Every morning, retired plastic surgeon Jim Johnson has a small bottle of liquid with his breakfast. It’s not fruit juice or yoghurt — instead, the 76-year-old is drinking a supplement packed with ketones.
These are molecules the body naturally produces and uses as fuel when it is running low on energy from carbohydrates — and instead, burns fat for fuel.
‘When I take it, I can feel the effect within about half an hour,’ Dr Johnson, a grandfather of six from Marin County, California, told Good Health. ‘I feel sharper, more able to focus — and happier. It has, over time, also improved my strength. I can lift weights more times than I used to.’
Dr Johnson is convinced the £5 supplement, which he has taken every day for about 18 months, has boosted his mental and physical health.
So convinced, in fact, that he helped fund a pilot study into its benefits for strength, movement and memory in old age — to the tune of just over £200,000.
Following this pilot study at the Buck Institute for Research on Aging, in Novato, California, a larger study is under way, with initial results of the pilot study due next year.
In the UK, meanwhile, researchers at Bath University are also looking at the use of ketone supplements for older people.
These two studies are part of a growing body of research focusing on ketones as possible preventative and treatment options for a range of conditions, including for mental illness, cancer, dementia, Parkinson’s and heart disease.
While this research is at an early stage, there have been some promising findings.
One study, for instance, suggested that ketone supplements improved the memory of people with early dementia, while a number of animal studies have found that a ketogenic diet (i.e. very low carb) alongside conventional cancer care may have an anti-tumour effect by slowing the growth of some cancer cells.
Ketones are produced by the liver, and are an essential source of energy for cells during long spells of exercise, or when someone has not eaten carbohydrates or is fasting.
Ketones are produced by the liver, and are an essential source of energy for cells during long spells of exercise, or when someone has not eaten carbohydrates or is fasting
More recently a keto diet has become a popular way to lose weight — and, as Good Health has reported, it may also have benefits for type 2 diabetes and mental illness, although research is in its infancy
The small ketone molecules can pass quickly through the cell walls and go straight to the mitochondria, the cell’s power-producing engine, to be turned into energy.
Ketone levels can be boosted by radically reducing carb intake — this is the basis of the ketogenic diet that is used to help manage drug-resistant epilepsy in children, although it’s not understood exactly how it works.
More recently a keto diet has become a popular way to lose weight — and, as Good Health has reported, it may also have benefits for type 2 diabetes and mental illness, although research is in its infancy.
However, it is a restrictive diet — high in fat (such as dairy, nuts and oil) and very low in carbohydrates (25-30g per day; a slice of white bread provides 6g) — and this must be adhered to strictly to achieve ketosis, where the body turns to ketones for fuel.
Now researchers are investigating use of synthetic ketones in supplement form (either drinks or powder) as an alternative, following promising animal studies — with particular emphasis on diseases of old age.
While all the ways that ketones work in cells are not fully understood, it’s thought they could provide a boost of energy for the brain in patients with dementia, as the ability of the brain cells to use glucose (produced by the breakdown of carbs) rapidly deteriorates.
Separately, ketones also seem to help protect muscles by preventing them from being broken down.
Last month, the Buck Institute, Ohio State University and the University of Connecticut were awarded nearly £3 million for research into ketone supplements for boosting muscle strength in older people, and researchers are now recruiting 180 people aged 65 and over — specifically those who have started to walk more slowly, a critical sign of losing strength and becoming frail.
Around one in ten people aged 65 is frail, rising to 50 per cent in the over-85s, according to Age UK, leaving them vulnerable to falls and other sudden declines in health.
In the new U.S. study, participants will have a daily ketone drink while sticking to a normal diet — when glucose and ketones are both present, the body will use the ketones first, says Dr Brianna Stubbs, lead translational scientist at the Buck Institute.
Their muscle strength will be measured by monitoring how much weight they can lift with their legs.
Ketone supplements have so far mainly been used by athletes and soldiers to boost endurance and strength, explains Dr Stubbs. ‘Ketosis has a powerful effect on all cells and we’ve started to realise that a lot of the processes or stresses that athletes are exposed to are similar to the impact of ageing,’ she told Good Health.
