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Ketones support the failing heart and may help repair it

I noticed that in the past few years there is quite a bit of research coming out investigating the effect of beta-hydroxybutyrate on a failing heart. It seems that a failing heart somehow increases the production of ketones which it then consumes to support its function.

As this is picking up attention in the scientific community, I also noticed a few papers trying to prove detrimental effect but these papers clearly make either an interpretation that doesn’t correspond with the situation observed or they create artificial situations in which nothing can help and then state that as a negative for ketones.

So what I want to do here is collect all heart related papers. I’ll be updating this page regularly. The idea is to show the volume and the findings so that if you see a paper appearing claiming negative properties, it has to be weighted against all the positive ones that are listed here.

As I don’t want to create bias, I’ll also list the negative ones and where possible, I’ll point out the issues in those studies if there are any.

Positive

2023

2022

2021

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2014

2007

Negative

There are also papers that state negative effects of low carb. However, the distinction should be made with a low carb ketogenic diet. Because of the distinct effect that ketones have, if a low carb diet is not low enough to elicit a substantial increase in ketones then it is also not listed. This selection is primarily done by checking if the paper explicitly mentions something about ketones or not. I did not arbitrate on the level of blood BHB itself.

One other point which I want to question is research that injures the heart and then shows adaptations noted by the KD. These adaptations may for example show enlargement of the heart or increased fibrosis. Those are generally seen as negative facts when evaluating a healthy heart. But these adaptations should be seen in light of the injured heart. For example, fibrosis may protect the heart from rupture when cardiac muscle cells are failing such as with Duchene muscle dystrophy. Without careful analysis, chronic fibrosis progression is considered detrimental. Finding more fibrosis is not necessarily detrimental when it is stable. I have not seen this analysis done in those that point out the higher fibrosis levels. Ideally they would also run longevity tests but to date these have not been done to my knowledge.

That said, there may be real cases where ketones are not desired or where the combination with other drugs creates negative effects. These are the cases that we want to identify and avoid. This can be the case especially when introducing exogenous ketones.

2022

There is no motivation provided why the DMDKD at the time of weaning were first put on 8% protein for the first 10 days while the normal diet group received 13% protein. The DMDND group received 62% more protein, should we expect this to make no difference?

2021

Follow this link for comments on the above study.

2020

2018

2006

2003

2001

Neutral

This is work that generally just shows the correlation between heart failure and increased circulating ketones or just reports on the observation without making a statement whether this is positive or negative.

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