I just read your comment and was wondering the same thing. I can see how exogenous ketones can be a great energy boost to people on the ketogenic diet, but I don’t see how they can speed fat loss. Keto OS claims you can eat higher carbs and still see the benefits of ketosis. I don’t see how that is possible. the whole point of weight loss through ketosis is the breaking down of your own fat to create energy. I don’t see how exogenous energy will increase natural fat breakdown. I wish I could get a straight answer to this from somebody.
Ketone supplements contain exogenous ketones—synthetic ketones made in a lab. Most use a type of ketone called beta-hydroxybutyrate (BHB), which is the same as the ketones the body produces naturally. “We’re literally biohacking," says Amie Heverly, who began taking a ketone supplement called Prüvit last year and now works as a promoter selling Prüvit products. "You’re not adding a foreign substance to your body, because BHB is identical to what your body would naturally produce,” she explains.

A growing number of people are giving it a try, thanks to exogenous ketone supplements that claim to launch your body into a state of ketosis within two and a half days—even if you’ve been living on pasta and cookies instead of following a low-carb diet. How can that be, though? And can that kind of rapid transformation actually be safe? Here’s what you should know.
We designed a test for each of the chosen benefit claims and enlisted the help of four of our Diet Doctor teammates to try out the supplements and go through the testing. They were Jonatan and Giorgos from the video team, Emőke from the recipe team and Erik from the IT team. We had a mix of people who were naturally in endogenous ketosis during testing, and people who were not.
Hybrid strategy: A hybrid strategy is to follow a low-carb/high-fat ketogenic diet to induce nutritional ketosis and use ketone supplements strategically. Supplements like Ketone salts or MCT oil can help ease the transition into ketosis, they can be an effective tool when we are knocked out of nutritional ketosis and they can help push ketone levels higher in the body for added benefit.
That said, there also remains the question of the relative benefits of AcAc versus BOHB, both as independent signaling molecules and as redox modulators in peripheral (aka non-hepatic) tissues. Seen from this perspective, AcAc generated in the liver acts as a NAD+ donor for the periphery, whereas pure BOHB taken orally, to the extent that it is retro-converted to AcAc (Sherwin 1975), potentially deprives the periphery of NAD+.

All of the data I’ll present below were from an experiment I did with the help of Dominic D’Agostino and Pat Jak (who did the indirect calorimetry) in the summer of 2013. (I wrote this up immediately, but I’ve only got around to blogging about it now.) Dom is, far and away, the most knowledgeable person on the topic of exogenous ketones. Others have been at it longer, but none have the vast experiences with all possible modalities (i.e., esters versus salts, BHB versus AcAc) and the concurrent understanding of how nutritional ketosis works. If people call me keto-man (some do, as silly as it sounds), they should call Dom keto-king.
Great question. So if you are already in nutritional ketosis from your diet, exogenous ketones would still help raise ketone (energy) levels when you want that (maybe for focus at work or energy at the gym. They also help get you back into ketosis after cheat meals and skip the “keto flu” which is the period when your body is using up stored glycogen.
About the only other negative thing I have heard about the company is that if you are placing an order over the phone, they don’t answer too many questions. Instead, they refer you to their website. Their website is very informative and pretty much answers any question you might have. Ketōnd has gotten too popular, and the company had to hire an answering service like they are selling George Forman Grills or something to take calls from around the world 24-7. I know it’s popular all over Europe and Australia too. My buddies that compete in Crossfit swear that this stuff gives them the edge.
