Keto Academy and Exogenous Ketones
Have to say that, absent some studies backing this, I’m not convinced.
There is some evidence I’ve seen that exogenous ketones may be beneficial for some brain disorders, but for the rest of us, ketones are a byproduct of eating keto, not necessarily a cause of the health benefits of eating keto. If you take exo ketones and still eat carbs, you are doing exactly nothing to help with insulin, which drives a great deal of the downsides attending the standard American diet.
And as @richard likes to point out, taking exogenous ketones when you’re supplying your body glucose is just making really expensive pee. If you have sufficient body fat, you can make more ketones than your body can use.
Everyone is free, of course, to use and eat what works for them. I have seen no scientific literature to suggest that exogenous ketones are beneficial to the general public, particularly in the context of carb consumption, and it seems that most people who recommend them have a commercial interest in selling them. Nothing wrong with recommending something you sell, but it shouldn’t be surprising that a self-interested recommendation receives some skepticism.
This is a very strong and troubling statement to me. We should be teaching our kids to “worry” about their diets by encouraging them to eat real food, not drink lab-made supplements whose long term effects on rapidly developing bodies is, at best, unknown. I’m sorry if this seems harsh, but at some point product pushing needs to be met with, well, some pushback. Especially for unverified and potentially dangerous claims regarding children and supplements.
One of the problems I have with exogenous ketones is that eating them is a different context than making them.
When we make them it’s because we are eating a high fat diet, and burning body fat for energy. The context is that we need to have ketones in our blood because glucose is low and insulin is low and that is the only context in which we make them.
We make 2 kinds of ketones, AcAc (acetoacetate) and BOHB (betahydroxybutyrate) and the ratio in which we make these is determined by the ratio of NAD+ to NADH in our cells. These are critical control levers for our metabolism called our redox state that affect systems throughout the body.
Finally there are actually 2 kinds of BOHB, it is what we call a chiral molecule, which just means it comes in multiple shapes - called stereo isomers. A left handed one (L-BOHB) and a right handed one (D-BOHB) each one a mirror image of the other.
We have only ever made D-BOHB and making and using that is a process that our ancestors have done for roughly 3 billion years … so we are good at doing that. You can think of it like the L-Tetris block we make the right kind to fit into the right hole. Same pattern, but mirror images.
Contrast all that to what happens when we EAT ketones
They are now present in our circulation WITH glucose and insulin, which is not a context our body has evolved to deal with. Dr Benjamin Bikeman gave a good talk about this at Brekenridge.
The TLDR version is there are a LOT of systems that can go slowly haywire over decades when the body experiences that kind of mixed message, not least of which is making both obesity and diabetes worse.
Secondly when we make BOHB we are making it out of AcAc and we are converting that in the ratio determined by our NAD+/NADH ratio.
D-BOHB + NAD+ ⇋ AcAc + NADH + H+
When we eat BOHB (which is what most exogenous ketones are) then we are putting our thumbs on the scale of our NAD+/NADH state. In essence we are removing some NAD+ to a sensitive ratio that controls reduction/oxidation processes throughout the entire body. You might think that scientists like DOm D’agostino and Jake Wilson have looked into what that means … but if they have they have yet to publish a paper on the topic.
Finally when we make BOHB in the lab, we make equal amounts of the D-BOHB that we have 3 billion years experience in using … and equal amounts of the L-BOHB that we have less than a decades experience in using.
It’s the other kind of L-Tetris shape
We don’t even know precisely what happens to L-BOHB as the enzyme that converts D-BOHB into AcAc so we can use it ONLY works with the D- form. Does the L-BOHB just hang around gumming up the works, or does it use some as yet unknown pathway that puts pressure on a different part of our metabolism, or does it compete for transport with critical metabolytes.
No-one knows.
Given we have less than a decade of data - what happens to young fit people who take a caloric amount of this stuff for a considerable fraction of their lives?
You might think that … well it’s the same chemical, just a mirror image version. What’s the harm?
There was once a chemical that was found to be especially effective in reducing nausea especially morning sickness during pregnancy. It was a chiral molecule too, one that has a mirror image. The one that caused the intended effect was the right handed (R-) form, the other left handed (S-) form was not as well researched.
Well it turned out that when this molecule was eventually manufactured in an industrial process they naturally made both molecules. It turns out that S-Thalidomide is teterogenic and caused 10,000 children to be born with limb deformities.
As podcasters Carl and I have been offered complimentary exogenous ketones from multiple suppliers, offered a lot of money to let them advertise on our show or have a booth at ketofest, put sponsored posts about exogenous ketones in our forum.
Personally I think we need to know the answers to THESE questions before we put our health at risk.
