Tools of Titans
Page 5
The primary resource, as you’ll come back to this: Dom’s top go-to resource for the ketogenic diet, including FAQs, meal plans, and more is ketogenic-diet-resource.com.
“I like to promote mild to moderate ketosis for health and longevity, which is between 1 to 3 mmol.”
TF: These levels help protect DNA from damage, among other benefits.
Why Consider Ketosis or Supplemental Ketones?
Fat loss and body recomposition
Potent anti-cancer effects
Better use of oxygen: Dom can hold his breath for two times his normal duration when in deep ketosis (2 minutes → 4 minutes). I observed the same. Essentially, you can derive more energy per oxygen molecule with ketone metabolism. This oxygen utilization advantage is why some elite cyclists are experimenting with keto. This also helps performance at high altitudes, if you’re going from sea level to mountains, for instance.
Maintain or increase strength: In a study with 12 subjects, Dom demonstrated that even advanced weight lifters could maintain or increase strength, performance, and hypertrophy after 2 weeks of keto-adaptation, consuming 75 to 80% of calories from fat (supplemented with MCT and coconut oils) and restricting carbohydrates to 22 to 25 g per day. Ketones have an anti-catabolic protein-sparing and anti-inflammatory effect.
Lyme disease: (Caveat: This is a personal experience, not a double-blind study.) Reaching deep ketosis (for me, 3 to 6 mmol) through fasting, then continuing with calorie-restricted keto for a week, completely eradicated symptoms of Lyme disease when all else failed. It was the only thing that helped after my first course of antibiotics. It produced a night-and-day difference: a 10-time improvement in my mental performance and clarity. I suspect this relates to mitochondrial “rehab” and the anti-inflammatory effects of ketones. More than a year has passed and the symptoms have not returned, despite following the non-ketogenic Slow-Carb Diet (see page 81) 90% of the time.
Why Consider Fasting?
Dom has discussed the idea of a therapeutic “purge fast” with his colleague Dr. Thomas Seyfried of Boston College. Per Dom: “If you don’t have cancer and you do a therapeutic fast 1 to 3 times per year, you could purge any precancerous cells that may be living in your body.”
If you’re over the age of 40, cancer is one of the four types of diseases (see Dr. Peter Attia on page 59) that will kill you with 80% certainty, so this seems like smart insurance.
There is also evidence to suggest—skipping the scientific detail—that fasts of 3 days or longer can effectively “reboot” your immune system via stem cell–based regeneration. Dom suggests a 5-day fast 2 to 3 times per year.
Dom has done 7-day fasts before, while lecturing at the University of South Florida. On day 7, he went into class with his glucose between 35 and 45 mg/dL, and his ketones around 5 mmol. Then, before breaking the fast, he went to the gym and deadlifted 500 pounds for 10 reps, followed by 1 rep of 585 pounds. Dom was inspired to do his first 7-day fast by George Cahill, a researcher at Harvard Medical School, who’d conducted a fascinating study published in 1970* wherein he fasted people for 40 days.
Fasting doesn’t need to make you miserable and weak. In fact, it can have quite the opposite effect. But let’s start with how not to do it. . . .
Some Personal Background
I did my first extended fast as a last resort. Lyme disease had decimated me and put me at 10% capacity for nearly 9 months. My joints hurt so much that it took 5 to 10 minutes to get out of bed, and my short-term memory worsened to the point that I began to forget good friends’ names. Adding inputs (e.g., drugs, IV treatments, etc.) didn’t seem to help, so I decided to try removing all inputs, including food. I did my homework, found the best-reviewed fasting clinics in the U.S., and headed off.
My first 7-day fast was excruciating. It was medically supervised at a clinic, where we also had room and board. Patients were permitted to consume nothing but distilled water. Tap water, toothpaste, and even bathing were advised against. No exercise or leaving the facility were permitted for liability reasons. From days 3 to 4, my lower back pain was so extreme that I remained on my bed in the fetal position. The doctors told me this was “toxins” being released, which I didn’t accept. I insisted on blood testing instead, and the explanation for the lower-back pain was simple: My kidneys were getting hammered by sky-high uric acid levels. I wasn’t allowed to exercise (not even brisk walking), so it was taking forever to get into ketosis. My body was breaking down muscle tissue so the liver could convert it into glucose, and uric acid was a by-product. On top of this, since patients were limited to distilled water, nearly all the fasters (about 40 in total) couldn’t sleep due to electrolyte depletion and subsequent cholinergic responses (e.g., rapid heart rate when trying to sleep). Nonetheless, I noticed benefits: Long-standing skin issues disappeared after a few days, as did chronic joint pain.
