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).
Beta-Hydroxybutyrate (BHB) is a ketone body produced by the liver, from fat, for energy when glucose isn’t available. It ultimately becomes the body and brain’s primary source of energy. Since the liver naturally produces BHB during ketosis, the process can take quite some time, often resulting in symptoms of fatigue, hunger (cravings for sugar, a faster energy source), and mental cloudiness. That’s why supplementing BHB on a keto diet can have a profound positive impact.

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