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Leaf A, Rothschild JA, Sharpe TM, Sims ST, Macias CJ, Futch GG, Roberts MD, Stout JR, Ormsbee MJ, Aragon AA, Campbell BI, Arent SM, D'Agostino DP, Barrack MT, Kerksick CM, Kreider RB, Kalman DS, Antonio J. International society of sports nutrition position stand: ketogenic diets. J Int Soc Sports Nutr 2024; 21:2368167. [PMID: 38934469 DOI: 10.1080/15502783.2024.2368167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
POSITION STATEMENT The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the use of a ketogenic diet in healthy exercising adults, with a focus on exercise performance and body composition. However, this review does not address the use of exogenous ketone supplements. The following points summarize the position of the ISSN. 1. A ketogenic diet induces a state of nutritional ketosis, which is generally defined as serum ketone levels above 0.5 mM. While many factors can impact what amount of daily carbohydrate intake will result in these levels, a broad guideline is a daily dietary carbohydrate intake of less than 50 grams per day. 2. Nutritional ketosis achieved through carbohydrate restriction and a high dietary fat intake is not intrinsically harmful and should not be confused with ketoacidosis, a life-threatening condition most commonly seen in clinical populations and metabolic dysregulation. 3. A ketogenic diet has largely neutral or detrimental effects on athletic performance compared to a diet higher in carbohydrates and lower in fat, despite achieving significantly elevated levels of fat oxidation during exercise (~1.5 g/min). 4. The endurance effects of a ketogenic diet may be influenced by both training status and duration of the dietary intervention, but further research is necessary to elucidate these possibilities. All studies involving elite athletes showed a performance decrement from a ketogenic diet, all lasting six weeks or less. Of the two studies lasting more than six weeks, only one reported a statistically significant benefit of a ketogenic diet. 5. A ketogenic diet tends to have similar effects on maximal strength or strength gains from a resistance training program compared to a diet higher in carbohydrates. However, a minority of studies show superior effects of non-ketogenic comparators. 6. When compared to a diet higher in carbohydrates and lower in fat, a ketogenic diet may cause greater losses in body weight, fat mass, and fat-free mass, but may also heighten losses of lean tissue. However, this is likely due to differences in calorie and protein intake, as well as shifts in fluid balance. 7. There is insufficient evidence to determine if a ketogenic diet affects males and females differently. However, there is a strong mechanistic basis for sex differences to exist in response to a ketogenic diet.
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Affiliation(s)
- Alex Leaf
- Alex Leaf LLC, Scientific Affairs, Scottsdale, AZ, USA
| | - Jeffrey A Rothschild
- Auckland University of Technology, Sports Performance Research Institute New Zealand, Auckland, New Zealand
- High Performance Sport New Zealand, Performance Nutrition, Auckland, New Zealand
| | - Tim M Sharpe
- University of Western States, Human Nutrition and Functional Medicine, Portland, OR, USA
| | - Stacy T Sims
- Auckland University of Technology, Sports Performance Research Institute New Zealand, Auckland, New Zealand
- Stanford University, Stanford Lifestyle Medicine, Palo Alto, CA, USA
| | - Chad J Macias
- University of Western States, Human Nutrition and Functional Medicine, Portland, OR, USA
| | - Geoff G Futch
- Springfield College, Department of Exercise Science and Athletic Training, Springfield, MA, USA
- FitPro Analytics, Scientific Affairs, Springfield, MA, USA
| | | | - Jeffrey R Stout
- University of Central Florida, School of Kinesiology and Rehabilitation Sciences, Orlando, FL, USA
| | - Michael J Ormsbee
- Florida State University, Institute of Sports Sciences & Medicine, Tallahassee, FL, USA
- University of KwaZulu Natal, Discipline of Biokinetics, Exercise and Leisure Sciences, Durban, South Africa
| | | | - Bill I Campbell
- University of South Florida, Performance and Physique Enhancement Laboratory, Exercise Science Program, Tampa, FL, USA
| | - Shawn M Arent
- University of South Carolina, Department of Exercise Science, Arnold School of Public Health, Columbia, SC, USA
| | - Dominic P D'Agostino
- Institute for Human and Machine Cognition, Human Healthspan, Resilience, and Performance, Pensacola, FL, USA
- University of South Florida, Department of Molecular Pharmacology and Physiology, Tampa, FL, USA
