Everything you need to know about Ketosis and Beta-hydroxybutyrate (BHB)

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Ah Ketosis, it has nearly become a household name due to its popularity and prevalence in various media platforms. One can hardly walk into the grocery store these days without seeing a headline like, “Lose weight fast,” or “All you need to know about Keto.” It can be daunting to try a new diet, especially if you are like me and have run away from diets multiple times before.

If you have been digging around online or in magazine articles, or even on television, you may have come across the unimaginably long word, beta-hydroxybutyrate, also known as BHB. My initial thought when I came across it for the first time was, “beta-hydro-what-a?” In this article, we will dive into all things beta-hydroxybutyrate, which I will refer to from here on out simply as BHB.

What is beta-hydroxybutyrate (BHB)?

Let us begin with a quick discussion about the brain. You see, your brain and my brain enjoy consistent meals. One of its preferred fuel sources is glucose, which blood delivers consistently as long as it is available. Glucose is the simplest carbohydrate and is also known as blood sugar. It is an energy source. When we eat carbohydrates our blood sugar level rises and glucose is brought to the brain to keep it running (or thinking smoothly. But what happens when we deplete our stored glucose? In comes BHB.

When your body does not have glucose, either due to starvation, prolonged exercise, or eating a ketogenic diet, your body produces ketone bodies (or ketones) to supply the much-needed energy that your brain needs. Ketones are created in the liver from converted stored fatty acids. Essentially your liver turns your stored fat into ketone bodies, which are then sent to your brain and muscles to maintain body functionality. Now you can imagine why the ketogenic diet has risen in popularity. The body produces three main types of ketones, acetone, acetoacetate, and beta-hydroxybutyrate (also known as beta-hydroxybutyric acid, β-hydroxybutyrate, or 3-hydroxybutyrate). When the liver begins to digest fatty acids, it produces the ketone body acetoacetate. Acetoacetate is then turned into beta-hydroxybutyrate from an enzyme called D-β-hydroxybutyrate dehydrogenase. So technically BHB is not a ketone; it’s a byproduct of acetoacetate, but most people don’t split hairs on this issue and just call BHB a ketone body.

So, what’s the big deal with BHB? Well for starters it is the most prevalent ketone in your body, BHB levels rise much quicker than other ketones, and it is easily dissolvable in blood or water, making it ideal for ketosis testing.

Types of BHB

Without getting too scientific and losing you (and myself) in the nomenclature, there are essentially two main types of BHB, R-BHB and S-BHB. R-BHB is a regular product of fatty acid metabolism for us humans. When we go on a ketogenic diet, restrict our caloric intake, or fast, R-BHB is produced endogenously (inside your body). S-BHB is a bit different. It is a momentary intermediate state in the final round of β-oxidation of fatty acids, usually not even lasting long enough to leave the mitochondrion and circulate through the blood. If I just lost you there, don’t sweat it. Just know that for this article when I discuss ketones or BHB, I’m referring to R-BHB. Ketone salts, a supplement discussed in further detail below, typically bind BHB to sodium, magnesium, calcium, or potassium and traditionally come in a pill.

Benefits of BHB

So, what are the benefits of having ketones such as BHB rushing through your body? I’m glad you asked that question because the benefits are numerous. Research has indicated that ketones, specifically BHB, have been linked to the protection of neuronal damage from glucose deprivation and have anti-epileptic effects. The ketogenic diet was initially developed to alleviate the symptoms of epilepsy. BHB has also been linked to the reduction of inflammation and oxidative stress. Oxidative stress is the imbalance between antioxidants and free radicals in the body. Long term oxidative stress can damage your cells, proteins, DNA, and result in inflammation and aging.

Ketones produced during a state of ketosis have also been shown to reduce the growth of cancer cells, improve your memory during your golden years, and help ward off Alzheimer’s. Dr. Gabriela Segura stated that entering ketosis through a ketogenic diet enables our mitochondria to perform better and reduces the production of harmful free radicals.

BHB and Weight Loss

One of the most famous attributes of BHB, resulting from ketosis, is weight loss. As mentioned before, ketosis essentially is the process by which your liver converts fatty acids from your stored fat cells into ketones that the body uses as fuel when glucose is not available. As your body consumes your stored fat cells, the amount of excess fat begins to shrink. When you finish a high fat low carbohydrate diet, your body will run out of its stored glucose and start the process of converting your stored fat into ketones. One can find story after story on the internet regarding their weight loss due to the ketogenic diet.

Consuming Exogenous BHB

The word endogenous is defined as having an internal cause or origin. In this case, endogenous BHBs are ketones that originate from within the body through the natural process of ketogenesis when your liver turns your fatty acids into ketone bodies. Whether it be through fasting, prolonged exercise, or dieting, ketogenesis will produce BHB naturally. Then there are exogenous BHB, and you guessed it, they originate from outside the body. Exogenous BHB or exogenous ketones are supplements that supply the body with a boost of ketone bodies. Ketone supplements will come as BHB ketones because the other prevalent ketone, acetoacetate, is not stable as a supplement.

Ketone supplements come as salts or esters. I mentioned earlier that BHB salts bind BHB to sodium, magnesium, potassium, or calcium. When you buy ketone salts, you are consuming the ketone BHB as well as the salt it is bound to. One needs to follow package instructions to avoid consuming too much of the salt. We will discuss this a bit more on this later. The other type of ketone supplement is called ester.  Ester typically comes in a liquid form that binds BHB to another compound called ester. Ester, being a liquid, hits the bloodstream faster and commences ketogenesis quicker than salts do, but they are not as prevalent in the market. One review of ketone ester reported ketone levels jumping from 0.2 mmol/L to 5.0 mmol/L in 30 minutes. Both forms increase blood BHB levels to mimic what occurs naturally when consuming a ketogenic diet. Thus, for those who want to initiate ketosis without dieting, taking BHB supplements will undoubtedly do the trick, but for a short duration.

Consuming BHB supplements comes with several benefits. Research suggests that BHB supplements may lower glucose levels and glycemic responses. Another study of 39 athletes who consumed ketone ester showed that they had improved physical endurance and decreased muscle glycolysis (the breakdown of carbohydrates) and plasma lactate. The study concluded that ketones may hold the key to more tremendous human potential in the future. Studies have indicated that BHB ester can suppress the appetite by lowering the hunger hormone ghrelin.

While suppression of the appetite may lead to weight loss, it cannot be suggested at this time that exogenous ketone consumption can lead to weight loss apart from following a ketogenic diet. When consuming exogenous ketones, especially ester, one needs to avoid intaking too much. Consuming excess exogenous ketones can cause your blood to become acidic, called ketoacidosis, and can lead to a coma or even death (20). If your goal is to enhance your energy and/or mental clarity for a few hours, exogenous ketones could be a great addition. If your goal is to shed some pounds, it’s probably best to follow a ketogenic diet and supplement your diet with exogeneous BHB to bring it to the next level.

Safety of Exogenous BHB Supplements

Exogenous ketones can be a great addition to your diet, but how safe are they? They are generally accepted as being safe supplements to increase your blood ketone levels, but potential side effects of long-term use are unknown at this time. As mentioned before, the biggest safety concern is the potential of consuming too much ester at one time which could lead to ketoacidosis. Ketone salts can also lead to electrolyte imbalance since they are bound to sodium, magnesium, calcium, or potassium. These concerns deal primarily with the consumer’s intake and current physical health. BHB supplements are currently not regulated by the FDA, are not tested for effectiveness or purity, and are not FDA approved. Like any other supplement, if you are considering taking ketone supplements or beginning a ketogenic diet, it’s probably best to speak with your doctor first.

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