Ketogenic diet, ketosis & hyperbaric oxygen: metabolic therapies for weight loss, cognition, Alzheimer's & more | Dom D'Agostino, Ph.D.

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Dom D'Agostino. Dom is a neuroscientist and professor at the forefront of metabolic therapies including ketogenic strategies, exogenous ketones and hyperbaric oxygen. In this episode, we discuss nutritional versus supplemental ketosis, clear definitions, thresholds for clinical ketosis and practical ways to achieve it while keeping protein adequate. Why the early transition into a ketogenic diet can be challenging and how electrolytes and ketone salts can smooth that on ramp. The growing landscape of exogenous ketones, the salts versus the esters, 1,3-butanediol, taste and insulin effects, and simple effective pairings such as caffeine, MCT and alpha GPC. Ketogenic diets as metabolic therapy for cancer, especially glioblastoma. The prospects for ketogenic diets in neurodegenerative diseases, including dementia and Alzheimer's disease specifically. Hyperbaric oxygen chambers, Dom's recommended protocols, practical barriers and the rigor of ongoing trials. When fasting and ketones shine as a situational tool for cognition, workload, travel and inflammation. And the carnivore diet as a ketogenic variant and what it implies for certain autoimmune and metabolic conditions. So without further delay, please enjoy my conversation with Dom D'Agostino.
Hey Dom, thank you for making the trip out to Austin. And it's, boy, it has been a long time since we've been in person. I'm afraid to hazard a guess as to when, but I know you and my brother see each other a lot more, and I'm always getting pictures of you visiting him and him visiting you.

**Dom D'Agostino** (2:43)
Yeah, Paul's amazing. He's a mentor to me and as you are through the health, and Paul's like an amazing entrepreneurial mentor and a life mentor in many different ways. So great to see you both. You guys are such uber high achievers in different domains, and I think it's great to see you in person for one thing, but it's great to see both of you thrive in doing what you do.

**Peter Attia** (3:04)
Well, the same can be said for you. Dom, you've been on the podcast a couple of times, but I know that in podcast land, A, we've probably got hundreds of thousands of listeners today that weren't listeners the first and second time you were on the podcast. Frankly, those that were, I think it would be understandable that they've forgotten most of what we've spoken about. Maybe just by way of background, I'll let folks understand how you and I connected. I believe Ken Ford connected us back in 2011-ish, thereabouts. At the time, I was about a year into experimenting with a ketogenic diet, having all sorts of interesting success with it for the most part, once I got over the hump of figuring out how to do it. I think we must have connected at his institute and then the rest is history. We then, through our friendship, became very deeply involved in the testing of the earliest generations of various forms of synthetic ketones. It's a topic we will undoubtedly get to today because it's impossible to imagine how much proliferation there has been of these things that were, I mean, literally, you're sending me dirty plastic bottles with stuff in my kitchen that I'm experimenting with and it's like, now look at what you've done. So maybe let's just talk a little bit about how your interest in this space came to be. So even for my recollection, I don't recall your PhD was in neuroscience, if I'm not mistaken.

**Dom D'Agostino** (4:24)
Yeah, nutrition and then at the time, studying nutrition and biology, I started doing a undergraduate thesis project in neuroscience and the neural control of autonomic regulation. So specifically the brain network, the rostral ventral lateral medulla. So they are the brain stem network that controls respiration. So inspiratory neurons, expiratory neurons and how they respond to oxygen and CO2. And that led me down the path of oxygen, hypoxia, hyperoxia, hypercapnia, extreme environments. What happens to the brain under oxygen deprivation and nutrient deprivation? At the time, I was interested in alpha-L polylactate because it was in Cytomax, which was something I used because I raced mountain bikes. I was testing some things, lactate, and then I got steered onto the ketogenic diet. After getting a fellowship, a postdoctoral fellowship by the Office of Navy Research, which is part of the Department of Defense, to understand the cellular and molecular mechanisms of central nervous system oxygen toxicity, which manifests as seizures. So I was mostly interested in drugs, but then I pivoted and went back to the ketogenic diet because the ketogenic diet works for many different seizure disorders when drugs fail. So I was like, oh, I can get nutrition back. Although I was gravitating towards a tenure track position and everybody told me this is like the dumbest thing to do. You can't get NIH funding with ketogenic. Nobody heard of the ketogenic diet.