5. Ketosis and Ketones

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The , uh , idea of a ketogenic diets become really popular lately with some sports like CrossFit and different things where people have really started to , uh , up their fat intake, eating a lot of bacon avocados and steaks, which sounds great. We're going to kind of get into why they're doing this , uh, the goals of this diet, and then also maybe some, some times when you shouldn't shoot for a ketogenic diet.

Yeah. This is a topic that , um , is widely popular, not just among athletes, but it's something that's really blown up probably in the last, I don't know, five years, maybe a little more than that. Um, and it's one that comes up with patients a lot. So I think it's a , a very pertinent topic for us to dig into today.

Yeah. Really looking forward to getting some , uh, some good answers and some background into what you're really trying to achieve with eating a higher fat diet or doing some of these practices to get into ketosis. So before we get into some diet and some practices and ways to achieve with ketosis, what we're trying to achieve is the body producing ketones. So what is a ketone? Yeah. So ketosis is, is just that it's a high level of ketones circulating in the blood.

And , and like you said, typically that's going to be the body producing it. And we'll talk about another way that can happen by taking in ketones. But , um , ketones themselves are these they're small metabolically active molecules. There's two of them primarily in the body acetoacetate and beta hydroxybutyrate . You don't need to remember those, but it's kind of important to know because when you're, when we talk about testing and , uh , you know , those are the things we're looking for.

Um, but the more important aspect is that ketones are a fuel that , that the body uses or even produces , uh, in periods of low caloric intake. So starvation , um, low carbohydrate intake, and then other scenarios like prolonged exercise, which kind of mimics a starvation. So it's when you start to run out of other fuels, the body can produce ketones from fatty acids and fuel certain tissues , uh , specifically heart muscle , um, brain tissue, neurologic tissue.

Those are the main ones that can pretty readily use ketones as fuel. Other tissues cannot use ketones. So men cannot live on ketones alone. Like you've got to have the other stuff , um, but they can serve as a , a fuel source in times of need. So to speak. Yeah. So with ketones, I've actually had a longer experience with it growing up with my sister as a type one diabetic.

So how do ketones in an otherwise healthy population differ from when she would be in ketoacidosis as a, as a type one diabetic? Yeah. So it's , it's very different. Um, people who are familiar with diabetics will recognize this term of , uh, you know, ketoacidosis or DKA, diabetic ketoacidosis, where it's a, it's a life threatening condition ketones go up. Um , they go up very high and it'll put somebody in the intensive care unit. Uh , that's not what we're talking about here.

What's happening in a type one diabetic who's unable to produce insulin and therefore unable to utilize circulating carbohydrate. Um, that's a , that's a very different scenario than someone who can, can utilize carbohydrates producing insulin , um, and can also manage the, the, the acidosis of the levels of acid in the blood that come along with this.

So even though it's along the same spectrum, it's kind of two ends of the spectrum , uh , ketosis from a dietary standpoint, even a supplementation standpoint, which we'll talk about is typically very safe. Uh , it's not going to put you in ICU. Excellent. Yeah. I remember some, some scary encounters and we had the , uh, the old urine test sticks and in some times, and it would be like, Oh, I have ketones.

So when, when this became really popular before I kind of understood was going on, that was, why would you want that? Because I've always seen it as a bad thing. Yeah. And you're not alone.

A lot of doctors , um, thought that because that's our initial experience as well, is that pretty much the only time typically that we're looking for ketones and blood worker or urine samples is in patients who are in a diabetic crisis, and we're trying to determine kind of how far along they are in that spectrum of crisis and how bad is it in the presence of ketones kind of points toward it being pretty bad, but that's, again, not what we're dealing with in a person who's not a type one

diabetic. Right . So since we're talking about , um, you know, a nondiabetic population right here, and we're thinking about ketones and the value of kind of switching what we're using for our energy systems, how do we achieve a state of this ketosis to get our body, to start producing these ketones? So , um, like I was saying, a minute ago, ketones are produced in times of starvation. So you can just start yourself.

