#116 - AMA with Dom D'Agostino, Ph.D., Part I of II： Ketogenic diet, exogenous ketones, and exercise
Episode Stats
Words per Minute
169.30873
Summary
Dom D'Agostino is a neuroscientist at the University of South Florida, where he teaches at the College of Medicine and the Department of Molecular Pharmacology and Physiology. He focuses on neuropharmacology, medical, biochemistry, physiology, neuroscience, and neuroscience. In this episode, Dom talks about keto, ketosis, ketogenic diets, and all things ketone related.
Transcript
00:00:00.000
Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
00:00:16.500
I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can
00:00:20.460
access the AMA episodes in full, along with a ton of other membership benefits we've created,
00:00:25.440
or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
00:00:31.140
So without further delay, here's today's sneak peek of the ask me anything episode.
00:00:39.260
Hey everyone, welcome to a special ask me anything episode. And when I say special,
00:00:44.840
I am not kidding. You'll see why in a moment. This is going to be part of a two part series
00:00:50.800
with Dom D'Agostino. Now, some of you may know Dom's name as he was, oh, I don't know,
00:00:56.220
probably our fifth guest when this podcast kicked off in 2018. Dom's episode to this day remains one
00:01:03.000
of our most popular episodes. And it's for that reason that we decided to go back and bring him
00:01:07.920
back on in the format of a Q and A. We had this interview scheduled for a long time. And right
00:01:14.060
when it was scheduled to happen, something came up, something very important came up where I had to
00:01:19.620
go away. And I had to go away such that I couldn't actually do the interview. We all powwowed and
00:01:25.660
contemplated, should we reschedule it for a little while? Dom had already set aside the time to do it.
00:01:30.620
And in the end, the consensus view was why not have Bob Kaplan, who many of you know from this podcast,
00:01:39.040
why not have Bob do it? Bob and Dom already have a great rapport. There's probably nothing here that
00:01:43.900
Bob would do that I wouldn't do and vice versa. So Bob and Tom ended up doing just that. And they
00:01:49.000
ended up sitting down for a heck of a lot longer than anticipated. Both true to the sport, Bob wanted
00:01:54.160
to go down every avenue and Dom left no stone unturned. And that's why it's being divided into
00:01:59.960
two parts so that a normal human being could actually listen to it in a reasonable sitting.
00:02:05.020
Now in the first episode, Bob and Tom cover a lot of questions, both general and specific about
00:02:10.420
ketogenic diets and ketosis. They also do a bit of a deep dive on the impact of ketosis on different
00:02:16.220
forms of exercise. Now, as a reminder, Dom is an associate professor at the University of South
00:02:20.900
Florida, where he teaches at the College of Medicine and the Department of Molecular Pharmacology
00:02:25.880
and Physiology. He focuses on neuropharmacology, medical, biochemistry, physiology, neuroscience,
00:02:31.560
neuropharmacology. As a reminder, I believe Dom actually got his PhD in neurobiology. For those of
00:02:37.440
you who haven't listened to it, it might even be worth going back and listening to at least part of
00:02:42.260
the first discussion I had with Dom in 2018, because it gives you an idea of how a neuroscientist
00:02:49.400
became one of the most credible voices on ketosis, ketogenic diets, and all things ketone related.
00:02:56.880
Lastly, it is important to note that while Dom is answering specific questions and scenarios,
00:03:01.640
he is not giving medical advice. Everything in this podcast is for general informational purposes only
00:03:06.860
and does not constitute the practice of medicine, including the giving of medical advice. So without
00:03:13.700
further delay, please enjoy part one of the AMA with Dom D'Agostino. All right, welcome to a very
00:03:24.880
special AMA with Dom D'Agostino. Dom, how are you doing? I'm doing well. Thanks for having me.
00:03:30.720
Absolutely. So it's been almost two years since you were on the podcast with Peter.
00:03:36.120
I met you in New York at that time. I think it was the summer of 2018.
