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Review
. 2025 Sep 1:12:1629921.
doi: 10.3389/fnut.2025.1629921. eCollection 2025.

The role of β-hydroxybutyrate testing in ketogenic metabolic therapies

Cristina Fante  1   2 , Franziska Spritzler  2 , Lori Calabrese  3 , Nicole Laurent  4 , Caroline Roberts  5 , Sofia Deloudi  2   6
Affiliations
Review

The role of β-hydroxybutyrate testing in ketogenic metabolic therapies

Cristina Fante et al. Front Nutr. .

Abstract

Accurate assessment of dietary adherence and metabolic outcomes remains a critical challenge in most nutrition studies. Ketogenic metabolic therapies (KMTs) provide a unique advantage by inducing nutritional ketosis and enabling the use of ketone bodies as biomarkers of metabolic state. This narrative review investigates the role of ketone testing as an integral component of KMTs. We introduce the key biomarkers and testing modalities currently used and present a comprehensive overview of the use of capillary blood β-hydroxybutyrate (BHB) testing across diverse therapeutic areas. Capillary blood BHB testing plays a multifaceted role in KMTs: it enables objective monitoring of dietary adherence, supports the interpretation of clinical outcomes, and informs personalized treatment adjustments based on individual metabolic responses. Additionally, it may facilitate behavior change through real-time feedback. Broader implementation of ketone testing in both clinical and research settings will require thoughtful protocol design that accounts for individual preferences and tolerability, continued technological innovation to enhance user experience, and further research into the relationship between ketone levels and therapeutic outcomes.

Keywords: dietary adherence; ketogenic diet; ketone testing; nutritional ketosis; patient empowerment; personalized medicine; β-hydroxybutyrate.

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Conflict of interest statement

CF and SD provide consulting services for, and FS is an employee of Keto-Check, a company that markets a medical device for measuring blood glucose and ketones (Keto-Mojo GKI and Keto-Mojo GK+). CF is employed by and owns MetaboliCo GmbH. LC is the founder and medical director of Touchpoints 180™ and Innovative Psychiatry, organizations offering metabolic health consultations and ketogenic metabolic therapies for psychiatric and medical conditions. NL is employed by and owns Family Renewal, Inc. DBA Mental Health Keto. CR is an employee of Virta Health, a clinic that provides ketogenic metabolic therapies for chronic metabolic conditions. SD is employed by and owns Metabolic Health Consulting GmbH.

Figures

Figure 1
Figure 1
Overview of biomarkers and testing modalities relevant to ketogenic metabolic therapies (KMTs). BHB, β-hydroxybutyrate.
Figure 2
Figure 2
The dynamic of ketone testing in ketogenic metabolic therapies (KMTs). (A) The feedback loop of ketone testing. Individuals test, receive biological feedback, evaluate it, and adjust their dietary or lifestyle choices. Then they assess the resulting metabolic response by performing further testing. This real-time feedback provides actionable information for achieving and maintaining nutritional ketosis. (B) The upward spiral effects of ketone testing. For patients, consistent testing leads to awareness of personal metabolic responses, reinforcement of behaviors, personal empowerment, and adherence to KMTs. For healthcare professionals, consistent testing enables real-time, remote monitoring, shared decision-making based on personal data, and tailored interventions.
See this image and copyright information in PMC

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