You are probably wondering how there could possibly be a benefit to eating less frequently that goes beyond what you are already getting with a ketogenic diet. Restricting carbs and eating enough fat and protein does come with a plethora of health benefits, but when you add intermittent fasting to your lifestyle you can increase energy and reverse aging by harnessing the power of a nobel prize winning process.
Firstly, in a randomized four-arm cross-over study, blood βHB concentrations were compared following ingestion of equal amounts of βHB as a KE or a KS at two doses by healthy volunteers at rest (Study 1; n = 15). Secondly, in a randomized five-arm cross-over study, inter- and intra-participant repeatability of ketosis was examined following ingestion of identical KE drinks, twice whilst fed and twice whilst fasted. As a control, participants also consumed one isocaloric (1.9 kCal.kg−1) dextrose drink (Study 2; n = 16). Finally, blood d-βHB was measured after equal amounts of KE were given as three drinks (n = 12) or a constant nasogastric (NG) infusion (n = 4) (Study 3; total n = 14) over 9 h.
The other potentially important distinction between nutritional ketosis and chemically-induced ketosis is the potential metabolic role played by liver AcAc production and redox status. Although the ratio of BOHB to AcAc in venous blood is typically 80% to 20%, classic studies by Cahill (1975) have observed important hepatic vein and peripheral arterio-venous gradients for this ratio in keto-adapted patients. What these observations imply is that the liver produces a higher proportion of AcAc than is found in the peripheral blood, and that this is due to uptake of AcAc in peripheral cells (principally muscle) with re-release as BOHB. In the process, the reduction of AcAc to BOHB produces NAD+, which is beneficial to mitochondrial redox state and mitochondrial function (Verdin 2015, Newman 2017).
It's important to listen to your body when going through the ketogenic process. This means that you should only eat when you're hungry and not every single time you get a craving. It's our obsession with food that causes us to stuff ourselves whenever we feel like it, and you should know by now that it's not healthy to do that. When you make it a point to eat only when you're hungry, you're diminishing any food intake that your body doesn't really need. 
Because they’re so expensive, you want to make sure you pick a good one. Griffin and Langer say to ignore the companies that make these supplements sound too good to be true. Just like with any supplement, Griffin says it’s important to look at what’s in it. Beware of products with lots of fillers and instead go for one with a short, straightforward list of ingredients (Griffin likes the options from KetoSports).
Effects of ketone supplementation on basal blood ketone and basal blood glucose levels: Rats administered ketone supplements did not have a significant change in basal blood ketone levels (a) or basal blood glucose levels (b) for the four week study. Two-Way ANOVA with Tukey’s post-hoc test, results considered significant if p < 0.05. Error bars represent mean (SD)
However, we will not be commenting on ketone esters since there are big differences between them and ketone salts, and the ketone salts are the ones that have been heavily commercialized and marketed to the public over recent years. Ketone esters may be more difficult to market due to their having an unpleasant taste. We may look more deeply into the esters in the future.
One common concern regarding the KD is its purported potential to increase the risk of atherosclerosis by elevating blood cholesterol and triglyceride levels [55, 56]. This topic remains controversial as some, but not all, studies have demonstrated that the KD elevates blood levels of cholesterol and triglycerides [57–62]. Kwitervich and colleagues demonstrated an increase in low-density lipoprotein (LDL) and a decrease in high-density lipoprotein (HDL) in epileptic children fed the classical KD for two years [27]. In this study, total cholesterol increased by ~130 %, and stabilized at the elevated level over the 2-year period. A similar study demonstrated that the lipid profile returned to baseline in children who remained on the KD for six years [63]. Children typically remain on the diet for approximately two years then return to a diet of common fat and carbohydrate ingestion [64]. The implications of these findings are unclear, since the influence of cholesterol on cardiovascular health is controversial and macronutrient sources of the diet vary per study. In contrast to these studies, the majority of recent studies have suggested that the KD can actually lead to significant benefits in biomarkers of metabolic health, including blood lipid profiles [65–72]. In these studies, the KD positively altered blood lipids, decreasing total triglycerides and cholesterol while increasing the ratio of HDL to LDL [68–77]. Although, the KD is well-established in children, it has only recently been utilized as a strategy to control seizures in adults. In 2014, Schoeler and colleagues reported on the feasibility of the KD for adults, concluding that 39 % of individuals achieved > 50 % reduction in seizure frequency, similar to the results reported in pediatric studies. Patients experienced similar gastrointestinal adverse advents that have been previously described in pediatric patients, but they did not lead to discontinuation of the diet in any patient [78].