00:03:41.120
I know how time flies. I was just talking to my wife about that. She would ask me what I'm doing
00:03:46.420
this week. And I was like, oh, I got the podcast with Peter. And she's like, didn't you just do one?
00:03:50.500
And I mean, she was happy that it was on, but we were just amazed at how fast that time flew by.
00:03:55.540
Yeah, the time in New York. So I give you credit for dealing with New York. It's always an adventure
00:04:02.360
every time we get. Absolutely. So since then, we certainly received a bundle of questions. And
00:04:08.040
then Peter went on social media and asked if there were any questions for you and particularly what
00:04:13.140
you've been up to in the last couple of years. But maybe you could fill us in just in general,
00:04:17.460
a little bit about ketosis or how'd you get into ketosis and what you've been up to in the last
00:04:23.420
couple of years? Sure. Well, I guess, yeah, like I said, the last two years, and we are really trying
00:04:30.580
to move the laboratory science into human applications. So we've been doing quite a bit
00:04:36.040
on that front. And that has been pretty, pretty time consuming in regards to kind of setting up all
00:04:42.060
the IRB protocols. We're doing quite a bit with NASA, Extreme Environment Mission Operations
00:04:47.980
research, where I was a crew member for mission 22. And my wife was a crew member for NEMO,
00:04:55.180
the acronym they use for that for NEMO 23. And that involves looking at everything from
00:05:01.720
cognitive function, body composition, gut microbiome, sleep, heart rate variability,
00:05:09.700
stress. So we have like an IRB protocol for each one of these. And we're evaluating the effects
00:05:15.820
of hyperbaric environments, extreme environments on human physiology, and all the things that I
00:05:21.660
mentioned. And I just happen to be on a ketogenic diet for my thing. But we're trying to collect
00:05:26.600
baseline data for future missions underwater where we can have an intervention, a dietary intervention,
00:05:34.060
for example, ketosis. So that has been a big focus of our research. Another space analog mission
00:05:39.920
would be high seas. So we're preparing for that. Of course, all this stuff is being on hold now
00:05:44.340
because of COVID-19. So that's kind of outside the lab. Inside the lab, we focused a lot. My
00:05:50.760
student, now Dr. Andrew Kutnick, last week actually, he graduated. And his research, PhD research, was
00:05:58.440
focusing on cancer cachexia. And we just got his manuscript, a massive manuscript published in
00:06:05.340
iImpact Journal. And he's really happy with that. And we have some interesting findings evolving
00:06:10.920
out of that research, looking at the effects of ketones on mitigating cancer cachexia and wasting
00:06:17.560
associated with metastatic cancer in the model that actually Thomas Seyfried developed. And we're
00:06:24.240
looking at Kabuki syndrome. We're looking at various genetic diseases and developing ketone metabolic
00:06:30.980
therapies as a means to treat these diseases, not only from a metabolic perspective, but as a means to
00:06:39.000
influence epigenetic pathways that may be used to treat the disease. And the model that we're using,
00:06:46.280
for example, for Kabuki syndrome was developed at Johns Hopkins. So we were able to work with the
00:06:51.760
folks there and get access to this animal model, which we're breeding up. And like things are on hold
00:06:57.040
now, but we're doing pretty well on these experiments, getting them started up. And that's becoming another
00:07:02.680
PhD dissertation for first year student of mine, Sarah Moss. And then we have a lot of little pet
00:07:08.780
projects on the side I could talk about forever. But I think there's kind of the main ones we're
00:07:12.740
working on. Cool. Well, we're going to double click on hyperbaric oxygen, cancer cachexia, and things like
00:07:18.220
that. I know that there are some questions that came in on that. But first, there were a few general
00:07:23.480
questions for you. The first being, is there a case for one to two months of ketosis a year if I am
00:07:31.620
perfectly healthy and don't have any problems with carbs? I kind of, I don't like to use this term,
00:07:39.160
but you have to sometimes. It depends on the individual and what their goals are. But I do think
00:07:44.840
there's definitely benefits that you can derive out of, I guess, what you'd call intermittent ketosis.
