What is it like to have COPD? Imagine breathing through a straw while running a marathon.

Russell Winwood, an athlete diagnosed with a chronic lung disease called COPD (Chronic Obstructive Pulmonary Disease), has experienced difficulty breathing during marathons for years– but it hasn't stopped him from pushing to the next level.

Russell follows a ketogenic diet, supplements with ketone esters and incorporates other strategies to help retain an active lifestyle despite lungs operating at 25% capacity.

In this episode, we dive into:

• Russell's experience with the ketogenic diet and H.V.M.N. Ketone to improve lung function.
• His mindset during endurance training as someone with a limiting factor he can't necessarily control.
• The future of COPD research and medicine.

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Transcription

Geoff: Welcome to this week's episode of the H.V.M.N. podcast. This is your host Geoffrey Woo, and I'm really excited to talk with Russell Windward. Russell, is an early ketone ester user, and was actually part of our early testing batch, that went out a few months ago, and I think you have a very unique story, because Russell actually suffers from COPD, which is a very serious disease affecting his lung capacity. Russ told me to have a straw on hand so we can mimic some of the experiences of what it's like to breathe with COPD. But, I really see Russ as not just a patient, or someone suffering from disease, but really turning that on its head and becoming an inspiring athlete. I think, we'll go through that trajectory and that journey of how he battled through, and accomplished, and finished a Boston Marathon in what was probably one of the harshest weather conditions ever in that race. But, along the way, I think you also become an expert, at least a practicing expert in ketogenic diets, and ketosis for the management of COPD, so I decided to bring Russ on the program today.

Russell: It's a pleasure to be here Geoff.

Geoff: Lets start from the top. COPD, so for the folks that are listeners that might not be familiar with what COPD is, can you explain that and how it developed, and the story of how this became an impact in your life?

Russell: Yeah, well, COPD is chronic obstructive pulmonary disease. It's a disease of the lungs, and it's defined by a fixed airway obstruction. That's an obstruction that cannot be reversed. The disease is progressive, there is no cure, and tragically, it kills about 3.2 million people globally, every year.

Geoff: Wow.

Russell: It's a disease that unfortunately not a lot of people know about, and it's predicted to be the third leading cause of death worldwide by 2030. I was diagnosed with COPD back in 2011. I've been an asthmatic all my life, and my asthma hadn't been managed correctly over the years. My fault, and it developed into COPD. Now, of course, smoking is part of COPD, 80% of patients with the disease are ex-smokers and I'm certainly one of those. But, I guess when I was diagnosed, and I was faced with the prognosis of needing a double lung transplant within five years, and not a long lifespan ahead of me, I sat back and thought I need to do something different, and that's been my journey. As far as what it's like to be a COPD patient, I believe you've got a straw there.

Geoff: Yeah.

Russell: Something that I often get people to try, because it demonstrates our disease. So, if you pinch your nose, put the straw in your mouth, and breath in and out, so you're only breathing in and out through the straw, you notice it's difficult to breath. It's harder to get air in, and air out. You imagine that 24 hours a day, that's how you're breathing.

Geoff: Yeah.

Russell: So, imagine trying to do a marathon.

Geoff: Right.

Russell: Or, do an Iron Man event, when you breathe like that. It's difficult.

Geoff: It's unimaginable. So, typically my understanding is that they typically rate your obstruction by a percentage of typical normal lung capacity.

Russell: In my scenario, I was diagnosed with 22% lung function. Pretty much, for about five years, it stayed in that range from 22 to 30%, but over the last couple of years, I've changed my dietary strategy, and I've now been able to get some improvement out of that. My highest reading so far, is 41% lung function, which is a significant improvement.

Geoff: Yeah.

Russell: It's still very hard to breathe when you're breathing at so low levels of lung function, but for a patient, when you're coming from 22% to 40%, it makes a big difference.

Geoff: Yeah, so I'm actually curious to learn about the history here, so it sounded like you had a history of smoking, and had a history of asthma, and was there a wake up call, where it was like "Oh", or was this like a gradual realization, or was it like you went to the doctor and the doctor was saying, "Hey, you're literally breathing 20% of normal capacity. You gotta change your life." Can you describe the evolution here?

Russell: Yeah. Look, my story's one that I wouldn't recommend people follow my example, because from a health point of view, I didn't look after myself at all. I was an asthmatic kid, I started smoking in my late teens, I smoked for probably about 25 years. At the age of 36, I had a stroke, because my life was so out of control as far as looking after myself, and my stroke was actually so severe that the paramedics who attended me, turned up at the hospital three days later because they didn't believe that I lived.

For me, that was the start of the wake up call. That I needed to change my life and I started doing that. I got into exercise. My son was an avid cyclist back then, and talked me into taking up cycling. Then, I started eating what I thought was a healthy diet, exercise, taking my medications regularly, and getting my life back on track. I still had asthma, which was never gonna go away, so that still affected my exercise ability. But, I really enjoyed triathlons and endurance events in general. In 2010, I had gone down to watch some friends to and Iron Man event. After watching it, I was inspired to actually have a crack at it myself. Iron Man I guess, for a lot of people, is the pinnacle of endurance sports. And so, I'd entered the Port McCoy, which is our home of Iron Man for 2011. But, what I found is once I started stepping up the training for Iron Man, so it's a longer endurance swims, rides, runs, more intense, that sort of thing, I was getting sick. So every time I'd step up the intensity, I would get chest infections, I'd become ill, I'd be on antibiotics. I'd get myself better again, and then start training again, and then it would repeat itself. It was like a vicious cycle.

