Two Distinct Roads to Elevated BHB
Circulating ketone levels can be elevated either through nutritional carbohydrate restriction or direct oral ingestion of exogenous ketone formulations. Understanding their physiological mechanisms is vital.
1. Endogenous Hepatic Beta-Oxidation
When liver glycogen is depleted and insulin remains basal, adipose tissue releases free fatty acids. The liver converts these into acetoacetate and beta-hydroxybutyrate (BHB), mobilizing stored fat for fuel.
2. Exogenous Ketone Salts and Esters
Exogenous BHB increases serum ketone concentrations acutely within 30 minutes without requiring glycogen depletion. However, this transient rise suppresses lipolysis via the GPR109A receptor, meaning it does not stimulate stored body fat oxidation.
3. Practical Applications
Exogenous ketones offer targeted utility for acute neurological focus, athletic endurance sparing, and high-altitude hypoxia, while endogenous ketosis remains the primary driver of body composition and metabolic flexibility.
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