Intense exercise — more than just fidgeting or pacing — uses ketones, when glucose is in short supply, which means the body has to create more ketones to replace what you use. This is great for those who are used to a moderate to intense activity level, but intensity is a fine dance between encouraging ketone production and elevating cortisol for the rest of us.


Exogenous ketones provide the body with another fuel to employ. Think about it like an electric car that runs on both gas and electricity: by consuming ketones along with carbohydrates, the body will preferentially burn the ketones first, saving the carbohydrates for later. Exogenous ketones allow us to enter a metabolic state that wouldn't occur naturally: the state of having full carbohydrate stores, as well as elevated ketones in the blood. This could be advantageous to athletes looking to boost their physical performance. 
1 – If you’re not looking to spend a ton of money up front while testing the ketogenic lifestyle – no problem! For starters, you need to try nutritional ketosis before ever worrying about exogenous supplementation. If you don’t like the diet, it’s not going to matter how many supplements you by. However, if you want to get an idea if exogenous ketones are for you, we would suggest a simple MCT Oil, or a great beginner exo keto like Keto CaNa.
Blood, breath, and urine ketone kinetics following mole-matched ketone ester (KE) and ketone salt (KS) drinks, at two amounts, in 15 subjects at rest. Values are means ± SEM. (A) Blood d-βHB. (B) Tmax of blood d-βHB. (C) AUC of blood d-βHB. (D) Isotopic abundance (%) of d- and l-chiral centers in pure liquid KE and KS. (E) Blood d-βHB and l-βHB concentrations in subjects (n = 5) consuming 3.2 mmol.kg−1 of βHB in KS drinks. (F) d-βHB and l-βHB concentrations in urine samples from subjects (n = 10) consuming 3.2 mmol.kg−1 of βHB in KS drinks. (G) Blood d- and l-βHB after 4, 8, and 24 h in subjects (n = 5) consuming 3.2 mmol.kg−1 of βHB in KS drinks. (H) Breath acetone over 24 h in subjects (n = 5) consuming 3.2 mmol.kg−1 of βHB in KE and KS drinks (ppm = parts per million). (I) Urine d-βHB excreted over 4 h after KE and KS drinks (n = 15). (J) Urine pH 4 h after drink, dotted line indicates baseline. †p < 0.05 KE vs. equivalent amount of KS, *p < 0.05 difference between 1.6 vs. 3.2 mmol.kg−1 of βHB, §p < 0.05 difference between amounts of d- and l-βHB, p < 0.05 difference between baseline and post-drink level.
Many of us avoid foods like processed meats and cheeses or salted nuts because of their high sodium content. However, processed carbohydrate sources can have equal or higher amounts of sodium per serving. An ounce of salted pretzels[3] has over four times as much sodium as an ounce of salted peanuts[4]. Just because we can’t taste the sodium doesn’t mean it isn’t in there. Flavors from other ingredients like sugar and spices can make it difficult to identify salt as a dominant flavor.

MCT Oil is a keto supplement that helps your body make ketones. The oil contains pure medium-chain triglycerides (MCTs), which are types of fatty acids that your body prefers using for immediate energy. Unlike long-chain fatty acids, MCTs don't require enzymes and bile for digestion and they go straight to the liver where they are used for making free fatty acids or ketones. Studies on MCTs show that they promote weight loss [5].