That's not going to be very helpful , uh , in the longterm, but, you know, simple fasting can lead to, or will lead to production of ketones , um, initially , uh, at a lower level. And then the longer you fast, you know, supposedly, or you could kind of expect that higher ketone levels will , uh, will result from that. So, but typically, you know, fasting isn't is a easy or a common way to do it. Um, we talked about ketosis from low carbohydrate , uh, availability.

So you can limit your carbohydrate intake. That's going to take a little bit longer cause your body stores some carbohydrate. But if you get to the point where you've basically run through all your carbohydrate or glycogen stores, and you still have metabolic activity that needs to happen, which, you know, if you're breathing and thinking and your heart's beating, that's the case, you need to support those activities.

Um, then your body will move toward using these free fatty acids, turn them into ketones and let the Oregon's use those for fuel. So limiting carbohydrates is another way. It's a little bit slower. Um, but it's , uh, it's something that you can do. And even in concert with these other methods, so you could do some intermittent fasting to get the levels up a little bit. And then when you do eat lower carbohydrate. And so you're kind of using two strategies there.

Um, the third one is supplementation. So actually taking in ketones, this is a bit newer that we have these molecules available as dietary supplements. Um, and they come in in two different forms. We'll talk about it later, but , um, you know, purportedly, you'd be able to eat more normal diet and then take exogenous or external ketones and bringing levels up.

So that's three ways, fasting carbohydrate restriction, supplementation, you hear a lot of people who will discuss, you know, I'm keto and I do intermittent fasting. Cause they're , they're both very popular terms. And they're interesting strategies that you can apply to whatever your physical outcome goal is, your performance goal and things like that.

But I think people are really, they see it in, you know, you see it in the news, you see it online and they're like, okay, these two things are good. So then I need to do them. So is it a safe practice to try and achieve this, this ketotic state or be in ketosis and eat this really low carb diet? Is that something that's safe for everyone it's, it's safe?

Like it's not, there's been a couple case reports in the literature of people who were not diabetic, who ended up in ketoacidosis, presumably from a ketogenic diet, although it's not real clear, it doesn't happen often. And there's been longterm studies of , uh , ketosis from a ketogenic diet for decades, really look primarily with kids , um, cause it's used as a treatment for a certain type of epilepsy. Um, and it's recognized as being safe across the board.

If you do anything in excess, it can end up bad. Right. And that's probably what happened in these case reports, but in general, it's a safe practice. Um, that's safety like medical safety. If you're looking at safety, when you're talking about , uh , performance and whatever your goal is, whether it's, you know, weight loss, cognitive performance, athletic performance, and whether it's going to be helpful and safe and moving you toward those things sometimes not.

And , and that's one of the things we'll talk about too, is, you know , it can be a strategy that's utilized, maybe athletically , um , but in many situations it will take your performance. So is that dangerous from a health standpoint? No. Is it dangerous from performance and kind of your stated goals? Yeah. So , um, as far as why we would want to do this, like this ketosis, or try to get our body to produce ketones, you know, we know we're good at burning carbohydrates. Um , we're okay .

At burning fats, it seems. So what are kind of like the goals you mentioned one with, with epilepsy, they're like, what are kind of the thought process behind why we're doing this as opposed to just kind of eating a normal diet? Yeah, I think it varies. Um, epilepsy is the one that's been studied and kind of been around for a long time. And it's a , it's a rare condition, especially the specific type of epilepsy epilepsy that responds to , uh , a ketogenic diet.

Um, the more common things that you'll see people using this for are , uh , I would say weight loss being number one. Um, it's, I mean, and that's in the general public, just, you know, people hear about ketosis and, and not really exogenous ketones, but just eating fewer carbs to the point that you're in ketosis.

