The ketogenic diet is trending up; the low-carb, high-fat diet is gaining popularity as people become more conscious of the carbohydrates and sugars packing food in western diets.
Scientific evidence supports a growing list of benefits of the ketogenic diet: better blood sugar control, neuroprotection, lower triglycerides. What’s more, subjective reports of improved mental focus and clarity and appetite-suppressing effects, make the diet not only effective for weight loss, but also for sustained cognitive performance throughout the day. But, on top of this, the diet has benefits outside of body composition; growing numbers of athletes are using the keto diet to help with their endurance performance and accelerate post-workout recovery.1,2
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For most, partaking in the keto diet involves a pretty radical change to normal eating habits. Ketones are made when the body burns fat;, in evolution, this happened when carbohydrate fuel sources were low, such as during times of fasting or starvation. In order for the body to produce ketones without the need to starve or fast, carbohydrate restriction or elimination is prescribed.
In the early stages, making the switch to keto can lead to difficulties in consuming a balanced diet, and may eventually cause health issues. For example, if mineral intake is inadequate on keto, people often get cramps. Another common problem is the keto flu, triggered in part by low blood glucose (due to carb restriction), while at the same time ketone levels aren’t yet high enough to fuel the brain. Keto diet symptoms can be relieved by using dietary supplements and by making long-term tweaks to balance the diet correctly.
You care about success on the keto diet–otherwise, you wouldn’t be doing it. Whatever your goals are, these supplements can help some of the growing pains associated with early keto dieting.
Supplements to Boost Ketones
Some of the benefits of the keto diet are caused by the presence of ketone bodies (such as beta-hydroxybutyrate or BHB) in the blood. This marks a body that’s in ketosis–considered to be elevated blood ketone levels of 0.5mM and up. Achieving ketosis happens in different ways: endogenously and exogenously.
Endogenous ketosis happens when the body produces ketones naturally, like through fasting of dieting. This is usually a long process that can take weeks or months. Exogenous ketosis happens through supplements like HVMN Ketone and can happen almost immediately. Both methods elevated ketone levels in the blood–this can help with keto flu while also providing an energy source.
Ketone levels can be elevated exogenously through supplements. Here are some of the best ones to use.
Medium-chain triglycerides, or MCTs, are a special type of fat found naturally in coconut oil, palm kernel oil, and butterfat. They do not contain ketones, instead of possessing a fat that’s readily converted to ketones.
Medium refers to the length of fatty acid chains. MCT fatty acids are between six and twelve carbons in length (most dietary fat is in the form of long-chain triglycerides, or LCTs, with greater than 12 carbon atoms). Because of their smaller size, MCTs are easily absorbed by the gut and rapidly sent to the liver where they’re preferentially converted to ketones.3The ketones are then transported from the liver to the heart, brain, muscles, and other organs to be used for energy. MCTs that are not turned into ketones are used as quick energy outright and are far less likely to be stored as fat than longer chain fatty acids.
While many food sources contain MCTs (coconut and palm oil), a purified MCT oil is a more concentrated way to boost your intake.
MCT oil is typically a mixture of different types of MCTs based on the length of its carbon chains. Among the various types of MCTs included in the oil, caprylic acid (an MCT with eight [C8] carbons) is the most ketogenic, meaning it more readily produces ketones.
Preferred brands of MCT oil will list the breakdown of component types on the label. The best brands of MCT oil contain roughly 60% caprylic acid (C8) and 40% capric acid (C10). Better yet are products with 100% C8.4
Supplementing your diet with MCT oil can generate more ketones, and may allow the consumption of more carbs while remaining in ketosis.3 But be warned–too much MCT can cause gastrointestinal distress in some. And MCTs also have a high caloric content, so consuming an excessive amount of MCT to reach ketosis might easily lead to weight gain.
MCTs kickstart ketone production, but only get you to BHB levels of 0.5 – 1mM.4
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Supplements used to achieve ketosis are considered exogenous ketones–they aren’t produced in the body. Most exogenous ketone supplements consist of beta-hydroxybutyrate (BHB), the main ketone body produced by the body naturally. BHB is also more chemically stable (than the other major ketone, acetoacetate) and easier to formulate into a shelf-stable consumer product.
