Metabolism of Exogenous D-Beta-Hydroxybutyrate, an Energy Substrate Avidly Consumed by the Heart and Kidney

Frontiers in Nutrition
Bernard CuenoudStephen C Cunnane

Abstract

There is growing interest in the metabolism of ketones owing to their reported benefits in neurological and more recently in cardiovascular and renal diseases. As an alternative to a very high fat ketogenic diet, ketones precursors for oral intake are being developed to achieve ketosis without the need for dietary carbohydrate restriction. Here we report that an oral D-beta-hydroxybutyrate (D-BHB) supplement is rapidly absorbed and metabolized in humans and increases blood ketones to millimolar levels. At the same dose, D-BHB is significantly more ketogenic and provides fewer calories than a racemic mixture of BHB or medium chain triglyceride. In a whole body ketone positron emission tomography pilot study, we observed that after D-BHB consumption, the ketone tracer 11C-acetoacetate is rapidly metabolized, mostly by the heart and the kidneys. Beyond brain energy rescue, this opens additional opportunities for therapeutic exploration of D-BHB supplements as a "super fuel" in cardiac and chronic kidney diseases.

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Citations

May 7, 2020·Diabetes, Obesity & Metabolism·Aman Rajpal, Faramarz Ismail-Beigi
Dec 17, 2020·Frontiers in Bioengineering and Biotechnology·Diana Larisa RomanManfred Zinn
Feb 28, 2021·Journal of the American College of Cardiology·Salva R YuristaB Daan Westenbrink
Nov 22, 2020·PET Clinics·Jose A RodriguezPaco E Bravo
Mar 12, 2021·Cardiovascular Research·Shingo TakaharaJason R B Dyck
Aug 21, 2021·Applied Microbiology and Biotechnology·Aliya YaoGuo-Qiang Chen
Sep 29, 2021·The British Journal of Nutrition·Étienne Myette-CôtéStephen C Cunnane

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Clinical Trials Mentioned

NCT03603782

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