AMA with Dom D'Agostino, Ph.D., Part II of II: Ketosis for cancer and chronic disease, hyperbaric oxygen therapy, and the effect of ketosis on female health

**Peter Attia** (0:11)
Hey, everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Hey everyone, welcome to part two in our AMA series with Dom D'Agostino.
As a reminder, you'll note that this interview had been scheduled for a very long time. And just when it was about to happen, I had to go to Mars on a spaceship that did not contain a Zoom setup, and I was unable to be a part of it. But both Dom and Bob Kaplan, my head of research, graciously agreed to do it in my absence. And so you will once again be graced by the presence of Bob and Dom speaking, instead of having to listen to me.
In this second episode, Bob and Dom dive deep again, this time really focusing on the effects of ketosis on various chronic diseases. Dom's work with hyperbaric oxygen therapy and its numerous applications, as long as the applications of ketosis on female health and performance. This is a topic that I know very little about outside of some reproduction. And also it's something that many of you have been asking about. And frankly, there's just not enough information out there on such topics. Dom is an associate professor at the University of South Florida, where he teaches at the College of Medicine and in the Department of Molecular Pharmacology, Physiology. He focuses on neuropharmacology, medical biochemistry, physiology, neuroscience, and neuropharmacology. He's also a research scientist at the Institute for Human and Machine Cognition to assist with their efforts towards optimizing the safety, health, and resilience of warfighters and astronauts.
Lastly, it's important to note that while Dom is answering specific questions and scenarios, he is not giving medical advice. Everything in this podcast is for general informational purposes only and does not constitute the practice of medicine, including the giving of medical advice. So without further delay, please enjoy part two of the AMA with Dom D'Agostino.

**Bob Kaplan** (2:27)
So we're going to switch gears to ketosis and disease.
And the first up is cancer and a lot of questions around updates on press-pulse therapy. Since a couple of years ago when you're on the podcast, you mentioned the press-pulse and the paper that you did with Tom Seyfried. Talk about that a little bit.

**Dom D'Agostino** (2:46)
I have to say I was not formally trained as a cancer biologist or cancer researcher. It just sort of fell in my lap, so to speak, I guess around 2010 And I think maybe I went into that on the first podcast.
And I have to say I've been extremely lucky to have brilliant students come into my lab. And that has made all the difference in the world. Because the other PIs or professors, they just get students then. And they're just kind of stuck with them for five years. But I've got the upper echelons, like the top of the top students in the program I always have. And not only are they brilliant, they just have a genuine interest in this topic. So they were able to basically be the engines behind a lot of the research that we did. That started laying the groundwork, I think, or the groundwork was already sort of laid because people were already doing ketogenic diet studies, like Tom Staford, who's been on the podcast before. But we sort of picked it up and took it in other directions. And we kind of worked on that Press-pulse review that sort of encompasses this idea using, I guess, what you would call ketone metabolic therapy or therapeutic ketosis and other modalities to compromise tumor growth and proliferation. And that weakens the tumor, and if we're talking about a solid tumor, to be more amenable to other modalities, which could be the one thing that we experimented on years ago. One of the first papers we put out was the ketogenic diet and hyperbaric oxygen therapy.
And there are a number of reasons why they are synergistic. So being in a state of therapeutic ketosis suppresses insulin signaling, which drives PI3 kinase. It lowers glucose availability to the tumor. It elevates ketone bodies, which as an alternative fuel, cannot be readily utilized by cancers. Most cancers as a source of fuel, perhaps anabolic processes, but they are not a good fuel source for cancer cells, most cancer cells. And they also do things like they impair antioxidant pathways that the tumor is used to defend itself. And a tumor is resilient because it has upregulated endogenous antioxidant pathways. By high levels of glutathione. So the pentose phosphate pathway, for example, generates more glutathione in cancer cells.