00:07:50.820
The main thing is, I think one of the main benefits is that it promotes metabolic. And
00:07:57.800
so having your body, we're relative, most people are adapted to frequent carbohydrate feedings. So
00:08:04.500
their metabolism is not adapted to using fat as a major energy source during times of limited
00:08:11.980
carbohydrate availability or calorie availability. So during periods of fasting, by promoting metabolic
00:08:19.920
flexibility, and I believe when you go into a state of ketosis, whether you do it with ketogenic
00:08:25.600
diet or fasting, it changes, it actually activates a genetic program that actually can allow you to
00:08:34.480
burn fat and make ketones more efficiently. And I think once, if you do that a couple times,
00:08:39.840
we have muscle memory, workout, you take time off, it takes a little bit of time to get back to where
00:08:44.380
you left off. But you get back to that level very, very quickly. And the same thing happens with your
00:08:50.780
metabolism. I would say there's a metabolic memory associated with it. So the more you do it, the more
00:08:56.780
benefits you derive from it over time. I think there's personal development reasons for intermittent
00:09:02.700
ketosis. There's logistical reasons, too. You could be a difficult period of your life that you don't have a lot of
00:09:08.380
time just based on work or other priorities and eating ketogenic actually saves time. I know Peter
00:09:15.020
was doing something like a three-day fast every month. I think that people could implement this
00:09:21.100
idea. I think the same thing could be achieved instead of fasting. You could do six days of a
00:09:27.260
restricted ketogenic diet every month. And I think you do get the same benefits if you didn't want to just
00:09:34.700
do fasting if people have an aversion to fasting three days out of the month. The thing to target
00:09:40.780
would be the glucose ketone index. And if you're doing, for example, intermittent ketosis, this guy
00:09:47.420
has a question, and you want to derive benefits of it similar to fasting, you could restrict calories
00:09:53.500
like 50% on a ketogenic diet and do that for six days a month. And I believe you would achieve,
00:10:01.180
at least for me, a glucose ketone index between one to two. And if you do your blood work, you'll find
00:10:08.140
that you'll have almost a similar level of insulin suppression, especially if you measure that insulin
00:10:13.980
even during that week of feeding just prior to eating a meal. If you do restricted ketogenic diet
00:10:20.140
and combine that with time-restricted feeding, you're hitting all the major drivers of the benefits that you'd
00:10:27.180
get from fasting, like suppressed mTOR, suppressed insulin, your body sensing low ATP. It's probably
00:10:35.500
stimulating autophagy, although we don't have a good means to measure that. So that would be my
00:10:40.140
suggestion. If you want to, you don't have any problem with carbs, but you want to get some of the
00:10:44.700
benefits of ketosis to maybe try once a month to do five or six days or five to seven days, let's say,
00:10:54.060
of a restricted ketogenic diet, which I think it's pretty easy to do.
00:10:58.700
That makes sense. One thing that Peter was doing previously, he was doing one week fast
00:11:03.020
and he would sandwich it between two weeks. A week prior, he would go on a ketogenic diet.
00:11:10.300
And then a week after he would go on a ketogenic diet. And one thing that I noticed too, just with
00:11:14.940
my own playing around and probably other people have experienced this, is that if you're trying to
00:11:20.440
dial in that glucose ketone index, and I think, is it like directionally, you want it basically one
00:11:26.120
to one with glucose and ketones? If you can achieve that, that's pretty good. I'm a little bit more
00:11:31.580
loose on it. I think if you can achieve one to two, just based on my observations from fasting
00:11:36.940
to ketogenic diet, I think you start to derive a lot of benefits. And I quantify that through the
00:11:43.920
level of insulin suppression. I've been able to kind of record from that. So I've been measuring,
00:11:49.540
taking a lot of insulin measurements. Yeah, that makes sense. So the second question,
00:11:56.420
what are some books you'd recommend to get knowledgeable on modified keto? And I guess
00:12:00.660
the preface there is that you do a form of a modified ketogenic diet. At least last time I spoke
00:12:05.040
to you, you were doing that. Yeah, that diet has been kind of evolved over the years. But some of the
00:12:11.920
books that really influenced me that are kind of mandatory reading for people entering the lab
00:12:16.560
are Jeff Bullock and Stephen Finney's book, The Art and Science of Low Carbohydrate Performance.
