Therapeutic Ketosis for Heart Failure: A State-of-the-Art Review

This state-of-the-art review covers myocardial ketone metabolism in heart failure, the current evidence for therapeutic ketosis in patients with heart failure, a framework to distinguish therapeutic ketosis from ketoacidosis, and practical considerations for managing patients who follow ketosis-inducing practices. It describes multiple small clinical trials with short-term follow up in which supplying the failing heart with exogenous ketone bodies may improve myocardial function. Therapeutic ketosis can be reached through exercise or diet, supplementation with ketone bodies, or treatment with a sodium-glucose cotransporter-2 inhibitor.