However, it’s important to consider whether similar benefits would be seen with exogenous BHB supplementation or if sustained endogenous ketosis reflects broader metabolic improvements, particularly reduced hyperinsulinemia, which is known to drive inflammatory pathways (e.g., NLRP3 via PI3K) and other renal stressors (34, 35). This evidence concerns the gene NLRP3 and hyperinsulinism.