Ketogenic diet, ketosis & hyperbaric oxygen: metabolic therapies for weight loss, cognition, Alzheimer's & more | Dom D'Agostino, Ph.D.
Peter Attia
Dec 8, 2025
Mindsip insights from this episode:
Utilize fasting strategically for cognitive demand and inflammation management
Fasting is best used situationally as a tool for periods of high cognitive demand or to manage inflammation, rather than as a daily default practice.
Choose "Keto Start" for balanced ketones and electrolytes
Dom recommends the product "Keto Start" by Audacious Nutrition, which is a racemic (D and L) ketone salt that provides both ketones and electrolytes without a large sodium chloride load.
Monitor ketone ester intake to prevent insulin spikes
Unlike ketone salts, ketone esters can cause an insulin spike if they raise blood ketones too rapidly above 1.5-2.0 millimolar, which can lead to a subsequent crash in both glucose and ketones.
Differentiate sodium chloride from other sodium salts for health benefits
The hypertensive (blood pressure raising) effect of salt is specific to sodium chloride, and does not apply to other sodium salts like sodium beta-hydroxybutyrate found in ketone supplements.
Leverage racemic ketones for energy and anti-inflammatory benefits
Racemic (D and L) ketone supplements are beneficial because the D-form provides rapid energy while the slower-metabolizing L-form acts as a persistent anti-inflammatory signaling molecule.
Determine effectiveness of hyperbaric oxygen therapy for PTSD and TBI
A major $30 million Department of Defense clinical trial is underway using a proper sham control to definitively determine if hyperbaric oxygen therapy is effective for PTSD and TBI.
Utilize carnivore diet as therapeutic elimination strategy
The carnivore diet is best viewed as the ultimate elimination diet and can be highly therapeutic for certain people with autoimmune disorders.
Set protein target at 1g per pound for high-protein keto success
A high-protein ketogenic diet can be 20-30% protein, with a personal target of one gram per pound of body weight to maintain muscle mass, far exceeding RDA guidelines.
Avoid excessive ketone levels to prevent energy toxicity
Pushing supplemental ketone levels too high (above 2-3 millimolar) can be problematic and lead to "energy toxicity," causing counter-regulatory reactions like insulin release and acidic stress.
More from
Peter Attia
The evolutionary biology of testosterone: how it shapes male development and sex-based behavioral differences, | Carole Hooven, Ph.D.
The impact of gratitude, serving others, embracing mortality, and living intentionally | Walter Green (#288 rebroadcast)
Thyroid function and hypothyroidism: why current diagnosis and treatment fall short for many, and how new approaches are transforming care | Antonio Bianco, M.D., Ph.D.
AMA #77: Dietary fiber and health outcomes: real benefits, overhyped claims, and practical applications
Women's sexual health: desire, arousal, and orgasms, navigating perimenopause, and enhancing satisfaction | Sally Greenwald, M.D., M.P.H.











