Ketones and Ketone Supplementation: Separating Fact from Fiction

Two things are certain in the healthcare industry:

1. Everybody wants quick results

2. Everybody wants something for nothing

Pardon the hyperbole, but you get my point.  I work with plenty of people that understand results take time and effort.  After all, health is earned... same is true of dis-ease.

Let's talk weight loss for now.  With all of the weight loss plans, food recommendations and supplements, it's hard to sift through all of it.  It seems that everyone claims to have the next best thing.  Let's take a deeper look at a somewhat recent, popular trend in the weight loss industry.

When people say they want to lose weight, what they really mean is they want to lose fat.  Nobody is running around saying, "I hate all this lean muscle I have!"  Or, "Somebody tell me how to lose these chiseled abs!"  Enter the new hype, ketone supplements.

Ketones?  What in the world is that?  Simply put, ketones are molecules produced when the body burns fat as fuel.  They are energy-containing molecules.  As a matter of fact, ketones are the preferred fuel for the brain in the absence of glucose and spares glucose.  It's a common misconception that the brain "needs carbs."  The brain will, in fact, use carbohydrates if you eat them.  On the other hand, if you eat a ketogenic diet, the brain is more than happy to use ketones.  Ketones are a very efficient metabolic fuel, even more so than glucose.  Ketosis is the state in which your body is using ketones as energy.  Essentially, this is the state when your body is almost completely fueled by fat.  

While on a ketogenic diet, your body switches it's fuel supply to run almost entirely on fat.  Insulin levels become very low and fat burning is dramatically increased.  If you're trying to lose fat, this is great.  ***As an aside, what we're talking about is nutritional ketosis, not diabetic ketoacidosis.  Nutritional ketosis is low blood sugar, high ketones.  Diabetic ketoacidosis happens in type 1 diabetes and characterized by high blood sugar and high ketones and is considered a medical emergency.

How do we "make" ketones or allow our bodies to transition into ketosis?  Simple.  Stop eating.  Yes, it is as simple as that, but I'll elaborate.  Think of a refrigerator and a freezer.  Think of your refrigerator as what houses sugar and your freezer as what houses fat.  Remember, we want to be using fat for energy.  Your refrigerator is very easy to access, you go there frequently and pull food from it.  Your freezer, on the other hand keeps the frozen stuff.  You rarely go there.  If we're constantly pulling from the refrigerator (sugar), we aren't pulling from the freezer (fat) because you keep stocking your refrigerator (sugar).  Still with me?  Good.

So, we have to exhaust what's in the refrigerator (sugar) so we can pull from the freezer (fat).  This happens most efficiently by doing a couple of things:

1) Eating a ketogenic diet (high quality fats, moderate protein intake and low carbs)

2) Daily intermittent fasting

3) Extended fasting

*** Note: the reason for restricted protein is 2 fold.  Too much protein de-amines to pyruvate in the liver and is converted to glucose.  And, protein is not an energy storage molecule.  It's stored very efficiently.

It's also important to note that the only way to know for sure if you're using ketones is to test.  I personally, like the monitors that look at ketone levels in blood.  As your body changes its fuel source from glucose/glycogen to ketones/fat, a bunch of amazing things start to happen.  Just to name a few:

* increase in energy

* mental clarity

* fat loss

* hormone sensitivity (most importantly insulin)

* increased metabolism (which is hormonally driven)

* improved libido

* decreased inflammation

* mobilization of visceral fat (fat in and on organs)

* improved lipid panels

* improvement or reversal of metabolic syndrome

So, what's the catch.  Well, there really isn't one.  Being in a state of ketosis the majority of the time is not only healthy but allows to maximize fat loss.  The real benefits of ketosis come with the ability to cycle in and out of it with ease.  This requires time and practicing the proper lifestyle changes that are necessary.

Since being in ketosis almost all of the time is a great idea for several reasons, the weight loss/healthcare industry wants to cash in.  What we're seeing a huge increase in are these supplements that claim to put you into ketosis or increase ketones in your body, AKA Exogenous ketones.  

Remember, ketones are a byproduct of burning fat.  So what happens if you introduce energy (ketone supplement)  into a physiological system?  Fat loss will not be promoted.  Skeletal muscle uses ketones.  Cardiac tissue uses ketones.  Exogenous ketone supplements augment therapeutic effects of the ketogenic diet (creating endogenous ketones).  

*** This is why all of the cutting edge research shows the benefits come from a calorie restricted ketogenic diet.  

When TOTAL energy in our bloodstream increases outside of the normal range, it appears the body raises insulin to store excess energy, untreated type 1 diabetics aside.  Regardless of whether your energy takes the from of glucose, ketones or free fatty acids, they all contribute to acetyl-coA which is oxidized to produce energy.  Forcing excess unused energy (cough cough exogenous ketones cough cough) will lead to oxidized LDL and glycation.

Fat doesn't normally trigger an insulin response, however excess unused energy will trigger an increase in insulin to reduce TOTAL energy in blood.  Exogenous ketones do not promote fat loss.

A number of studies seem to support the view about TOTAL energy including the paper, "Hypoglycemic Action of Ketones.  Evidence for a Stimulatory Feedback of Ketones on the Pancreatic Beta Cells.

Roger Unger wrote:

"Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively.  Ketones also have a direct inhibitory effect on lipolysis in adipose tissue."

In english please?  OK.  What that's saying is ketones raise insulin... if TOTAL energy is plentiful.  You have to look at glucose AND ketones together.  

Now, can exogenous ketones (ketone supplements) be beneficial for someone who is metabolically healthy and is consuming mostly a low calorie, ketogenic diet?  Perhaps.  But, how many people do you think expect to just take exogenous ketone supplements while changing nothing else?  I bet the answer is many.

  

Remember, the goal is to be metabolically flexible.  

There is no such thing as something for nothing.