Barbell Shrugged - [Ketones] How to Use Exogenous Ketones to Improve Cognitive and Athletic Performance w/ Dr. Latt Mansor, Dan Garner, Anders Varner, and Doug Larson #706

Episode Date: August 2, 2023

Dr. Latt Mansor holds a PhD in Physiology, Anatomy and Genetics from the University of Oxford, where his research focused on the metabolism of the type 2 diabetic heart in hypoxia.  He also holds an M.A. (Columbia University) and B.Sc. (Hons) (University of Nottingham) in Biotechnology. He is a world expert in physiology and metabolism, and consults with elite sport, military, clinical and research organizations. His interest in diabetes and cardiovascular disease stemmed from the high prevalence of those diseases in both his parents’ families.  He then developed interests in metabolism and exercise during his undergraduate years as he created a mathematical model of adipose tissue (fat) metabolism for his final year project. He then researched using exercise as an intervention for sarcopenia, muscle loss due to aging, for his Master’s thesis.  Along his journey of acquiring more knowledge on metabolic health and physiology, he started applying his findings in his daily life to strive for better health and to prove that genetic disposition to chronic diseases is not the entire equation. Epigenetics and lifestyle choices have been proven to change the trajectory of disease progression or in some cases, even reverse it! To learn more, please visit rapidhealthreport.com to see Dr. Andy Galpin and Dan Garner do a free lab, lifestyle, and performance analysis. Latt Mansor on Instagram Dan Garner on Instagram Anders Varner on Instagram Doug Larson on Instagram

Shrugged Family, this week on Barbell Shrugged, Lat Mantor is coming on the show. And this is a super cool episode. This is an insanely cool episode. We're gonna be talking about exogenous ketones a lot. And what's cool about this show is every time I hear the word ketone or ketosis, I have this like really aggressive eye roll to the left.

I don't know why it goes to the left, but I always go, oh my gosh, another keto person. So we've heard so much kind of crap over the years about the keto diet and basically how it's going to give you a cape and turn you into Superman, but that's not really the case. But what's really cool about this is that with all of the kind of like marketing gimmicky things that go along with the keto diet and ketosis and things that just really make you have that reaction, that eye roll reaction. Latt Mansour comes on here today and actually drops some real scientific knowledge. He works for a company called HVMN.

They have created a product called Ketone IQ. Dan Garner is a massive fan of them. I've tried their products as well. But what we dig into today is a lot of understanding how you can use ketone, ketone, exogenous ketones for cognitive, athletic performance, the health side of things. And a lot of this stuff I just didn't know. And that's one of the most beautiful things about Barbell Shrugged and having it in my life and being able to meet all these people is that I come many times. I feel like I've heard everything so much that this must just be the answer. And then I meet somebody that has a much deeper knowledge set and actually can bring some

real science to the conversation and bring value to exogenous ketones and how you can actually use them, some protocols that you can follow and the real benefits of them. So I'm very grateful, one, for the show, two, that Latt was able to come on here. And he's got like the coolest name of all time if you're a meathead, like who doesn't want to be named Latt if you're a meathead? As always, friends,

make sure you get over to rapidhealthreport.com. That is where Dan Garner and Dr. Andy Galvin are doing a free lab lifestyle and performance analysis. Get over to rapidhealthreport.com. Friends, let's get into the show. Welcome to Barbell Shrug. I'm Anders Varner, Doug Larson, Dan Garner. Today on Barbell Shrug, Lat Mansour.

You have the coolest name ever. Lat is a great name. Thank you. You are the research lead at HBMN, and today we're going to be talking about exogenous ketones. Dan brought all the ketone IQ to our last executive retreat. Oh, wow. We were all hopped up on all the energy you were giving us through ketone IQ. So welcome to the show, man.

Thank you very much for having me. So I'm glad to know that you guys all have experienced it already. Yeah. Yeah. Yeah. Dan was living off of it. Yeah. We had a long day of business development, business strategy, long days of meetings and

figuring stuff out. And then around five or so, we decided we to go train and uh all had a shot of ketones and got after it nice nice yeah i remember a while like a couple of months ago when i interviewed dan on hvm and podcast um dad still haven't tried our ketone iq and i offered you know let let me send some to you and maybe you know if you want to get your athletes on and whatnot and dan was like messaging me afterwards is like, Hey, I'm on, I'm on the diet and it really works. It gives me energy. I get, I get my, my appetite suppression. Can you send some more?

I was like, absolutely. Yeah. I get sent a bunch of stuff and it's not often I messaged the person back and like, this stuff really works. This works. And for full context, Dan, Dan, you were in the middle of a cut. You're, you're, uh, trying to get as lean as possible and peaking at a specific date. And so your calories are very low and you are wanting to have more energy. And so this was helping you when you were on a very low calorie diet. Uh, you, you, you can, uh, make comments about the details of your, of your diet and cut and whatnot. But

yeah, how did it affect you? Given you are in a caloric deficit? Yeah, so the benefits were actually great. I thought it was a good time to actually incorporate it because I everything was so controlled. I was basically in a metabolic ward because I was getting ready for a photo shoot. So all of my protein, carbs, fats, everything was being weighed to the gram. My training volume is very exact, keeping the logbook going. Everything is hyper, hyper dialed in. And I was near the end phases of my diet. And anybody who has reached levels of extreme leanness knows what that feels like.

