Ketone Drinks: Are They Safe and Should You Try Them?

The ketogenic (keto) diet has gained mass popularity in the last few years as millions of individuals have shown successful weight loss results from its low-carb, high-fat diet. However, while the diet may benefit followers, it also comes with challenges. Following the diet requires adhering to a rigorous schedule to stay in ketosis and maintain proper ketone levels.

While some individuals can produce ketones naturally, others can benefit by supplementing. Luckily, there are alternatives to raising ketone levels for maximum efficiency.

What are ketones?

The body naturally uses insulin to change glucose sugar into energy, but when our bodies don't have enough insulin, we burn fat as an alternative. When we burn fat for energy, the liver produces ketones. This typically occurs during fasting, long periods of exercise, or when your body lacks carbohydrates (i.e., while on the keto diet).

Two types of ketones provide energy: endogenous and exogenous. Endogenous ketones are naturally produced within the liver, which occurs with carbohydrate restriction and low glucose levels. Conversely, exogenous ketones are synthetic ketone bodies that you can get by consuming supplements, effectively raising your ketone levels without restricting carbohydrates. Drinking ketone beverages is an excellent alternative if your body isn't making ketones naturally.

What are ketone drinks?

Ketone drinks (or exogenous ketones) are a supplement form of ketones that you can consume, which are found in liquid, powder, or pill form. The two synthetic ketone bodies are keto esters (liquids) and ketone salts (powders). Ketone salts are typically combined with sodium, calcium, magnesium, and potassium electrolytes. Studies suggest that ketone salts can elevate blood ketones in the range of 0.5–1.5 mmol/L for up to a few hours for an immediate burst of energy. Additionally, this self-limiting feature of ketone salts prevents higher therapeutic levels and reduces the potential for serious side effects such as ketoacidosis. However, little is known regarding the long-term effects of ketone salt consumption.

Ketone esters are the purest and most potent form of ketone supplementation. They start working quickly, in as little as 10–15 minutes, as opposed to the ketone salts, which can take up to an hour. In addition, research has shown that ketone esters can help maintain ketosis longer; one of the main components, (R)-3-hydroxybutyrate (ketone monoester; KME), can sustain ketosis for up to 28 days when taken at 25 ml three times daily. While this supplement is highly effective, it can also be costly, and many complain of an unpleasant taste.

Do ketone drinks work?

While every keto supplement can vary from product to product, ketone esters and salts have proven effective in various scenarios. With salts, ketone bodies attach to a mineral, and the salts raise your blood ketones; unfortunately, they don't work as effectively as ketone esters do. Ketone esters are already ketone bodies, so by the time they enter the bloodstream, they are chemically identical to the ketones your body naturally makes.

Can I take ketones every day?

Supplementing with ketones daily is perfectly safe, and the ingredients used in the drinks are FDA approved. Individuals who supplement with ketones typically consume at least one dose daily, but following the package's directions (and checking ketone levels) is best. Because it can cause stomach upset and dehydration, you might consider starting with a low dose until your body adjusts.

Benefits of ketone drinks

The Keto diet is very popular because it has helped many people shed weight by altering their body's metabolism. However, though weight loss is the biggest draw, ketones provide the user with various other reasons for changing their diet.

1. May suppress appetite

The keto diet is great for weight loss, and part of this can be attributed to the benefits of going into ketosis, which is the suppression of appetite. For example, following an overnight fast, 15 healthy-weight subjects who consumed a ketone esters beverage experienced 50% less hunger than other participants drinking a sugar drink. This appetite-suppressing effect was attributed to lower levels of the hunger hormone ghrelin between two and four hours after drinking the ketone ester drink. It's important to note that this study was conducted following an overnight fast; therefore, it's more likely that participants successfully go into ketosis than if they had just recently finished a meal.

2. Optimizes your workouts

While there is conflicting evidence backing up ketone beverages and increased workout performance, one study shows how being in a metabolic state of ketosis improved physical endurance. In five separate studies of 39 high-performance athletes, the unique metabolic state improved physical endurance by altering fuel competition for oxidative respiration. In addition, ketosis decreased muscle glycolysis and plasma lactate concentrations while providing an alternative substrate for oxidative phosphorylation. Ketosis increased intramuscular triacylglycerol oxidation during exercise, even in normal muscle glycogen, co-ingested carbohydrates, and elevated insulin.

