Ketone Salts: Ketosis with a Cost
8 min read

Ketone Salts: Ketosis with a Cost

Updated Nov 16, 2019
Nate Martins

With the increasing excitement and emerging scientific research surrounding keto, more and more people are trying out the high-fat, low-carb diet for body composition and exercise performance. Maybe you’re one of them!

While the health benefits are promising, you may have also found that maintaining a state of ketosis can be extremely difficult, especially with the Western diet’s love affair with carbohydrates.

If that's the case, you may want to consider optimizing your keto diet. Supplements could be a great tool that can help you get into a deep state of ketosis faster than dieting and / or fasting alone.

The most widely-available keto supplements on the market are exogenous ketone salts, which are formed when ketones (energy-generating molecules derived from fatty acid breakdown) are bound to a mineral ion. Let’s assess some of the nuances around ketone salt supplements and other types of exogenous ketones to help you make the best decision for optimizing ketosis.

Ketones 101

Before launching right into ketosis, it’s important to understand the science behind ketones themselves.

Ketones are a fundamentally different fuel source than the carbohydrates, fat, and protein that our bodies typically rely on for energy. A highly efficient energy source, the body produces ketones when pushed to its limits - either during extreme carb restriction1 or after heavy exercise.2

Achieving Ketosis

Ketosis is generally defined as elevated blood ketone levels greater than 0.5mM.1 There are two types of blood ketones: endogenous and exogenous ketones. Both ultimately can get you into a state of ketosis, albeit through very different methods.

Endogenous ketones are produced by the liver, usually when someone is in a fasted state or on a ketogenic diet. The production of endogenous ketones can take weeks or months of strict dieting.1 But there’s a payoff to that patience: your body ends up becoming fat-adapted; learning to use fat as fuel when carbohydrate intake is depleted. This process is sometimes referred to as nutritional ketosis.

Taking exogenous ketones can deliver a fast-acting, deep state of ketosis almost immediately.

Exogenous ketones are often consumed as a dietary supplement or through food consumption. They can put you in a state of ketosis,3 but the body isn’t "technically" ketogenic because the ketones were delivered from an external source (meaning, the body didn’t produce from fat them itself). Exogenous ketones don’t trigger natural ketone production, but they still lead to elevated blood ketone levels.

an image of a salad to showcase how to achieve endogenous ketosis, and an image of HVMN Ketone to show exogenous ketosis

Different Types of Ketone Bodies

The three primary ketone bodies are beta hydroxybutyrate (BHB), acetone, and acetoacetate (AcAc). Most exogenous ketones products utilize BHB rather than AcAc because BHB is more stable and easier to make into a sellable product while acetone is considered to be a waste product of fatty acid breakdown.

Acetoacetate is created in the liver from the breakdown of fatty acids, and is then mostly converted into BHB for transport in the blood. Any AcAc in the blood can be either taken up into the cells or spontaneously broken down to produce acetone–which cannot be used for energy production. Acetone is removed from the body through waste product like urine, or through the breath.

BHB is the ketone body present in the blood at the highest level when produced naturally.4 This is because it doesn’t spontaneously degrade like AcAc .

Once taken up into the cells from the blood BHB offers the advantage of being reduced easier than AcAc. This means that when BHB is converted into AcAc inside the cell’s mitochondria, it generates NADH–a coenzyme needed for ATP production. AcAc whiffs on the energy-providing power of NADH. Plus, when an AcAc-based supplement is consumed, the body will reverse-convert some of to BHB, which actually uses up those NADH molecules.

The perfect macronutrient calculator for keto

Maintaining balanced macronutrients is a challenge. Subscribe, and we'll send you our easy-to-use macronutrient calculator to track all your food.

Exogenous Ketones: Salts, MCT and Esters

We'll first explore ketone salts before analyzing some potentially more effective alternatives.

Ketone Salts

Ketone salts typically come as a powder containing BHB bound to a mineral salt (usually either sodium, potassium, or calcium) or an amino acid (like lysine or arginine). These powdered BHB salts are commonly dissolved in liquid to be consumed in drink form.

Despite the lack of published work analyzing the effects on biomarkers or performance measures in humans, ketone salts are a growing market. It is important to note that the FDA doesn’t recognize ketone salts as GRAS (Generally Regarded as Safe) food ingredients.

