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Ketone Supplements for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Apr 27, 2022 · Leave a Comment

Summary: There are a few mechanisms by which having elevated blood ketones could be therapeutic for IBD, and one case report demonstrated benefit of ketone salts in the context of a low-carb (but not ketogenic) diet for Crohn’s disease. Exogenous ketones can reliably elevate blood ketones as well as or better than a ketogenic diet, without the potential attendant downsides of such a diet. Ketone esters elevate blood ketone levels more than ketone salts, and may be better tolerated, but are also more expensive. MCT oil (particularly pure caprylic acid) can promote ketogenesis in the liver, but has a limited ability to do so compared to exogenous ketones. All of these supplements have various strengths and weaknesses and may be worth experimenting with for someone with IBD who is attempting to achieve therapeutic ketosis, whether in the context of a ketogenic diet or not.

This article is part of the IBD Index. Last updated on May 2, 2022.

In my (rather lengthy) article about the ketogenic diet, I discussed the background, risks, and potential benefits of a ketogenic diet in the context of IBD. Ketone supplements have become popular as both an adjunct to a ketogenic diet and as a way to get some of the benefits of ketone metabolism without the stringent dietary restrictions. But do they actually work? Are they safe? And are they worth trying if you have ulcerative colitis or Crohn’s disease?

Table of Contents
Ketone supplements vs. ketogenic diet: which is better?
Could ketone supplements be effective for IBD?
        Inhibiting growth of Bifidobacterium and reducing Th17 activation
        Overcoming energy starvation in enterocytes
        Clinical evidence
Which type of ketone supplement is best?
        D-BHB vs. L-BHB enantiomers
        Ketone salts
        Ketone esters
Available products and brands
Ketone supplement pharmacokinetics
Limitations of breath and urine for measuring ketosis
What about MCT oil?
The bottom line

Ketone Supplements vs. Ketogenic Diet: Which is Better?

We know that ketone supplements do, in fact, elevate circulating blood ketone levels (ie, they “work”).

A 2017 paper describes three studies testing the metabolism of ketone salts and ketone esters (both as drinks) in humans, reporting maximum beta-hydroxybutyrate (BHB) concentrations between 1.0 mM (for ketone salts) and 2.8 mM (for ketone esters). Levels returned to baseline within 3-4 hours.

However, an increased concentration of ketones in the blood is not the only feature of true metabolic ketosis.

For someone trying to lose weight, or resolve metabolic dysfunction, or treat neurodegenerative disorders or epilepsy, or improve outcomes for cancer treatment, it’s possible that the cascade of metabolic effects induced by a ketogenic diet is necessary for success; that’s beyond the scope of this article. But for IBD, that may not be the case.

As I discussed in my article about ketogenic diets, the most unique and intriguing potential mechanisms by which ketosis could benefit IBD patients (two of which I’ll mention below) appear to be dependent on the presence of ketone bodies themselves.

If that’s the case, it’s very possible that any benefits to be had from a ketogenic diet could be had through exogenous ketone supplementation, while avoiding many of the potential downsides of a ketogenic diet.

Just for fun, here’s a handy chart comparing and contrasting the effects of a ketogenic diet and exogenous ketones from the perspective of exercise performance:

Features of convergence and divergence between ketosis achieved by ketogenic diets compared with exogenous ketones. Poff et al, Nutritional Ketosis with Ketogenic Diets or Exogenous Ketones: Features, Convergence, and Divergence (2020)

Could Ketone Supplements Be Effective for IBD?

Of the several potential IBD-relevant mechanisms I discussed in my ketogenic diet article, the two that are most relevant to exogenous ketone supplementation are immune modulation via inhibition of Bifidobacterium growth and energy provision to enterocytes. We also have one relevant case report in a Crohn’s patient.

