Ketones

  • When there isn’t a sufficient level of available glucose — which is what the body uses for its main source of fuel — and glycogen levels are depleted, blood sugar and insulin are lowered and the body looks for an alternative source of fuel: in this case, fat.
  • This process can happen when a person fasting, after prolonged exercise, during starvation, or when eating a low-carb, ketogenic diet.
  • And when the body begins breaking down fats for energy like this, a process known as beta-oxidation, ketones are formed for use as fuel for the body and brain. This is known as ketosis.
  • People following a ketogenic diet specifically reduce their carbohydrate intake for this reason: to create ketones for energy.

Best Ketone Supplements

#1 Real Supplements Rated Best in 2020
Keto BHB Exogenous Ketone Supplement - Beta Hydroxybutyrate Ketone Salt, Keto Pills - 60 Capsules
1,896 Reviews
Keto BHB Exogenous Ketone Supplement - Beta Hydroxybutyrate Ketone Salt, Keto Pills - 60 Capsules
  • Vitamin Bounty Keto BHB is Ketogenic ROCKET FUEL!
  • SUPERCHARGE your Ketosis and get you into keto ultra fast! This is the boost you need.
  • PERFECT Dietary Supplement for KETO! Enjoy the immediate benefits of Beta Hydroxybutyrate with no bad taste.
  • Backed by Vitamin Bounty's world class support and integrity, our Keto BHB is the ultimate choice.
  • Each bottle of BHB is always MADE IN THE USA and tested for quality assurance and efficacy in a GMP facility.
#2 Real Supplements Rated Best in 2020
MCM Nutrition – Exogenous Ketones Supplement & BHB - Boosts Energy & Suppresses Appetite - Instant Keto Mix That Puts You into Ketosis Quick & Helps with The Keto Flu (Lemon Flavor - 15 Servings)
  • BHB RESTORES YOUR ENERGY, PUSHES PEAK PERFORMANCE & IMPROVES RECOVERY: Beta-Hydroxybutyrate (BHB) is your brain’s main energy source for ketosis! By fusing BHB & exogenous ketones, you unleash a ketosis supplement that renews your energy levels, enriches mental clarity & enhances recovery post-workout!
  • ACHIEVE KETOSIS IN 30-MINUTES & SUPPRESS YOUR APPETITE: Take control of your body, whether you’re keto or just intermittent fasting, this lemon-flavored mix will deliver ketosis in minutes! Best of all, it makes tracking your calories & managing your macros EASIER than ever, by reducing your appetite!
  • PEACE OF MIND FOR HIGH-CARB DAYS, REWARDS YOUR WEIGHTLOSS GOALS: Finally, your sacred cheat days don’t have to kick you out of ketosis! MCM Nutrition’s keto drink-mix gives you access to instant ketones so you maintain ketosis… even while you indulge little! You’ll wonder how you ever managed without it!
  • FIGHTS “KETO FLU” & SUPPORTS BLOOD SUGAR: It’s no secret, brain-fog & hunger weigh you down when getting back into ketosis! Skip the side-effects & unlock a ketosis drink containing the essential nutrients to achieve QUICK ketosis! Ketones also balance your blood sugar, leaving you with consistent energy levels!
  • 100-PERCENT SATISFACTION OR YOUR MONEY BACK: Keto supplements are nothing short of an investment into your own body and we understand that! That’s why we allow you to put our ketones to the test! If for any reason you are not satisfied, we will refund EVERY penny… so you have nothing to lose!
#3 Real Supplements Rated Best in 2020
Keto Plus™ Exogenous Ketones (goBHB™) - 30 Servings | Formulated for Ketosis, Energy and Focus | Keto Certified, Vegan Friendly (Raspberry Lemonade)
  • ►►Exogenous Ketones (BetaHydroxybutyrate) + Amino Acids, Chromium Picolinate & Prebiotic Fiber.
  • ►►Sustained energy for your workout, school work, or as an afternoon pick-me-up.*
  • ►►Refreshing Raspberry-Lemonade Flavor. Mixes easily in water.
  • ►►Benefits of a Keto diet without the carb restriction or fasting.*
  • ►►90-day Money Back Guarantee (^See details below).
Sale#4 Real Supplements Rated Best in 2020
VitaRaw Exogenous Keto Pills - (3X Powerful Dose | 2100mg Keto BHB) Best Keto Burn Diet Pills - Advanced Ketones BHB Supplement - Max Strength Keto Diet Pills for Women + Men - 90 Capsules
248 Reviews
VitaRaw Exogenous Keto Pills - (3X Powerful Dose | 2100mg Keto BHB) Best Keto Burn Diet Pills - Advanced Ketones BHB Supplement - Max Strength Keto Diet Pills for Women + Men - 90 Capsules
  • ✅ WHY CAN'T I LOSE WEIGHT & KEEP IT OFF? Diet is key when it comes to weight loss, but with modern diets being so heavily carb loaded, our bodies are burning the carbs for fuel instead of our stored fat! This makes it very difficult to get rid of excess weight.