00:12:22.240
That was a great book. But since then, I guess since we've last spoke, a couple of really good books
00:12:26.540
have come out. The Ketogenic Bible is a fantastic, comprehensive overview of the ketogenic diet.
00:12:35.100
And it's got everything from recipes. It breaks down the terminology. It's written for the layperson
00:12:41.440
and the people who are really interested in the science, too. Keto Answers is a great book for
00:12:47.460
the layman. And it really breaks down what a modified ketogenic diet is, recipes, suggestions on a lot of
00:12:55.000
tips, troubleshooting and things like that. Now, if you really want to geek out on the science,
00:13:00.680
I would definitely recommend, I know a lot of listeners are interested in the science,
00:13:04.640
the ketogenic diet and metabolic therapies. So Google that term, ketogenic diet and metabolic
00:13:11.660
therapies. Primary author would be Susan Massino. I am the editor of that. So kind of disclosed that I
00:13:18.260
do get royalties. It's from Oxford University Press. And it's a book that really delves into very deeply
00:13:24.680
into the science. And I guess the book that has probably one of the biggest impact on me for the
00:13:30.040
modified ketogenic diet or the modified Atkins, which sort of evolved around 2008 when I became
00:13:36.440
aware of it, was more of a clinical book by Dr. Eric Kossoff from Johns Hopkins. So if you're
00:13:43.140
interested in the modified ketogenic approach from a clinical perspective, just look up Eric Kossoff
00:13:49.320
from Johns Hopkins and check out his book on the modified ketogenic diet. Okay. So they're all the
00:13:55.880
books right now sitting next to me on my shelf. So that's the ones I'd recommend.
00:14:00.660
Yeah, I'd recommend those as well. Particularly the art and science of low carb
00:14:04.560
performances. It's not a pamphlet, but it's not a novel either.
00:14:11.080
Update on ketone measurement devices, breath, blood, et cetera. I guess I would say urine. I'm not sure
00:14:20.340
That about covers it. Yeah. The urine strips are actually something I don't discourage against.
00:14:25.720
And I think they could be a good kind of yes or no if you're in ketosis and it gives you a relative
00:14:32.120
reading, but I tend not to, the Siemens multi-stick SG is pretty good and it gives you other parameters
00:14:40.120
on the urine strip. But when it comes to blood meters, which I've used most often, the precision
00:14:46.680
extra remains one of the meters I use almost on a daily basis. Abbott Lab makes that. It's
00:14:54.100
well validated. It's very reliable. It's got a track record. People publish with it. The newer device
00:15:00.400
that's out is the Keto Mojo. And I have the Keto Mojo GKI, which has the glucose ketone index sort
00:15:07.880
of incorporated into the algorithm here. And what I find is that the Keto Mojo device, it's got a lot
00:15:16.040
of pros, a lot of benefits to it. The strips are much cheaper. It does the GKI, of course. It's a
00:15:22.900
little bit larger, so it doesn't, it's a little bit bigger than the precision extra. And it records
00:15:30.600
higher beta hydroxybutyrate in the low ranges. So if I'm 0.5 on the precision extra, I'm usually like
00:15:38.060
0.9 or like a 1.1 with the Keto Mojo. Now, when my ketones get into like the 2 and 3 range,
00:15:46.480
then they're pretty, they correlate. I think the Keto Mojo may be measuring slightly higher in the
00:15:52.960
low ranges, but I also think that the precision extra may be measuring slightly lower. And there
00:15:59.900
is, for example, if I was 0.8 from an assay we do in the lab, I think the Keto Mojo would maybe have
00:16:08.020
me at 1.0, whereas the precision extra would be 0.5. So I think there's somewhere in the middle
00:16:13.720
is the correct one, but they're relatively, they're easy to use. And I think they're devices
00:16:19.240
that I use pretty much on a daily basis. The breath acetone meter, now that's what I've been
00:16:24.480
spending a lot of time evaluating that technology. Biosense makes this device. And in regards to
00:16:31.580
breath acetone meters, I would say it's like a next level kind of stuff. The breath acetone
00:16:37.360
does correlate well with beta hydroxybutyrate from my measurements if you're in a fasted state.
