Right now the Ketogenic diet is gaining popularity and its fame is being spread throughout medical journals, various health blogs and even a plethora of social networks. While there are plenty of documented health benefits from being in a state of ketosis, I wanted to take a moment and address the newest “ketosis craze” – portable ketopackets/powders. There are various companies, from Prototype Nutrition’s “Ketoforce” and “KetoCaNa” to the more recent “KetoOs” by Pruvit.
Supplemental ketone packets and powders contain ketone esters and/or ketone salts – also know as exogenous ketones (Ketones that are consumed). They offer a relatively instant state of ketosis (having the ketone body β-Hydroxybuterate in your blood and urine) without the carbohydrate restrictions or fasting needed to produce endogenous ketones (those made by the human body).
The real question at hand: Does consumption of exogenous ketones result the same health effects as activating the ketogenic pathway of producing endogenous ketones?
My conclusion (I want you to arrive at your own after reading the remainder of this article) is that the two approaches are wildly different – thus placing KetoCaNa, KetoForce and KetoOS into the category of the next weight loss/energy scams.
Ketogenesis
Ketogenesis is the biochemical process where ketone bodies (Acetoacetone, Acetone & β-Hydroxybuterate) are produced through the breakdown of fatty acids and ketogenic amino acids for energy. This chemical reaction takes place mostly in the liver mitochondrial cells and is initiated during low levels of blood glucose (low carb/no carb dieting and/or fasting) as a way to release available energy stored in fatty acids.
Fatty acids are converted into energy through a process called β-oxidation, which results in a molecule known as Acetyl-CoA. Under normal circumstances (normal blood glucose, non-fasting) Acetyl-CoA enters the TCA/Krebs cycle and mitochondrial electron transport chain reactions to form cellular energy molecules (ATP).
During the state of low blood glucose (fasting/low carb diets) oxaloacetate, a necessary intermediate for the TCA/Krebs cycle to function is depleted; thereby shunting fatty acid derived Acetyl-CoA away from the TCA/Krebs cycle towards the ketogenesis cycle. This is done so that the body can utilize an alternative source of energy during an ATP crisis. Enter β-Hydroxybuterate, a ketone alternative energy source.
Image Source: wikipedia.com
β-Hydroxybuterate carries a unique ability to cross the blood-brain barrier (BBB), which allows it to provide energy directly to the central nervous system and brain. In addition to being an alternative glucose energy source, β-Hydroxybuterate has been found to act as a Histone deacetylase inhibitor (HDAC), thereby allowing for an increase in brain derived neurotropic factor (BNDF), which plays a roll in neurogenesis (formation of new nerve cell synapses), long term memory creation, cognitive function, and reduction of neurological diseases (depression, anxiety, OCD, Alzheimer’s, epilepsy, seizures and dementia – to name a few).
Achieving a state of natural ketosis (the presence of β-Hydroxybuterate in both blood and urine) is the result of removing nearly all carbohydrates from the diet for a period of time and increasing consumption of healthy fats which encourages additional formation of Acetyl-CoA. As fats are now used as the primary source for energy when in ketosis, one can see its effect on weight loss.
According to The Art and Science of Low-Carbohydrate Living by Volek and Phinney – nutritional ketosis is defined by blood serum ketones ranging from 0.5 to 3.0mM and occurs when the body is in a state of lipolysis (the breakdown of fats and other lipids to release fatty acids for energy metabolism)
The Keto Supplement Scam
Can you swallow β-Hydroxybuterate and be in a state of ketosis? The answer is yes if your definition is simply having β-Hydroxybuterate in the blood and urine. However – was ketogeneis initiated? Is the body in a state of lipolysis? Are ketones being created endogenously as a result of metabolic conversion from carbohydrates to fatty acids for energy? No, No & No!
This is why I call scam on swallowing exogenous ketones and claiming to be in nutritional ketosis. Not only will these products mislead you into believing you are in a ketogenic state; they actually can lead to an inability to burn fat and short circuit metabolic function.
When consumed, β-Hydroxybuterate levels do elevate for short periods of time, resulting in suppression of hunger, increased energy and cognitive ability (which is why almost everyone endorsing or supporting the Keto Supplement movement swears the packets are the most amazing invention in the 21st century – some will even go as far as becoming distributors for the companies producing the product).
When consumed, elevated levels of blood bound ketone bodies down regulate lipolysis and ketogeneis. Any naturally occurring glucose or fatty acids in the blood are now converted into stored energy (glycogen and additional stored fatty acids) until the ingested ketones are metabolized.