You are you're very hungry. Cognitive performance goes down. Physical performance goes down. Appetite never really goes away, no matter what time it is. And no matter if you just ate a meal or not, it's kind of just always there. So it was a good time to try something like this. And I'd never done exogenous ketones ever before. And I just started having it. And just from a, the perspective of just incorporating it from someone who's been training for 20 years, who really knows their body. Um, it was really beneficial. I didn't expect to, to feel that good

that quickly it takes like, and, and for full context that had about a shot like 10 minutes ago. So I am currently, I am currently on, uh, keto IQ, but, um, I, I, when I introduced it, I was very surprised in about like 10 minutes or so, you already start feeling a little bit more energy and alertness and focus. And but more beneficial for me is it increased my energy. So I could keep calories, the calories outside of the equation, rocking and rolling while I was getting leaner to continue that process. But because of the focus and attention, I was actually able to still continue to stay more productive at work. Whereas other than that, like, you can add in more caffeine, but your sleep is already bad because you're so hyper

hypocaloric. So I don't really want to add more stimulants to it. If you take keto IQ, even later in the day, it does not impact sleep at all. It just really increases your cognitive performance, helps reduce appetite and help increase my energy expenditure. So then I just started thinking about my athletes because sure, I'm getting ready for a photo shoot, but like I'm replicating like a fight camp in a way because I am extreme energy expenditure. I'm trying to drop weight. Everything is dialed in. And what do I need? Appetite suppression, mental performance, physical performance. That's a UFC fight camp. We're trying to lose weight and we're trying to stay dialed in and what do i need appetite suppression mental performance physical performance that's a ufc fight camp we're trying to lose weight and we're trying to stay dialed in from a mental and

physical perspective so we can i was just thinking about how this is impacting me and how it can impact my athletes and i had a good experience and i began experimenting with my athletes as well yeah there you go dan do you need a job as a spokesperson? I guess you spoke about Ketone IQ so well. I don't know. It might be the Ketone IQ that you just took. It's all hopped up on Ketone IQ right now, and you're not even going to be able to talk on this podcast. People are after honest opinions. I just had a good experience. really appreciate the feedback dan um and i mean i can talk science about ketone iq all day every day right but ultimately it's in the hands of athletes like you guys that have tried it and experienced it and sharing then your honest opinion is what make us a brand that is worth trusting yeah as as a research a research lead uh in this space, what are the generally accepted, already pre-established

benefits of ketones that everyone knows about and everyone agrees is the case? And then what are the new things that people are looking into that research is hoping to unveil? That's a great question. So ketone esters, when it first came out, it was very much heavily researched into sort of endurance exercise, cycling, triathlon, and even long distance of endurance runs. And we have had a mixture of papers that showed either improvement of performance or non-improvement depending on the protocol. And as I tell many people, I'm very transparent about it. A lot of these studies have been done on ketone esters because they have been around for the longest. And there are some studies that showed improvement from 2%

to up to 15% if you look at the paper on recovery. And then there are some papers that show no difference. And then there's one paper one paper recently that got published that showed detrimental performance like a little bit less performance compared to placebo but then i went in and look at the paper the protocol is very different it's a very short workout it's about half an hour um workout versus a lot of these other studies that looked at three hours five five hours. We ourselves run another study on anaerobic work, which is 10-second sprints after a 5K run. And that is with ketone IQ, which is different from ketone SN.

We can talk about the different exogenous ketones in a bit. But I think in endurance sports especially, regardless of what mixed studies data have shown, we have a lot of athletes, cyclists who truly believe in exogenous ketones because they have used it. They've experienced it. They have broken records with it. So that is a more established side of things when it comes to performance enhancement. And then we also finished a $6 million contract, almost finished a $6 million contract with

the DOD looking at ketone esters and cognitive and physical performance in hypoxia. So low oxygen environment, especially in high altitude. This is especially important for special operators who have to operate in mountain ranges and all of that. And we have seen the cognitive decline when you are in hypoxia get mitigated when they are on ketones. And on top of that, we also see increase in vigilance, increase in reaction time, accuracy, and all that. So this is definitely a very, very interesting area where you can look at performance, but then there are the other areas that has been shown in an established way is that it has a glucose lowering effect. So a study by University of British Columbia by Professor Jonathan Little, he showed that across the board when taking

