Exogenous ketones are a hot topic at the moment in the ever-growing keto community in Dubai and the UAE, but what are they and are they safe? We’ll catch you up on what you need to know in this short article.
15-Dec 2018, by Lee Sandwith
I started dabbling with exogenous ketones back in late 2014 when Tim Ferriss introduced the world to the mighty Peter Attia on his podcast, The Tim Ferriss Show.
The episode, entitled “Dr. Peter Attia on Life-Extension, Drinking Jet Fuel, Ultra-Endurance, Human Foie Gras, and More”, was a biohacker’s dream as it covered a wide range of longevity-related topics from performance enhancement, blood testing, enhancing longevity by avoiding certain types of exercise and, you guessed it, exogenous ketones.
If you don’t know of Peter Attia he’s well worth checking out as he’s a fascinating character. He earned his M.D. from Stanford University, holds a B.Sc. in mechanical engineering, resided at John Hopkins Hospital as a general surgeon, he’s an ultra-endurance athlete, compulsive self-experimenter, and a truly remarkable human being.
To boot, he’s just started an amazing podcast of his own called The Drive which is super technical and extremely appealing for anyone who likes to geek out and get into the weeds on all things biochemistry.
This podcast came out at a similar time as Tim’s episode that unleashed Dom D’Agostino into the public eye. This episode was much more geared towards the ketogenic diet as a potential intervention for cancer and the topic of exogenous ketones was raised in depth.
Dom actually developed the formula for Kegenix’s exogenous ketones product and during the podcast he recommended KetoSports’ KetoCana.
Having two keto heavyweights behind exogenous ketones was enough to inspire my curiosity and given that this was the time when I started indulging in self-experimentation with lots of longevity related things, I was sold.
What are ketones?
Supplements aside, I think it’s pretty common knowledge these days that ketones are what the body produces when one follows a ketogenic diet.
Surprisingly, this is quite a controversial question which causes much debate in UAE keto circles, so let me try to keep this as simple as possible.
The original ketogenic diet, sometimes referred to as “classic keto”, was designed in 1923 by Dr. Russell Wilder at the Mayo Clinic for the treatment of epilepsy. The diet was initially developed in response to the observation that fasting had antiseizure properties and that keeping carbohydrates extremely low would have a fasting-mimicking effect (1).
In the classic diet, the “means” is an adjustment in the macronutrient ratio where there should be a 4:1 ratio of fat to protein and carbs, with 90% of calories coming from fat, 6% from protein, and 4% from carb (2).
Typically, this results in a diet with less than 20g carbs and is pretty much guaranteed to kick the body into fat burning mode where the liver starts to produce ketones for fuel in place of glucose.
So why would this have any benefit in terms of preventing seizures?
From a biochemical standpoint, during the process of nutritional ketosis the body metabolizes fat stores via lipolysis following which the fatty acids undergo beta-oxidation into acetoacetate, β-hydroxybutyrate (βHB), and acetone.
These ketone bodies can then be used by the cell as precursors to generate adenosine triphosphate (ATP), the body’s energy form (3).
This mechanism is sometimes referred to as a secondary metabolic system which evolved in humans to allow us to withstand prolonged periods of starvation (4).
Further, ketone bodies, in particular βHB, may well be the brain’s preferred fuel source* over glucose which is one of the reasons the ketogenic diet is used an intervention for epilepsy.
*For more info on that, you may wish to check out this lecture from Dr. Stephen Cunnane on Brain Glucose and Ketone Metabolism.
The Modern Day Ketogenic Diet
The ketogenic diet has become extremely popular globally over the last few years mainly as it is an effective “tool” for weight loss.
I would say that the vast majority of people follow the diet for this reason, especially in the UAE keto community, however, there are many other benefits beyond weight loss such as:
- Better control over appetite and hunger
- Increased cognitive ability
- Improved lipid profile: Triglycerides and HDL cholesterol*
- Optimisation of blood sugar and insulin
- Potential treatment and cure for type 1&2 diabetes
- Potential cancer prevention and treatment
*In a small percentage of people, however, cholesterol can dramatically increase to dangerous levels. Check out this article for further reading on cholesterol.
The major issue with the classical ketogenic diet is that many people find it extremely difficult to keep carbs under 20g carbs per day which presents issues of adherence.
Fortunately, though, for many people the state of nutritional ketosis can be achieved much more easily that this.
Even if you have the most basic understanding of the science behind ketosis, biochemically the goal is to get your body to produce ketone bodies, especially βHB.
The line which I keep regurgitating in the keto community is that “low-carb is the means, not the end”.
What I mean by this is that you may be able to achieve nutritional ketosis by consuming more than 20g carbs per day!! This is true especially as you become keto adapted and if you’re in to rigorous exercise.
Personally, I can still maintain fairly high levels of βHB when eating a much higher percentage of carbs than most, even up to 200g on a good day. I know this as I regularly test my blood ketone levels.
I enjoy tracking things and self-experimenting, simple as that. In fact, I see it as an inherently good thing and expect that we’ll be measuring ketones continuously within the next year or two. Think Continuous Blood Glucose system for ketone bodies, another biohacker’s dream!!
To tie this back to exogenous ketones, they have been created to allow us to intensify the effects of the naturally occurring ketones in our bodies.
