May 25, 2016

Podcast from https://bengreenfieldfitness.com/2016/05/what-are-ketone-salts/

[0:00] Introduction

[0:33] Straight From the Root

[1:47] Ministry of Supply

[3:40] Harry's Razors

[6:26] Background on Ketones

[8:14] Dr. Richard Veech

[9:38] Ketosis and Ketone Function

[11:25] Man vs. Other Mammals

[14:15] What are synthetic ketones?

[21:30] Bill’s case of Parkinson’s

[24:31] Esters vs. Alcohols

[27:58] Why ketones that are non-racemic and non-salt so expensive?

[29:18] The Ketone Market

[32:05] Ketones and Cancer

[37:00] Ketones and Nutrition

[38:36] NAD and Its Link to Anti-Aging

[43:35] Issues with NAD Supplements

[45:27] What is Q?

[45:59] Antioxidants

[48:34] MCT and C8 Usage

[51:05] Dr. Veech's Supplement Use

[51:59] DARPA funding that Dr. Veech get

[54:54] Coconut Oil and Alzheimer’s

[57:44] Ben's Use of Ketones

[59:47] Measuring Ketone Levels

[1:03:33] Research on the use of Ketones

[1:05:28] Breakfast for Dr. Veech 

Ben:  Hey, what's up?  It's Ben Greenfield.  I dunno if you've ever heard of sous-vide, s-o-u-s-v-i-d-e, but sous-vide is a way of cooking things really fast and foolproof with perfect texture.  The problem is, sous-vide cookers are extremely expensive.  Now, sous-vide is a very healthy cooking method because you retain all the vitamins, and the juices, and the nutrients, and the flavors in whatever it is you're cooking, but again it's tough to actually afford one of these home sous-vide products.

So, this is where this company called Straight from the Root comes in.  What they make are these fresh, pre-cooked organic root vegetables, and when I say root vegetables, I'm talking about stuff like sweet potatoes, and beets, and butternut squash, and they sous-vide cook them and then they send them to you in these BPA-free grade cooking bags and you simply reheat them.  It takes like 90 seconds to reheat them.  I actually made myself a salad the other day, I wanted some butternut squash on it, I took out one of these sous-vide bags that Straight from the Root sent me, and just dumped it on the salad and it's extremely convenient.  You can throw 'em in the freezer, they can keep for a long period time or they can keep for 30 days in the refrigerator, and they are extremely free of preservatives because oxygen never touches the vegetables during or after their sous-vide cooking process.  It's really cool stuff.  So you can check these out and get a discount on them if you go to bengreenfieldfitness.com/fromtheroot.  That's bengreenfieldfitness.com/fromtheroot, and you use code Ben to get 15% off these sous-vide vegetables.

This podcast is also brought to you by the Ministry of Supply.  No, it's not a church.  Basically, I'm wearing one of their shirts right now.  So here's the deal: as a human, you sweat and very rarely does this sweating actually take place at a convenient time and gym clothes can handle this well, but the clothes that you wear to work, like the majority of the day that you might pit-out in, they don't really help this issue and they're stiff, and they're restricting, and they only add to the sweating and the discomfort issue.

So what the Ministry of Supply does is they create these special kind of clothing that looks like dress shirts and slacks that wick sweat, and breathe, and stretch as you move.  They actually make one suit, literally a suit, that's so stretchy and so breathable that people have actually run marathons in their suit.  The Ministry of Supply co-founder actually set the Guinness World Record for the fastest half marathon run wearing a suit.

So their dress shirt has NASA-invented fibers in it that regulate your body temperature based on your surroundings.  It's all machine washable, and you can get this stuff in a huge variety of fashion.  I've got their pants, I've got their shirts, and I actually like the way they fit.  So you can get 15% off of any of this Ministry of Supply clothing if you go to ministryofsupply.com.  That's just like it sounds, ministryofsupply.com/ben and you get 15% off your first purchase when you use this code: Ben15.  So go to ministryofsupply.com/ben, get fifteen percent off with code Ben15.  You can also go to any of their stores in Boston, or San Francisco, or the one that's coming soon to Washington D.C., and just mention this podcast, and they'll give you a 15% discount in the store too.  So you too can go running half marathon wearing a suit.

And then finally, this podcast is brought by the most technically engineered, five-blade, high quality razors on the face of the freaking planet and that's Harry's razors.  These are the exact blades that I use.  They have a flex hinge, they have a lubricating strip, and they make these amazing shave sets that you can get from their site for a fraction of the cost of what you'd pay at, say, the drugstore for razors that are far, far less, shall we say, fancy.  They even have an ergonomic handle, so you don't get carpal tunnel while you're shaving.  That joke will never get old.  So anyways, here's how you get Harry's.  You go to H-A-R-R, I almost said that like they do in Britain, I just got back from London.  Did you hear I almost said “haych”? H-A-R-R-Y-S dot com, that's harrys.com and use code Ben at checkout to get $5 off.  So quit compromising on your shave and try these Harry's blades.

Now let's jump in to today's podcast with Dr. Veech, who I'm just gonna nickname right now the grandfather of ketones.

In this episode of The Ben Greenfield Fitness Show:

“If you say that there are 5,000,000 Alzheimer's patients in the United States and you say you want to feed them 150 grams a day, you could do the math.  If you say that there are 600,000 Parkinson’s men, you want to treat them the same way, and you could get a big market.”  “Beta-hydroxybutyrate, which is a physiologic form, causes a reduction of the mitochondrial NAD and it causes an oxidation of the next site, which is Q.  So you increase the redox band between NAD and Q.  When you do that, you increase the energy of ATP.”

He’s an expert in human performance and nutrition, voted America’s top personal trainer and one of the globe’s most influential people in health and fitness.  His show provides you with everything you need to optimize physical and mental performance.  He is Ben Greenfield.  “Power, speed, mobility, balance – whatever it is for you that’s the natural movement, get out there! When you look at all the studies done… studies that have shown the greatest efficacy…”  All the information you need in one place, right here, right now, on the Ben Greenfield Fitness podcast.

Ben:  Hey, folks.  It's Ben Greenfield here, and it seems that this special kind of compound called ketones, or ketone esters more specifically, seem to be taking the sports world, and the biohacking world by storm.  For example, Scientific American recently published an article called “Ketone-based Sports Drink Promises Edge For Athletes” and in that article they claimed an extra 2% of energy from the use of something called ketones, which would be the equivalent of 60 yards in a 30 minute row, along with claims of a world record broken in a lab test of ketones.  Cycling Weekly wrote an article about how ketones are the new energy drink that could be the next big thing in cycling.  There was an article in Tech and Innovation Daily entitled “The Difference Between Sports Champs and Sports Chumps: Ketones.”  Daily Mail Online reported “Could This Elixir Hold The Key To Weight Loss?  Experts Hope It'll Also Treat Diabetes, Epilepsy, and Alzheimers.”

And of course, I've also personally written and reported about my own forays into ketosis for everything from Ironman triathlon to increasing my breath-hold time for free diving and spearfishing, but when it comes to ketosis, and ketones, and ketone esters versus ketones salts, and synthetic ketones, and all these terms that are thrown around these days, I know it can get confusing and frankly, as you're going to learn today, it can be even downright dangerous to play around with a lot of these ketone supplements that are coming out on the market, unless you really know what you're getting into.

