375 - The ketogenic diet, ketosis, and hyperbaric oxygen: weight loss, cognition, cancer, and more
Episode 375 - The ketogenic diet, ketosis, and hyperbaric oxygen: weight loss, cognition, cancer, and more
Peter Attia MD hosts neuroscientist Dom D'Agostino for a deep dive into metabolic therapies. They discuss nutritional versus supplemental ketosis, defining ketone thresholds and practical application. The conversation covers the ketogenic diet's role in weight loss, cognitive function, cancer, and neurodegenerative diseases, emphasizing protein intake and avoiding common mistakes. They also explore exogenous ketones (salts, esters, 1,3-butanediol) and hyperbaric oxygen therapy for brain injuries. Dom shares insights into the carnivore diet and the future of metabolic research.
Topics Covered:
00:00:00 Introduction to the podcast and guest Dom D'Agostino
00:02:07 Dom D'Agostino's background and interest in ketosis
00:05:06 Dom's work with the Navy on oxygen toxicity and accidental cancer discoveries
00:10:50 History of oxygen toxicity and military diving issues
00:13:48 Clinical trials for ketosis and oxygen toxicity funded by the DoD
00:16:46 Defining nutritional ketosis and its physiological effects
00:19:46 History of ketogenic diets for epilepsy and early ketone identification
00:22:43 Efficacy of ketogenic diets for pediatric and adult epilepsy
00:25:32 Dom's personal experience with ketogenic diet and tracking ketones
00:28:24 Common mistakes when starting a ketogenic diet
00:31:01 Continuous ketone monitors and their accuracy
00:33:38 Ketogenic diet as a prescription metabolic therapy; importance of blood work
00:36:28 Guidance for weight loss on a ketogenic diet: high protein, moderate fat, high fiber
00:39:16 Mechanisms behind ketogenic diet efficacy for weight loss
00:42:16 Defining 'high protein' for active individuals on a ketogenic diet
00:45:10 Incorporating carbohydrates (fibrous foods, berries) into a keto diet
00:48:07 The carnivore diet as an extreme form of ketogenic therapy
00:51:03 Micronutrients and considerations for a pure carnivore diet
00:53:41 Introduction to exogenous ketones: 1,3-butanediol and early products
00:56:51 Biochemistry of 1,3-butanediol and its metabolism
00:59:52 Analogy of 1,3-butanediol to alcohol metabolism and liver toxicity concerns
01:02:59 Alcoholic ketoacidosis and the liver's role in ketone regulation
01:05:48 Liver toxicity and narcotic effects of high-dose 1,3-butanediol
01:08:33 Ketone salts vs. esters: biochemical differences and benefits
01:11:28 How ketone salts mitigate the 'keto flu' and electrolyte imbalance
01:14:30 Insulin response to ketone esters vs. salts and risk of hypoglycemia
01:17:24 Dosing and effects of ketone salts on blood ketone levels
01:20:22 D- and L-beta-hydroxybutyrate: anantimers and their metabolic differences
01:23:20 Signaling effects of L-beta-hydroxybutyrate in the brain
01:26:24 Ketogenic diets and NAD+ elevation; challenges with NAD supplementation
01:29:12 NAD+ for performance enhancement and neuroprotection in stress conditions
01:32:22 Emerging evidence for ketogenic diets in psychiatric disorders, including anorexia
01:35:22 Ketone supplementation for cognitive performance and glucose lowering
01:38:22 Dangers of 'energy toxicity' from excessively high ketones
01:41:22 Optimal formulation of ketone molecules; role of MCTs
01:44:25 Mitigating negative effects of rapid ketone rise with MCTs and proper dosing
01:47:23 Ketogenic metabolic therapy framework for glioblastoma
01:50:34 Efficacy and ongoing RCTs for ketogenic therapy in glioblastoma
01:53:34 Comprehensive metabolic intervention: targeting glucose and glutamine in cancer
01:56:24 Challenges in funding and conducting clinical trials for metabolic therapies in cancer
01:59:23 Ketogenic therapies for Alzheimer's disease and mild cognitive impairment
02:02:21 Inflammation as a major driver in Alzheimer's disease
02:05:30 Patient selection and the role of glucose hypometabolism in Alzheimer's
02:08:29 Preserved brain ketone utilization with aging; comprehensive metabolic approaches
02:11:18 Alpha-GPC and other cognitive enhancers, situational use of fasting
02:14:17 Hyperbaric oxygen therapy for concussion and TBI: protocols and evidence
02:17:16 DoD-funded rigorous clinical trials for hyperbaric oxygen in TBI and PTSD
02:20:12 Concluding remarks: progress in exogenous ketones, ongoing research, and resources
02:22:50 Dom D'Agostino's affiliations and resources
Key Quotes:
"The ketogenic diet is the most scientifically researched diet that has an objective biomarker that defines the physiological state of being in the diet."
"Higher ketones are not advantageous, and I think potentially very problematic."
Resources Mentioned:
[Placeholder for resources mentioned in the podcast]
https://youtube.com/watch?v=jW0cVEgW9YY