exogenous ketones after food, it lowers blood glucose levels. So this is especially important for people who are metabolically unhealthy, who are pre-diabetic, obese and whatnot, and have that effect of not having your blood sugar level constantly elevated. And then there are other more day-to-day sort of effects where cognitive function, focus, as well as just general well-being, because we are so exposed to the ubiquitousness of glucose in our lives that most of us find it very, very difficult to even have that metabolic flexibility to be able to switch substrates, to burn fat, to burn ketones. So having some form of fuel that is not glucose in our bodies, essentially train our body to upregulate the enzyme, the hormones that's needed for those pathways and

therefore increase our metabolic flexibility. So that's how I would see it. Shark family, I want to take a quick break. If you are enjoying today's conversation, I want to invite you to come over to rapidhealthreport.com. When you get to rapidhealthreport.com, you will see an area for you to opt in, in which you can see Dan Garner read through my lab work. Now, you know that we've been working at Rapid Health Optimization on programs for optimizing health. Now, what does that actually mean? It means in three parts, we're going to be doing a ton of deep dive into your labs. That means the inside out approach. So we're not

going to be guessing your macros. We're not going to be guessing the total calories that you need. We're actually going to be doing all the work to uncover everything that you have going on inside you. Nutrition, supplementation, sleep. And then we're going to go through and analyze your lifestyle. Dr. Andy Galpin is going to build out a lifestyle protocol based on the severity of your concerns. And then we're going to also build out all the programs that go into that based on the most severe things first. This truly is a world-class program. And we invite you to see step one of this process by going over to rapidealthreport.com. You can see Dan reading my labs, the nutrition and supplementation that he has recommended that has radically shifted the

way that I sleep, the energy that I have during the day, my total testosterone level, and just my ability to trust and have confidence in my health going forward. I really, really hope that you're able to go over to rapidhealthreport.com, watch the video of my labs, and see what is possible. And if it is something that you are interested in, please schedule a call with me on that page. Once again, it's rapidealthreport.com. And let's get back to the show. To what degree are ketones just a replacement for glucose? How is that statement accurate and not accurate, both physically and cognitively? So the way I see it, it's not replacement in a way or another.

Metabolism is always an interweb of relationships. It's a very sophisticated seesaw effect. And it's always in a flux situation, in a flux position where it is not one fully turned on, the other one turned off. You will always have some form of glucose metabolism. You will always have some form of glucose metabolism. You will always have some form of fat, fatty acid oxidation. Knowingly, if you increase fatty acid oxidation, you will

decrease glucose metabolism and vice versa, but you will never completely turn one off and the other on because ultimately there are processes in our bodies that require fats. There are processes that require glucose. So when ketones enter the body as another source of fuel, it's in the same process. It all goes into the Krebs cycle, right? It goes into the Krebs cycle in the mitochondria and then goes into the oxidative phosphorylation, creates ATP, which is the energy currency of the cell. So when it comes down to that is essentially what does your body, so our bodies are very, very smart, right? It will always prioritize the most efficient fuel at the moment. So depending on what activity you're doing. So if you are doing sprints, it will prioritize glucose. That's what

we will understand in terms of, you know, metabolism. If you go for zone two cardio, it will prioritize fat burning because, you know, you have that time to really get in the oxygen and really burn fat required for, for respiration. So same thing here, if ketone comes in, we have seen again and again, and a lot of cases where the brain, the heart, and to a certain extent, the muscles would prefer to uptake glucose, sorry, uptake ketones over other substrates. In the failing heart, what we have seen is that the upregulation or the uptake of ketones is independent of other other substrates so the glucose and fat uptake is still maintaining whereas as soon as they they increase the ketone

availability ketone uptake also increases so that said it just basically taking in more um fuel and source of energy for the failing heart in order to help it mitigate the damage or help with recovery. So that's another very interesting role that ketone places like it's a source of energy, but it's also a source of energy that the body recognizes as as very efficient, and will always prioritize, especially when it comes to brain health. Okay, so in terms of like fuel sources, like peri workout nutrition is always popular topic in the industry of having pre intro and post workout nutritional guidelines for given training volume and size. Do you have or recommend direct combination of carbs and ketones taken

together? Or do you prefer one or the other? Absolutely. The first, the former, um, we never intended it to replace glucose when it comes to workout and performance supplementation. So what we are actually recommending is the hybrid dual fuel system where you have access to both glucose and ketones. So we always recommend our athletes to have ketone IQ half an hour before their workout together with carbs, and then top up 90 minutes into their workout. Also with carbs, the standard carb load, which is one gram per kilogram body weight per hour, or 60 to 70 grams per hour. So that is the recommended dose. And then as far as post-workout goes, one study specifically looked at the intake of ketones together with protein and carbs actually increases their performance after three weeks,

about 15% workout output. And then another paper that looked at a more molecular mechanism of action showed that when you put ketones, carbs and protein as a post workout intervention or post workout nutritional strategy, they saw an increase in mTOR activation, specifically leucine mediator mTOR activation, which is essentially more important for protein synthesis and recovery of muscles as well. Okay, so in this peri-workout guideline, you're talking glucose and so glucose and ketones 30 minutes prior to and then your typical glucose recommendation. Is this only for aerobic efforts? Because typically ketones are kind of connected to longer term endurance, just at least from industry perspective standard. Do ketones have benefits in an anaerobic session as well?