So, my guest today is probably the world's foremost expert on ketosis.  His name is Dr. Richard Veech.  He is the senior researcher and laboratory chief at the National Institute of Health, the NIH, and he's worked for the past 47 years researching the mechanics behind things like cellular energy and homeostasis, and he's the guy who actually invented the ketone ester.  So, when you see all these different supplements, and ketones, and talk about ketosis, and everything popping up in all these sports magazines and podcasts and blogs these days, Dr. Veech is the guy who was here long before this stuff all became so popular and so sexy in the media.  So, he and I today are gonna take a really deep dive into ketosis and fill in the gaps for you, clear up some of the confusion about everything from ketone salts to synthetic ketones to ketone esters, and hopefully we're even gonna get a chance to talk a little bit about this brand new anti-aging supplement that everyone is touting to be the next big thing, this NAD.  So that all being said, Dr Veech, I'm honored to have you on the show today and welcome to The Ben Greenfield Fitness Podcast.

Dr. Veech:  Thank you.

Ben:  So, I have a question for you, and that first question is this idea behind ketones.  We've talked about ketosis quite a bit on the show.  Most listeners know what ketosis is, but when it comes to ketosis, people are now claiming you can get into ketosis by taking exogenous ketones, by consuming ketones.  What exactly are these synthetic ketones that people are talking about consuming?

Dr. Veech:  Well, there're two major classes of [0:10:12] ______ I've been taking.  The first one is what they call mid-chain, well, before I get into that, ketosis occurs normally when a person fasts.  So if you just fast for two to three days, you've got a physiologic state of ketosis.  [0:10:29] ______ lab levels of ketones being about 7 millimolar.  So that's the evolutionary development of ketones, and only mammal, only man does that.  No other animal does that.

Ben:  Really?

Dr. Veech:  We developed that because we need to chase the next mammoth.  I mean there weren't McDonald's in the beginning and so therefore you needed to have a source of fuel for your brain.  If you made your ketones from the muscle, you'd be dead in six days and, in fact, you could live 74 days at a normal weight man, and so you make ketones to feed your brain.  The brain is a ferocious consumer of energy and, in addition to glucose, they would use ketones, and that's really the contribution that George Cahill made.  So that's the first thing to say.

Ben:  So there are no other animals or mammals on the face the planet, aside from humans, who actually can endogenously produce ketones in response to fasting?

Dr. Veech:  Yeah.  There's, there is one exception of that, a lactating cow, where they have a huge, let's say a hosting cow is producing 60 liters of milk can get ketotic because it's a glucogenic burden.  But that's the only other animal and that's a different circumstance.

Ben:  Wow.  That's fascinating.

Dr. Veech:  But then, the bear, a bear, for instance, which fasts all winter, doesn't get ketotic.  It's got enough fat, but it lives, it destroys the fat and uses the glycerol to make glucose.  So, yes, for all intents and purposes man is the only animal that does this and he does that for the reasons I said.  Like you've got to catch the next mammoth, you've got to have to be able to run, and chase him, and then kill him, and that required a special evolutionary adaptation, and those, that adaptation is ketones and, specifically, it made a new fuel for the brain.  So that's the reason for ketones.

Ben:  And these ketones can also be used by tissues other than the brain, correct?

Dr. Veech:  Yes.  It can, man can use ketones everywhere but the liver because he makes, when you, when you starve, you release free fatty acids from the fat.  You send them to the liver and convert them into ketones.  So the liver in man, in the rat doesn't metabolize ketones.  Now mouse is a bit different, which is, I bring it up because a lot of genetic studies are done on mice and that's much more confusing than even man or the rat.  But, yes, only a liver, the liver can't use ketones.

Ben:  Okay.  Got it.  For the longest time, when I, well, I first started becoming interested in ketosis so that I would be able to do about anywhere from nine and a half to ten and a half hours of Ironman racing with limited fuel sources and with less glucose burning.  And I would primarily achieve that via long periods of time spent exercising with limited amounts of fuel, or long periods of time spent fasting, and in the years since I have not been doing as much Ironman racing, now folks are trying to, I guess the correct term would be fast track, their way into ketosis by using, not just things like medium chain triglycerides, which I know can get burnt and ketones can be produced as a byproduct of their metabolism, but they're also using these synthetic ketones.  What exactly is a synthetic ketone? 

Dr. Veech:  First of all, a ketone is really composed of two major compounds.  One called beta-hydroxybutyrate, and the other called acetoacetate.  So those are ketones.  People often class acetone as a ketone body, but there's very little of it and it's not really a ketone in the physiologic sense.  So when we talk about artificial ketones or synthetic ketones, what I've made is a dimer, a model ester which is comprised of beta-hydroxybutyrate, it's a 1, 3-Butanediol and a monoester, and the 1, 3-butanediol is converted to beta-hydroxybutyrate.  So when you take this ester, all you're getting is beta-hydroxybutyrate.  Now there are a number of other so-called artificial ketones that are being made and I actually sold.  One is acetoacetate racemic butane.  You don't want to use acetoacetate because it's [0:15:21] ______, and beta-hydroxybutyrate is the reduced products.  So, when you eat, or metabolize acetoacetate, you oxidize the NAD in the mitochondria. and you actually lose an ATP and Krebs showed this in the 80s.

Ben:  And so, what it sounds like you're saying is that if you were to say, purchase a sports supplement being marketed as an exogenous ketone and that were, if that were to contain acetoacetate, you would actually be causing oxidative damage to the mitochondria even though you'd be getting, getting ketones on board, the end result would actually be cellular damage?

Dr. Veech:  It would be less energy.

Ben:  Less energy because you'd have to be a net loss of energy because you'd actually be using an ATP?

Dr. Veech:  You'd go in, normally the mitochondria makes three ATP.  If you go acetoacetate, it misses the first one, so you can only make two.  Now if you're giving a racemic butanediol, that's another matter.  The body is not racemic.  It uses specific isomers, in our case the R-1, 3-butanediol and the R-betahydroxybutyrate and, so you wanna keep with the physiologic forms.  Now for commercial reasons, mainly cheapness of manufacturing, people make these racemic mixtures and they're to be avoided.

Ben:  Now a lot of these racemic mixtures that you're talking about, if you look at the label, though in many cases list the ketone being used as beta-hydroxybutyrate and not acetoacetate.  If it's beta-hydroxybutyrate, do you run into the same issues with damage to the mitochondria if it's in non-physiologic orientation, it's non-racemic orientation?

Dr. Veech:  By convention, when you list a compound as beta-hydroxybutryate and don't say RRL, or D, or S, then you mean, by definition of racemic mixture and, yes, if you're in a racemic mixture, you cause a lot of problems.

Without getting too technical, let me just put it this way: the D-form of beta-hydroxybutyrate, which is a physiologic form, causes a reduction of the mitochondrial NAD, and it causes an oxidation of the next site, which is Q.  So you increase the redox band between NAD and Q.  When you do that, you increase energy of ATP.  Now if you give the racemic mixture, it's metabolized, but it causes reduction at site 2.  So you're narrowing this redox band between NAD and Q, and that gives you less energy.  The same thing goes when you're using mid-chain triglycerides, only 10% of them are converted to ketone bodies.  The other 90% are directly burned in the mitochondria.

Ben:  It's very interesting.  So it sounds like, if you're consuming one of these racemic mixtures of exogenous ketones, and all that means for those of you listening without a chemistry background is that just means there's equal amounts of kinda like the left-handed and the right-handed orientations of that molecule, even if you're, say, measuring your blood-ketone levels, or measuring your breath-ketone levels and it's showing that you're in ketosis, what you're actually experiencing on a cellular level, what you're saying would be a net loss of ATP along with oxidative damage to this NAD structure in the mitochondria which, I know we'll get into what that is here in a little bit, but ultimately you're creating that damage?

