Astrocytes—the brain's primary support cells—undergo extensive metabolic and structural changes when exposed to ketone therapies including ketogenic diets, intermittent fasting, and ketone supplementation. These cells demonstrate morphological remodeling, altered calcium signaling, transcriptional reprogramming, and modified neurotransmitter uptake patterns in response to elevated ketone bodies. This represents a significant shift in our understanding of ketogenic interventions. While most research has focused on how neurons respond to ketones, astrocytes may actually be the key mediators of ketotherapy's neuroprotective benefits. These cells both produce and consume ketones while maintaining the metabolic environment that neurons depend on for optimal function. The findings suggest that astrocytes actively orchestrate the cognitive and protective effects observed with ketogenic approaches, particularly during aging and neurodegenerative conditions. However, this field remains in its infancy. Critical questions about timing, dosage, regional brain differences, and long-term consequences remain unanswered. The research gap is substantial—we're implementing ketogenic therapies without understanding how they affect the brain cells that may be most responsible for their benefits.