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

Podcast: The Peter Attia Drive

Published: 2025-12-08

Duration: 2 hr 8 min

Summary

In this episode, Peter Attia talks with neuroscientist Dom D'Agostino about the benefits of ketogenic diets and hyperbaric oxygen therapy as metabolic therapies for various health conditions, including weight loss and neurodegenerative diseases. They explore the science behind ketosis and its applications in cancer treatment and cognitive health.

What Happened

Peter Attia welcomes Dom D'Agostino, a leading neuroscientist focusing on metabolic therapies like ketogenic diets and hyperbaric oxygen. Attia emphasizes the importance of making longevity science accessible, and they dive into the nuances of nutritional versus supplemental ketosis. D'Agostino shares insights on the challenges of transitioning to a ketogenic diet and the importance of maintaining adequate protein levels, alongside discussing exogenous ketones and their potential effects on metabolism.

The conversation then shifts towards the role of ketogenic diets in treating serious conditions such as glioblastoma and neurodegenerative diseases like Alzheimer’s. D'Agostino provides a background on his research journey, including his early work funded by the Department of Defense and his pivot from neuroscience to studying the ketogenic diet for seizure disorders and cancer. They also touch on hyperbaric oxygen therapy, explaining how it works in military applications and its potential therapeutic benefits.

Key Insights

• The ketogenic diet can be an effective metabolic therapy for various health conditions, including cancer and neurodegenerative diseases.
• Exogenous ketones, particularly salts and esters, play a significant role in achieving and maintaining ketosis.
• Transitioning to a ketogenic diet can be challenging but is manageable with proper understanding and preparation.
• Hyperbaric oxygen therapy has FDA-approved applications and can be utilized in different medical contexts, including military diving.

Key Questions Answered

What are the benefits of a ketogenic diet?

In this episode, Dom D'Agostino discusses how the ketogenic diet serves as a metabolic therapy for various health issues, particularly glioblastoma and neurodegenerative diseases like Alzheimer's. The diet works by shifting the body's primary energy source from carbohydrates to fats, which can lead to weight loss and improved cognitive function. D'Agostino emphasizes that a well-formulated ketogenic diet can be beneficial when drugs fail for certain seizure disorders.

How do exogenous ketones work?

D'Agostino explains that exogenous ketones can enhance ketosis beyond what dietary changes alone might achieve. He differentiates between various forms of exogenous ketones, such as ketone salts and esters, and discusses their effects on insulin and metabolism. He also highlights effective pairings like caffeine, MCT oil, and alpha-GPC that can optimize the benefits of exogenous ketones.

What challenges are associated with starting a ketogenic diet?

Transitioning to a ketogenic diet can present challenges, particularly in the beginning. D'Agostino notes that individuals may struggle with adapting their metabolism to utilize fats instead of carbohydrates for energy. It's essential to maintain adequate protein levels during this transition to support muscle mass and overall health. Understanding these challenges can help individuals navigate the initial phases of adopting a ketogenic lifestyle.

What is hyperbaric oxygen therapy?

Hyperbaric oxygen therapy involves breathing 100% oxygen in a controlled environment, typically at pressures greater than atmospheric pressure. D'Agostino explains its applications, especially in military contexts where divers use closed-circuit rebreathers to avoid nitrogen narcosis. He notes that this therapy has FDA-approved uses for various medical conditions and explores its potential therapeutic benefits beyond traditional treatments.

How has Dom D'Agostino's research evolved?

D'Agostino shares his journey from studying neuroscience and autonomic regulation to focusing on the ketogenic diet and its effects on health. Initially interested in drugs, he pivoted to nutrition due to the ketogenic diet's success in treating seizure disorders. His research has also expanded to include cancer studies, where he observed unique mitochondrial behavior in cancer cells, prompting further investigation into metabolic therapies.