00:16:43.480
So it's exceptionally good in a fasted state. There are some drawbacks to it, I think. For example,
00:16:50.860
if I have wine or if you eat a meal, you're going to get a false positive, which means you're going
00:16:56.560
to get an elevation breath ketones that's outside of the spectrum where you're really at. And that
00:17:02.700
suggests that it's picking up something other than breath acetone. Definitely picks up breath alcohol,
00:17:08.500
but it is pretty reliable. I've used it hundreds of times, and that would have been thousands of
00:17:13.980
dollars worth of strips. And it correlates well, especially if you're into fasting. And if you're
00:17:19.700
following a ketogenic diet and you just abstain from food or chewing gum or alcohol or whatever for
00:17:25.780
a good hour, then the measurements correlate pretty well with beta hydroxybutyrate in the blood.
00:17:34.200
A couple of years ago, I had a, what was it called, ketonics, which I think was measuring
00:17:39.140
acetone. And it wasn't, what should I say, quantitative. It basically gave you a, I think
00:17:44.420
it was a green, a yellow, or a red. And I think green meant that you're probably not in ketosis. And
00:17:50.400
then yellow was moderate. And then red was something along the lines of deep ketosis. I don't know if
00:17:54.900
this correlates with maybe the urine strips or something like that. Is the one that you have,
00:17:59.180
is it, is there something that you can quantify in terms of the amount of acetone?
00:18:04.000
Yes, they have ACEs and 10 ACEs. You might see some of the measurements I've been posting,
00:18:11.360
like on Instagram, 10 ACEs would correlate to 1.0 beta hydroxybutyrate pretty much. So it's like
00:18:18.840
an order of magnitude above. And I think I got that right, but you might want to check out the specs.
00:18:24.900
On the website. So yeah, it's just in order of magnitude higher, the numbers. And these numbers
00:18:33.840
were developed to sort of correlate to beta hydroxybutyrate. I think that's how it's more
00:18:40.320
or less calibrated, sort of in that way, the algorithm. And they've done quite a bit of work
00:18:45.280
at bioscience to make the meter reliable, which I, on my third one now, I have to say,
00:18:50.560
because the first two, I think were sort of beta versions. Just sent the other one back and I have
00:18:56.720
a new one now, but I carry it with me in my pocket. It's been to many countries. It worked well and it's
00:19:04.140
reliable. So the ketonics meter, I think has gradually become more quantitative. So you might
00:19:10.420
want to check to see the latest version of that. Although I have to say that the biosense breath
00:19:15.920
acetone meter is the most quantitative breath meter that I've seen so far. And they've done quite a bit
00:19:22.640
of research. One other drawback is that it takes about a minute or two to calibrate. So you have to
00:19:28.940
press it and kind of wait to blow in it. If you're kind of impatient, you could probably take a blood
00:19:34.200
measurement a little bit quicker. And if it's windy out or you're outside, things sometimes get an error
00:19:40.960
reading. But generally, I'm testing at my desk, I'm testing inside. And, you know, I do like
00:19:47.480
measuring blood, but this is a very close second to my favorite measuring device if I'm going to
00:19:52.700
quantify ketosis. Breath acetone is a very strong indicator of fat oxidation. So if you're just using
00:19:59.380
it as you're following a ketogenic diet, burning fat, that acetone is basically was derived from fat.