  • ✅ WHY IS VITARAW'S KETO BURN SUPPLEMENT THE ANSWER? There are many different ketone supplements on the market, how do you know which is right for you? It comes down to formulation and the dosage! Our powerful beta hydroxybutyrate formula is made with 2,100 mg of pure exogenous BHB ketones. These ketosis pills contain a perfect keto complex containing a powerful dose of ketogenic BHB salts. BHB salts been have shown to drastically enhance & prolong the state of ketosis - the fat shredding state.
  • ✅ YOU DO NOT HAVE TO SUFFER: Some diets can be brutal ... and Thats NOT a sustainable recipe for long term weight loss. With our optimally formulated, BHB keto capsules, you will encounter compelling results. Once in the state of ketosis you will experience lasting energy through out your day, a peak level of focus, and an added boost of endurance to conquer your toughest workouts.
  • ✅ REACH YOUR GOALS: Our ketogenic diet pills are extremely potent and powerful, they provide your body with the keto boost it needs to start slimming down and feeling energized. Let our keto pill reduce your cravings, kick start your metabolism, shred excess fat, and help you power through your longest days. Our bhb exogenous ketones will assist you in looking and feeling your best.
  • ✅ A BRAND YOU CAN TRUST: Our keto vitamins are scientifically formulated so that each diet pill we produce aims to provide you with effective results. Our ketones supplement is manufactured in a state-of-the-art facility here IN THE USA with non-GMO ingredients. You can be sure that you are getting the safest, purest, and highest quality keto supplements on the market. Our team of experts are always free to answer any questions you may have.
#5 Real Supplements Rated Best in 2020
Keto Science Real Ketones Powder Dietary Supplement, Sugar-Free Lemon Drink Mix, Supports Carb-Fighting Diet and Weight Loss, 5.3 oz. (15 Servings)
136 Reviews
Keto Science Real Ketones Powder Dietary Supplement, Sugar-Free Lemon Drink Mix, Supports Carb-Fighting Diet and Weight Loss, 5.3 oz. (15 Servings)
  • SUPPORTS WEIGHT LOSS: Ketones promote increased metabolism, weight loss and enhanced brain function
  • FOR A KETOGENIC LIFESTYLE: Promote ketosis and improve ketogenic performance for an active, on-the-go lifestyle
  • EASY TO MAKE: Just mix with water, shake, and enjoy the metabolism-boosting benefits
  • PROVEN FORMULA FOR RESULTS: Formulated with patented and proven GoBHB ketones that your body can put to work quickly
  • KETO & PALEO: Ketogenic and Paleo-friendly lemon flavored drink mix that’s sugar free
Sale#7 Real Supplements Rated Best in 2020
5x Potent Apple Cider Vinegar Capsules with Mother + BHB SALTS Keto Diet Pills With MCT OIL, Fat burner & Weight Loss Supplement Formula Keto Pills For Women Men Appetite Suppressant ACV Detox Support
  • ✔️ Our Apple Cider Vinegar with Keto supplement will expedite your Weight loss journey! See a HUGE reduction in your weight and put your body into ketosis in less than 1 week! Works for both men and women.
  • ✔️ We have taken calorie burning to a whole new level, combining together powerful ingredients like apple cider vinegar with BHB salts and MCT oil to give you the perfect edge for your weight loss routine. This powerful combination with proper exercise will surely show results in no time, so you best say goodbye to all your excess fat! Here comes the Keto diet!
  • ✔️ POWERFUL APPETITE SUPPRESSANT & NATURAL DETOXIFIER: our apple cider vinegar plus keto dietary supplement contains anti-inflammatory and antioxidant properties that will give you a healthier lifestyle. It supports the body’s natural cleansing process, by stimulating the colon and bowel to flush away undigested waste, reduce bloating, and boost your metabolism.
  • ✔️ NON-GMO FORMULA: This formula is made in the USA in a GMP certified facility. It is all natural, non-GMO, and does not contain unneeded preservatives. Since quality and reliability is our highest concern, our formula is 3rd-party tested to ensure potency and purity. We include 1500mg of pure apple cider vinegar with mct oil and bhb salts per serving (750mg per vegetable capsule), with 120 capsules in each bottle to take all your worries away for 60 days!
