Optimal Result:
3.2 - 116.4 nmol/mg Creatinine.
b-hydroxybutyrate is one of the ketone bodies.
The term ketone body describes any of 3 molecules: acetoacetate, b-hydroxybutyrate, or acetone. Acetoacetate is produced by acetyl-CoA metabolism, b-hydroxybutyrate is the result of acetoacetate reduction, and acetone is produced by the spontaneous decarboxylation of acetoacetate.
Ketone bodies are fundamental for metabolic homeostasis during periods of prolonged starvation. The brain cannot use fatty acids for energy production and usually depends on glucose to meet its metabolic needs. In cases of fasting or starvation, ketone bodies become a major fuel for brain cells, sparing amino acids from being catabolized to gluconeogenesis precursors to be used to supply the brain with energy. After prolonged starvation, ketone bodies can provide as much as two thirds of the brain's energy needs.
Ketone bodies are strong organic acids that fully dissociate in blood. When ketone body production becomes uncontrollable, the buffering systems are saturated, and blood pH drops; this is a condition known as ketoacidosis.
The two common clinical scenarios for ketoacidosis are diabetic ketoacidosis and alcoholic ketoacidosis.
Diabetic ketoacidosis
The most clinically relevant application of b-hydroxybutyrate determination involves the diagnosis, management, and monitoring of diabetic ketoacidosis. During states of insulin deficiency, lipolysis at the adipose tissue (stimulated by insulin deficiency) provides a huge fatty acid load to the liver. Fatty acids are initially metabolized to acetyl-coenzyme A that cannot enter the citric acid cycle in the mitochondria due to oxaloacetate deficiency. Thus, acetyl-coenzyme A is diverted to ketone body production through the activity of several enzymes, producing acetoacetate. Acetoacetate is then reduced to 3-b-hydroxybutyrate by 3-b-hydroxybutyrate dehydrogenase.
The ratio of acetoacetate to 3-b-hydroxybutyrate depends on the redox status in the liver mitochondria (ie, the NAD+/NADH ratio). Under normal circumstances, the b-hydroxybutyrate to acetoacetate ratio is around 1; however, in diabetic ketoacidosis, this may increase to 7-10. Acetone is produced by the spontaneous decarboxylation of acetoacetate.
Traditionally, the diagnosis of diabetic ketoacidosis was based on the detection of ketones in urine using the Legal reaction, during which acetoacetate reacts in the presence of alkali with nitroprusside to produce a purple-colored complex on a test strip. However, this method has significant drawbacks. It is semiquantitative and not equally sensitive for urine and blood.
Moreover, not all the patients with diabetic ketoacidosis are able to provide a urine sample upon presentation, and ketones in urine are not a precise estimation of blood ketones. Most importantly, the most abundant ketone body during diabetic ketoacidosis is b-hydroxybutyrate, with a concentration 3-10 times higher of that of acetoacetate. As diabetic ketoacidosis is treated, serum b-hydroxybutyrate is transformed to acetoacetate due to the correction of the mitochondrial redox status, elevating urine acetoacetate levels and giving the false impression that the patient has not responded to treatment.
Lastly, urine ketone strips can give false positive results in patients receiving drugs with sulfhydryl groups and false-negative results when they have been exposed to air for a long period of time or when the urine is acidic. These disadvantages necessitate the evolution of a more reliable method for the diagnosis and management of diabetic ketoacidosis.
Alcoholic ketoacidosis
This is the second most common cause of ketoacidosis, although significantly less common than diabetic ketoacidosis. In most cases, patients report significant alcohol consumption accompanied by fasting. From a biochemical point of view, ethanol is metabolized to acetoacetate and then acetate, producing significant amounts of NADH. In order to regenerate NAD+, pyruvate is metabolized to lactate and oxaloacetate is consumed to produce malate, depleting gluconeogenesis precursors. During starvation, insulin levels are extremely low and facilitate acyl-CoA entry into mitochondria, producing significant amounts of acetyl-CoA that cannot be metabolized in the Krebs cycle and is diverted towards ketone body synthesis.
In alcoholic ketoacidosis, the b-hydroxybutyrate to acetoacetate ratio is extremely high and b-hydroxybutyrate levels may be useful in the diagnosis and management of alcoholic ketoacidosis. However, no studies have been performed to actually compare b-hydroxybutyrate (serum or blood) with the traditional diagnostic parameters for alcoholic ketoacidosis and thus no recommendations can be made in favor or against its use in this setting.
Elevated serum b-hydroxybutyrate levels can be observed in various conditions associated with metabolic substrate use disorders, insulin deficiency, and altered redox status, including the following:
→ Diabetic ketoacidosis: Ketone body production is stimulated by dehydration and insulin deficiency. Levels are usually more than 3 mmol/L.
