The Metabolic Classroom with Dr. Ben Bikman

Ketones and Your Heart - How Ketones Protect the Cardiovascular System

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Nov 24, 2025

Delve into the powerful role of ketones, specifically beta-hydroxybutyrate (BHB), in enhancing heart health. Discover how ketones act as an efficient energy source for the heart, especially during heart failure. They increase cardiac output and reduce the heart's workload by lowering vascular resistance. Learn about BHB's unique ability to promote vasodilation, improve circulation, and provide anti-inflammatory effects. Plus, explore practical strategies like ketogenic diets and exogenous supplements to boost heart resilience.

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INSIGHT

Ketones Are Active Metabolic Signals

Ketones, especially BHB, act as active metabolic signals beyond mere backup fuel.
They reduce cardiac workload, relax vessels, dampen inflammation, and modulate gene expression.

INSIGHT

BHB Is Oxygen-Efficient And Energy-Dense

BHB yields more ATP per oxygen than fatty acids, making it oxygen-efficient.
On a weight basis, 100 g of BHB produces more ATP than 100 g of glucose.

INSIGHT

Failing Hearts Shift Toward Ketone Use

The failing heart upregulates ketone oxidation machinery like BDH1.
Increasing ketone supply improved contractility in preclinical heart failure models.

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In this Metabolic Classroom mini lecture, Dr. Bikman explores the powerful effects of ketones—particularly beta-hydroxybutyrate (BHB)—on the cardiovascular system. While ketones are typically thought of as a backup fuel, Ben explains how they are, in fact, an adaptive and efficient energy source that can support heart function in both healthy and failing states.

Ben breaks down groundbreaking studies showing that ketones increase cardiac output, reduce vascular resistance, and improve heart function—especially in heart failure cases. He highlights the unique ability of BHB to reduce “afterload,” or the resistance the heart must pump against, effectively easing the heart’s workload. He also details ketones’ role in promoting vasodilation by acting on endothelial cells and smooth muscle, increasing nitric oxide and improving overall circulation.

Beyond fuel metabolism, BHB also acts as a signaling molecule with epigenetic and anti-inflammatory effects. It can modulate gene expression by influencing histone acetylation and β-hydroxybutyrylation, leading to improved antioxidant defense and reduced inflammation via inhibition of the NLRP3 inflammasome—a key player in heart failure and atherosclerosis.

Finally, he touches on the practical implications, suggesting both ketogenic diets and exogenous ketone supplements—particularly L-BHB—as viable strategies for enhancing cardiovascular resilience. This lecture positions ketones not just as fuel, but as potent metabolic signals capable of supporting and even restoring heart health.

Show Notes/References:

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IMPORTANT NOTE: The information presented is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Dr. Bikman is not a clinician—and, he is not your doctor. Always seek the advice of your own qualified health providers with questions you may have regarding medical conditions.

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