I am delighted to have the opportunity to connect with Dr. Latt Mansor today! Dr. Mansor is the Research Lead at HVMN. He oversees all the company's research efforts and collaborations with universities and research institutions. He has a Master’s degree in sarcopenia and a P.h.D. from Oxford University. His background is predominantly in metabolism and physiology.
Dr. Mansor is a delightful individual who makes science and physiology accessible to everyone! In this episode, he and I discuss the role of ketones. We dive into how ketones are the fourth macronutrient, the role of energy and ATP, and using CGMs and glucometers to empower and motivate patients. We define endogenous versus exogenous ketones and explain how to utilize them in our daily lives. We also get into how ketones can improve cognition and performance, the cause of keto flu, fatty coffees, and the ongoing research that HVMN is doing.
We hope you enjoy learning from today’s fascinating conversation with Dr. Latt Mansor! Stay tuned for more!
IN THIS EPISODE YOU WILL LEARN:
Dr.Mansor shares his fascinating educational and career background.
The relevance of sarcopenia and how it impacts metabolic flexibility.
What are ketones?
The difference between endogenous and exogenous ketones.
Dr. Mansor explains how ketones are the fourth macronutrient.
How modern-day lifestyles make it harder for our bodies to make endogenous ketones.
How does utilizing a more fuel-efficient substrate make us less hungry?
How can the use of glucometers and CGMs empower people?
Dr. Mansor explains how the HVMN product, The Ketone IQ, differs from other kinds of exogenous ketones.
The cognitive benefits of BHB (Beta-hydroxybutyrate).
Who should use exogenous ketones?
Exogenous ketones and keto flu.
How Dr. Mansor came to live a healthier lifestyle.
Dr. Mansor talks about research currently being done at HVMN.
“Thirty years and above- if we don’t do any resistance exercise, our muscles start to atrophy.”
-Dr. Latt Mansor
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Submit your questions to support@cynthiathurlow.com
Connect with Dr. Latt Mansor
On LinkedIn
Transcript:
Cynthia: Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
Today, I had the opportunity to connect with Dr. Latt Mansor. He's the research lead of H.V.M.N. and oversees all of their research efforts and collaborations with universities and research institutions. He has a PhD from Oxford University, as well as a Master’s in sarcopenia. His background is predominantly in metabolism and physiology. We discussed the role of ketones, how ketones are the fourth macronutrient, the role of energy and ATP, how CGMs and glucometers can help empower and motivate patients, defining endogenous versus exogenous ketones and how we can utilize these in our day to day lives, the role of how ketones can improve cognition as well as performance, what is actually behind keto flu, the role of fatty coffees, as well as ongoing research that H.V.M.N. is doing. This is our first of two interviews and I know that you will enjoy Dr. Mansor. He is absolutely delightful and really makes the science and physiology accessible for all.
I am delighted today to be joined by Dr. Latt Mansor and we originally connected out of an interest of learning about exogenous ketones but when I dove into your background, it was a plethora of really relevant topics. For my listeners, things I talk about all the time, you have a PhD in physiology and you have a Master’s in sarcopenia, which is one of my favorite, not my favorite words per se, but it's a really important topic for people that are north of 35 to understand, so that we can work against this. So, let's start with your background, which I think is really fascinating and enlightening, and I know that even when we were talking before recording what you were sharing are there so many good nuggets there that will be relevant to the listeners.
Dr. Latt: Thank you so much, Cynthia. I'm honored to be here talking to you and on your podcast. I was born and bred in Malaysia until I was 20 years old, I finished my A levels, I moved to the UK, did my undergrad in biotechnology in University of Nottingham, and then straight after I thought to myself, “Well, having a science degree because I want to go into science, having just a science degree may not be enough. So, let's go further.” I want to do a post grad, but I wasn't sure if I was ready for a PhD. I applied for a Master's in New York City and I got into Columbia University doing biotechnology as well with a lot of focus around drug development and regulation. Sarcopenia was the topic of my Master's thesis. Right after that, I was like, “All right, I've got enough degrees now, I've got to go start working, earn money,” and I joined a pharmaceutical company, the medicines company in New Jersey for half a year before they turned me full time, and then I moved to Munich working for the Munich office.
During that year and a half, I worked for them full time. I was really inspired by the people there. They were PhD holders, who are very eloquent in what they say, what they talk about, what they are passionate about, but at the same time they are also very entrepreneurial. That inspired me to apply for a PhD at Oxford University in the UK because one of main reason is also because in the UK it’s three years to get a PhD versus five to six years in the US.
Cynthia: Wow.
Dr. Latt: I knew I wanted to get it done, and go back out, and start making an impact in people's lives. I got accepted December 2010, and then started 2011 at the University of Oxford in DPhil in Physiology, Anatomy, and Genetics. My thesis was on metabolism of type 2 diabetic heart in hypoxia. I looked at different forms of hypoxia, both acute and chronic hypoxia and I use a type 2 diabetic model, a rat model to basically investigate what metabolic flexibility is, how does that affect diabetic hearts, and how can we possibly reverse or rectify that in flexibility to make sure that diabetic hearts do not get an increased risk of heart failure after they come through myocardial infarction, or ischemia, or hypoxia. Then I joined a diabetes management program company in Singapore after my graduation ran the business development for a year and a half and then started my own health tech company in Malaysia for a year and a half before H.V.M.N. found me. They needed a physiology expert and run their military program. So, now, I'm the principal investigator for a $6 million military STTR grant looking at cognitive and physical performance using exogenous ketones, especially in hypoxia.
