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Brady AJ, Egan B. Acute Ingestion of a Ketone Monoester without Co-ingestion of Carbohydrate Improves Running Economy in Male Endurance Runners. Med Sci Sports Exerc 2024; 56:134-142. [PMID: 37565450 DOI: 10.1249/mss.0000000000003278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
PURPOSE Acute ingestion of a ketone monoester, with and without co-ingestion of carbohydrate, was investigated for effects on running economy (RE), time to exhaustion (TTE), and other related indices of endurance running performance. METHODS Using a three condition, placebo-controlled, randomized crossover design, 11 male middle- and long-distance runners ran at five submaximal speeds (10-14 km·h -1 ) on a motorized treadmill for 8 min each, immediately followed by a ramp test to volitional exhaustion. Participants consumed either a 10% carbohydrate solution (CHO), a 10% carbohydrate solution with 750 mg·kg -1 body mass of an ( R )-3-hydroxybutyl ( R )-3-hydroxybutyrate ketone monoester (CHO + KE), or 750 mg·kg -1 body mass of the ketone monoester in flavored water (KE) before (two-thirds of the dose) and during (one-third of the dose) exercise. RESULTS β-hydroxybutyrate concentration averaged 1.8 ± 0.3 and 2.1 ± 0.3 mM during exercise in CHO + KE and KE, respectively. RE was lower at each submaximal running speed (effect size = 0.48-0.98) by an average of 4.1% in KE compared with CHO, but not between CHO + KE and CHO. TTE did not differ between CHO (369 ± 116 s), CHO + KE (342 ± 99 s), or KE (333 ± 106 s) ( P = 0.093). CONCLUSIONS Acute ingestion of a ketone monoester without carbohydrate, but not when coingested with carbohydrate, improved RE in middle- and long-distance runners at a range of submaximal running speeds and did not alter TTE in a short-duration ramp test to volitional exhaustion. Further investigation is required to examine if these differences translate into positive performance outcomes over longer durations of exercise.
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Margolis LM, Pasiakos SM, Howard EE. High-fat ketogenic diets and ketone monoester supplements differentially affect substrate metabolism during aerobic exercise. Am J Physiol Cell Physiol 2023; 325:C1144-C1153. [PMID: 37721006 PMCID: PMC10635661 DOI: 10.1152/ajpcell.00359.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
Chronically adhering to high-fat ketogenic diets or consuming ketone monoester supplements elicits ketosis. Resulting changes in substrate metabolism appear to be drastically different between ketogenic diets and ketone supplements. Consuming a ketogenic diet increases fatty acid oxidation with concomitant decreases in endogenous carbohydrate oxidation. Increased fat oxidation eventually results in an accumulation of circulating ketone bodies, which are metabolites of fatty acids that serve as an alternative source of fuel. Conversely, consuming ketone monoester supplements rapidly increases circulating ketone body concentrations that typically exceed those achieved by adhering to ketogenic diets. Rapid increases in ketone body concentrations with ketone monoester supplementation elicit a negative feedback inhibition that reduces fatty acid mobilization during aerobic exercise. Supplement-derived ketosis appears to have minimal impact on sparing of muscle glycogen or minimizing of carbohydrate oxidation during aerobic exercise. This review will discuss the substrate metabolic and associated aerobic performance responses to ketogenic diets and ketone supplements.