- Is there any benefit to type 2 diabetics and the obese of exogenous ketones
- What is the effect of Glucose, Insulin and BOHB coexisting in concentration in circulation
- What are the acute and chronic effects of wrenching the Re/Dox state
- How is L-BOHB metabolized
- Is a caloric amount safe
- Is a caloric amount over a significant fraction of a human life span safe
I can make ketones any time I need to by just not eating carbs … or if I really want to make ketones in bulk by eating medium chained triglycerides. The right kind of ketone, in the right context. That’s good enough for me.
What's the benefits of drinking ketones
Bhb Salts..any suggestions on brand that really works
Ketone supplements?
Studies using ketone salts and esters
Hi Andrew. Thank you for your input. I really appreciate it as I think open dialogue is a great way to sharing information.
It has been my experience that those who take exogenous ketones, usually are introduced to them before they have ever heard of a Ketogenic diet - that was certainly the case for me. However, once people begins to feel better and look better they start to do better. They start to make better food choices, they begin to move more they become more active. You are right that to keep a high carb diet and drink ketones would be pretty silly.
As for research - did you know hat it can take up to 17 years of research before it goes to clinical trials? However keto community is pushing things forward at a rapid pace. Because people are giving feedback to the changes that are happening, more independent research is now being done. I have also heard antidotal testimonies from people about how this has changed their lives. There are doctors and medical professionals that are using it and giving it to their patients. This has been my experience and I think there are many ways to be at your best and sometimes it takes some tweaking and finding what works best for each individual.
I work for a non profit and have done my entire adult life. I work with premed students and you bet I tell them about a ketogentic diet before they get to med school!!!
Hi Richard.
Thank you so much for taking the time to write your response. I really admire your work and your knowledge on the Ketogenic lifestyle and how you relay that to everyone. I was listening to Dr Jacob Wilson talking about the Tetris analogy the other day. What I do know is that there are people that are people having incredible results and have been sharing this back to researchers and that it is driving research forward. Which I think is a great thing. There are a great many people that have had significant changes in their health because of exogenous ketones. I think of it as a starting block. It’s a way to get you on the right foot and get you going. I never would have known about the Ketogenic diet or what it was all about unless I had heard of exogenous ketones. For me, it has helped me immensely and now I have changed my life. I follow a keto/low carb woe and I do intermittent fasts and longer fast - I try and participate in the Monthly fast each month!
I love this community and I love how we all share and support each other. It’s nice to come to a place where you are not feeling like an outsider because of the way you eat. My doc gave me the eye roll when I told him what I was doing but raised his eyebrows when he read my blood work results for my annual check up! 
Hi there. I don’t mind your pushback. Sorry, sometimes I don’t explain myself well. When I was talking about children I was thinking of stories from parents and medical practitioners who shared with me how it had helped their kids with ADD/ADHD and autism spectrum. Sometimes a restricted diet is difficult for children or young adults to maintain because of food sensitivities or taste or textures. They found it was very helpful for them with a drink and the benefits they saw in their children was pretty amazing. They were speaking from their experiences and I thought it was incredible because I understand how hard it can be to feed a picky eater - I can’t imagine what it might be like for someone with sensitivities. Some families are also vegan, vegetarian or have other reasons they can’t do a keto diet.
Again, I have heard from people who have said it helped them immensely.
I suspect some of that apparent effect may be caused by a drop in appetite because of a sudden over supply of energy in circulation. You would notice that. You might also notice that you feel mentally clear when you have ketones fueling your brain. Ketones do feel great.
You wouldn’t burn fat, tho. You wouldn’t need to burn any as you now have an abundance of energy. Your insulin might rise just to lock energy into adipose tissue. And if you had too much energy in circulation you might actually turn some of those ketones into new palmitic fatty acids (de novo lipogenesis) that insulin would help you store in body fat.
If you were trying to not eat carbs then the other thing you wouldn’t notice is that you would still be needing to make glucose but now you don’t have the glycerol from the triglycerides (which you aren’t burning) as a substrate, so you would need to draw down even more lean mass to fuel that.
So over time you’d be using less body fat, using more lean mass - your body composition could be going in the wrong direction.
You might feel much the same if you have 3 mmol/l of ketones from making them, and 6 mmol/l of racemic (left and right handed) ketones from eating them.
You have roughly 5 litres of blood, so you’d have (3x5=)15 mmol of D-BOHB and 15 mmol of L-BOHB.
Eventually your body uses the 15 mmol of D-BOHB, you lose the great feeling and you test and now you are out of ketosis. NOTE: Ketone testing strips only register D-BOHB ( they use the same enzyme that only works with the D- form of the stereoisomer).