Cynthia: I think it's all fascinating. I don't know, if you know this about me, but my whole background as a nurse practitioner was working in cardiology. Part of my endeavor and my focus of my work is ensuring that people understand the role of metabolic flexibility, why it's so important, because I saw the byproduct of what happened. One of the reasons why I left clinical medicine was that our current model is so broken that we aren't equipping our patients with the strategies that really are the lifestyle piece that are so integrated and so important in this work. To back up a little bit, for purposes of our discussion because I talk a lot about, let's back up to when you did your Master’s, and then I want to weave in when you were doing your doctoral work. You were at Columbia and you did your thesis in sarcopenia. So, let's talk about the relevance of sarcopenia, this muscle loss of aging to how it impacts metabolic flexibility. Because all these pieces come together so beautifully. I talk a lot about sarcopenia, but it's really wonderful to have the opportunity to connect with a scientist, so they can give their perspective about sarcopenia and why it's so significant.
Dr. Latt: I think I'm going to start with why it's important, especially in elderly population. I remember writing that thesis. I didn't realize that one of the highest causes of mortality is for an elderly population. One of the main reasons of them falling, and it puncturing organs, or breaking bones, or internal bleeding that leads to death is because of the lack of support of the muscle for their movement, for their ability. That was how I was like, “Okay, sarcopenia.” I did research what can we do then to make sure that we don't get there? What I found is that 30 years and above if we don't do any resistance exercise, our muscles start to atrophy. Because of that I was like, “Okay, so, let's all do resistance exercise.” But it's not just as simple as that because as we age, we also accumulate oxidative damage, so then we can't just do resistance exercise without the endurance exercise. Aerobic exercises is as important as resistance exercise when it comes to aging.
What really fascinated me was that when I looked at studies of 80-year-olds, 90-year-olds, who has gone to rehab and gone through resistance exercise, they saw increase in muscle mass, significant increases in muscle mass. The fact that our body at that age can respond so effectively with resistance exercise shows that there's no reason for us not to do it. Then it comes to the metabolic flexibility part of things where we have increased muscle mass and therefore increasing our basal metabolic rate. That's a whole different issue about insulin resistance, insulin sensitivity, weight loss, keeping that healthy weight through our aging process, as well as the ability to switch substrates because your body is so energy efficient that you can use any substrates that you give your body, the fats, the proteins, the glucose, the ketones, which is what we're doing in H.V.M.N.
Cynthia: I think it's really important. One of the things that really struck me and obviously when I was a nurse practitioner, I started in my 20s and because I was working with such a diverse process, so cardiovascular disease impacts people nearly every age group and 20 years ago people were a little bit healthier than they are today. We've continued to trend in a direction where there's a lack of metabolic flexibility, rampant obesity, etc. And so, for me I just recall the impression someone made on me. It was a 50-year-old patient, who had a bedside commode. They were in a stepdown unit, they had a myocardial infarction, so heart attack. It was really interesting to me that this patient could not get out of bed, and get to the toilet, and go to the bathroom, and get back in bed. They had not enough strength to be able to-- With their quadricep muscles, they had so much muscle atrophy that they were unable to get from the bed to the commode, which is pretty significant and in a 50-year-old you wouldn't expect to see that.
I recall one of the cardiologists I was working with, he and I were talking about this and he was talking about how significant this was. And so, that was probably the first time that I started to think about this interrelationship of strength and muscles being-- If you have a lack of strength in muscle, it's a poor prognostic indicator. You're right to your point. We know that if a patient falls and breaks a hip, there's significant morbidity and mortality associated with that. It's not as benign as we'd like to think it is for a lot of different reasons and beyond the scope of our conversation, but you touched on the ketones piece. When we're talking about metabolic flexibility, let's start from the perspective of defining what are ketones because I think there's a lot of misinformation that's out there. I love that you use that terminology, “fuel substrate,” because I use that, too. Don't be worried, we're talking about macros and nutrients, but I even heard you in a podcast talking about ketones as another type of macronutrient, the fourth macronutrient. So, let's start the conversation there, because this is really interesting and I don't want anyone to feel we're going to be too sciency. We're going to be defining terms and we're going to be weaving through relevancy, so that it'll be an accessible conversation for everyone.
Dr. Latt: Thank you, thank you very much for bringing that up, Cynthia, because I do think there is a lot of misinformation out there. Even just normal emails or I was at Metabolic Health Summit two weeks ago presenting our work with the military and granted the audience there, they were very well versed and very knowledgeable around ketones. But I can imagine at another conference, a weight loss conference or national strength and conditioning, where people are more focused on other areas, they may not know what ketones are and they would just go straight into ketogenic diet given that ketogenic diet is way more prevalent in the past decade or so. Ketones are essentially a molecule that our body creates in the state of low glucose and low glycogen stores. When you're fasting, when you are on ketogenic diet, which means you're restricting your carbs intake to a very low amount, then your body starts breaking down fat, and turning it into ketones in your liver, and then it will get transported around the body, and functions the same way as fat or glucose in the sense that it goes into the mitochondria, the powerhouse of the cell to create energy. That is why we say, it's the fourth macronutrient. Even though it goes, it shares the similar pathway as fatty acid oxidation. If you take exogenous ketones, it goes straight into the acetyl-CoA, goes into the Krebs cycle, and then oxidative phosphorylation. In that sense, we can argue that did not come directly from your fats, a complete different molecule than glucose and fat, it has its own calories. We found that that each gram has about six calories. And so, that's what ketones are.