Geoff: You were just coughing up phlegm, like your lungs were-

Russell: Coughing up phlegm, very breathless, lack of energy.

Geoff: Okay.

Russell: Being tired all the time. So-

Geoff: You weren't diagnosed with COPD yet? This was a post stoke wake up call, you're getting inspired by your friends. You had a history of asthma, but you didn't realize that you had the underpinning symptoms of COPD, right?

Russell: Yeah, and I got into 2011, and it was probably about three or four months before the Iron Man race that I had entered, and I realized there was no way I was going to do it. I was still sick, I couldn't train, so I pulled out of the event. Which, was a tough pill to swallow, because you don't get a refund on your entry fee.

Geoff: You don't get a refund on all the trainings. I know that the training for a full Iron Man, that's months of dedication and sweat.

Russell: Yeah, so I pulled out of the event and just decided I needed to focus on getting my health back in order, because by that stage, I'd become really breathless. I was sick all the time, I had no energy whatsoever. I got to the stage where my day would consist of going to work for two hours, coming home and sleeping the rest of the day. It's one of the costs with COPD is the exhaustion you get from the breathing, because breathing is so much harder, you use so much more energy.

I said to myself, by stopping training, that I would get back to where I was before, but I didn't. I was still continually sick. At that stage, I went off to my doctor and said, look, we need to investigate this further. I don't think this is asthma, this is more than asthma. Something's not right. He went me off to a respiratory physician, who sent me away to get spirometry testing, which is the gold standard in diagnosing respiratory disease. When the results come back, he said to me, "Your lung function is 22%. You have a disease called COPD. There is no cure for it, it's progressive." I'd never heard of the disease. I didn't know what COPD was. That's how my story evolved, as far as the diagnosis of COPD. Looking back now, I probably had the disease for maybe three or four years before I was diagnosed, because the severity of my diagnosis, it wouldn't have just happened overnight.

Geoff: Right.

Russell: I think it's built up. I guess a lot of patients fall in the same track. They become more breathless, and they put it down to either getting older, or that they've got asthma, and it's getting worse. Quite often, it can be something a little bit more sinister.

Geoff: Right. I think, your story is unique, because you didn't just take the diagnosis and rolled over. You've really become an advocate for the community, raising funds for research, and also starting to be an N=1 guinea pig on different interventions, like a ketogenic diet, and recently our human ketone ester, and then following the work of Professor Karen Clark over at Oxford. Can you tell us about the journey from getting the prognosis that your lungs are 22% of capacity, you're probably not gonna have a great quality of life breathing 22%, and breathing through a straw all day for the rest of your life. I guess, before you started tackling that problem, that must be a horrific, daunting indictment on the rest of your life. How did you react? It's interesting to see that you just rebounded, and I think, almost are as strong as ever. But, I think a lot of people would have taken that diagnosis and folded. I'm curious to get into your head there.

Russell: I guess, for me, initially when I was diagnosed, I certainly fell into a hole. I didn't know what to do, there wasn't a lot about how to manage my disease back then. I made the mistake of going home after my diagnosis, and asking Dr. Google about quality of life, and how long I was going to live for. If you type in life expectancy for a severe COPD patient, you're gonna see something, six to 10 years, and that's it. I did all the wrong things, as far as mindset is concerned. I guess, I reached the stage where me and my wife sat down and said, we can't live like this, we've got to change things. I was only 45 when I was diagnosed. I wanted to see my kids grow up, I wanted to see them get married, I wanted to see grandkids, all those sorts of things.

Geoff: Right.

Russell: My wife started researching about different strategies we could use, and the first thing we come up with was salt therapy. You go into salt rooms, and it's supposed to be good for lung disease, and we tried that, it had no effect on me, so we kept looking. My wife came across an article about a Chinese medicine doctor in our local area, who had success with different diseases. We thought, well, nothing to lose, we'll go and visit him. It was interesting, because the doctor examined me, and he looked me in the eye, and he said, "I can't do anything about your lungs." He said, "But, what I can do, is I can give you more energy." I said, well, I'll take that. Because, I knew myself, if I could get more energy, I can get back to exercise. Because, at this stage, I wasn't doing anything. I was too sick. I knew if I could get the energy to get back into exercise, I could maybe turn things around. I was a skeptic, I didn't believe in Chinese medicine. Over the course of the next three or four months, I took these pills, and these herbs, and mixed them up, and took them every day religiously. My wife made sure that happened. What I did notice is, I was starting to get more energy.

Geoff: Hmm, what kind of herbs, what kind of tonics would he, do you remember?

Russell: I can't remember what it is, and he's no longer practicing. I'd actually tried to investigate that.

Geoff: Right.

Russell: But, I don't think I would have any luck there. I don't whether it was what he gave me, or it was a placebo effect.

Geoff: Right.