→ Alcoholic ketoacidosis: Ketone body production is stimulated by altered redox status within the liver mitochondria.
→ High fat diet
→ Steroid or growth hormone deficiency
→ Salicylate poisoning
→ Fasting and starvation: Serum b-hydroxybutyrate levels are increased after approximately 3 days, rising to a plateau after 4 weeks of food deprivation.
→ Lactation: Ketone body production is stimulated by the high-fat content of milk.
→ Ketogenic diets: These diets are popular for the control of refractory seizures and body weight in obese individuals.
→ Glycogen-storage diseases and other metabolic disorders
A prospective study by Flores-Guerrero et al indicated that high plasma levels of b-hydroxybutyrate signal an increased risk of heart failure with reduced ejection fraction (HFrEF), especially in females. In terms of incident HF (which in these results was primarily due to HFrEF), the hazard ratio per one standard deviation increase in the b-hydroxybutyrate concentration was 1.40. More specifically, in women, one standard deviation was associated with a hazard ratio for HFrEF of 1.73, compared with 1.14 in men.
References:
Flores-Guerrero JL, Westenbrink BD, Connelly MA, Otvos JD, Groothof D, Shalaurova I, Garcia E, Navis G, de Boer RA, Bakker SJL, Dullaart RPF. Association of beta-hydroxybutyrate with development of heart failure: Sex differences in a Dutch population cohort. Eur J Clin Invest. 2021 May;51(5):e13468. doi: 10.1111/eci.13468. Epub 2020 Dec 18. PMID: 33616911; PMCID: PMC8244065.
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β-hydroxybutyric acid is a ketone and a byproduct of fatty acid metabolism and makes up ~70% of ketones produced in liver mitochondria.
Low levels of 3-Hydroxybutyric acid (=beta-hydroxybutyrate) may occur if there are low levels of precursors (fat, amino acids), if there are nutritional enzyme inhibitions, or if a low-activity enzyme variant is inherited. Ketone bodies are derived from fatty acids, levels may be lower on high carbohydrate diets. Ketogenesis occurs within the liver mitochondria, which are sensitive to oxidative stress and environmental toxins. Liver disorders may impair ketone synthesis and abnormally low levels of ketone bodies may impair liver functions.
Low levels of malate or orotate may also impair liver function.
→ Consider supporting synthesis pathways with vitamin B3 and phosphatidyl choline. Increasing healthy dietary fats, digestion and absorption may improve beta-hydroxybutyrate levels.
→ Review Citric Acid Cycle Metabolites and consider nutritional support for mitochondria.
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Our database covers over 10,000 biomarkers with clear, simple explanations—so you can finally understand your results and what to do next.
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Enter Your Lab Reports — Always Free
If you'd like to handle inputting your health data into your account, you can do so with our easy-to-use data entry forms. Our user-friendly form is designed to guide you through the quick and easy submission process, making it simple to keep track of your health metrics. This is available to both Complete plan and Unlimited plan members.
Our user-friendly form guides you through a quick, simple submission process, making it easy to enter your health metrics.
Add your results anytime with our easy entry form. It's quick, guided, and helps you stay organized — free for all members.
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View your lab data through easy-to-read graphs and tables. Quickly spot patterns, track changes, and compare results across different dates — all without digging through multiple reports. You can also select and compare graphs of specific biomarkers side-by-side to better understand how they relate and change over time.
See your lab reports in clear graphs and tables. Spot patterns, track changes, and compare results over time — all in one place.
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Export Your Complete Lab History
After collecting lab results from different providers, you can download your entire history combined into a single file. Choose from PDF, Excel, or CSV formats to easily review, share, or get a second opinion—no more juggling multiple reports.
After collecting lab results from different providers, you can download your entire history combined into a single file.
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Data Entry Service for Your Reports
Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest. Complete plan members receive one report entered for free, then $15 per report after that. Unlimited plan members receive ten report entries for free, then $15 per report after that.
Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest.
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Whether you're working with a doctor, nutritionist, caregiver, or wellness coach, you can securely share your complete lab history by sending an invite link to anyone you trust. You have full control over who sees your information and for how long, ensuring your privacy and peace of mind at every step.
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Healthmatters is a personal health dashboard that helps you organize and understand your lab results. It collects and displays your medical test data from any lab in one secure, easy-to-use platform.
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If you are still determining whether Healthmatters support your lab results, the rule is that if you can test it, you can upload it to Healthmatters.
While we work with many popular labs, we welcome reports from lots of other places too.
It's as simple as this: if you can get a test done, you can upload it to Healthmatters and we can interpret results from any lab out there. If laboratories can analyze it, we can interpret it.
If you're on the hunt for a specific biomarker, contact us and we'll add it to our database. Anything from blood, urine, saliva, or stool can be uploaded, understood, and tracked with your Healthmatters account.
