Ketones (exogenous ketones & MCT)
Alternative fuel that lets the energy-starved failing heart pump better; BHB also dampens NLRP3 inflammation.
Summary
In heart failure the heart shifts away from fatty acids and ketones; a cardiac resynchronization device study found shifting it back reversed enlargement, cutting left-ventricular volume by almost 50% in six months. Several human trials of IV ketones, ketone esters, (R)-1,3-butanediol and MCT oil raised blood ketones and improved ejection fraction, cardiac output or NT-proBNP in heart failure patients. Elsewhere she notes beta-hydroxybutyrate lowers NLRP3 inflammasome activation, which may explain why a ketogenic diet helps some in Alzheimer's, though keto does not fix dementia.
Impressed that heart failure can be reversed; 'ketones for the heart may be one option to keep in mind.'From Ketones for heart failure
The evidence
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Human trial
In a 2019 randomized crossover trial, 3-hour IV 3-hydroxybutyrate infusions in heart failure with reduced ejection fraction raised ketones to about 3.3 mmol/L and increased LVEF by 8%.
Read the study Discussed in Ketones for heart failure -
Human trial
In a 2024 clinical trial in HFrEF patients, 25 g ketone ester four times a day lowered NT-proBNP by 18% and increased LVEF.
Read the study Discussed in Ketones for heart failure -
Human trial
In a 2025 trial, HFrEF patients given 0.5 g/kg (R)-1,3-butanediol vs taste-matched placebo raised ketones by about 1.4 mmol/L and increased LVEF by 3%.
Read the study Discussed in Ketones for heart failure -
Human trial
In a 2025 study, 0.5 g/kg MCT raised blood ketones by about 1 mmol/L, increased cardiac output by 16% and LVEF by 5% in heart failure.
Read the study Discussed in Ketones for heart failure -
Human trial
In a 2024 trial in heart failure plus type 2 diabetes, two weeks of 25 g D-BHB-(R)-1,3-butanediol four times a day raised cardiac output by 0.2 L/min and reduced filling pressures and ventricular stiffness.
Read the study Discussed in Ketones for heart failure
Doses used in studies
Amounts reported in the research, not dosing recommendations.
| Dose | Context |
|---|---|
| 0.5 g/kg MCT | Heart failure study; by her math about a couple of tablespoons a day for an average adult |
| 0.5 g/kg (R)-1,3-butanediol | 2025 trial in HFrEF patients |
| 25 g D-BHB-(R)-1,3-butanediol, four times a day for 2 weeks | Heart failure plus type 2 diabetes trial |
| 25 g ketone ester, four times a day | 2024 HFrEF trial |
Cautions
- Many ketone products are pre-workout drinks with added caffeine; check labels.
- Cardiologists don't recommend a ketogenic diet for heart failure: it can raise cholesterol substantially in some people and can be stressful.
- MCT/coconut oil may be too much saturated fat for some people.
- SGLT2 inhibitors, which slightly raise ketones, are prescription-only; talk with your doctor about any diet or supplement for heart failure.