Inhibiting growth of Bifidobacterium and reducing Th17 activation

As discussed here, a ketogenic diet has been found to inhibit growth of Bifidobacterium in the gut, thereby reducing the activation of inflammatory Th17 cells in the intestine. (Source)

Notably, the inhibition of Bifidobacterium growth is a feature of ketone bodies themselves, rather than a consequence of dietary composition (like carbohydrate or fiber content). In the study cited, ketone ester supplements in mice elevated BHB in both the gut lumen and intestinal tissue and significantly decreased Bifidobacterium abundance.

While the various species of Bifidobacterium are generally considered to be commensal, we know that IBD is characterized by maladaptive response to commensal gut bacteria, and patients often have elevated Th17 activation compared to healthy controls, so it seems plausible that this mechanism could have therapeutic relevance.

Overcoming energy starvation in enterocytes

As discussed here, ketones may also provide an alternative fuel source for intestinal epithelial cells. Butyrate is generally considered the preferred fuel source for enterocytes, but IBD patients often have reduced luminal butyrate (from bacterial dysbiosis), impaired uptake and oxidation of butyrate, or both, leading to energy deficiency. (Source)

Since exogenous ketone supplementation elevates levels of ketone bodies in circulation, and ketone bodies are intermediates in the pathway for butyrate oxidation, they could provide an alternative source of readily-usable energy for enterocytes.

Clinical evidence

Unfortunately, we don’t yet have data to verify whether the above mechanisms could be clinically relevant for IBD patients. But as discussed in my aforementioned ketogenic diet article, there is one case report of a woman with Crohn’s disease who achieved remission using exogenous ketone salts and a relaxed low carbohydrate (but not ketogenic) diet: The effects of exogenous ketones on biomarkers of Crohn’s disease: A case report.

The authors report the case of a 51-year-old woman with fairly severe untreated Crohn’s disease (diagnosed for 25 years, unmedicated for 15) who felt “markedly better” after only one week of supplementation with BHB salts, and achieved full clinical remission after 3 months, along with significant improvements in body composition (fat loss with maintenance of lean mass).

She took 4g sodium BHB in water each morning for 2 weeks, then 4g of a mixture of sodium, calcium, and magnesium BHB twice per day thereafter. She experienced flatulence the first week, but reported no other side effects.

Her diet was described as a “flexible, non-ketogenic low-carb diet” with at least one higher-carb day per week. She apparently couldn’t eat large amounts of oils, and her diet overall was relatively low in calories.

The authors didn’t spend much time discussing the potential mechanisms that could be responsible for this patient’s dramatic results, but they speculate that the general anti-inflammatory effects of BHB could have played a role.

Which Type of Ketone Supplement Is Best?

In addition to ketone salts, which were used in the case described above, the other source of exogenous ketones is ketone esters.

L-BHB vs. D-BHB Enantiomers

One thing that’s helpful to understand when assessing ketone supplements is that BHB is chiral, which is an organic chemistry term meaning that it is not three‑dimensionally symmetrical. Thus, the two enantiomers, or “mirror image” versions, of BHB (denoted as D-BHB and L-BHB) have different properties.

There seems to be a bit of controversy (or at least incomplete understanding) regarding the role of L-BHB in the human body (possibly because most of the research characterizing these enantiomers has been done in rodents), but it’s generally accepted that only the D-BHB enantiomer is produced by the liver during normal human ketogenesis.

The L-BHB enantiomer appears to only exist as a transient intermediate of beta‑oxidation, and thus isn’t found circulating in the blood the way D-BHB is. (Source 1, 2, 3, 4)

L-BHB may have helpful signaling and biosynthetic roles that we have not yet fully characterized (some discussion of this in the papers linked above, if you’re interested), but only D-BHB is efficiently used as an energy substrate.

Ketone Salts

Ketone salts consist of a ketone body, most often BHB, bound to a mineral ion such as sodium (Na+), potassium (K+), calcium (Ca+2), or magnesium (Mg+2). Most commercially available products use a blend of these salts to avoid overloading the body with any one electrolyte or mineral.