Then there is exogenous ketones and endogenous ketones. What I explained earlier, it's more around the endogenous ketone, where your body creates itself so, inside. Exogenous ketone has only been around in the past two decades or so, where research start to look at the benefits of ketogenic diet, for example, in seizures. And how can we then combat that adherence issues, where people don't want to be on a ketogenic diet, people don't feel good in a ketogenic diet, people don't want that increase in lipids or fats in their body, the LDL, and all the other cholesterol. Then exogenous ketones come in where you can directly drink or eat a ketone product and increases your blood ketone levels. Granted that is temporary. So, that's exogenous ketones, where externally you consume ketones. It's temporary, it will last a few hours, and it will go back down. But nonetheless studies have shown that you will get that benefit depending on what benefit either performance, or cognitive, or brain network stabilization. A lot of studies have shown that acute phase of benefits even with one dose, so which is great because then you're thinking, “Okay, you don't need that adaptation process in order to get the benefit.” You can get it straight away and you don't need to get on a strict diet.
Cynthia: Well, and what is it that you think has occurred with our modern-day lifestyle that has made it harder for people to make endogenous. So, making ketones within our own bodies, what is made that so challenging?
Dr. Latt: Great question. Now, insulin is anti-ketogenesis. Ketogenesis, let's talk about the word, ketogenesis. Ketogenesis means the process of making ketones in your liver by converting your fat into ketones. The presence of insulin actually inhibits that because it's telling your body, “Hey, look, you've got glucose in your body, you've got all these other substrates that you can use for faster energy, don't burden your body to create these ketones.” With our current Standard American Diet, Standard Western Diet, where it's so high in carbohydrates, we have a constant elevation of insulin. A lot of research also shown. That's a whole different conversation around consistent elevation of insulin causing inflammation, and it could be the thing that causes insulin resistance, and diabetes and all that, and chronic diseases. Because of our current lifestyle, the majority of the developed world are having, it basically prohibits ketogenesis. That is exactly why and that is why you need to either go in on intermittent fasting or restricting your carbs severely in a ketogenic diet in order to create your own ketones.
Cynthia: I think this is a really important distinction to make that it's our modern day lifestyles that are impeding our body's ability to make a fuel substrate that it should be able to make on its own naturally because we overeat the wrong types of foods, i.e., carbohydrates and we are eating too often. We have this state of chronically elevated insulin which does not allow our bodies to be able to go in and use this alternative pathway or even break down fatty acids to be able to use as a fuel substrate. If people are listening and they're trying to figure out, “Does this mean you have to eat a ketogenic diet?” No, it does not. But it does mean that you need to eat less frequently, if you want to make your own endogenous ketones and you need to make better food choices by. If you're going to have carbohydrates, get them from real Whole Foods sources and not processed foods. What I think is really interesting is that when our body is able to make ketones, we're consuming exogenous ketones. We tend to be less hungry. I think this is what goes contrary to everything I used to tell my patients, “Eat frequently to stoke your metabolism, you shouldn't be getting hungry.” Well, we know that by utilizing this more efficient fuel substrate that we will be less hungry, can we talk about that?
Dr. Latt: Sure. I think, so far, there is one study that showed exogenous ketones, using ketone ester actually suppresses ghrelin, which is the hunger hormone. That has already been proven. But we are actually in the process of doing a collaboration with the university to run a study on our own product Ketone-IQ in appetite suppression. I can't wait to see the results on that because we will be measuring ghrelin, we'll be measuring leptin, we'll be measuring calories as well on top of just the hormone regulation. We want to see if it actually translates right away as to how much they eat. Some of the studies that has been ongoing at the moment not published yet. They showed that you feel satiated, but it didn't reflect in the calorie intake in the sense that they just ate less calories, which is equivalent to the calorie that a keto they took, which is quite interesting. They just replace instinctively is that, “Oh, I've got 120 calories from ketones, I just feel more full before I reach that 120 calories after I have the full meal.” A lot more to unpack there, a lot more to investigate there, but I think what was very important what you said earlier as well about, does that mean everyone needs to go on low carb, does that mean everyone needs to go on ketogenic diet? I don't think so as well.
When I was working for the diabetes management program company, what I noticed is that people most of the time, they know what to eat. They are eating the right things, but they're eating at the wrong proportion and they're eating way more frequently than they should. I think that was what people need in terms of guidance, and advice, and information from people like yourself, and dietitians, nutritionists, and a lot of companies are doing that diabetes prevention programs. I think that is what people need, because people know that okay, they need the veg, they need the fruits, the grains, the proteins, the fats, but it's just over time, especially when you're cooking for families. It's not really regulated per se. So, it's ad libitum, which is just eat however much you want until you feel full.
