While the KetoneAid folks have been seeing tremendous success working with elite athletes to improve athletic performance, I thought it would be interesting to quantify the effects of ketone esters on cognitive performance. For the week prior to taking the ketones, I re-established baseline scores in a number of cognitive testing areas using Lumosity*:
The year before last I somehow full on Rocked at the keto diet lost 100lb, and was taking adderall. I am transitioning back into it again also back on the adderall, but i seem to have no energy and last time my doc did my blood work i was only 16% hydrated. Obviously it’s a huge problem for me, staying hydrated and trying to lift the fogginess. I am type 2 diabetic and my doctor is on board with me trying all to keep my sugars down YEAH!!! I have never tried any exogenous product. My body seems to not absorb much vitamins. Can anyone make a or any suggestion to me as to how to get this under control?
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. 
If you have already mastered the Very Low Carbohydrate (VLC) or ketogenic way of eating, and/or are eating at a caloric deficit, exercising or fasting you are naturally creating the optimal conditions for your body to produce ketones and put your body into nutritional ketosis. By strict adherence to a well-formulated ketogenic diet (complete with higher levels of mineral salts) you should be able to produce all the ketones you need naturally (endogenously). If you are new or inexperienced in ketogenic eating however; or if you or a family member struggles to adhere to a ketogenic diet, then supplementation with exogenous ketones may be very beneficial. Not only will ketone supplements help to mitigate hunger and carb cravings, but they will also help you stave off carb flu symptoms (see below), giving you the best possible chance of long-term success.
Most of the information regarding the effects of ketosis come from studies on the ketogenic diet, wherein ketones are made by the liver and become a major fuel source for the body. The ketogenic diet is currently under investigation for its potential therapeutic effects in a number of healthy and disease states. More recently, studies are beginning to reveal that many of the effects observed with the ketogenic diet are mechanistically attributable to ketones, which is a primary reason that exogenous ketones are being developed and studied. However, because they are such a new technology, there’s not a lot of data on exogenous ketones themselves. In a few pre-clinical studies, exogenous ketones have mimicked the therapeutic effects of the ketogenic diet”
Ketone Esters: These are not normally found in the body, but exogenous ketone esters convert into BHB once it is in the body. They are also synthetically (lab) made compounds that link an alcohol to a ketone body, which can then be metabolized by the liver into a ketone. They are like ketone salts on steroids as they have 5-10 time more BHB per serving/maximum daily intake than ketone salts. To date, pure ketone esters have been very expensive to produce and have only been available to researchers, elite athletes (Tour de France cyclists), and the US Department of Defense (people have spent more than $20,000 to have an independent lab produce a single serving!).
But going keto takes work. You have to overhaul your diet, restrict certain classes of foods, and pay close attention to what you eat. People prefer to avoid work if they can. They like shortcuts. Exogenous ketone supplements promise a shortcut—swallow this pill or mix this powder into your water and see your ketones skyrocket without changing the rest of your diet.
As for MCT oil (and oil powders), powder formulations tend to cause less digestive distress (e.g. probiotics), but some folks object to the additional ingredients like sunflower lecithin or soluble corn fiber). Even if you’d like to eventually settle on an oil, I’d recommend starting with a powder to see how you respond and to give your body the chance to adapt over time.
Hi Acadia, just want to clear up a few things you noted in your post: The manufacture of BHB salts involves ionic bonding of an anion (beta-hydroxybutyrate) with a cation (Na+, K+, Ca+, Mg+). At least one of the exogenous ketone products you listed does in fact contain potassium ions. People taking potassium-sparing drugs need to know this and that raises concerns about leaving it off your chart. Some people are genuinely sodium sensitive even to small amounts of salt added to otherwise healthy foods. This can hold true even for those following ketogenic diets. The term you’re looking for… Read more »
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.
There are many different variations of intermittent fasting as well. Dr. Dom D’Agostino, the well-known ketogenic diet researcher, suggests doing a longer intermittent fast for 3 days, 3 times a year. This means not eating for 3 days, and eating normally until the next fast. Daily intermittent fasts are recommended as well. He says that it is ideal to have one to two meals after fasting for most of the day to reap the benefits of intermittent fasting every day.
Relationship between blood ketone and glucose levels: a BMS + MCT (5 g/kg) supplemented rats demonstrated a significant inverse relationship between elevated blood ketone levels and decreased blood ketone levels (r2 = 0.4314, p = 0.0203). b At week 4, BMS + MCT (10 g/kg) and MCT (10 g/kg) showed a significant correlation between blood ketone levels and blood glucose levels (r2 = 0.8619, p < 0.0001; r2 = 0.6365, p = 0.0057). Linear regression analysis, results considered significant if p < 0.05
Ketosis supplements made in poor quality, have proven to lead to side-effects such as constipation and increased levels of cholesterol and triglycerides in men, and women may also experience amenorrhea or other disruptions to the menstrual cycle. This is why it is really important to know what combination of compounds you are consuming, particularly while you are on this very strict diet because the wrong balance can really mess with you in the long term and won't give you the high performance that you are looking for. 
While we know that both MCT Oil Powders and BHB salts are proven supplements to increases ketosis, the winner of a top 5 exogenous ketones list I think should be a true direct form of exogenous ketones – one of the BHB salts. Perfect Keto’s BASE takes the win here. The edge ranking factor is its flavor. With stevia-based flavors such as chocolate sea salt, and the fact that it uses zero additives and actually tastes good, this BHB salt is going to have to take the W. They’re the only 100% coconut MCTs that don’t utilize the goMCT™ form.. this is neither a pro or con. And while it doesn’t have the best bang for your buck compared to the other BHB salts on this list, it’s the most proven as far as happy customer track record and consistent high-quality keto supplements.

