POST SUMMARY: What this means for you…
Let ketones be your guide to knowing how well you’re controlling your insulin levels (because ketones are easier to measure at home than blood insulin levels). Make an effort to keep insulin low by avoiding the starchy carbohydrates and consuming insulin-friendly fat.
If you’ve heard the word “ketone” before, I bet it was in the context of a conversation about someone with diabetes. And rightly so—diabetes (type 1 or 2) is a problem of insulin (not glucose!), and insulin and ketones are, in a way, opposites.
Ketones are an inverse indicator of insulin because insulin inhibits ketone production (i.e. ketogenesis) [1, 2]. In other words, if insulin is high, ketones are low; if insulin is low, the liver breaks down fat into small pieces called ketones (insulin in fact tells the liver to make and store fat) . For this reason, a diet that keeps insulin low is referred to as a “ketogenic diet”—the low insulin levels allows the production of ketones.
I used to consider ketones as a simple indicator of insulin—for me they were only relevant insofar as I wanted insulin to be low and increased ketones are a sign of low insulin.
However, ketones are enjoying their day in the sun, but it wasn’t always this way.
Ketones were once considered “metabolic garbage” because scientists were unaware of any role for them. Oh how the times have changed! Not only are ketones recognized as a viable fuel source for almost every cell, including the brain and muscles, but they’re also important signaling molecules that have multiple beneficial effects. Some of the known benefits of ketones include increasing the number of mitochondria in the cell (where fats are broken down) , reducing oxidative stress , controlling inflammation , improving brain/cognitive function  and, in the case of some organisms (no evidence in humans), extending lifespan .
It’s for these reasons that people have started selling (and buying!) supplements with ketones.
Nutritional vs. Supplemental Ketosis
With evermore evidence supporting the benefits of ketones, several companies have come to life that seek to capitalize on ketones’ new reputation. These companies claim to improve one’s health by providing oral ketone supplements and there is evidence, mentioned above, that supports the benefits of ketones. However, putting ketones in your mouth is a very different state than that created by a diet that induces ketone creation in your liver from your own fats.
Oral ketone supplements may be beneficial, but this is inarguably an artificial condition where ketones may be increased at the same time as insulin. Ketones and insulin are opposites—they are never high at the same time in normal physiology. It just doesn’t happen. If insulin is high, ketone production (i.e., ketogenesis) is blocked. If insulin is low, ketone production is increased.
Doing More Harm Than Good?
The effects of having possibly both insulin (due to diet) and ketones (due to supplements) elevated simultaneously are unknown. But I’ll speculate. The main circulating ketone (and what is ingested with ketone supplements) is β-hydroxybutyrate, which is converted to acetoacetate and then to acetyl-coA. Acetyl-coA is at the crux of multiple important metabolic pathways dictated by the energetic state of the cell and the prevalent mix of hormones. Acetyl-coA, as mentioned, is involved in ketone formation (and use), as well as the formation (and use) of fats and, finally, it can be broken down for the production of chemical energy. When insulin and acetyl-coA are increased, insulin activates an enzyme called acetyl-coA carboxylase (ACC) . ACC is a key enzyme in a process called lipogenesis—the creation of fat. So, taking oral ketones while eating a typical insulin-spiking diet may be doing more harm than good, increasing fat production in the liver.
Again, It’s All About Insulin
In the end, here’s a reminder: it’s the insulin that we really care about. Ketones, in the context of insulin resistance, are mostly useful because they’re an inverse indicator of our insulin levels—they simply tell us how we’re doing keeping our insulin in check. We don’t seek high ketones as much as we seek low insulin. The fact that ketones are themselves beneficial molecules for our health is a bonus.
Should You Be Worried About Ketones?
If you have a functioning pancreas, you’re fine. In the near total absence of insulin (i.e. type 1 diabetes), the amount of ketones produced can be dangerous—a condition called “ketoacidosis”. But a person with a functioning pancreas could avoid carbs completely (I’m not suggesting you do it) and only be in “ketosis”—a level of ketones about a tenth of what’s required for ketoacidosis.
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This blog post (and all other posts and content on this website) is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
About Benjamin Bikman, Ph.D. – Ben earned his Ph.D. in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore in metabolic disorders. Currently, his professional focus as a scientist and professor (Brigham Young University) is to better understand chronic modern-day diseases, with special emphasis on the origins and consequences of obesity and diabetes. He frequently publishes his research in peer-reviewed journals and presents at international science meetings.