Cynthia: I think that's important because when I'm working with women, a lot of what I talk about is hitting their protein macros because it is so satiating. Most of us are eating a Standard American Diet or Western Diet, we're likely eating too many carbohydrates, too little protein, the wrong types of fats like seed oils that I talk a lot about. I think that with the understanding that you may have to do a little bit of tinkering. What are your thoughts about the use of glucometers and CGMs to help with people determining where their threshold needs to be? Because we mentioned and I think this does happen frequently, people aren't really mindful of portions, and that does add up, and maybe they're having one big meal a day, and then they're not hungry for more meal, but they're chronically undereating protein, and this is important for prevention of sarcopenia.
Dr. Latt: Yeah, I think that's a great point because when I was doing my PhD, yes, I was investigating metabolic flexibility in diabetes, and how can I possibly come up with some insight to make an impact in the diabetic population. But then later on, I realized, “Okay, we can have all the intervention we have but what about the tracking?” Because diabetes is one of the chronic diseases where it develops 15 years in the making before you get diagnosed being a diabetic. It's also really important for us to track what is impacting our lifestyle that is contributing to the disease progression, but also how effective an intervention is. That's why when you mentioned CGMs, I think that's great for people especially people who are not that in tune with their bodies yet, they don't. Sometimes, you can feel that you're not eating right, you're not sleeping right, you're not having the right lifestyle, when you feel fatigued, when you just feel sluggish and bloated. You know that, but then having CGM, it puts everything objectively with numbers and now you can say definitively certain types of food, certain types of lifestyle does not suit you or it's not good for your body.
Cynthia: Absolutely. I think it's important for people to understand that with this muscle loss, with the sarcopenia, with aging in general, especially for women as they're losing estradiol signaling, which we know is an insulin sensitizing hormone, those combinations of factors will impact your ability to your carbohydrate threshold is. If you're still lifting weights in your mid to late 40s, you are going to be more metabolically flexible than someone who has is effectively not exercising, has a very heavy carbohydrate diet, and is in a position where they're making it much harder for their body to be more metabolically attuned, flexible, etc. I think it's important for people to understand, throughout most of my podcasts, I have some reoccurring themes. Knowing your numbers, I would say, “Get empowered. Don't feel overwhelmed with the information.” But I think having a continuous glucose monitor even for a month of your life is very enlightening. This even happens for me. I'm very metabolically flexible, but there are certain types of carbs that don't agree with my body and that's okay, but I know how to navigate around that. So, I think it's an important distinction. I'm glad that you are also supportive of this.
Dr. Latt: I was going to add to that like be empowered by that information because it's your body's data. You are fully owning that data, but also that gives you motivation to things that you change in your lifestyle that affects those numbers. That gives you power because it just shows that you are actually in control. You make your choices and then you see the results. It's amazing how that transformation I see in most people, especially prediabetics, when they realize their glucose levels start going down when they make those changes. Three months in or early diabetic patients got off metformin, got off medication, they're like, “Wow, this is actually possible.” So, having that data is so empowering and that just cultivates positive feedback loop and you just keep going.
Cynthia: Well, and I think it's really encouraging for people to feel they're in control of something.
Dr. Latt: Absolutely.
Cynthia: The traditional allopathic model here in the States, the traditional old model was that the patient showed up to the doctor's office or provider's office and whatever they were told is what they did and I think now, there's--
Dr. Latt: [unintelligible [00:23:23]
Cynthia: Right. Now, I think of it more as a collaborative relationship, we both bring something to the table, we talk about things. I think that many people are now more aware that there are lots of ways to track information whether it's a glucometer, a continuous glucose monitor, whether you're wearing an Oura Ring, which I talk about a lot. I love it. It's probably my favorite thing that I used to track information. But there're so many other things that are out there that people can do. Acknowledging the importance of people feeling empowered and inspired to continue making better choices is significant. I can imagine for you having with your background in type 2 diabetes, which is a lifestyle disease, it's probably very gratifying for you to be able to work within a company in an organization where you're really making a big impact. So, let's talk a little bit about we were talking about endogenous versus exogenous ketones and talk to us about how the H.V.M.N. product, the Ketone-IQ, how is this different from other types of exogenous ketones that are available?
Dr. Latt: Sure. H.V.M.N., I work for company Health Via Modern Nutrition. We have this product called Ketone-IQ, where in it is (R) 1,3-butanediol is the active ingredient. Essentially, it goes into your liver, it gets converted into beta-hydroxybutyrate. The three main ketone bodies in your body, beta-hydroxybutyrate, which is the primary one that is used for energy. We've got acetyl acetate and then we've got acetone, which is usually this byproduct that gets released through respiration. Now, how is it different from other exogenous ketones. Right now, because people are realizing the benefit of ketones, there are a lot of exogenous ketones out there. I think it started probably with ketone salts, companies like Prüvit. They're very big. The problem with salt is that one, it doesn't increase your blood BHB or blood beta-hydroxybutyrate to a level high enough to get us certain benefits like performance, you need quite high, and other benefits you need maybe above one millimolar versus two. On top of that because of the salt load, a lot of cardiovascular researchers, they can't use that because it increases risk for hypertension patients and increase heart complications. So, that's ketone salt.
