July 16, 2018

Podcast

#05 – Dom D’Agostino, Ph.D.: ketosis, n=1, exogenous ketones, HBOT, seizures, and cancer

"I immerse myself in what I’m doing...that’s how we learn." —Dom D'Agostino

by Peter Attia

Read Time 29 minutes

In this episode, Dom D’Agostino, one of the smartest people on all things related to ketones, digs deep into the research and application of these molecules. We discuss ketone esters, diesters and monoesters, racemic ketones, medium-chain triglycerides (MCTs), C8 (caprylic acid) on the exogenous ketone (EK) side of things. We also cover a lot of Dom’s fascinating work with hyperbaric oxygen therapy (HBOT). If you’re just curious about ketosis and/or HBOT, or working on a dissertation related to nutritional biochemistry, there’s probably something in this episode for you to take away.

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Dom also discusses the strategy and tactics of the metabolic management of cancer, which includes, but is certainly not limited to, a ketogenic diet (KD). Cancer is covered throughout this episode, but if there’s one section to listen to, skip ahead to the 2-hour mark and listen to what Dom has to say about the Press-Pulse approach.

We discuss:

  • Dom’s early medical training in hyperbaric chambers [7:00];
  • Effect of ketones on cancer cells [20:00];
  • Ketones and oxygen toxicity seizures [32:00];
  • HBOT & its many applications [40:00];
  • Ketones, MCTs, and exogenous ketones [59:15];
  • How ketones affect blood glucose [1:20:00];
  • Ketone esters, salts, enantiomers vs. racemic BOHB [1:38:00];
  • Dom’s ketone tolerance test [1:56:00];
  • The metabolic management of cancer using a Press-Pulse approach [1:59:45]; and
  • More.

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Dom D'Agostino, Ph.D.

Dominic D’Agostino, Ph.D., has maintained involvement in a vast array of professional, academic and personal endeavors. As an Associate Professor with tenure at the University of South Florida, Dom teaches students of the Morsani College of Medicine and the Department of Molecular Pharmacology and Physiology, with a focus on such topics as neuropharmacology, medical biochemistry, physiology, neuroscience, and neuropharmacology. He is also a Research Scientist at the Institute for Human and Machine Cognition (IHMC) to assist with their efforts towards optimizing the safety, health and resilience of the warfighter and astronaut.

His laboratory develops and tests metabolic-based strategies for targeting CNS oxygen toxicity (seizures), epilepsy, neurodegenerative diseases, and cancer. To investigate the mechanism of these pathologies he uses a variety of in vivo and in vitro techniques, including radio-telemetry (EEG, EMG), electrophysiology, fluorescence microscopy, confocal microscopy, atomic force microscopy (AFM), biochemical assays and in vivo bioluminescence imaging. His laboratory has adapted many of these techniques for use inside environmental chambers, which allows them to manipulate oxygen concentrations (from hypoxia to hyperbaric oxygen). His current project is to identify cellular mechanisms of seizures from CNS oxygen toxicity and to develop mitigation strategies against it. His efforts have focused specifically on measuring brain EEG, neuronal excitability, reactive oxygen species (ROS) production and biomarkers of oxidative stress. The main focus of his lab over the last 10 years has been understanding the anticonvulsant and neuroprotective mechanism of the ketogenic diet and ketone metabolite supplementation. The shift in brain metabolism (from glucose to ketones) reduces neuronal hyperexcitability, oxidative stress and enhances brain energy metabolism. This approach can be used to treat a wide variety of pathologies linked pathophysiologically to metabolic dysregulation, including cancer. Other areas of interest include researching drugs that target cancer-specific metabolic pathways. He was a research investigator and crew member on NASA’s Extreme Environment Mission Operation (NEEMO 22) and has a personal interest in environmental medicine and methods to enhance safety and physiological resilience in extreme environments. His research is supported by the Office of Naval Research (ONR), Department of Defense (DoD), private organizations and foundations.

With a wide range of research interests, Dominic D’Agostino holds membership in the Undersea and Hyperbaric Medicine Society, Aerospace Medical Association, Society of Neuroscience, American Physiological Society, and the American Association of Cancer Research, additionally serving on numerous editorial boards and as a Reviewer for dozens scholarly publications. Before joining the faculty at USF, D’Agostino completed a postdoctoral fellowship in neuroscience at Boonshoft School of Medicine at Wright State University. A graduate of Robert Wood Johnson Medical School and Rutgers University, Dominic D’Agostino earned his Ph.D. and B.S. from these respective institutions. [ketonutrition.org]

Dom on Facebook: Dominic D’Agostino

Dom on Instagram: @dominic.dagostino.1

Dom on Twitter: @dominicdagosti2

Dom’s website: ketonutrition.org

Dom’s blog: ketonutrition.org/blog/

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.
  1. Thank you for sharing this information. Even though it is beyond my complete comprehension of all the information presented, it confirms my beliefs of diet and the use of hbot.
    I’m currently the caregiver of a 33 year male survivor of medullablostoma and a 9 year survivor of right medullary infarct, which left the patient with physical disabilities. We are now financially able to pursue HBOT therapy for the residual effects of his stroke. We have a scheduled interview with Dr. Harch this week. Dr. Harch as well as Dom have been on my radar for some time. We’ve been turned away from the medical facility where his resection of the tumor and the 55GY of radiation therapy occurred. We’re interested in working with anyone that wants to study the outcome. Thank you again for publishing this generous article.

  2. Thanks Peter & Dom, excellent podcast.
    I love how it turned quite technical and all the notes you prepared.

  3. Thank you for the excellent discussion! I’m curious about your thoughts on application of these principles in management of poisoning patients. E.g., for individuals with CO poisoning for whom HBO is being considered, would it be reasonable to add MCT oil and/or ketone esters to their therapy?

    FYI: the tox community sometimes uses high dose insulin (e.g., >/= 1 unit/kg/hour along with enough dextrose to maintain euglycemia) in patients with severe calcium channel blocker overdose. The idea is to provide cardiac tissue with a source of fuel to help improve cardiac function. Medical metabolic management in the acute care setting.

  4. The pictures are % in terms of total daily kcal intake. The macronutrient ratios are in terms of grams of macronutrients (fat:protein+carb).

    Example for Classic Keto:

    % of total kcal:

    60 gm protein = 240 kcal (6% of total kcal)
    40 gm carb = 160 kcal (4% of total kcal)
    400 gm fat = 3600 kcal (90% of total kcal)
    Total kcal = 4000 kcal

    Macronutrient ratio:

    Fat gm = 400
    Protein + carb = 100
    Fat:protein+carb (in gm) = 4:1

    Example for Modified Atkins:

    % of total kcal:

    ~187 gm protein = 750 kcal (30% of total kcal)
    ~31 gm carb = 125 kcal (5% of total kcal)
    ~180 gm fat = 1625 kcal (65% of total kcal)
    Total kcal = 2500

    Macronutrient ratio:

    Fat gm = ~180
    Protein + carb = ~218
    Fat:protein+carb (in gm) = ~0.8:1

  5. Do you have any experience with gout attacks post intermittent fasting? I’ve read that fasting can increase levels of uric acid.

  6. I loved this podcast. I know way too many people with cancer and I’m at very high risk for certain types, so I’ve been following Dom D’Agostino for some time.

    Peter, I’d love it if you’d talk to some expecters about the use of low dose anabolic steroids for those in chemo and/or radiation. The small number of studies I’ve seen on the topic suggest that anabolics can improve tolerance to the treatment and quality of life. I’m trying to learn more.

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