Russell: I don't know, but whatever it was, it worked. I had more energy. From when I first started walking again, and going from short walks to longer walks, and building my exercise capacity is what I call it. The more I exercised, the better I felt. It encouraged me to keep exercising, because I could see the benefits of doing that. I had more energy, and by exercising, I was getting more energy again. Gradually, I worked myself out of the negative mindset, and it was process. I went on walking, and I decided I wanted to hop back on the bike again, and start bike riding, and I did that. That was a slow process, but I gradually built up my ability to ride bikes over longer distances. The big challenge then was, I wanted to get back into swimming. The first time I hopped in the pool and went to swim, and I'm swimming freestyle with arms, and trying to kick my legs, I got so breathless, I just sunk.

Geoff: I can imagine. Your breathing is already restricted due to the disease, and then more than half the time your face is in the water. That must me a little bit frightening, just from a psychological drowning effect.

Russell: Look, it was, but I started in smaller pool, a 25 meter pool, so if I was going to drown, I could stand up basically. But, I thought to myself, all right, I need to get back to swimming, so how am I going to do it? I think bought a device called a pool board, and it's flotation device that we put between our legs, and it basically keeps, from our hips downward, afloat, so we don't have to kick. All I have to do then is swing my arms, and that was working. I could get back in the pool using a pool board, and I slowly started to swim again, and increase my ability to swim.

I got to the stage where I could walk, I wasn't running, I could cycle, and I could swim. Because, I liked to bite off more than I can chew, and decided that I was now an elite athlete, I went to my wife and said, I want to do an Iron Man, and she laughed. She said, "I think those days are over." I said, well, I at least want to have go at doing an Iron Man event. She said, all right, well, let's go up and see the respiratory doctor, and see what he's got to say about that. I said, "I want to do an Iron Man." and I think after 10 minutes he picked himself up off the ground, because of laughing so hard. He said to me, he said, "You're not gonna finish a Iron Man." He said, "You've got chronic lung disease." He said, "I'm happy for you to train for an Iron Man, as long as you abide by the rules I set out training wise, and that had to do predominately with my heart rate. We started training for an Iron Man, but this time around it was very different to the time before. I had some guidelines I had to adhere to, and one was keeping my heart rate below 150 beats per minute. The reason why I had to do that is, my oxygen levels dropped significantly once I get over 150 beats per minute, so it was important that I keep my heart rate as low as I could.

Geoff: Basically, below your lactate threshold, lactate acid threshold essentially, is probably what range we're targeting.

Russell: Yeah, exactly. The other rule was that, if at any stage, I started to become sick, then I had to pull out of the race. Because, for a patient, when you have an exacerbation of a disease, that's when you really get some damage done to your lungs. The whole idea is to minimize exacerbations. I had a look around about products I could use to boost my immune system, so hopefully I wouldn't get sick, and come across some research about zinc. From that day until today, I take a zinc powder supplement, which our friend Professor Clark also takes. It [inaudible 00:17:08] I've been able to minimize my exacerbations. I still have them, but not as much as I used to. I went to Iron Man training for, I think it was about eight months. Trained for the Port McCoy Iron Man. I remember being there on the start line of the day of the race, and looking out, because I've got to do a 2.4 mile swim. No idea whether I was going to be able to do that. In fact, I didn't even know whether I'd be rescued or not, but I knew I was gonna give it a go.

Geoff: In your training, did you never do a 2.4 mile swim?

Russell: I did, but training and race day is very different. Because, when you jump into the water with 2000 other competitors-

Geoff: Right, everyone's tearing at each other, I see, I see.

Russell: Yeah, and I made the decision early one, that I would actually wait until everyone else got in the water, and then I would follow in lasts. Because, the last thing I need to do is, having other athletes from over the top of me. I was having enough trouble keeping afloat. The beauty with Iron Man, for me, as far as swimming was that, you get to wear a wetsuit. A wetsuit gives you some flotation.

Geoff: Right.

Russell: Which, is good. The downside of that is, wetsuits are also quite restrictive, which is not something I wanted. But, it was a trade off.

Geoff: Right.

Russell: Flotation versus restriction.

Geoff: Right.

Russell: I jumped in the water. My wife did the race with me. Jumped in the water, and off I went. My target was actually, my first goal was to finish the swim length. My second goal was to beat my wife in the swim length. I achieved my first goal. I got out of the water after one hour and 31 minutes, and completed the swim. I didn't beat my wife out of the water. She's a far better swimmer than me. Then, it was a process, so that part's done. Now, it's time to go and get changed into my cycling gear. Because, now I had to do 112 mile bike ride.

Trust me, as someone who's used to breathing through a straw all the time, that is quite daunting. Because, at Port McCoy is one of the hilliest Iron Man events. Hills, and people with lung disease, don't go well together. I start off on the bike ride, I knew I had to do the ride in around the eight hours, which is a long time to be on a bike. About 80 mile into the bike ride, I was quite fatigued. I wasn't coming last, but I was near last, and we have what they call a sweeper vehicle. They're a vehicle that come around and pick up all the athletes who don't want to keep going, or they're not gonna make the cut off time, or whatever.

