Evidence-based articles on therapeutic ketosis, brain energy optimization, and metabolic health — written by a physician who lives the protocol.
Every Thursday: the real numbers from Dr. Dublin’s 180-day therapeutic ketosis attempt — including the weeks he’s losing — plus the science behind them. Issue #32: “Same number, two different brains.” Three mornings at the same ketone reading, one slow brain and two sharp ones — why the week behind the number matters more than the number, every study attached.
Three mornings, the same ketone reading of 4.5. On one my reaction time was the slowest of the run; on the other two it was about 50 milliseconds faster. The difference was the week behind the number. Why epilepsy clinics give the diet months, a 1967 fasting study, rat mitochondria, the first randomized trial of the diet in psychosis, a correction to last week’s letter, the sprint session my body billed me for, tired hitters — and how sure I am about each claim. Companion to Issue 32.
For years I said “I sleep better in ketosis.” So I lined up 443 nights of watch data — four attempts, three breaks — against my ketone log, then read 431 nights of deep-sleep and REM minutes out of the app by hand. The on/off pattern held: better scores, fewer awakenings, a slower sleeping heart. The thing I was surest about did not: deep sleep and REM were the same in ketosis and out of it, and higher ketones bought none. A lifetime of light sleep, nocturia, weight-linked apnea, seven questions to ask about your own nights, and how sure I am about each claim. Every study attached. Companion to Issue 31.
My memory, my bathroom scale and the AI keeping my notes all said I’d spent two weeks starving my muscle. My written log said my average protein was above my floor. What the log actually showed — feast and famine, late plates, and the day-by-day readings behind them — what the research says about protein timing, including the 2023 study that challenges the “per-meal ceiling,” why a body-composition scale can’t prove muscle loss, and how sure I am about each claim. Every study attached. Companion to Issue 30.
Twenty-five years ago I told weight-loss patients “people who drink more lose more” and never knew why. This summer a blood-pressure cuff read 80/68 while I felt fine, a glass of water dropped my heart rate twenty beats, and my ketone meter moved hours later. The empty-tank pattern that corrects within a day, the deconditioning tax that takes three, the insulin switch at the centre of both, the study that argues against me, and what the water-and-weight-loss trials actually show. Every claim labelled, every paper checked. Companion to Issue 29.
My knees were a 10 out of 10 on my own scorecard. Two years of a cane on and off, stairs by the bannister, the grocery store too far to walk. On Day 81 I ran for an hour and they did not send a bill. Here is what is actually broken inside an arthritic knee — synovium, cartilage, bone, tendon — and what the evidence says BHB does at each tissue, labelled established, plausible, or speculative, including the mouse study that goes the other way. Companion to Issue 28.
Twice this summer a hard workout dropped my ketone number below my floor for three days. The textbooks say ketones should go up after exercise. Mine went down. The machinery — the glycogen pantry, the 48-hour insulin window, the repair job, the dehydration-cortisol chain — with every paper cited, a prediction on the record for the week of September 13, and the honest answer on whether any of this makes you faster. Companion to Issue 28.
You went low-carb, felt better than you had in years, and your LDL rocketed. Here is what cholesterol actually is, why it rises in lean people and not heavy ones, and the honest state of the argument — including the reassuring study the whole internet cites, which was retracted this year at its own authors’ request. Delivery vans, cracked roads, the Oreo experiment, the real numbers on statins, and the four tests to ask your doctor for. Every study attached.
For months I walked with a cane and nobody said a word. Then I got healthier — and the questions started. The social machinery that ends more health transformations than hunger ever did: why the compliment is a trap, why the people who love you attack at your weakest moment, the chemistry waiting for anyone who quits mid-protocol, and the one-person vaccine that protects against all of it. Every mechanism named, every study attached.
For years I could not dial a phone number — and I never told anyone, including my own doctor. A field guide to the six most common cognitive workarounds of middle age: the doorway you walk through and forget why, the keys you never actually remembered putting down, the name that won't come. The real science of each, and the honest version of why a change of fuel might touch any of it.
622 points to 268. The full scorecard, section by section — and the actual biology of why a change of fuel quiets a body: NLRP3 inflammasome inhibition, HDAC inhibition and BDNF, and an honest account of why mitochondrial biogenesis probably explains none of it yet. Every term defined, with the research attached.
490 blood ketone readings, 300 days, 23 restarts — and one pattern I missed for four years. Why a good number on a good day protects almost nobody, and the house call that changed how I think about all of it.
The working plan I actually use with patients. The numbers I pay attention to. The order of operations for recovery from metabolic disease — from elimination to exercise to therapeutic ketosis.
The inflammation produced by sugar damage activates kinases that physically cut the insulin relay cable. Glucose piles up in the blood while cells starve. The brain begins to fail. The link between sugar and dementia, made explicit.
