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In conditions of overproduction of acetoacetic acid this accumulates above normal levels and part is converted to the other two ketone bodies. The main ketone body produced in the liver is acetoacetate but the primary circulating ketone is 3-hydroxybutyrate. Under normal conditions the production of free acetoacetic acid is negligible and can be metabolised by various tissues such as skeletal muscle and the heart. The maximal oxygen uptake by body weight had a mild increase during KD and the mechanical efficiency (Wmax/VO2max) increased from 13.1 to 16.5% (normal value ≥20%). These mechanisms are to provide an efficient source of energy for the treatment of certain types of neurodegenerative diseases characterized by focal brain hypometabolism; to decrease the oxidative damage associated with various kinds of metabolic stress; to increase the mitochondrial biogenesis pathways; and to take advantage of the capacity of ketones to bypass the defect in complex I activity implicated in some neurological diseases. The idea is that if you cut out all carbs, add fats, and eat a moderate level of protein, then you, too, can brag about higher energy levels and slimmer builds - all while staying full. It is known that single nutrients may exert positive effects on skeletal muscle health and moreover a combination of nutrients can attenuate signs and symptoms of some neuromuscular diseases.
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