In published research, ketone salts generally elevate blood ketones to 0.5–1.5 mM for up to a few hours. (Source) Higher levels are generally prevented by the high mineral load and gastrointestinal intolerance associated with larger doses.

Ketone salts are more widely available and cheaper than ketone esters, and apparently taste far less unpleasant. (Although if you’re anything like me, taste is lowwww on your list of priorities when you’re in the throes of a chronic illness!)

Ketone Esters

Ketone esters consist of BHB esterified to a backbone molecule, most commonly 1,3‑butanediol. This molecule itself is converted to BHB in the liver, so this formulation of ketone ester is metabolized completely into BHB. (The company HVMN even sells a ketone supplement that is just 1,3‑butanediol, without any BHB attached to it.)

This ketone monoester can achieve much higher circulating BHB concentrations than salts in a relatively dose-dependent fashion, with fewer gastrointestinal side effects, which means there’s a risk of inducing ketoacidosis if overconsumed. (Source) Circulating BHB levels of ≥2.0 mM have generally been observed among studies using ketone monoester. (Source)

The longest study we have thus far had 24 volunteers consume 25mL of a ketone monoester drink three times per day for 28 days, and blood concentrations of BHB 30 minutes after the drink increased to between 1.8 and 6.3 mM, with an average maximum of 4.1 mM over the four weeks. (Source)

There’s also a new ketone diester in development, but not yet commercially available: 1,3‑butanediol (the “backbone” molecule in the common BHB ester discussed above) esterified to bis-hexanoyl (which is a precursor to the medium-chain triglyceride hexanoic acid). A randomized controlled trial found that one daily beverage (consumed with breakfast) achieved circulating BHB levels around 1 mM one hour after the drink. (Source)

Available Products and Brands

I did not do an exhaustive search of all extant ketone supplements, but there appear to be two major products containing the ketone monoester D-BHB-D-1,3-butanediol, along with a slew of various ketone salts.

Of note, unlike the liver, the factories that produce BHB do not have chiral specificity, so most ketone salts include a racemic (50/50) mixture of D-BHB and L-BHB. As I mentioned above, L-BHB may still provide some benefit, but for the purposes of energy metabolism, products with pure D-BHB will provide twice as many easily‑metabolizable ketones.

Also of note, most of the ketone supplement brands on the market seem to be marketed for athletic performance or weight loss, so many have additional additives such as caffeine or various amino acids.

Below is a table I put together summarizing some of the main products on the market, in alphabetical order:

Company/ProductFormDetailsAdditional Information
Audacious Nutrition (KETOSTART)SaltD/L-BHB as Ca and Na salts
deltaGEsterD-BHB/D-1,3-butanediol monoesterFunded by NIH and DARPA, and has been tested in more clinical studies than any other ketone supplement; first paper describing its chemical composition/synthesis.
HVMN
(Ketone-IQ)
Alcohol D-1,3-butanediol1,3-butanediol is the backbone molecule used in the available ketone monoester supplements, but is not itself a ketone ester (although it is converted to BHB by the liver).*
KetoForceSaltD/L-BHB as Na and K saltsThis is the only supplement I’ve found that is unflavored and unsweetened. It was the salt used in these studies.
Ketōnd
(BioMAX)
SaltD-BHB as Na, Mg, Ca, and K saltsAlso contains extra ingredients to increase weight loss and appetite suppression: L-leucine, L-taurine, acetyl-L-carnitine, and “Solathin”.
Ketōnd
(Advanced Blend)
SaltD/L-BHB as Na, Mg, and Ca salts
KetoneAid
(KE4)
EsterD-BHB/D-1,3-butanediol monoesterUsed as a ketone monoester supplement in a few clinical trials.
Perfect Keto
(Base)
SaltL-BHB as Mg, Na, and Ca saltsContains no D-BHB, which seems odd.
Pruvit
(KETO//OS NAT)
SaltD-BHB as Na, Mg, and CaAmount of BHB not specified; “propriatary blend” includes L-arginine, L-taurine, and L-leucine.
TruBrainEster + SaltBHB (unspecified) as ester (unspecified) and Na, Mg, and K saltsDoesn’t specify L/D proportions, and doesn’t specify the chemical identity of the “ester”.
*The confusion is increased by the fact that HVMN used to sell the deltaG ketone monoester under a licensing agreement, but that agreement ended in 2019, and their product is no longer a ketone ester.