Exogenous ketones drinks are growing in popularity as a method to elevate blood ketone concentrations and mimic a ketogenic diet without the need for dietary changes (Ari et al., 2016; Cox et al., 2016; Kesl et al., 2016; Caminhotto et al., 2017; Evans et al., 2017). The present study describes the pharmacokinetic and pharmacodynamics properties of ketone ester and salt drinks in humans at rest, and characterizes the effects of a prior meal, which is pertinent to use as a dietary supplement. The main findings were that KE drinks elevated blood d-βHB > 50% higher than KS drinks, the latter significantly increasing blood l-βHB, which was metabolized more slowly by the body. Both drinks had similar effects on FFA, TG, glucose and electrolyte concentrations, although with disparate effects on pH. A prior meal decreased total blood d-βHB appearance after a KE drink. Finally, either three KE drinks or nasogastric feeding effectively maintained nutritional ketosis over 1 mM for 9 h.
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.
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)!
I’m not sure whether I am leto-adapted but have been following the keto program for about 6 weeks. The scale and the eye confirm I have been burning fat. I’ve been using ketostix to keep track of ketones as I don’t prefer to prick my fingers to get blood measurements. I have reached my weight loss goal and planning to transition to maintenance in the next couple of weeks. I’m curious if exogenous ketones will be aid in maintaining my weight.
I’m not sure whether I am leto-adapted but have been following the keto program for about 6 weeks. The scale and the eye confirm I have been burning fat. I’ve been using ketostix to keep track of ketones as I don’t prefer to prick my fingers to get blood measurements. I have reached my weight loss goal and planning to transition to maintenance in the next couple of weeks. I’m curious if exogenous ketones will be aid in maintaining my weight.

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.

Blood d-βHB, pH, bicarbonate (HCO3-) and electrolytes measured in arterialized blood samples from resting subjects (n = 7) following a ketone ester or salt drink containing 3.2 mmol.kg−1 of βHB. Shaded areas represent the normal range. Values are means ± SEM. (A) Venous blood d-βHB. (B) Arterialized blood pH. (C) Blood bicarbonate. (D) Blood potassium. (E) Blood sodium. (F) Blood chloride. †p < 0.05 difference between KE and KS, *p < 0.05 difference from baseline value.


BS, KC, and PC designed the research studies. BS, PC, RE, SM, and PS carried out the studies. SH provided the gas analyser used in the study on behalf of NTT DOCOMO Inc. BS, MS, and SM analyzed the data and performed statistical analysis in collaboration with JM. BS wrote the paper with help from KC, PC, and OF. KC had primary responsibility for final content. All authors read and approved the final manuscript.

The difference in peak blood d-βHB concentrations between matched amounts of βHB as ester or salts arose because the salt contained l-βHB, as the blood concentrations of d- plus l-βHB isoforms were similar for both compounds. It is unclear if kinetic parameters of KE and KS drinks would be similar if matched d-βHB were taken in the drinks. Unlike d-βHB, blood l-βHB remained elevated for at least 8 h following the drink, suggesting an overall lower rate of metabolism of l-βHB as urinary elimination of l-βHB was in proportion to plasma concentration. Despite similar concentrations of total βHB, breath acetone was ~50% lower following KS drinks compared to KE, suggesting fundamental differences in the metabolic fates of D- and L-βHB. These findings support both previous hypotheses (Veech and King, 2016) and experimental work in rats (Webber and Edmond, 1977), which suggested that the l-isoform was less readily oxidized than the d-isoform, and is processed via different pathways, perhaps in different cellular compartments. It seems that l-βHB is not a major oxidative fuel at rest, and may accumulate with repeated KS drinks. However, the putative signaling role of l-βHB in humans remains unclear. In rodent cardiomyocytes, l-βHB acts as a signal that modulates the metabolism of d-βHB and glucose, Tsai et al. (2006) although no differences in blood glucose were seen here. Furthermore, L-βHB can act as a cellular antioxidant, although to a lesser extent than D-βHB (Haces et al., 2008).


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.
After a minimal amount of internet "research," I decided to try my first exogenous ketones. I have used the ketogenic diet off and on for at 15 years and my body is pretty efficient at fat adapting. (Usually by the end of 2 strict days, I am in ketosis, but not without symptoms and intense cravings.) I can consistently fast from carbs for 20 - 24 hours and do this consistently. However, around hour 20, my mind begins to negotiate that intermittent fasting is advantageous too and that I can afford to have some carbs once a day. Hence the yo-yo effect.

We will go deep in the science behind this fascinating diet and then review some of the best exogenous ketone supplements out there in the market. Because without the knowledge and the right information about exogenous ketones that you can properly follow, you might never reach your goals and you may as well keep eating that mashed potato for dinner and club sandwich for lunch.


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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