Yes. So that is a great question. So let's go back to basic metabolism for a second, right? So what are ketones? Ketones, like I said, is essentially substrate and fuel. Our bodies are designed and programmed to be able to make our own ketones as well as metabolize it. And we only make our ketones when we are low on carb storage and we are low on glycogen storage. So that happens when we are either fasting, we're going through starvation, or we are going through a very carb-restricted diet, i.e. keto diet. So when that happens, our body will break down fats into ketones in our liver. The whole purpose of this is so that ketones can bypass the blood brain barrier, which fats cannot do in order for the brain to metabolize and create energy, because usually the brain would use

glucose for energy. But when we are low on carb storage and glucose storage, we don't have energy source. Therefore, we need to use ketones. So that's where ketone comes from. So as the sort of metabolic understanding of ketones, we always thought that ketones come from beta oxidation, which is the fatty acid oxidation pathway, right? So it will only be better for endurance exercise because it uses, you know, more oxygen to, to create ATP versus glucose, which the first half of glucose metabolism is glycolysis, which is oxygen independent. So you can create energy without using oxygen. Granted, it's just a oxygen debt that you have to pay off later on when you, you know, have, have the oxygen available, but nonetheless, that's why glucose

is always the preferred, quote unquote, preferred fuel when it comes to anaerobic. And we have seen all this time that endurance exercise have been really benefited from ketone supplementation. But recently we just completed a study with the University of North Georgia, one of the best

top military school in the US. We looked at anaerobic exercise. So the protocol is pretty simple. We put these participants through a 5K run at their own pace. They can just finish it whenever, however fast they want. But knowing that after the 5K run, they will put immediately on a stationary bike and do a Wingate anaerobic test. A Wingate anaerobic test, they have to go through five bouts of sprints, 10-second sprints

with half a minute rest in between at 7.5% body weight as their resistance. And they have to just push as hard as possible, right? So in terms of ketone supplementation, they were given ketones and carbs before the 5k and top up with ketones after the 5k before the Wingate. And to our surprise, we have seen an increase in peak power, average power, velocity. So not only they're pedaling harder, they're pedaling faster as well. And then they also decrease their fatigue index. So we measure how fast they get fatigued over the five bouts of sprints. And those who are on ketones, ketone IQ and carbs actually fatigue less compared to placebo.

Now, this is a very interesting area, right? Because we measure RE outreach is respiratory exchange ratio. And that tells us whether you are metabolizing more glucose or carbs. Both groups are way above one, which means they are both metabolizing a lot of carbs, right? A lot of glucose. But the one group on ketone IQ have significantly lower RER compared to the placebo, meaning that they shifted the glucose metabolism down a little bit, although they're still utilizing glucose. So the improvement in performance, what we think it is, is something to do with the cognition. Either there is something that is being turned on in the brain, or it could be a numbing of the perception or sensation of pain, because the whole point of anaerobic test is a buildup of lactic acid and buildup of, of essential localized pain in the muscles so that you will go through fatigue faster. And, you know, we measure performance that way.

So we suspect there is a mild energetic effect of ketones on the brain that makes these participants feel less painful and essentially make them push further and, and essentially not feel as tired compared to placebo. All of the ketone information, I feel like from maybe six, eight years ago was all about, you don't have to eat carbs. You still have energy and you can be on this ketogenic diet and it works. And you got to walk around and like test your blood to make sure you're in ketosis. Um, when did you start to turn the corner and thinking

about this in like a performance, uh, with a performance mindset versus just what everybody wants in, in fat loss. That's, that's great. A question as well, because, um, as you said, like keto diet has been around for more than a hundred years, actually they invented keto diet for treating epilepsy, right? Because, um, they, they saw that an increase in ketones help with epilepsy and they help with a certain, you know, neurodegenerative diseases. People have been taking MCT, the medium chain triglycerides, to the increase in the chronic disease epidemic that we're facing, right? But DOD, the Department of Defense of the US have other ideas because about 20 years

ago, they asked scientists to create a super fuel to fuel soldiers on long and demanding missions. And we already have calves, we have proteins, we have fats as micronutrients. So they were sort of experimenting with other form of substrates and fuels, and they sort of played around with ketones. And that was how Ketone Esther was created by Dr. Richard Veach from NIH. And it was initially costing like $25,000 for a dose. And then, you know, through scale and everything and, and manufacturing, we managed to launch it, HVMN launched the first ketone ester into the world in 2017 and that was when it was used for performance because it was

conceived due to a grant that was sort of focused on performance and therefore it's used for performance so it sort of didn't come through oh ketogenic diet was good so let's create an exogenous ketone to supplement it was more like keto diet is great okay we know the effects of ketones and then another group was like actually you know ketones could be a super fuel because we see certain organs does prefer ketones to a certain extent and in 1995 as well sato et al published a paper that showed ketones are a more efficient fuel compared to glucose per molecule of oxygen used. So that's when the idea came up with, you know,

