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

What It Covers

Dom D'Agostino discusses ketogenic diets, exogenous ketones, and hyperbaric oxygen as metabolic therapies. Topics include achieving nutritional ketosis, managing electrolytes during transition, differences between ketone salts versus esters, applications for epilepsy and cancer, and carnivore diets as ketogenic variants.

Key Questions Answered

• •Ketogenic Diet Efficacy for Epilepsy: Two-thirds of pediatric epilepsy patients who fail multiple drug therapies respond therapeutically to ketogenic diets, with one-third achieving complete seizure control. Ten to fifteen percent become super responders who maintain seizure freedom even after discontinuing the diet, suggesting curative potential through network stabilization.
• •Protein Requirements on Keto: Modified ketogenic diets should contain twenty to thirty percent protein rather than the historical eight to twelve percent. For active individuals, this translates to approximately one gram per pound of body weight to prevent muscle loss and sarcopenia, especially critical after age fifty when muscle turnover accelerates significantly.
• •Ketone Esters versus Salts: Ketone salts provide sustained elevation for four to six hours without insulin spikes when keeping blood levels under two millimolar. Ketone esters cause rapid rises that trigger counter-regulatory insulin release and potential hypoglycemia two hours post-consumption, making salts preferable for most applications outside acute medical interventions.
• •D versus L Enantiomers: Racemic beta-hydroxybutyrate contains fifty percent D-enantiomer metabolized rapidly for energy and fifty percent L-enantiomer metabolized three to four times slower. The L form provides sustained signaling effects including NLRP3 inflammasome suppression and epigenetic modifications while D provides immediate fuel, creating complementary therapeutic benefits.
• •Electrolyte Management During Transition: Ketogenic diets cause natriuretic and diuretic effects leading to sodium depletion and orthostatic hypotension. Consuming ketone salts bound to sodium, potassium, calcium, and magnesium during the first four to six weeks prevents brain fog and smooths adaptation by replacing lost electrolytes while bridging the energetic gap.