To determine the reason for the differences in blood d-βHB concentration, the KE and KS drinks were analyzed for enantiomeric purity. The KE contained >99% of the d-isoform, whereas ~50% of the KS βHB was the l-isoform (Figure ​(Figure1D).1D). Plasma samples from participants who consumed the high dose KS drink (n = 5) were analyzed to reveal higher l-βHB than d-βHB, the total βHB Cmax being 3.4 ± 0.2 mM (Figure ​(Figure1E),1E), with a total βHB AUC of 549 ± 19 mmol.min. After 4 h, plasma l-βHB remained elevated at 1.9 ± 0.2 mM; differences in urinary excretion of the two isoforms could not explain this observation as both d- and l-βHB were excreted in proportion to their blood AUCs (Figure ​(Figure1F).1F). Therefore, in order to determine the time required for l-βHB elimination, a follow-up experiment was undertaken in which subjects (n = 5) consumed 3.2 mmol.kg−1 of βHB as KE and KS with hourly blood and breath sample collection up to 4 h, plus additional samples at 8 h and 24 h post-drink. l-βHB was found to be 1.1 ± 0.1 mM at 4 h, and 0.7 ± 0.2 mM after 8 h, but undetectable after 24 h (Figure 1G). Low amounts of d-βHB (0.3 ± 0.1 mM) were present at 24 h, presumably due to endogenous production. Both ketone drinks significantly increased breath acetone concentration, but at a slower rate than blood d-βHB, reaching a peak after 3 h that was twice as high following the KE (87 ± 9 ppm) than the KS (44 ± 10 ppm), suggesting that d-βHB was readily converted to acetone, but l-βHB was not (p < 0.005, Figure ​Figure1H1H).
The many roles of magnesium include helping us maintain normal nerve and muscle function, as well as heart rate, supporting a healthy immune system, regulating blood glucose levels, and making energy production and protein synthesis possible[23]. Magnesium is also involved in both aerobic and anaerobic energy production. ATP synthesis (the body’s energy source) depends on enzymes that are activated by magnesium.
A sound sleep is highly associated with the dark. Also, studies have proven that our body’s natural defense mechanisms against cancer cells get activated in the absence of light (that’s why sleeping is the best way to natural healing). So turn off all the lights, TV screen, lamps, and all other light emitting devices at least 30 minutes before going to sleep. With this trick, you are actually preparing yourself to fall asleep.
I had heard horror stories about how bad ketone esters tasted (like “rocket fuel”!) so was prepared for the worst. I followed their instructions and drank the contents of the bottle in one gulp, then chased it with a sip of sparkling mineral water. While not the most pleasant aftertaste, the flavor wasn’t any worse than after a shot of well tequila. Within 15 minutes I was already well into therapeutic ketosis, and after 30 minutes my ketone meter displayed a “HI” error message (meaning my level was greater than 8.0 mmol/L)!
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.
Those new to keto should be testing to see if their bodies are in ketosis, regardless of method. Testing, in general, is the most objective way to know if you’re in ketosis. There can be some subjective benefits of ketosis: appetite suppression, fat loss, low blood sugar, improvement in mental cognition and focus. But before recognizing these subjective benefits, it’s important to track and measure the level of ketones in the blood to ensure ketosis on a physical level.
The liver is always producing ketones to some small degree and they are always present in the bloodstream. Under normal dietary conditions, ketone concentrations are simply too low to be of any significant benefit. A ketogenic diet and exogenous ketone supplements will increase the amount of ketone in your body. The idea that ketones are “toxic” is ridiculous. Ketones are a normal physiological substance that play many important roles in the human body.
Exogenous ketones (also known as ketone supplements) and well-formulated ketogenic diets share at least one thing in common. They both result in increased circulating concentrations of beta-hydroxybutyrate (BOHB), but ultimately are associated with very different patterns of ketosis, as well as differing metabolic and physiologic outcomes. In short, they should not be assumed to have equivalent effects simply because they achieve similar BOHB blood levels. Having said that, there are many reasons we should continue to study the various forms and potential applications of ketone supplements.
That’s not all. Though Prüvit in particular has a legion of fans (the brand has nearly 35,000 Instagram followers and some 256,000 likes on Facebook) and a small team of affiliated medical experts, there’s no hard science on Prüvit or similar products. (Prevention reached out to several Prüvit experts and employees for interviews but did not receive a response.) The research page on the brand’s website does include links to legit scientific studies. But the studies are on the keto diet—not on Prüvit’s products. When it comes to research on the actual supplements, the brand’s website simply says “Human studies on finished products (underway) at various universities and research facilities.” In other words, there’s no scientific evidence available yet to show that they actually work.
In a keto-adapted individual where ketone metabolism is brisk with up to 100 grams or more being oxidized (i.e., ‘burned for energy’) daily, the small amount lost in breath and urine as acetone is minor. But because this breakdown occurs spontaneously without needing the help of enzymes, it also happens to AcAc in a stored beverage or food (even in an air-tight container), making the shelf-life of AcAc-containing products problematic. Thus all current ketone supplements consist of BOHB in some form rather than the naturally occurring mix of BOHB and AcAc produced by the liver.