As I'm riding along, the sweeper vehicle pulls up beside me, and I look over to this guy and say, are you gonna pull me out of this race? He said to me, "Are you gonna stay at this pace," and I said, yeah. He said, "Well, if you stay at this pace, I'm not gonna pull you out of the race, because you'll make the cut off point." I said, okay. I stayed at that pace, and this is probably the time in my journey that really started to make a difference to me. I got into the cycle leg, and handed my bike over to one of the officials, and went into the change tent, where you get changed into your running gear. I actually sat down on a chair, and put my head in my hands, and I cried like a baby. Because, the dumb idiot had just hit me. I've just 2.4 miles, I just rode 112 miles on a bike, and I've got lung disease, and I'm doing all this. But, then the thought of going out, and now doing a marathon as well, that was playing with my head.

Geoff: Yeah.

Russell: I started making excuses to myself. I can pull out of this race now, because I've done a great job for someone with 22% lung function. I can hold my head up. But, then it hit me. One thing I said to my family when I was first diagnosed is, I said to them, I don't want to treated like an invalid. I don't want to be treated any differently to anyone else. Here I am, two thirds of the way through an Iron Man event, making excuses for myself, and I'm treating myself like an invalid.

I started to think, this is not who I am, and at that moment I looked up, and there was one of the officials was sitting in a chair straight across from me. In his best Australian accent, he looked at me and say, "What are you doing?" He says, "Mate, if you're gonna finish this race, you need to get your clothes on, and get your butt out of here. You can't be sitting here crying like a baby," and that was it. He was right. Stop making excuses. In Australia, we, especially in Iron Man races, we don't take any prisoners, and we don't get any sympathy. You're just like anyone else, you either get out and run, or you get out of the race. I got changed.

Geoff: Right.

Russell: My mindset was that, I was going to get into this race, and the only way I was gonna get off the course is, someone dragging me off the course. For the next six odd hours, I made my way around Port McCoy. The cut off time for an Iron Man event is 17 hours. The whole time I'm out there, I'm resigned to the fact that I'm not going to make the cutoff time, I'm too slow. By this stage I've become incredibly breathless. I was walking most of the time. I couldn't run anymore. I had my wife, and the kids, and the coach following me around the course encouraging me to keep going.

I got to the stage, every lap you run past the finishing shoot, so you see the time allotted. I come past it, and I had a look, and I looked at the time I had left to finish the race, and how far I had to go, and I thought to myself, I can finish this race. It was the first time all day that I actually felt like, hang on, I might be able to do this. 16 hours and 15 minutes into the race, I crossed the finishing line with 10 minutes to spare. That to me, was a defining moment in my journey with my disease. I talk about this when I talk to patient groups, and respiratory professionals. It's the 16 hours and 15 minutes that changed my life. Because, what I realized is that, I didn't have to let my disease define me. I could be whatever I wanted to be. It was all in my mind, and it's all about setting myself goals, and following these goals through. Yes, I've got COPD. Do I believe it's going to be the disease that finishes me? No, because I made a decision back then that I'm gonna beat the disease. I'm not gonna cure it, but I'm not gonna let it get me. From that day one, my life changes. I've now done three Iron Man events, plus marathons, plus all sorts of things. The more I do, the better I feel. I've still got COPD, and I've still got very severe COPD. I have my good days, and my bad days.

Geoff: Right.

Russell: But, mindset is a very powerful thing when you're dealing with lots of things in life, but especially with chronic disease.

Geoff: That's incredible. I would say most modern humans can't be on their feet for 16 hours, let alone even contemplate doing a half Iron Man, or even just an Olympic course triathlon. For different guests on the podcast, I think you have one of the most compelling stories, in the sense that you just overcome so many challenges, and stuck through it. I think that inspires, I think, just me personally, as someone who doesn't have any disease excuses to not push yourself in a way, right? If you can overcome real physical limitations, and choose not to be invalid, and not to be treated as an invalid, and just power through, I think that's inspiring, so keep that up. If there's any way that we can support with that, please let us know. I think that in some sense, we have started to support you with our ketone ester product. But, I think before even talking about the experience with the Boston Marathon, as you were developing your athletic career, it sounds like to me that you also started diving more, and more into different management strategies and effective treatments for COPD. Can you also describe the different iterations, and evolutions, and journeys that you've done around ketosis, different supplements, different routines?

Russell: Yeah, look, my journey with nutrition started a couple of years ago. It was funny, because the reason why it started is, because of the New York Marathon. I ran that in 2015, and my goal was to go under six hours for a New York Marathon. People might think, well, that's very slow. But, trust me, running while you're breathing through straw, it's pretty quick. I did the marathon in six hours and five minutes, and I was very frustrated that I wasn't able to get under six hours. Because, I trained for 22 weeks for this marathon. I did everything I possibly could to prepare myself, and this was the result, and I wasn't happy.

When I got back to Australia, I started to think, all right, what strategies can I change? I knew from my background in triathlons, that fueling your body is very important, so I started looking at nutritional aspects to create an action plan. I guess the first thing I went down, was the paleo mode. Which, probably didn't make a lot of difference. It made a little bit of difference to me. Because, my dot wasn't that bad previous. Then, I started finding some, or reading studies about low carbohydrate diets, and their application to respiratory disease. There's studies going back 30 years, but they're studies that are widely ignored these days. I transferred into a low carbohydrate diet. After about six months of doing that diet, I did my next marathon, which was back here at home. My time was 34 minutes quicker than New York.

Geoff: Wow.

