Dr. Dominic D’Agostino holds a PhD in neuroscience and physiology from the University of Medicine and Dentistry of New Jersey. Focusing on areas like ketone supplementation and ketone technologies, Dr. Dominic D’Agostino is currently an associate professor at the University of South Florida College of Medicine’s molecular pharmacology and physiology department. He is also a research scientist at the Institute for Human and Machine Cognition (IHMC).
Dr. Angela Poff, a research associate from the same department at USF, recently commented on studies to cover the science supporting the ketogenic diet as an adjuvant treatment for breast cancer. Dr. Poff discussed that since tumor cells rely primarily on glucose and glutamine, a low-carbohydrate diet keto diet may indeed deprive the cancer of its preferred source of fuel, also emphasizing the suppression of insulin signaling. She also emphasized, however, that further ketone research is needed to fully understand the cancer-suppressing characteristics of this diet. The preclinical work is compelling, but human clinical trials are needed.
The ketogenic diet is a low-carb diet that places the body under the metabolic state of nutritional ketosis. Carbohydrate restriction shifts the body’s metabolic physiology from a carbohydrate and glucose dependent metabolism to a fat and ketone-based metabolism. This process also suppresses may of the signaling factors that are driving the growth and proliferation of cancer.
According to studies, particularly one by Professor Thomas Seyfried of Boston College, the ketogenic diet may be capable of revolutionizing the treatment of breast cancer, even contending that cancer can be investigated as a metabolic disease rather than a genetic one. Evidence supporting the theory of cancer as a metabolic disease has major implication on how we treat and prevent cancer. It is likely that metabolic-based approaches will also synergize with other mof=dalities and further augment the cancer-killing effects of radiation, chemotherapy and newly evolving immune-based therapies.
Associate professor at the University of South Florida’s Morsani College of Medicine, Dominic D’Agostino focuses his work on metabolic-based therapies, including ketogenic diets, and their potential for treating seizure disorders, muscle-wasting diseases, and other health problems. His lab oversees research on ketone technologies and ketone supplementation using ketone esters. Dominic D’Agostino’s work in the area of ketone research has also focused on following a vegan ketogenic diet.
The goal of someone on a ketogenic diet is to enter a state called ketosis, which occurs when the metabolism switches from burning glucose to burning ketones for fuel. In order to produce ketone bodies, a person must carefully manage their macronutrients so they are consuming much more fat than carbohydrates or protein. Although this can be a difficult task when following a plant-based diet, it certainly isn’t impossible.
A vegan or vegetarian interested in following a ketogenic diet must understand they will have to remove or severely limit their intake of fruit, grains, legumes, and some vegetables. They should replace these items with healthy plant-based fats, low-carb nuts and seeds, and low-carb vegetables such as broccoli, cauliflower, spinach, mushrooms, and cabbage.
It’s important for anyone wishing to reach and maintain ketosis to monitor what they’re eating to ensure 65 to 85 percent of their daily caloric intake comes from fat, 15 to 35 percent from protein, and 5 to 15 percent from carbohydrates. The exact nutrient ratio needed to adapt to ketone burning varies. Those who become “keto-adapted” report numerous benefits, including weight loss, increased energy and endurance, improved cognitive function, and reduced hunger.
Dr. Dominic D’Agostino serves as an associate professor of molecular pharmacology and physiology at the University of South Florida in Tampa. In this position, Dr. Dominic D’Agostino studies the effects of ketone supplements.
A recent study published in the Journal of Physiology investigated the effects of a drink containing ketone esters on insulin control. Entering ketosis typically requires days on a strict diet–yet this drink proved to have similar results within minutes.
Participants in the study included 20 healthy males and females between the ages of 18 and 35. During the investigation, each participant fasted overnight and was then administered a standard oral glucose tolerance test upon waking to determine the effects of the drink on blood sugar and insulin levels.
Some of the participants were given a ketone supplement before the test, while a control group was administered a placebo. Participants who drank the ketone supplement not only showed a smaller resulting spike in their blood sugar levels, but also an improved insulin response. The study’s outcomes are promising since they suggest that ketone monoester supplements could have potential for managing and preventing metabolic disease.
Dominic D’Agostino, PhD, is an expert in ketone supplementation and undertakes KetoNutrition research as Associate Professor at the University of South Florida (USF). Focused on metabolic-based therapies, Dominic D’Agostino, PhD, emphasizes the benefits of a ketogenic diet and ketone esters in causing physiological shifts whereby fats are utilized for physical energy rather than glucose.
