Ketone Body Supplementation—A Potential New Approach for Heart Disease

[Bongleur]

Unclear whether this statement presumes extremely low carb intake or if it happens with "normal diet" quantities of carbs:
"a daily dose of 75-100 grams of ketone esters would be required to achieve steady state ketosis"

https://jamanetwork.com/journals/jama/fullarticle/2781359

Medical News & Perspectives
Quick Uptakes
June 17, 2021
Ketone Body Supplementation—A Potential New Approach for Heart Disease
Jennifer Abbasi
JAMA. 2021;326(1):17-18. doi:10.1001/jama.2021.8789
snip

But ketone bodies could have benefits beyond weight loss and blood sugar management. Researchers have discovered that the failing heart uses them for energy. A recent review in the Journal of the American College of Cardiology considered this and other emerging evidence that could support ketone body supplementation as a novel cardiovascular disease (CVD) treatment.

The Backstory

The healthy heart mainly uses fatty acids for fuel. In patients with early indications of heart failure, the organ switches to less reliance on fatty acids with an increase in glucose metabolism. As the disease progresses, the organ’s ability to use glucose also appears to be disrupted, starving it of energy and further worsening heart failure. According to the review’s authors, supplemental ketones could help this fuel starvation problem.

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...suggests that “the ketogenic shift is a universal cardiac response to stress,” the review’s authors wrote. What’s more, preclinical research suggests that the heart failure benefits of sodium-glucose cotransporter 2 inhibitors depend on ketone bodies. Animal experiments and early clinical studies, some using the ketogenic diet, have also demonstrated benefits of ketones on:

Endothelial function
Oxidative stress and mitochondrial function
Inflammation
Cardiac remodeling
Cardiovascular risk factors including blood pressure, body weight, blood glucose, and lipids

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Why Supplements?
There’s also evidence that the more ketones circulating in the body, the more the heart can and will use, regardless of whether a person has heart failure. Boosting ketones, therefore, could prove beneficial for patients who have CVD or are at risk for it, according to the reviewers.

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“Exogenous ketones are poised to have predictable pharmacokinetics, making state of the art clinical trials possible.”

Achieving Nutritional Ketosis
In fact, over-the-counter ketone supplements already exist. Some amateur athletes consume drinks containing ketone esters or ketone salts to improve exercise performance. Ketone salts are higher in sodium, one reason why Westenbrink is more interested in esters. He recently showed that ketone esters help prevent and treat heart failure in rodent models and he’s now testing their effects on energy production in the leg muscle during exercise among patients with heart failure.

“We have reason to believe that a daily dose of 75-100 grams of ketone esters would be required to achieve steady state ketosis in patients,” he wrote.

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Ketones also may have cardioprotective effects after STEMI (ST-segment elevation myocardial infarction)

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A Caveat
Despite the research so far, Westenbrink cautioned that little is known about the safety of the ketogenic diet or ketone supplements for patients with CVD. He noted that their interactions with diabetes medications could cause ketoacidosis. “We need to do the research before I would recommend it to anyone,” Westenbrink noted in regard to ketone supplementation.

 

[audreyh1]

Interesting.

The brain can also use ketone bodies for fuel, and “exogenous ketones”, i.e. ketones ingested as supplements or whatever are being explored as treatment for Alzheimer’s. With Alzheimer’s the brain is no longer able to take up sufficient glucose causing shrinkage, and available ketone bodies bypasses this obstruction.

As the disease progresses, the organ’s ability to use glucose also appears to be disrupted, starving it of energy and further worsening heart failure. According to the review’s authors, supplemental ketones could help this fuel starvation problem.

The mirrors the brain failing and subsequently starving in dementia. Even though the brain starts out as a massive consumer of glucose, it can develop insulin resistance and not be able to take up sufficient glucose to remain healthy.

Of course your body can easily make plenty of ketones by you eating a very low carb diet. So I’ve wondered why people get excited about ketone supplementation. I guess the answer is that a lot more is even better?

On ketoacidosis: if someone is on medication for diabetes, they have to reduce carbs and their medications under a doctor’s supervision because blood sugar reducing medications including insulin can cause blood sugar to go dangerously low. This is not a problem once you are off those medications.

 

[braumeister]

Of course your body can easily make plenty of ketones by you eating a very low carb diet. So I’ve wondered why people get excited about ketone supplementation.

Right.

 

[audreyh1]

^^^

In reading further I see that the scientists writing articles about therapeutic benefits of ketone supplementation mention that a ketogenic diet is hard to stick to long term.* I don’t get that at all, because I’ve been low carb enough to stay in ketosis for over 2 years now and have no problem sticking to it.

In my ketogenic diet I stopped counting carbs after 6 months. Simply avoiding grains, potatoes, and sweets, and eating fruit only occasionally, seems to keep me plenty low carb enough. I even have a very small amount of extreme dark chocolate almost every day. It seems super simple to me. Maybe some folks have lower a daily carb threshold than I do, requiring stricter adherence for them.

Now if someone is not able to control the food they are given to eat for whatever reason, that is another matter entirely.

*I suspect a lot of this is simply our pharmacologically oriented medical culture. Why teach people how to eat right for their condition when you can give them a few daily pills instead?