Dr. Veech:  Yes.  That's essentially correct.

Ben: And this 1,3-butanediol, I think you said that you guys actually created that.  You made this different form of ketone, this physiologically similar form of ketone in your laboratory?

Dr. Veech:  Yes.  In other words, if you gave the salt, let's say you gave a sodium salt a beta-hydroxybutyrate, how many grams are you have to build with [0:19:41] ______ .

Bill:  Physiologically, when you're fasting, you can make a 150 grams of beta-hydroxybutyrate a day.  In order to take that much into salt form, you have to consume about 80 grams of salt, which, there's two different ways that they define the upper limit of how much salt you should take depending on who you are, but the American Heart Association just keep with 1, that’s 1 gram a day, so the salt forms, what they're doing is they're putting the maximum amount of beta-hydroxybutyrate [0:20:26] ______ , but it's limited by exceeding the daily allowance of salt.  So, you really can't put too much in.  What they wind up doing is giving you a little bit of beta-hydroxybutyrate and some MCT and saying don't take this more than twice a day, and that way, you only get 80% of the higher level of salt that the USDA approves.

Ben:  Right, and that's actually what I've noticed if I look at the label of a lot of these exogenous ketones.  They all say that they're a BHP salt, like bound to sodium or calcium, and they'll contain somewhere between like 10 and 15 grams of the ketone body bound to the salt, and what you're saying is that physiologically you are, you're taking in that much salt when, if you look at say, like even, you know, not that I necessarily agree with everything that the FDA recommends or the USDA recommends, but that's exceeding the recommended intake of say, like 2 grams of salt per day by a factor of five or six.

Dr. Veech:  Yes, at least.  You can't really do that.  Your cardiologists go mad.

Ben:  Interesting.  Oh!  And by the way, for those of you who thought Dr. Veech's voice just significantly changed and that he has this magic voice changing power, that was not Dr. Veech just the speaking.  That was Bill who's there with Dr. Veech and, what is your role, Bill, by the way?  Are you Dr. Veech's assistant or…? 

Bill:  I've had Parkinson's for 16 years and I was helped quite a bit by ketones and I wanted to understand it, so about five years ago, I sorta corresponded with Dr. Veech.  He seemed to be the only one that knew what was going on, so that's my relationship to Dr. Veech. 

Dr. Veech:  I might just add that you're interested in the effects of ketones on the energy that you produce, let's say for an athlete.  A second major effect of ketones, or the metabolism of ketones, is to produce free radicals and it does that by reducing enough [0:22:23] ______ NAD, but NADP.  And in Bill's case,  the cause of Parkinson's is an oxidation of the basal ganglia, and Bill, when he first came to me, was taking dopa carbidopa,, an MAO inhibitor, an inhibitor of methylation enzyme, an agonist dopa.  None of this held it, you get it a little ketotic, he looks perfectly normal, and this is done because you've reduced the oxidative stress on the mid-brain, and, in which case that's the etiology of Parkinson's.

Ben:  So you've essentially reversed much of Bill's Parkinson's by shifting his brain from glucose utilization and the production of free radicals from glucose utilization, to purely relying upon ketones as an energy source?

Dr. Veech:  Absolutely.  That's the essence of it. 

Ben:  And the type of ketones that Bill is using is not a beta hydroxybutyrate salt?  He's using something like a 1,3-butanediol? 

Dr. Veech:  No.  He's using two forms of, he's using a coffee drink that, where you're just taking the fat and making ketone bodies.  You could also take the ketone esters, but that takes some approval from FDA.

Ben:  So is this fat, is this the same thing as you would find on something like, say, Bulletproof coffee?  Is that what you were referring to? 

Dr. Veech:  Yes.  That's right.  Exactly.  It's the same sort of stuff you'd use, Dr. Seaford uses in his cancer patients.

Ben:  Okay.  So like a C8 form of a medium chain triglyceride?

Dr. Veech:  That's right.  It's not ideal, but you can do it without FDA approval.

Ben:  And you're saying that that would be far safer than him being on one of these exogenous ketones sources such as a beta-hydroxybutyrate salt?

Dr. Veech:  Yeah.  No, that really couldn't do that.  [0:24:30] ______

Ben:  Okay.  Gotcha.  Now this butanediol that this ketone, would the appropriate term be a ketone ester?

Dr. Veech:  It's a ketone alcohol.  It's just the alcohol form of beta-hydroxybutyrate.

Ben:  Why not just take that?  I mean why wouldn't you take what you've got there in the lab, and make it into a powder or into something that people could use as an alternative to a salt?

Dr. Veech:  Well, if you wanna get the ketone levels, let's say we wanna duplicate [0:25:00] ______ starvation levels.  We want to get you up to 7 millimolar ketones.  1, 3-butanediol is an alcohol.  When we give it to you as an ester, it's rapidly converted to beta-hydroxybutyrate.  If we gave you just a pure 1, 3-butanediol, you'd get drunk.  (chuckles)

Ben:  Okay.  So you have to figure out how to convert it into a form in which it's not accompanied by this alcohol?

Dr. Veech:  Yeah.  It's, all we're trying to do is not give salt because we've told you why we can't give that.  If we're giving essentially a mole of ketones a day.  If we gave you a mole of acid in the acid form, you'd become acidotic.  So we can't do that.  So we have to give you an ester, and we give you an ester that, one path of which is the ketone body itself, and the other is a compound which is rapidly converted to a ketone body.  So you're getting nothing but ketones.  We could give you, say, a glycerol ester, but then you'd have too much glycerol.  And then if you had diabetes, you would, your glucose would go up.  In fact, when you take the ester we're talking about, the glucose goes down, the insulin goes down.  So you can't just use any ester.  You really, you can't fool mother nature's [0:26:20] ______.  You wanna give, if you're giving ketones, you wanna give ketones.  You don't wanna give…

Ben:  Okay.  Gotcha.

Bill:  What is the enzyme [0:26:28] ______?

Dr. Veech:  [0:26:31] ______.

Bill:  Which is the same thing that converts ethanol?

Dr. Veech:  Yes.  Absolutely.  Same thing.

Bill:  Is this 1,3-butanediol found naturally in your body?

Dr. Veech:  Yes.  It can be formed if you're very reduced and you get ketotic, you form a small amount of 1, 3-butanediol ‘cause you reduce it with NAPDH.  So, yes.

Bill:  So this is something that bodies use to [0:26:52] ______.

Dr. Veech:  No.  It was, butanediol was first used as a pig food by Marian Keyes in the University of Nebraska and she got it from [0:27:04] ______ .  Now that was a racemic mixture.  That was in the 70's.  It actually, you actually make 1, 3-butanediol in small amounts.  So it and beta-hydroxybutyrate are normal products, so you would expect no toxicity from these compounds.

Bill:  So both of these form mirror images?

Dr. Veech:  Yeah.

Bill:  Yes, right form of those?

Dr. Veech:  That's right.  It's just, you said it right.  It's just like your hand.  You got a right hand and a left hand.  These compounds are right-handed or left-handed, and you gotta use the right hand, you gotta use the proper hand, not the right hand.  The proper hand.

Ben:  Now from what I understand, it can be extremely, extremely expensive to actually create a non-racemic, non-salt version of a ketone in the form that you're saying you'd actually have to take to, to get into true ketosis without damage.  Why is it so expensive?