By: Guest Author – Kristi Storoschuk
By now you have probably heard of the ketogenic diet but never really thought it would be possible on a plant-based diet. First, let’s first clear up any confusion you might have when it comes down to what the diet actually is. There are several different variations of the ketogenic diet and as it grows in popularity it’s becoming more of an umbrella term for all the ways you can achieve nutritional ketosis (defined by elevation of blood ketones). The fascinating origin and history of the ketogenic diet is covered in the 3 part series on Robb Wolf’s blog. Each variation stems from the classical ketogenic diet, where your daily calories come from approximately 90% fat, 6-10% protein, and 2-4% carbohydrates (4:1 ketogenic diet). What came later were modified versions of this diet which, for most, may be a little more approachable and sustainable long term. These modified versions of keto (aka modified Atkins) range from 65-85% of your daily calories coming from fat, 15-35% from protein, and 5-10% from carbohydrates. Can you see the trend? Fat is our friend. The modified versions are more liberal with protein and non-glycemic fibrous carbs (i.e. veggies). These modified versions can still allow you to reap all those superhuman benefits of ketosis that everybody raves about without having to significantly restrict protein or giving up carbs completely.
If you have ever talked to someone that has entered ketosis before, there is little chance they will describe it as a walk in the park. There is a conscious process to becoming “keto adapted” (i.e. metabolic transition from glucose to fats and ketones). The process triggers acute and gradual alterations in metabolic control and even signalling effects like epigenetic regulation and suppression of inflammation. Not to mention it is SO different for each individual considering all the factors that influence the process, such as how much/type of exercise you do, if you are calorie restricted (CR), if you practice time restricted feeding (TRF), variations in baseline metabolism, even genetics play a role. One person may be able to enter ketosis on a modified version allowing 100g of carbs a day, whereas as little as 5g carbs could kick someone OUT of ketosis, especially if it is sugar or starch. It is recommended to keep your daily total carbs to fewer than 50g. The only sure way to know which ratio is best for you is to measure blood ketones, or at the very least urine ketones. Anecdotally, it is observed that ideal blood ketone (beta-hydroxybutyrate; BHB) levels ranging from 1-3 mM may be optimal. A measurement of 0.5 mM is the bare minimum, that is the clinical threshold for ketosis. Urine ketone measurement (acetoacetate; AcAc) can vary depending on hydration status, but the clinical threshold is an AcAc level greater than 15 mg/dL (on a Ketostix). There are new blood ketone monitoring systems emerging, like the Keto Mojo that have made tracking nutritional ketosis easy and affordable. Keep in mind, especially when first attempting keto, that a BHB level of 1.0 mM is approximately 5-10X higher than the general population ever gets eating a Standard American Diet (SAD).
Ok, so how do I do this if I’m vegan?
There are a number of great blogs that have addressed this topic with different approaches and meal plan recommendations. You don’t have to be stuffing your face with heavy cream yogurt or fatty bacon to follow a ketogenic diet, au contraire, a plant-based keto diet is 100% possible for those willing and motivated. We are hoping that this article provides more additional support for those seeking to attempt this dietary strategy from a vegan perspective. Here are some tips for following a vegan ketogenic diet: Remove/severely limit grains, legumes, and fruit – preventing ketosis will be a sure deal by incorporating these food groups, so best to cut them out. Make oil your friend – without meat there are minimal sources of fat that aren’t found in combination with carbohydrates, so in order to reach your fat quotas for the day, healthy oils (see below) are the way to go. Stick to low-carb fibrous veggies – sorry, that means no sweet potatoes, beets, or any root vegetables for that matter. Track your macros – no not calories, macros (cannot emphasize this enough). Without tracking there is no way to know your daily macronutrient ratios needed to sustain nutritional ketosis. Carbs are sneaky and are hidden in more foods than you think! I suggest downloading the app “Chronometer” or “MyFitnessPal” both are very user friendly.
These tips generally apply to anyone following a ketogenic diet, meat-eater or not. If the thought of not being able to put that banana in your smoothie tomorrow freaks you out a little, do not fret, there are acceptable alternatives (unfortunately there is no solution to the banana dilemma, you still won’t be able to eat it).
So what CAN you eat?