  • ✔️ CARB BLOCKER: Not only do these keto pills with ACV help you suppress your hunger but at the same time put your body into ketosis, a burning state, which burns carbohydrates faster than you can imagine!
#8 Real Supplements Rated Best in 2020
Exogenous Ketones Powder, BHB Beta-Hydroxybutyrate Salts Supplement, Best Fuel for Energy Boost, Mental Performance, Mix in Shakes, Milk, Smoothie Drinks for Ketosis – New Chocolate, 9.0 oz (255 grs)
  • NEW ADVANCED FORMULA: We reinvented our original Ketone Base formula to make it better tasting and less bitter. Same high-quality ingredients, but with no sugar or fillers.
  • SWEET, NOT BITTER: We use monk fruit for the perfect sweetness and eliminated the usual bitterness of BHB. Enjoy our delicious Chocolate flavored Exogenous Ketones mixed into drinks and smoothies.
  • KICK INTO KETOSIS: Exogenous ketones supplement may help you get into a ketogenic state quicker. The beta-hydroxybutyrate (BHB) formula helps support raised blood ketone levels & weight loss efforts.
  • MIX ON THE GO: Powdered base dissolves easily into water, coconut milk, coffee, and shakes. It’s made with only clean ingredients, nothing artificial, and has added electrolytes for pure hydration.
  • BODY FUEL: Supplementing with ketones may help improve athletic endurance, mental performance, and energy levels. Sustained ketosis has been shown to support healthy weight management.
#9 Real Supplements Rated Best in 2020
Keto-Mojo 50 Blood Ketone Test Strips, Precision Measurement for Diabetes & Low-Carb Weight Loss, Monitor Your Diabetic & Ketogenic Diet for Nutritional Ketosis, Strips Work Only in Keto-Mojo Meters
  • INSTRUCTIONAL VIDEOS: Beware of the E-2 error – strips are not expired! Watch our instructional videos to optimize your testing results; videos on YouTube, our website, or here at Amazon.com/ketomojo; US-based Customer Support available to answer questions
  • ENDORSED BY: Leading ketogenic industry doctors, scientists, trainers, and researchers all recommend Keto-Mojo ketone strips for accurate testing
  • BEST IN CLASS CUSTOMER SUPPORT: Our knowledgeable, friendly, US-based support team is eager and ready to help you! Any issues, please don't hesitate to contact us via our company website
  • INCLUDES: (50) Keto-Mojo Blood Ketone Test Strips, (1) Code Chip; does not measure blood glucose; Note: These test strips are exclusively for use with the Keto-Mojo Meter
#10 Real Supplements Rated Best in 2020
#11 Real Supplements Rated Best in 2020
Get Into Keto - Exogenous Ketone Beta Hydroxybutyrate (BHB) for Men and Women - Supercharge Ketosis & Manage Cravings, 60 ct
  • ⚡ GET INTO KETO FAST - Increase the Ketone Levels immediately in your body with Beta Hydroxybutyrate Ketone Salt Pills
  • ⚡ BEAT THE KETO FLU - It takes your body some time to adjust to ketosis. Get Into Keto will help you BEAT the keto flu!
  • ⚡ STRONGER & MORE POWERFUL - Ever have a cheat day on Keto and feel bad the next day? Worried that you will get kicked out of keto? WE have the solution!
  • ⚡ SUPERCHARGE KETO - Keto Pills with great results like a BHB Ketone drink, without any of the bad taste.
  • ⚡ MADE IN THE USA, and bottled in a GMP certified facility, Vitamin Bounty products are a worry-free choice.
#12 Real Supplements Rated Best in 2020
Pruvit Keto//OS NAT – Raspberry Lemonade Charged (5 Single Serve Packets)
  • Facilitates quick absorption of ketones which allows a state of ketosis to be reached faster than ever for unrivaled results.
  • facilitates quick absorption of ketones which allows a state of ketosis to be reached faster than ever for unrivaled results.
  • facilitates quick absorption of ketones which allows a state of ketosis to be reached faster than ever for unrivaled results.
  • facilitates quick absorption of ketones which allows a state of ketosis to be reached faster than ever for unrivaled results.
#13 Real Supplements Rated Best in 2020
KETO-MOJO Bluetooth Ketone & Glucose Blood Testing Kit + APP, 20 Test Strips (10 Each), 1 Meter, 10 Lancets, 1 Lancing Device, Monitor Your Ketosis & Ketogenic Diet
  • MORE THAN A METER - Your purchase comes with a free smartphone app where you can instantly sync your readings to your phone and track your ketones and glucose. The app automatically calculates your Glucose Ketone Index (GKI), an important measure of metabolic health.
  • GET RESULTS ON YOUR KETO DIET by testing for ketosis with the most advanced technology including Bluetooth integration. This dual test kit - both glucose and ketones - gives you greater insight into your diet and what foods may adversely affect your results. Test, Don't Guess!
