Positives

• One ME/CFS patient described a hand dynamometer test showing strength more than doubled after a beta-hydroxybutyrate dose, although still below normal range Mecfsmc.
  
  
• Patients trialing ketogenic metabolic therapy in long COVID have described improved mitochondrial energy and reduced post-exertional symptom intensity over 30 days Withpower.
  
  

Negatives

• In another ME/CFS case, a patient could only sustain energy for a few minutes on exogenous ketones and developed pain attributed to acidification Mecfsmc.
  
  
• Patients commonly describe BHB salts as causing significant gastrointestinal upset and a strong unpleasant taste that limits daily use Frontiers.
  
  

Hurdles & Side Effects

• Ketone esters cost roughly 30 dollars per serving, putting sustained dosing out of reach for most patients Frontiers.
  
  
• BHB salts deliver substantial sodium loads that can be problematic for patients with hypertension or kidney disease PostViral Nutrition.