*Low-carb plant-based protein powder suggestions:
1. MRM Veggie Elite Performance Protein (best tasting)
2. Vega Sport Performance Protein (best quality)
3. Garden of Life Raw Organic Protein
This list is just a handful of foods that you can include on a vegan ketogenic diet. A ketogenic diet does not have to be complicated, heck blend an avocado, some coconut cream, 1-2 TBS of MCT oil, a handful of spinach and a scoop of protein together and you have a meal. If the kitchen is an unfamiliar territory for you, luckily a quick google search can lead you to some great vegan keto recipes. Ever heard of zucchini noodles, Brazil nut parmesan, coconut butter fat bombs? Well, these may become new staples in your diet.
Another easy way to get your fat in is by starting your day with a veganized version of “Bulletproof Coffee”:
Throw 1-2 TBS of Brain Octane or XCT oil, 1-2 TBS of coconut oil or coconut cream (in place of grass-fed butter), and your favourite cup of coffee into your blender and you have a dairy-free, creamy keto coffee that will make getting out of bed a little bit easier.
Where things may get iffy:
Although a vegan ketogenic diet is very doable, there is the issue of simply being on a high-fat low-carb diet rather than a ketogenic diet. Yes, there is a difference. If you’re following a vegan high-fat low-carb diet you can still get some benefits, like improved insulin sensitivity, and the level of satiation you experience after a high-fat meal. However, being “low-carb” but not quite ketogenic has its pitfalls. Before you enter ketosis your body will scavenge for any glucose available. If you are eating just a little too many carbs or protein (that’s right, protein can be a source of glucose) you are still giving your body small amounts of glucose (and spikes in insulin) that prevent sustained ketosis and eventually leave you feeling depleted. At this point you may experience fatigue, muscle loss, and a decrease in strength and physical performance. This is when you know you are not in ketosis and you should reconsider your ratios of fat, protein, and carbohydrates.
Note: once in ketosis, ketones are actually ANTI-catabolic, meaning muscle sparing, so don’t worry about losing those gains if you think you’re not consuming enough protein. As long as you are meeting your calorie requirements you’ll be ok.
How to avoid eating “high-fat low-carb” vs “ketogenic”: Intermittent fasting in addition to a modified keto diet – by shortening your eating window to 4-8 hours and fasting from 16-20 hours a day you increase your likelihood of depleting liver glycogen and forcing your body to start producing its alternate energy source – ketones. Avoid snacking if possible and if you’re up for it you can even try a 24 hour fast once a week to kickstart your ketogenic journey. Periodic intermittent fasting is also a good strategy for creating a calorie deficit in those desiring to lose weight. Exercising regularly – exercising will likely help you enter ketosis faster by depleting glycogen. Once in ketosis, exercise will help maintain the state and the duration/type of exercise you do will impact the amount of carbs you can “get away with” in a day. Exogenous ketones – if you just can’t get those carbs to a level that will put you into nutritional ketosis, exogenous ketones may be the solution. In animal models, exogenous ketones, even when given in combination with a normal rodent high-carb chow, showed benefits (anti-seizure, anti-cancer, anti-anxiety, anti-inflammatory) typically associated with a more rigorous ketogenic diet.
Hopefully by now you realize a plant-based diet is possible and may not be as daunting as you once thought. Individual meal plans will be based on your own food preferences. I do want to mention again that measuring blood ketone levels really is an important part when getting started with keto to make sure you are on the right track. The more you do it the easier is gets and the more benefits you will notice over time. Finally, remember that everybody is different and your lifestyle plays a huge role in how your body responds to a certain amount of carbs. Don’t feel discouraged if you’re hitting what you think is the “right” amount of carbs and still not becoming keto adapted, because it just might not be “right” for you. You may need to do some experimenting to find your sweet spot (while trying to lose your sweet tooth). For more information, check out “A Comprehensive Guide To The Vegan Ketogenic Diet“. Good luck!
Known for his research in areas ranging from ketone ester, ketone salts and other ketone technologies, Dominic D’Agostino teaches at the University of South Florida’s Morsani College of Medicine and serves the Florida Institute for Human and Machine Cognition (IHMC) as a visiting research scientist. In his research, some of which is highlighted on the KetoNutrition website, Dominic D’Agostino has investigated the benefits of ketone supplementation and the ketogenic diet for a broad range of neurological diseases, cancer and to enhance safety and resilience in in the warfighter and astronaut.