One monk, for example, set out to do a 40 day fast with medical supervision while maintaining his daily activities in the monastery. After 36 days, the medical professionals had to step in due to “profound weakness” and low blood pressure when standing. Although the monk fasted for 15 days longer than Ghandi, the medical professionals were able to stop the fast in time so that he could recover.

Hi all…thanks for your articles and info. I am currently on a paleo diet, but want to lose more weight and bring it up a notch w/ ketogenic diet and be in ketosis. Not sure which product is best? Do you take the MCT oil and also a ketone powder. I know it may be difficult at first, but I am up for the challenge as we start the new year and would like to loose 40 lbs by May/June. Please advise as to what products are best so I can purchase. THANKS
The “BHB salt” is simply a compound that consists of sodium (Na+), potassium (K+), and the ketone body β-hydroxybutyrate.  In supplements like Pruvit’s Keto OS  these individual components are being held together by ionic bonds; however, when you consume the product, it is absorbed into the blood where it dissociates into free Na+, K+, and BHB since it is a water-based solution.  Thus, consuming the product directly and immediately puts more ketones into your blood.

Importantly, at Diet Doctor we do not think you need to spend any extra money at all in order to revolutionize your health. You can achieve radiant health just by enjoying authentic food that is naturally low in carbohydrates, getting plenty of sleep and some exercise (going for a walk is free) and reducing stress. A lot of you who answered the survey made exactly these points in your explanations of reasons for not taking the supplements. I whole-heartedly agree.


North Americans typically live pro-inflammatory, pro-disease lives (think about your everyday: likely sitting in a flexed position for hours on end, not enough natural sunlight, not enough movement, artificial food stuffs, artificial colouring, going to bed late, blue light exposure, less in-person contact with our loved ones, late night snacks, the list goes on and on).
Although most of the research has been done utilizing ketone esters, ketone salt supplementation has the potential to provide additional benefits through the extra electrolytes/nutrients that are required to make the ketones. While ketone esters are expensive due to the manufacturing process involved in making them, ketone salts might be a more convenient option for both inducing a state of ketosis and elevating blood ketone levels for various reasons we will discuss in another article.
This is delicious! I'm not sure what people are talking about when they say it tastes bad. I put a half scoop only (because its soooo expensive) in my iced coffee with have cream every morning and it tastes better than it ever did without. I'm not sure its really working and it does upset my stomach. I will have to get some strips to check ketosis and will come back to update. I think I'll probably still only give three stars though because it is WAY WAY WAY OVERPRICED! I can't believe how small the container was when it arrived for almost $60!! Even if it works, and it does taste delicious, I can't justify this kind of price point. This is such a bad business model. You probably get people to buy this once, maybe twice at this price, whereas if you made it more affordable, like double the product (an actual month's supply) you'd have customer's for life! Drop the price and I will buy again for sure!
Effects of ketone supplementation on organ weight: Data is represented as a percentage of organ weight to body weight. a, b, d, f Ketone supplements did not significantly affect the weight of the brain, lungs, kidneys or heart. c Liver weight was significantly increased as compared to body weight in response to administered MCT ketone supplement compared to control at the end of the study (day 29) (p < 0.001). e Rats supplemented with BMS + MCT, MCT, and BD had significantly smaller spleen percentage as compared to controls (p < 0.05, p < 0.001, p < 0.05). Two-Way ANOVA with Tukey’s post-hoc test; results considered significant if p < 0.05. Error bars represent mean (SD)
Perfect Keto MCT Oil Powder is number one on this list for a few different reasons. The company is founded by functional medicine clinician Dr. Anthony Gustin and each ingredient is used in specific amounts to provide maximum ketone benefits. They use zero binders and fillers often found in other MCT oil powders. It’s a premium product and they don’t make up for it by jacking up the price. However, number 3 on this list has a very similar product at a better value. That’s what keeps this from being a complete 5. However, it’s quality is one of the very best. This MCT Oil powder is one of the only MCT powders that uses ZERO additives and fillers.
For all studies, the area under the curve (AUC) of blood [βHB] was calculated using the trapezium rule. In Study 3, for each of the three drinks, the initial rate of d-βHB appearance was estimated using d-βHB concentrations at baseline and 30 min post-drink, and d-βHB elimination was estimated using the AUC between the post-drink peak (60 min) and trough (180 min) d-βHB concentrations, with a baseline correction to the value at 180 min.