Dr. Veech:  If we had the production with the sources that we are trying to get it from, it would be about $12 a kilo.  In other words, very, very, cheap, but for this unique industrial production, and you really need this from agricultural sources, like corn or sugar cane, you can't make it from the normal chemical companies.  You've got to get, you know, we're sitting on the largest mutable source of carbon bonds in the world, in the Midwest and it's called corn. (chuckles)  That's what you want to use because that is cheap.

Ben:  So, why wouldn't you use corn?  What's the barrier?

Dr. Veech:  Companies that do it.

Ben:  Okay.  So they won't allow you to use their corn to create these salts or these ketones?

Dr. Veech:  Well, these people, I don't wanna get too personal, but these people are used to making tank cars full of ethanol or high fructose corn syrup.  They're not pharmacologists.  They also pay themselves for the, or the board pays themselves rather generous salaries.  And why change somebody, baggy pants biochemist comes in there and start jumping up and down?

Ben:  Yeah.  It just seems, I guess perhaps the market is somewhat small, you know, we're not talking about something like the market for say, like whey protein or the market for something like, you know, like wine.  These ketones, you know, they still seem to kind of fly under the radar in terms of their use.

Dr. Veech:  Actually the market isn't small.

Ben:  Really?

Dr. Veech:  If you say that there are 5,000,000 Alzheimer's patients in the United States and you say you want to feed them 150 grams a day, you can do the math.

Ben:  Yeah.  That's true.

Dr. Veech:  If you say that there are 600,000 Parkinson’s men, and you want to treat them the same way, then you've got a big mark.  If you say there are 33,000,000 obese people in the United States with type II diabetes and you want to get them ketotic, so the markets actually are not small at all.

Ben:  So what can we do?  How can we actually accelerate the ability to create an absorbable, usable form of ketones that's not damaging?

Dr. Veech:  The engineers that run these things understand it perfectly and the problem is, to get to the boards of directors who are not, these are fermentation processes.  If board of directors has no scientists or has an accountant, and head of it, these are difficult terms.  So the best way to do it is find someone with more diplomatic skill than me, and they convince people that run these companies to do this.  We really need it.

Ben:  Well, tell me the names of the companies and I'll start making some phone calls.  We’ll get…

Bill:  To be fair, the companies are quite aware of this and they're a little bit gun shy.  They just spend a half a billion dollars making this biodegradable plastic, and it turned out that the plastic bags shredded…

Dr. Veech:  They couldn't sell it.  We, you know, they couldn't sell it.  I don't wanna get in, I already have too many enemies. (chuckles)

Ben:  Okay.  Alright.  We won't make more enemies, but, in the meantime, if there's anything that myself or my listeners can do to help move this along because it sounds like it'd be good for a lot of people, you know, including Bill, to have access to this stuff on a relatively affordable basis.

Dr. Veech:  Absolutely, and there are other things.  For instance, because I have a mild trouble with atherosclerosis, they have a death sentence in two years.  So, this is not fooling around.  I mean, those people are gonna die.

Ben:  Now what about, what about cancer?  I recently read a book about the metabolic theory of cancer in which it was proposed that cancer is not necessarily a genetic issue, but is instead, or it is a genetic issue, but a big, big part of that genetic issue is the cell going into a state of glycolysis, or production of lactic acid, even if it's, if it has oxygen available to it and if it's able to metabolize it in an aerobic state, the cell isn't doing so.  It's burning up a bunch of glucose for fuel and I've seen talk about the potential therapeutic use of ketones in a state like that.  Would that be another application, do you think?

Dr. Veech:  Well, cancer is an extremely complex and disparate disease state, and what you're quoting is a so-called barbaric hypothesis, and there are a certain number of cancers that do exactly what you say, they glycolyze and don't use their mitochondria even in the presence of oxygen.  But that's not true of all of them and it's not universally true.  So…

Ben:  So there are some cancers that would respond favorably to the presence of ketones, or ketosis, or fasting and others that would not and that particular scenario might aggravate?

Dr. Veech:  I don't think it would aggravate, but it certainly wouldn't help.

Ben:  Okay.  What would be an example of a cancer, do you know off the top your head, an example of a cancer that ketosis may actually be favorable for?

Dr. Veech:  Well, some of the brain tumors.

Ben:  Okay.

Bill:  Dr. Veech…

Dr. Veech:  Alright…

Bill:  My brother in law was travelling in Sri Lanka in January, and most of his peripheral vision started to go and they’ve been to a doctor, and they examined with CT and it turned out that he had a two and a half, about the size of a golf ball, tumor in his occipital lobe.  They rushed back to Sweden, and it turned out that he had glioblastoma.  This is pretty much a death sentence.  A very short time.

Dr. Veech:  The lifespan of glioblastoma is about 12 to 14 months.

Bill:  So there was a person who did some research with mice, I forget her name, but what she did was she took glioma cancer cells, human glioma cancer cells, put it into mice, but she also modified them with the [0:34:30] ______.  And so you can actually see the tumors without sacrificing the mice, sacrificing mice.  She fed the mice just regular food and they died in about 30 days.  She fed them on a ketogenic diet and they lasted about 4, 5 days longer.  She fed them on a normal diet, treated them with radiation, and they lasted about 5 or 6 days longer.  She fed them on the combination of ketogenic diet with radiation and the tumors went away and they all lived, pretty much most of them lived two and a half years, no sacrificing the normal life span and none them had a tumor left.

Ben:  Interesting.

Bill:  Now, with glioblastoma, Joe Biden's son had this and it just so happened that my sister and her husband ran into a doctor in Sweden from Italy who was working on it, and he's found that almost 99% of the glioblastomas had cytomegalovirus.  So what may be happening is the cytomegalovirus stays in the brain and causes other tumors to generate, and that's why it's so difficult to cure.  But he thought that if he had gotten hold of Joe Biden's son who would still be alive today.  So, anyway, to make a long story short, my brother-in-law has been on this ketogenic diet religiously, which is what bhp levels up to, sometimes, off the scale 8.  It keeps his glucose levels extremely low down 80, and we have high hopes for this treatment, and we still have to keep it that which was a combination of retroviral drugs to knock out the cytomegalovirus.  The current cancer's very complex.  You can't just give people hope that if they…

Dr. Veech:  I would modify that.  We don't have, I wouldn't say high hopes.  We hope mightily, but in general, as Bill said, this is a death sentence.  So if you can do anything to retard glioblastoma, it's a plus.  And, normally, they're dead like, say, in 12 to 14 months, and so we'll see as time goes on whether we've done anything to prolong this man's life.  We hope so.

Ben:  Interesting.  So, from cancer to Alzheimer’s, to MS and a variety of issues along with the ability to be able to, for example, prolong sports performance in the face of limited calories, I mean, there's a ton of therapeutic medical uses of ketones, a lot of exercise uses of ketones, so a question that I have for you is, so if this true ketone ester that you talked about is actually a salt free, non-racemic ketone that replicates the actual fuel that the body is producing during times of restricted calories, is there any reason to not just say, hey, eat less, pardon the expression, eat less damn food, throw in some intermittent fasting, eat, and you know, drink more of like the MCTs, or like a C8 in your coffee, or, you know, eat a diet that is skewed greatly towards fat production and simply leave it at that?

Dr. Veech:  Well, I would say that, in general, that's true, except I would say convert entirely to the ketone ester.  In other words, in the patients that I've treated with Alzheimer’s for about six years, if you give mid-chain and ketones, you're getting, you're losing some of the effect of Coenzyme Q that I talked before.  So you really would be better off just taking the ketone esters if you could get.  The mid-chain is simply a stop gap A that you can do at the present time ‘cause they're easily available and there's no restrictions on them, but from a biochemical point of view, they're far from ideal.