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Affiliation(s)
- Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Stefan M Pasiakos
- Office of Dietary Supplements, U.S. Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Emily E Howard
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
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3
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Yu Q, Falkenhain K, Little JP, Wong KK, Nie J, Shi Q, Kong Z. Effects of ketone supplements on blood β-hydroxybutyrate, glucose and insulin: A systematic review and three-level meta-analysis. Complement Ther Clin Pract 2023; 52:101774. [PMID: 37327753 DOI: 10.1016/j.ctcp.2023.101774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Effects of ketone supplements as well as relevant dose-response relationships and time effects on blood β-hydroxybutyrate (BHB), glucose and insulin are controversial. OBJECTIVE This study aimed to summarize the existing evidence and synthesize the results, and demonstrate underlying dose-response relationships as well as sustained time effects. METHODS Medline, Web of Science, Embase, and Cochrane Central Register of Controlled Trials were searched for relevant randomized crossover/parallel studies published until 25th November 2022. Three-level meta-analysis compared the acute effects of exogenous ketone supplementation and placebo in regulating blood parameters, with Hedge's g used as measure of effect size. Effects of potential moderators were explored through multilevel regression models. Dose-response and time-effect models were established via fractional polynomial regression. RESULTS The meta-analysis with 327 data points from 30 studies (408 participants) indicated that exogenous ketones led to a significant increase in blood BHB (Hedge's g = 1.4994, 95% CI [1.2648, 1.7340]), reduction in glucose (Hedge's g = -0.3796, 95% CI [-0.4550, -0.3041]), and elevation in insulin of non-athlete healthy population (Hedge's g = 0.1214, 95%CI [0.0582, 0.3011]), as well as insignificant change in insulin of obesity and prediabetes. Nonlinear dose-response relationship between ketone dosage and blood parameter change was observed in some time intervals for BHB (30-60 min; >120 min) and insulin (30-60 min; 90-120 min), with linear relationship observed for glucose (>120 min). Nonlinear associations between time and blood parameter change were found in BHB (>550 mg/kg) and glucose (450-550 mg/kg), with linear relationship observed in BHB (≤250 mg/kg) and insulin (350-550 mg/kg). CONCLUSION Dose-response relationships and sustained time effects were observed in BHB, glucose and insulin following ketone supplementation. Glucose-lowering effect without increasing insulin load among population of obesity and prediabetes was of remarkable clinical implication. REGISTRY AND REGISTRY NUMBER PROSPERO (CRD42022360620).
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Affiliation(s)
- Qian Yu
- Faculty of Education, University of Macau, Macao, China
| | - Kaja Falkenhain
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Ka Kit Wong
- Faculty of Education, University of Macau, Macao, China
| | - Jinlei Nie
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Qingde Shi
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Zhaowei Kong
- Faculty of Education, University of Macau, Macao, China.
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4
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Howard EE, Allen JT, Coleman JL, Small SD, Karl JP, O'Fallon KS, Margolis LM. Ketone Monoester Plus Carbohydrate Supplementation Does Not Alter Exogenous and Plasma Glucose Oxidation or Metabolic Clearance Rate During Exercise in Men Compared with Carbohydrate Alone. J Nutr 2023:S0022-3166(23)35281-7. [PMID: 36893935 DOI: 10.1016/j.tjnut.2023.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Increasing β-hydroxybutyrate (βHB) availability through ketone monoester plus carbohydrate (KE+CHO) supplementation is suggested to enhance physical performance by sparing glucose use during exercise. However, no studies have examined the effect of ketone supplementation on glucose kinetics during exercise. OBJECTIVES This exploratory study primarily aimed to determine the effect of KE+CHO supplementation on glucose oxidation and physical performance during steady-state exercise compared with carbohydrate. METHODS Using a randomly assigned, crossover design (clinicaltrials.gov, NCT04737694), 12 men consumed KE+CHO (573 mg ketone monoester/kg body mass, 110 g glucose) or carbohydrate (110 g glucose) before and during 90 min of steady-state treadmill exercise [54 ± 3% peak oxygen uptake (V̇˙O2peak)] wearing a weighted vest (30% body mass; 25 ± 3 kg). Glucose oxidation and turnover were determined using indirect calorimetry and stable isotopes. Participants performed an unweighted time to exhaustion (TTE; 85% V̇˙O2peak) after steady-state exercise and a weighted (25 ± 3 kg) 6.4 km time trial (TT) the next day after consuming a bolus of KE+CHO or carbohydrate. Data were analyzed by paired t-tests and mixed model ANOVA. RESULTS βHB concentrations were higher (P < 0.05) after exercise [2.1 mM (95% CI: 1.6, .6)] and the TT [2.6 mM (2.1, 3.1)] in KE+CHO compared with carbohydrate. TTE was lower [-104 s (-201, -8)], and TT performance was slower [141 s (19,262)] in KE+CHO than in carbohydrate (P < 0.05). Exogenous [-0.01 g/min (-0.07, 0.04)] and plasma [-0.02 g/min (-0.08, 0.04)] glucose oxidation and metabolic clearance rate {MCR [0.38 mg·kg-1·min-1 (-0.79, 1.54)]} were not different, and glucose rate of appearance [-0.51 mg·kg-1·min-1 (-0.97, -0.04)], and disappearance [-0.50 mg·kg-1·min-1 (-0.96, -0.04)] were lower (P < 0.05) in KE+CHO compared with carbohydrate during steady-state exercise. CONCLUSIONS In the current study, the rates of exogenous and plasma glucose oxidation and MCR were not different between treatments during steady-state exercise, suggesting blood glucose utilization is similar between KE+CHO and carbohydrate. KE+CHO supplementation also results in lower physical performance compared with carbohydrate. This trial was registered at www. CLINICALTRIALS gov as NCT04737694.