maybe this form of fuel could be used to really push performance or also just provide the energy needed for long and demanding missions. Okay. So when does it make sense to actually do your best to go into ketosis without supplementing exogenously versus supplementing exogenously? There's probably pros and cons to both paths. When does it make sense to just do it kind of the old school way? We'll say, I think, I think it really depends on your goal. So if your goal is metabolic health in terms of if you're trying to lose weight, I think keto diet has been shown to be very, very successful when it comes to losing weight,

when it comes to lowering hyperinsulinemia, which means, you know, if you have elevated insulin all the time, and possibly, you know, going through pre diabetes or, or diabetes, early stage diabetes, you will definitely benefit more by going through the diet. Because if you think about it this way, if you follow the ketogenic diet, it's more of a lifestyle change, right? If you supplement with exogenous ketones, it's more of a supplement. So if you break this down, I always tell people that ketone IQ is a supplement. If you want to live healthily, if you want to perform great, you need to still dial in your foundational work, i.e. your activity, your physical activity, your nutrition, you know, what you eat on a daily basis, your sleep and

stress management, your recovery. And when those are dialed in, then you can sort of augment it with supplementation, i.e. like ketone IQ and carbs and nootropics and all of that to add on to. But if you're trying to fix those foundations to begin with, and if your problem is having too much processed sugar, having too high insulin levels, too high blood glucose levels, then keto diet could be an answer for you. Hope that answers the question. Yeah, given like taking lifestyle out of the equation, and just purely diving into chemistry here. Yeah. Because there's a lot of benefits, of course, the lifestyle, but just zoning in a little bit more, I kind of have a two part question for you. Number one, what differences are there between endogenous

and exogenous ketones, if there are any differences occurring there? And number two, you mentioned that this diet was originally founded through helping epilepsy, you've mentioned it crossing the blood brain barrier. So I'm wondering, if endogenous ketone supplementation is beneficial for brain health, if there's any differences between it and exogenous ketones, and if so, are exogenous ketones also beneficial for brain health? Yes. Great questions, Dan. So first of all, the first question about, is there any difference with exogenous and endogenous ketones? If we're looking at a molecular point of view, ketones are ketones are ketones. Your body will recognize ketones the same, whether it's being produced in the body or when you're taking it directly from a drink.

So from a molecular point of view, they are the same. Now, if you are saying, if it's the same, why do you call call endogenous ketones and exogenous ketones? I think that falls down to the origin of where the molecule comes from, right? Endogenous ketones, you create internally. Exogenous ketones, you essentially ingest it externally. Now, there's always pros and cons. When you create your endogenous ketones, you will have, you know, provided you're going through that same sort of lifestyle, you will have unlimited amount of

ketones because you keep producing ketones because that's your main source of fuel versus glucose, for example. Whereas if you take exogenous ketones is a temporary source of ketones, and you will either need to top it up or it will come back down to baseline level after X amount of hours. So then it comes down to what, like I said, you know, what your goals are. If your goal is to be in ketosis as long as possible, then maybe keto diet could be good. And then you augment that with exogenous ketones to keep you in even deeper ketosis. Or if you enjoy a more flexible lifestyle and not have to cut your carbs, but you still want that extra ketosis benefit, i.e. like cognitive clarity or performance boost,

then you can have exogenous ketones. Now, when it comes to brain health, though, they both, since I said molecularly, they are both the same molecule, BHP, beta-hydroxybutyrate is the main ketone body that is being transported around the body and being metabolized for energy. They cross the blood-brain barrier the same. So having said that, a study actually looked at brain network stability. They looked at the interaction between brain regions. They put the participants on one week keto diet, and then the other group was one dose of ketone ester versus placebo. And both groups, both on keto diet and ketone esters, they saw an increase in brain network

stability, showing that ketones work the same, but it is really depending on what degree you want it to work on. Let's say if you have Alzheimer's and you have developed it for a while, you probably want to have a much more sustained effect of ketones when it comes to that, right? So that's where you have either a consistent loading of the supplement of ketone, of exogenous ketone, or if you're on ketogenic diet. I think, you know, how long do you need or want to be in ketosis versus one over the the other, which one is, is, is more sort of, you know, one, which one is better than the other. I would see, I would see, see the use cases

instead of the origin of, of the molecule. Does that extend out to traumatic brain injury, TBI? Yes. So what actually two years ago, 2021, I published a review paper looking at potential use of ketones as an intervention for traumatic brain injury and as an extension to neurodegenerative diseases. Because first and foremost, we saw some similarity in terms of metabolic dysfunction when it comes to traumatic brain injury and neurodegenerative diseases, i.e. especially when it comes to glucose utilization, we see a glucose deficiency, glucose utilization deficiency in both TBI patients, as well as say Alzheimer's patient. And that's a reason why they call Alzheimer's patient type three diabetes,