  • TESTED AND RECOMMENDED BY EXPERTS - Leading keto experts, healthcare professionals and researchers trust and recommend KETO-MOJO for accurate testing of ketosis and diabetic monitoring. Our LIFETIME WARRANTY backs that up.
  • RESOURCES TO HELP YOU LIVE A KETO LIFESTYLE - Keto-Mojo provides you with more than just testing strips. We provide you with all the information you need to be successful on your low-carb or keto journey. We help you understand keto basics, testing basics, food basics, and more. We provide hundreds of FREE articles, videos, and recipes!
  • EXCELLENT CUSTOMER SUPPORT – Our customer support team is based in the US and all live a keto lifestyle. They are highly qualified and can help resolve any issues you have with your meter or strips. Note that no test strips sold on Amazon are expired. If you get an E-2 error, your date may not be set correctly. Contact our customer support team.
#15 Real Supplements Rated Best in 2020
KetoneAid KE4 World's Strongest Ketone Ester Drink, 30g Exogenous D BHB. Not a Salt. Sugar Free, Caffeine Free. (3 Count)
  • WORLD'S STRONGEST EXOGENOUS KETONE DRINK. With 30 grams of D-Beta Hydxoxybutyrate (D-BHB) per serving, that makes Ketone Aid's KE4 Ketone Ester the most concentrated product on the market. However most find benefit with only 10ml, which is 1/6th of a bottle/serving. One can test the effectiveness of a BHB drink using a blood ketone meter. With 10ml, most experience a 1.0mm jump blood ketone levels
  • NOT A KETONE SALT. Most of the Exogenous Ketone Drinks on the market are referred to ask "Ketone Salts". Not sure if it is a salt? Look at the supplement facts and you will see 1-4 grams of total salt per serving (Including Sodium, Potassium, Calcium and Magnesium). You would have to drink 10-20 servings of ketone salts to match 1 serving of Ke4, however doing so would require a salt load of 20+ grams of salt
  • NON-RACEMIC 100% BIOAVAILABLE. Most of the Exogenous BHB Ketone Supplements are racemic. Racemic means that it contains both the bioavailable (the body can use it), "D" (or R) form and also the form that the body can't use, called the "L" (or S) form. This essentially doubles the salt load even further and if a product has 11.7g of BHB and it is racemic, it is effectively only 5.85g of the D form of BHB. Furthermore salt will limit the uptake of BHB, further reducing effectiveness.
  • NATURALLY DERIVED. Many incorrectly think the ketone salts are natural and the ester is synthetic. That is incorrect. Most, if not all, ketone bhb drinks are not naturally derived, in part because they are racemic. KE4 is naturally derived and undergoes a fermentation type process.
  • THE ONLY KETONE ESTER that is Made in the USA, used in a placebo controlled Clinical Trial* and about $1 per gram.
#16 Real Supplements Rated Best in 2020
MCM Nutrition - Exogenous Ketones Supplement & BHB - Caffeine Free and Suppresses Appetite - Instant Keto Mix That Puts You into Ketosis Quick & Helps with The Keto Flu (Fruit Punch - 15 Servings)
  • BHB PROVIDES MENTAL CLARTIY, PUSHES PEAK PERFORMANCE & IMPROVES RECOVERY: Beta-Hydroxybutyrate (BHB) is your brain’s main energy source for ketosis! By fusing BHB & exogenous ketones, you unleash a ketosis supplement that subtly renews your energy levels, enriches mental clarity & enhances recovery post-workout!
  • ACHIEVE KETOSIS IN 30-MINUTES & SUPPRESS YOUR APPETITE: Take control of your body, whether you’re keto or just intermittent fasting, this Fruit Punch-flavored mix will deliver ketosis in minutes! Best of all, it makes tracking your calories & managing your macros EASIER than ever, by reducing your appetite!
  • PEACE OF MIND FOR HIGH-CARB DAYS, REWARDS YOUR WEIGHTLOSS GOALS: Finally, your sacred cheat days don’t have to kick you out of ketosis! MCM Nutrition’s keto drink-mix gives you access to instant ketones so you maintain ketosis… even while you indulge little! You’ll wonder how you ever managed without it!
  • FIGHTS “KETO FLU” & SUPPORTS BLOOD SUGAR: It’s no secret, brain-fog & hunger weigh you down when getting back into ketosis! Skip the side-effects & unlock a ketosis drink containing the essential nutrients to achieve QUICK ketosis! Ketones also balance your blood sugar, leaving you with consistent energy levels!
