Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype?

Philippe J M Pinckaers, Tyler A Churchward-Venne, David Bailey, Luc J C van Loon, Philippe J M Pinckaers, Tyler A Churchward-Venne, David Bailey, Luc J C van Loon

Abstract

Elite athletes and coaches are in a constant search for training methods and nutritional strategies to support training and recovery efforts that may ultimately maximize athletes' performance. Recently, there has been a re-emerging interest in the role of ketone bodies in exercise metabolism, with considerable media speculation about ketone body supplements being routinely used by professional cyclists. Ketone bodies can serve as an important energy substrate under certain conditions, such as starvation, and can modulate carbohydrate and lipid metabolism. Dietary strategies to increase endogenous ketone body availability (i.e., a ketogenic diet) require a diet high in lipids and low in carbohydrates for ~4 days to induce nutritional ketosis. However, a high fat, low carbohydrate ketogenic diet may impair exercise performance via reducing the capacity to utilize carbohydrate, which forms a key fuel source for skeletal muscle during intense endurance-type exercise. Recently, ketone body supplements (ketone salts and esters) have emerged and may be used to rapidly increase ketone body availability, without the need to first adapt to a ketogenic diet. However, the extent to which ketone bodies regulate skeletal muscle bioenergetics and substrate metabolism during prolonged endurance-type exercise of varying intensity and duration remains unknown. Therefore, at present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes' performance under conditions where evidence-based nutritional strategies are applied appropriately.

Conflict of interest statement

Compliance with Ethical Standards Funding No sources of funding were used to assist in the preparation of this article. Conflict of interest Philippe Pinckaers, Tyler Churchward-Venne, David Bailey, and Luc van Loon declare that they have no conflicts of interest relevant to the content of this review.

Figures

Fig. 1
Fig. 1
Graphic representation of the potential effects of ketone bodies on exercise metabolism. Important factors for use of ketone body supplements may include taste, dose ingested, timing of intake relative to training/competition, ketone salts versus esters, and co-ingestion with other nutrients (i.e., carbohydrate). These factors may impact gastrointestinal function of the athlete following ingestion. Increased concentrations of ketone bodies during exercise can increase their utilization by tissues such as skeletal muscle and brain. Ketone bodies may also alter the utilization of other endogenous fuel sources including protein, carbohydrate, and fat. GI gastrointestinal, KB ketone bodies, EE energy expenditure, MPS muscle protein synthesis, IMTAG intramuscular triacylglycerol

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