Then there are ketone esters. Ketone esters have been shown to increase blood BHB to a quite high level. Now, the difference between ketone ester and Ketone-IQ is that we are basically half of ketone ester. Ketone ester is an esterified form of BHB, beta-hydroxybutyrate, esterified with butanediol. Ours is just a butanediol. We found that to be more cost effective to be similar in terms of efficiency, but most importantly, the taste. We've done some research around the taste of ketone ester, and a lot of people do know how bad it tastes, and how bitter it tastes. I actually presented our flavor research work at Metabolic Health Summit, and people were cackling about how it doesn't only-- Because we use different sweeteners, different maskers to suppress the bitterness. It didn't work and not only that, it actually suppresses the sweetness of the sweeteners. We use like seven times sucrose of a can of Coke and four times sucralose of Diet Coke. That is a high amount of sweeteners we put in there, but it literally suppresses the sweet taste and the bitterness just stays on. That was ketone ester. I think there are other ketone esters as well like C-6 bound with butanediol. It's a diester. 2-C6 fatty acid molecules bound with butanediol. That’s also another product on the market. I think the miscellaneous products as well that adds free acid, free BHB, beta-hydroxybutyric acid with butanediol just straight up without binding them via the esterification process. That's a mouthful word.
Cynthia: Yes, it is and it's really interesting. Two years ago, I was supposed to do travel to Asia and a friend convinced me I needed ketone esters and then the pandemic happened. So, I never made this trip to Asia, and I had bought ketone esters and in the midst of the pandemic, I was like, “I should probably taste these.”
Dr. Latt: [laughs]
Cynthia: When you mentioned they have a very bitter almost to the point where it's unpalatable. So, I kept thinking. My friend who's been using these regularly, I'm like, “Do you hold your nose? How do you manage to get these down?”
Dr. Latt: Yeah.
Cynthia: I'm glad to know that H.V.M.N has been doing a lot of research to try to counteract some of this. One very important ketone body that you mentioned is beta-hydroxybutyrate. I talk a lot about this about how it diffuses the blood-brain barrier. Let's talk about some of the cognitive benefits of BHB. I know that your product breaks down into BHB and so this is oftentimes the crux when I'm trying to get people to fast, I always say, “It improves cognition and energy and really it's a byproduct of this amazing ketone.”
Dr. Latt: Yeah, so, BHB, we have been talking about ketones for the first half of the podcast. Whenever we mention ketone, most of the time, about 99% of the time we are referring to beta-hydroxybutyrate, because like I said that is the primary form that is in our body and getting metabolized, and all those good benefits come from beta-hydroxybutyrate elevation in your blood. As you said, Cynthia, it does bypass the blood-brain barrier and that is the benefit of it because so far, the brain obviously can metabolize glucose, but not fat. Fats cannot bypass the barrier because of the large size of molecule. Now, beta-hydroxybutyrate can but because of our current modern lifestyle, we are suppressing ketogenesis, we are suppressing the production of ketones. Therefore, our brain only has glucose as the sole source of substrate or the sole source of energy. What happens if that pathway gets impeded, if you have insulin resistance, if somehow your glucose transporters are impaired, or if you are in a traumatic brain injury situation or Alzheimer's, where they saw a dysfunction in glucose metabolism? What then your brain is running out of energy and it will create a lot of damage from trying to balance that energy deficiency. So, that's where beta-hydroxybutyrate comes in and fill in that gap to really compensate for the energy deficiency.
One study that looked at both ketogenic diet for a week versus a ketone ester administration for just one dose of 25 grams, and they looked at functional MRI, and they found that with the ketogenic diet, and the exogenous ketones, both have the same result as in they both increased brain network stability. Now, this is very important as we age. They found that our brain networks have brain regions, the communication between them start destabilizing and having the ketones in the body somehow increases that stabilization.
Cynthia: It's really interesting, because I think that as I'm listening to this, I'm thinking about how to utilize the Ketone-IQ and actually I've enjoyed it. I've been using it before speaking events. And so, I try to do them fasted anyway, but I think that's going to turn up the signaling in my brain, so that I'm feeling even sharper is certainly important. Are there people that should not use exogenous ketones? I don't know the answer to that question. I thought I would ask you. Is there any-- [crosstalk]
Dr. Latt: No, that’s a good question. They are, as we speak, [unintelligible [00:31:06] of Ketone-IQ actually.
Cynthia: [laughs]
Dr. Latt: I think generally exogenous ketones are safe. Our product is FDA GRAS generally recognized as safe, but we do see a trend of low glucose temporarily as you drink the Ketone-IQ. I would say for people who have hypoglycemia, who have problems with lower blood glucose just on a daily basis on a basal level might want to be careful with that because sometimes it might lower your glucose to a level that is too low, even though yes, it does provide the energy, but it might also affect other metabolic pathways. So, consult your doctor before drinking that if that is of a concern. Other than that, I don't think there is any strict no-no groups for taking exogenous ketones. Now, if you talk about different goals that's a different conversation because we're now not talking about the side effects, we're now not talking about why should you not take it for health reasons. But now, we're talking, “Okay, should you take this if you want to lose weight,” for example. What I say is like, “Oh, if people are already on ketogenic diet, they're already seeing results.” This might compliment the ketogenic diet in sense that it puts them in deeper ketosis if that's what they want. But in terms of losing weight, as I said, we are still looking at studies of appetite suppression. But if they're already doing well on ketogenic diet, there's no reason for them to get this product.
