Effect of a Sodium and Calcium DL-β-Hydroxybutyrate Salt in Healthy Adults

Abstract

Background Ketone body therapy and supplementation are of high interest for several medical and nutritional fields. The intake of ketone bodies is often discussed in relation to rare metabolic diseases, such as multiple acyl-CoA dehydrogenase deficiency (MADD), that have no alternatives for treatment. Case reports showed positive results of therapy using ketone bodies. The number of ketone body salts offered on the wellness market is increasing steadily. More information on the kinetics of intake, safety, and tolerance of these products is needed. Methods In a one-dose kinetic study, six healthy subjects received an intervention (0.5 g/kg bw) using a commercially available ketone body supplement. The supplement contained a mixture of sodium and calcium D-/L-β-hydroxybutyrate (βHB) as well as food additives. The blood samples drawn in the study were tested for concentrations of D-βHB, glucose, and electrolytes, and blood gas analyses were done. Data on sensory evaluation and observed side effects of the supplement were collected. The product also went through chemical food analysis. Results The supplement led to a significant increase of D-βHB concentration in blood 2.5 and 3 h after oral intake (p=0.033; p=0.043). The first significant effect was measured after 2 h with a mean value of 0.598 ± 0.300 mmol/L at the peak, which was recorded at 2.5 h. Changes in serum electrolytes and BGA were largely unremarkable. Taking the supplement was not without side effects. One subject dropped out due to gastrointestinal symptoms and two others reported similar but milder problems. Conclusions Intake of a combination of calcium and sodium D-/L-βHB salt shows a slow resorption with a moderate increase of D-βHB in serum levels. An influence of βHB salts on acid-base balance could not be excluded by this one-dose study. Excessive regular consumption without medical observation is not free of adverse effects. The tested product can therefore not be recommended unconditionally.

The use of sodium DL-3-Hydroxybutyrate in severe acute neuro-metabolic compromise in patients with inherited ketone body synthetic disorders

“…There have been stable isotope studies in neonates utilising and measuring metabolism of the D-stereoisomer. Similarly clinical studies typically measure the D-isomer even when the racemic mixture has been administered [36].…”

Ketone body supplement label claims: what supplement has been supplemented?

“…Traditionally, supplementation focussed on glucose as a fuel source for increasing performance. More recently, awareness has shifted to the role of ketone body supplements to increase performance.Ketone bodies can be endogenous where they are produced by the body in the liver, or exogenous, where they are taken in the form of a supplement [4] . Ketone body supplements are commonly composed of β-hydroxybutyrate (βHB) combined with a salt, such as potassium, calcium or sodium (Na-βHB) [4] , which are then known as ketone salts.…”

“…More recently, awareness has shifted to the role of ketone body supplements to increase performance.Ketone bodies can be endogenous where they are produced by the body in the liver, or exogenous, where they are taken in the form of a supplement [4] . Ketone body supplements are commonly composed of β-hydroxybutyrate (βHB) combined with a salt, such as potassium, calcium or sodium (Na-βHB) [4] , which are then known as ketone salts. A ketone ester, otherwise known as a ketone monoester, such as (R)-3-hydroxybutyl (R)-3hydroxybutyrate, is salt-free [5] and not commercially available.Ketone bodies, namely acetoacetate (AcAc), acetone, and βHB are lipid-based organic compounds produced by the liver during times of starvation and nutritional manipulation [3] , such as a high-…”

“…Modern ketone supplement manufacturers claim to cut out this nutritional manipulation period with the ingestion of a supplement containing on average 12g βHB [4] . This amount can be supported by studies [1][2][3] showing that by ingesting a ketone supplement, can result in ketosis in 30 minutes.…”

“…This amount can be supported by studies [1][2][3] showing that by ingesting a ketone supplement, can result in ketosis in 30 minutes. Theoretically, increasing ketone body production via the decreased availability of glucose in the body, the ketone bodies become the alternative fuel source necessary for the brain and muscles of the body [4] . Thus, it is suggested that ketone supplementation has potential positive effects on exercise metabolism and performance in recreational and competitive sportspeople.…”