<p><a href="https://peterattiamd.com/domdagostino2/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=251208-pod-domdagostino2&utm_content=251208-pod-domdagostino2-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&domdagostino2%20=referral&utm_campaign=251208-pod-domdagostino2&utm_content=251208-pod-domdagostino2-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=251208-pod-domdagostino2&utm_content=251208-pod-domdagostino2-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>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.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Dom and Peter's shared interest in ketosis, and Dom's scientific journey [2:30];</li> <li>Dom's work for the Navy on oxygen toxicity [7:00];</li> <li>Nutritional ketosis defined: physiology, biomarkers, and how fasting and diet generate therapeutic ketones [15:00];</li> <li>The historical roots of ketogenic diets in epilepsy treatment, and evidence showing ketones reduce seizure activity and strengthen brain resilience [19:00];</li> <li>Dom's personal experience on the ketogenic diet: tracking macros, getting enough protein, and monitoring ketone levels [24:15];</li> <li>Using a ketogenic diet for weight loss: Dom's guidance on protein, fiber, calorie tracking, lipid monitoring, and more [31:00];</li> <li>Protein on ketogenic diets: Dom's rationale for higher intake and muscle preservation [38:00];</li> <li>Incorporating carbohydrates into keto: timing, high-fiber foods, and other considerations [41:30];</li> <li>The carnivore diet: whether this diet induces ketosis, how it functions metabolically, and why it may help individuals with autoimmune conditions [44:15];</li> <li>Early exogenous ketones: how 1,3-butanediol works, its liver toxicity risk, and why ketone esters replaced it [48:15];</li> <li>The progression of exogenous ketones: why BHB monoesters and ketone salts emerged as better alternatives to 1,3-butanediol for ketone supplementation [59:30];</li> <li>Ketone salts: easing the transition into ketosis, dosing, and how they compare to ketone esters [1:04:00];</li> <li>The differences between D- and L-β-hydroxybutyrate, and how racemic mixtures may elevate ketones longer and offer unique biological effects [1:09:30];</li> <li>How ketosis may boost NAD, and why NAD supplements have fallen short so far [1:16:30];</li> <li>Emerging evidence for using a ketogenic diet to treat anorexia and other psychiatric disorders [1:20:30];</li> <li>Potential cognitive and performance benefits of ketone supplementation, and why pushing ketones too high can be dangerous [1:23:45];</li> <li>Applications for ketone esters, and why ketone salts or MCT-blended formulations may be safer and more practical for most people [1:29:15];</li> <li>The role of a ketogenic diet in treating cancer [1:34:45];</li> <li>The potential of a ketogenic diet for treating Alzheimer's disease [1:45:45];</li> <li>Tools for cognitive enhancement: ketones, alpha-GPC, MCT, caffeine, strategic fasting, and more [1:53:45];</li> <li>Hyperbaric oxygen therapy for concussion, TBI, PTSD, and cognitive function, including protocols and dosing approaches [1:55:30];</li> <li>Peter's takeaways, recommended products, and additional resources to learn more [2:03:00]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Prioritize Protein Intake
Ensure adequate protein intake on a ketogenic diet, especially if active or aiming for muscle gain, potentially doubling the recommended daily allowance. This prevents muscle loss and supports higher protein turnover.
2. Track Diet & Biomarkers
Track total calorie intake, macronutrient ratios, and blood ketone levels (or urine/breath) to correlate diet with physiological state. Additionally, regularly monitor lipids (triglycerides, HDL, ApoB, LDL), hemoglobin A1C, and insulin levels to assess metabolic health and manage potential adverse effects.
3. Mitigate Keto Flu with Electrolytes
Use ketone electrolytes (e.g., KetoStart) when initiating a ketogenic diet to replenish sodium and other electrolytes. This helps mitigate ‘keto flu’ symptoms, brain fog, and plasma volume contraction caused by the diet’s natriuretic and diuretic effects.