Ben:  Okay.  Got it.  Now in terms of ketones, I think we've probably kicked the horse to death that a ketone ester is going to be favorable to a ketone salt for a lot of the reasons that we just talked about, but right now, the fact of the matter is it's just way too frickin' expensive to produce, and so folks will want to engage in calorie restriction and the use of, you know, things like, like Bill has right now, like the C8.  But what about this idea behind NAD which has come up a few times, and which I've seen all over the headlines recently in terms of like, you know, Scientific American, for example, recently did an article about reversing age with NAD, and NAD, nicotinamide adenine dinucleotide, for those of you who want to impress people at cocktail parties is, you know, something we've known about for a long time but I never, until recently, saw people talking about using it to mimic anti-aging and to mimic exactly what it is we were just talking about, calorie restriction.  So where does NAD fit in here and do you think that these companies that are now beginning to market NAD as a supplement are actually providing something valuable to the general public?

Dr. Veech:  NAD is, what you're doing with ketone bodies is reducing the NAD in the mitochondria. So it’s quite at the center, so if you're gonna make 50 kilos of ATP a day, you're gonna need 15 kilos of NAD to do that.  And so, it's at the heart now and regard to aging, the best work that's been done on that has been done on nematodes, that's been done in California by a woman named, what's the woman's name in California?  Works on nematodes?  I can't, Mary, anyway, she was at UC San Francisco… What's her name?  We can't remember.

Ben:  So she's been working on, like nematodes, like the round worms? 

Dr. Veech:  Yes.  And if you look at the effects of giving ketone, making animals, rats, ketotic with ketone esters, you lower their insulin, you lower their blood glucose, you lower their cholesterol, you increase their energy, and you decrease their appetite, and they lose weight.  So most of the effects that you associate with the disease of aging, you've reversed.  Now, the mechanisms of aging are, like cancer, are complex.  We're actually beginning to work on that now, and the idea that you can feed NAD and reverse aging is unlikely, for the reasons I told you.  If you'd need to…

Ben:  Because of how much you'd have to take? 

Dr. Veech:  Yeah.  You'd have to take 15 kilos.  And this is the same reason that ketones work in free radical disease.  I can feed you all the vitamin C in the world and you won't do anything.  If I let you generate the NADPH by ketones, you reduce all the things you want to and Bill quit shaking.  Now, that's the sort of argument that Krebs and Linus Pauling got into.  Well, maybe 20 years ago where Linus Pauling was arguing that people should take massive doses of vitamin C.  It's not in fact true and, finally, one day Krebs just wrote him a letter and said, “Please quit writing about that which you do not understand.”  And I think Krebs was quite right, and Pauling didn't understand it, and it doesn't work.

Ben:  So, mega dosing with vitamin C is not something that you're a fan of?

Dr. Veech:  Well, I'm an old opponent.  If you take a large dose of vitamin C, you'll produce kidney stones and diabetics, Krebs has written about this.  No.  Mega doses of vitamin C can be actually dangerous.

Ben:  Interesting.

Dr. Veech:  So, and it's not gonna do what Pauling thought or advocated.  It's just not true.  Pauling was a chemist, Krebs was a biochemist.  There's a difference.

Ben:  Why is it that so many alternative medical physicians, and I've even seen MDs do this as well, they'll prescribe like high dose vitamin C for immune system issues, or for infections, or for fighting high amounts of oxidation?

Dr. Veech:  Without making more enemies, my medical colleagues are very well educated and they do silly, stupid things.  There's no, there's absolutely no basis to say that you're gonna reduce something by feeding vitamin C.  There's just no basis for this at all and, you know, the fact that they do it, doctors used to bleed people too.

Ben:  Yeah.  You know, with this NAD issue, what the claim is that with the use of a single dose in NAD, or a single dose of NAD, you can get a, what they describe is a statistically significant increase in NAD levels.  That's what these companies that are now producing, I believe Chromadex is the name of a company that's trying to come out with like a new NAD drug.  Now I would imagine that they're not saying a single dose is 15 kilos.  So what it is that they're missing here?  What component of it, of the use of NAD supplementation, is it that they're wrong about?

Dr. Veech:  Well, I have no doubt that if you gave a large dose of NAD, you would increase the tissue levels of NAD in the tissue you're looking at.  You're not interested in the NAD.  You're interested in the ratio, you're interested in the redox stature, interested in NAD to NADH ratio.  Now that is not changed by feeding NAD.  So all the operational things you're talking about is changing the redox state of the NAD couple like we're changing the redox state of the Q couple.  By redox state, I mean the potential to donate hydrogen.  So just increasing the NAD won't do anything.  Let's, a lot of people advocate feeding people Q.  You've read this, I'm certain.  If you increase Q, [0:45:06] ______ showed years ago that the biggest source of free radicals is Q semiquinone, a half oxidized form of Q.  And so if you're feeding people Q, you're actually making more free radicals.

Ben:  And the use of an NAD supplement would be the equivalent of feeding someone Q?

Dr. Veech:  Oh, not the equivalent of it.  It's essentially worthless.

Ben:  It would be very similar to it.  And, just for our listeners to clarify, what is Q again?

Dr. Veech: Q is the second site after.  In the mitochondria, you start with NADH and you go, the next site where your next ATP site 2 is Q semiquinone, or, sorry, Q, coenzyme Q. 

Ben:  Right.

Dr. Veech:  So it's the next transport form in the mitochondria.

Ben:  So, we're talking about it being synonymous to CoQ10?

Dr. Veech:  Yes.  Exactly.

Ben:  Okay.  Got it.

Bill:  I think that all of the antioxidants work, except they have an active form in it, an active form.  When they are active, they are actually going to take on a free radical and become a free radical themselves.  Now, the reason that they aren't as harmful is that they have ways of distributing that electron and holding it that, the hydroxyl radical for instance, could be able to do it, so activate such a small structure.  But, once they, say vitamin C has gone from the active state to the inactive state by [0:46:35] ______ hydroxly radical, you need to recharge that with vitamin C.  What Dr. Veech is saying is that NADP is the recharger of every antioxidant.  So, taking vitamin C by itself would be like eating rechargeable batteries without the battery recharger.

Ben:  I gotcha.

Dr. Veech:  Well, look.  The negative, the most negative potential in the cell is the NAD and that's -0.42 volts.  All the other, ascorbic acid is +10.  So all the other redox couples, of which there are many, are all slaves to this most negative couple which is the NADP couple.  So all the other things, Q, everything is a slave to that.  So, if you keep that reduced, then you're gonna destroy free radicals and you're gonna…

Bill:  And the magic of what beta-hydroxybutyrate works is it's going to change the ratio of NADH to NAD in the mitochondria.  It's also gonna change the ratio of NADPH to NADP in the cytosol.  And by doing that, it recharges all of the antioxidants, it does all these things that NAD is supposed to be quite doing, but it does it in a much more effective way.

Dr. Veech:  Yeah. 

Ben:  Without producing an actual free radical?

Dr. Veech:  The decreased and, you know, this is all, Krebs and I worked this fixes.  And so…

Ben:  Okay.  So you would not, if you had your way, you would not use NAD, you would not use vitamin C, and you would not use any ketone salt due to the potential for production of free radicals, mitochondrial damage, and also excessive intake of sodium and/or calcium, and the potential for everything from calcification to kidney stones?

Dr. Veech:  And hypertension.

Ben:  Okay.  Gotcha. 

Dr. Veech:  Yes.  No.  That's right.  I wouldn't use any of those.

