Supplements · Diets
Can drinking ketones help the heart pump better?
The claim, precisely: exogenous ketones improves cardiac output
Strong support Supplements
RefutedContestedStrong support
consensus score 0.93
Yes in heart-failure patients, but trials are short, from one group, and measure performance not survival.
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: Human trials (RCT / n-of-1)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
6 support 0 contradict 0 tested null 1 mixed · 5 sources, 3 independent groups
What the evidence shows
Exogenous ketones acutely raise cardiac output and myocardial efficiency in heart failure (HCA2-mediated) - the best clinical ketone signal. But short-term, surrogate endpoints (not mortality), and essentially one research group (Aarhus).
The evidence (7)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Selvaraj 2025 · JACC Heart Fail | RCT | supports | moderate | [FT-verified] KETO-HFpEF 2025 crossover n=20 resting CO +0.6 L/min though peak VO2 null; independent group |
| Nielsen R, et al. 2019 · Circulation | RCT | supports | moderate | HFrEF: dose-dependent rise in cardiac output & myocardial efficiency |
| (HFrEF 14-day) 2024 · (RCT) | RCT | supports | moderate | 14-day oral ketone-ester n=24 HFrEF resting CO 5.2 vs 5.0 L/min lower wedge pressure |
| (HFrEF 14-day) 2024 · (RCT) | RCT | supports | moderate | HFrEF 14-day RCT: improved resting + exercise hemodynamics |
| Lyhne 2025 · Intensive Care Med Exp | animal | supports | moderate | 3-OHB increased cardiac output and reduced pulmonary vascular resistance in porcine pulmonary embolism |
| Seefeldt 2024 · Sci Rep | animal | mixed | moderate | 3-OHB raised cardiac output via stroke volume but caused inotropy-resistant vasoplegia in transplant |
| Nielsen R, et al. 2019 · Circulation | RCT | supports | moderate | Landmark crossover n=16 HFrEF 3-OHB raised CO +2.0 L/min P<.001 via SV+HR; LVEF +8% acute |
Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.