Introduction

Ketone drinks contain artificial ketones that provide the body with an alternative energy source to carbohydrates and fat. They are designed to increase energy levels, improve mental clarity and support weight management. These drinks are gaining popularity, particularly amongst top endurance athletes many of whom believe that they increase performance and support the recovery process. Despite their development and increased use, scientific research does not yet consistently support all of these claims. This article will explore the theories and science behind the benefits of ketone drinks, and how and when to use them to maximise their benefits.^1,2,3

What are ketones?

Ketones are molecules generated by the liver from fatty acids during periods of low carbohydrate intake, prolonged exercise, or fasting. They play an important role in the body's energy and metabolism by ensuring the vital organs have an alternative energy source to glucose. You may have encountered the term 'keto diet' in discussions about nutrition, particularly in the 2010s when this began to gain mainstream popularity as a weight-loss strategy.

The keto diet is a high-fat, moderate-protein, and very low-carbohydrate diet designed to shift the body's metabolism from relying primarily on glucose (derived from carbohydrates) to using fat as the main energy source. By significantly reducing carbohydrate intake and increasing fat consumption, the body enters a metabolic state called ketosis. With reduced carbohydrate intake, the body begins to use glycogen (a stored form of glucose) from the liver and muscles. Glycogen stores become depleted within 24-48 hours and the body begins to break down stored fat into fatty acids and glycerol for energy. These are both released into the bloodstream where eventually the mitochondria in the liver convert the fatty acids into ketones, and they are used as an alternative energy source by muscles and organs.

Ketosis provides numerous benefits, including weight loss, improved blood sugar control, increased energy, and potential therapeutic effects for various medical conditions. Ketone drinks aim to mimic the metabolic effects of the ketogenic diet by providing exogenous (artificial) ketones, which are ketones produced outside the body. These drinks contain compounds that deliver ketones directly into the bloodstream, raising blood ketone levels and inducing a state of ketosis without the need for strict dietary carbohydrate restriction.¹

Types of ketone drinks

Ketone drinks usually come in two forms:

• Ketone salts: These are typically a combination of ketone bodies (such as beta-hydroxybutyrate) bound to minerals like sodium, potassium, calcium, or magnesium. They often come as powders that can be mixed with water or other beverages. The added minerals improve absorption and reduce gastrointestinal discomfort
• Ketone esters: These are more potent than ketone salts and are typically in liquid form. They contain pure beta-hydroxybutyrate (BHB) ketone bodies and are usually consumed as shots or mixed with a beverage. As they are pure they tend to have a more strong and unpleasant taste

Ketone salts typically have a longer shelf life than pure ketone ester drinks. When consumed, ketone salts are broken down in the digestive system, releasing ketone bodies and mineral ions into the bloodstream. The body then metabolises the ketone bodies for energy. Ketone esters on the other hand are rapidly absorbed into the bloodstream, bypassing digestion. This allows for a quick increase in circulating ketone levels, making them a more efficient way to raise ketone levels compared to ketone salts.⁴

When to consume ketone drinks?

Typically, because ketone salt powders raise the blood ketone levels at a slower rate they may be more suitable for maintaining moderate ketosis during a ketogenic diet or providing sustained energy during endurance activities. Some individuals may experience gastrointestinal discomfort or electrolyte imbalances when consuming ketone salts, but the effects are usually less severe compared to ketone esters.

Ketone esters on the other hand are ideal for situations where a rapid increase in ketosis is desired, such as before intense physical activity or cognitive performance. The only downsides are their taste and the chance of causing severe stomach problems during exercise. It's essential to experiment with both types of supplements to determine which works best for your specific needs and preferences.