Many studies have been conducted in rats5,6,7 and have shown relatively low levels of BHB in the blood. Human studies showed similar results, with clinical trials reporting blood BHB levels of 0.6 - 1 mM after ketone salt drinks.8,9,3

One recent study in young adults illustrated the differences between salts and esters (more on these later) acutely: ketone salts provided a peak D-BHB of 1 mM whereas the same amount of BHB in a ketone ester raised blood BHB levels to 2.8 mM.3

For performance, data has been mixed at best. Four studies investigated the effects of ketone salts in athletes (total n = 22) with none of the studies finding significant improvements in performance markers.8,9,10,11 In one study, performance actually decreased by 7%, and GI distress (ranging from nausea to diarrhoea to vomiting) was reported in a high percentage of athletes.10,12

While ketone salts are relatively inexpensive and may be a nice co-deliverer of other nutrients, BHB levels are only raised slightly–to 1 mM.8,9 ,3 There are also some health concerns with consuming enough salt to raise BHB significantly.

Excessive salt consumption may have long-term health implications.

High salt intake is linked to hypertension, cardiovascular disease and even stomach cancer.13 The 2015 - 2020 Dietary Guidelines for Americans recommends 2,300mg of salt consumption a day; but most Americans consume 3,400mg daily. Some ketone salt products contain nearly 70% of the recommended daily allowance of sodium in a single serving.

A perceived benefit of ketone salt supplementation is a potential replacing of lost electrolytes. Electrolytes loss is a common problem in the early weeks of the keto diet. However, electrolyte imbalances usually don’t persist after keto-adaptation period of about 28 days,14 and so then excessive salt consumption may still be harmful.

Let’s review: ketone salts provide sub-optimal BHB, have no effect on performance and may cause significant GI issues. That could be why some makers of ketone salts have cited studies conducted on ketone esters.

So if not salts, then what other options do you have to increase ketones exogenously? Here are two, which have shown varying degrees of success.


OK–you caught us. MCT oils don’t actually contain ketones. They’re medium-chain triglycerides (MCT) fat molecules made of glycerol joined to three medium-length fatty acid chains that are between 6-12 carbons in length.

So where do the ketones come from? Ketone generation results from the breakdown of MCTs by the body. They’re processed differently than long-chain fats, which are absorbed and released into the blood via the lymphatic system, bypassing the liver (where ketones are produced). Instead, MCTs are transported straight to the liver in the blood, where they’re either used directly for energy or turned into ketones.

MCTs exist naturally in some foods such as coconut oil and dairy products. But a high amount is required to increase blood BHB. Studies on MCT supplements report that blood ketone levels following MCT use were relatively low (0.5 - 1mM).15 However, the consumption of large amounts of MCTs can cause gastrointestinal side distress.15,16 Additionally, people who are trying to loose weight should watch out for MCTs (specially if supplementing with MCT powders) as they are highly caloric.

While MCTs aren’t exactly exogenous ketones, they do provide a substrate by which one could potentially increase blood ketone levels.

Ketone Esters

Ketone esters are salt-free liquids that contain BHB without any extras. Instead of being bound to a mineral, like BHB salts, they’re bound to a ketone precursor (like butanediol or glycerol) via an ester bond. You can tell how many ester bonds there are from the name: monoester (one), diester (two), or triester (three).

They aren’t exactly a new discovery either. The first ketone ester was developed in the late 70s, and other types were developed in the mid-90s.17,18

There are a couple types of ketone esters being developed and sold right now with each affecting the body differently.

An AcAc diester was developed at the University of South Florida. In rodents, it increased blood D-BHB to 1 - 4mM, and blood AcAC up to 5mM.19 Animal studies have also shown that it might help with seizures,19 weight loss,20 and cancer.21 A published study in humans, however, identified a 2% decrease in a 31km cycling time trial performance. The lack of efficacy was potentially thought to be due to low levels of BHB (less than 2mM), the short high-intensity nature of the time trial, and / or the use of AcAc vs. BHB.22,23

The D-BHB monoester raises blood ketones to exceptional well, roughly a 3 - 6 mM increase within 30 minutes of consumption.3,24,25,26 This means you enter into a state of ketosis faster than other products currently on the market. It was developed over the course of 15+ years by DARPA, the NIH, and University of Oxford.

