Why a d-β-hydroxybutyrate monoester?

This review explains why a d-beta-hydroxybutyrate monoester is a useful tool, describing it as a salt-free precursor that yields only the biologically active d-isoform and quickly and accurately raises blood ketone concentration. It covers fundamental concepts of endogenous and exogenous ketone body metabolism, the differences between the monoester and other exogenous ketones, and the biochemical and physiological rationales for its use in diabetes, neurodegenerative diseases, heart failure, sepsis-related muscle atrophy, migraine and epilepsy. It states that pharmacokinetics and safety have been studied in athletes and healthy volunteers, and it addresses limitations and areas of uncertainty.