deltaG appears to be the most thoroughly documented and vetted ketone monoester supplement on the market; their website has a detailed timeline recording the formulation, production, testing, and patenting of the compound.

However, KetoneAid also has a ketone monoester product; this article on their website compares/contrasts the deltaG products and their own products. Assuming there isn’t blatant lying going on, it looks like you can get essentially the same compound from KetoneAid for less money, but deltaG appears to be a generally more reputable company. The two brands also have slightly different additional ingredients (and presumably taste), which is something to consider.

As far as ketone salts, the two products containing all D-BHB (and no L-BHB) are BioMAX from Ketōnd (note that their other product, Advanced Blend, is a racemic mixture) and Pruvit.

Ketone Supplement Pharmacokinetics

To give you an idea of the blood BHB levels you might achieve with ketone supplements, below is some of the pharmacokinetic data from the 2017 Stubbs et al study On the Metabolism of Exogenous Ketones in Humans.

For the first graph, the “low” and “high” doses were about 12g and 24g, respectively. You can see that ketone monoester raises blood BHB concentrations significantly more than the same amount of ketone salt.

Note that they used equimolar amounts of ester and salt, taking into consideration that each molecule of ketone monoester delivers two ketone “equivalents” (one from the BHB molecule, and one from the 1,3-butanediol).

The middle graph used the “high” dose of about 24g each.

The graph on the right compares BHB levels achieved with the “high” dose of ketone monoester when fed vs. fasting. The “fed” state comprised a breakfast of oatmeal, skim milk, and banana, providing 600 calories and a macronutrient ratio of 2:1:1 carbs to fat to protein.

As you can see, the circulating ketone levels achieved by the ketone monoester supplement are impressive, but once you start comparing the gram amounts used in this study to the gram amounts supplied per serving by the commercially available supplements (and the associated cost), you’ll probably be less enthused.

Limitations of Breath and Urine for Measuring Ketosis

I wanted to include one final excerpt from this study, regarding measuring ketosis. Stubbs et al, take it away…

“Breath acetone and urinary ketone measurements provide methods to approximate blood ketosis without repeated blood sampling. However, breath acetone did not change as rapidly as blood βHB following KE and KS drinks. Acetone is a fat-soluble molecule, so may have been sequestered into lipids before being slowly released, resulting in the differences observed here. Similarly, significant differences in blood D‑βHB between study conditions were not reflected in the urinary D-βHB elimination. As the amount of d-βHB excreted in the urine (≈0.1–0.5 g) represented ~1.5% of the total consumed (≈23.7 g), it appears that the major fate of exogenous d‑βHB was oxidation in peripheral tissues.

These results suggest that neither breath acetone nor urinary ketone measurements accurately reflect the rapid changes in blood ketone concentrations after ketone drinks, and that blood measurement should be the preferred method to quantitatively describe ketosis. That said, it should be noted that although commercial handheld monitors are the most practical and widely available tool for measuring blood ketones, they can overestimate blood D-βHB compared to laboratory measures and these monitors do not measure L-βHB and so may not provide accurate total blood ketone concentrations, especially if a racemic ketone salt has been consumed.” (Source)

What About MCT Oil?

One additional supplement that is popular for increasing circulating levels of ketones is medium-chain triglycerides, or MCT oil. MCTs contain fatty acids that are between 6‑12 carbons long: caproic acid (C6), caprylic acid (C8), capric acid (C10), and lauric acid (C12).

