Exogenous ketones for social stress, verbal fluency and public speaking

The relationship between metabolism, energy availability, and mental health is admittedly complex. However, I think we can boil down some of the complexity down into the following statement — Fuel avalavibility and fuel utalization (which simply refers to the body's capacity to utilize different energy sources effectively) plays a massive role in maintaining cognitive function.

When we are starved of nutrition, the brain isn’t going to function properly. Full stop

Often times, I think it’s easy to confuse a general ‘lack of avaliable fuel’ and or the inability to use it with [insert psychiatric condition].

For example, Individuals who experience ‘social anxiety’ may not necessarily have a mood disorder; rather, their brains may require more energy to process social stressors. When energy levels are low, social interactions can feel disproportionately taxing, exacerbating those feelings of anxiety and social unease.

There are a few things that can be said here: Not everyone with less than adequate energy availability will have a diagnosed mood disorder. But everyone with a mood disorder likely ALSO has inadequate fuel utalization.

Lets dive into that biochemistry a little.

Metabolism is the set of life-sustaining chemical reactions that convert our food into energy. The brain, despite constituting only about 2% of our body weight, consumes approximately 20% of the body's energy. This high energy demand is primarily met through glucose metabolism. However, under conditions of stress or when energy reserves are depleted (not eating enough, lack of bio-avaliable nutrients etc) the brain may struggle to maintain optimal function, which may predispose us to feelings of anxiety and overwhelm, particularly in social situations.

Ray peat (a prominent proponent for the importance of energy metabolism in cognitive and psychological health) argues that metabolic efficiency is actually at the crux of mental well being. Peat has mostly argued that a well-functioning metabolism can help mitigate these feelings by ensuring that the brain has adequate energy to cope with stressors. This requires a few different things

1. An adequate supply of protein, carbohydrates (especially carbs),

2. fat, and total calories in the diet

3. Sufficent micro-nutrients, particularly water soluble vitamins and minerals that buffer stress like b-vitamins, magnesium, potassium, calcium and sodium.

Before we touch on supplemental solutions, it’s important to we have our foundation in check.

This means eating enough carbs and protein first and foremost. rice, quinoa, and berries tend to be the best choices for carbs, especially if you’re following something like the fungal protocol. 100-150g usually tends to be a decent range for most. 0.8g of protein per LBS of BW tends to be a good range for protein. Individual needs may vary, but these are a good starting place. You should also be eating enough to maintain your current bodyweight.

This also might mean possibly supplementing with additional magnesium and b vitamins if you aren’t able to hit the RDA for these nutrients via food, are under a lot of stress, sweating profusely on a regular basis and or engaging in intense physical or cognitively demanding activities (all of these things will rapidly deplete water soluble micro-nutrients).

You may also need to add extra salt into the diet and consume more potassium, calcium (these are are usually easy to get via food) and other mineral rich foods like potatoes, avacodos, sprouted pumpkin seeds, salmon, sardines, oysters, berries etc.

Once you’ve nailed these, I think a great case to be made for layering on some occasional supplemental strategies , particularly during times of intense psychological stress.

One of my all time favorites is exogenous ketones. Particularly for individuals who need to perform well in social settings. They’re fantastic for verbal fluency, stress, and maintaining mental flexibility under duress.

What are exogenous ketones

Exogenous ketones are supplements that provide the body with ketone bodies, which serve as an alternative fuel source for the brain, particularly during periods of low glucose availability. Ketones, primarily beta-hydroxybutyrate, are produced during the metabolism of fats and can be utilized by the brain more efficiently than glucose under certain conditions. The brain's preference for ketones arises from their ability to cross the blood-brain barrier and provide a readily available source of energy, especially during metabolic stress or fasting states

Here’s the thing though — you DO NOT need to get into ketosis (which is super metabolically stressful ) in order to benefit from ketones. You can supplement with them directly. While still enjoying your carbs.

For the pro-metabolic crowd, you might be interested to hear what Ray Peat has said about the use of ketones:

“Anything that stresses you can turn on your production of ketones. And so, it's better to have some sugar in your diet, so you don't have the stress that makes the ketones. But if you can get ketones from fruit and potatoes, for example, they're fine”

Personally, I don’t think you’re going to get a meaniful bump in ketones from fruit or potatoes (MCT oil can be effective, but doesn’t provide quite the punch that exogenous ketones do).

