There are three ways to raise blood levels of ketones and obtain the potential benefits from them: physiological ketosis via strict carbohydrate limitation or fasting; supplementation of medium-chain triglyceride (MCT) oils that are metabolized in the liver to ketones; and actually taking the ketone, beta-hydroxybutyrate. In this Undoctored Blog post, I’d like to discuss exogenous ketones. While fascinating with potential for substantial health benefits, there are some very real dangers with the current products on the market, so much that I have reported two of the products to the FDA.
This is part of the expanded health discussion I begin in the new Undoctored book, Undoctored: Why Health Care Has Failed You and How You Can Become Smarter Than Your Doctor, with a comprehensive discussion of all aspects of ketosis in the Undoctored Inner Circle Advanced Concepts, the membership site for the truly serious Undoctored follower. You will also find a brief conversation about what I call “Assisted Fasting” using MCT oils in this video.
Early research on supplemental exogenous ketones demonstrated fascinating effects, such as protection from hypoglycemia (as ketones are an alternative source of brain energy), protection from seizures (including in Navy seals who breathe high levels of oxygen that can cause fatal underwater seizures), and improved aerobic performance in trained athletes.
More recent research has uncovered or confirmed additional effects of supplemental exogenous ketones:
- Improved endurance and aerobic performance in athletes—-Indeed, many professional athletes are supplementing exogenous ketones.
- Modest increase in muscle growth with exercise; less muscle lost with weight loss
- Greater fat burning (oxidation) during exercise, less reliance on glycogen/sugar
- Reduced insulin resistance
The effect on weight and whether exogenous ketones might be a strategy for enhancing weight loss are simply not yet clear given current data.
Exogenous ketones generate higher levels of blood ketones than MCTs, about 10-fold higher. While the low ketone levels generated by MCT supplementation have been demonstrated to partially reverse the memory deficits of Alzheimer’s dementia, exogenous ketones have the potential for greater memory-improving effects, with maximum effect likely occurring at a beta-hydroxybutyrate blood level of 4 mmol/L or higher, the level at which ketone transport into the brain is maximized. No clinical studies with exogenous ketones on dementia have been performed yet, however.
Another exciting but speculative application of exogenous ketones is in cancer treatment. Because cancers are known to be glucose-dependent (accounting, for instance, for increased labeled glucose uptake on PET scans), could cancer be reduced/reversed by administering insulin to lower blood glucose to levels that would otherwise be fatal by concurrently administering exogenous ketones to provide an alternative source of energy not usable by cancer cells? The feasibility of this combined treatment has already been demonstrated, but efficacy in treating cancer has not.
Ketones themselves, such as beta hydroxybutyrate, because they are already a physiologically generated compound, are harmless and potentially beneficial at the levels that are achieved with these products.
All these products, however, share a problem: Because of the volume of ketones required for perceptible physiologic effects, large quantities of calcium, magnesium, potassium, or sodium are required (because beta hydroxybuyric acid requires a positively-charged mineral in order to be stable). In particular, excessive calcium and potassium intake are issues, particularly if these products are used more than once per day and/or taken frequently or chronically. The Kiss My Keto product, for instance contains 1240 mg calcium per serving. Taking this product three times per day yields a potentially toxic 3720 mg calcium per day. Recall that daily supplemental intakes of calcium of 500 mg per day or more have been associated with increased cardiovascular risk, i.e., cardiovascular death, despite the fact that many physicians continue to advise daily intakes of calcium of around 1500 mg per day for bone health (that does not yield increased bone density nor reduction in bone fracture incidence). Many of these products provide 1000 mg per dose or more. If taken more than once per day, exposure to 2000, 3000 mg or more of calcium is possible, a dangerous level of intake.
Other products, such as InstaKetones (unflavored version) and Nutricost 4-in-1, yield potentially toxic levels of potassium that, especially if taken more than once per day, can increase risk for sudden cardiac death within weeks. (I have brought this issue to the attention of the companies and the FDA.) Excessive blood levels of potassium (hyperkalemia) yield heart rhythm instability and sudden cardiac death. Single occasional doses of this product would likely not yield risk in people without kidney disease or a history of high potassium blood levels, but repeated use, especially more than once per day, can yield dangerous blood potassium levels. I would urge you to absolutely steer clear of the InstaKetones and Nutricost products because of this.
Cost is another issue with most products costing around $4 per dose. Multiple daily dosing is therefore not only potentially dangerous, but also costly.
These are therefore real potential problems with the current formulations of exogenous ketones. Until these issues are addressed and safer preparations are formulated, nobody should be taking these preparations more than once per day. The products with high potassium should be avoided altogether and should be removed from the market or reformulated by their manufacturers.
Given the substantial problems with current exogenous ketone preparations, the only products that are recommended as safe are Perfect Keto, KetoBlitz, and Pruvit, with no more than once per day dosing.
For the full discussion about ketosis, including detailed resources for safe exogenous ketone products, see the Undoctored Inner Circle Advanced Concepts.