BHB Salts – Get Into Ketosis With Betahydroxybutryate

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Ketogenic diets have been a popular way to lose body fat. Arguably effective, they can be traced back to at least the 1920s.

The use of ketogenic diets for other reasons, such as curing or mitigating the effects of epilepsy, likely goes back even further. Possibly as far back as 70-110 AD. There appears to be a reference to this eating style in the New Testament (see Book of Matthew, 17:14-21).

So these methodologies are not exactly new. Before I delve too far into what is new, I suppose it is best to review briefly what ketosis actually is; the true definition of this state, and how a typical person can induce and maintain ketosis.

Related – Does the Keto Diet Fight Cancer?

When there is a complete absence (fasting) of carbs, or reduction of intake to below (about) 50g per day, the stores of glucose (the primary and preferred “fuel source” in the human body) becomes inadequate for normal oxidation of fat and for the supply of glucose to the brain (J Clin Invest 1967;46: 1589-1595). Since your brain can’t directly use fat as an energy source – it is normally restricted to using glucose – after about 72 hours of without any or with significantly reduced carbohydrate ingestion – your brain needs to find an alternate form of energy.

This alternative form of energy comes from the overproduction of Acetyl Coenzyme A, which was discussed in great length by Owen, Morgan & Kemp, et al, as noted in the reference supra.

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This situation is observed in both normal and abnormal pathological states, such as fasting and high fat/low carbohydrate dieting (e.g., an Atkin’s type diet). These dietary situations eventually lead to an over production of something called “Ketone Bodies” (KB) of which there are three variants – acetoacetate, β-hydroxybutyrate, and acetone via a process which occurs primarily in the mitochondria of the liver and is known as “ketogenesis” (Prostaglandins Leukot Essent Fatty Acids 2004;70: 243-251).

The principal KB that the liver produces is acetoacetate. However, somewhat surprisingly, the principle ketone found in the plasma is actually β-hydroxybutyrate (BHB). Although if we want to get picky about it, technically BHB is not really a KB because the ketone functional group on BHB has been converted to a hydroxyl group.

But it essentially functions like a ketone so… If you eat a normal diet with more than (about) 50g/day of carbs, the liver produces very little in the way of ketone bodies and the small amount that it does produce is rapidly metabolized by skeletal and cardiac muscle. When the liver is coaxed into “overproduction” of ketone bodies, they accumulate in the blood at above normal levels obviously, which leads to ketosis (ketonemia and ketonuria – the ability for us to detect KB’s in blood plasma and urine).

As a side note, one KB can be detected in the breath of people in ketosis (the “bad breath” that is often associated with people who are on high fat/low carb diets). This particular ketone body is actually the acetone moiety.

In a normal state, the amount of ketone bodies in the blood is quite low (< 0.3 mmol/L) when compared to with glucose (around 4 mmol/L). Since ketone bodies and glucose have about the same kM for transport into the brain, the brain will start to use ketone bodies as an energy source when their amounts approach 4 mmol/L. (Prostaglandins Leukot Essent Fatty Acids 2004;70:309-319).

A couple of other interesting notes and tidbits. Ketone bodies are able to generate more energy than glucose based on the way they are metabolically processed (Prostaglandins Leukot Essent Fatty Acids 2004;70:309-319). Additionally, and this is quite amazing, is that plasma glucose levels, even though they are reduced while someone is in a state of ketosis, still remain within normal physiological levels because glucose can (and is) formed from two other metabolic processes in the human body.

  1. Gluconeogenic amino acids (Alanine, Arginine, Asparagine, Cysteine, Glutamic Acid, Glutamine, Glycine, Histidine, Methionine, Proline, Serine and Valine) are readily converted to glucose in the liver and
  2. Glycerol can be freed from the degradation of circulating triglycerides (Am J Clin Nutr 2009;90:519-526).

So a person can be clearly and massively ketogenic while maintaining a blood sugar level that is well within physiologic levels.

The other thing to consider is when/what is a textbook, medical definition of ketosis? And how do we measure it and quantify it?

Quite simply: Ketosis is a metabolic state in which some of the body’s energy supply comes from KB’s in the blood (https://en.wikipedia.org/wiki/Ketosis).

So it does not really matter where the KB’s are derived from (exogenous sources like BHB salts dietary products or from the metabolism and degradation of endogenous fat stores) – ketosis is ketosis!