00:20:05.820
So you have it's a very good quantitative measurement of fat oxidation. Also, from the
00:20:10.960
clinical perspective, which I'm most excited about is that a lot of kids do not like to get their
00:20:16.080
finger pricked, obviously. A device like this is very appealing to children who have epilepsy and breath
00:20:22.120
acetone correlates really well with seizure control. So I'm excited that this technology can make it into
00:20:28.300
the clinical realm, especially in epilepsy. Yeah, I was going to ask you actually between beta
00:20:34.520
hydroxybutyrate, acetoacetate and acetone, if it's actually telling you something a little bit
00:20:39.760
different physiologically or biochemically, that maybe one may tell you a little bit more about
00:20:43.780
the availability versus utilization. And it sounds like with the acetone, it might actually tell you
00:20:49.320
a little bit more about the ketones that you're actually burning. And I think you mentioned this,
00:20:53.280
that instead of a glucose tolerance test, you thought of like a ketone tolerance test. When you think
00:20:58.220
about it, if you're utilizing the ketones quite efficiently, then, and this is one of those things that I
00:21:03.700
think, some people get into ketosis, meaning they get into the diet or ketogenic diets. And it's
00:21:09.180
almost like a challenge to see how high you can get your BHB, like how high are your ketones.
00:21:14.140
But in some ways you think, well, maybe I want to utilize those things. And if I'm utilizing them,
00:21:18.580
then maybe it would be the substrate might be small, lower for BHB. But it sounds like that's right,
00:21:23.460
that the acetone tells you a little bit more about the utilization of ketones versus maybe BHB.
00:21:27.860
Yeah, you bring up a good point. I think if beta-hydroxybutyrate stays circulating in the
00:21:33.060
blood longer, it's more likely to, you're going to have more acetone as well. And that can
00:21:39.640
spontaneously decarboxylate or acetoacetate, I should say. And you maintain a ratio of about
00:21:45.000
four to one. And some measurements I've seen people at six to one beta-hydroxybutyrate to
00:21:49.660
acetoacetate. So if your acetoacetate is elevated in the blood, that spontaneously decarboxylates to
00:21:55.740
acetone. And that's what, it's very volatile. So you're breathing that off. But in regards to the
00:22:00.460
ketone tolerance test, yeah, if you're using ketones at a fast rate, there'll be less beta-hydroxybutyrate
00:22:05.760
and acetoacetate available for spontaneous decarboxylation. So that volatile organic
00:22:12.560
compound is not going to show up in the breath. So if you exercise, acetone goes down. I did yesterday
00:22:17.980
and noticed that a workout can really lower my acetone level, breath ketone, as it does with
00:22:24.880
blood beta-hydroxybutyrate. But if I work my metabolism up and I come back to my desk and I'm
00:22:31.000
sitting there and you have like that post-exercise elevation and metabolism, then you start seeing
00:22:36.160
that acetone starting to shoot back up again when you're at rest. Because the ketones are, you've
00:22:41.720
ramped up metabolism, fat oxidation, ketogenesis, and you start building up ketones, but you're not using
00:22:47.680
them. And athletes do really well, I guess you could say, on a ketone tolerance test. Because if you
00:22:53.880
give them a bolus of exogenous ketones, they clear it from the system pretty quick. And they clear it
00:23:00.320
very quick when they start exercising. So which is a really good indication that they're using
00:23:04.780
that metabolic substrate for fuel. You talked about this a lot. George Cahill,
00:23:10.340
his study, the 40 days of fasting, and he looked at, what did he look at? He looked at beta-hydroxybutyrate.
00:23:15.320
And I think on the same graph, he had acetoacetate and free fatty acids. I don't think that he had
00:23:20.080
acetone. But maybe a future question, I don't know if it's in here, but something about free
00:23:24.880
fatty acids and acetoacetate seem pretty close, that they were pretty close together as far as
00:23:30.360
substrates, but gets into the idea of how many free fatty acids are we burning compared to maybe
00:23:35.440
ketones as well, and the interplay between those two.
00:23:38.460
Yeah, there's some interesting dynamics going on for sure. And I think you'll notice a couple things
00:23:43.820
from that work. You'll notice that, well, they didn't measure acetone because it's very hard to measure.