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Affiliation(s)
- Emily E Howard
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Jillian T Allen
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Julie L Coleman
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Stephanie D Small
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - J Philip Karl
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Kevin S O'Fallon
- Soldier Effectiveness Directorate, United States Army Combat Capabilities Development Command Soldier Center, Natick, MA, United States
| | - Lee M Margolis
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States.
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5
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Dearlove DJ, Soto Mota A, Hauton D, Pinnick K, Evans R, Miller J, Fischer R, Mccullagh JS, Hodson L, Clarke K, Cox PJ. The effects of endogenously- and exogenously-induced hyperketonemia on exercise performance and adaptation. Physiol Rep 2022; 10:e15309. [PMID: 35614576 PMCID: PMC9133544 DOI: 10.14814/phy2.15309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 05/22/2023] Open
Abstract
Elevating blood ketones may enhance exercise capacity and modulate adaptations to exercise training; however, these effects may depend on whether hyperketonemia is induced endogenously through dietary carbohydrate restriction, or exogenously through ketone supplementation. To determine this, we compared the effects of endogenously- and exogenously-induced hyperketonemia on exercise capacity and adaptation. Trained endurance athletes undertook 6 days of laboratory based cycling ("race") whilst following either: a carbohydrate-rich control diet (n = 7; CHO); a carbohydrate-rich diet + ketone drink four-times daily (n = 7; Ex Ket); or a ketogenic diet (n = 7; End Ket). Exercise capacity was measured daily, and adaptations in exercise metabolism, exercise physiology and postprandial insulin sensitivity (via an oral glucose tolerance test) were measured before and after dietary interventions. Urinary β-hydroxybutyrate increased by ⁓150-fold and ⁓650-fold versus CHO with Ex Ket and End Ket, respectively. Exercise capacity was increased versus pre-intervention by ~5% on race day 1 with CHO (p < 0.05), by 6%-8% on days 1, 4, and 6 (all p < 0.05) with Ex Ket and decreased by 48%-57% on all race days (all p > 0.05) with End Ket. There was an ⁓3-fold increase in fat oxidation from pre- to post-intervention (p < 0.05) with End Ket and increased perceived exercise exertion (p < 0.05). No changes in exercise substrate metabolism occurred with Ex Ket, but participants had blunted postprandial insulin sensitivity (p < 0.05). Dietary carbohydrate restriction and ketone supplementation both induce hyperketonemia; however, these are distinct physiological conditions with contrasting effects on exercise capacity and adaptation to exercise training.
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Affiliation(s)
- David J. Dearlove
- Department of Physiology, Anatomy and GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Adrian Soto Mota
- Department of Physiology, Anatomy and GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - David Hauton
- Chemistry Research LaboratoryUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Katherine Pinnick
- Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill Hospital and Oxford NIHRBiomedical Research CentreUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Rhys Evans
- Department of Physiology, Anatomy and GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Jack Miller
- Department of Physiology, Anatomy and GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
- The PET Research Centre and The MR Research CentreAarhus UniversityHeadingtonOxfordUnited Kingdom
- Clarendon LaboratoryDepartment of PhysicsUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Roman Fischer
- Target Discovery InstituteUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | | | - Leanne Hodson
- Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill Hospital and Oxford NIHRBiomedical Research CentreUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Kieran Clarke
- Department of Physiology, Anatomy and GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Pete J. Cox
- Department of Physiology, Anatomy and GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
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6
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Cruz R, Koch S, Matsuda M, Marquezini M, Sforça ML, Lima-Silva AE, Saldiva P, Koehle M, Bertuzzi R. Air pollution and high-intensity interval exercise: Implications to anti-inflammatory balance, metabolome and cardiovascular responses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 809:151094. [PMID: 34688752 DOI: 10.1016/j.scitotenv.2021.151094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 06/13/2023]
Abstract
High-intensity interval exercise (HIIE) is an effective non-pharmacological tool for improving physiological responses related to health. When HIIE is performed in urban centers, however, the exerciser is exposed to traffic-related air pollution (TRAP), which is associated with metabolic, anti-inflammatory imbalance and cardiovascular diseases. This paradoxical combination has the potential for conflicting health effects. Thus, the aim of this study was to determine the effects of HIIE performed in TRAP exposure on serum cytokines, non-target metabolomics and cardiovascular parameters. Fifteen participants performed HIIE in a chamber capable to deliver filtered air (FA condition) or non-filtered air (TRAP condition) from a polluted site adjacent to the exposure chamber. Non-target blood serum metabolomics, blood serum cytokines and blood pressure analyses were collected in both FA and TRAP conditions at baseline, 10 min after exercise, and 1 h after exercise. The TRAP increased IL-6 concentration by 1.7 times 1 h after exercise (p < 0.01) and did not change the anti-inflammatory balance (IL-10/TNF-α ratio). In contrast, FA led to an increase in IL-10 and IL-10/TNF-α ratio (p < 0.01), by 2.1 and 2.3 times, respectively. The enrichment analysis showed incomplete fatty acid metabolism under the TRAP condition (p < 0.05) 10 min after exercise. There was also an overactivity of ketone body metabolism (p < 0.05) at 10 min and at 1 h after exercise with TRAP. Exercise-induced acute decrease in systolic blood pressure (SBP) was not observed at 10 min and impaired at 1 h after exercise (p < 0.05). These findings reveal that TRAP potentially attenuates health benefits often related to HIIE. For instance, the anti-inflammatory balance was impaired, accompanied by accumulation of metabolites related to energy supply and reduction to exercise-induced decrease in SBP.
