New question on exogenous ketones for Anthony and others

I just listened to a recent podcast with Dr. Dom D’Agostino, whom I’ve been following for almost two decades and whose opinion I highly value.

If I understood correctly, he doesn’t seem particularly enthusiastic about ketone esters. (I know this may be related to the promotion of ketone salts, but he is probably the most important ketone researcher at the moment.)

His reasons:

a) The rapid and excessive rise in ketones triggers an insulin response, which in the context of fasting and a ketogenic diet is not ideal. I assume it may make sense post-workout, when glycogen stores are being replenished. In addition, this insulin release suppresses endogenous ketone production.

b) The second reason seems more concerning. Ketone esters are said to be metabolized by the liver in a way similar to alcohol, and if used too frequently or long-term, they could place a heavy burden on the liver—especially in older individuals or those on multiple medications. He also mentioned a new triester, without the alcohol part, as a potentially better next-generation option.

Overall, he seems to favor a combination of MCTs and ketone salts, which both boost endogenous ketone production and provide some exogenous ketones. The electrolytes included are not a problem ( within a ketogenic diet—in fact, they are beneficial) .

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