because they're not able to utilize glucose properly. So in TBI, when you have a concussion, when you have a brain injury, acutely within 48 hours, what they have observed is that they saw a hyper metabolism of glucose. They have an increased intake of glucose. They have an increased metabolism of glucose. Some says that it's increasing metabolism to create energy to deal with the damage and mitigate damage. Some people say, some researchers think that it's being shoved into the pentose phosphate

pathway to create NADPH to help with both mitigation and recovery. So we don't know exactly why there is hypermetabolism of glucose specifically, but we saw that. And just right after that, the glucose metabolism would go down. And then we see an increase in metabolism. And over a long period of time, like the long-term damage of TBI patients, we have observed that they have, like I said earlier, hypometabolism of glucose. So they're not able to use glucose properly. So that being said is an energetic problem as much as it is an inflammatory problem. And when you put ketones into the mix, you are essentially providing the brain with the energy it needs that it can't use glucose for. Either there is a dysfunction in

the uptake, either the glucose transporter or the glucose pathway, it doesn't matter because ketones use a complete different metabolic pathway and therefore able to really compensate for the gap of energetic deficiency that glucose is missing, right? So, and then on top of that, we also have seen a profound effect of ketone on inflammation, especially NLRP3 inflammasome. So that could also potentially help with the recovery of TBI patients. In fact, right now we are applying for a grant in partnership with Naval Health Research Center based in San Diego to use Ketone IQ to look at TBI patients, especially within our military population, who's, you know, has high risk of, of really being exposed to TBI. And in two weeks, we are going to Vegas and NSEA conference as well. We are hopefully going to talk to some NFL teams who are also very

interested in TBI. Obviously, you know, that's one of their main concern of the athletes getting exposed to TBI. So this could potentially be a really great partnership to one really prove the science, whether or not it works like we want to know either way, we're not trying to push it because we we know that it will work. I think coming from a scientific point of view, I am really, really interested. If there is something we can do nutritionally, not just mechanically to prevent and mitigate the damage of TBI,

then why not, right? Yeah. This seems highly related to what you just said, but totally anecdotal and observational. But over the years, I feel like I've heard many people talk about exogenous ketones and related related to uh kind of mental clarity and it's always older folks in

my experience that they're in their 50s and 60s that they take ketones and they go wow just provide so much mental clarity and then my younger friends in the 20s and 30s they're like they're like uh yeah it didn't didn't really do it they don't seem like as enthusiastic about the mental clarity benefits, but it sounds like that's more or less what you just said, like neurodegenerative disease, even if it's not like diagnosable, they don't have Alzheimer's, but maybe they're along that continuum at some level, they're getting benefits from exogenous ketones from a cognitive perspective. So is that true? Like as you get older, you're more likely to get those benefits?

So one of the main reason why the paper on the brain network stabilization, why they did that experiment is because they know that as we age brain network, destabilization, um, will occur over time as we age. So that's when, you know, people have higher risk of developing neurodegenerative diseases, dementia, Alzheimer's, and all of that. So it comes with age and age does increase the risk of developing neurodegenerative diseases, dementia, Alzheimer's and all that. So it comes with age and age does increase the risk of developing those as well. So yeah, you could be right that because we age, we are developing those form of deficiency and dysfunction, which also comes with metabolic dysfunction, and our inability to metabolize glucose as well as we do when we're

younger and therefore giving us ketones, we'll be able to really compensate that energy deficit. Yeah. Are there negative benefits to, uh, too many ketones? Like if I take the ketone IQ bottle and just take it down in one shot. Are there negative drawbacks to... It's the same as if there are negative drawbacks when you drink too much glucose or you drink too much fat or you take too much proteins. Too many fish oils.

Yeah, too much fish oils. I was on board with you until you said too much protein. I was going to say, although now in our world the problem is a lot of people don't have enough protein that's the problem right um i think one is in terms of of calories you know you are still if you have a lot of ketones that's that's calories as well right like i said one one dose 10 grams of butanol is about 70 calories so you will have excess of calories there and two you probably get some gi gi distress because you know same thing when you have too much glucose uh your body will try to expel it you'll feel like sick uh you might

go through diarrhea or vomiting yeah and that's that's just how it is so when you have excess of substrates or energy you just go through that so yeah so i would not so what we normally would recommend is not more than three doses per day but a lot of our athletes obviously they use more than three doses just because they are using it up as they work out and they top it up and even if you measure their blood glucose and blood ketone levels, you will be able to see that both substrates are going down because they're working out so hard that they are actively burning off the substrate

that they are ingesting. You're counting a dose as 10 grams that you just mentioned? Yeah. And then for exogenous ketones, is there like maybe per company or however it's set up, but like the quality of those ketones, does that vary from company to company? Like, is there a quality control issue across the board like there isn't every supplement i really wish there is because we all know you know we're all in this space that we know that the supplement market yeah it's it's a black hole