  • 100-PERCENT SATISFACTION OR YOUR MONEY BACK: Keto supplements are nothing short of an investment into your own body and we understand that! That’s why we allow you to put our ketones to the test! If for any reason you are not satisfied, we will refund EVERY penny… so you have nothing to lose!
#17 Real Supplements Rated Best in 2020
Pruvit Keto//OS NAT Heart Tart Charged (5 Single Server Packets)
  • Facilitates quick absorption of ketones which allows a state of ketosis to be reached faster than ever
  • Supports and maintains healthy cell function, maximizes cell debris removal, and extends DNA telomere length
  • Increased appetite suppression & helps burn fat
  • Controls hunger and reduces your urge to snack
  • Experience unparalleled mental clarity and optimized cognitive function
Sale#19 Real Supplements Rated Best in 2020
Keto Drive Exogenous Ketone Performance Complex - BHB Salts - Formulated for Ketosis, Energy and Focus - Patented Beta-Hydroxybutyrates (Calcium, Sodium, Magnesium) - Orange Mango
  • PEAK PERFORMANCE. This keto complex of patented beta-hydroxybutyrates (BHB) was designed to help you achieve ketosis and perform at your peak. It’s formulated to help support increased blood ketone levels, athletic endurance, mental performance and sustained energy.
  • REFRESHING FLAVOR. Finally, a BHB drink that actually tastes good! Ketones themselves have a very strong taste that's difficult to mask. Zhou's experts spent countless hours crafting a refreshing Orange Mango flavor that you’ll look forward to.
  • KETO CLEAN. No carbs, no caffeine, no sugar, no guilt. Just the highest quality exogenous ketones and a delicious Orange Mango taste you'll love.
  • CONVENIENT & MIXES EASILY. Keto Drive Orange Mangotastes great with plain ol’ water, but feel free to add it to shakes or other liquids. The powder mixes easily into cold beverages and is convenient for travelling or your daily trip to the gym.
  • WHAT SETS US APART? At Zhou, we use only the highest-quality ingredients following GMP (good manufacturing practices). Plus, we test everything at our lab in Utah, so you can be confident that you’re fueling your body with the very best.
Sale#20 Real Supplements Rated Best in 2020
Keto Pills - [2 Pack | 120 Capsules] Advanced Keto Burn Diet Pills - Best Exogenous Ketones BHB Supplement | Keto BHB Diet Pills for Women and Men - Max Strength Boost
2,675 Reviews
Keto Pills - [2 Pack | 120 Capsules] Advanced Keto Burn Diet Pills - Best Exogenous Ketones BHB Supplement | Keto BHB Diet Pills for Women and Men - Max Strength Boost
  • ✅ HARD TIME LOSING WEIGHT? - No one said slimming down was going to be easy but with Our advanced Keto, You will definitely feel like you are getting the competitive edge! These Keto pills will allow your body to finally shred fat while maintaining muscle. These exogenous ketones will also give you a full energy boost you need to align yourself with your fitness goals without burning out!
  • ✅ ALL KETO PILLS ARE THE SAME - WRONG! Not all diet supplements are created equal. The key attribute is the formulation! Our scientifically formulated product contains a specialized blend of premium, keto friendly ingredients that will assist in putting you on the fast-track to the the fat burning state of ketosis. This product will provide you with the extra ketones you need to help kickstart your ketosis. For a real boost, add a ketogenic diet to the mix and fatstrack your results.
  • ✅ ENERGY ✅ BURN ✅ RESULTS - Serious products contain powerful ingredients! Our keto hack pills are designed for men and women alike. Our advanced formula contains a Powerful Complex; beta-hydroxybutyrate (BHB) and caffeine. Each pill produces ketones that assist you in losing unwanted fat, while the caffeine reduces hunger and boosts energy level. With these Keto Burn pills you can be confident that you are on the right path to rapid fat loss.
  • ✅ A FOOL PROOF KETO SYSTEM - With OroLine Nutrition's Advanced Keto Formula, say farewell to unnecessary weight gain! Get in control with the help of our results packed diet pills. Experience the revolutionary concept of fat for fuel, increased satiety, great natural energy boost and the ultimate increase in focus.
  • ✅ A BRAND YOU CAN TRUST - Our keto pills are formulated based on scientific research to provide you with results. This product is manufactured in a state-of-the-art facility here IN THE USA with Non-GMO ingredients.