Uh, but most of the studies tend to show that people who , who utilize a ketogenic diet do lose weight and they do lose fat, but it, you can't point to the fact that they're in ketosis as the cause for that. Um, often a key , a ketogenic diet leads to decreased calorie intake, which across the board will lead to weight loss. So one of the benefits about a ketogenic diet is that it often leads to a higher level of satiety. So you don't feel as hungry.

And then that in turn will lead to less caloric intake and weight loss. So it's not a direct correlation, but it is useful for that. I'm assuming you can maintain a caloric deficit. Now, if you eat a ketogenic diet, like you were talking about that is, you know, it's butter and eggs and avocado and bacon, and you're eating thousands of more calories per day than you need. You're not going to lose weight, you're going to put on weight.

Um, so it, it kinda depends there, but let's say weight loss is likely the number one reason people start doing a ketogenic diet. Um , when we talk about performance, it gets a little more nuanced , um, with respect to fueling for events and whether that's beneficial, given a certain bent , uh , event duration and intensity, or is it detrimental? I think you're a couple of points on your weight loss.

Is that a lot of people, like you said, think that if I do this, this, this I'm getting in to ketosis because I'm restricting the , how long that I'm eating, that I'm also eating more fat, rich foods. They tend to just eat less overall. So, I mean, for weight loss, the caloric deficit is kind of the magic pill that everybody's always looking for, but the higher fat diet is not necessarily going to be that answer.

It's just hard to really overindulge and things that are very rich, very protein, rich like that. Cause they, like you said, lead to a lot more satiation and like you're not as hungry. Yeah. It fills you up quickly. I mean, you can't, there's only so many avocados you can eat.

So moving on from that going into performance here , um, why would we want to kind of switch our energy system over from where, you know , we know we're eating carbohydrates, you've always seen, I'm taking in a goo every 45 minutes. If you're on an endurance sport, you have a , an intro workout shake. If you're in the gym and things like that.

Why is it that there's kind of been a shift where some people have really switched to where they're eating a very heavy fat diet and kind of trying to kind of tweak their physiology a little bit? Well, I think there's, there's two parts of that. One is decreasing reliance on glycogen , um , and carbohydrate, which , um, we'll, we'll address a little more deeply in a different episode. Uh, the other part of that though is to actually produce ketones as a third fuel source.

So the body can, our muscles can run on carbohydrate or glycogen. They're kind of the same thing. Glycogen is stored carbohydrate. That's the preferred fuel. If it's around the body , the muscles are going to go for that.

Um , it can run off of , uh , fats and then it can run off ketone bodies themselves as kind of a , uh, another fuel source, a third fuel source , um, about, I'd say eight, maybe 10 years ago, there was a initial surge in endurance sports to start using ketones as that third fuel, you know, you can eat fat, you can eat carbohydrate, you can try to get your body to produce ketones, but what if we actually put them in?

And so now we have this third fuel source and the idea was that it would almost act as a safety net that , um , you would spare glycogen, which means that at a given effort, rather than using , uh, you know, X amount of glycogen in an hour, you would use 90% of that. So you'd spare that 10%. You could use it later, cause it's a limited resource and ketones would kind of fill the 10% or whatever the number is. But the idea is it would kind of it's spare. The glycogen would be a third fuel source.

Um, and you saw exogenous ketones use that way for a few years. Uh, and recently , um, actually it was last year, there was a paper that was , uh, presented by a guy named Peter Hess fell out of the out of Belgium. He's at the , the university hospital and movin .

And he's done a lot of research on this and he actually presented a paper , uh, prior to the tour to front at a, at a conference I attended where he showed that he thought that that was maybe not the case , um, and that there was another mechanism leading to potentially improve performance. Uh, this past year he , uh, his group published a paper and the title of it kind of tells you exogenous ketosis impacts neither performance nor muscle glycogen breakdown and prolonged endurance exercise.

So in other words, what they found is that that idea of using ketones to be a third fuel source and spare glycogen, although the concept makes sense when they put it into practice and test it, it doesn't work that way.