A second campaign of damage that requires no overload, no enzyme, no special pathway. Sugar in your bloodstream is slowly gluing your structural proteins into dysfunctional shapes — arteries, kidneys, eyes, nerves, skin. The AGE story.
Fructose plays by different rules than glucose. It hits a different organ. It triggers a different cascade. And once your mitochondria are compromised, fructose — whether from Coke or fresh-squeezed orange juice — can push a stressed cell over the edge.
When too much glucose arrives too fast at the electron transport chain, sparks fly. Hydroxyl radicals attack cardiolipin, membranes, and mtDNA. The vicious cycle locks in. The molecular fire that eventually becomes disease.
The electron transport chain is a five-complex molecular machine that converts food into cellular energy. Understanding how it works is the key to understanding how sugar destroys it.
She was sixty-three. Three doctors said it was just aging. It was not aging. It was a power outage — forty years of sugar damage to her mitochondria. This is the story of what sugar actually does to your cells.
You do not need to fix every chemical in the world. You need to stop swimming in the worst of them while giving your body the inputs that allow it to rebuild. A nine-step order of operations — from exercise to therapeutic ketosis — based on the biology in this series.
Heavy in the morning, foggy in the afternoon, wired at night. What most people call 'getting older' is partly real aging and partly an accumulated mitochondrial wound that did not have to happen this fast. The generational biomarker data proves it.
Six doorways through which modern life delivers mitochondrial damage: air pollution, plastic chemistry, PFAS, pesticides, ultra-processed food, and heavy metals. Learn the framework that makes sense of every chemical scare story you have ever read.
Microplastics in every placenta tested. PFAS in cord blood. Altered mitochondrial DNA in newborns. The evidence that cellular energy damage begins before birth — and what it means for the rising tide of childhood chronic illness.
Something has changed in modern medicine. Children are sicker at younger ages. Adults feel old before their time. The explanation is hiding in plain sight — inside a tiny structure most people have only vaguely heard of: the mitochondrion.
The three pillars of brain health don't just add to each other — they multiply each other. BHB unlocks the BDNF gene. Exercise produces BHB. Sleep consolidates what exercise built. A physician's complete guide to the synergy that reverses neurodegeneration.
The ability to feel impaired disappears before the impairment itself does. This is the physiological crime scene most people never see — because it builds slowly, quietly, and in places you can't feel until the damage is already serious. A system-by-system account of what chronic sleep deprivation does to the brain, heart, immune system, and metabolism.
In 2012, a neuroscientist discovered that the brain runs a dedicated waste-removal system while you sleep — flushing out the proteins that cause Alzheimer's disease. Without it, amyloid-beta accumulates in a single night. This is the science of why sleep is not rest. It is repair.
Only 12% of exercise's weight loss benefit comes from burning calories. The other 88% comes from what exercise does to the brain — rewiring the food reward system, producing BDNF, growing the hippocampus, and taming the cortisol system that drives stress eating. A physician's account of the real mechanism.
What therapeutic ketosis did to my sleep, my mind, and everything I thought I was quietly losing to age. A physician's personal account of cognitive restoration through metabolic optimization.
Your MRI shows damage, but your pain is worse than the image suggests. The reason: inflammation and fluid pressure amplify the structural problem. How therapeutic ketosis addresses the amplifier, not just the structure.
Millions of people try keto for brain health and feel nothing. The reason isn’t that keto doesn’t work — it’s that they never actually tried therapeutic ketosis. A physician’s honest account of what standard keto gets wrong, and the four differences that actually matter.
This is the most complete explanation of the SKLeTT Protocol I have published anywhere. Not a diet. Not a wellness program. A precise, physician-guided restoration of the metabolic conditions under which the human brain performs at its best — developed over 25 years of clinical practice.
Your mother’s brain essentially became diabetic. Not her body — her brain. The term is Type 3 Diabetes, and the science increasingly shows that Alzheimer’s has metabolic roots that begin decades before the first memory slip.
Every week in my clinic, a patient asks: ‘Should I just get on Ozempic?’ These drugs work — but the weight you lose is only part of the story. The type of weight, what happens to your brain, and what happens when the drug stops — that’s the rest.
Most people think ketosis is just a diet trend. It’s not. Therapeutic ketosis is a precise metabolic state — targeting ketone levels of 4.0–6.0 mmol/L — where measurable cognitive and neurological benefits begin. Here’s what the science actually says.
You’ve tried sleeping more, drinking more water, cutting caffeine. The fog doesn’t lift. What if the problem isn’t your habits — but your brain’s energy supply? Here are 5 clinical signs that your brain fog has a metabolic root cause.
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