Ketone Facts and Benefits

Ketones, also known as “ketone bodies,” are byproducts of the body breaking down fat for energy that occurs when carbohydrate intake is low.

Here’s how it works:

  • When there isn’t a sufficient level of available glucose — which is what the body uses for its main source of fuel — and glycogen levels are depleted, blood sugar and insulin are lowered and the body looks for an alternative source of fuel: in this case, fat.
  • This process can happen when a person fasting, after prolonged exercise, during starvation, or when eating a low-carb, ketogenic diet.
  • And when the body begins breaking down fats for energy like this, a process known as beta-oxidation, ketones are formed for use as fuel for the body and brain. This is known as ketosis.
  • People following a ketogenic diet specifically reduce their carbohydrate intake for this reason: to create ketones for energy.

Exogenous ketones have become a popular nutritional supplement since their introduction in 2014.

Like with any new supplement, though, there tends to be a lot of misinformation that you have to sift your way through to find the reliable data. So, this article does the hard work for you and gets right to what the true benefits and drawbacks of exogenous ketones are.

We also cover what forms of ketones to consider, how they function in the body, and their role in future research.

What Are Ketones?

Ketones are fuel for the energy-generating mitochondria within the cells of our bodies. They are an alternative fuel source to glucose.1

Ketones are simple compounds because of their small molecular structure and weight. Specifically, they are organic (carbon-based) compounds that contain a central carbon atom double-bonded to an oxygen atom and two carbon-containing substituents, denoted by “R” .

Generic Ketone Structure

In humans, there are 3 different ketones produced by the mitochondria of the liver. These are also often referred to as ketone bodies 2.
The three ketones are:

  1. Acetone
    Acetoaceate ( also know as Acetoacetic Acid)
  2. Beta-Hydroxybutyric Acid (also known Beta Hydroxybuyrate or BHB). Other chemical names include 3-hydroxybutyric acid or 3-hydroxybutyrate.
  3. BHB is not technically a ketone since it contains a reactive OH-group in place of where a double-bonded oxygen normally would be as you can see in the diagram below. Yet, BHB still functions like a ketone in the body and converts into energy much like acetoacetate and acetone.

Exogenous Ketone Bodies Explained

Exogenous ketone bodies are just ketone bodies that are ingested through a nutritional supplement. Ketone bodies produced in the liver are more properly referred to as endogenous ketone bodies.

Exogenous = Originates from a source external from the body.
Endogenous = Originates from a source internal to the body.
Most supplements rely on BHB as the source of their exogenous ketone bodies. BHB is converted to acetoacetic acid with a small quantity converted to acetone through a acetoacetate decarboxylase waste pathway. Some of the acetoacetic acid will enter the energy pathway using beta-ketothialase, which converts acetoacetic acid to two Acetyl-CoA molecules.

Important note: Research is in its early stages and we need more data to understand the long-term effects of combining high blood ketone levels with high or moderate carbohydrate based diets.

We don’t yet fully understand what the long term effects of combining a non ketogenic diet with exogenous ketone supplements are. Research is in its early stages and more data is needed.

A common question is why BHB is the go-to ketone body for exogenous ketone supplements. The likely reason is a combination of its efficient conversion into energy and its ease of formulation. In other words, that it is easier to formulate BHB into a nutritional supplement. And the body efficiently converts BHB to acetoacetic acid, which effectively raises blood ketone levels.

 

Ketone Salts vs. Ketone Esters

Exogenous ketones of beta-hydroxybutyrate are available in two forms:

  1. Ketone Salts: Naturally-derived compounds that simply mix sodium (and/or potassium, or calcium) with BHB to improve absorption. Commercially available supplements are all made from ketone salts currently (includes KetoForce, KetoCaNa and Keto OS). These are also sometimes called “Ketone Mineral Salts” of “BHB Mineral Salts”.
  2. Ketone Esters: Synthetically-made compounds that link an alcohol to a ketone body, which is metabolised in the liver to a ketone. Ketone esters are used primarily in research for testing their efficacy in elevating ketone body levels. Yet, the first commercial Ketone ester drink will be available in 2018 by HVMN. Research esters are reportedly very unpleasant tasting which HVMN hopes to change.