To make matters worse for exogenous ketones, we need to discuss the effect of insulin. Under endogenous ketogensis, insulin beings to lower as carbohydrates are reduced and the body activates lipolysis to produce ketone bodies (see pathway above). When ketone bodies are consumed, and naturally occurring sugars are forced to be stored as glycogen or fatty acids, insulin will often increase to assist this process. Thus, despite some claims that exogenous ketones increase glucose uptake (through pyruvate dehydrogenase activation) it’s quite evident that they result in an increase in insulin.
Figures 1&2 Demonstrate that the pancreatic beta cells respond to increased ketones in the blood, induced by infusion of β-Hydroxybuterate, with an increased rate of insulin secretion that is immediate and longstanding. (Source)
What is the appeal of a instant ketone supplement?
In my researching this subject, the justifications I came across were, in not so many words, it’s hard to fast and/or restrict carbohydrates long enough to achieve a measurable state of endogenous ketones. I came across articles, blog and social media posts littered with “difficulties in lifestyle adaptation” and “dietary resistance.” For example, one article professing the benefits of exogenous ketones is found in the Federation of American Societies for Experimental Biology, which notes
“to achieve effective ketosis with ketogenic diets, almost complete avoidance of carbohydrates is required to keep blood insulin levels low to maintain adipose tissue lipolysis. Such high-fat, no carbohydrate diets are unpalatable, leading to poor patient compliance” (emphasis mine).
Is this really a surprise? Most people simply are not willing to put in the hard work and self discipline required to activate endogenous ketosis and there will always be a quick fix (in this case β-Hydroxybuterate Supplements).
Entering a state of keto-adaptation (a process where underlying metabolism is shifted away from glucose for fuel, instead relying on fat based sources of ketone bodies) is a lifestyle adaptation. Taking supplemental exogenous ketones is yet another “prescription” for continued use of poor lifestyle (akin to an acid reflux sufferer eating any food their heart desires as long as they take their pill before, during or after).
Achieving a normal state of endogenous ketosis offers more than just metabolic energy, weight loss and mental clarity. One physiological benefit (that will never be achieved through exogenous ketosis) is worth mentioning, mostly because of its correlation to anti-cancer, anti-aging/longevity and organic disease prevention.
Chronic normoglycemia (CN) – a metabolic state of consistent and stable levels of blood glucose and insulin. When in CN, there are little to no fluctuations in blood sugar or insulin. Random spikes in elevated blood sugar and insulin has been associated as a predictor for various chronic health conditions, including diabetes, kidney failure and cancer. Consistent levels of blood glucose, lowered insulin and the ongoing presence of blood bound free fatty acids (FFAs) and β-Hydroxybuterate are the rights of being in endogenous ketosis.
FFAs are crucial for the decoupling oxidative phosphorylation by dissipating intramembranal proteins without inhibiting ATP synthesis, thereby allowing the electron transport chain to produce ATP without oxidation. Thus, when β-Hydroxybuterate is produced by endogenous means, FFAs increase. When consumed, exogenous ketones do not encourage an increase in FFAs, thus lending to increased oxidation, inflammation and potential cellular toxicity.
Additional toxic ingredients found in exogenous ketone supplements
KetoOS: MCT Powder, β-Hydroxybuterate, Natural Flavor, Malic Acid, Stevia, Caffeine, Milk Ingredients.
KetoCaNa: β-Hydroxybuterate, Calcium, Citric Acid, Natural Flavor, Stevia
KetoForce: β-Hydroxybuterate, Potassium, Water, Citric Acid and/or Sodium Hydroxide
Both KetoOS and KetoCaNa contain “Natural Flavor” which is one ingredient that can be deceiving. It’s a chic marketing term to describe a flavoring agent that is derived from animal or plant sources, regardless if chemicals were involved in extracting the flavoring agent. With limited regulation on this ingredient phrase, many times monosodium glutamate (MSG), aspartame any another other organic compounds found in plants or animals are allowed to hide under the natural flavoring label.
While KetoForce contains no natural flavoring, note that each supplements offer β-Hydroxybuterate as one of the major ingredients.
Engaging a more natural, long standing healthy process of Ketosis
As with any metabolic process, it’s best to encourage its expression naturally. Instead of consuming exogenous ketones to “scam” or “trick” your body into a ketogenic state, change your mindset, decrease your carbohydrates, increase your healthy fat consumption, enter a fasting state and know that your body will work better when you do some actual work.
About The Author
Dr. Aaron Ernst, D.C., D.C., PSc.D. owns and operates Cornerstone Health Center, located in Charlotte, NC. He is a maximized living chiropractor with expertise in spinal correction, customized nutrition, cellular detoxification and exercise. Additionally, Dr. Ernst is host of AskDrErnst, a weekly health broadcast and podcast on News 1110, 99.3 FM and streaming online at www.wbt.com. For more information visit www.askdrernst.com.