And it’s salt free so it won’t impact water retention or pose any of the health risks often associated with high salt levels. Side effects of the ester itself are also minimal. A single does of D-BHB mixed with a meal replacement formula reported very little gastrointestinal issues at typical doses and only caused mild symptoms when taken at 4x the recommended amount.24

Ketone esters have proved beneficial for endurance performance also.27,26 Athletes using ketone ester drinks before a workout reported no major side effects hindering performance. This is in contrast to ketone salts and the acetoacetate diester which have reported side effects (GI issues) that hampered performance.23 There have been published clinical trials in humans demonstrating the efficacy of ketone ester drinks on improving performance, recovery and several health outcomes such as appetite control,3 blood glucose management28 and even neurodegenerative disease.29

And while list of benefits of BHB monoesters runs long, for now, taste is not on that list. We’ve heard it “tastes like it works,” which is a polite way of saying that the taste is distinct and strong. But for athletes, a single bitter sip is worth the performance benefits. Certain ketone esters have FDA GRAS (generally regarded as safe) status as a food, are cleared for use in athletes by the World Anti Doping Agency (WADA), and are batch tested as part of the NSF Safe for Sport program.

For performance and recovery, human studies on ketone esters have demonstrated extremely positive results.

When consumed before exercise, the D-BHB from helps muscle work 28% more efficiently than carbs alone. This means that the body does more work with the same amount of oxygen.30 In a 30-minute time trial test in which cyclists consumed the D-BHB ester before exercise with carbohydrates, riders’ performance improved by 2-3% (400m).26 When taken after exercise with glucose, the D-BHB ketone ester also improved the rate of resynthesis of glycogen as well as the rate of muscle protein synthesis.27,31

There’s also some exciting research emerging around the cognitive benefits of ketone bodies (because ketones can cross the blood-brain barrier). The D-BHB ketone ester has been shown to help mice solve maze puzzles 38% faster than normal32 as well as shown to improve cognitive performance in a simulated soccer trail.10

Are Ketone Salts Right For You?

While deciding which exogenous ketone supplement is best for you depends on a number of factors, it ultimately lands on what goals you're looking to achieve.

Ketone salts are less expensive than ketone esters, and do provide a mild boost in ketone levels. They have a milder taste that is easier to mask with artificial sweeteners, like stevia and other natural flavors. However, the science behind ketone salts is still lacking, with no clear evidence for weight loss, cognitive ability or improved performance. In fact, in some cases, performance decreased due to overwhelmingly negative side effects.

While the taste of some ketone esters leaves something to be desired, the data pointing to increased performance in human studies makes it worth while to investigate as a potential ergogenic aid.

If you’re an athlete or dieter considering an exogenous BHB supplement for physical performance or nutritional support, evidence-based results are best for helping highlight how exogenous ketones might affect you. Ultimately, you're choice of supplement should be based on your budget and personal needs.

Have you used BHB salts? Have you tried esters? Let us know your experience in the comments.

The best keto products, ranked

Here's our list of the supplements and foods that can help supercharge your keto diet.