In terms of epigenetic signaling, initial studies of the effects of BOHB on class-1 histone deacetylase activity against oxidative stress (Schimazu 2013), NLRP3 inflammasome suppression (Youm 2015), mouse longevity (Roberts 2017), and other epigenetic regulatory effects suggest that levels as low as 1 mM have potent effects. Furthermore, the association between very mild ketonemia and reduced coronary mortality with SGLT2 inhibitor use in patients with type 2 diabetes (Ferranini 2016) suggests that there might be clinical benefits with chronic BOHB levels as low as 0.3 mM (Gormsen 2017. Vetter 2017).
You must realise that our bodies are lazy and switching to a new energy source means hard work, that means that your body will not do this easily and you basically have to force it. One way to speed up this process is to put your body into fight or flight mode. My preferred  controlled exercise to do this is to have a high intensity workout followed immediately by a  cold shower.  I am describing it in the article to go slowly, but in this case it will actually be beneficial if you can force your self to go straight into a cold shower and try to stay there at least 2 minutes. One of the benefits of this that your body will produce the hormone noradrenaline. Obviously this is something for people in perfect health. Please advice your doctor before you want to take cold showers.
First, there’s something unnatural about having elevated levels of ketones and glucose together. It’s really hard to make that happen using traditional whole foods. The closest natural approximation you could get to it would be the traditional coconut-rich diets of the Kitava people in the South Pacific, where the medium chain triglycerides (MCT) in the coconut fat increased ketone production alongside the carbs in the fruit and tubers they ate. They had excellent metabolic health, but they weren’t anywhere close to a ketogenic diet. Coconut fat isn’t as ketogenic as purified MCT oil, let alone exogenous ketones.
In fact this was one of the biggest surprises I had when exploring ketosis. For years I have been following a cyclical lower carb diet. For years I wouldn’t consume a carb until later in the afternoon (ala Carb Backloading style). After eating 5 days without any carbs I tested my ketone levels… they were 0.1 mmol. This reading was done first thing in the morning (10 hours fasted) after 5 days without a carb in my diet.