How did I do this? Simple, I went into a full fast and exercised. What prevents you from entering ketosis is all the glycogen stored in your liver and muscles. Your body can use this glycogen instead of ketones to fuel your brain, so until you deplete your stores of glycogen, you won’t be able to enter ketosis. By eating nothing, you are going to tap into the glycogen to fuel your brain because you are eating 0 grams of carbs and will also be using that glycogen to walk around all day.
Are you ready for a very basic metabolism overview? Most modern humans break down carbohydrates into glucose and this then breaks down further and enters mitochondria to produce ATP, which is the energy system of your cells. In other words, you use carbs for energy. When you are on a ketogenic diet, you are breaking down fats into things called ketone bodies, and this is how you provide your body with energy, instead of via carbohydrates. So, you’re either using carbohydrates for fuel or fat for fuel. 

When choosing an exogenous ketone supplement, make sure to read the ingredients carefully. Brands that have a “proprietary blend” don’t allow you to see the quantities of each ingredient in their mix. You should know every detail about the supplements you choose, so you know exactly what is affecting your body, and you have control over the variables of your intake.
Currently, we lack enough evidence to change the recommendations for calcium intake. The Tolerable Upper Intake Level (UL) for adults 19-50 years old is 2500 mg. This is well over the RDA of 1000 mg for the same age group. Calcium supplements commonly contain 600-1200 mg. When assessing your own calcium intake, keep in mind that calcium from food sources and calcium from supplements may have different outcomes.
However, it's important to NEVER overlook the power of exercise and of course sticking to a proper routine to get the most optimized results. The most common mistake people make is by treating any keto supplement like a "wonder drug" that will help them shred weight in their sleep. Seriously... how is that even scientifically possible. So if you are thinking about trying out a particular supplement, I would suggest two things:
Plasma glucose, free fatty acids (FFA), triglycerides (TG) and urinary d-βHB were assayed using a commercial semi-automated bench-top analyzer (ABX Pentra, Montpellier, France), and insulin was measured using a commercially available ELISA assay (Mercodia, Uppsala, Sweden). Both the pure liquid KS and KE, and a subset of plasma (n = 5) and urine (n = 10) samples from a subset of participants in Study 1 underwent analysis using GC-MS and a chiral column, and the concentrations of l-βHB was calculated using the enzymatically determined concentration of d-βHB and the ratio of the d/l-βHB peaks obtained through GC-MS. Acetoacetate was assayed using an enzymatic method (Bergmeyer, 1965), and breath acetone was measured using GC-MS (Study 1) or with a handheld electrochemical device (Study 2; NTT DOCOMO, Japan) (Toyooka et al., 2013).
The way you make an exogenous BHB is by attaching it to some type of other compound (sodium, potassium, calcium, or magnesium) so that your body can process the molecule by cleaving the bond between the salt and the beta hydroxybutyrate. BHB + bound to a salt = BHB salts, which is what most people in the ketosis community call exogenous ketones. There are also things called esters, which are basically unbound BHB molecules. These are really disgusting and cause massive digestive issues, so I like to ignore them until we can produce them in a more appealing way.

Testing BHB levels in the blood is simple but can get pricey if you are doing it many times a day.  The Precision Xtra blood glucose and ketone meter is a good buy at $28-$30.   The expensive part is the ketone test strips here which can cost $4 each.   If you are looking at testing yourself every day it is going to cost you $120 a month and the $30 meter.  Here is a starter kit you can get on Amazon.
The ketone supplements were associated with a 5.4% decrease in physical performance while the artificially-sweetened, non-caffeinated beverage I used as a placebo was associated with a 20.3% increase: a big difference in favour of the placebo. Before you go rushing out to buy some, remember that this experiment was not performed under fully-controlled, laboratory conditions, and we were working with too small a group to prove that the placebo caused an increase in physical performance. But what we can say is that we couldn’t find any correlation between ketone supplements and an increase in physical performance in this experiment. According to Brianna Stubbs, some of the work currently being done on new kinds of ketone salts is starting to show more promise in relation to physical performance, so there may be better news on this down the line.