Russell: I thought, hang on, what's going on here. The only thing I've changed is my nutrition. It was about that time that my respiratory doctor had said to me, he had listened to a podcast, and that podcast was, that was Dominic D'Agostino, and Tim Ferris. I think a lot of people in this space have heard that podcast. I listened to it, and I then decided I was going to try ketogenic diet, so moved into the space. In the meantime, I was reading up on Dom's work with ketone ester, and come across Professor Clark's, her work with ketone ester as well. After about four months on the ketogenic diet, I've noticed a range of difference with my disease. I was breathing easier, my day-to-day life was better, less flare-ups, and one of my medications I use, which is a reliever medication, I pretty much stopped using it. Because, it just made that much of a difference with my breathing.

Geoff: Sorry to interject here, so to clarify for the audience here, you distinguish a low carbohydrate diet from a ketogenic diet. What were the differences there, and what were your net carbs?

Russell: If I'm going back to a low carbohydrate diet, I was probably doing about 100 to 120 grams a day.

Geoff: Okay, which is low in terms of the standard Western diet, but pretty high in terms of someone who's trying to elevate ketones. Okay, so when you shifted to the ketogenic diet, you were closer to 25 grams net carbs.

Russell: Less than that.

Geoff: You're trying to go as close to zero grams as possible.

Russell: I would say between 10 and 20 grams of net carbs per day. Well, get onto the story what's happened since then. But, the main thing that interests me with ketogenic diets was, a study done in 2015, I think it was, where they showed that ketones could suppress the NLRP3 inflammasome.

Geoff: Yes.

Russell: That particular inflammasome is a major driver in many diseases, including mine. It wasn't just suppressing one type of inflammation, it was suppressing the mother load, if you want to call it, of inflammation. Most researchers will say that these types at NLRP3 has a significant role to play in chronic diseases. My research in that got me around to Professor Clark's work with the ketone ester at Oxford University. It just so happens I was going to run the London Marathon, and that was in April of 2017. We'd organized for me to catch up with her while I was over in London, because I wanted to pick her brain, so to speak, and she was willing to help me out. This was really interesting, so I did the London Marathon in nutritional ketosis. Before the race, my ketone readings were about 2 millimolar, my blood glucose, I think, was about 3.8 millimolar. I ran the London Marathon in about five hours 22 minutes.

Geoff: Right.

Russell: When you think of New York-

Geoff: Your blood sugar was quite low. I'm just doing the math in my head, so 3.8 millimolar to the American listeners is around 70 milligrams. You were quite ketotic at the time.

Russell: Yes, definitely. What's interesting, what I found is, my fueling strategies through these races, and I'm not advocating this, and I'm not saying it's right or wrong. It's what I found happens with me, is that I don't fuel during a race. London Marathon, I took a couple of Quest nutrition bars, and I had Hydralyte tablets that I took as well. I didn't eat anything through the race, and I didn't feel like I needed fueling. I didn't have that feeling where you hit the wall, which I've experienced many times before. In fact, I did the race, and after the race I met up with the chief operating officer of the British Lung Foundation, because I was actually running the race to raise money for them. He looked at me and said, "You don't even look like you've run a marathon." I just felt so good afterwards. In fact, that night we did a very un-ketogenic thing. Myself, my family, and some friends when out had beer and pizza.

Geoff: Great.

Russell: But, that's what made it interesting to my visit for Oxford. Because, I was finding it very hard to find the right types of food to eat while I was in London, I basically went off the diet. Within three days, my symptoms returned. I'd become quite breathless. I was using my relieve medication a lot more. I got to Oxford University, and met up with Professor Clark, who was sitting there in her office, and talking, and she said she couldn't believe how breathless I was, and that's I'd just run a marathon. We got talking about how the ketone ester may help a respiratory patient. This is all new stuff, because ketone esters haven't been tried in the respiratory world. In fact, I get a lot of pushback in the respiratory world about using a ketogenic diet. But, that's starting to change. I'm starting to get people more on board with it. Because, there's science that support it. Before I left Professor Clark's office, she said, "Do you want to sample the raw ketone ester," which I'd heard was very badly tasting. I had a, she had first made me a cup of tea and she said, "Well, what you've got to do is drink this like a shot, and then follow it down with your cup of tea chaser." I said, oh, okay. I had the ester, and it wasn't as bad as what I thought it was gonna be. I'd prepared myself for the worst, so it wasn't that bad.

Geoff: I don't think it's ever that bad. I think people get freaked out, but it's never that bad.

Russell: No, it's jet fuel, and blah-blah-blah-blah-blah. But, I think I've had worse when I was a teenager going to nightclubs. But, anyhow, I had the ester, said my goodbyes, hoped in the car. Within an hour, my symptoms had gone back to what they were like when I was in ketosis. My breathlessness was back under control, I was feeling really good, and the funny thing was, what my wife and my son had said when we were driving back into London, was that I wouldn't shut up. I kept asking questions, and doing all things, and it was like my brain was going 100 miles an hour. That is my experience, that, whether they call it mental clarity, or whatever, buy you definitely have clarity of mind, which is something which is really good when you're in a race. Because, times when you are under stress, you need to be thinking clearly. Especially, if you're taking on nutrition, or hydrating, or whatever you need to know what you're doing. For me, it certainly makes a difference.

