Exogenous Ketones in Cardiovascular Disease and Diabetes

Author: Dr. Andreia Torres

Dr. Andreia Torres

Clinical nutritionist with a doctorate in health education. International expert in ketogenic nutrition.

Review: Dr. Natalia Drabińska

Dr. Natalia Drabińska

Scientist specialising in nutrition, food research and the ketogenic diet. She is conducting pioneering global research into the effects of the keto diet on the human body.

What will you learn from the article?

Exogenous Ketones in Cardiovascular Disease and Diabetes

In recent years, interest in ketone metabolism has increased as it has been discovered that ketone bodies are not only vital sources of energy, but also powerful signaling molecules that influence cell metabolism, inflammation and bioenergetics in various organs. This has led to ketones being researched as potential therapeutic agents for a range of diseases including cancer, diabetes, heart disease and neurodegenerative disorders. In the past, ketones were feared by doctors because they were associated with diabetic ketoacidosis. However, research has changed this view and revealed their role as important metabolic intermediates, especially in times of starvation or carbohydrate deprivation.

What Are Ketone Bodies?

The three main ketone bodies produced during ketogenesis are β-hydroxybutyrate (BHB), acetoacetate (AcAc), and acetone. BHB is the most abundant ketone body and has gained particular attention for its ability to influence metabolic and signaling pathways rapidly. Amino acids like lysine and leucine also contribute to ketone body synthesis, providing key substrates in the liver.

Ketones as Ancient Survival Tools

Did you know that ketone bodies evolved as a survival mechanism? During periods of fasting or carbohydrate scarcity, our ancestors relied on ketones as a stable energy source to fuel their brains and muscles. This evolutionary advantage allowed early humans to thrive during food shortages, and today, these same ketones are being studied for their potential in modern medicine.

The Promise of Ketones in Therapeutic Interventions in Cardiovascular disease

Exogenous ketones, particularly BHB, have shown potential as adjuncts to traditional pharmacological therapies, especially in the management of cardiovascular diseases and diabetes. Research suggests that ketone bodies could be used to preserve heart function and improve metabolic health, acting in synergy with existing treatments. 

Research involving exogenous BHB has shown beneficial effects on cardiac function. In healthy volunteers, BHB supplementation improved cardiac performance, reduced vascular resistance, and increased myocardial blood flow. This suggests that BHB can enhance heart function and may be beneficial in heart disease treatment (1).

A small study of patients with heart failure with reduced ejection fraction (HFrEF) confirmed these findings. Patients who received intravenous BHB showed improved cardiac output, stroke volume, and oxygen consumption. Importantly, these effects were achieved without compromising myocardial efficiency, a critical factor in heart failure prognosis (2).

Another study with patients suffering from non-diabetic HFrEF showed that 14 days of oral BHB supplementation improved stroke volume, left ventricular ejection fraction (LVEF), and vascular resistance (3).

More robust trials, like the KETO-SHOCK1 study, demonstrated that intravenous ketone ester improved cardiac function in patients with acute myocardial infarction. These findings support BHB as a potential drug candidate for heart failure treatment (4).

Ketones and Diabetes: A Glimpse into Promising Therapeutic Benefits

Human studies have also pointed to the therapeutic potential of BHB in diabetes. For example, a meta-analysis with 327 data points from 30 studies indicated that exogenous ketones, like BHB, reduced blood glucose levels in individuals with obesity and prediabetes (5). Another study showed that ketone supplementation could lower blood glucose without increasing insulin levels—an exciting finding for managing type 2 diabetes (6).

Ketones as Anti-Inflammatory Agents

While ketones are known for their role in energy metabolism, they also possess powerful anti-inflammatory properties. β-hydroxybutyrate (BHB) has been shown to inhibit pathways involved in chronic inflammation, making it a potential therapeutic option for diseases like diabetes, heart disease, and even neurodegenerative disorders.

In addition to glucose-lowering effects, ketones have been shown to reduce inflammation. Inflammation is a major contributor to the development of T2D and its complications. A study on individuals at risk for T2D showed that BHB supplementation suppressed pro-inflammatory cytokines, which are often elevated in those with diabetes (7).

BHB’s impact extends beyond metabolism—it functions as an inhibitor of several NAD+-independent histone deacetylases (HDACs), which could directly influence glucose regulation, oxidative stress, and mitochondrial health. This opens up exciting possibilities for BHB in treating various metabolic diseases. A graphical summary illustrating BHB’s protective effects on heart and pancreatic beta cells is provided by Kansawar et al., 2024:

Conclusion

In conclusion, ketone bodies, particularly exogenous BHB, hold promise not just as metabolic fuels but as modulators of health, from immune function to heart health. BeKeto™ is the first brand in the UK and Europe fully dedicated to the ketogenic and low-carbohydrate (low-carb) diet. Our mission is to help as many people as possible achieve a state of ketosis and optimal health by following the healthiest low-carbohydrate lifestyle possible.

We’ve spent thousands of hours bringing you the highest quality ketogenic products, such as Exogenous Ketones in different flavours. Whether you’re already keto or just starting your amazing journey, BeKeto™ is the perfect fit. 

Be well, BeKeto!

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