It's a common misconception among those who are trying to lose weight that fat is dangerous, but this is not the case at all. You will need to rely on healthy sources of fat to reach ketosis, and this can be achieved by choosing the right type of food. Go with those that contain butter, olive oil, coconut oil and avocado oil, among others. Opt for oils that are not heavily processed so you can get the most benefits out of them.
MCT oil has recently been used to induce nutritional ketosis although it produces dose-dependent gastrointestinal (GI) side effects in humans that limit the potential for its use to significantly elevate ketones (>0.5 mM). Despite these limitations, Azzam and colleagues published a case report in which a 43-year-old-man had a significant decrease in seizure frequency after supplementing his diet with 4 tablespoons of MCT oil twice daily [96]. An attempt to increase his dosage to 5 tablespoons twice daily was halted by severe GI intolerance. Henderson et al. observed that 20 % of patients reported GI side effects with a 20 g dose of ketogenic agent AC-1202 in a double blind trial in mild to moderate Alzheimer’s patients [24]. We visually observed similar gastrointestinal side effects (loose stools) in the rats treated with MCT oil in our study. Rats were closely monitored to avoid dehydration, and gastric motility returned to normal between 12–24 h. Interestingly, the BMS + MCT supplement elevated βHB similarly to MCT oil alone, without causing the adverse gastrointestinal effects seen in MCT-supplemented rats. However, this could be due to the fact in a 10 g/kg dose of BMS + MCT, only 5 g/kg is MCT alone, which is less than the 10 g/kg dose that elicits the GI side effects. This suggests that this novel combination may provide a more useful therapeutic option than MCT oil alone, which is limited in its ability to elevate ketones in humans.
Ketone supplementation did not affect the size of the brain, lungs, kidneys or heart of rats. As previously mentioned, the rats were still growing during the experimental time frame; therefore, organ weights were normalized to body weight to determine if organ weight changed independently to growth. There could be several reasons why ketones influenced liver and spleen weight. The ratio of liver to body weight was significantly higher in the MCT supplemented animals (Fig. 5). MCTs are readily absorbed in the intestinal lumen and transported directly to the liver via hepatic portal circulation. When given a large bolus, such as in this study, the amount of MCTs in the liver will likely exceed the β-oxidation rate, causing the MCTs to be deposited in the liver as fat droplets [94]. The accumulated MCT droplets in the liver could explain the higher liver weight to body weight percentage observed with MCT supplemented rats. Future toxicology and histological studies will be needed to determine the cause of the observed hepatomegaly. It should be emphasized that the dose in this study is not optimized in humans. We speculate that an optimized human dose would be lower and may not cause hepatomegaly or potential fat accumulation. Nutritional ketosis achieved with the KD has been shown to decrease inflammatory markers such as TNF-α, IL-6, IL-8, MCP-1, E-selectin, I-CAM, and PAI-1 [8, 46], which may account for the observed decrease in spleen weight. As previously mentioned, Veech and colleagues demonstrated that exogenous supplementation of 5 mM βHB resulted in a 28 % increase in hydraulic work in the working perfused rat heart and a significant decrease in oxygen consumption [28, 41, 42]. Ketone bodies have been shown to increase cerebral blood flow and perfusion [95]. Also, ketone bodies have been shown to increase ATP synthesis and enhance the efficiency of ATP production [14, 28, 40]. It is possible that sustained ketosis results in enhanced cardiac efficiency and O2 consumption. Even though the size of the heart did not change for any of the ketone supplements, further analysis of tissues harvested from the ketone-supplemented rats will be needed to determine any morphological changes and to understand changes in organ size. It should be noted that the Harlan standard rodent chow 2018 is nutritionally complete and formulated with high-quality ingredients to optimize gestation, lactation, growth, and overall health of the animals. The same cannot be said for the standard American diet (SAD). Therefore, we plan to investigate the effects of ketone supplements administered with the SAD to determine if similar effects will be seen when the micronutrient deficiencies and macronutrient profile mimics what most Americans consume.
I have tried the following preparations of exogenous ketones: BHB monoester, AcAc di-ester, BHB mineral salt (BHB combined with Na+, K+, and Ca2+). I have consumed these at different concentrations and in combination with different mixing agents, including MCT oil, pure caprylic acid (C8), branch-chained amino acids, and lemon juice (to lower the pH). I won’t go into the details of each, though, for the sake of time.

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