MCTs, particularly C8 and C10, are able to elevate blood ketone levels regardless of calorie or carbohydrate content of the diet, although the levels achieved are usually no higher than about 1 mM. (Source) And like ketone salts, high doses of MCT oil tend to produce gastrointestinal side effects.

(Fun fact: breast-feeding infants maintain a mild state of ketosis regardless of when they were last fed, in large part due to the relatively high proportion of MCTs in breast milk.)

The reason MCTs have this ketogenic property is because unlike longer-chain fatty acids, MCTs are absorbed into the portal vein and transported directly to the liver, rather than being first offered up to all the peripheral extrahepatic tissues of the body. MCTs can also enter beta-oxidation (and subsequent ketogenesis) without activation by carnitine. (Source)

Coconut oil is the best source of naturally occurring MCTs, but even then the amount is small. Most commercial MCT oils include purified C8 and C10, with some products such as Dave Asprey’s Brain Octane containing pure caprylic acid (C8).

Studies have shown that pure C8 is more ketogenic than other MCTs; see below. Note that the graph uses μM instead of mM (which has been used throughout this article so far), so you’ll need to move that decimal point three spaces to the left if you want a direct comparison.

Plasma concentration and summed daily means (far right) during the metabolic study days for total ketones (β-HB and AcAc) obtained without an added test oil (CTL; ●) or after taking two 20-mL doses of CO alone (▵), C10 alone (□), medium-chain TGs (C8-C10; ★), or C8 alone (⋄). The open arrow indicates when the breakfast plus test oil was consumed; the solid arrow indicates when the test oil alone was consumed without an accompanying meal at midday. (Source)

As you can see, even pure C8 only achieved a peak blood ketone concentration of not even 1 mM, so while MCT oil is another tool in the toolbox, it isn’t in the same league as, say, a ketone monoester supplement.

If you’re curious, the breakfast given in the study (at the first arrow in the figure) consisted of 2 pieces of toast with raspberry jam, a piece of cheese, and 2 scrambled eggs.

The Bottom Line

  • Ketone supplements allow for the elevation of circulating ketone bodies without needing to restrict dietary carbohydrate.
  • Such an elevation of blood ketones could conceivably be therapeutic for IBD patients, possibly by providing an alternative fuel source to enterocytes with dysfunctional butyrate metabolism.
  • One published case report describes a woman with Crohn’s disease who achieved remission using 4g of ketone salts twice per day in combination with a “relaxed” low-carb diet.
  • Exogenous ketones are available as salts or esters; salts are more available, affordable, and taste less bad, but ketone monoesters can achieve much higher levels of circulating ketones with fewer gastrointestinal side effects.
  • Most ketone salts contain a mix of D-BHB (which is the form naturally produced by the liver and is readily metabolized) and L-BHB (which is not). BioMAX and Pruvit both provide pure D-BHB.
  • deltaG and KetoneAid provide the ketone monoester D-BHB-1,3-butanediol, which has been tested in numerous clinical trials and reliably achieves the highest blood BHB concentrations.
  • MCT oil (especially pure C8, or caprylic acid) can also promote ketogenesis, with similar or slightly lower efficacy than ketone salts, and similar gastrointestinal side effects.
  • All three supplements (ketone salts, ketone monoesters, and MCT oil) are generally safe, with the caveat that ketone monoesters could theoretically induce ketoacidosis if overconsumed (as if you ever would, with how much they cost…).
  • Ketone salts and MCT oil are both apt to cause gastrointestinal side effects like diarrhea and bloating, which makes the dose self-limiting, but these effects are generally transient and can be reduced by introducing the supplement slowly.
  • Ketone salts and MCT oil are both slower-acting than ketone esters, and taking into account considerations of cost and taste as well, some combination of the three products could be a good strategy for achieving sustained elevated blood ketones.