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Affiliation(s)
- Ramon Cruz
- Endurance Performance Research Group (GEDAE-USP), School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil; Sports Center, Department of Physical Education, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Sarah Koch
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat de Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Monique Matsuda
- Laboratory of Investigation in Ophthalmology (LIM-33), Division of Ophthalmology, University of São Paulo Faculty of Medicine, São Paulo, SP, Brazil
| | - Monica Marquezini
- Laboratory of Investigation in Ophthalmology (LIM-33), Division of Ophthalmology, University of São Paulo Faculty of Medicine, São Paulo, SP, Brazil; Pro-Sangue Foundation, São Paulo, SP, Brazil
| | - Mauricio L Sforça
- Brazilian Biosciences National Laboratory (LNBio), Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, SP, Brazil
| | - Adriano E Lima-Silva
- Human Performance Research Group, Academic Department of Physical Education (DAEFI), Technological Federal University of Parana, Curitiba, PR, Brazil
| | - Paulo Saldiva
- Institute of Advanced Studies, University of São Paulo, São Paulo, SP, Brazil
| | - Michael Koehle
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Romulo Bertuzzi
- Endurance Performance Research Group (GEDAE-USP), School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil.
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Acute Ingestion of Ketone Monoesters and Precursors Do Not Enhance Endurance Exercise Performance: A Systematic Review and Meta-Analysis. Int J Sport Nutr Exerc Metab 2022; 32:214-225. [PMID: 35042186 DOI: 10.1123/ijsnem.2021-0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
There has been much consideration over whether exogenous ketone bodies have the capacity to enhance exercise performance through mechanisms such as altered substrate metabolism, accelerated recovery, or neurocognitive improvements. This systematic review aimed to determine the effects of both ketone precursors and monoesters on endurance exercise performance. A systematic search was conducted in PubMed, SPORTDiscus, and CINAHL for randomized controlled trials investigating endurance performance outcomes in response to ingestion of a ketone supplement compared to a nutritive or nonnutritive control in humans. A meta-analysis was performed to determine the standardized mean difference between interventions using a random-effects model. Hedge's g and 95% confidence intervals (CI) were reported. The search yielded 569 articles, of which eight were included in this review (80 participants; 77 men and three women). When comparing endurance performance among all studies, no significant differences were found between ketone and control trials (Hedges g = 0.136; 95% CI [-0.195, 0.467]; p = .419). Subanalyses based on type of endurance tests showed no significant differences in time to exhaustion (Hedge's g = -0.002; 95% CI [-0.312, 0.308]; p = .989) or time trial (Hedge's g = 0.057; 95% CI [-0.282, 0.395]; p = .744) values. Based on these findings, exogenous ketone precursors and monoesters do not exert significant improvements on endurance exercise performance. While all studies reported an increase in blood ketone concentrations after ingestion, ketone monoesters appear to be more effective at raising concentrations than precursors.
