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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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Ketones and Your Heart - How Ketones Protect the Cardiovascular System

The Metabolic Classroom with Dr. Ben Bikman