Ben:  Now, now you did mention, of course, you know, so far, that you do like the use of like MCTs or C8.  Is there, in your opinion, because I was recently at a conference where there were a bunch of people drinking this fatty coffee, but they were, their, next to their big cup of coffee, they had eggs, bacon, berries, muffins, et cetera, and my opinion, and my advice to them was either do the coffee by itself, without anything at all, or just eat the food by itself, but don't do both together because the potential for excessive calorie intake and the potential for fat oxidation from, you know, high blood glucose combined with high amounts of fat intake.  What's your take on the best time to actually use something like C8 or MCT if you were going to use that to generate ketones or to mimic a somewhat fasted state while still keeping some calories on board?

Dr. Veech:  Well, let's take the case of Bill, since he's here.  He really can't get along without an adequate level of blood ketone bodies.  And right now, for administrative reasons, having to do with FDA and what not, we can't give him the ester.  So the only thing we can do is give him the mid-chain.  It's far from ideal, but it'll work as a stop to death.

Ben:  Okay.

Bill:  If I could just interject that I have sort of a sensitive system for testing.  The effects of mixing, as you said, a lot of food for breakfast with the coffee, and if I eat anything else with the coffee, it does not work at all to relieve my symptoms.  So, I'm suggesting that, because I have Parkinson's, it's a very, it's like having your own canary be able to test whether your theory works or not.  You're absolutely right that, I would say if you're trying to prevent the degenerative diseases by taking, say, coconut oil, using it for meals and eating a lot of fruits and things, it's probably having no effect.

Dr. Veech:  Bill, one day, went out to dinner, we had a big slab of cheesecake and he was erect the next day.  So, destroyed the effect of his ketosis.  So, you're quite right.  You don't want a high glucose.

Ben:  Okay.  Got it.  Now, Dr. Veech, do you use supplements?  Like if you were going to use something for anti-aging, for example, like what would be your recommendations?  Or what would you yourself use based off the research that you've seen?  ‘Cause it seems like you're pretty steeped into research.

Dr. Veech:  I'd take a normal vitamin pill that you'd get at the Giant Food and, if I could get hold of one, I'd take the ketone esters and that's all I'll do.

Ben:  And that's it?  Now what about like fish oil or anything like that?

Dr. Veech:  Oh!  Yeah!  You can take that.  They wouldn't hurt you.  You know, the PUFAs have been, if you're a neonate and don't get enough PUFA in your breast milk and it has definite effects to see PUFAs working in things like traumatic brain injury, there's no evidence.  Mega studies show much effect, but they're not harmful.

Ben:  Now, from what I understand, like DARPA, and I've heard about like different Tour de France cycling teams, I know you guys got some DARPA funding for your group.  I've heard about professional cycling teams using ketones as like a brand new fuel.  There are some of those headlines that I've read off in the intro to our podcast, can you tell me a little bit about the DARPA funding that your group received, and what you wound up doing with that?

Dr. Veech:  Well, actually, the man that gave us that, in charge of that project was Dr. Joseph Polinski and he actually was an ironman marathoner.  He gave us the task of making a new diet for their special forces that would increase their physical performance and not impair their cognitive function, and we did that.  This ketone ester that we made took us several years.  We came up with this thing and, in fact in rats, it didn't, in the perfused rat heart, working perfused rat heart, we could increase the energy production by the heart by 28% and like I said, I told Henry Lardy who was professor of enzymology at the University of Wisconsin, I said we've increased the efficiency of ATP production in the heart by 28%.  He said, “I don't believe you.”  We said, “Okay.  Well, what number do you want me to change?”  We're only doing joules, we're doing pressure and volume.  Now that's joules.  So we're increasing energy.  Now, in the athletes, you don't, there's a lot of wasted energy when you're actually running.  Dr. Clark, I think, can get 2% increase which makes a difference if you're a rower and one of the people around the Olympic, set an Olympic record and I, the only other thing I'd say is our primary purpose of doing this was to make a new fuel for our special forces and also we have some medical uses.

Ben:  But at this point that fuel that you developed, that one that allowed the perfused rat heart to be 28% or to produce 28% more energy, this runs us up against the same wall we were talking about before, where this is the non-racemic, non-salt version of the ketone that you were given this rat.

Dr. Veech:  That's right.  That's right, and but it will work but, you know, if I had, if I had a couple of tons of this stuff, giving it to a bunch of athletes would be last thing I'd do.  I'd give it to the ALS and to the Parkinson and the Alzheimer's first because the athletes, sure they'd do better on the stuff, but they can get along without it.  Some of these diseases can't get along without it and so, in a field of shortage, you'd deal with the women and children first.

Ben:  We've had a lot of listeners speaking of diseases like this, write in and ask about Alzheimer's, and I know that Dr. Mary Newport, for example, has a website called coconutketones.com, and she wrote a book called “Alzheimer's Disease: What If There Was A Cure?”  When it comes to Alzheimer's, do you think that it's the same issue? That these ketone, these non-racemic versions of ketones would be what's necessary?  What do you think about Dr. Mary Newport's use of, basically just coconut oil?

Dr. Veech:  Well, Dr. Newport called me, I, she, first, she knew about ketones.  Dr. Newport is a neonatologist.  She's well trained, and her husband had had 16 years of Alzheimer's and he was going downhill and she tried him on ketones and he showed a slight positive response for maybe a couple of months.  That then quit and he lost the response and so, at that point, we had to put him on the ketone esters.  And he was on that for about five or six years.  He [0:56:00] ______ died in January, and I think part of the reason was that, either we didn't give him enough, or didn't have enough, or the disease progressed, and we didn't stop it.

Ben:  And he was literally just getting them from your lab?

Dr. Veech:  That's correct.  Made in my lab by Todd King.

Bill:  Something we didn't know at the time was that [0:56:24] ______ .

Dr. Veech:  Yeah, well, and Dr. Newport was giving up with coconut oil cause, bless her heart, she thought if something's good [0:56:33] ______ .

Ben:  Wait.  What was she doing? 

Dr. Veech:  Well, she was feeding coconut oil at the same when she was feeding ester.  I don't wanna, I don't want to be critical of Dr. Newport, but she did heroic duty, I mean this guy was really severely impaired, so, and she kept him alive.  He would've been dead six years before he did die if it weren't for her and her care.  That's how he  kept him alive and if for some reason, Todd couldn't make the ketones, he just totally fell apart.

Ben:  Okay.  So when it comes to whether or not coconut oil can truly work for curing Alzheimer's as some may claim, really what it comes down to is that it would turn out that ketone esters would hold much more promise than just overdosing with coconut oil.

Dr. Veech:  Yes.  Dr. Newport gets hundreds of e-mail and she doesn't wanna put out that there's no hope, you know, and so, it's sorta like Bill with the mid-chain, with no alternative, you could try it.  Was it ideal?  No.  It's not ideal.

Ben:  Now I've used ketones before, like I mentioned, for, you know, these ketone salts at least for, you know, while free diving, you know, and that was based off a discussion with Dominic D'Agostino about an increase in breath-hold time and a reversal of hypoperfusion to brain tissue in rat models.  So I figured it'd be at least worth a try, and I've also used them for cycling, for example, mixed with MCT oil in a bottle.  And I've written articles about this, by the way, everything that we're talking about I'll link to if you go to bengreenfieldfitness.com/veech.  That's bengreenfieldfitness.com slash V-E-E-C-H.  You can access all the show notes for everything that we're discussing, but Dr. Veech, I found that, although it did indeed increase my ketone production, it's not too friendly to the gut, these ketone salts.  Can the same be said for ketone esters?  Are they difficult to digest?  Do they, could they lead to gut distress?

