On the other hand, exogenous ketosis is achieved through the use of exogenous ketones like ketone esters or ketone salts. It may be an evolutionary advantage that our brains use BHB instead of its precursor, fatty acids. These fatty acids are then sent to the liver and broken down into a molecule known as acetyl-coenzyme A (acetyl-CoA). It_s transported out of the liver through a transporter known as the monocarboxylate transporter (MCT)-not to be confused with MCT oil (short for medium-chain triglyceride oil). Once BHB is produced, specialized transporters then shuttle it out of the liver and into circulation, where it_s used as a fuel. While BHB has a double bond to oxygen, it is bound to only one carbon. One form, R-BHB, is the molecule produced normally in human and animal metabolism-fasting, exercise, and ketogenic diets can all boost levels of R-BHB in the blood. BHB is produced through a process known as ketogenesis ("the origin of ketones"). S-BHB is actually just an intermediate (a step before) R-BHB is produced from fatty acid oxidation. R-BHB is the only form of BHB that we can break down into acetyl-CoA and, eventually, ATP for energy. Ketosis can be contrasted with the metabolic state of carbohydrate oxidation, or glycolysis-where glucose is burned for energy.

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