Ray seems to be supportive of ketones (particularly for short term, acute use) but isn’t a fan of the metabolic adaptions required to produce them (high fat, extremely low carb etc)

Overall, research indicates that ketones not only serve as an amazing energy substrate but also possess neuroprotective properties. They can reduce oxidative stress and inflammation in neurons. When we supplying the brain with a consistent, strong and rapidly avaliable energy source like exogenous ketones, we can effectively mitigate the cognitive fatigue associated with social stress.

Several studies have explored the impact of ketones on mental health, particularly in relation to anxiety and cognitive performance. For instance, research has shown that ketogenic diets, which naturally increase ketone levels, can improve symptoms in individuals with mood disorders and cognitive impairments. These diets have been associated with enhanced verbal fluency and cognitive flexibility. Again, I don’t think you need to use a strict ketogenic diet to achieve this though.

A study published in Frontiers in Psychiatry highlights the potential of exogenous ketones in addressing metabolic deficits in the brain, which are linked to psychiatric conditions. The research suggests that by providing an alternative energy source, ketones effectively help stabilize mood and improve cognitive function, particularly in individuals experiencing anxiety.

A pilot study at Stanford Medicine is investigating the effects of metabolic interventions, including exogenous ketones, on patients with serious mental illnesses. So far, preliminary findings suggest that improving metabolic health through ketone supplementation enhances brain function and alleviate symptoms of anxiety and cognitive dysfunction effectively

How do you use them?

Like most supplements, I don’t believe ketones should be used on a regular basis. This is a complex subject, but the most important thing to keep in mind is that if you use them too frequently, your body will adapt, and they won’t be effective anymore. Instead, you should use ketones intermittently (maybe once or twice a week) during particularly high stress activities and or situations where you need to perform well cognitively. Then, go longer periods of time without them when you don’t need them,

Ketones can have some benefits for physical performance as well, but they tend to be a little more isolated to endurance activities. Although the boost in cognition very well may have some distinct advantages for CNS driven activities as well

There’s a lot of debate around what form of ketones work best. It’s typically well accepted that ketone esters tend to be the most effective form of exogenous ketones. However, I’ve had great personal success using ketone salts as well. Ketone salts tend to be a lot cheaper than ketone esters. While esters tend to work better on paper, I’d give the salts a shot first. If they work well for you, you may not need to use an ester at all. Salts tend to work well for those that have never used ketones before

Ketone salts in particular may cause some GI distress for some individuals due to their high mineral content. If you decide to try ketone salts, drink the slowly and use one that’s well balanced between the different salts bound to the ketone — magnesium, potassium, calcium and sodium BHB.

In my opinion, it’s best to give ketones a trial run first. Take them on a day off and see how you handle them. Using them for social stress and then having to run to the bathroom is exactly ideal

Ideally, you want to use somewhere around 5-15g of ketones. New users can start on the lower end (regardless of wether you’re using a salt or ester), sometimes as low as 2g. Salts are generally dosed somewhere between 7-15g (they tend to be less bioavaliable than esters, so you need more). However, Ive had great results using very low doses (1-2g) of even the salts initially. Esters are usually doses around 2.5-10g, but the same would apply here — start off with a small amount and see how you feel. If it lights your brain up off a micro-dose, stay at that dose for as long as it remains effective.

Remember, ketones are a powerful card you can play for cognitive performance. But If you abuse them, they stop working.

Exogenous ketones are best taken on an empty stomach, either 30-45min before or 3-4 hours after a meal. Avoid taking ketone or salts with caffeine. They can potentiate the effect of the caffeine too much and cause GI distress.

Its also best to avoid taking with them MCT oil. This is a bit counterintuitive, but the simultaneous intake of ketone esters and MCT oil can cause metabolic competition.

Both substances are converted into ketones, but they do so via different mechanisms. Ketone esters are metabolized in the liver to produce BHB while MCT oil is broken down into medium-chain fatty acids that also contribute to ketone production. When taken together, they may compete for metabolic processing, leading to inefficiencies and reduced effectiveness in raising blood ketone levels. If you want to use MCT oil, use it 4-5 hours away from your exogenous ketones.

Ketones take about 20-30min to really kick in, so keep this in mind when deciding when you’re going to dose them

My two favorite brands of ketones are

1. Ketone Aid Ketone Shot ( keytone ESTER)

2. Nutricost BHB salts

In the past, I’ve also tried Ketone-IQ, which uses R1-3 butanediol. After consistent back and forth use, I’ve found the that the Ketone Aid Ketone Esters tend to work better. The butanediol tends to have a slightly more intoxicating feel (which has also been demonstrated in the literature) and is actually sometimes used as a alcohol alternative in some products. I don’t particularly think this is the best form for mental performance or even social anxiety to be honest. Although some may want to experiment with them and see how they feel.