Structure of a BHB Ester

The Ketone esters raise blood levels of beta-hydroxybutyrate to higher levels than the Ketone salts. There is also strong evidence that ketone esters are more effective than ketone salts as far as their physiological benefits go. It is not clear why this happens, but could be because of a difference in the absorption rate in the GI tract.

However, esters tend to be a little tougher to tolerate (due to gut distress after ingestion) and don’t have the most pleasant taste (as mentioned earlier).

Why use Exogenous Ketones?

Exogenous ketone supplements may provide a multitude of benefits. These include athletic performance enhancement, more efficient weight loss, cancer prevention, cognitive improvement and anti-inflammatory properties.

Weight Loss Goals

  • Appetite suppression: Appetite was measured in 10 males and 5 females after consuming a ketone ester (KE) or a dextrose (DEXT) drink . Desire to eat and perception of hunger dropped after both drinks, but the KE was 50% more effective for 1.5-4hrs. Insulin levels rose for both drinks but were 3x less with the KE drink after 30mins (Fig 2). The hunger hormone, ghrelin, was significantly lower between 2 to 4 hours after drinking the KE. In conclusion Ketone esters delay the onset of hunger and lower the desire to eat.
  • The fate of excess ketones: In the event someone has an excessive amount of ketones in the blood, the body (specifically the kidneys) will work as quickly as possible to filter out ketones via urine rather than converting them to adipose tissue.9 This is not to say that you can’t gain fat if you consume an exorbitant amount of exogenous ketones, but that they are less prone to be converted to fat than other nutrients.
  • More tolerable than MCT oil: MCT oil has been known to cause gastrointestinal distress in users, especially when taken in higher amounts. Exogenous ketones in the form of ketone salts, in comparison, are well-tolerated. Thus they enable one to avoid adverse GI events while providing the body with similar types of benefits. Figure 2 shows Ketone esters can be effective at reducing appetite. A combination of MCT oil and exogenous ketones may aid weight loss and allow a lower loading of ketone supplements, without the GI distress seen with MCT oil.

Performance Goals

  • Athletic enhancement: The improvement of energetic efficiency and fuel sparing mechanisms. Exogenous ketone supplementation could enhance both of these components of athletic performance. There is a promising outlook in this area for a variety of reasons:
    • Exogenous ketones induce acute ketosis, lasting for several hours. This is without needing to have depleted muscle glycogen stores. (Low muscle glycogen is well known to impair sustained physical performance).10.
    • The ‘carb-sparing’ effect from BHB suppresses the break down of muscle glycogen. This leads to lower lactate levels. When increasing exercise intensity, fat oxidation (burning) reaches a limit. At that point the muscle burns carbohydrates as fuel. But when consuming Ketone esters, the body does not make this switch. This suggests Ketones are being used instead. 11
    • Exogenous ketones cause the body to rely less on fat as fuel. Fat takes longer to metabolise for energy than muscle glycogen. This is why fatty acids are not the preferred fuel under heavy exercise. This could be useful for keto-adapted athletes performing high-intensity cardiovascular or strength training.12 This is particularly useful for the Keto-adapted athlete who wants to undergo high-intensity cardiovascular or strength training.
    • Ketone esters increase free carnitine whilst exercising (which seems to improve physical performance).
    • Exogenous ketones reduce the use of Branched-chain amino acids (BCAAs) as fuel (deamination). Consumption of a ketone ester drink reduced the rise in muscle BCAAs by 50% during exercise. 6
  • Improved cognition: Elevated plasma ketone concentrations divert the brain to utilize ketone bodies for synthesis of phospholipids, which drives growth and myelination. Normally, glucose would be the preferred substrate, which is much less efficient.14 BHB seems to act as a signal for neuronal pathways. These enhance synaptic plasticity, cognition and neuronal stress resistance. 15 In rat studies, ingestion of a ketone ester for 5 days improved their spatial learning and memory. 16.

 

Health & Longevity

  • Anti-carcinogenic properties: Data seems to suggest that exogenous ketones are an effective anti-carcinogen. The reason behind this is that cancer cells are unable to use ketone bodies effectively, unlike most healthy tissues in the body. In fact, dietary ketone supplementation has been shown to increase survival rates of mice with systematic cancer by as much as 70%.17
  • Neuroprotection: As humans age, the brain becomes more susceptible to neurodegeneration and subsequent conditions such as Alzheimer’s and Parkinson’s disease. Exogenous ketone supplementation appears to ameliorate the typical decline in cognitive function that comes with aging. The likely mechanism for this neuroprotective property is that ketone bodies reduce the inflammation and hyperexcitability that is normally exhibited as glucose metabolism declines in the brain.18, 19
  • Anti-Inflammatory properties: There is evidence that ketone bodies play a crucial role in reducing inflammation by inhibiting a specific class of proteins called inflammasones.20
  • Gene regulation profile change. There is evidence that gene sets can be up regulated or down regulated. Still early days but an example of this is a change in mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase (mHS) in rats on a ketogenic diet.

