The Question of "Peetosis' with Exogenous Ketones

by Eric Gordon on November 29, 2017
A common question that arises with our BHB product, as well as other brands', is whether the exogenous ketones you get actually help with ketosis, or are they just being urinated out and giving a false reading.  This is commonly referred to as "peetosis" and is a rather polarizing issue when it comes to BHB ketone products.
After answering this question on social media and through email, we decided to put it all together for you to read and understand.  And of course, feel free to direct any other questions to us regarding ketosis and our products!
The Long Answer:
The ketones in your urine (which were in your blood first - key point) are from exogenous sources and not from the metabolism of endogenous fat.
So you are not metabolizing (burning) your own fat to produce those ketones.  Those ketones came from something you drank.  Ketones (irrespective of where they are sourced) in your blood have some unusual and desirable metabolic effects if you are trying to become keto-adapted and enter into ketosis (a "fat burning" metabolic state).
1) BHB tends to blunt insulin secretion even in the presence of massive amounts of carbs.  So, if you are keto-adapted and you have an "oopsie" moment, you can cover up your mistake with exogenous ketones for a few hours (we have had people do it for 7.5 hours on a single serving of Giant Keto) and stay ketotic/keep insulin levels low while your body uses those carbs as an energy source as you stay ketotic and do not suffer the negative effects of increased insulin (being blown out of ketosis).  Insulin absolutely will inhibit your own body from releasing fatty acids from adipose tissues.  So keeping insulin levels as low as possible is an ideal goal.  Exogenous ketones obviously help.  In adipose tissue lipolysis is inhibited and re-esterification enhanced with consequent decrease of fatty acid release. Both these processes are extremely insulin-sensitive.  Lower insulin = better metabolism (for burning fat)
Insulin also has effects on the liver as related to fatty acid usage.  In the liver insulin increases fatty acid synthesis and esterification. At the same time malonyl-CoA formation is increased, which inhibits the acylcarnitine transferase system and thus decreases the transport of fatty acids into mitochondria and hence fatty acid oxidation and ketogenesis. So less fatty acids get to the mitochondria and less endogenous ketones are produced when insulin increases.
Key Point - low insulin = good. BHB products help to keep insulin levels low.
2) Ketones (does not matter where they come from) tend to increase glucagon levels with further stimulate ketosis (e.g., breaking down your fat to create endogenous ketones). Glucagon and insulin tend to be inversely proportional in the blood.  So, if you suppress insulin, glucagon levels tend to rise tell your fat cells to "release more energy" (ketones eventually).  When insulin levels are lower, glucagon causes a stimulatory effect on lipolysis, increasing fatty acid supply to the liver. The main effects of glucagon is, however, on the your liver. It activates the carnitine acyltransferase system through inhibition of malonyl-CoA synthesis. Fatty acid oxidation is increased and ketogenesis enhanced/increased.  So, more glucagon is a good thing to help get you into endogenous ketosis faster.
A rough analogy is that BHB salts in a drink (e.g., Giant Keto) are a bit like a fuse to help jump start/ignite the whole shebang and we suspect, dramatically shorten the time it takes your body to start preferentially burning fat and creating ketones via lipolysis.
Yes, we agree that more study is needed and we know it is being done now.  And that's just what BHB can maybe do regarding fat.
Ketones/BHB tend to have a CNS euphorigenic/mood elevating effect as BHB is a structural isomer to GHB.  BHB is also known to absolutely pass the blood brain/barrier and also may have some anti convulsive/anti-anxiety/anti ADHD effects.
The result here is many people "feel good" (focused, motivated, alert, "better") due to the presence of high amounts of BHB, irrespective of whether it is exogenous or endogenous in origin.  That aspect is well characterized in the literature over many decades.
The Short Answer:
You are not just "peeing" out ketones.  They have an active effect on the hormonal regulation of your metabolism via their effects on insulin/glucagon by helping someone who is trying to become ketogenic actively become ketogenic from lipolysis of adipose tissue somewhat faster than if they were likely not present.  In some cases, a lot faster.  Additionally, they (BHB) has a very noticeable "feel good" effect, especially in the multi-gram dosage range.  There is also some evidence that these may also increase satiety (reduce hunger) which of course, can potentially help with weight (fat) loss.
But yes, exogenous ketones are not from your own fat and they are not present from lipolysis of adipose tissue any more than consuming MCT or a piece of fatty meat is going to cause you to lose extra fat from or as "caloric expenditure."
What BHB salts (and later on, MCT's and fatty foods) do is they set the stage for you to become keto-adapted and stay keto-adapted a lot faster and easier.  But nobody, certainly not Giant Sports, is claiming exogenous BHB salts are causing any increase in caloric expenditure directly.  Our product has about 60 usable calories per serving which gets used the same way fat does (as fat is metabolized to BHB in vivo) and should count towards your fat macros in a keto based diet.