The Effect of a Ketogenic Low-Carbohydrate, High-Fat Diet on Aerobic Capacity and Exercise Performance in Endurance Athletes: A Systematic Review and Meta-Analysis

Jingguo Cao, Siman Lei, Xiuqiang Wang, Sulin Cheng, Jingguo Cao, Siman Lei, Xiuqiang Wang, Sulin Cheng

Abstract

A low-carbohydrate, high-fat (LCHF) diet has been proposed to enhance the fat utilization of muscle and the aerobic capacity of endurance athletes, thereby improving their exercise performance. However, it remains uncertain how the macronutrient intake shift from carbohydrate to fat affects endurance exercise training and performance. This study performed a systematic review and meta-analysis to explore the effects of a ketogenic low-carbohydrate, high-fat (K-LCHF) diet on aerobic capacity and exercise performance among endurance athletes. Searches were carried out in five electronic databases, and we followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The search included studies using an LCHF diet as an intervention protocol and compared data on factors such as maximum oxygen uptake (VO2max) and rating of perceived exertion (RPE) from the graded exercise test. In this case, 10 studies met the criteria and were included in the meta-analysis. We did not find a significant effect of K-LCHF diet interventions on VO2max, time to exhaustion, HRmax or RPE. However, a significant overall effect in the substrate oxidation response to respiratory exchange rate was observed. The meta-analysis showed that K-LCHF diets did not affect aerobic capacity and exercise performance. Therefore, high-quality interventions of a K-LCHF diet are needed to illustrate its effect on various endurance training programs.

Keywords: aerobic capacity; endurance athletes; high-fat diet; ketogenic low-carbohydrate.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Risk of bias included studies in meta-analysis.
Figure 2
Figure 2
Flowchart for studies in the meta-analysis.
Figure 3
Figure 3
Effect of the ketogenic low-carbohydrate, high-fat (K-LCHF) diet on VO2max during graded exercise test (GXT); CI: confidence interval; SMD: standardized mean difference.
Figure 4
Figure 4
Effect of the ketogenic low-carbohydrate, high-fat (K-LCHF) diet on total time to exhaustion (TTE) during graded exercise test (GXT); CI: confidence interval; SMD: standardized mean difference.
Figure 5
Figure 5
Effect of the ketogenic low-carbohydrate, high-fat (K-LCHF) diet on maximal heart rate (HRmax) during graded exercise test (GXT); CI: confidence interval; SMD: standardized mean difference.
Figure 6
Figure 6
Effect of the ketogenic low-carbohydrate, high-fat (K-LCHF) diet on respiratory exchange ratio (RER) during graded exercise test (GXT); CI: confidence interval; SMD: standardized mean difference.
Figure 7
Figure 7
Effect of the ketogenic low-carbohydrate, high-fat (K-LCHF) diet on rating of perceived exertion (RPE) during graded exercise test (GXT); CI: confidence interval; SMD: standardize mean difference.

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