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

Peter Attia

8 dic 2025

Episode description

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Dom D'Agostino is a neuroscientist and professor at the forefront of metabolic therapies, including ketogenic diets, exogenous ketones, and hyperbaric oxygen. In this episode, Dom breaks down nutritional versus supplemental ketosis, defines meaningful ketone thresholds, and outlines practical ways to achieve ketosis. He explains how a ketogenic diet can support metabolic health and weight loss, and advises on how to maintain adequate protein and avoid common mistakes. Dom surveys the growing landscape of exogenous ketones—from salts and esters to 1,3-butanediol—and effective pairings like caffeine, MCT oil, and alpha-GPC. He highlights the role of ketogenic therapy in cancer (particularly glioblastoma) and its promise for neurodegenerative diseases. The conversation also covers recommended hyperbaric oxygen protocols for brain injuries and cognitive function, situations where fasting or ketones offer cognitive and anti-inflammatory benefits, and touches on the carnivore diet as a ketogenic variant with potential relevance for autoimmune and metabolic conditions.

We discuss:

  • Dom and Peter's shared interest in ketosis, and Dom's scientific journey [2:30];

  • Dom's work for the Navy on oxygen toxicity [7:00];

  • Nutritional ketosis defined: physiology, biomarkers, and how fasting and diet generate therapeutic ketones [15:00];

  • The historical roots of ketogenic diets in epilepsy treatment, and evidence showing ketones reduce seizure activity and strengthen brain resilience [19:00];

  • Dom's personal experience on the ketogenic diet: tracking macros, getting enough protein, and monitoring ketone levels [24:15];

  • Using a ketogenic diet for weight loss: Dom's guidance on protein, fiber, calorie tracking, lipid monitoring, and more [31:00];

  • Protein on ketogenic diets: Dom's rationale for higher intake and muscle preservation [38:00];

  • Incorporating carbohydrates into keto: timing, high-fiber foods, and other considerations [41:30];

  • The carnivore diet: whether this diet induces ketosis, how it functions metabolically, and why it may help individuals with autoimmune conditions [44:15];

  • Early exogenous ketones: how 1,3-butanediol works, its liver toxicity risk, and wh

Episode description

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter's Weekly Newsletter

Dom D'Agostino is a neuroscientist and professor at the forefront of metabolic therapies, including ketogenic diets, exogenous ketones, and hyperbaric oxygen. In this episode, Dom breaks down nutritional versus supplemental ketosis, defines meaningful ketone thresholds, and outlines practical ways to achieve ketosis. He explains how a ketogenic diet can support metabolic health and weight loss, and advises on how to maintain adequate protein and avoid common mistakes. Dom surveys the growing landscape of exogenous ketones—from salts and esters to 1,3-butanediol—and effective pairings like caffeine, MCT oil, and alpha-GPC. He highlights the role of ketogenic therapy in cancer (particularly glioblastoma) and its promise for neurodegenerative diseases. The conversation also covers recommended hyperbaric oxygen protocols for brain injuries and cognitive function, situations where fasting or ketones offer cognitive and anti-inflammatory benefits, and touches on the carnivore diet as a ketogenic variant with potential relevance for autoimmune and metabolic conditions.

We discuss:

  • Dom and Peter's shared interest in ketosis, and Dom's scientific journey [2:30];

  • Dom's work for the Navy on oxygen toxicity [7:00];

  • Nutritional ketosis defined: physiology, biomarkers, and how fasting and diet generate therapeutic ketones [15:00];

  • The historical roots of ketogenic diets in epilepsy treatment, and evidence showing ketones reduce seizure activity and strengthen brain resilience [19:00];

  • Dom's personal experience on the ketogenic diet: tracking macros, getting enough protein, and monitoring ketone levels [24:15];

  • Using a ketogenic diet for weight loss: Dom's guidance on protein, fiber, calorie tracking, lipid monitoring, and more [31:00];

  • Protein on ketogenic diets: Dom's rationale for higher intake and muscle preservation [38:00];

  • Incorporating carbohydrates into keto: timing, high-fiber foods, and other considerations [41:30];

  • The carnivore diet: whether this diet induces ketosis, how it functions metabolically, and why it may help individuals with autoimmune conditions [44:15];

  • Early exogenous ketones: how 1,3-butanediol works, its liver toxicity risk, and wh

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.

DESCARGA LA APLICACIÓN

Descubre la sabiduría de la longevidad

DESCARGA LA APLICACIÓN

Descubre la sabiduría de la longevidad

DESCARGA LA APLICACIÓN

Descubre la sabiduría de la longevidad