Whether ketosis is taking place can be checked by using special urine test strips such as Ketostick™. The strips have a small pad on the end which is dipped in a fresh specimen of urine.

Within a matter of seconds, the strip changes color indicating the level of acetoacetate ketone bodies detected, which reflects the degree of ketonuria which, in turn, can be used to give a rough estimation of the level of ketonemia in the body (see Table I below). Alternatively, some products targeted to diabetics such as the Abbott Precision Xtra or the Nova Max can be used to take a blood sample and measure the β-hydroxybutyrate ketone levels directly.

Normal plasma reference ranges for KB’s are 0.05–0.29 mmol/L.” (Information paper PS-002588E Rev. 2 10/05 by Polymer Technology Systems)

Table 1

“The concentration of KB’s may vary depending on diet, exercise, degree of metabolic adaptation and genetic factors (ed. note – and additional ingestion of exogenous ketones). Ketosis can be induced when a ketogenic diet is followed for more than 72 hours. This induced ketosis is called “Nutritional Ketosis” Table II shows the concentrations typically seen under different conditions.”

Table 2

Bottom line: If you’re urine is “1+” using a urine test strip or your blood is >0.5 mmol/L by testing your blood, irrespective of the reason why? You are absolutely in ketosis/ketotic. Fact!

What are Ketogenic Diets Most Likely Useful For?

There is robust evidence that ketogenic diets are effective, useful tools for weight loss (fat loss in particular). There are differing opinions however, through how these work.

To be fair, there exists some research that would indicate that ketogenic diets do not offer any real metabolic advantages over simple, reduced calorie diets. Any additional weight loss from a ketogenic diet results simply from reduced ingestion of calories which may be due to the increased satiety effect of protein (Annu Rev Nutr 2009;29:21-41).

Some people, this author included, think that ketogenic diets do offer a very real metabolic advantage in weight/fat loss. As an amateur physics buff, I am well aware of the first law of thermodynamics (conservation of mass and energy) that would ostensibly have us believe that “a calorie is a calorie” irrespective of what macronutrient it comes from.

However, there are a number of studies published in highly respected and reputable journals that clearly show that people who follow a ketogenic diet lose more weight in the first 90-180 days versus those who ate more traditional, balanced diets (J Clin Endocrinol Metab 2003; 88: 1617-1623 – JAMA 2007; 297: 969-977 – NEJM 2008; 359: 229-241) – calories be damned.

So, maybe several reasons exist for the above situation that does not violate the first law of thermodynamics.

The average person requires 60-65g of glucose per day. During the initial phases of a ketogenic diet about 15%-16% of this is obtained from glycerol, with the bigger part coming from the gluconeogenesis of proteins either from ingestion of such or by the metabolism of existing tissues. (Annu Rev Nutr 2009; 29:21-41).

The “energy cost” of gluconeogenesis has been confirmed and calculated in peer reviewed, published research (Am J Clin Nutr 2009; 519-216 – Nutr Metab (London) 2004; 1:15) to be around 500 Kcal/day which hypothetically would lead to an additional one pound of weight loss per week.

KB’s appear to have an appetite suppressing effect. There is a growing body of evidence that KB’s influence circulating levels of hormones that influence appetite, such as leptin and ghrelin (Eur J Clin Nutr 2013;7:759-64). Eat less, lose more.

Ketogenic diets/ketosis appears to reduce the resting respiratory quotient and thus, may increase metabolic efficiency in consuming fats (BMC Proceedings 2012; 6: 37 – Agro Food Indi Hi-Tech 2010; 21: 24).

There is other evidence that ketogenic diets and ketosis may be useful in the treatment of some cardiovascular diseases, metabolic syndrome/NIDDM Type II, and of course epilepsy. There are other claims made regarding ketogenic diets/ketosis that I feel are premature now (including that ketosis and/or BHB salts “cure cancer”) but I am not going to address these here due to space considerations and will address them at a later date on my blog at www.giantsportsinternational.com if you are interested.

What are BHB Salts and What’s New?

BHB salts are just that – usually mineral salts (typically sodium, calcium and/or magnesium) of β-hydroxybutyrate. The do not have to be mineral salts, in theory. They could be amino acid salts, as some amino acids have a strongly positive side chain (Lysine, Arginine & Histidine come to mind) and can theoretically form an ionic salt bond with BHB.