I got back to Australia thinking, this is great. In the meantime, I'd come in contact with Dominic D'Agostino, and he has a background in pulmonary critical care. We started talking about my disease, and how ketones may, can benefit my disease. I had shared my experience with him, and I've been able to measure things, as far as lung function, and obviously, blood ketones, and blood glucose levels. I started seeing a correlation between my lung function, and my blood glucose and low ketone level. The higher my ketones were, the lower my blood glucose was, the higher my lung function was. That's been the norm since I've been doing this strategy, is that when I'm in a state of ketosis, my lung function is significantly better, than when it hasn't. That is how I've got to this stage now, and people say to me, "When are you gonna get off this diet," and I say, well, I won't be. This is just the way I eat. Do I stay on a ketogenic diet seven days a week? No. I believe it's important to cycle in, especially extra carbs in the form of vegetables. I enjoy a glass of great wine, which no longer kicks me out of ketosis. That's the other thing I've found along the way is, that when you spend so much time in ketosis, your body then comes more, I guess, relaxed to what you can eat. I find that I can eat more carbohydrates, and it not throw me out of ketosis.

Geoff: Right.

Russell: Which, I think is just an adaptation. We hear people talking about metabolic flexibility, and be able to burn both fuels. I know, that's where I am at the moment.

Geoff: I think your muscles are just up taking glucose, and sucking that in really quick, and then you're still keto adapted. You're converting fat into ketones. I think that does seem to be the experience with people that are essentially keto adapted, absolutely. I think, the interesting thing is that most people think that a ketogenic diet can just be a fad. But, I think people fail to realize that it's actually sustainable as a lifestyle. You're basically living ketogenic, and then cycling in as an occasion, versus the vise versa, right? I think most people think of, oh, I'll eat ketogenic for a meal or something, but that doesn't even make any sense. It's very much like flipping the script against standard Western diet.

Russell: It is without a doubt, and for me, I incorporate other strategies, like intermittent fasting as well. What happened to me last year is, after the marathon I went on a holiday, and we did a river cruise through Europe. On the second week of the cruise, the whole ship got the flu, basically. I got quite sick, to the point where I was concerned that I actually, I was not going to wake up one morning. My disease, I had a massive exacerbation, I couldn't breathe. I was stuck in my room, I was on oxygen, I just had to let the medication take effect. That resulted in me having four months off work, because I got so sick.

Geoff: Wow.

Russell: I was in the cycle of using antibiotics, and steroids, in the form of Prednisone, to try and open up my airways to get rid of the infection, and it wasn't working. I was just keep going through the cycle. At that time, I hear from Dr. Walter about the effects of a long fast, and regeneration of your immune system. I thought, you know what, I'm gonna do this and see if it makes any difference to me. I did a five day fast of water and bone broth. After the fast, I didn't have any antibiotics, or any steroids. In fact, three weeks after the fast, I went back to work. Now, I'm not going to sit here and advocate that patients should do that. I did it, and I believe it changed something inside of me. It resulted in me getting better. I can't speak about the mechanisms of how that may work, because I'm not a scientist. That was my experience. From pretty early on, I basically used a time restricted feeding, so 16, 8 is pretty much my protocol. One day a week, I'll fast for 24 hours. But, I just find eating like that, and when I'm in a fasting state, my breathing is a lot better, and obviously, that's getting my ketone levels a lot higher.

Geoff: Yeah, it makes sense. I think all these trends run intermittent fasting, extended fasting, ketogenic diet, and now exogenous ketones, like ketone ester, I think just all implicate that the ketone body Beta-Hydroxybutyrate is such an important [inaudible 00:38:50] molecule. I think one exciting aspect is the NRLP3 inflammasome path, really mitigating inflammation. I think that has interesting applications, not only for lung disease, but neurological conditions, just general muscle recovery, which is pretty exciting. My sense, as we're in this space, is that you just attack this end point with all the different strategies, and I think that's exactly what you're doing. You have your timer defeating strategy, then you eat fairly keto on a regular basis, and then you supplement here and there with exogenous ketones. That will maintain a fairly high ketonic range for you, basically, throughout your entire day.

Russell: Look, definitely. As you know, I used the ester in the Boston Marathon. The day didn't go according to play, because of the weather conditions, but I was able to do some testing the day before. What was interesting is, when I woke up, I didn't take my normal medication. I took the ester, and then I measured my lung function over the course of about three hours. What I found is, as my ketone levels went up, my lung function improved as well.

Geoff: Like linearly, essentially.

Russell: Yeah.

Geoff: Okay, and what percent to what percent.

Russell: Not a lot, well, when I say not a lot, about 18% improvement in my lung function, which I wasn't expecting, to tell you the truth. Because, I thought it would take longer.

Geoff: Right.

Russell: And, more dose to see a rise like that. But, what was interesting was, as my ketone levels rose, and got up to a peak of 4.2 millimolar, my blood glucose come down. For respiratory patients, that's beneficial in two ways. I think our blood glucose having spikes, and that drives a lot of inflammation in our body. But, the ketones have the ability to suppress it as well. I did that the day before. The day of the marathon, I took the ester does about half an hour before the start of the race. I do feel, although I couldn't measure anything on the day, because of the weather, which was disappointing, I could feel my airways opening up. I guess it's a hard thing to describe, but to noticeably feel like you're breathing easier, is quite amazing when you're not taking medication to do it.

Geoff: Right.