For those already on the keto diet, exogenous ketones can enhance some of the beneficial effects of a keto diet, like decreased appetite, alertness, focus and performance. They can also help you power through the keto flu, related to the transition into keto as your body adapts to using fat as fuel.5
Ketone salts are one type of exogenous ketone supplement consisting of a mineral (sodium, potassium, calcium, or magnesium) bound to beta-hydroxybutyrate to form a salt. Hearing the word “salt,” you might think of sodium chloride (table salt); but in chemistry, there are many types of compounds referred to as salts (including ketone salts).
There are many products that use this type of compound, for example, Keto OS is a ketone salt; sodium and/or potassium are the minerals used to buffer the beta-hydroxybutyrate. Some ketone salt products are fortified with MCT powder, caffeine, carbohydrate, or select amino acids for specific effects.
Few studies have been conducted to evaluate the clinical or performance benefits of ketone salts. Two clinical studies supplementing with BHB salts in children with genetic disorders of metabolism resulted in improvement in neurological symptoms. Maximal levels of BHB were 0.4 to 2.5mM in these studies.6,7
Since ketones can fuel muscle, keto supplements have been evaluated for their potential performance-enhancing effects. In a recent study, BHB salts given to participants before five minutes of continuous cycling induced a shift toward greater burning of fat and less burning of glucose for energy.8,9 However, in a growing number of studies (three to date), the use of BHB salts either has no effect or even impaired performance– ketone levels in this study were relatively low, not exceeding 0.8 mM.8,10,11
Ketone salts can raise blood ketone levels–but come with some side effects. Large amounts of mineral salts are consumed when using ketone salts, which can lead to gut issues.9,12,11 And high salt intake is associated with increased risk of cardiovascular diseases,13 and potential imbalances in mineral levels could develop long-term.
What’s more, ketone salts contain a mixture of equal amounts of two different forms of BHB: D-BHB and L-BHB (learn more here). D-BHB is the predominant ketone naturally generated and burned for energy; L-BHB is produced in insignificant amounts.14 It’s uncertain how the body uses L-BHB. Animal studies suggest that it is not used as a fuel but rather, is used to make fat.15 Or to act as a signal to the body in various metabolic pathways.16,17
Importantly, most ketone salts have not received GRAS (generally recognized as safe) status from the FDA.
Ketone esters are liquids containing a ketone chemically bonded to a ketone precursor. When an ester is broken down in the gut, the ketone precursor is released and travels to the liver, where it’s rapidly converted into another ketone. Ketone esters are like a one-two punch: two molecules of ketones for each molecule of ketone ester.
The ketone body present in esters is either BHB or acetoacetate (AcAc). HVMN Ketone, the world’s first ketone ester drink, contains 100% D-BHB and is approved as a food by the FDA and is World Doping Agency (WADA) compliant. HVMN Ketone can induce ketosis within minutes,18,19 even if you’re not on the keto diet and consuming carbohydrates.
For athletes, ketone esters like HVMN Ketone, provide the body with increased energy levels without carbohydrates.
In fact, BHB in HVMN Ketone has been shown to increase endurance performance.20When taken before or during exercise, D-BHB (the ketone body in HVMN Ketone) is 28% more efficient than carbohydrates alone, helping your body do more work with the same amount of oxygen.21 In one study, cyclists went ~2% further in a 30-minute time trial.20Professional cyclist and HVMN Athlete, Vittoria Bussi, used HVMN Ketone to power her world record-breaking attempt at one of cycling’s most grueling challenges: the Hour.
For recovery, those using HVMN Ketone have seen a decrease in the breakdown of intramuscular glycogen and protein during exercise, when compared to carbs alone.22 It expedited the resynthesis of glycogen by 60% and boosted the signals for protein resynthesis by 2x when added to normal carb/protein post-workout fuel.
Just like there are a few different types of ketone salts and MCTs, there are also different types of ketone esters being researched.
One is an AcAc-based compound, developed by Professor Dominic D’Agostino in Florida. The ester has been tested in animals and has shown elevated ketone levels,5 reduced seizures occurring in response to high oxygen,23 decreased cancer metastasis,24 lowered inflammation,17 and decreased anxiety behaviors.25 While this provides plenty of animal research, human evidence is limited.
To date, there is only one human study of the acetoacetate ester. The study tested the performance effect on cyclists, but the acetoacetate ester made almost all the athletes feel nauseous, so they ended up going slower during the time trial.26 This study highlights the need to undertake proper testing and development of any ketone compound to make sure it is tolerable before testing for performance changes.