However, as of this date, I am unaware of anyone synthesizing and selling any amino acid BHB salt product on a commercial level. Regardless, BHB mineral salts are hydrosoluble powders that mix pretty well into aqueous solutions (e.g., water).

And as you would expect, the ingestion of these ingredients will increase your plasma ketone level (BHB level) rapidly and dramatically as well as your urinary ketone level. Theses products are a hot, contemporary ingredient in the supplement market as of late.

There exists a lot of hyperbole regarding what these BHB salts will and will not do. Much to my amazement and chagrin, I have never seen an ingredient so polarizing as these BHB salts.

People either swear by them and think they are the best thing ever, or they find them contemptible and something that needs to be relegated to the snake oil bin as fast as possible. My opinion falls in the middle so – lucky me – I am getting it in the neck from both sides.

Here is where I think BHB salts products are useful:

Ketogenic bodies seem to have a profound, appetite suppressant effect. So if you’re looking to lose weight and have trouble controlling your caloric intake, these BHB type of products may be quite useful for you.

Without a doubt, BHB salt products are ideally suited for people who do fasted cardio in the morning. Fasted cardio is a controversial topic with many claiming the process does not work or that it is catabolizing to muscle mass. However, most bodybuilding/physique competitors I know and work with use fasted cardio to get in shape for a competition.

Granted, many of these people may be using other PEDs to prevent muscle wasting but without a doubt, they like their fasted cardio a lot because the claim is you can metabolize up to 20% more fat if you do your cardio fasted. To me, whether this is true or not is irrelevant.

I like BHB salt products for fasted cardio because of the “anti-bonk” effects they seem to induce. I can increase both intensity and duration of my fasted cardio sessions when I use BHB salts. So even if my efficiency in burning fat does not increase one iota, the fact that I can train longer and harder means I will need to use more calories and even better, if I am fasted or in ketosis, these calories of course should come from endogenous fat.

Fasting euphoria is something that is well-characterized in literature. Evidence links the initial phase of fasting or a low-carbohydrate diet with feelings of well-being and mild euphoria. These feelings have often been attributed to ketosis, the production of ketogenic bodies – specifically BHB – which is a positional isomer and structural analog of GHB (gamma-hydroxybutyrate).

It is highly likely that ingesting multi-gram amounts of BHB salts will induce a slightly relaxed, euphoric and anxiolytic response. I notice that I personally sleep a lot better when I ingest a BHB salt product before bed.

That mild euphoria often observed with fasting or low-carbohydrate diets may be due to actions of BHB on the brain. I truly believe that BHB probably induces this mild euphoria by being a weak partial agonist for GABA(B) receptors in the brain. If you have ever used the “product” phenibut you will notice the effects of BHB salts to be similar, although much, much less pronounced. For more information – Med Hypothesis 2007;68(2):268-71.

BHB salts can help people on the precipice of transitioning from a carbohydrate utilizing metabolism to a fat utilizing metabolism do so in a shortened period of time. Usually, with diet and exercise, it takes 48-72 hours to make this metabolic shift – a process that is often described as greatly uncomfortable and marked with lethargy and weakness (aka, “Keto Flu”) – since BHB products can have you into full ketosis in well under an hour, this uncomfortable period of time can be reduced substantially.

BHB salts can also help people in low carb, SKD/TKD/CKD and paleo diets who “mess up their macros” recover and maintain ketosis instead of having to start the whole 48-72 hours process all over again.

An important note to all readers who want to flame me for my thoughts. If you do not see me laying claim to something in the five points above, then do not attribute “BHB salts are miracle products that do XYZ and can change the oil in your car while giving you a deep tissue massage that includes a happy ending,” to me please.

These products are NOT for everyone or even for some people to use incessantly. What they are is a highly efficacious and quite safe tool – one of many nutritional tools that should be in the athlete’s tool box – that may be of incredible assistance under specific sets of circumstances.

If your circumstances do not make BHB salts a good fit? Then move on and find something else. It’s really that simple.

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Name: Bruce Kneller

Bio: Bruce Kneller is the Chief Formulator for Giant Sports supplements and a veteran "industry personality" who has been intimately involved with the success of numerous sports nutrition companies over the past two decades.