it's you know everyone can claim anything and it's marketing language you know everything and all so there isn't a standardized quality assurance, quality control per se for ketones. The only ones, you know, the overall sort of seeing, overseeing body would be FDA. And we are FDA-grasped, generally recognized as safe. And then we also send our samples to third-party testing facilities for banned substances we are

water compliant and that's why a lot of athletes are able to use our products because we do provide our certificate of analysis and all of that we're very transparent with our ingredients um they are i can't speak for other you know companies out there that some of them they call it proprietary ketone blend um and i like the fact that a lot of these ketone salts nowadays, they start marketing themselves as ketones because now that people realize that ketone salts don't work as well because you can't increase your blood ketone levels to a significant level unless you increase those. But then if you increase those, you are increasing salt load and you increase salt load, you increase GI distress. And then there's now starting to market it as ketones.

They don't call it ketone salts anymore. And then you look at the ingredient is BHB bound with sodium, BHB bound with magnesium, potassium, and those are ketone salts. So that's another form of exogenous ketones. Ours is butanediol that gets converted into BHB, beta-hydroxybutyrate directly in the liver. And then there is ketone ester. And ketone ester is essentially half of it, or ketone monoester, half of it is BHB bound with butanediol in an ester bond. That's why it's called ketone ester. It's just a generic molecular term for a ketone bound with something in an ester bond. So when we came up with the first ketone

ester in 2017, it was only that, but now you get other ketone esters. You get, there is a 2C6 bound with the butanediol. C6 is a medium change of triglyceride to two fatty acids bound with a butaned dial and that's ketone diaster. And then you get like, um, as to acetate diaster. So that's another ketone form because we produce three ketones forms in our bodies. So beta-isotoxibutrate, which I talked about is the main ketones that's being metabolized. And then there are the other two intermediates forms as well, acetoacetate and acetone. Acetone usually gets released in your breath. When people on keto diet, you get the fruity breath that's acetone. And nail polish is also made of acetone. And acetoacetate usually comes out in urine. So whenever you do urine tests for ketones, that's usually what it measures. It measures acetoacetate usually comes out in urine. So whenever you do urine tests for ketones, that's usually what it measures.

It measures acetoacetate. So there are so many exogenous ketones out there at the moment, and it's really difficult to find the correct and real information and data. And that's also part of what I do with HVMN podcast is really to spread the knowledge and information and let people make informed decision because

everyone is trying to sell things, right? Everyone's marketing their own things and trying to say that products is better than the other. So we're just very transparent about it. It's like, I was just beating dial really converts to beta hydroxybutyrate and it increases your blood BHP, can increase your blood BHP up to 2.5 millimolar. What we have seen is that higher dose than that, you will still cap at 2.5.

I think the reason is because it goes through your liver and your liver has feedback from the rest of your body. If the rest of your body says, I have enough energy, I have enough ketones in my body, it will then slow down the conversion to BHP. Versus ketone ester, half of it goes through your liver because it's still butanil, but the other half, the BHP, goes directly into your blood. And as a result, the more you take, the higher your blood ketone levels go. And what we have seen is that with a military project, people you know because we we do body weight matched and some some of the guys are big

right so they have like high doses and they reach like six seven millimolar and they start to feel sick as you said you know too much ketones um and then another paper also showed the acidification of blood because of the drastic increase in blood ketone levels drop your blood ph level and that's why one paper showed that taking it together with bicarbonate sodium bicarbonate actually neutralizes it and increase performance but the good thing with ketone iq is that you don't have to go through all that because it doesn't go over 2.5 so what we now call the optimal threshold optimal dose for both therapeutic and performance is that you want to stay between 1 to 2.5 millimolar i think that's a really great goldilocks zone and one thing we as human beings will always do as a mistake is that we think one thing is good so more is always better. No, when it comes to metabolism,

when it comes to physiology, everything needs to operate within an optimal level. Dan, I know you know this very well because you work with blood work. You need it to be in the optimal level. Just because if someone says cholesterol is good for you, doesn't mean more is better. If someone says fats are good for you,

doesn't mean more is better if someone says you know fats are good for you doesn't mean more is better it needs to fall within the ultimate um optimal level for that specific purpose so same here with ketones for sure yeah everything seems to operate in a u-shaped curve where too little of something's not very good and then there is a sweet spot in the middle that's optimal and then too much of something becomes not good again. Exactly. Biology never likes to operate on extremes. And you learn that lesson so many times. So many times that we still forget and we still forget how creatine is good. I'm going to bathe in creatine. Yeah. Even along those lines, would you even recommend like a ketogenic diet to, I'm saying this on like a broad spectrum,

but recommend it to people if, if they can still eat carbohydrates and take exogenous ketones and get benefits from both at the same time, kind of doesn't seem like you need to cut carbohydrates out of your life and, and then check every, every hour and a half or whatever it is to make sure you're in ketosis still. That's, that's the value proposition, right? That's, that's essentially the pitch that we make to most people who want to be more flexible with their diet. However, we've got one of our HVMN athlete, he's type one diabetic. So he just prefer not to, um, take glucose at all. And he just go on a ketogenic diet and ketone iq for his runs and his long long distance run and he can and he's so fat adapted that he can just go on a keto diet and

