The first instalment of this two-part series, which can be found here, takes an in-depth look at what exactly exogenous ketones are and how they work. If you haven’t had a chance to read that yet, it is highly recommended you do so before continuing on with this instalment.
Before moving on, it’s necessary to clarify that beta-hydroxybutyrate (BHB) is the predominant ketone found in exogenous ketone supplements. Therefore, “BHB” supplement (i.e. beta-hydroxybutyrate supplements) is just another name for exogenous ketone supplement.
The State of Exogenous Ketone Supplements
Exogenous ketone supplements are somewhat new on the scene, with a select few companies manufacturing them for dietary use. The exogenous ketone products currently available on the market are BHB mineral salts (BHB with sodium and potassium to improve absorption). The term “BHB mineral salts” is synonymous with beta-hydroxybutyrate salts and ketone salts.
There are also combination BHB supplements that include MCT (or other) oils. Exogenous ketone products come in either liquid or powder form.
Timeline of Introduction of Ketone Supplements
Exogenous ketone supplements have been in research & development since the early 2000s, but didn’t start making their way to the general public until late 2014.
Ketoforce by Prototype Nutrition was the first to launch, followed up shortly thereafter by Pruvit’s Keto OS (and Keto OS Charged, a caffeinated version of Keto OS).
Keto OS and Keto OS Charged are combination supplements that combine MCT powder (and other ingredients) with BHB mineral salts. Whether or not this is more effective than pure BHB mineral salts is still up for debate as data doesn’t show a large difference between the two1 (refer to our previous exogenous ketone article for more on this).
KetoCaNa (also made by Prototype Nutrition) made it’s way to the market in 2015. It is a better tasting, powdered form of BHB salt (this time using calcium and sodium as mineral support).
The Patents Behind Ketone Supplements
There are several companies/inventors that own patents behind exogenous ketones (both BHB salts and esters). Currently, however, all products commercially available are derived from the first of these – the University of South Florida (USF) patent. Companies either make use of the patent directly or license it from USF for their products.
Existing patents include:
- University of South Florida with the named inventors being Patrick Arnold (behind KetoTech and the KetoSports products), Dominic D’Agostino and Shannon Kesl. The main patent is this one.
- Richard Veech, M.D. who is working on ketone ester production (rather than ketone salts). These are not yet ready for commercial sale.
- TΔS® (T Delta S) a UK based company working on the future commercial sale of the ketone ester product, ΔG® (DeltaG). TΔS is linked to the University of Oxford in the UK.
Products Often Mistaken for Being Ketone Supplements (But Aren’t..)
Pruvit also released a dietary creamer supplement, called Keto Kreme, made with coconut oil and cinnamon extract. Be aware that Keto Kreme does not contain exogenous ketones like many people mistakenly believe. It is an MCT Powder product similar to Quest Nutrition’s MCT Oil Powder or others on the market.
Forever Green’s Ketopia Weight Management System includes KetonX and KetoPM, two patented products that claim to assist the body in reaching a state of ketosis within hours (but neither contain exogenous ketones). In the future, depending on legal outcome of current licensing litigation, KetonX and KetoPM will have BHB salt patented by the University of South Florida (same ketones used in Keto OS).
What to Look Out for in Exogenous Ketone Supplements
Depending on how your goals and preferences you may favor one supplement over another. There are a number of factors you should consider to help you decide which supplement is objectively the best suited for you.
We explore these in this section, and later on in the article compare the currently available supplements against these criteria.
How Strong is the Blood Ketone Impact?
Ultimately, one of the most objective parameters you can look at is the impact of the products on your blood ketones. Depending on a product’s configuration (what type of ketone salt is it? how pure is it? what other ingredients are added?) a ketone salt may have a differing end impact on blood ketone levels.
We define this as…
- Power: The products impact on BHB levels in the blood. The stronger the product, the more effective it is as putting the body into ketosis and the longer the effect lasts.
There is very little publicly available data on human consumption of the different ketone salts, and supplement products. Published studies are on mice, and in human based data-sets the specific product is not revealed.
Some limited data is available via self-experiments published on blogs, where we know which ketone salt product was used. The information available currently is only for the KetoSports products (the KetoForce product in particular).
KetoForce Average Blood Beta-Hydroxybutyrate Levels Over Time
Note: Blog currently has had some connection issues.
Although, not confirmed, it is probable that the ketone salt used in Peter Attia’s self-experiment published here is through the BHB salt KetoForce (to confirm). The serving taken in the experiment is just lower than the typical serving size used for KetoForce currently (15.6g instead of 19g). Attia’s data shows a bump of 1.9 mmol/L (2.6 mmol vs. 0.7 mmol) at the 60 minute post ingestion mark with the BHB salt compared to his baseline nutritional ketosis.
(Note: Since we can’t provide data for the different products currently, the next article in this series, yet to be published, will be dedicated to this topic. It will provide the results of our own self-experiments with different ketone salt supplements)
How Many Ketones for the Price?
BHB is the main active ingredient in ketone supplements and it’s impact on per gram dose should be similar across ketone salt products. As such it makes sense to standardize how you look at the cost of the supplement based on how many grams of BHB it contains. This allows you to compare supplements with different serving sizes, and take into account the supplements BHB density and weighting of additional ingredients in its makeup.
This brings us to the next criteria we can look at…
- Price per BHB gram: The cost for each active gram of BHB contained in the product. Derived by dividing total grams of BHB in a serving by the cost of the serving.