Russell: Now, I'm not for one minute suggesting that patients should stop taking medication, and I certainly won't. But, what I think I'm finding is that, either the ester enhances the medication, or the medication enhances the ester. I'm not sure, but when I measure my lung function using both the ester and medication, that's when the magic happens. That's when I see a significant increase in my lung function.

Geoff: What's the percentage there?

Russell: My best is about 48% increase improvement.

Geoff: Wow.

Russell: That's massive.

Geoff: Yeah.

Russell: If you can say to any respiratory patient that, hey, through your diet, or through supplementation, we can potentially give you an increase in getting your lung function, well, they're gonna jump at it.

Geoff: Yeah, yeah.

Russell: Why wouldn't you? I didn't set any records the day of the Boston Marathon, but it wasn't a day about setting records. For a respiratory patient whose triggers are rain, cold weather, wind, and smoke, we've had rain that was sideways. It was torrential. We had 30 mile per hour wind. You just know at the start line, and then because it was so cold, a lot of the houses were burning timber for their heating. That smoke was affecting my lungs as well. I had all these things to contend with. Plus, I knew I had to keep dry. I was wearing four layers of clothing, so if you imagine trying to run with four layers of clothing, it's pretty difficult. My strategy to start the race was just to finish the race, and I did that. I will say, I hope no one ever had to run the Boston Marathon in those conditions again, because everyone I spoke to said it was jus appalling, and it was.

Geoff: I can imagine, four layers of clothes, they're probably sopping wet. You're carrying an extra 10 pounds of just water there. Congratulations on finishing. I remember, in the office, we knew that you were gonna test human ketone with the ester in the race. We were looking at the weather reports, and like, ooh, we hope that Russell's gonna be okay, because it looked terrible out there, in terms of the weather. But, glad you were able to power through that. But, about the lung capacity function, is that new science? Has anyone studied that in the clinic?

Russell: No, it's, unfortunately, with respiratory disease, we don't, we miss out on funding. To give you an example of how much we miss out, in 2015, 150 thousand people died of COPD in the United States, third leading cause of death. On the NRH funding, we were 150th. We receive no funding, so studies for this sort of-

Geoff: Why, why?

Russell: It's a stigma associated with the disease has a lot to do with it. An example of that is something that I and other patients get. When someone asks us, "What's your disease," we say, it's COPD, and they go, "Oh, that's a smoker's disease. You deserve it." That's the mentality, you deserve the disease. But, my answer to them is, okay, if you're type two diabetic, do you deserve it, because you've eaten the wrong sort of food for your entire life?

Geoff: That's a good comparison.

Russell: The fact is, anyone who says, I haven't made a poor lifestyle choice, well, they're lying, because we all do it. Some of us dodge a bullet, and some of us don't. I make no excuses that I did the wrong thing. I was a smoker. Back when I started smoking, there wasn't a huge amount of information about it. We knew that it probably wasn't the greatest thing in the world. But, nowadays, there's a lot of information about smoking, about diet, and what's good for you, and what's not. It still probably doesn't make it any easier for people to avoid the pitfalls of what makes you eat bad foods, or what makes you smoke cigarettes. A lot of that can come down to stressors in your life, and different environment. To turn around and say to someone, you deserve your disease is, wrong. But, we get it. The problem is, it affects the amount of funding we get. For our disease, we haven't seen an actual change in our medications, as far as the type of medications, in 20 years. We see different ways of delivering medication, but no new advances in medication. I've spoken to a number of researchers who are so frustrated with this. But, they say, "Our hands are tied, because there's only so much money to go around that we can actually do research."

Geoff: That's a shame.

Russell: It is, but to me, this is part of my journey is, that if I can show people strategies that I use that work, then maybe other people will try it. I know, from the experience and the feedback I get from people via Facebook, and via my website, patients have tried, and are doing this strategy, and they're noticing a difference in their quality of life. To me, managing type two diabetes has become this huge push, because they evidence there, you can reverse it through diet. COPD, we can't reverse it. But, what we can do is, improve our quality of [crosstalk 00:46:26].

Geoff: You can manage it, yeah.

Russell: That's all we want as patients. We just want to have an improved quality of life. If this a way forward, then well and good. I do have researchers who are interested in studying what I'm doing, and I'll hopefully, next time I'm back in the US. We're actually gonna line up some studies, and some tests in a lab, so we can measure what's happening with me in a controlled environment.

Geoff: Yeah, you would expect that, if you can acutely change lung function, lung capacity, and directly correlate it to ketone levels, that seems to be an important result. That's an interesting phenomenon with human physiology that should be published and incited. Right? It's just, like [inaudible 00:47:11] is so fundamental, it's a life, and we have a direct lever on that. For the researchers out there who want to have a peer reviewed published paper, that we have Russ here basically serving up as N=1 proving some sort of signal here. It seems like an easy paper, and an easy research paper project to run and publish.

Russell: Look, I do too. As you know, I have my own podcast series, and I have Dr. Stephen Finney on there last year. Now, he wants to use a ketogenic diet to treat respiratory patients when he was practicing in a hospital environment, and this has been years ago. He said to me, he has no understanding of why doctors aren't using this strategy, because he was able to show how it worked. He was able to get patients who were on respirators off respirators. Now, generally, when patients are on respirators, it's a downhill slide.

Geoff: Yeah.

