Ketones and the Heart
Ketone bodies and their use as a metabolite for the brain and neurons is probably the most-studied aspect of ketone physiology. It’s well known and established that ketones have an important role in the treatment of a few neurological conditions. That also makes compelling interest to explore other medical conditions that may be impacted by the use of ketones or a ketogenic diet. It doesn’t seem to matter if a person is for or against going full keto or using supplements for the occasional increase in BOHB, ketones are about to be a hot topic in the field of medical research.
Consider this (though not the topic of this post), ketogenic diets were originally developed to treat epilepsy — and they work! The idea for carbohydrate restriction in epilepsy was born from the Greek observation that epilepsy could be controlled through fasting, and thus brought about the use of carbohydrate restriction to treat epilepsy. The practice of using the ketogenic diet for treatment of neurological disorders is almost a century old (physicians used the ketogenic diet for epilepsy starting in the 1920's), and continues on today. Due to a [somewhat] renewed interest in the mechanisms behind the successful treatment of epilepsy, people have started to look into other neurological disorders such as Alzheimer’s and Parkinson’s. Moreso, the ketogenic diet is now being explored heavily in the treatment of metabolic disorders and cancer.
Personally, I think the evidence for the efficacy in some of these diseases isn’t as useful as some pro-keto people would make it out to be. Cancer is too complex and full of nuances to say ketogenic diets would benefit all types of tumors. Trials in Alzheimer’s and Parkinson’s have yet to be successful (and some trials haven’t even been able to show success). Now, I’m not trying to be a Debbie Downer here. I think there could be a lot of upcoming research that will show some positive impact of ketogenic diets on these diseases. Even if nothing pans out well for the pro-keto folks, I think we will at least be able to increase the understanding of the physiology of these conditions.
However, there is an unsuspecting condition that I think could benefit from the use of ketones and/or a ketogenic diet: Heart Failure
Now, the research on this is not as strong as it needs to be for anybody to give any medical advice on using ketones for HF, but there is quite a bit of compelling evidence. As always, what I say on these posts is not medical advice and should not be taken as such. Always consult with your physician.
Heart Failure is a very interesting condition, broadly defined as the inability for the heart to pump enough blood to the peripheral tissues (brain, muscle, etc). When the heart is unable to provide a sufficient amount of blood to these parts of the body, people will experience lethargy, fatigue, exercise intolerance, and eventually death. The causes of heart failure aren’t completely understood and are too complex for the focus of this post, so I’ll just make it understood that heart failure = no bueno.
It’s been well established that ketones are the “preferred” fuel source for both the brain and the heart. It seems that when these organs are presented with ample amounts of glucose and ketone bodies, the ketones are oxidized while glucose consumption is reduced. I don’t think we know enough to pan out exactly why this is the case, but it makes an interesting argument for ketones as an ergogenic aid for these tissues: Even if the performance of these tissues aren’t enhanced by ketones directly, it spares glucose and makes it available for use later.
Even more interesting, glucose and fatty acid metabolism appear to be blunted in heart failure — which makes ketones much, much more important for the proper metabolic functioning of heart failure. This hypothesis has been the topic of discussions surrounding the findings in the EMPA-REG trial, which found a major decrease in cardiovascular-related hospitalizations and deaths in diabetic patients (who, as a population, are at higher risk for heart failure). This study was tracking a new class of SGLT2 inhibitors, drugs that prevent kidney reabsorption of glucose and have been known to induce ketonemia — and in extreme cases, ketoacidosis — and has since raised questions about the role of ketone bodies in proper metabolic functioning.
Many people are on board with the idea that ketones may be a potential therapy for heart failure. A recent paper with some small preliminary data showed some pretty impressive improvements in patients with heart failure after going on SGLT2 inhibitors. It could be possible that there are other effects of these medications that improve cardiovascular outcomes. However, I think the evidence is in strong support for further investigation into ketone bodies and their role in heart failure.