The other reason using this metric makes sense is that it is the most expensive ingredient in the supplements.
Most of the supplement products provide this information directly now, and where they don’t it’s easily calculated based on the nutrition facts labels. We’ve provided this cost comparison in our review.
However, it should be noted that it is slightly reductive to look at the supplements this way. Other ingredients may provide other benefits you are looking for.
Specifically, some supplements contain a mixture of BHB, and another active ingredient, MCT Powder (e.g. Keto OS). So just looking at the BHB doesn’t do a supplement justice – even where we’re only interested in the supplements Ketone Power. The MCT powder provides an additional bump in ketones, and this is something we’ll look at separately in an upcoming article on MCT Powders.
The Product Experience
A variety of factors affect how you experience the product, and how easily you can fit it into your life. Many questions we receive at Ketosource relate to the items below – so we know these are important factors for you.
- Taste: The palatability of the product. Exogenous ketones naturally have an unpleasant taste, so efforts are made by product manufacturers to compensate this via the mix of additional ingredients used in products. Some products fair better than others in this area.
- Form (Convenience): Denotes whether the product is available in liquid or powder form. Generally, powder products are easier to transport so keep that in mind if you need something available on-the-go.
- GI Tolerance: A major limiting factor for ketone supplements to date has been the human guts tolerance of their intake. MCT oil has a relatively low gut tolerance (highest tolerable dose in a case study was 4 tablespoons in one intake2). For this reason, it’s something to consider for ketone supplements, especially for those with more sensitive or chronically damaged guts.
- Electrolyte Balancing: Exogenous ketones may throw electrolyte balance out of whack, so whether there are added electrolytes is something to consider when purchasing a ketone supplement. This topics deserves deeper discussion, as a variety of ideas have surfaced which differ. The electrolyte balance of a supplement can also become a key determining factor in how you should use the supplement optimally. So we’ll discuss this separately in a future article to give it the attention it deserves.
Other Aspects to Consider…
Products contain more or less additional ingredients that provide side benefits, or may be included for other reasons. This is an area which you should consider based on your goals and relative costs. Current products on the market vary widely in the number and extent of additional ingredients used.
- Other Ingredients: This category includes any other ingredients aside from electrolytes and ketone bodies found in the product. Examples include: MCT powder and what it’s made from, caffeine, sweeteners, etc.
Of the current products, KetoCaNa and KetoForce are the simplest products, with Kegenix being the most complex in terms of ingredients.
Exogenous Ketone Supplements Review
All prices reflective of current US pricing and availability.
*Doesn’t account for MCT Powder active ingredient that also contributes to Ketone Power.
**Information currently not available – will be updated shortly.
The Future of Ketone Supplements
In the near future, a broader range and variety of ketone salt based products are likely to come to market. There are indications that some of these may arrive before the end of 2016, and will be of improved taste, convenience and GI tolerability.
The outlook for the other, more powerful form of exogenous ketone, the ester, is still highly volatile and subject to change.
Ketone esters (also known as ketone mono-ester supplements) have been used in research for some time but their use in the general population has been extremely limited.
Anecdotal evidence suggests that ketone ester supplements are extremely hard to palate. That being said, it is viable/ likely ketone esters will reach consumers in the coming years as was discussed in part one of this series. Unfortunately, they are extremely costly to manufacture at this point, which is the barrier that needs to be overcome in order to make them as widely available as the ketone salts.
For a more in-depth comparison of ketone esters and ketone salts refer to the previous exogenous ketone article.
Of the two entities bringing ketone esters to market, that led by the researcher, Richard Veech, and the other by the company TΔS in the UK, TΔS is likely to be the first with the announced product ΔG. TΔS is aiming to commercialize the ΔG product inside 2016, so they’re adamant about finding potential investors to help accelerate that process (it is a costly endeavor to bring new ingredients to market due to the regulatory approval process amongst other costs).
Consideration: Is it OK for Everyone to Take Ketone Supplements?
Some individuals may want to take caution before supplementing with ketones as there are potential downsides. Particularly those with gastrointestinal disorders/ issues as some ketone supplements can cause diarrhea, upset stomach, and flatulence.
Type-1 and type-2 Diabetics should consult a physician before initiating usage of exogenous ketones as ketones can significantly alter blood sugar levels. However, exogenous ketones may actually be therapeutic for type-2 diabetics; this is an ongoing area of research that could change treatment for these individuals.
It is very early days with respect to ketone supplements, as patents that have not yet resulted in commercial supplement products will eventually bring more and different supplements to market.
Nonetheless, we’re already seeing a variety of ketone supplement options based on University of South Florida patent.
Which supplement you decide to use will depend on your personal goals (supporting keto adaptation when starting a ketogenic diet, fat loss, endurance, resistance training, general performance or health and longevity) and budget. In future articles, will look at best practices in how to use ketone supplements to achieve these different goals.
- Kesl, S. L., Poff, A. M., Ward, N. P., Fiorelli, T. N., Ari, C., Van Putten, A. J., … & D’Agostino, D. P. (2016). Effects of exogenous ketone supplementation on blood ketone, glucose, triglyceride, and lipoprotein levels in Sprague–Dawley rats. Nutrition & metabolism, 13(1), 1.
- Azzam R, Azar N. (2013). Marked Seizure Reduction after MCT Supplementation Case Reports in Neurological Medicine)