Ketone drinks can also be used for:^4,5

• Midday energy boost: Ketone drinks can serve as a quick energy boost during the day, particularly for individuals experiencing fatigue or mental fog. The rapid availability of ketone bodies can provide a source of energy to the brain, helping to enhance cognitive function and alertness
• During periods of fasting: They can help mitigate hunger and provide sustained energy without disrupting the fasting state. Additionally, ketone drinks may support the maintenance of ketosis during fasting, aiding in fat metabolism and preserving muscle mass
• Cognitive Enhancement: Ketones have been studied for their potential cognitive benefits, including improved focus, mental clarity, and memory. Ketone drinks may be used to support cognitive function during periods of intense mental activity, such as studying or working on demanding tasks
• Weight Management: Ketone drinks, particularly those consumed as part of a ketogenic diet, may aid in weight management by promoting satiety, reducing appetite, and enhancing fat metabolism
• Neurological Conditions: Ketone bodies have shown promise in the treatment of certain neurological conditions, including epilepsy, Alzheimer's disease, and Parkinson's disease. By using an alternative energy source some of the symptoms of common neurological disorders are reduced
• Anti-inflammatory Effects: Ketone bodies have been associated with anti-inflammatory effects in the body, which may have implications for various inflammatory conditions and diseases. Ketone drinks could be used as a dietary intervention to help modulate inflammation and promote overall health and wellbeing

Science behind the benefits of Ketone Drinks

Enhanced physical performance – Ketone drinks are gaining popularity for top-class athletes in endurance events such as cycling and running. The science suggests that ketone bodies inhibit glycolytic flux, this is the rate at which glucose is metabolised through the glycolysis pathway to produce energy in the form of ATP. Fast ketone supplementation before or during exercise might represent an extra energy supply for muscle work, potentially sparing muscle glycogen stores.^1,4 In addition to this, ketones are a more efficient energy fuel when compared to glucose or fatty acids. Glucose must be converted and oxidised into a molecule called acetyl coenzyme A before it is broken down to create energy.

This requires an input of energy in the form of ATP while ketone bodies do not require energy to be converted into an oxidisable form meaning a more favourable ATP yield (energy) relative to the energy input. Some scientists report that due to their anti-inflammatory properties and their ability to promote protein synthesis, they can aid recovery and reduce muscle breakdown. It is important to note that despite the biological rationale the actual evidence is mixed with many small studies and the ability to assess improved performance due to ketone supplementation being challenging¹.

Improved cognitive function – Ketone bodies, specifically beta-hydroxybutyrate (BHB) and acetoacetate, can cross the blood-brain barrier and be used directly by brain cells as an efficient energy source. Using an alternative energy source to glucose can help stabilise glucose levels and avoid sugar fluctuations that can impact the brain. Furthermore, ketone metabolism produces fewer reactive oxygen species when compared to glucose metabolism which can damage the cells. Reduced reactive oxygen species reduces damage to brain cells and is therefore beneficial for brain health.¹

FAQs

What is a ketogenic diet?

A ketogenic diet, often referred to as the keto diet, is a high-fat, moderate-protein, and very low-carbohydrate diet designed to induce ketosis.

What is ketosis?

A metabolic state that occurs when the body burns fat for energy instead of glucose.

Do I need to follow a ketogenic diet to use ketone drinks?

While ketone drinks can be used without following a strict ketogenic diet, they are often more effective when combined with a low-carbohydrate, high-fat diet. This can help to maintain elevated ketone levels and enhance the benefits.

Are there any side effects of ketone drinks?

Some people may experience side effects such as gastrointestinal discomfort, nausea, and diarrhoea, especially when first starting to use ketone drinks. It's advisable to start with a smaller dose and gradually increase it to allow the body to adjust.

Summary

Ketone drinks, containing artificial ketones, offer an alternative energy source to carbohydrates and fats. They aim to boost energy, improve mental clarity, and aid in weight management. Popular among endurance athletes, these drinks come in two main types: ketone salts and ketone esters. Ketone salts provide gradual ketosis and sustained energy, while ketone esters induce rapid ketosis. They can be used for energy boosts, cognitive enhancement, weight management, and during fasting. Ketone drinks may enhance physical performance by sparing muscle glycogen and providing efficient energy, and they support brain health by stabilising glucose levels and reducing oxidative stress. However, more research is needed to confirm these benefits.