Absorption: BHB salts are rapidly absorbed in the body, leading to an increase in blood ketone levels shortly after ingestion. Studies have shown that after consumption, BHB salts can significantly elevate circulating BHB levels, with peak concentrations often observed within 30 minutes to 2 hours post-ingestion. This rapid rise in BHB occurs because the salts dissociate into BHB and the associated minerals (like sodium, calcium, or magnesium) in the gastrointestinal tract, allowing BHB to be quickly absorbed into the bloodstream.
Distribution: Once absorbed, BHB is distributed throughout the body, crossing the blood-brain barrier to provide energy to the brain and other tissues like the heart and kidneys. BHB's distribution is facilitated by specific transporters and is known to be utilized preferentially by tissues during states of reduced glucose availability, such as fasting or ketogenic diets.
Metabolism: BHB is metabolized primarily in extrahepatic tissues where it can be converted back into acetoacetate, which then enters the citric acid cycle to produce ATP. The liver, which produces BHB, does not use it for energy but rather for synthesis and export. The interconversion between BHB and acetoacetate is catalyzed by the enzyme beta-hydroxybutyrate dehydrogenase (BDH1). This process is reversible, allowing BHB to serve as an efficient energy substrate.
Excretion: The body can excrete excess BHB through the kidneys, where it is filtered and can appear in urine. However, under normal physiological conditions, the amount excreted is minimal as BHB is efficiently utilized for energy. Acetone, a byproduct of BHB metabolism, is also excreted through breath and urine, contributing to the characteristic "fruity" breath odor observed in ketosis.

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