just go on ketone iq and achieve the results that he achieves some people are just not as keto that they need some form of carbs for example like i go to the gym when i lift and i feel that when i went through keto diet for like two months some people said that was not long enough but i felt that i was more fatigued uh faster compared to if i have a little bit of carbs granted i also can't eat a lot of carbs because growing up in malaysia every meal is freaking like you know carb central right it's like noodles or rice um but that lifestyle doesn't suit me either because i'll put on weight like you know without even wanting to so i need some form of carbs for that high intensity like uh strength

training but then also dial it dial it down enough that I can really burn fat when I need to. Yeah. What triggered, what made me think about that is like, we get, we get tons of people into the program and they've got a fasted blood glucose issues and they're freaking out about it. And the next thing you know, it's like, and then I tried keto and it didn't go away. Right. And then they're stuck because they've gone all the way to the end. They cut carbohydrates completely out of their life. And they have nowhere to go. Yeah. And they've got nowhere to go. That's when Dan shows up. But you're offering really like a different point of view and that they don't need to go that far. And there's likely some other cause of why they're having this

glucose issue. That's right. That's right. I think, yeah, like I said, I think, you know, two points, two reference points that I always refer to when it comes to that, right? One is the end goal. What is the end goal? What are you trying to achieve?

Are you trying to achieve metabolic health? Are you trying to achieve performance? And then the other end is like what your body is doing. It needs to be somewhat personalized to you. If you're a better fat adapted, if you're better carb adapted, if you're better, you know, Dan can speak more to this about, you know, how someone is just better at utilizing certain substrates and then tie that into your final goal. And then you get the answer in the middle. Yeah, for sure. One thing I'm interested in is if there's any theoretical or mechanistic reasons to why there would be gender differences. ketones are human, right? So is there any is there any

difference in how you would apply exogenous ketones between males and females? I think I think there is, as much as as much as I want to say ketone is ketone is ketone. Um, I think they are some differences. Well, so far I've seen one paper. Um, I think there are more that looked at differences of, of, of, of, you know, male and female going on a keto diet. And I believe post menopause, if I remember, if my memory serves me correctly, post-menopausal female is very much similar to male. And then pre-menopausal is slightly different when they go on ketogenic diet. But this is a diet though I'm talking about.

I'm not, I think as far as exogenous ketone go, because like I said, it's so transient and it's such a low calorie, the result should be insignificant. But when you go through a whole lifestyle change, it will inevitably change your hormonal system as well, because your hormones are being run by fats, glucose, and a lot of your hormones are being synthesized by, you know, fats by steroidal hormones, hormones. And if you suddenly increase those, what will happen to them? So obviously, the male and female hormonal system are very different. There's hormonal cycles for females as well. So when you look at those differences, there's no wonder that there is

difference when you employ a certain lifestyle change between males and females. But as far as performance and supplementation with ketone IQ go, we haven't seen any significant difference. In fact, we have a lot of very successful female marathoners, including Sarah Hall, you know, breaking records on Keto and IQ. Yeah. Fantastic, man. Where can people find you? People can find me on all social media

at Lat Manso, L-A-T-T-M-A-N-S-O-R. They can find HVMN as well on all social media at HVMN, as well as check out our podcast, HVMN podcast well on all social media at HVMN, as well as check out our podcast, HVMN podcast with Dr. Lattman. So on all podcast platforms and YouTube and Dan Garner will be on in a couple of weeks.

There it is. Dan Garner. All right. You guys know where to find me. You can find me at Dan Garner nutrition. Thanks so much for coming on. This is awesome. Doug Larson.

You bet. Latt. I'll pair it with Dan said, man, thank you for coming on here. You're incredibly well-educated on this topic. So I really enjoyed talking with you. Yeah. Thank you very much for having me. I had a blast. You guys really asked very, very great questions, very specific and, um, educated questions. I'm, I'm, it's a pleasure for me to, to answer these questions and have a chat with you, gentlemen. For sure.

I'm on Instagram, Douglas E. Larson. Appreciate it, man. I didn't even know you existed. Now I can't wait to check out your show. There you go. Yeah. You should come on. I don't know if I'm on.

I'm on this. Dan's like, I don't know if that's for him. That might not be good for this guy you've ever had on the show. That might not be good for our brand. I think we should all get into in-person and record one in-person. I would love that, man. That would be fun.

Yeah. I'm Anders Varner at Anders Varner, and we are Barbell Shrugged at barbell underscore shrug. Make sure you get over to rapidhealthreport.com. That is where Dan Garner and Dr. Andy Galvin are doing a lab lifestyle and performance analysis that everybody inside Rapid Health Optimization gets for personalized supplementation, nutrition, lifestyle. You can see that over at rapidhealthreport.com. Friends, we'll see you guys next week.