please make that distinction for us. And please, also understand and add the the bullet points that; so many things can and will alter that molecule – before it has a chance to “work” for you; heat, light, time (decay), oxygen.

    So, and this is where knowing a wee bit of chemistry comes in, once you know how molecules change, and once changed they can no longer do what you wish for them to do, what you say they will do when recommending a high fat diet, you have to tell people thus – not to change the molecule.

    Which means you’ll be telling people in the mission statement, that cooked foods are out, oxidized oils are out (olive oil, coconut and vegetable oil etc.), and rancid fats are out.

    Which means the keto diet in the mission statement will no longer include steak, eggs, hot dogs, ham sandwiches, ice cream, butter – and my all time fav, Bacon. Or you can mention in the keto mission statement that you can still have and enjoy bacon and butter but that those items have nothing to do with the ketogenic process, cause chemistry and biology says they don’t.

    Chemistry and biology, along with physiology, also says that even a perfect intact molecule of fat eaten, will no longer be that same molecule once met with digestive enzymes. And this is what I meant by remember that we humans make our own fat molecules, just like the pig we eat or avocado we eat.

    So, at this point – half a mind is starting to realize that there is no food that will help to lose weight or trigger some appetite suppressant thing. Cocaine I guess though could be one food group/plant that suppresses the appetite (cue the sexy music :).

    So, fat is now out of the equation. And as many in science and medicine are realizing about ketogenics, for seizures, the seizures, “it’s mainly a high carb problem”. And also when researching, we see that this “diet” has been tweaked and modified a plenty over the hundred years of it’s existence. And a more recent modification has been to suggest the MCT keto diet due to a significant lowered risk of health problems associated with a common ketogenic diet (mention that in the statement).

    It is important to mention that in the statement because as I mentioned – All this recommending stuff, there needs to be accountability and that means we must always be uber aware of the dangers of doing some diet or another. For instance;

    A person with a disorder of fatty acid oxidation is unable to metabolize fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their body would consume its own protein for fuel, leading to ketoacidosis, and eventually coma and death.

    So now, the average but rare bloke reading so much here on the internet probably won’t come across that little ditty. And they most likely wouldn’t other wise think to consider it – since everyone seems to be fine. And then, when they are feeling like crap and a keto spokesperson says that is the way you’re supposed to feel, like crap (the Keto flu), the bloke says okay, I’ll ride it out…and then they continue, not knowing they have this fatty acids oxidation disorder – dot dot dot (include that in the mission statement).

    And lets include this about kidney stones – Kidney stone formation (nephrolithiasis) is associated with the ketogenic diet for three reasons:

    Excess calcium in the urine (hypercalciuria) occurs due to increased bone demineralisation with acidosis. Bones are mainly composed of calcium phosphate. The phosphate reacts with the acid, and the calcium is excreted by the kidneys.Hypocitraturia: the urine has an abnormally low concentration of citrate, which normally helps to dissolve free calcium.The urine has a low pH, which stops uric acid from dissolving, leading to crystals that act as a nidus for calcium stone formation.

    And lets throw this into the mission statement: Ketogenics diets for adults can bring about constipation, raised cholesterol levels and, in women, menstrual irregularities including amenorrhoea.

    And again, as I mentioned before – Because of the risk of complications during ketogenic diet, most hospitals begin the diet under close medical supervision.

    Now, we can say this about a lot of things, plenty of diets perhaps. We can also find bad news about breathing and drinking water… The choices will always be yours but the best choices made are the ones that are the most informed.

    They are also finding out now, 2012, – as opposed to the crude science of the early days of ketogenic study (1920’s) – that it is not a ketone, or fat molecule or sugar but a specific protein that had to do with seizures. and of course we make that protein ourselves in our bodies – or in a lab.

    As for this state of ketosis – having higher levels of ketones in your blood does not mean you are in a state of ketosis. And it does not mean that now you are running on fat and not glucose – this is not the case. And all the symptoms or pre symptoms of this “state” are not consistent with all people – as well there is no clear identifiable characteristic of this state of ketosis – like say when you smoke a joint, there is a clear and distinct new ‘state of being’, so too with booze or Quaaludes etc.

    Also, no one online or anywhere here who has claimed to be in a “state of ketosis”, perhaps cause their keto meter blood reading told them they were, has ever been in a hospital under close monitoring – to actually verify some type of metabolic transferring of fuel types – from glucose running things to now fat running things or ketones running things.

    But the problem with that will always be that there will always be glucose in the body. Even the early days of keto, 1920 those patients never were without blood sugar, sugar in the cells and body tissue and sugar in the brain – science of the 1920, was lacking in many things, especially hyper microscopic in vivo study of patients.