Dr. Veech:  I hesitate, certain people can take in above and ain’t problem, I for instance because I was getting it [0:58:59.1] ______.  I took them just to see if it was gonna kill anybody.  It didn't kill me.

Ben:  Sounds like a safe self-experiment.

Dr. Veech:  Well, the, they certainly are aversive in taste.  So, the athletes, it doesn't matter, the special forces, it doesn't matter.  If you're dealing with demented patients, that's a very big problem because they won't take something that tastes bad.  So we're working on getting rid of that bad taste.  In general, I recommended taking the ketone esters in the morning and in the late afternoon.  I don't recommend taking them and then laying down immediately.  You can get some degree of esophagitis or reflux if you take these late at night.

Ben:  Okay.  Gotcha.  Now you mentioned that in many cases, many of the therapeutic effects of ketosis are seen up around 7 millimolar, which is quite high, even when I'm fasted, I'm generally around 1 to 3, and if I combine fasting with exercise, I'll get in that 3 to 7 range, but it's difficult.  We're talking about a two hour bike ride at an overnight fasted state.

Now, in terms of measuring that number, there are a variety of different ketone measuring devices that are out there.  Everything from the fingertip pricking for the blood measurement, to urinary measurements, which I know have fallen quite out of favor due to them showing simply unmetabolized ketones, to my understanding.  But then there's breath testing.  Do you experiment with different forms of measuring ketones?  And if so, what have you found to be best or most user friendly?

Dr. Veech:  Well, the only thing that we had really tested extensively, unfortunately, is the Abbot, what's it called?

Bill:  It's the [1:00:53] ______ of ketone.

Dr. Veech:  Yeah.  And that is quite accurate.  There was another stick that was…

Bill:  I will say that it won't detect a racemic, if you have a racemic mixture, that's a mixture of both the right-handed and the left-handed forms, it only detects the biologically active forms so, you could potentially poison yourself by thinking that you're at, you're at 7 millimolar when, actually, you're at 14 because the test kit only measures the D form of beta-hydroxybutyrate.

Dr. Veech:  Some of these kits don't work, for instance, another person that's an athlete is taking high fat and he kept getting high glucose and it worried me, but in fact it was just a stick.  It was stick that came from CVS and I don't know what it was, but it didn't give accurate glucose. 

Ben:  But at CVS, for example, you can get these precision xtra blood ketone test strips made by Abbott.

Dr. Veech:  They sell something else that's cheaper.

Ben:  Okay.  I gotcha.  Yeah, I don't know the name of the other.  What about these, these breath testing devices, like Ketonix?

Dr. Veech:  No.  They're based on acetone and that's a byproduct, that small amount that you're getting that doesn't tell you anything.

Ben:  Do you think it's coincidence?  Because I've tested with Precision Extra Blood and with Breath Ketone Monitors, and I've found there to be pretty decent correlation.  Do you think that's just chance?  Or is it really only acetone that the breath is measuring?

Dr. Veech:  It's only acetone but you did an extra arm, you're way ahead of me so I should shut up. (laughs)

Ben:  Okay.  Yeah.  It was my impression that there were a few of them.  There are some that are basically like tubes that you breathe into, and then you break a little ampoule and that does indeed measure acetone, but there's another one called a Ketonix breath testing device that actually seems to correlate well to blood measurements, but I was just curious if you'd ever actually tested something like that.

Dr. Veech:  I don't know anything about it.  You're way ahead of me.

Ben:  Okay.  I'll send you information.  The only reason I like it is when I'm out exercising and stuff, a lot of times just constantly, you know, pricking my finger.  It can be annoying versus breathing into this breath ketone monitor.

Dr. Veech:  If it works, it's good.  The only reason I don't like Abbott is it costs a lot.  I wish it were cheaper, but from a, we've calibrated it and it works.  We've calibrated against enzymatic tests in the lab and it's pretty accurate.

Ben:  Now, one last question for you.  We have folks like, and I don't know if you're familiar with, for example, Dr. Peter Attia, or Dr. Dominic D'Agostino, or a lot of these people that are out there doing research on things like performance and the use of ketones, or the use of ketosis, for example, in Dom's case, to, you know, reduce the damage done, you know, to divers, for example, who are breath holding for long periods of time.  In your opinion, based off of what you've discovered so far, would you say that at this point, where the research and the available, you know, supplements and synthetic ketones stand, that these type of folks would be best incorporating fasting with something like, you know, C8 and Bill's approach versus the use of salts, until these ester’s actually become available, is a basically what the takeaway is here?

Dr. Veech:  Yes.  I agree and I think Dr. Attia, he does just fasting, I think.  I think he'd do mid-chain too.

Ben:  I don't know if he uses exogenous ketones.  I know he does fasting and some amount of carbohydrate restriction.

Dr. Veech:  Yeah.  Well that, that'll give you ketosis.  And, yes, I would think that it would be best to avoid the salts and it would also be best to avoid, there are some esters that are, as I said, are acetoacetate and racemic 1, 3-butanediol and those should be avoided altogether.

Ben:  Okay.  Gotcha.

Bill:  If you're chasing Chris run up a hill and you're wondering why he's pulling away from you because he's on Dr. Veech's ester, maybe.  I’m not [1:05:15.2] ______.

Ben:   (chuckles) Nice.  There's a secret sauce.

Bill:  You're on, make this, make sure or something that has acetoacetate, which is like the spent form of the fuel, you're gonna have a hard time catching up to this.

Ben:  Dr. Veech, what's a typical breakfast for you?

Dr. Veech:  Well, I don't really eat breakfast.  I'm quite old and I don't need many calories and so I eat some toast with some peanut butter and jam for breakfast.

Ben:  Which would definitely not be like a ketotic, high fat approach.

Dr. Veech:  No, no.  Not at all.

Ben:  So, you yourself do not try to keep yourself in a state of ketosis?

Dr. Veech:  No.  Not really.  For many years I took the ketone esters just to see what it would do, and that'll get you ketotic, but I'm, you know, I don't need to be an athlete.  I don't go on these ultra marathons so, it…

Ben:  What about for disease prevention?  Are you concerned at all about like, you know, glycation end products or fluctuations in blood sugar, or things like that?

Dr. Veech:  Yes, and I think I'll also for general, prevention of, you know, when you get to my age, the incidence of Alzheimer's is quite high and so, yes, for prevention of cognitive impairment, prevention of Parkinson's, and probably prevention of age you would want to get value.

Ben:  Yeah.  Eventually for you just wish to having an avocado with some olive oil for breakfast. 

Dr. Veech:  That's right.  That's right.

Ben:  There you go.  I'll send you some recipes.  I'll send you my avocado chocolate pudding recipe.  It's fantastic.

Dr. Veech:  Well, I have people that work with me that are devotees of that.  It also takes a lot of time and I don't have that much time.  I'm in the lab by 6:30 and so I just don't…

Ben:  Well, you can just make a big, big batch of chocolate pudding, high fat chocolate pudding and keep it there in the lab.  Well, I know I've kept you for a while here and this has been fascinating to hear, the take of an actual ketone researcher on ketones, you know, rather than what pop culture and the media, and supplement companies might say about them.  So certainly plenty of fuel, pun intended, for thought here.  I look forward to seeing how these true ketone esters and their availability progresses.

Again anything that myself or my listeners can do to help make that happen, you know, feel free to reach out.  We've got kind of a big, big army of folks listening in who can do things like write letters or make phone calls if it would be helpful ‘cause it sounds like this could help a lot of people if these things became more commercially available. 