If like you said, they want to get that cognitive benefit that high ketone levels just in the morning before they start their day, before they go on a podcast, then yeah, have a shot and have the serving of Ketone-IQ, and then go about your day. Then you can also fast. That's also a very common question by our customers. Can I drink Ketone-IQ if I am fasting? I use it to intermittent fast, actually. I use it in the night before and I don't have to eat until lunchtime. But my question to them is that what is the purpose of your fast? The purpose of the fast is say 16:8, 16 hours of fasting, eight hours of feeding window, and you just want to restrict your calories, you just want to have that increase endogenous ketones, then by all means Ketone-IQ would definitely help and complement their lifestyle. But if you're fasting goal is to create autophagy, now, you have to be fasting for 48 hours and above, and you can't take any calories in. So, remember earlier on this podcast, I talked about ketones having calories, so ketones, one serving is around 60-70 calories that might impede your process of getting into autophagy. Think more about what your goal is, what your lifestyle change is, what your interventions are, and then go from there rather than saying, “Okay, this product is magic, this product is good for everything and everyone,” but personalize to yourself.
Cynthia: I think that's an important distinction. One that is, it will probably generate a lot of questions. I use this in a fasted state, but I recognize that if I'm doing a clean fast where I'm normally just doing water and green tea, etc., I'm doing it for a specific purpose. I want to make sure when I get up there and I'm speaking that I'm not having-- thankfully, it's never happened to me having a loss of words, but I really like to know that my brain is going to be in the most advantageous state while I'm speaking. I think that's super important. When I mentioned to my followers that we were going to connect, I got a lot of questions about keto flu, which we both know is when people are struggling to go from being predominantly using glucose as a substrate to trying to get to a point where their body can utilize fatty acids. And so, let's talk a little bit about keto flu and is this a product that someone could utilize to bridge that gap? I find for a lot of people a lot of what keto flu is related to electrolyte depletion. I always say, if you're fasting, you have to make sure you're replacing your electrolytes. It's a standard methodology for me. But for people that are worried about maybe fasting or dipping their toe into that pond, they've heard about keto flu, what would your thoughts be?
Dr. Latt: I think what we have seen anecdotally now, no studies have shown in terms of keto flu on this product, but anecdotally, a lot of people who are dipping into ketogenic diet, they do find having exogenous ketone to be helpful because it puts your body in that ketotic state earlier. What studies have shown though, if you have exogenous ketones, you are up regulating hormones and enzymes related to ketone metabolism. What does that mean? That means that once you deplete the exogenous ketones in your body, you metabolize it for energy, then you are leaving your body with the upregulation of these enzymes that could hopefully help you be more efficient in your own endogenous ketone production and metabolism. Definitely, on top of that half the water, half the electrolytes because we are losing the water from the glycogen because glycogen holds a lot of water. If you are going on a ketogenic diet initially, especially if you're adding fasting on to it, you're losing a lot of that glycogen stores and as a result you're losing all the water that glycogen is holding, and with that also the electrolytes that is dissolved in that water. Yeah, for sure, you have to all those prerequisites taken care of and then have this and take a look for yourself. Some people might find it useful, some people might not as well. So, listen to your body.
Cynthia: I think it's important just to give context, because I was getting lots of questions. Does this mean that this will help bridge the gap? I always remind people that keto flu are those feelings which are generally related to loss of electrolytes are really meant to be temporary. It's not going to be forever, but I find the people who are the most metabolically inflexible are the ones that will struggle the most as I tried to explain it. It was interesting. I had forgotten this because my pathophysiology days are many years behind me. As you become keto adapted, the reduction in glycogen, it's like one gram of glycogen equals three grams of water. It makes sense that if you're urinating a lot in a lower carbohydrate state, you understand you're urinating out your electrolytes. That's actually what's happening and that's what mitigates those symptoms that you're experiencing in “keto flu.”
Dr. Latt: Yep, absolutely.
Cynthia: What are your thoughts on fatty coffees?
Dr. Latt: Fatty coffees, I think they're fine if you're on ketogenic diet and depending on the quality of fat, if you've been saying like, know the quality of the fat that you're taking in, if you are struggling to get the fat calories in. I tried a strict ketogenic diet when I first joined the company because I wanted to try it myself, so that I can talk to my customers and I can talk to people who are related to the company and the product. I found myself struggling to keep up with the calories because I'm replacing the calories from carbs with fat. Now, because fat has twice the amount of calories, my brain is not computing how much fat do I actually need now, and because I'm still lifting weights in the gym, I can feel the fatigue kicking in, I can feel that I'm just more tired than when I was on normal diet. So, I had to tweak it around a little bit as well to include a little bit more carbs, but still on a low-carb diet in order for me to be productive at the gym.
Cynthia: That’ll makes sense. I think I guess my concern about fatty coffees is always coming from the perspective of, we know that the macronutrient fat overall is nine calories per gram and I remind people that you have to be conscientious. You can't have half a stick of butter, and five tablespoons of cream, and adding all the fats, and thinking-- At some point, if you're trying to lose weight or change body composition that you could unknowingly, yes, it's relatively healthy, but unknowingly, you could be putting yourself in a surplus and not a deficit. I know before we started recording you were talking a little bit about your background and how you came to a healthier lifestyle. Do you mind touching on some of this? Because I think this pain to purpose, allows for patience, people that are listeners to feel they really are understanding who I'm connecting with today.