Related

Supplements for IBD beta-hydroxybutyrate, caprylic acid, ketogenic, ketone monoester, ketones, ketosis, MCT oil, medium chain triglycerides

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Hi! I’m Alyssa. I like thunderstorms and cats, hate wearing shoes, and enjoy devising extensive research projects for myself in my free time. This is me in Bali with a monkey on my shoulder. And this is my blog, where I muse about health-related topics and document my relentless self-guinea pigging. If you want to know more about me, click here!

alyssa.luck

alyssa.luck
Photo dump from the last year. Thanks to everyone Photo dump from the last year. Thanks to everyone who made 28 the best yet - excited for 29🥰

(PS. In case anyone wants to know what it’s like in my head, I was going to write something like “year 28” or “my 28th year” but then I realized that the year between your 28th and 29th birthdays is not your 28th year of life, it’s your 29th year. I am turning 29 because I have been alive for 29 years. So then I had a whole thing about how to word it without being inaccurate and ended up going with what you see above which is vague and weird but the point is it was a good year and I love all the people in my life dearly)
Biology of Belief (2005) was written by Bruce Lipt Biology of Belief (2005) was written by Bruce Lipton, who earned a PhD in developmental biology in 1971 and was an anatomy professor and academic researcher in the 70s and 80s. Despite the book's presentation and Lipton's background, this is not a science book. It is an exposition of an ideology, supported by haphazard and poorly contextualized nuggets of evidence, rhetorical leaps, and a mind-boggling overuse of analogies. 

The book largely failed to deliver on its promised content. What it does is argue for the primacy of the environment over DNA in controlling life; propose that the cell membrane rather than the nucleus is the "brain" of the cell; invoke quantum physics to explain why modern medicine fails; explain that our behavior is largely controlled by our subconscious mind; inform parents that they therefore have a great deal of control over the destiny of their children; and conclude that humans must become nonviolent protectors of the environment and of humanity because Everything Is Connected.

It’s not that these points aren’t relevant to the topic at hand - they are. But they were not connected in a coherent way that would explain how “belief” actually works (like…biologically), and the treatment of scientific concepts throughout was careless, or perhaps disingenuous.

I think he's correct about many things, some of them being common knowledge. For instance, the "new" science of epigenetics is now old news, as is the critical role of parenting and early environment in shaping a child’s future. But however important these and attendant concepts may be, the book did not do a good job explaining, supporting, or connecting them. 

As far as practical guidance, he refers the reader to a list of resources on his website, which is fine, but I expected some scientific insight into how/why those modalities work. None was given. 

On the plus side, the book was quite thought-provoking, and I came away with loads of references and topics to follow up on. My favorite line? "There cannot be exceptions to a theory; exceptions simply mean that a theory is not fully correct."
Friedrich Nietzsche, The Gay Science (section 382) Friedrich Nietzsche, The Gay Science (section 382), as quoted in the introduction to Thus Spoke Zarathustra because I like the translation better.
This paper totally changed the way I think about e This paper totally changed the way I think about early nervous system development and the relationship between physiology and sociality. 

The authors propose that newborn babies are not inherently social, and have just one goal in life: physiological homeostasis. I.e. staying alive. This means nutrients, warmth, and regulation of breath and heart rate, i.e. autonomic arousal (it’s well-accepted that newborns sync their breathing and heart rate with caregivers through skin to skin contact). 

All these things are traditionally provided by a loving caregiver. So what the baby experiences during the first weeks of life, over and over, is a shift from physiological perturbation to homeostasis (a highly rewarding event inherently) REPEATEDLY PAIRED with things like the sound of a caregiver’s voice and seeing their face. Thus, over time, the face/voice stimuli become rewarding as well. 

The authors argue that THIS is the beginning of humans’ wiring for sociality, and may explain why loving social interactions can have such a profound regulating effect on physiology throughout life: because the brain was trained for it at an early age. 

