Low levels of beta-hydroxybutyrate may occur if there are low levels of precursors (fat, amino acids), if there are nutritional enzyme inhibitions, or if a low-activity enzyme variant is inherited. Ketone bodies are derived from fatty acids, levels may be lower on high carbohydrate diets. Ketogenesis occurs within the liver mitochondria, which are sensitive to oxidative stress and environmental toxins. Liver disorders may impair ketone synthesis and abnormally low levels of ketone bodies may impair liver functions. Low levels of malate or orotate may also impair liver function.

• Consider supporting synthesis pathways with vitamin B3 and phosphatidyl choline. Increasing healthy dietary fats, digestion and absorption may improve beta-hydroxybutyrate levels.

• Review Citric Acid Cycle Metabolites and consider nutritional support for mitochondria.

High levels of beta-hydroxybutyrate may occur when there are nutritional enzyme inhibitions of the breakdown pathways, inherited low-activity enzymes are present, or if there are high levels of precursors (fatty acids). Ketone synthesis can be increased by hormones such as cortisol, insulin, glucagon, thyroid, etc. If the body’s carbohydrate stores are depleted and gluconeogenesis can no longer occur, ketone synthesis will increase and diabetics with poor insulin control may be in a state of ketosis. Beta-hydroxybutyrate levels may also increase in individuals using low- carbohydrate, high-fat, or “keto” diets.

• Consider supporting breakdown pathways with vitamin B2, B3, B12 and phosphatidyl choline.