Dr. Latt: Yeah. Well, first of all, I'm so, so happy that you’ve mentioned in terms of the calorie surplus and calorie deficit thing. Because a lot of people will they feel like, “Oh, I'm on X and Y diet. I should see results.” But they fail to realize that they're consuming more than they had before or they're consuming more than they can burn off and therefore it still comes back as storage whether it's glycogen storage or whole fat storage. That's a very important point. Yes, choosing the right macronutrient is important, but having the right amount is also as important. In terms of what I've gone through of my health journey, I'm not proud of it, but I used to be a smoker for seven years, and during that time as well, I was overweight, I was drinking a lot of soda, I was not eating healthy, and definitely consuming a lot of carbs. Until I was in my second year in my undergrad in the UK, I was 22 years old and I have actually started running. But the whole story of me starting running it was quite funny because my housemate asked me to go run with her, but she was a state swimming captain back in Malaysia, so she could run.
Cynthia: [laughs]
Dr. Latt: I was this always snijer, I almost went blue, I couldn't breathe and she was panicking. She was like, “Do I need to call 911, do I need to call the ambulance?” As I know, I'm fine. I think part of it is also my pride, where I had a couple, they must be in their 70s, and they were running faster than me, and they were cheering me on. As a 22-year-old I was like, “This cannot be happening at the age of 22.”
Cynthia: [laughs]
Dr. Latt: I was embarrassed. I was very, very terrified because of that I started running every day. I didn't realize in my head. I didn't run to lose weight, I didn't run to get fitter, I just wanted to be able to run. It was as simple as that. There's a University Park in Nottingham, and I ran around the park around two kilometers, and I aim further every day, and then before I knew it, I lost about 45 pounds in four months. But at that point because I lost so much weight so quickly, I almost look ill that was when I started joining the gym, and starting to learn about resistance exercise, and that was my entire final year, and my final year thesis for my undergrad was adipose tissue metabolism and a mathematical model of adipose tissue, which is fat metabolism. And then I went on to do my Master’s in biotechnology and that was when I incorporated the knowledge of resistance exercise. That was when sarcopenia came in. So, I was doing a lot of endurance, I was afraid of getting bigger as I lift weights, because in my mind, I'm getting bigger, because I'm getting fat.
Again, I'm going back to where I was, I don't want to go there, I start restricting my diet, I start doing a lot of cardio, and then I learned about the balance between resistance exercise, endurance exercise, metabolic flexibility. Then, [unintelligible [00:42:29] my PhD in metabolism of type 2 diabetic heart as my family side, my mom's side has really high prevalence of diabetes. My sister, she had gestational diabetes, which I told her, “You got to be careful because you got gestational diabetes you got 50% higher risk of developing diabetes later on in life. You got to be careful with what you eat, and how you live, and exercise, and all that.” And my father's side, my late father died of stroke and my half-brother died of cardiovascular disease. They have a high prevalence of cardiovascular disease. It was not fully planned, but it happened that I ended up doing a PhD combining both diabetes and cardiovascular disease and now, I'm like, “Great, I've got deposition of these two genes on both of my family sides.” So, it's great to know the knowledge that I need in order to prevent that in order to live as healthy as possible for as long as possible.
Cynthia: I appreciate you’re sharing that, because I'm sure there are many people listening that have gone through weight loss resistance, and then they get to a point where they do lose the weight, and then they get triggered, if they're lifting weight, and muscle weighs more than fat, and so they start sometimes second guessing the process. I would say trust the process. I would say non-scale victories, etc. That's why taking measurements are so important. But thank you for sharing that because I thought that discussion that we started having at the beginning, I was like, “This is really good because people can really relate to that.” I'm so grateful that the things you have learned and obviously through your family and you can counsel the rest of your family members about how they can help avoid developing cardiovascular disease or issues related to insulin resistance. So, let's bring this back full circle. You mentioned at the beginning that H.V.M.N. is doing some pretty incredible research with the military. Are you able to talk about any of the current research is going on in a way that you're not compromising what you're doing?
Dr. Latt: Yeah, I can talk briefly about it. We are using exogenous ketones and look at cognitive and physical function in hypoxia. This is especially relevant for military operators, who are on long and demanding missions, especially at a higher altitude. Altitude sickness and the loss of cognitive ability, if you would when you are in hypoxia because like say, 20,000 feet, which is what we simulated, you get a significant drop of oxygen saturation in your blood. It goes down from sea level about 97%-100% to 60-75%. Now, with exogenous ketones, what we saw was amazing because we saw an increase of 7.7% of oxygen saturation. That means you are getting that much more oxygen when you're on ketones and that is helping you think properly because oxygen in the brain is super important for you to get accuracy, or for you to get response reaction time, and do make the right response given the right stimulus. So, that's what we did. We did all these cognitive tests, and we asked them to exercise beforehand in hypoxia, fatigue them, and then ask them to do a shoot simulator, and all these different cognitive tests. They saw an improvement in reaction time, they saw improvement in accuracy, and that is huge because if you're out in the field operation and all those split decision making would make all the difference.
