Will exogenous BHB supplements treat my mental illness?

There are ketone esters that have their own individual characteristics and considerations. Some have both D and L forms of BHB, some are monoesters and provide only D-BHB. There are practical considerations such as cost and some forms tasting pretty bad, but also in regards to their effects on metabolism. All are factors that need to be assessed with mental health populations looking to use them as either an adjunct to ketogenic diets or as a stand-alone treatment for mental health symptoms. All these variables would benefit from study.

BHB Supplementation Alone: A Clinical Perspective

Where do I stand on BHB supplementation alone?

I continue to be super excited about the emerging research on Beta-Hydroxybutyrate (BHB) and its role in neuropsychiatric health. It is super promising. However I want to be really clear with my current opinion on the use of BHB as a stand-alone treatment for mental illness and neurological disorders. As research comes out, my opinion may completely change. As always, I reserve the right to change my opinion based on what I learn in the future and the great research that will inevitably come out.

But here is the thing. I do not believe that simply supplementing with BHB or ketone salts will serve as an effective treatment for mental illness. In my clinical practice, I sometimes see improvements in mood and cognitive function using Ketone Salts (BHB Salts) as an adjunct on top of a well-formulated ketogenic diet that is optimized for the treatment of mental illness and neurological function. I have had many people try just the supplementation of BHB salts alone, without changing their diets.

While there is the occasional person who finds significant enough improvement and stops there, I have never seen this be the case for serious mental illnesses, such as schizophrenia, bipolar, treatment-resistant depression, or chronic anxiety. For most, any improvements seen in symptom reduction are described as insufficient or fleeting. Let’s talk about why that might be.

Mental illnesses are intricate conditions influenced by a myriad of factors, including genetics, environment, lifestyle, and brain chemistry, all of which are profoundly impacted by metabolic health. The benefits of BHB in the context of a ketogenic diet are part of a broader metabolic shift within the body and the brain, a shift that is not fully replicated by current supplementation with BHB alone.

Challenges and Realities of BHB Supplementation

While BHB can provide an alternative energy source for the brain, it does not correct the fundamental issue of impaired glucose uptake due to insulin resistance. Do you know exactly the dose of BHB you would have to ingest in order to fuel such a high-energy organ as the brain? Or to correct impaired immune function driving neuroinflammation? How much BHB supplementation is needed, and how often will it upregulate endogenous glutathione in the brain? Do you know what dose is needed to keep up with current levels of oxidative stress caused by eating a level of carbohydrates higher than one’s current metabolic health can handle? Do you know the dose amount and schedule needed to heal a brain despite an individual not making lifestyle changes needed to reduce these factors contributing to mental illness?

You don’t know?

Me neither. And neither do the researchers.

But beyond not knowing the perfect dosage for every brain, there are real practical considerations about relying solely on BHB supplements.

If you use BHB salts (also known as ketone salts), you will over-supply the mineral portion long before you get a sustainable energy source to fuel your brain.

But let’s say you find a D-BHB supplement that is not linked to salts (minerals), because they do exist on the market. Beyond the considerable cost of using such supplements throughout the day – a cost that is often prohibitive for many and not covered by insurance companies yet – there’s another challenge I really wonder about.

How will you fuel your brain while you sleep? When your higher carb intake occurs at dinner because you have not changed your diet, and your insulin resistance does not allow an adequate amount or duration of ketone production in order to stabilize neural networks, what does that mean for a brain trying to heal? I will tell you. High blood sugar levels continue to contribute to metabolic dysregulation, which BHB supplementation alone cannot fully rectify.

BHB has anti-inflammatory properties, but chronic high blood sugar and insulin resistance can perpetuate inflammatory pathways in the brain. BHB may alleviate some inflammation, acting as a molecular signaling body against chronic inflammation, but it doesn’t stop the ongoing inflammatory response caused by behaviors and environmental factors causing persistent metabolic imbalance.

BHB can reduce oxidative stress, but high blood sugar levels continuously generate reactive oxygen species, creating a cycle of oxidative damage. BHB supplementation can help, and yes, it can act as its own form of antioxidant, but it’s not a complete solution to the oxidative stress caused by chronic hyperglycemia.

I could go on about how untreated brain insulin resistance contributes to altered neurotransmitter function, reduced neuroplasticity, hormonal dysregulation, and compromised blood-brain barrier integrity, but you get the idea.