High-stress occupations are associated with cardiometabolic diseases due to chronic stressors. Ketones, specifically R-βHB, modulate intracellular signaling cascades to promote a robust mitochondrial environment that favors reductions in oxidative stress and inflammation. The scope of this review is to detail the mechanisms of R-βHB as a signaling metabolite and the role that exogenous ketones might play in mitigating diseases in individuals serving in high-stress occupations.