On the morning of day 7, I woke up to blood spilling out of my mouthguard. I had been dreaming of strawberry shortcake (seriously) and chewed the fucker so hard that my gums split open. Basta.
I broke my fast with stewed pork—against doctor’s orders—and decided two things: Fasting was very interesting, but this wasn’t how I would do it.
Wait . . . So What’s the Fasting You Practice?
In the last 2 years, I’ve done a lot of fasting experiments, focusing on real science instead of old wives’ tales (e.g., you must break your fast with shredded cabbage and beets). I now aim for a 3-day fast once per month and a 5- to 7-day fast once per quarter. I would like to do one 14- to 30-day fast per year, but the logistics have proven too inconvenient.
The longest fast I’ve done to date was 10 days. During that fast, I added vitamin C IVs and hyperbaric oxygen (2.4 ATA x 60 minutes) 3 times per week. I did DEXA body scans every 2 to 3 days for tracking and also consumed roughly 1.5 g of BCAAs upon waking and roughly 3 g of BCAAs intra-workout. After a 10-day fast, I had lost zero muscle mass. In contrast, I lost nearly 12 pounds of muscle in that first 7-day fast.
How and why the difference?
First, I allowed trace amounts of BCAAs and 300 to 500 calories of pure fat per day on my “fast.”
Second, I got into ketosis as quickly as possible to skip muscle wasting. I can now do this in under 24 hours instead of 3 to 4 days. The more often you enter keto, the faster the transition takes place. There appears to be a biological “muscle memory” related to monocarboxylate transporters and other things beyond my pay grade. Fasting is key, which is why the keto protocol used at Johns Hopkins for children with drug-resistant seizures begins with fasting.
Here’s my protocol for my usual monthly 3-day fast from Thursday dinner to Sunday dinner:
On Wednesday and Thursday, plan phone calls for Friday. Determine how you can be productive via cell phone for 4 hours. This will make sense shortly.
Have a low-carb dinner around 6 p.m. on Thursday.
On Friday, Saturday, and Sunday mornings, sleep as late as possible. The point is to let sleep do some of the work for you.
Consume exogenous ketones or MCT oil upon waking and 2 more times throughout the day at 3- to 4-hour intervals. I primarily use KetoCaNa and caprylic acid (C8), like Brain Octane. The exogenous ketones help “fill the gap” for the 1 to 3 days that you might suffer carb withdrawal. Once you’re in deep ketosis and using body fat, they can be omitted.
On Friday (and Saturday if needed), drink some caffeine and prepare to WALK. Be out the door no later than 30 minutes after waking. I grab a cold liter of water or Smartwater out of my fridge, add a dash of pure, unsweetened lemon juice to attenuate boredom, add a few pinches of salt to prevent misery/headaches/cramping, and head out. I sip this as I walk and make phone calls. Podcasts also work. Once you finish your water, fill it up or buy another. Add a little salt, keep walking, and keep drinking. It’s brisk walking—NOT intense exercise—and constant hydration that are key. I have friends w
ho’ve tried running or high-intensity weight training instead, and it does not work for reasons I won’t bore you with. I told them, “Try brisk walking and tons of water for 3 to 4 hours. I bet you’ll be at 0.7 mmol the next morning.” One of them texted me the next morning: “Holy shit. 0.7 mmol.”
Each day of fasting, feel free to consume exogenous ketones or fat (e.g., coconut oil in tea or coffee) as you like, up to 4 tablespoons. I will often reward myself at the end of each fasting afternoon with an iced coffee with a bit of coconut cream in it. Truth be told, I will sometimes allow myself a SeaSnax packet of nori sheets. Oooh, the decadence.
Break your fast on Sunday night. Enjoy it. For a 14-day or longer fast, you need to think about refeeding carefully. But for a 3-day fast, I don’t think what you eat matters much. I’ve done steak, I’ve done salads, I’ve done greasy burritos. Evolutionarily, it makes no sense that a starving hominid would need to find shredded cabbage or some such nonsense to save himself from death. Eat what you find to eat.