Um, what his group did find is that there's something about the intake of these exogenous ketones during a very high training block that makes the body's day to day recovery improved and limits the chance that a given athlete with a high training load is going to have kind of a mal adaptation or a, you go into an overtrained state. Um, and that in a setting of like a, a multi-day race or something like that could certainly improve performance , um, you know, across the, across the spectrum.

Um, and, and really to be fair, it's probably not even improving so much as it is decreasing the decline in performance , um, from, from , uh , day to day recovery. That's inadequate. So all this to say is it's very much an emerging part of science, but that's kind of where it's leading at the moment.

So with the supplementation of ketones, what you're kind of alluding to, is that how we've used them is kind of shifting right now and the practice of maybe you thought, Oh, I should drink this delicious bottle of Keystone esters before my, before my bike ride or during my bike ride might not be the best time to do that. Yeah. In fact, it might be detrimental from what they're , they've shown in Belgium.

Um, so we talked about ketoacidosis , which means that the blood becomes a little bit acidic or very acidic in those ICU patients, but a little bit acidic high levels of exertion and, and, you know, exercise activity also lead to an acidic environment. You hear about lactic acid and those things.

Um, well, what they've hypothesized it with this group in Belgium is that if you're actually taking ketones during your activity, which was what was pretty common using it as a fuel source and whatnot, that you're causing just a little bit of a bump in acid levels, which means that when you hit that next climb or a sprint or whatever part of your athletic endeavor is coming up and your body generates acidic particles.

Anyway, you have a decreased buffer capacity, which means if you hadn't taken the ketones, you probably be able to adjust to that effort, better buffer that acid and have a better performance than if you make the blood a little bit acidic and then throw an acidic effort on top of it.

Um, and so with that, and the idea that it's perhaps actually a recovery affected the exogenous ketones or are promoting , um, that's really changed totally how these are used in like ultra endurance events and stuff. Um, but that's, again, it's an emerging science, all this is coming out , uh, you know, it's, it's new stuff now, the use of, of ketosis and the ketogenic diet , um, and even exogenous ketones to some degree there's there's years or even decades behind those things.

And, and w w we can rest pretty, pretty certain that they're safe, but I don't think we yet know what the optimal way to use these things are, although we're starting to hone in on it. Thanks again, to the feat , our sponsor for season one of the podium today, they have an incredible offer on their entire KIDO collection though . Some manufacturer restrictions imply one useful new product is the ketone breath meter from the bio-sense needs, not just sports, nutrition, and supplements.

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So if your goal is athletic performance , um, and looking at it from a fueling standpoint, I wouldn't do it. Um , just personally, I think that's that the science is starting to show that that's, that's not the way to go. So like, you know, throwing a couple in your pocket for a long trail run or a six hour bike ride to use while you're out there, I'm not convinced that's the best way to go about it.

However, if I was going to use it myself, what I would say is in a big training block, maybe use exogenous ketones after training to promote recovery for the next day. Um, there's also some evidence that it's helpful from a cognitive standpoint. So the brain and neurologic tissues in particular like to use ketones for fuel is not the preferred fuel , uh , glucose or carbohydrate is a preferred fuel, but it can also use , uh, uh, ketones.

And so some people notice that when they take exogenous ketones or use dietary ketosis, or even both prior to a very cognitively demanding task, that they perform better, that the research on that isn't robust , um, is something that's definitely being looked into. But it's, I think it's worth trying if someone's interested , uh, then we get into the idea of salt versus esters.

So you can, you can purchase exogenous ketones as assault , uh , which is just that it's, it's these ketone bodies bound to, you know, usually sodium salts or you can purchase an Ester , which is , um, uh , kind of a more concentrated form with, no, it doesn't have the salts in it. Uh, both tastes pretty horrendous. Um, there's just no two ways about it. The esters tastes worse, but they work better. Um, and by work, I mean, they will get your ketone levels measurably higher.