So now you take another hit, you now have another 15 mmol of D-BOHB again and feel awesome. But here’s the thing. Noone knows how much L-BOHB you have in circulation. Do you now have 15 mmol, or do you have 30 mmol? You can’t test it, you can’t feel it, you can’t use it.
Does the body clear it? What does it make it into? Does it clear it at the same rate as it clears D-BOHB. As far as I can tell no-one knows the answer to that, and no one who sells them (or holds patents in processes to make them) wants to know the answer to that question.
Ok, fair enough. That’s a much different statement than what I originally interpreted (i.e., all children). I don’t know enough about the science of exogenous ketones in the context of ADD/ADHD/Autism, so I can’t comment further, other than to state, as a father, the science of exogenous ketones is too new for me (and for my children). In my view, we, as parents, don’t have the moral license or luxury of looking back and saying “oops.”
So, to sum up, the effects are probably superficial at best, and maybe a degree of placebo effect. With unknown impacts from the unwitting by-products within the ketones, this sounds like another in a long line of taking advantage of emerging science to sell snake oil at high profit margins. Or am I just cynical?
Hi Rob.
What my experience has been has not been superficial. I understand that you may not want to use exogenous ketones but I have had significant changes with my health and I know many others that have as well. There are countless stories of people who have benefited from them. You may not want to try them, or believe in them or maybe you want to wait for more research - ironically I also get this response from people who don’t believe in a Ketogenic diet. But I know what has worked for me. I think we are all in on a movement that is huge. We are all changing people’s concepts with what the American diet should be. I think it’s amazing.
I don’t have any fancy data to back it up, but I use exogenous ketones before my heavy leg days at the gym, and when I am having a long day at work. Dom D’Agistino discusses in his recent podcast with Joe Rogan that he feels better when his ketone levels are higher, and he can only get there by supplementing.
I have not seen an issue with my weight loss, and I feel awesome using them. If used as a “quick fix” for weight loss or to try and cancel out eating carbs, then yes, they are a giant waste of money.
However, if used thoughtfully alongside a ketogenic diet, I really have found them to be an awesome tool
I wonder if the exogenic ketones can damage the metabolism over a period of time? e.g. just because you see indications of ketones in blood, urine or breath from this external source; are you observing a non-functioning (symbiosis) suspension of exogenic ketones floating around in the body chemistry and assume we are in endogenic/organic (other than a non-fat burning benefit) Ketosis?
What is that actually doing to our over all metabolic fitness and processes or making the body dependent on an external source to the point when we decide to stop the external supply we open a Pandora’s box on our body?
This sounds more like a Rabbit Hole money making scheme than organic science!
A little disturbed by this!
I’m happy for your n=1 be it real or placebo effect but you have a self confessed promotional agenda which makes it harder to believe the pitch in the absence of real science (not just longitudinal studies) or more than anecdotal evidence.
A doctor friend told me recently that I sounded like an anti-vaxxer when I was explaining the appalling lack of science and wrong-headed guidance in most mainstream nutritional advice. I said that I could hear that in myself but the key difference is that Keto and the overturning of most nutrition conventional wisdom has full scientific and broad experiential backup. You must admit that most fads and scams sound exactly like that (take a grain of truth and then add something unproven to make money from suckers) but this makes Keto the exception, not the model to offer false credibility to anything else.
Just my 2c.
Hi Capbob.
I said I promote it because I wanted to be transparent and truefull and it was from a comment from my original post - which I had not yet become a promotor but basically wanted to say I do know because I believe in it. I have a lot of respect for this community and am really one of you. I may not be as strict in the guidlelines that you follow, but I do what works for me, and it seems I’m not alone on here. My doctors results are no placebo effect, nor are they for many many people I know.
I did not actively promote here. I was cautioned by Daisy as my post sounded like a pitch and that was not my intent. I don’t even have anything on my bio to promote any product or affiliation, I have never PMd anyone to tell them about the product to solicit them. I wouldn’t do that. it’s just my story and journey. I believe that there are many ways to live a keto lifestyle and I believe we all have the right to our opinions.
Disagreement is not the same as suppressing your speech (#1 damn rule of the Internet). You made your point, some people agree, some disagree. Feel free to keep on with your POV here (not that you need my permission).
I’m sure you were just being transparent (after admin intervention), but all good sales pitches also have a solid bit of ‘open and honest’ to kick them off - just Sales 101. How is anyone able to tell the difference?
You’re right. I’m sure you have heard lots of sales pitches and of course you don’t know me so you don’t know my intentions or my heart - but I do work for a non profit. I have for over 15 years. It’s my passion and my heart. I work with premed students and teach them about relationship centered care. I also tell them about the Ketogenic diet as I believe they need to know before they go the med school. I promote because I believe in the product but that is because of my experience.
Anyway. Happy holidays. Love peace and happiness everyone.