00:23:47.540
We've just doing the experimental procedure to store the blood to make an acetone measurement
00:23:55.100
possible through gas chromatography and mass spec. It's quite an achievement. So it's kind of hard to
00:24:01.200
do because it's volatile. But you'll see that glucose was relatively stable throughout. Another
00:24:06.580
diagram on the same subjects demonstrates an injection of insulin or IV infusion of 20 IUs of insulin.
00:24:13.920
You see fatty acids in the blood go down, ketones go sharply down. So you see a lot of that ketogenesis
00:24:21.920
and fat mobilization for fuel is really a function of insulin suppression. I think that's really
00:24:28.820
important to note. And that has implications for sort of other things, like do exogenous ketones
00:24:34.200
elevate insulin? And so if you take exogenous ketones, will it promote a decrease in your own endogenous
00:24:41.040
ketone production? And I think it's really important to understand what's going on in the liver and what's
00:24:47.020
going on in the muscle and what's going on in the brain when you're delivering exogenous ketones,
00:24:52.000
which we think have many therapeutic applications and everyday applications. So that's, I've been
00:24:57.700
focusing a lot sort of on some personal studies on that now and also in the lab. We're looking at that.
00:25:03.800
So let's get into, we've got a couple of questions around genes. The first one is very broad. It says,
00:25:10.340
what genes are not good for keto? They're EG, for example, FTO. I'm wondering if this is around
00:25:16.980
maybe like the PPARs and FTO. And I think some people have talked about this and how they handle
00:25:24.100
saturated fat and fats in the diet and things like that. Are you aware of any of this literature?
00:25:29.040
Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested in
00:25:34.740
hearing the complete version of this AMA, you'll want to become a member. We created a membership
00:25:39.440
program to bring you more in-depth exclusive content without relying on paid ads. Membership
00:25:45.780
benefits are many and beyond the complete episodes of the AMA each month, they include the following
00:25:50.920
ridiculously comprehensive podcast show notes that detail every topic, paper, person, and thing we
00:25:57.360
discuss on each episode of The Drive. Access to our private podcast feed. The Qualies, which were a
00:26:03.860
super short podcast, typically less than five minutes, released every Tuesday through Friday,
00:26:08.780
which highlight the best questions, topics, and tactics discussed on previous episodes of The Drive.
00:26:14.000
This is particularly important for those of you who haven't heard all of the back episodes.
00:26:19.120
It becomes a great way to go back and filter and decide which ones you want to listen to in detail.
00:26:23.560
Really steep discount codes for products I use and believe in, but for which I don't get paid to
00:26:28.960
endorse. And benefits that we continue to add over time. If you want to learn more and access these
00:26:34.660
member-only benefits, head over to peteratiamd.com forward slash subscribe. Lastly, if you're already a
00:26:42.120
member, but you're hearing this, it means you haven't downloaded our member-only podcast feed where you can
00:26:46.680
get the full access to the AMA and you don't have to listen to this. You can download that at
00:26:51.880
peteratiamd.com forward slash members. You can find me on Twitter, Instagram, and Facebook, all with the
00:26:59.800
ID peteratiamd. You can also leave us a review on Apple Podcasts or whatever podcast player you listen
00:27:06.620
on. This podcast is for general informational purposes only and does not constitute the practice
00:27:11.800
of medicine, nursing, or other professional healthcare services, including the giving of
00:27:16.800
medical advice. No doctor-patient relationship is formed. The use of this information and the
00:27:22.520
materials linked to this podcast is at the user's own risk. The content on this podcast is not intended
00:27:28.700
to be a substitute for professional medical advice, diagnosis, or treatment. Users should not
00:27:34.740
disregard or delay in obtaining medical advice from any medical condition they have, and they should
00:27:40.900
seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts
00:27:46.860
of interest very seriously. For all of my disclosures and the companies I invest in or advise, please
00:27:52.920
visit peteratiamd.com forward slash about where I keep an up-to-date and active list of such companies.
00:28:10.900
For all of my disclosures, please visit peteratiamd.com forward slash about where I keep an up-to-date,