4. Gradual Keto Diet Transition
Transition to a ketogenic diet gradually over four to six weeks rather than abruptly. This approach improves adherence and can lead to more favorable health responses, potentially avoiding negative blood work or electrolyte issues.
5. High-Fiber Carb Choices
When consuming carbohydrates on a ketogenic diet, prioritize high-fiber sources like berries, broccoli, asparagus, and dark chocolate. Fiber helps prevent glycemic spikes and supports ketosis.
6. Situational Fasting Strategy
Employ fasting situationally for specific benefits rather than as a daily default. It can be particularly effective for managing inflammation events (e.g., shingles, GI issues), enhancing cognitive sharpness during demanding work, or adapting to travel.
7. Consider Carnivore for Autoimmune
For individuals with autoimmune disorders, consider a carnivore diet as an ultimate elimination diet. If following, ensure nose-to-tail eating to cover micronutrient needs (e.g., Vitamin C from liver) and consider magnesium supplementation.
8. Target GKI for Cancer Therapy
For metabolic therapy in cancer (e.g., glioblastoma), aim to achieve and maintain a Glucose Ketone Index (GKI) of 1 to 4. This GKI range sets the stage for other modalities to work by creating an energy crisis in cancer cells.
9. Ketone Salts for Supplementation
Prefer ketone salts (e.g., KetoStart by Audacious Nutrition) for exogenous ketone supplementation over ketone esters or 1,3-butanediol. Ketone salts do not cause an insulin spike, are generally safer as natural buffers, and provide sustained ketone delivery, especially when combined with MCT.
10. Optimal Exogenous Ketone Levels
When using exogenous ketones, aim to elevate blood beta-hydroxybutyrate levels to a ‘sweet spot’ of one to two millimolar. This range provides a significant increase in brain energy without risking energy toxicity or triggering counter-regulatory insulin responses.
11. Cognitive Enhancement Stack
For cognitive enhancement and sustained focus, consider a combination of alpha-GPC, MCT, caffeine, and theanine (e.g., in a product like Ketobrain). This stack provides energy, focus, and a calming effect for demanding cognitive tasks.
12. HBOT for Acute Concussion
For acute concussion, especially within the first 48-72 hours, consider hyperbaric oxygen therapy (HBOT) at 2 atmospheres for 60-90 minutes, 3-5 days a week, for up to 40 sessions. A milder protocol (1.3 atmospheres, 3 times/week for 2 weeks) can be considered for mild concussions.
13. Consult Dietitian for Clinical Keto
If using a ketogenic diet to manage a clinical condition, work with a knowledgeable registered dietitian. This ensures proper guidance and management of the therapeutic diet.
14. Reintroduce Carbs Slowly
If reintroducing carbohydrates after a period of low-carb eating, titrate them back in slowly, starting with fibrous vegetables. This helps avoid negative counter-regulatory effects, GI distress, and mood swings.
15. Avoid High-Dose 1,3-Butanediol
Avoid consuming large, chronic doses of 1,3-butanediol, especially if elderly or with compromised liver function. Large doses can cause liver enzyme elevation, aldehyde generation, and a narcotic (intoxicating) effect.
If considering ketogenic therapy for Alzheimer’s disease, prioritize patients who present with remarkable glucose hypometabolism in the brain. This patient selection criterion may lead to more favorable responses.
Approach Alzheimer’s disease management with a comprehensive metabolic therapy strategy that targets multiple contributing factors. This may involve a ketogenic diet or formula combined with various cofactors.
18. Use Ketones for Cognitive Deficit
Utilize ketones and other cognitive enhancers primarily in contexts of cognitive deficit or environmental stress. They tend to be most effective when addressing an existing deficit or stress rather than for already optimal function.
19. Consider Creatine Supplementation
Consider creatine supplementation, as it is used by Dom for its potential benefits on metabolic rate and performance.
If considering NAD supplementation, seek stabilized forms that can effectively reach target tissues like muscle and brain. This may help overcome delivery problems and achieve desired benefits for performance or brain health.
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