Essentially, you can reap the same benefits as nutritional ketosis by taking a supplement.
For many, they are an excellent supplement to a ketogenic, low-carb or intermittent fasting way of life, as they can provide you with that extra boost you may need in some situations.
They have been shown to give high intensity or endurance athletes the power to reach peak performance in training and competing.
They are a powerful nootropic (brain-enhancing ‘smart drug’), since they cross the blood brain barrier with ease and are the brain’s preferred fuel source.
They are a potent appetite suppressant during fasting windows and can help to extend fasts.
A short-cut to all of the benefits?
The word “exogenous” means external, as opposed to “endogenous” which mean internal. When you are in a state of nutritional ketosis, your body is “endogenously” producing ketones, when you take a ketone supplement the process is “exogenous”.
Studies: Are exogenous ketones safe?
The short answer to this question is that we simply don’t know as they have not yet been adequately studied. There are some studies on rats, however, there is very little on humans, in fact, we could find a couple of studies!
In terms of efficacy, there is no doubt that exogenous ketones raise blood ketone levels. That can be determined through a simple blood ketone test where you’ll find that the decent products boost your βBH levels by around 1.2-1.4 mM.
Interestingly, one study from the University of Oxford in 2017 showed that not only do exogenous ketones raise βBH levels, they also lower blood glucose (5).
In a 2016 study from the University of South Florida, a study in rats confirmed the “efficacy and tolerability of oral exogenous ketone supplementation in inducing nutritional ketosis independent of dietary restriction”.
Nutritional ketosis is defined as a diet which increases βHB in the blood to over 0.5 mM. (6)
In the study, the effects of the 28-day administration of five ketone supplements on blood glucose, ketones, and lipids in male Sprague–Dawley rats we studied. Rats received a daily 5–10 g/kg dose of their respective ketone supplement via intragastric gavage during treatment.
Weekly whole blood samples were taken for analysis of glucose and βHB at baseline and at 28 days, triglycerides, total cholesterol and high-density lipoprotein (HDL) were measured. Exogenous ketone supplementation caused “a rapid and sustained elevation of βHB, reduction of glucose, and little change to lipid biomarkers compared to control animals”.
Another study from the same university also showed that exogenous ketones may have a place in the treatment of anxiety (7) and in terms of exercise performance, several studies have been conducted.
One such study from the University of British Columbia showed that “nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males” (8) which interestingly contradicts anecdotal reports that exogenous ketones can be used to fuel endurance and rigorous exercise.
My personal position
Which ever way you choose to look at exogenous ketones, from a scientific standpoint, there isn’t a great deal of available data so the jury is clearly still out.
Personally, I have been using them successfully for several years as a pre-workout, nootripic and appetite suppressant. I honestly believe that βHB is one of the most interesting supplements available and it’s the only sports supplement I’ve used which has a direct, immediate and tangible effect.
The only negative thing I’ve experienced with βHB is a slight GI tolerance issue with some of the products but overall I’ve found them to be the best supplement to a keto diet available.
I would like to make it clear that I’ve always used them as a supplement to a well-formulated ketogenic diet, not in place of one.
Many people seem to be using them to get back into ketosis after a carb binge which doesn’t sound like an intuitively sensible thing to do.
There have also been some murmurs about the potential insulinemic effects of exogenous ketones which would make using them in conjunction with carbs a bad idea.
Where to get exogenous ketones in the UAE
If you’re a fan of Perfect Keto, KetoSports or Kegenix, you can easily get their products online and shipped from the US albeit it a slightly higher than desirable price point.
If you want something a bit quicker and a bit cheaper, head over to ingfit.ae and check out our in-house βHB called KetoVita. It’s doctor developed, tastes much better than any other βHB supplement we’ve tried and it’s tried and tested and is just as potent as the big guns.
Watch our podcast on exogenous ketones
- Bailey EE, Pfeifer HH, Thiele EA. The use of diet in the treatment of epilepsy. Epilepsy Behav. 2005;6:4–8. [PubMed]
- The Charlie Foundation – The Original Ketogenic diet
- Barañano KW, Hartman AL. The Ketogenic Diet: Uses in Epilepsy and Other Neurologic Illnesses. Curr Treat Options Neurol. 2008 Nov; 10(6): 410–419. [PubMed]
- White H, Balasubramanian V. Clinical review: Ketones and brain injury. Published online 2011 Apr 6. [PubMed]
- Stubbs BJ, Cox PJ, Evans RD, Santer P, Miller JJ, Faull OK, Magor-Elliott S, Hiyama S, Stirling M, Clarke K. On the Metabolism of Exogenous Ketones in Humans. Published online 2017 Oct 30. [PubMed].
- com – What is The Ketogenic Diet?
- Ari C, Kovács Z, Juhasz G, Murdun C, Goldhagen CR, Koutnik AP, Poff AM, Kesl SL, D’Agostino PD. Exogenous Ketone Supplements Reduce Anxiety-Related Behavior in Sprague-Dawley and Wistar Albino Glaxo/Rijswijk Rats. Mol. Neurosci., 13 February 2017.
- O’Malley T, Myette-Cote E, Durrer C, Little JP, Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males. Applied Physiology, Nutrition, and Metabolism. 2017 Jul, 42(10):1031-1035.
image credits: The Health Cloud, Perfect Keto