| | - Michelle T Barrack
- California State University, Department of Family and Consumer Sciences, Long Beach, CA, USA
| | - Chad M Kerksick
- Lindenwood University, Exercise and Performance Nutrition Laboratory, College of Science, Technology, and Health, St. Charles, MO, USA
| | - Richard B Kreider
- Texas A&M University, Exercise and Sport Nutrition Lab, Department of Kinesiology and Sports Management, College Station, TX, USA
| | - Douglas S Kalman
- Nova Southeastern University, Department of Nutrition. Dr. Kiran C. Patel College of Osteopathic Medicine. Davie, FL, USA
| | - Jose Antonio
- Department of Health and Human Performance, Nova Southeastern University, Davie, FL, USA
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Panza L, Piamonti D, Palange P. Pulmonary gas exchange and ventilatory efficiency during exercise in health and diseases. Expert Rev Respir Med 2024:1-13. [PMID: 38912849 DOI: 10.1080/17476348.2024.2370447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) is nowadays used to study the exercise response in healthy subjects and in disease. Ventilatory efficiency is one of the main determinants in exercise tolerance, and its main variables are a useful tool to guide pathophysiologists toward specific diagnostic pathways, providing prognostic information and improving disease management, treatment, and outcomes. AREAS COVERED This review will be based on today's available scientific evidence, describing the main physiological determinants of ventilatory efficiency at rest and during exercise, and focusing also on how CPET variables are modified in specific diseases, leading to the possibility of early diagnosis and management. EXPERT OPINION Growing knowledge on CPET interpretation and a wider use of this clinical tool is expected in order to offer more precise diagnostic and prognostic information to patients and clinicians, helping in the management of therapeutic decisions. Future research could be able to identify new and more simple markers of ventilatory efficiency, and to individuate new interventions for the improvement of symptoms, such as exertional dyspnea.
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Affiliation(s)
- Luigi Panza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Daniel Piamonti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Bódis K, Breuer S, Crepzia-Pevzner A, Zaharia OP, Schön M, Saatmann N, Altenhofen D, Springer C, Szendroedi J, Wagner R, Al-Hasani H, Roden M, Pesta D, Chadt A. Impact of physical fitness and exercise training on subcutaneous adipose tissue beiging markers in humans with and without diabetes and a high-fat diet-fed mouse model. Diabetes Obes Metab 2024; 26:339-350. [PMID: 37869933 DOI: 10.1111/dom.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/24/2023]
Abstract
AIMS Exercise training induces white adipose tissue (WAT) beiging and improves glucose homeostasis and mitochondrial function in rodents. This could be relevant for type 2 diabetes in humans, but the effect of physical fitness on beiging of subcutaneous WAT (scWAT) remains unclear. This translational study investigates if beiging of scWAT associates with physical fitness in healthy humans and recent-onset type 2 diabetes and if a voluntary running wheel intervention is sufficient to induce beiging in mice. MATERIALS AND METHODS Gene expression levels of established beiging markers were measured in scWAT biopsies of humans with (n = 28) or without type 2 diabetes (n = 28), stratified by spiroergometry into low (L-FIT; n = 14 each) and high physical fitness (H-FIT; n = 14 each). High-fat diet-fed FVB/N mice underwent voluntary wheel running, treadmill training or no training (n = 8 each group). Following the training intervention, mitochondrial respiration and content of scWAT were assessed by high-resolution respirometry and citrate synthase activity, respectively. RESULTS Secreted CD137 antigen (Tnfrsf9/Cd137) expression was three-fold higher in glucose-tolerant H-FIT than in L-FIT, but not different between H-FIT and L-FIT with type 2 diabetes. In mice, both training modalities increased Cd137 expression and enhanced mitochondrial content without changing respiration in scWAT. Treadmill but not voluntary wheel running led to improved whole-body insulin sensitivity. CONCLUSIONS Higher physical fitness and different exercise interventions associated with higher gene expression levels of the beiging marker CD137 in healthy humans and mice on a high-fat diet. Humans with recent-onset type 2 diabetes show an impaired adipose tissue-specific response to physical activity.