3. Increases fat-burning abilities

As your body breaks down fat for energy, it produces ketones, which can be used as the primary energy source for your body and brain. This process occurs when the body does not have enough carbohydrates for fuel. By shifting your metabolism in this way, your body can burn fat more efficiently and lead to a higher rate of fat loss, resulting in overall weight loss. Additionally, the breakdown of fat for energy helps reduce hunger, allowing for a more balanced and sustainable diet. This also means that while in a state of ketosis, your body will burn stored fat.

4. May improve Alzheimer's disease

In a 2015 case report, ketogenic metabolic therapy (KMT) in the form of medium-chain triglycerides (MCT) and KME was administered to a male patient with early onset, sporadic Alzheimer's disease. Within three months, the patient experienced remarkable cognitive and physical improvements, and their mini-mental state examination (MMSE) score improved from 12 to 20. In addition, the patient reportedly enhanced in many aspects of daily living, regaining the ability to recite, write the alphabet, and dress again.

5. Helps you transition into ketosis

Supplementing with ketone drinks can be helpful (especially on the keto diet) because it supplies your body with a direct source of ketones, easily used as fuel. However, using the drinks to transition can help you in a few different ways.

For example, individuals starting the keto diet might supplement to boost their body into ketosis. Restricting carbs can take 2–4 days to enter ketosis, and exogenous ketones can speed up this process. Additionally, others may supplement to avoid the dreaded 'keto flu,' producing flu-like symptoms when you first start the diet. Symptoms can include nausea, headaches, fatigue, bloating, irritability, and the most common, severe stomach upset.

Ketone supplements can also help if you slip out of ketosis. Consuming 50 grams or more of carbohydrates daily can cause your body to fall out of ketosis, which can quickly happen with the daily intake of carbs at approximately 225 to 325 grams.

For those who aren't keen on going full keto, but still want to experience the added benefits of a low-carb diet, ketone drinks can help your body transition into ketosis (as long as you maintain low-carb levels). A 28-day study examined the effect of rats consuming 5–10 g/kg of ketone supplements. At the end of the study, researchers found that the exogenous ketone drinks raised ketone levels without restricting carbs, and as a result, weight was reduced compared to placebo subjects. However, while rats could withhold restricting carbs, it may not be a successful strategy for humans.

Possible side effects of ketone drinks

Noticing when your body begins to produce ketones is a vital step. You should check for ketones in your blood or urine for any possible side effects, including:

• Electrolyte imbalance. High levels of ketones in the body can cause some individuals to feel more thirsty than usual and cause dehydration. Many ketone salt beverages contain added electrolytes in their products to help with the imbalance.
• Digestive issues. High blood levels of ketones can often cause an upset stomach, leading to loss of appetite, nausea, or vomiting.
• Hypoglycemia. Ketones can cause blood sugar levels to drop too low, which can be extremely dangerous for individuals with diabetes. It can also make people feel fatigued or lethargic.
• Diabetic ketoacidosis (DKA). Diabetic ketoacidosis (DKA) occurs when a severe lack of insulin forces the body to use fat instead of glucose. When ketones are released but not consistently checked, they can build up and cause your blood to become acidic. DKA can be life-threatening, so it's critical to know the symptoms. Those with type 1 diabetes risk experiencing DKA more than those with type 2 diabetes. If the ketone levels in your blood are high, you're at risk of DKA. If you suspect DKA, seek medical attention immediately.

Whether you've splurged on the weekend and fallen out of ketosis or just started your keto journey, ketone drinks can help your transition into ketosis. Exogenous and endogenous ketones are both effective, but you may need to supplement if you're not producing enough ketone naturally.

It's important to note that ketones alone won't directly lead to weight loss. If you plan on supplementing with ketones, you will still need to make lifestyle changes, including a healthy diet and regular exercise.