The ketogenic diet involves the intake of foods high in fat very low in carbohydrates, and moderate in protein. Following a well formulated ketogenic diet typically results in significant body composition alterations, including rapid fat loss and sparing of muscle tissue. When accompanied with resistance training a modified ketogenic diet can effectively build muscle and strength. This approach works, in part, due to enhancing insulin sensitivity and preventing the development of insulin resistance that normally occurs with aging. Thus, the ketogenic diet is an effective means to enhance longevity.
When you eat carbohydrates, your body produces insulin. Greater levels of sustained insulin secretion result in decreased insulin receptor signaling, leading to insulin resistance and high levels of blood glucose. Persistent hyperglycemia trigger inflammation, nonalcoholic fatty liver disease and de novo lipogenesis. Ultimately your body then stores extra glucose as fat, causing weight gain, metabolic derangement, type 2 diabetes, and perhaps increasing the risk of cancer and other age-related chronic diseases.
Because a ketogenic diet reduces carbohydrate intake, it typically results in decreased insulin levels and an overall suppression of insulin signaling. Consequently, this accelerates fat mobilization and fat burning processes in the body and can help prevent or reverse the negative effects of insulin resistance.
With a PhD in neuroscience and physiology from the University of Medicine and Dentistry of New Jersey and Rutgers University, Dominic D’Agostino is now an associate professor at the University of South Florida Morsani College of Medicine. Dominic D’Agostino’s research is focused on areas such as nutritional ketosis, ketone supplementation and a wide range of metabolic-based therapies.
The ketogenic diet has become popular for its ability to help people lose weight and maintain muscle through supporting the body’s ability to remain in a state of nutritional ketosis. In ketosis, the body’s metabolic system gains its energy primarily from fatty acids, which the liver converts fast into molecules called ketones. Ketones also serve as powerful signaling molecules to boost antioxidant gene expression and reduce systemic inflammation.
Taking ketone supplements, often referred to as “exogenous ketones”, can play an important role in pursuing a optimizing your metabolic health. These supplements function in one of two ways: they augment energy levels for those already in ketosis, or they help push the body into nutritional ketosis. Ideally the ketone supplement (ketone salt) should be mixed with ketogenic fats, like medium chain triglycerides (MCT oil), which also stimulates endogenous ketogenesis.
Eating a ketogenic diet and taking supplements may not be enough to reach your goals, however. If you continue to gain weight, you may need to further decrease your carbohydrate intake to start ketosis, or you may need to decrease your overall calories (most important) to ensure you take in less than your body requires to maintain your current weight so that you can burn stored fat. Interestingly, things like nutritional ketosis, ketone supplementation and intermittent fasting make it easier for people to create a calorie deficit through appetite suppression effects.
With a background in the improvement of high-performance neurological and muscle capacities, Dominic D’Agostino, PhD, serves as an Associate Professor at the University of South Florida College of Medicine. He also serves as a research scientist at IHMC. As a guest on the Sigma Nutrition and Performance podcast (accessible at https://sigmanutrition.com) in February 2017, Dr. Dominic D’Agostino focused on the cancer fighting abilities of a “press pulse protocol” that incorporates a variety of modalities, including hyperbaric oxygen, ketogenic diet and metabolic drugs.
Dr. D’Agostino describes ketone supplementation and intermittent fasting as placing intense metabolic stress on tumor cells that are dependent on glucose for aggressive activity. Particularly when calorie restricted, the ketogenic diet is effective in reducing insulin levels and pathways that drive tumorous cells’ hyper-metabolic state.
Among the effects are a reduction in blood glucose and a mobilization of fatty acids in ways that starve the tumor and suppress cancer growth. The spikes that typically occur in glucose and insulin through carbohydrate feeding are significantly decreased. The combination of insulin signaling suppression and glucose availability is a powerful tool in transitioning the body toward a ketone and fatty acid metabolism.
Dr. D’Agostino notes that this is a difficult process for many people, as the body undergoes glucose withdrawal before reaching a new physiological stasis in which abundant ketone bodies are produced. The brain, with its inherent metabolic flexibilities, can ultimately adapt to this new energy source and thrive. Oncologists at numerous institutes are working on developing Press Pulse protocols as a “comprehensive stand alone nontoxic approach” or as means to further augment standard of cancer therapies.