There’s debate raging about which dietary tactic is the god particle for making you leaner, faster and healthier. How the ketogenic diet option squares off against the low carb route is vital for understanding the ways in which exogenous ketone supplements work. To get into ketosis the natural way, you need to keep your carb intake low enough for long enough for your body to begin using use fat as fuel. Your liver then converts a portion of that fat into energy molecules called ketones. These work together with glucose as a fuel source, but can actually kick in faster, allowing your body to operate more economically during lengthy, high-energy exercise efforts.

 Effects of beta-hydroxybutyrate on cognition in memory-impaired adults. – Glucose is the brain’s principal energy substrate. In Alzheimer’s disease (AD), there appears to be a pathological decrease in the brain’s ability to use glucose. Neurobiological evidence suggests that ketone bodies are an effective alternative energy substrate for the brain. Elevation of plasma ketone body levels through an oral dose of medium chain triglycerides (MCTs) may improve cognitive functioning in older adults with memory disorders. On separate days, 20 subjects with AD or mild cognitive impairment consumed a drink containing emulsified MCTs or placebo. Significant increases in levels of the ketone body beta-hydroxybutyrate (beta-OHB) were observed 90 min after treatment (P=0.007) when cognitive tests were administered. beta-OHB elevations were moderated by apolipoprotein E (APOE) genotype (P=0.036). For 4+ subjects, beta-OHB levels continued to rise between the 90 and 120 min blood draws in the treatment condition, while the beta-OHB levels of 4- subjects held constant (P<0.009). On cognitive testing, MCT treatment facilitated performance on the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog) for 4- subjects, but not for 4+ subjects (P=0.04). Higher ketone values were associated with greater improvement in paragraph recall with MCT treatment relative to placebo across all subjects (P=0.02). Additional research is warranted to determine the therapeutic benefits of MCTs for patients with AD and how APOE-4 status may mediate beta-OHB efficacy.

Another important difference between endogenous and exogenous BOHB is that most synthetic BOHB used in dietary supplements is a mixture of the two ‘D’ and ‘L’ isomers, whereas endogenously produced BOHB consists of just the D-isomer. Metabolically, the two isomers are very different, and current published information indicates that most of the energy and signaling benefits of BOHB derive from the D-form. This is potentially problematic because the L-isomers are not metabolized via the same chemical pathways as the D-forms (Lincoln 1987, Stubbs 2017), and it remains unclear whether humans can convert the L-form to the D-form.
Look around your grocery store, and you’ll soon start to see “Fortified with Calcium” on a variety of different labels, along with calcium supplements everywhere you look. Calcium is essential for cardiovascular health, but several studies have found too much calcium to be associated with cardiovascular events and even death.  One study found that consumption of 1000+ mg of supplemental calcium per day was associated with an increased risk of death from cardiovascular disease in men but not women[13]. Dietary calcium intake (i.e., calcium from incorporated foods such as milk, etc.), on the other hand, was not associated with death from cardiovascular disease in men or women. Additionally, a different study found 1000 mg of supplemental calcium to be associated with an increase in rates of cardiovascular events in women[14].
Your body uses the energy source that is the easiest to use, in our case this is glucose. Glucose is just a type of sugar. As our body cannot store glucose as such it stores the extra glucose in form of glycogen that is stored in our liver and muscles. To initiate production of ketones in your body as fast as possible you must deplete your body of glycogen reserves. The best way to do this is a simple 24 hours fast. This will deplete your glycogen stores as fast as possible. If you don’t over eat for dinner or you even skip it all together you will already wake up in state of mild ketosis the next morning due to the overnight fast. Here are also described some signs that you are in Ketosis already.

BHB easily crosses the blood-brain barrier resulting in easily accessible energy to the brain and muscle tissues, becoming a source of energy after entering the mitochondria, being converted to Acetyl-CoA, and then ATP through the Krebs cycle (the same process that glucose goes through to become ATP). This ultimately results in many direct benefits, including:

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