The salts will bring your ketone levels up moderately or modestly I'd say, but also get this massive salt dump . I mean, you could get in , in one pack of these things , sometimes you'll get a whole day's worth of sodium intake, which will have its own problems with it. So I'm not a real big proponent of using ketone salt , even though they're cheaper and easier to find. I think the esters are , are the way to go if you're going to try it. So if we are, I'm giving it a shot.

And when you're maybe playing around with , uh , like a ketogenic diet or restricting our eating or taking these , uh, these ketone esters, how , how do we really know if we're achieving the state of ketosis? I know a lot of people talk about, Oh, I'm in ketosis and they describe maybe what they had for breakfast and , um , yeah, maybe not likely.

Yeah. Yeah. I mean, I think the only true way to know is to measure , um, people you'll hear people who utilize ketogenic diets and say, you know, they feel like they can feel when they're in ketosis and dropping in and out. And I don't know, maybe they can, but I mean, I, I think measuring it's just the way to go. So the, probably the most accurate measurement , um, or the most uniformly agreed upon would be like a capillary finger stick. Uh, just like testing your blood glucose.

In fact, a lot of the glucose monitors, you can switch the strip out , um, and , and test your ketones as well. So , uh , there's one called Kito mojo. There's one , um, precision extra is that what's called. So yeah, they do . They make one. Um, and those are good devices that the problem with those is that you kind of want to know where you are throughout the day.

If you're going to test what works and what doesn't, then, you know , you may set up a day where you're fasting in the morning and around 10 o'clock you're like, Hey, I wonder what my ketone levels are. So you want to test them. And then you say, okay, well, there were at 0.5, well, I'm going to take some exogenous ketones and I wonder where they are, and then you test it. And then maybe you get, you push lunch out a little bit and you want to know where they are.

So you ended up maybe testing multiple times through the day and your fingers get pretty beat up. So there's been a increase in the availability of breath, ketone meters, which are great because you're not sticking your finger all the time. You're not bruised. You're not having to buy the strips. It's a kind of a onetime cost . Some of those meters are , uh, pretty unreliable. Um, and there's lots of reasons for that, but they're just not the best way to measure.

So they're convenient, but they're not as accurate, or you can have the accuracy, but you end up, you know , kind of paying more for the strips and hurting your finger. There, there is a new one called Biosense , which I've had a chance to play around with, and it's much more accurate, a new breath meter , uh , it's much more accurate. Um, it is , uh, it kind of samples the breath or the air at the end of a breath .

So kind of from deep in the lungs, supposedly , uh , and it gives a much better reading. So it's one that I think kind of splits the difference between the two, like you get the convenience of a breath meter with accuracy that moves toward , uh , like a finger stick. So , um, for my patients, I would recommend that as a, as a great way to kind of get in there without having to stick yourself all the time. What is it that is in your breath that is measurable.

Are you actually breathing out ketones or what is it that it can, it can pick up on at the end of your breath? Yeah. So if , um, uh , you may have noticed this with your sister when she had some of the, some of the DKA episodes , uh, the higher, the ketone levels go, you can actually smell ketones on people's breath and smells , um, kinda like a fruity smell, almost like a nail Polish.

Sometimes one of the things that I was taught back when I was working on an ambulance years ago is that guy that gets pulled over and you think they're driving drunk, always check the blood sugar because a lot of times that when the ketones get really high and they get a little disoriented, they'll have that smell that almost smells like alcohol, but it's actually ketones they're breathing off.

Um, so that's, that's a long way of saying, yeah, you can, the ketones are very measurable and in the breath and even noticeable to the smell at a certain level, probably not at what we're talking here. Interesting. So , uh , I never noticed that Jesse , you always have wonderful breath.