Dr. Veech:  Absolutely.  We can't make enough and it would be a shame if there were a lot of people that actually need these things quite bad.  Thank you for your time.

Ben:  Yeah.  Thank you for coming on, and again, if you're listening, you can go to bengreenfieldfitness.com/veech.  That's bengreenfieldfitness.com slash V-E-E-C-H, and all link to Dr. Veech's website along with some of other things we talked about like the book on Alzheimer's disease, and this C8 form of oil, these articles that I was talking about about NAD, and the anti-aging NAD fad and, oh so much more ketone goodness.  So, Dr. Veech and Bill, thanks so much for coming on the show.

Bill:  My pleasure.

Dr. Veech:  Thank you.
Ben:  Alright, folks.  This is Ben Greenfield signing out from bengreenfieldfitness.com.  Have a healthy week. 

You’ve been listening to the Ben Greenfield fitness podcast.  Go to bengreenfieldfitness.com, for even more cutting-edge fitness and performance advice.

 

A special kind of compound called “ketone esters” seem to be taking the sports and biohacking world by storm.

Scientific American published the article “Ketone-Based Sports Drink Promises Edge for Athletes”, claiming an extra 2% of energy from the use of ketones, which is the equivalent of 60 yards in a 30 minute row, along with a world record broken in a lab test of ketones.

Cycling Weekly wrote “Ketones: New energy drink could be next big thing in cycling.”…

 

Tech and Innovation Daily featured the article “The Difference Between Sports Champs and Sports Chumps? Ketones.”…

 

…and Daily Mail Online reported “Could this elixir hold the key to weight loss? Experts hope it’ll also treat diabetes, epilepsy and Alzheimer’s”…

…I’ve even written about my own forays into ketosis for everything from Ironman triathlon to freediving in the article “How To Get Into Ketosis“.

In today’s podcast, I take an even deeper dive into ketosis and specifically focus on a type of ketosis supplement called “ketone salts”, also known as “synthetic ketones”.

My guest is Dr. Richard Veech. Dr. Veech is one of the world’s foremost experts on ketosis, and the Senior Researcher and Laboratory Chief at The National Institutes of Health, the inventor of the ketone ester, and has worked for the last 47 years studying cellular energy and homeostasis.

During our discussion, you’ll discover:

-The fastest way to get into ketosis…

-Why humans are the only animal that can truly get into ketosis…

-Why Dr. Veech believes that the exogenous ketones currently on the market can be extremely dangerous…

-Why a “true” ketone ester is actually a salt free and non racemic (D-bhb) drink that replicates the actual secondary fuel that the body produces during times of starvation…

-Why a non-racemic, non-salt version of ketones so expensive ($3000+ a bottle!)…

-The truth about something called “NAD” as the next big anti-aging drug…

-Which supplements Dr. Veech would use for anti-aging…

-Whether or not coconut oil can truly work for curing Alzheimer’s as some may claim…

-How Dr. Veech received DARPA funding and created a new fuel for the troops…

-Dr. Veech’s most recommended method of measuring ketones…

-And much more!

Resources from this episode:

–Precision Xtra blood monitors

–book – Alzheimer’s Disease: What If There Was a Cure?: The Story of Ketones

–Dr. Veech’s NIH website

–Brain Octane C8

–1,3 Butane-Diol

–Beyond Resveratrol: The Anti-Aging NAD Fad

–Ketonix breath testing

 

Research:

1. Lendvai N, Pawlosky R, Bullova P, Eisenhofer G, Patocs A, Veech RL, Pacak K. Succinate-to-fumarate ratio as a new metabolic marker to detect the presence of SDHB/D-related paraganglioma: initial experimental and ex vivo findings. Endocrinology. 2014;155(1):27-32.
2. Veech RL. Ketone esters increase brown fat in mice and overcome insulin resistance in other tissues in the rat.Ann N Y Acad Sci. 2013;1302:42-8.
3. Nakagawa T, Ge Q, Pawlosky R, Wynn RM, Veech RL, Uyeda K. Metabolite regulation of nucleo-cytosolic trafficking of carbohydrate response element-binding protein (ChREBP): role of ketone bodies. J Biol Chem. 2013;288(39):28358-67.
4. Kashiwaya Y, Bergman C, Lee JH, Wan R, King MT, Mughal MR, Okun E, Clarke K, Mattson MP, Veech RL. A ketone ester diet exhibits anxiolytic and cognition-sparing properties, and lessens amyloid and tau pathologies in a mouse model of Alzheimer’s disease. Neurobiol Aging. 2013;34(6):1530-9.
5. Srivastava S, Baxa U, Niu G, Chen X, Veech RL. A ketogenic diet increases brown adipose tissue mitochondrial proteins and UCP1 levels in mice. IUBMB Life. 2013;65(1):58-66.

A Response from Dr. Dominic D’ Agostino:

Veech’s comments on racemic BHB salts have created confusion. Henri Brunengraber (Veech’s colleague) demonstrated the metabolism of racemic ketones and BHB.  S-BHB goes to acetyl CoA and inter-converts to R-BHB. Lots of data, even tracer studies.

No data supports Veech’s claim they are “dangerous” or even “ineffective”. Veech thinks dietary fat is bad and “acetoacetate will stop the heart”. Obviously that is not the case, even with a very high dose to animals
I have served in government workshops with Veech, and for these reasons much of what he says gets dismissed.

When serving on an panel for FDA GRAS, there was NO scientist or toxicologist that could find a study consistent with Veech’s claim that racemic BHB salts are dangerous, unless consumed in very high amounts.  Of course ALL things are dangerous if dosed high enough.. caffeine, tylenol, etc. will kill you if dosed high.

Many studies show racemic BHB salts are safe in high doses, even in kids given pure sodium BHB over periods of years. Treating MADD is a good example. Check out the following studies:

Highly efficient ketone body treatment in multiple acyl-CoA dehydrogenase deficiency-related leukodystrophy.
Gautschi M, Weisstanner C, Slotboom J, Nava E, Zürcher T, Nuoffer JM.
Pediatr Res. 2015 Jan;77(1-1):91-8. doi: 10.1038/pr.2014.154. Epub 2014 Oct 7.
PMID: 25289702

-Favorable outcome after physiologic dose of sodium-D,L-3-hydroxybutyrate in severe MADD.
Van Rijt WJ, Heiner-Fokkema MR, du Marchie Sarvaas GJ, Waterham HR, Blokpoel RG, van Spronsen FJ, Derks TG.
Pediatrics. 2014 Oct;134(4):e1224-8. doi: 10.1542/peds.2013-4254. Epub 2014 Sep 22.
PMID: 25246622 Free Article

-D,L-3-hydroxybutyrate treatment of multiple acyl-CoA dehydrogenase deficiency (MADD).
Van Hove JL, Grünewald S, Jaeken J, Demaerel P, Declercq PE, Bourdoux P, Niezen-Koning K, Deanfeld JE, Leonard JV.
Lancet. 2003 Apr 26;361(9367):1433-5.

A note/correction from Mary Newport, who wrote:

Dr. Veech said that Steve started taking the ester two months after he started the coconut oil because it was no longer working. Actually it was two years. Steve improved steadily and very significantly over the first year and stabilized the second year but then began to have new problems after he was on a clinical trial drug for 5-7 months that turned out to accelerate Alzheimer’s disease.  He started coconut oil in May 2008 and the ketone ester at end of April 2010.

Read more https://bengreenfieldfitness.com/2016/05/what-are-ketone-salts/