Once You’re in Keto, How Can You Keep It Going Without Fasting?
The short answer is: Eat a boatload of fat (~1.5 to 2.5 g per kilogram of body weight), next-to-no carbs, and moderate protein (1 to 1.5 g per kilogram of body weight) each day. We’ll look at Dom’s typical meals and day in a minute, but a few critical notes first:
High protein and low fat doesn’t work. Your liver will convert excess amino acids into glucose and shut down ketogenesis. Fat as 70 to 85% of calories is required.
This doesn’t mean you always have to eat rib eye steaks. A chicken breast by itself will kick you out of ketosis, but a chicken breast cut up into a green leafy salad with a lot of olive oil, feta cheese, and some Bulletproof Coffee (for example) can keep you in ketosis. One of the challenges of keto is the amount of fat one needs to consume to maintain it. Roughly 70 to 80% of your total calories need to come from fat. Rather than trying to incorporate fat bombs into all meals (one does get tired of fatty steak, eggs, and cheese over and over again), Dom will both drink fat between meals (e.g., coconut milk—not water—in coffee) and add in supplemental “ice cream,” detailed on page 29.
Dom noticed that dairy can cause lipid profile issues (e.g., can spike LDL) and has started to minimize things like cream and cheese. I experienced the same. It’s easy to eat a disgusting amount of cheese to stay in keto. Consider coconut milk (Aroy-D Pure Coconut Milk) instead. Dom doesn’t worry about elevated LDL as long as other blood markers aren’t out of whack (high CRP, low HDL, etc.). From Dom: “The thing that I focus on most is triglycerides. If your triglycerides are elevated, that means your body is just not adapting to the ketogenic diet. Some people’s triglycerides are elevated even when their calories are restricted. That’s a sign that the ketogenic diet is not for you. . . . It’s not a one-size-fits-all diet.”
All that preamble out of way, here’s what Big Dom eats. Keep in mind that he weighs roughly 100 kg (220 lbs), so scale as needed:
Breakfast
4 eggs (cooked in a combo of butter and coconut oil)
1 can of sardines packed in olive oil (such as Wild Planet brand)
½ can oysters (Crown Prince brand. Note: Carbs on the label are from non-glycemic phytoplankton)
Some asparagus or other vegetable
TF: Both Dom and I travel with boxes of sardines, oysters, and bulk macadamia nuts.
“Lunch”
Instead of lunch, Dom will consume a lot of MCT throughout the day via Quest Nutrition MCT Oil Power. He will also make a Thermos of coffee with a half stick of butter and 1 to 2 scoops of MCT powder, which he sips throughout the day, totaling about 3 cups of coffee.
Dinner
“One trick I’ve learned is that before dinner, which is my main meal of the day, I’ll have a bowl of soup, usually broccoli cream soup or cream of mushroom soup. I use concentrated coconut milk in place of the dairy cream. I thin it out [with a bit of water] so it’s not super dense in calories. After eating that, the amount of food that I want to consume is cut in half.”
Dom’s dinner is always some kind of large salad, typically made up of:
Mixed greens and spinach together
Extra-virgin olive oil
Artichokes
Avocado
MCT oil
A little bit of Parmesan or feta cheese
A moderate amount—about 50 g—of chicken, beef, or fish. He uses the fattiest versions he can get and increases the protein in the salad to 70 to 80 g if he had a workout that day.
In addition to the salad, Dom will make some other vegetable like Brussels sprouts, asparagus, collard greens, etc., cooked in butter and coconut oil. He views vegetables as “fat delivery systems.”
Dom’s Recipe for Keto Ice Cream
Dom’s “ice cream” recipe contains roughly 100 g of fat, or 900 kcal of keto goodness. It can save the day if your dinner is lacking fat (remember to hit 70 to 85% of total calories from fat!):
2 cups sour cream (I like Straus Creamery brand) or unsweetened coconut cream (not coconut water)
1 tablespoon dark chocolate baking cocoa
1–2 pinches of sea salt (my favorite is flaky Maldon)
1–2 pinches of cinnamon
A small dash of stevia (Dom buys NOW Foods organic stevia in bulk)
Optional: 1/3–1/2 cup blueberries, if Dom hasn’t had carbs all day, or if he has worked out
Stir that all into a thick mousse and stick it in the freezer until it takes on an ice cream–like consistency. Once you’ve removed it and are ready to dig in, you can eat it straight or add toppings:
Make whipped cream using heavy cream (nearly 100% fat) and a bit of stevia.