This framework holds all kinds of fascinating implications for what happens if that initial “training” isn’t so ideal. What if the return to nutritional homeostasis via feeding is paired with negative expressions and vocalizations rather than loving ones, perhaps as could occur with PPD? What happens if the caregiver has poor autonomic regulation, such that social stimuli become paired with cardiorespiratory overexcitement in the baby? Could that have potential for influencing later introversion vs extroversion? (Because if social interaction is paired with autonomic overexcitement, that could lead to social interaction literally being more energetically draining, which is what introverts experience. Thoughts?)

For my energy metabolism enthusiasts: Table 1 in the paper draws a link between metabolic rate and sociality across species. Swipe for a screenshot. 

Anyway, check out the paper! It’s free, just google “growing a social brain pdf.”
I’ll be under general anesthesia in a couple day I’ll be under general anesthesia in a couple days to have two tooth implants placed, and I think I’ll take the opportunity to have a little heart-to-heart with my subconscious mind. A bit of medically-assisted self-hypnosis, if you will. 

I randomly stumbled upon these papers a couple months ago - an RCT showing reduced post-op pain in patients who listened to recorded positive messages while under general anesthesia, plus a post-hoc analysis of the same data that found reduced post-op nausea and vomiting in a subset of high-risk patients. 

The full review paper from the first slide is unfortunately in German, but it has long been recognized that even when unconscious, the patient is listening (for better or for worse). 

It boggles my mind that it isn’t standard of care to have patients listen to recordings like this while under sedation, considering that almost nothing could be easier, safer, or cheaper, and we have at least some evidence of significant efficacy. I mean c’mon, what more could you want from an intervention? 

(Yeah, I know. Profit. If anyone still thinks that our medical system operates with patient well-being as the foremost goal, you’re deluding yourself.)

“There should be a fundamental change in the way patients are treated in the operating room and intensive care unit, and background noise and careless conversations should be eliminated.”

“Perhaps it is now time to finally heed this call and to use communication with unconscious patients that goes beyond the most necessary announcement of interventions and is therapeutically effective through positive suggestions. When in doubt, assume that the patient is listening.”
If you've seen "vagus nerve exercises" that have y If you've seen "vagus nerve exercises" that have you moving your eyes or tilting your head, you've probably encountered the work of Stanley Rosenberg. The exercises he created and introduced in his 2017 book now appear in instructional videos all over the internet. 
 
The book itself has much to recommend it: it's accessible, it's practical, it's inspiring. But it has one major flaw: the solid practical and informational content regarding the cranial nerves is framed in terms of the scientifically dubious polyvagal theory. 
 
I particularly enjoyed the book as an introduction to the therapeutic arena of bodywork, of which Rosenberg is a skilled practitioner. His book is full of case reports that demonstrate how immensely powerful extremely subtle movements and physical manipulations can be. These do need to be kept in perspective: it's a small sample size of the most remarkable cases, and the results were achieved within the supportive clinical environment of a skilled practitioner. You can tell from his descriptions how refined his technique is. But nevertheless, it was a paradigm-shifting read for me, and the exercises give you something concrete to play around with. 
 
The book also brought the cranial nerves and the concept of “social engagement” to the fore as arbiters of health. Rosenberg has a solid background in cranial nerve anatomy and shares many interesting tidbits and considerations that you don’t typically hear; for instance, the potential impact of dental and orthodontic work on cranial nerve function.
 
So, is it worth reading? If any of the above piques your interest, go for it! Just read my post on polyvagal theory first – you can use the book to practice separating the wheat (solid informational content) from the chaff (pseudoscientific framing). If nothing else, the book is a nice reminder that genuine healers who get lasting results for their patients do exist.

But if you just want to try the exercises, you can easily find them all on YouTube. 

“You learn techniques to understand principles. When you understand the principles, you will create your own techniques.” -Stanley Rosenberg
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