Um, so outside of , of measuring and kind of the, some of the supplementation that we've talked about with the , the diet side of it, how would you apply, you know, using a ketogenic diet into your performance, into someone who comes to you and says, you know, I'm interested in this, you know, just kind of maybe a general cyclist runner, not crazy ultra endurance. Do you think it's good application?

Like what, how would we kind of want to work that into our, into our, our week, if it's someone who, like you say is not in the like super long endurance stuff, they're just kind of a more regular recreational athlete going for high performance, but, you know, durations are shorter. I'd have a hard time seeing where it's really a good strategy , um, except perhaps for the recovery component day to day. Uh , and that again is still kind of under investigation, but it looks promising.

Um, the reason I say it that way is because those efforts that are, that are shorter efforts, you know, two hours and less or less an hour less , um, they're really glycogen dependent. And so if you have a diet that is low in carbohydrate and on purpose lowers glycogen stores, so that you're more ketotic , you're going to sacrifice performance for shorter, higher intensity training and racing. So for me in that scenario, it's maybe something to play around with, if you've nailed everything else.

And you want to kind of see how it impacts you at from a performance standpoint, but it's not, it's not where I would point someone initially. Um, if you're talking about that same person, who's kind of a, a recreational athlete competitive, but you know, also have a corporate job, very cognitively dependent, and they want to continue to train the way they do, but also use the potential cognitive benefits of ketosis for work, not for their athletic activity.

Then I think you look at using more of a cyclical ketosis within the day. So maybe time restricted eating , um , skipping breakfast in the morning, having a , maybe a small intake of ketone Ester at work, and then starting to fuel getting ready for afternoon workouts, making sure that glycogen stores are , are full and ready to go for the workout so that your workout doesn't suffer and then maybe drop back into ketosis the next morning.

Um, that's, it can be a little bit onerous to go in and out in and out like that, but that could be a strategy that allows you to play kind of both sides of the coin. Um, but where I think it could be really useful as someone who either has a very high endurance training load and wants to recover day to day , um, as best they can.

So, you know , putting in 30 hours a week, training 25 hours, you know, that there may be a role for this as a, as a recovery support, or like we said, for weight loss and kind of , uh , changing your metabolism a bit to , to get away from glycogen independence and more , uh, more capable of burning fat and using ketones for fuel. Um, but that's , uh , there's a lot of ifs ands or buts around that too. Absolutely.

It's, it's always really intrigued me that the keto diet has kind of gone hand in hand with the CrossFit world in some aspects, just because that's such a, an anaerobic and explosive activity that I think a lot of people, they see these things and they think, okay, this diet is , is effective. There's some longevity benefit that might be out there.

Like, I'm going to try this, but they're going in and they're doing a 20 minute email I'm there , you know, that, or they're working in a very anaerobic state and they're wondering why their performance is suffering. So I think it's good. Like you said, to keep in mind your goal with it. So, yeah.

Yeah. And there's some thought around, like there's an added adaptation or an adaptive period for even events like that, where, you know, after two months, six months, a year of a more key tonic diet, that those higher intensity performance has come around and are able to be fueled with fewer carbohydrates. That's not really born out in the studies.

Um, I think that there may be a little of a move physiologically toward that, but I still think carbs are King when it comes to feeling for those things. Now that doesn't mean you need to have a high carb diet. It just means that you need, when , when that high intensity performance is the goal, you need to feel for that. And when it's not, then you may be able to use these other strategies for different benefits. Um , but you can't have your low carb cake and eat it too. It makes sense.

So outside of kind of the , uh, the performance goals, the, the workout based strategies and things like that, what kind of people really need to be careful and maybe stay away from the ketogenic diet and like contraindications with, with health factors and things like that that might be reason to kind of stay away from that and keep it more balanced.

Yeah, I think , um, with, with anything we've talked about the importance of, you know , talking with your doctor before you implement it, and even something like the, like a ketogenic diet, I think that's really important, and that's just not lip service to this. Like each individual is going to respond differently and have a different set of circumstances surrounding, surrounding where they start. Um, someone who has a dyslipidemia or high cholesterol levels may want to stay away from it.