Scientific Citations

1.Hallberg, S. J., McKenzie, A. L., Williams, P. T., Bhanpuri, N. H., Peters, A. L., Campbell, W. W., Volek, J. S. (2018). Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther.
2.Noakes, M., Foster, P.R., Keogh, J.B., James, A.P., Mamo, J.C., and Clifton, P.M. (2006). Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk. Nutr Metab (Lond) 3, 7.
3.Stubbs, B.Cox, P.; Evans, R.; Santer, P.; Miller, J.; Faull, O.; Magor-Elliott, S.; Hiyama, S.; Stirling, M.; Clarke, K. (2017). On the metabolism of exogenous ketones in humans. Front. Physiol.
4.Cahill, G.F., Jr. (2006). Fuel metabolism in starvation. Annu Rev Nutr 26, 1-22.
5.Kesl, S.L., Poff, A.M., Ward, N.P., Fiorelli, T.N., Ari, C., Van Putten, A.J., Sherwood, J.W., Arnold, P., and D’Agostino, D.P. (2016). Effects of exogenous ketone supplementation on blood ketone, glucose, triglyceride, and lipoprotein levels in Sprague–Dawley rats. Nutr. Metab. 13, 9.
6.Ari, C., Kovács, Z., Juhasz, G., Murdun, C., Goldhagen, C.R., Koutnik, A.P., Poff, A.M., Kesl, S.L., and D’Agostino, D.P. (2016). Exogenous Ketone Supplements Reduce Anxiety-Related Behavior in Sprague-Dawley and Wistar Albino Glaxo/Rijswijk Rats. Front. Mol. Neurosci. 9, 137.
7.Caminhotto, R.d.O., Komino, A.C.M., de Fatima Silva, F., Andreotti, S., Sertié, R.A.L., Boltes Reis, G., and Lima, F.B. (2017). Oral β-hydroxybutyrate increases ketonemia, decreases visceral adipocyte volume and improves serum lipid profile in Wistar rats. Nutr. Metab. 14, 31.
8.Rodger, S., Plews, D., Laursen, P., and Driller, M. (2017). The effects of an oral β-hydroxybutyrate supplement on exercise metabolism and cycling performance.
9.O’Malley, T., Myette-Cote, E., Durrer, C., and Little, J.P. (2017). Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males. Applied Physiology, Nutrition, and Metabolism, 1-5.
10.Evans M, Patchett E, Nally R, Kearns R, Larney M, Egan B. Effect of acute ingestion of β-hydroxybutyrate salts on the response to graded exercise in trained cyclists. Eur J Sport Sci. 2018:1-11.
11.Waldman HS, Krings B, Basham SA, Smith JW, Fountain BJ, McAllister MJ. Effects of a 15-Day Low Carbohydrate, High-Fat Diet in Resistance-Trained Men. (1533-4287 (Electronic)).
12.Tobias Fischer, Ulrike Och, Ira Klawon, et al., “Effect of a Sodium and Calcium DL-β-Hydroxybutyrate Salt in Healthy Adults,” Journal of Nutrition and Metabolism, vol. 2018, Article ID 9812806, 8 pages, 2018.
13.Strazzullo, P., D'Elia, L., Kandala, N.B., and Cappuccio, F.P. (2009). Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 339, b4567.
14.Rabast, U., Vornberger, K.H., and Ehl, M. (1981). Loss of weight, sodium and water in obese persons consuming a high- or low-carbohydrate diet. Ann. Nutr. Metab. 25, 341-349.
15.Henderson, S.T., Vogel, J.L., Barr, L.J., Garvin, F., Jones, J.J., and Costantini, L.C. (2009). Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial. Nutr Metab (Lond) 6, 31.
16.Ivy JL, Costill DL, Fink WJ, Maglischo E. Contribution of Medium and Long Chain Triglyceride Intake to Energy Metabolism During Prolonged Exercise. Int J Sports Med. 1980;01(01):15-20.
17.Birkhahn RH, Border JR.Intravenous feeding of the rat with short chain fatty acid esters. II. Monoacetoacetin. Am J Clin Nutr. 1978 Mar;31(3):436-41.
18.Desrochers, S., David, F., Garneau, M., Jette, M., and Brunengraber, H. (1992). Metabolism of R-1,3-Butanediol and S-1,3-Butanediol in Perfused Livers from Meal-Fed and Starved Rats. Biochem. J. 285, 647-653.
19.D'Agostino, D.P., Pilla, R., Held, H.E., Landon, C.S., Puchowicz, M., Brunengraber, H., Ari, C., Arnold, P., and Dean, J.B. (2013). Therapeutic ketosis with ketone ester delays central nervous system oxygen toxicity seizures in rats. Am. J. Physiol. Regul. Integr. Comp. Physiol. 304, R829-836.
20.Davis RAH, Deemer SE, Bergeron JM, et al. Dietary R, S-1,3-butanediol diacetoacetate reduces body weight and adiposity in obese mice fed a high-fat diet. FASEB J. 2018;:fj201800821RR.