Drizzle on 1 tablespoon of heated coconut oil (especially if the “bomb” has the blueberries in it) and mix it all in, which produces the mouthfeel of crunchy chocolate chips.
The keto diet calls for around 300 g of fat per day at Dom’s body weight of 100 kg (220 lbs). This dessert helps up the ante dramatically. It’s also delicious. Dom’s wife does not follow a ketogenic diet, but even she loves this dessert.
Dom’s Tip for Vegetarians
“MRM Veggie Elite Performance Protein—the chocolate mocha is very good. If you take roughly one scoop and mix it with coconut milk, throw in a half an avocado, pour in some MCT oil—the C8 oil—the [shake] that I made up has 70% of the calories from fat and 20% of the calories from protein, 10% of the calories from carbohydrates.”
Dom’s Go-To Supplements
Quest Nutrition MCT Oil Powder and Quest Nutrition Coconut Oil Powder
Kettle & Fire Bone Broth—2 to 3 times per week
Idebenone “is another product that I take [400 mg] when I fly or before hard exercise. I think of idebenone as a version of coenzyme Q10. It’s more absorbable and gets to the mitochondria easier. It’s like a mitochondrial antioxidant.”
Magnesium daily. “Magnesium citrate, magnesium chloride, and magnesium glycinate . . . When I started the ketogenic diet, I started getting cramps. Now that I’m supplementing, I don’t get any cramps. . . . If I had one go-to magnesium, it would be this magnesium citrate powder called Natural Calm.”
Scivation XTEND Perform branched-chain amino acids (BCAAs): leucine, isoleucine, and valine in a 2 to 1 to 1 combination, leucine being the predominant branch chain amino acid in the formula. “Leucine is a powerful activator of mTOR, which is a good thing; activating mTOR in skeletal muscle is really important in a short workout. I use the product pre-workout and intra-workout.”
KetoCaNa and KetoForce
Prüvit KETO//OS—Creamy exogenous ketones, tastes great
Kegenix—More of a tangy Kool-Aid flavor
Both Prüvit and Kegenix are based on a BHB + MCT patent Dom’s lab developed, which is owned by his university.
More on Fasting and Cancer Treatment
“Fast
ing before chemotherapy is definitely something that should be implemented in our oncology wards,” says Dom. He adds, “Fasting essentially slows (sometimes stops) rapidly dividing cells and triggers an ‘energetic crisis’ that makes cancer cells selectively vulnerable to chemo and radiation.” There are good studies to support this.**
One of my friends is in full remission from advanced testicular cancer. Others in his chemo cohort were laid out for 2 to 3 days in bed after chemo sessions, but he fasted for 3 days before sessions and was running 10 miles the next morning. Fasting sensitizes cancer cells to chemo, as mentioned, but it also helps normal cells resist the toxicity. This isn’t appropriate for all patients, especially those with extreme cachexia (muscle wasting), but it is applicable to many.
In cases of cachexia, some selective androgen receptor modulators (SARMs), which are designed to have the anabolic tissue-building potency of testosterone (and other anabolic steroids) without the androgenic (i.e., secondary hormonal) effects, could be helpful. Dom is also researching the use of BCAAs. He has had ~50% increase in survival in cancerous rats by adding the branched-chain amino acids to a ketogenic diet. Just as promising, the animals maintained their body weight.
In one study, treating mice with aggressive metastatic brain cancer using keto and hyperbaric oxygen treatment (HBOT), Dom, Dr. Seyfried, and other scientists were able to increase the average survival time from 31.2 days (standard diet) to 55.5 days. For the HBOT protocol, Dom used 2.5 Atmospheres (2.5 ATA) for 60 minutes on Monday, Wednesday, and Friday. Including pressurization and depressurization, each session lasted about 90 minutes.
Even in a worst-case scenario—if a patient is intubated and on their last legs—one could potentially add exogenous ketones to an IV alongside (or in place of) glucose, as exogenous ketones have been demonstrated to have a significant tumor-suppressing or -shrinking effect, even in the presence of dietary carbohydrates. To me, the last italicized part is the most remarkable.