It depends a little bit on what that high cholesterol looks like, but it's pretty well documented that a ketogenic diet will increase LDL, which is the low density lipoprotein, the quote unquote bad cholesterol , um, which in somebody who's already got suboptimal cholesterol profile, that's not the move we want. We don't want LDL going up. Um, we do know that a low carbohydrate ketogenic diet will lower triglycerides, which is part of the lipid profile. So in that case, it could be beneficial.

So that's just kind of an illustration of the fact that, you know , somebody with bad cholesterol, it could be a really bad choice for them, or it could be really good choice for them depending on what that bad cholesterol looks like. So it's worth digging into that with, with your doctor or a dietician . Um, the other place that I think, you know, well, we talked about diabetics. I want to throw that out there.

Like it's having high ketone levels in a, in a diabetic is ill-advised without very, very close supervision. So I would never recommend it for a type one diabetic , um , or even type two without very close supervision. Um, but at the other place, I think it could be potentially contra-indicated is just in that realm of high performance.

Uh, if , if high performance is a run across America, then it may be great because you're really hopefully using this as a tactic to get your body to burn fat more efficiently and , uh, utilize ketones as a fuel along with the glycogen and everything else. But that's not typically what people are looking at when they talk about high performance.

Um, if you're running a five K a 10 K doing a CrossFit wide , uh , riding, you know , racing in your local crit , um, doing an Olympic triathlon, like any of these things at a QI tonic or ketogenic diet is more likely to be detrimental to your performance than it is to be beneficial. So in that scenario, I'd say probably lay off it or test, test the cyclical nature , uh, significantly before you delve into it in a race scenario. So, you know what you're getting into.

Definitely it seems, you know, like with most things, most interventions, most supplements, know your goals, you know, test retest, apply the ketogenic diets , see if you're doing better. See if you're doing worse through that period and understanding that, you know, it's not for everybody, there's no magic fix to getting you to burn a whole bunch of fat. Having ketones isn't necessarily a good or bad thing in a general healthy population.

It's just kind of another kind of piece in the puzzle to play around with and see if it might be something that , that helps you out a little bit. Yeah, it's a tool. And, you know, there's, there's the old saying that if, if the only tool you have is a hammer, everything looks like a nail. Um, you know , you can't, you can't walk around with this mentality. That there's one thing that fixes everything, right? Because you'll end up using a hammer to fix your window and that's catastrophic.

So instead it's recognizing this is a tool in the toolbox, and if you're encountering a certain hurdle, whether that's performance-based cognitive base, weight loss, it may be when you want to go to , um, but just to use it, you know , all the time indiscriminately and expect benefit is, is not smart, nor is that a smart strategy for anything really excellent. I think we've got a lot of good actionable points about this.

Hopefully clears up some things, you know, maybe some, some misconceptions that people have about what ketones are, what ketosis is and the ketogenic diet before we wrap up today. Is there anything else you'd like to add? I would just say to our patients that this is something, again, it's a tool that could be useful for them.

Um, you know, our , our patients run the gamut of , uh, you know , people who have cognitively demanding corporate jobs , uh, PGA, golfers, majorly, baseball players , uh, Ironman triathletes. I mean, you can see that it's , it's just a wide wide spectrum. And so for each person, I do think there's potential utility , uh, in, in utilizing ketosis and ketones. Um, so if you're interested, give us a call and let's , let's talk through it for your individual scenario.

Um, sometimes it's just fun to play around with, to kind of the, the whole idea of, of the in equals one studies , like try something and see how it impacts you. Um, so yeah, I would say don't write it off either. It's kind of a fun thing to play with. Absolutely. Like to use , uh, use my own performance, my own body as a bit of a laboratory for a lot of these different things and kind of see how it goes. Yeah. Cool. Alright . Well, thanks Patrick. Thank you. We'll uh, we'll

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