375 - The ketogenic diet, ketosis, and hyperbaric oxygen: weight loss, cognition, cancer, and more

Before starting any ketogenic diet, track everything: use apps to log macronutrients and total calories, measure blood ketones daily with a meter like Keto Mojo, and monitor your lipid panels regularly. Most people fail because they don't track - you can't manage what you don't measure when entering

December 8, 2025 2h 25m
The Peter Attia Drive Podcast

Key Takeaway

Before starting any ketogenic diet, track everything: use apps to log macronutrients and total calories, measure blood ketones daily with a meter like Keto Mojo, and monitor your lipid panels regularly. Most people fail because they don't track - you can't manage what you don't measure when entering nutritional ketosis.

Episode Overview

Neuroscientist Dom D'Agostino discusses his journey from studying oxygen toxicity in Navy divers to becoming a leading ketone researcher, covering the mechanisms of nutritional ketosis, common mistakes people make when starting keto, and the latest developments in continuous ketone monitoring technology.

Key Insights

Ketogenic Diet Success Requires Adequate Protein

D'Agostino learned through personal experience that protein is crucial on keto - dropping from 250g to 70-80g daily caused significant muscle loss despite ketones' anti-catabolic effects. The key variable for ketogenic diet success is titrating protein to meet individual needs, especially for athletes.

Tracking is Essential for Ketogenic Success

The most common mistake people make is not tracking their food intake and ketone levels. You need to correlate blood ketone measurements with macronutrient ratios and total calories to understand what works for your body.

Blood vs Breath Ketones Tell Different Stories

During calorie deficits, blood ketones can be low while breath ketones remain high because tissues rapidly consume ketones from blood while acetone production increases. This reflects the balance between ketone production and utilization.

Ketogenic Diet Shows Remarkable Medical Efficacy

For pediatric epilepsy, two-thirds of drug-resistant patients respond therapeutically to ketogenic diets, with one-third achieving complete seizure control. Some patients can even transition off the diet permanently while remaining seizure-free.

Notable Quotes

"The ketogenic diet is indeed a magical diet in the way that it remarkably changes our physiology and there's no other diet that exists that can for example manage drug resistant seizures"

— Dom D'Agostino

"I probably rapidly lost 10 to 15 pounds and then my my exercise and my lifts tank too. Like I lost strength on bench press and not so much deadlift and squat"

— Dom D'Agostino

"Not tracking. I mean, people do it. They're just like, 'Oh, I'm just going to eat, you know, this or that and not try.' It's like, uh, no, you need to like just write"

— Dom D'Agostino

Action Items

  • 1
    Start Tracking Before Going Keto

    Download a nutrition tracking app like Carbon and begin logging all food intake, focusing on macronutrient ratios and total calories before attempting nutritional ketosis.

  • 2
    Invest in Blood Ketone Monitoring

    Purchase a blood ketone meter (like Keto Mojo) and test strips to measure beta-hydroxybutyrate levels daily, aiming for 0.5+ mmol/L for clinical ketosis.

  • 3
    Prioritize Adequate Protein Intake

    Calculate your protein needs based on activity level and goals - don't drastically reduce protein when starting keto, especially if you're active or trying to maintain muscle mass.

  • 4
    Monitor Lipid Panels Regularly

    Get baseline lipid measurements before starting keto and retest periodically, as some people experience significant increases in LDL and ApoB that may need management.

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