Obviously, they are very physically demanding as well. Having that clear mind and that focus to make the right decision at the right time, I think, it's very vital. Besides, it was DARPA from the Department of Defense that funded the whole research of exogenous ketone to begin with about 20 years ago. They were looking for a super field. They looking for a field that can essentially support these operators at long and demanding missions. Then from then on, it's evolved, and we have more data around performance, and then we have more data around flavors as I was talking earlier. We have more data about around scalability, around affordability because we also want to bring this to the general public. If it's good for top athletes, if it's good for top military personnel, it should be good for the rest of the population because we're all humans, we're all metabolizing all the time, we are all creating ketones if we want to. We all have the same enzymes, same hormones, same regulation, some have high, some have lower, but we are all able to metabolize ketones. So, we want to make it affordable enough so that people can take it on a daily basis.
Cynthia: I love this and it's interesting, I just watched a documentary and I believe it was a gentleman from Bhutan, but he went to all the highest peaks in the world. One of the things he talked about was the issues with hypoxia at higher elevations. Because of where he grew up and because he had been climbing from the time he was able to walk that he felt his body was better adapted. But one of the things they talked about was, these weekend warriors that want to go in and do extreme, they're going to go hike the Himalayans as an example, and they're not really physically prepared to do it. He said, “I've seen a lot of people do crazy things when they're hypoxic because they're just not thinking clearly.” I can imagine, if the US military is involved there's probably a lot of special ops. Men and women that need these kinds of resources. So, I love that. That research is now translatable down to the general public. It's not just for the special ops, although obviously it makes sense why they would need it. But for those of us that are in the lay public or in the medical community. Let listeners know how to connect with you, how to connect with H.V.M.N.? For full disclosure, I'm very happily able to share that H.V.M.N. is a podcast sponsor. I do use the products, I've got my husband who does jujitsu, I'm trying to get him to try it. I'm like, “Really try it before you go for a match and see how you do.”
Dr. Latt: One of the military guys that we worked with, he does jujitsu, and he used it for the first time, and he really loved it. He felt that after taking ketones he could see-- It's almost everything is slower. He could see things slower and he could move faster. It's the mind perception of movement and time, which is quite interesting because all this while we understand that ketone has been beneficial to endurance exercise. Cyclists, a lot of cyclists do it. We have supported more than 60% of the teams that Tour de France and they know of ketones, they know the benefits, and they have been using it. But in terms of strength training or high intensity training, I always say from a metabolism point of view, glycolysis, which is glucose metabolism will always be better because it creates fast energy for you. But nonetheless, the ketones actually provide the benefit, the cognitive benefit for that. Instead of using it for endurance exercise, I'd be using it for heavy lifting because it puts me in the zone, it gives me really sharp focus, and gets me-- Because I think a lot of listeners probably can relate. When you are exercising, when you're pushing yourself physically to the limit, yes, physical strength is important, physical endurance is important, but as important is your mental strength. Will you give up, do you feel good about it, are you in the zone to be motivated enough to go for the next set, to go for the next lap? I think that is super helpful with this product at least from my personal point of view. In terms of how to connect our website is www.hvmn.com. You can find me on Twitter and Instagram @lattmansor. L-A-T-T-M-A-N-S-O-R. Yeah, I’d love to speak to more listeners, more audience, and just answer questions get the information, get the education out there. I would like to learn as much from you guys, as much as you are learning from me.
Cynthia: Well, I love your enthusiasm and I like that you mentioned another aspect that this can be beneficial for us is the mental focus. I tell everyone mindset is everything and it's certainly no exception. But I've loved our conversation. I'll have to have you come back again. You can clearly tell how enthusiastic you are about this topic and making the science translatable because one of the things that I have found as a clinician and also someone who has this pretty solid science background that sometimes researchers or scientists can be absolutely brilliant, but they struggle to communicate in a way that makes the information relatable. And so, obviously, you've been able to bridge both those things. So, it's really a pleasure to interact with you. We'll have to do this, again.
Dr. Latt: I would love to. It is as my pleasure. Pleasure is all mine. Yeah, it's really important and I always tell people who are doing their undergrad or Master’s or in science field in general, the journey that I have been on is that going from explaining things simply in undergrad to explaining things in a very sophisticated manner in Master’s. And then in my PhD, I got told that I use too many fancy words people don't understand. Now, you need to explain this complicated concept in the simplest way, so that you can then translate it to people who are not in your area of research. That is definitely a journey that I enjoyed and a skill that I definitely make use of now because that is what I saw the lack of in the world right now where you have the general public, you have the industry, you have the scientist. You get a triangle there and there's a lot of misinformation, a lot of broken communication channels. If you don't go out there and google and then search it you won’t know. How do we get that information out there and people are interested enough to listen, and people can understand and relate? I think there's a lot to do with. I love how you structure your podcast because you always bring it back to relatability, the relevance. Where is the so what to the audience? And I think that for me is key.
Cynthia: Thank you. That's a huge compliment. I do endeavor. I always say there are some podcasts that are out there that demonstrate how smart the host is. To me, I would much rather bring on the experts and try to make sure that everything is accessible, so that we bring it back to relevancy because then people can take action. They don't have to go down-- I'm old enough to say we used to use the sources back in the day before we had all this online accessibility to information. It's like I don't want someone to have to spend two days on a concept that we've brought up in a discussion. I want them to be able to take action from here.
Dr. Latt: I agree. 100%. Well, thank you so much for having me.
Cynthia: Absolutely. Thank you.
Cynthia: If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.
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