    Even without any glucose intake or intake of foods that will convert to glucose – we will still make glucose – we can not get around that – and we don’t want to get around that- or we are dead- glucose molecules equal life.

    And i will put this in bold type for those who think a ketone is replacing glucose as the fuel source; THE KETONES YOU REFER TO ARE OF THE CARBOHYDRATE FAMILY! Yes, it will always be a sugar molecule doing the fueling. The end of the energy train, ATP, has a sugar component. Your fat molecule will always, if used for fuel, end up as a ribose.

    Even DNA/RNA dynamics don’t happen without a sugar molecule – a chemist would quickly tell you that RNA – of DNA/RNA dynamics – the key to, starting point of, our personal genetics and making everything that is our physical, chemical and biological selves – is a sugar molecule – RNA is Ribonucleic acid – a ribose sugar.

    And to that, many contradictions abound (which is normal in the evolution of science and medical study); low blood sugar can cause seizures… ???


    But back to fasting, Fasting folk don’t have these horrid symptoms that some Keto persons describe. None of them And no person that I have ever known, and I know plenty, has experienced this – even the first time fasters.

    What I can conclude, in addition to safety first of course – is that most things, many industries, like all manner of convoluted – it somehow makes it seem more of a vast study, more significant than it really is or needs to be, one.

    Two, a keto diet would do better to first lose the high fat part, from the name and from the diet. It does come down to carbs in and carbs out. Three, anything extreme, should always be met with caution and every question about it should be answered fully and without iffyness. Run fast away from the iffyness – and of course, iffyness can include youtube videos and diet and fitness gurus – no matter how educated some of them are.

    Four, if there is any mention that a hospital is usually where a diet type is initiated – then also back away.

    And for those who say, it worked for me, even more reason to back away – and head towards something that is more consistent and working for more people more of the time. Better safe than sorry. Or we can investigate and see why it worked for that person. And then look into why the same exact diet is not working for so many more. Why are thousands doing this diet yet only the smallest fraction of people are having any success? All things being equal, everyone doing the exact same things eating the same things on the keto menu. ???

    And if the answer comes up – “everyone is different” then that would tell half a brain guy that it ain’t the diet at all but rather how that person responds to a low carb diet. And lastly, it is all about and only about a low carb diet – the only difference with keto is that it is a very low carb diet – and that could work if eased into it. Humans have been led to believe over this past century that we need so many calories daily – we do not. We need not even half the amount that is currently recommended. Always, for athletes and couch potatoes alike, the less food we eat the more energy we will have.


    1. Oliver. Great response raising several good points of concern about the health issues. I actually came across this article mentioning that fat “is” the cause of type 2 diabetes. Have you heard about it too?

      Overall, I see people around me with good weight loss result for them but I am slightly afraid for their health as they love to push the “I haven’t taken anything out, I eat my burgers, bacon, beer and fries and I lose weight” That does not sound like a healthy long term thing to me…

  54. There is a week I am planning to go off of the keto diet, and I will be consuming high carbs. During this week should I continue taking MCT powder and trying to consume high fat like coconut oil and olive oil on top of the carbs I will be eating? Or will all the added calories I’m consuming from the oils just make me pack on weight because the body is no longer burning fat for energy and has switched over to carbohydrates?

    1. If you will be high carbohydrate I would suggest you moderate fat intake to keep calories in the desired range

  55. Weight loss is not rocket science – yes there is some science to it but far less convoluted than all the weight loss folk make it seem. Barring surgery or drugs, if humans want to lose weight they simply have to burn more calories than they consume.

  56. I’m about to listen to both videos and wonder if each will answer my questions. Does Dom workout out at higher heart rate intensities while on a ketogenic diet such as zero carb? Or does he meal time with loading carbohydrates solely for the workout and no other time of the day, or few carbs the rest of the day? I think guys that follow a ketogenic diet usually work out at lower intensities also while lifting heavy so they don’t burn as much glycogen because they have zero carb. I think caffeine hurts a ketogenic diet because it sets the metabolism too high to burn too much protein but I don’t know what Dom would say on this, I also need to study Mark Bell’s videos because he has like 100 hours worth of videos on I think losing 100 pounds of fat with a ketogenic diet. He does seem to have kind of funky energy on a ketogenic diet especially when workout out. Does Dom go zero or low carb and still work out at higher intensities such as intense weightlifting and 155 heart beats a minute + running including all out sprints. I think someone can go zero carb and still lift heavy because there’s long rest periods inbetween 1-4 rep max sets and so the heart rate isn’t that high so ketogenic diet might be popular with powerlifters. Bodybuilders might be scared of ketogenic diets on the other hand.