 

Mechanisms: How Exogenous Ketones Work

Exogenous ketones have a variety of physiological effects shortly after ingestion:

  • For starters, ingesting ketones (especially ketone esters) is an efficient way to elevate BHB in the blood by upwards of 2 mMol for nearly 8 hours (see Ref. 2). Ketone salts don’t appear to elevate BHB in the blood as efficiently (or significantly) as ketone esters do, though.
  • Exogenous ketone supplementation causes blood glucose to decrease significantly, likely due to the acute increase in insulin sensitivity. Therefore, exogenous ketones may present a potential therapy for type-2 diabetics via regulation of blood glucose.
  • Exogenous ketones also improve oxygen utilization, especially in the central nervous system (CNS).21 This effect decreases the likelihood of oxygen reaching potentially toxic levels in the CNS, which in turn has a number of other positive health ramifications (such as those discussed in the previous section).

Possible Downsides to Ketone Supplementation

As with almost any nutritional supplement, side effects and downsides are possible after consuming exogenous ketones. That being said, they tend to be rather benign and will most likely improve as exogenous ketone supplementation becomes more prominent. The most common side effects to be aware of when using exogenous ketones include:

Electrolyte Imbalance – The physiological reasoning behind electrolytes becoming depleted during a state of ketosis is due to lack of water retention and frequent urination. When supplementing with exogenous ketones, the acute state of ketosis will likely increase the frequency of urination, but it won’t deplete glycogen stores. Therefore, it may be useful to drink an electrolyte solution if you are urinating a lot after taking exogenous ketones, but it’s dependent upon how you feel.

Halitosis (bad breath) – If you’re on a ketogenic diet you are probably aware that as the body starts to metabolize fat, ketones can cause poor breath. There is very little one can do about this, it’s just the nature of the beast. Unfortunately, this can also arise when using exogenous ketones, but it’s not as lasting as when on a ketogenic diet. Chewing gum or mints is about the best option if it becomes a noticeable issue. This maybe caused by over consumption of the ketone supplement, tailoring the quantity consumed may prevent excess BHB being converted to acetone, which is likely excreted by the lungs.

Possible GI distress (flatulence) at exceptionally high doses – In the studies referenced in this article, exogenous ketones taken in large doses occasionally resulted in GI distress, especially flatulence. However, the cause of this is hypothesized to be due to the fact that ketones were mixed in a milky fluid that wasn’t very palatable. If you’re taking a nominal dose of exogenous ketones the likelihood of GI distress is rather low. Moreover, if some GI distress is prevalent, it should improve as you become accustomed to taking ketones.

Hypoglycemia: why not to be concerned – Taking exogenous ketones can drive blood glucose levels quite low, but you are not likely to feel the typical symptoms of hypoglycemia. This is because when ketone levels are high enough, they dominate as fuel in the brain; hence, you will feel just fine despite having low blood glucose. A highly-cited study by George Cahill, found elevated ketone levels could protect fasted participants when they were administered insulin to induce hypoglycemia.

 

Future Applications & Research

Most current research on exogenous ketones focuses on the health and longevity applications of their use.

Another area that is targeted, is the psychological benefits of exogenous ketones, especially with how they can help protect brain tissue from degradation. As mentioned earlier, this has implications for the prevention of conditions like Alzheimer’s disease, Parkinson’s disease, and epileptic seizures.

Hopefully, in the not-too-distant future research will also focus more on the athletic performance benefits of exogenous ketones, specifically with regards to resistance training and cardiovascular exercise. The data on each of these applications is very limited at this time.

Takeaways

Exogenous ketones are becoming a popular topic of research. Importantly, research aims to validate their various uses (physical performance, weight loss, neuroprotective effects etc.). While there is good research on many of these, more data is needed to provide conclusive evidence.

Exogenous ketones, especially Ketone esters, achieve ketosis without following a ketogenic diet. But they must be consumed regularly to maintain ketosis. If Ketones are readily available then they may be used preferential over carbohydrates and fats when exercising. Even in highly glycolytic (carbohydrate) activities, such as sprinting.

Exogenous ketones certainly appear to have strong health and longevity properties at this point, especially for reducing the risk of cancer and possibly preventing/reversing type-2 diabetes.

 


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