The Complete Plan ($15/month) is perfect for individuals who want ongoing access to their health data. It includes unlimited lab imports, visual tracking, custom ranges, result explanations, full account exports, and secure sharing — all with a simple monthly subscription. You can cancel anytime and restart your plan whenever you're ready — your data will still be there waiting for you. You can also upgrade to the Unlimited Plan at any time, with the cost prorated based on what you've already paid.
The Unlimited Plan ($250 one-time) is also designed for individuals but offers lifetime access with no ongoing subscription. You'll get all the same features as the Complete Plan, plus a larger initial data entry allowance (10 reports), making it a great choice if you prefer a one-time payment and long-term use without monthly fees.
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There are two ways to add your test reports to your Healthmatters account. One option is to input the data using the data entry forms. The other method is to utilize our "Data entry service."
Our data entry forms offer an easy, fast, and free way for you to input the reports yourself. Self-entry allows you to add an unlimited number of reports at no cost. We make the self-entry process user-friendly, providing dozens of templates that pre-populate the most popular laboratory panels and offering instant feedback on entered values.
For those who prefer assistance, we offer a "Data entry service" to help you input your data. Simply attach an image or file of your lab test results, and a qualified team member from our data entry team will add the results for you.
We support various file types, including PDFs, JPGs, or Excel. This service is particularly useful if you have many reports to upload or if you're too busy to handle the data entry yourself.
Our Data Entry Service is for when you don't want to manually type in your lab results yourself. You simply upload your report (PDF, image, or screenshot), and our trained team enters the information into your Healthmatters account for you — accurately and neatly organized, ready to view in graphs, tables, and timelines.
The $15 per report covers the time and care it takes for a real person to review your file, make sure each result is entered correctly, and double-check for accuracy. This ensures your health data is precise and easy to work with — without you having to spend the time doing it yourself.
Prefer to do it yourself? You can always use our free self-entry tool to add results manually — it just takes a bit more time and attention.
For users on the Complete monthly plan, the first report is entered free of charge, and each additional report incurs a fee of $15.
Unlimited account holders enjoy the entry of ten reports without charge. Subsequent reports are subject to a $15 fee per report.
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All professional accounts allow you to import and onboard an unlimited number of clients and their lab results. The distinction between professional plans lies solely in the data entry service.
The Pro Monthly Plus plan is priced at $75 per month and includes a data entry service for five reports each month. Additional reports can be self-entered at no extra cost or, if preferred, you can use our data entry service for an additional fee of $15 per report.
The Pro Monthly plan is priced at $45 per month and does not include a data entry service. Self-entry is free for an unlimited number of reports, and you can opt for the data entry service at a fee of $15 per report.
You also have the option to upgrade to higher monthly or to annual plans, which come with substantial discounts. All upgrades can be done directly from your account.
Simply log in and navigate to your account settings to cancel your subscription. Scroll down to locate the 'Cancel' button at the bottom of the page. Ensure you cancel at least one day before the renewal date to prevent any charges. Once cancellation is requested, the subscription remains active until the conclusion of the current billing cycle.
Our goal has been to make your Healthmatters account as intuitive as possible.
We've crafted multiple ways for you to navigate your data, whether you're glancing at a single report or delving into your historical test reports.
1. Graph View:Dive into a visual journey with our biomarker graphs, showcasing over 40 data points. Combining years of results unveils trends, empowering you to make informed decisions. Our visualization tools make it a breeze to compare and understand changes over time, even if your results are from different labs. A search function and filters simplify the exploration of extensive data, allowing you to focus on what needs attention.
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3. Table View:For a holistic view of all biomarkers side by side, our table view is your go-to. Results are neatly displayed in a categorized and dated table, ideal for those with an extensive test history. Utilize sorting, filters, and color-coding to enhance your analysis and gain extra insights.
Yes, you can download your information anytime. We offer two easy ways to export your lab data:
This makes it simple to save, back up, or share your health data whenever you need.
Yes, you can print your report. To do so, navigate to "All tests" and open the report you wish to print. You'll find a print button in the right corner of the report. Click on it, and your browser's print window will open. If you prefer to print in a bigger typeface, adjust the scale using the print window settings.
Yes, you can! We highly recommend activating Two-Factor Authentication (2FA) for your account. To do so, please navigate to the "Profile and Security" section of your account, where you will find instructions for activating 2FA.
Yes, you can. When entering values for the biomarker, you will see an "Edit Range" button. Click this button, and you'll have the option to enter a custom range.
A personal account is all about keeping your own lab test results in check. It's just for you and your personal use.
The professional account is designed for health professionals who wish to track and organize their clients' laboratory results.
To learn more about Healthmatters Pro, please refer to the professional page.
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