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Affiliation(s)
- Kálmán Bódis
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Saida Breuer
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Assja Crepzia-Pevzner
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Oana-Patricia Zaharia
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Martin Schön
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Nina Saatmann
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Delsi Altenhofen
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Christian Springer
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- Joint Heidelberg-IDC Transnational Diabetes Program, Inner Medicine I, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Wagner
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Dominik Pesta
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Endocrinology, Diabetes and Preventive Medicine (CEDP), University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Alexandra Chadt
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
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Kominami K, Akino M. Prolonged mean response time in older adults with cardiovascular risk compared to healthy older adults. BMC Sports Sci Med Rehabil 2022; 14:173. [PMID: 36151572 PMCID: PMC9503204 DOI: 10.1186/s13102-022-00565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022]
Abstract
Background During incremental exercise (Inc-Ex), the mean response time (MRT) of oxygen uptake (V̇O2) represents the time delay before changes in muscle V̇O2 reflect at the mouth level. MRT calculation by linear regression or monoexponential (τ’) fitting of V̇O2 data are known to be highly variable, and a combination of incremental and constant load exercise (CL-Ex) is more reproducible. Methods We evaluated MRT in older adults using linear regression and combination methods. We recruited 20 healthy adults (male: 9, 69.4 ± 6.8 years) and 10 cardiovascular risk subjects (male: 8, 73.0 ± 8.8 years). On day 1, they performed Inc-Ex using a 10W/min ramp protocol, for determination of the ventilatory anaerobic threshold (VAT) using the V-slope method. On day 2, they performed Inc-Ex to VAT exercise intensity and CL-Ex for 25min total. The MRT was calculated from the CL-Ex V̇O2 average and the time at equivalent V̇O2 in the Inc-Ex. We also assessed the amount of physical activity using the International Physical Activity Questionnaire short form (IPAQ-SF). Results The MRT of healthy participants and those at cardiovascular risk were 49.2 ± 36.3 vs. 83.6 ± 45.4s (p = 0.033). Total physical activity in the IPAQ-SF was inversely correlated with MRT. Conclusion The MRT was significantly prolonged in cardiovascular risk participants compared to healthy participants, possibly related to the amount of daily physical activity. Individual MRT may be useful for adjustment of exercise intensity, but this should also be based on daily physical activity and individual condition during exercise.
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Affiliation(s)
- Kazuyuki Kominami
- Department of Rehabilitation, Sanseikai Kitano Hospital, 6-30, 1-chome, Kitano1-jyo, Kiyota-ku, 004-0861, Sapporo, Hokkaido, Japan.
| | - Masatoshi Akino
- Department of Rehabilitation, Sapporo Kiyota Orthopedic Hospital, 1-50, 4-chome, Kiyota1-jyo, Kiyota-ku, 004-0841, Sapporo, Hokkaido, Japan
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Kominami K, Imahashi K, Katsuragawa T, Murakami M, Akino M. The Ratio of Oxygen Uptake From Ventilatory Anaerobic Threshold to Respiratory Compensation Point Is Maintained During Incremental Exercise in Older Adults. Front Physiol 2022; 13:769387. [PMID: 35309068 PMCID: PMC8927902 DOI: 10.3389/fphys.2022.769387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The period from ventilatory anaerobic threshold (VAT) to respiratory compensation point (RCP) during incremental exercise (isocapnic buffering phase) has been associated with exercise tolerance and skeletal muscle composition. However, several reports compare younger and older healthy adults, and specific age-related changes are unclear. This study aimed to examine the oxygen uptake (VO2) from VAT to RCP and its change over time in younger and older healthy adults. Methods A total of 126 consecutive participants were divided into two groups (95 younger and 31 older than 50 years of age) who underwent cardiopulmonary exercise testing, and VAT and RCP were determined. The ratio (RCP/VAT) and difference (ΔVO2 RCP-VAT) were calculated from the VO2 of VAT and RCP and compared between groups and ages. Statistical analyses included t-tests and Spearman’s correlation tests, and the significance level was set at <5%. Results RCP/VAT was not significantly different (1.40 ± 0.19 vs. 1.59 ± 0.24, p = 0.057) but weakly correlated with age (r = −0.229, p = 0.013, y = −0.0031x + 1.7588, lowering rate: 0.185%/year). Conversely, ΔVO2 RCP-VAT was significantly lower in the older group (7.7 ± 3.1 vs. 13.8 ± 4.9 ml/kg/min, p < 0.001) and correlated significantly with age (r = −0.499; p < 0.001; y = −0.1303x + 16.855; lowering rate, 0.914%/year). Conclusion ΔVO2 RCP-VAT was considered to be a poor indicator of lactate buffering capacity in the IB phase because both VAT and RCP were greatly affected by age-related decline. Conversely, RCP/VAT was suggested to be an index not easily affected by aging.
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Affiliation(s)
- Kazuyuki Kominami
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
- *Correspondence: Kazuyuki Kominami,
| | - Keiko Imahashi
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Toko Katsuragawa
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Mitsuyo Murakami
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Masatoshi Akino
- Department of Cardiovascular Medicine, Sapporo Ryokuai Hospital, Sapporo, Japan
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