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Medical protocols prioritize safety and metabolic stability over aggressive dosing strategies

Specifically, BHB binds to and engages hydroxycarboxylic acid receptor 2 (HCAR2, also known as GPR1O9A) and free fatty acid receptor 3 (FFAR3, or GPR41) [43]

Its not something new: it was introduced around 1950 and today it can be used up to 1% worldwide

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Mol Biol Evol 28(10):27312739 Tan DX, Chen LD, Poeggeler B, Manchester LC, Reiter RJ (1993) Melatonin: a potent, endogenous hydroxyl radical scavenger