Russell: But, he was able to get patients off respirators. Now, surely that must ignite some sort of thought in researchers and doctors. What we're doing is not working, here's a strategy that not only is Russell Winwood doing, and it's working for him, but other doctors have tried. There are studies supporting this sort of practice, so why aren't we doing it?

Geoff: Right. I think that's a broader question. Maybe you can touch upon that here. It just seems to be in the current medical establishment, there is a bias towards pharmaceutical intervention, that seems like nutritional interventions. It gives you a diet, or fasting, or more dismissed. They seem less robust, but it seems like, obviously, in your specific case, and published, and it sounds like in clinical research, over the last, but forgotten research 20, 30 years ago, that these nutritional interventions worked just as, if not better than some of the pharmaceutical alternatives. Is this a cultural problem, is this an incentives problem, because doctors don't get paid, insurance companies don't pay for nutrition, they only pay for drugs? What do you see from your perspective as a patient is wrong with the system?

Russell: I think that there's a few things wrong, and don't get me wrong. I am a staunch advocate of taking your medication as a rescue.

Geoff: Agreed, yeah.

Russell: However, in saying that, I did a podcast with one of the leading respiratory researchers in the world, and had been for the last 20 years. He said, his fear is that, a certain medication that is prescribed for COPD patients, is corticosteroid, is not actually any good for COPD patients. It's good for asthma patients. He said, problem is, is that pharmaceutical see the money in promoting these sort medications, and just recently I've come across another pharmaceutical company who are launching a brand new medication that has this corticosteroid in it, that has been proven not to work for COPD patients, in asthma patients, and patients who have asthma and COPD, yes it has some benefits.

For me, what's happening at the moment is that pharmaceuticals are dictating treatment, not doctors. I think that's a big mistake. I know in our own respiratory world here in Australia, now patients don't have a very loud voice. I've been to a number of respiratory conferences where you don't hear from patients. All you hear is from researchers saying, sadly, a lot of these researchers, their only source of funding is from pharmaceutical companies. I wonder whether their direction is painted for them before they even start. I've talked to people who have other diseases, and go to other conferences, and they hear from patients, what patients want, and their experiences, and that sort of thing. That's meaningful information.

In my recent visit to the states, I talked to a couple of companies who invited me there to talk about patients needs for devices, because they're not in touch with patients. They're actively seeking patients inputs into improving devices. I think, there needs to be a change or a shift in how pharmaceutical companies pursue research, and there needs to be more patient involvement with what the patient needs. Science is good, and we should always follow the science. But, listening to patients, and patient experience is just as important. There's a lot of work to be done in respiratory world, and there's a lot of work to be done in, I think, realigning priorities with pharmaceutical companies, researchers, and physicians, so we're all going in the same direction.

Geoff: Absolutely. I think that you put it really well there. As we wrap up here, what's next for you? I know that we're sending you a special shipment of ketone ester to Australia. But, what's next? Other big events, big Iron Mans, big marathons that you have planned for this year? Any other COPD advocate programs you're working on? What can we shout out here?

Russell: Even wise, in eight weeks time, I'm doing our home marathon, which is the Gold Coast Marathon. Hopefully, we're going to have lovely prime weather, and I'm gonna be powered by the human [crosstalk 00:52:30]. Hopefully we'll get some nice, some good data for that, that can show what I'm talking about. Moving forward, I've got six marathons around the world I want to complete. Three are done, now, so New York, London, and Boston. I've still got Tokyo, Chicago, and Berlin to go. In 2020, we're actually looking at doing Race Across America, so the cycle race, team of eight. I'll be the first patient ever to do the race, and I'll have to use oxygen to get myself through the race as well. A whole new learning experience for me, as far as riding 3000 miles on a bike, and using oxygen. We're starting to organize that now.

As far as patient work, I do a lot of advocacy work. One thing that I've just started in, in the last four or five months, is working for an organization, and we're rolling out a wellness program. The wellness program pretty much mimics how I live my life. It's through diet, and actual the nutritional plan in the wellness program has been designed by Dominic D'Agostino. He's had a quite a bit of input into this, and I would say to respiratory patients who are interested in following my plan, this plan is actually, has the help of dieticians, there's support, and there is a cost, of course. But, I think, from my point of view, and my experience, it's well worth it.

The company who I'm working with is called the Lung Health Institute, so as I've said, they're rolling out a wellness program that is specifically designed for COPD patients. If a patient is interested in that, they just have to Google the Lung Health Institute, and they'll find all the information they need. I wouldn't advocate this if I didn't believe in it. I don't advocate anything I don't strongly believe in. Over the last two years, I've seen what a difference nutritional strategies can make. To me, I'm now getting to, what you might call, a cutting edge, and what is the perfect plan for a COPD patient.

I look at the product you guys are putting out there, and think to myself, obviously, over time it's going to become less inhibited as far as price is concerned. If we could get to a stage where a COPD patient could take two or three doses of that ester a day, I think that's gonna make huge difference to their quality of life. In conjunction with their medication, and still having a healthy diet, limiting their carbohydrate intake. All these things are what I call extra tools that patients can have in their toolbox, and they're useful strategies, and they work.

Geoff: Russell, you're an inspiration. Thanks so much for taking the time.

Russell: It's been my pleasure, Geoff, thank you.

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