‘For instance, stress on the muscles and inflammation are part of ageing as well as the result of the intense physical demands of elite sport. So ketones could be a health intervention — not just a sports drink.’
As we age, the mitochondria become less efficient at using glucose for power, she explains.
‘If ketones can get round those blocks in an ageing metabolism that can starve tissues of energy, it could improve how our cells use energy.’
She adds that while it’s been known for some time that ketones can be an energy source, ‘we are finding out more about ketones’ role in acting as chemical messengers to affect other chemical processes, including those in the immune system and which can protect muscle strength’.
This widespread effect is due to ketone molecules having a number of different docks on their surface that connect with receptors in different areas of the body, including molecules involved with inflammation.
Inflammation is a normal part of healing, but when it becomes chronic it can play a role in many conditions, including cancer, arthritis — and ageing (known as ‘inflammageing’).
Inflammation is partly regulated by inflammasomes, molecules in immune cells. Inflammasomes cause the release of inflammatory cytokines to fight infections or tackle injury.
But they can become chronically activated in disease and ageing.
This is where ketones come in: laboratory research shows they bind with receptors on the inflammasomes, reducing the release of cytokines and helping turn down the process of chronic inflammation, says Dr Stubbs.
Ketones also appear to protect muscles — activating signals inside the muscle cells that stimulate new tissue, while inhibiting the breakdown of muscle.
‘Declining strength is one of the key signs of frailty and we expect that taking ketones may improve muscle strength by stopping this breakdown,’ says Dr Stubbs (who is involved financially with the firm behind the supplements being researched at the Buck Institute).
Meanwhile, in the Bath University study (funded by UK Research and Innovation, a Government agency), 30 healthy people between the ages of 60 and 80 will have a ketone drink or a placebo three times a day for a month. They will then undergo tests of their physical health and cognitive function.
In Alzheimer’s disease, the most common form of dementia, the brain cells’ ability to use energy from glucose declines rapidly as the mitochondria stop working so well
Other researchers are looking at ketone supplements specifically for dementia.
In Alzheimer’s disease, the most common form of dementia, the brain cells’ ability to use energy from glucose declines rapidly as the mitochondria stop working so well.
It’s thought that ketones may provide a different source of energy, and even increase the number of mitochondria (as seen in animal research).
Human studies are so far small, but there have been some encouraging findings. Research published in 2020, involving 83 people with mild and early signs of memory loss, found that those who drank supplements twice a day performed better in memory tests compared with a control group.
A ketogenic diet has also been shown to have benefits: in a 2021 study in New Zealand, a ketogenic diet improved Alzheimer’s patients’ ability to do everyday tasks and their quality of life.
But are supplements a better option?
One of the pioneers in this area, Kieran Clarke, an emeritus professor of physiological biochemistry at Oxford University, says these have some major benefits over altering diet.
‘Keto diets are very restrictive and people find them hard to stick to in the long term,’ adds Professor Clarke (who is financially involved with a ketone supplement firm).
‘With the supplements, you can eat your normal diet, and they also boost ketones much more quickly in the blood — achieving levels of ketones within 30 minutes that would take several days with a diet,’ she says.
‘Ketogenic diets can also be high in fat, which can increase the risk of other conditions.’ (Although other experts would contest this.)
Supplements are, however, expensive and some can also taste unpleasant, described as like cheap, strong alcohol.
And it’s too early to say if supplements can replicate the impact of a ketogenic diet, suggests Professor Helen Cross, head of the developmental neuroscience programme at the UCL Great Ormond Street Institute of Child Health.
‘The problem is the ketogenic diet induces a variety of changes in the body, with multiple suggested mechanisms of action — it’s not all about the ketones,’ she told Good Health.
Furthermore, studies of athletes have been mixed — while some have shown better performance with ketone supplements, others have not.
‘There are a lot of powerful anecdotal successes and people think it might be the treatment for everything,’ says Professor Cross. ‘Ketones may have benefits in some areas where we’ve got little other treatment, such as brain tumours and neurodegenerative disease, but it still needs a lot more research.’
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