21.Poff, A.M., Ari, C., Arnold, P., Seyfried, T.N., and D'Agostino, D.P. (2014). Ketone supplementation decreases tumor cell viability and prolongs survival of mice with metastatic cancer. Int. J. Cancer 135, 1711-1720.
22.Stubbs BJ, Cox PJ, Evans RD, Cyranka M, Clarke K, De wet H. A Ketone Ester Drink Lowers Human Ghrelin and Appetite. Obesity (Silver Spring). 2018;26(2):269-273.
23.Leckey, J.J., Ross, M.L., Quod, M., Hawley, J.A., and Burke, L.M. (2017). Ketone Diester Ingestion Impairs Time-Trial Performance in Professional Cyclists. Front. Physiol. 8, 806.
24.Clarke, K., Tchabanenko, K., Pawlosky, R., Carter, E., Todd King, M., Musa-Veloso, K., Ho, M., Roberts, A., Robertson, J., Vanitallie, T.B., et al. (2012). Kinetics, safety and tolerability of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate in healthy adult subjects. Regul. Toxicol. Pharmacol. 63, 401-408.
25.Shivva, V., Cox, P.J., Clarke, K., Veech, R.L., Tucker, I.G., and Duffull, S.B. (2016). The Population Pharmacokinetics of d-β-hydroxybutyrate Following Administration of (R)-3-Hydroxybutyl (R)-3-Hydroxybutyrate. The AAPS journal, 1-11.
26.Cox, P.J., Kirk, T., Ashmore, T., Willerton, K., Evans, R., Smith, A., Murray, Andrew J., Stubbs, B., West, J., McLure, Stewart W., et al. (2016). Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes. Cell Metabolism 24, 1-13.
27.Holdsworth, D.A., Cox, P.J., Kirk, T., Stradling, H., Impey, S.G., and Clarke, K. (2017). A Ketone Ester Drink Increases Postexercise Muscle Glycogen Synthesis in Humans. Med Sci Sports Exerc.
28.Myette-Cote E, Neudorf H, Rafiei H, Clarke K, Little JP. Prior ingestion of exogenous ketone monoester attenuates the glycaemic response to an oral glucose tolerance test in healthy young individuals. LID - 10.1113/JP275709 [doi]. 2018(1469-7793 (Electronic)).
29.Newport, M.T., VanItallie, T.B., Kashiwaya, Y., King, M.T., and Veech, R.L. (2015). A new way to produce hyperketonemia: use of ketone ester in a case of Alzheimer's disease. Alzheimer's & dementia : the journal of the Alzheimer's Association 11, 99-103.
30.Sato, K., Kashiw.aya, Y., Keon, C.A., Tsuchiya, N., King, M.T., Radda, G.K., Chance, B., Clarke, K., and Veech, RL. (1995). Insulin, ketone bodies, and mitochondrial energy transduction. FASEB J. 9, 651-658.
31.Vandoorne, T., De Smet, S., Ramaekers, M., Van Thienen, R., De Bock, K., Clarke, K., and Hespel, P. (2017). Intake of a Ketone Ester Drink during Recovery from Exercise Promotes mTORC1 Signaling but Not Glycogen Resynthesis in Human Muscle. Front. Physiol. 8, 310.
32.Murray, A.J., Knight, N.S., Cole, M.A., Cochlin, L.E., Carter, E., Tchabanenko, K., Pichulik, T., Gulston, M.K., Atherton, H.J., Schroeder, M.A., et al. (2016). Novel ketone diet enhances physical and cognitive performance. FASEB J.
Editor's Choice
Emails worth reading.

Once a week, we'll send you the most compelling research, stories and updates from the world of human enhancement.

H.V.M.N. Co-founders Michael Brandt and Geoffrey Woo

These statements have not been evaluated by the FDA. Our products are not intended to diagnose, treat, cure, or prevent any disease.

© 2020 HVMN Inc. All Rights Reserved. H.V.M.N.®, Health Via Modern Nutrition™, Nootrobox®, Rise™, Sprint®, Yawn®, Kado™, and GO Cubes® are registered trademarks of HVMN Inc. ΔG® is a trademark of TΔS® and used under exclusive license by HVMN Inc.

38 Mason St, 3rd Floor, San Francisco, CA 94102
Email us:

These statements have not been evaluated by the FDA. Our products are not intended to diagnose, treat, cure, or prevent any disease.

© 2020 HVMN Inc. All Rights Reserved. H.V.M.N.®, Health Via Modern Nutrition™, Nootrobox®, Rise™, Sprint®, Yawn®, Kado™, and GO Cubes® are registered trademarks of HVMN Inc. ΔG® is a trademark of TΔS® and used under exclusive license by HVMN Inc.