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8
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The effect of a low carbohydrate ketogenic diet with or without exercise on postpartum weight retention, metabolic profile and physical activity performance in postpartum mice. J Nutr Biochem 2022; 102:108941. [PMID: 35017000 DOI: 10.1016/j.jnutbio.2022.108941] [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: 07/28/2021] [Revised: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE the present study examined the effect of the isocaloric low-carbohydrate ketogenic diet (LCKD) with or without exercise training for 6 weeks on postpartum weight retention (PPWR), body composition, metabolic profile and physical activity performance in postpartum mice. METHODS postpartum mice were assigned to 4 groups (n=8/group) as follows: (1) those on a control diet without aerobic exercise (CN); (2) those on a control diet with aerobic exercise (CN+EX), (3); those on a LCKD without aerobic exercise (LCKD); (4) those on a LCKD with aerobic exercise (LCKD+EX). CN+EX and LCKD+EX mice performed 6 weeks of exercise training on a treadmill. After the 6-week intervention, physical activity performance was determined. RESULTS postpartum mice in all groups experienced progressive reductions in body weight over the study period. The LCKD group had the smallest reduction in PPWR (p<0.05). The LCKD group had significantly higher total cholesterol, low-density lipoprotein cholesterol and lactate dehydrogenase levels, and liver lipid concentrations with a worsened glucose tolerance, compared to the CN group (p<0.05). The LCKD group showed significant reductions in physical activity performance, whilst the LCKD+EX group showed significantly improvement in endurance performance, and paralleled the concomitant elevation in blood ketone levels. CONCLUSIONS 6-week LCKD feeding on its own was less effective for reducing PPWR, and more detrimental to postpartum metabolic outcomes and physical activity performance of the postpartum mice. The feasibility of a LCKD with or without exercise during the postpartum period as a strategy for managing PPWR and improving postpartum metabolic profiles should be carefully considered.
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9
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Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future. Sports Med 2022; 52:25-67. [PMID: 36214993 PMCID: PMC9734240 DOI: 10.1007/s40279-022-01756-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 12/15/2022]
Abstract
The ketone bodies acetoacetate (AcAc) and β-hydroxybutyrate (βHB) have pleiotropic effects in multiple organs including brain, heart, and skeletal muscle by serving as an alternative substrate for energy provision, and by modulating inflammation, oxidative stress, catabolic processes, and gene expression. Of particular relevance to athletes are the metabolic actions of ketone bodies to alter substrate utilisation through attenuating glucose utilisation in peripheral tissues, anti-lipolytic effects on adipose tissue, and attenuation of proteolysis in skeletal muscle. There has been long-standing interest in the development of ingestible forms of ketone bodies that has recently resulted in the commercial availability of exogenous ketone supplements (EKS). These supplements in the form of ketone salts and ketone esters, in addition to ketogenic compounds such as 1,3-butanediol and medium chain triglycerides, facilitate an acute transient increase in circulating AcAc and βHB concentrations, which has been termed 'acute nutritional ketosis' or 'intermittent exogenous ketosis'. Some studies have suggested beneficial effects of EKS to endurance performance, recovery, and overreaching, although many studies have failed to observe benefits of acute nutritional ketosis on performance or recovery. The present review explores the rationale and historical development of EKS, the mechanistic basis for their proposed effects, both positive and negative, and evidence to date for their effects on exercise performance and recovery outcomes before concluding with a discussion of methodological considerations and future directions in this field.
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10
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Clark D, Munten S, Herzig KH, Gagnon DD. Exogenous Ketone Salt Supplementation and Whole-Body Cooling Do Not Improve Short-Term Physical Performance. Front Nutr 2021; 8:663206. [PMID: 34336907 PMCID: PMC8319384 DOI: 10.3389/fnut.2021.663206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Exogenous ketone supplementation and whole-body cooling (WBC) have shown to independently influence exercise metabolism. Whether readily available ketone salts, with and without WBC, would provide similar metabolic benefits during steady-state aerobic and time-trial performances was investigated. Nine active males (VO2peak: 56.3 ± 2.2 mL·kg−1·min−1) completed three single-blind exercise sessions preceded by: (1) ingestion of placebo (CON), (2) ketone supplementation (0.3 g·kg−1 β-OHB) (KET), and (3) ketone supplementation with WBC (KETCO). Participants cycled in steady-state (SS, 60% Wmax) condition for 30-min, immediately followed by a 15-min time trial (TT). Skin and core temperature, cardio-metabolic, and respiratory measures were collected continuously, whereas venous blood samples were collected before and after supplementation, after SS and TT. Venous β-OHB was elevated, while blood glucose was lower, with supplementation vs. CON (p < 0.05). TT power output was not different between conditions (p = 0.112, CON: 190 ± 43.5 W, KET: 185 ± 40.4 W, KETCO: 211 ± 50.7 W). RER was higher during KETCO (0.97 ± 0.09) compared to both CON (0.88 ± 0.04, p = 0.012) and KET (0.88 ± 0.05, p = 0.014). Ketone salt supplementation and WBC prior to short-term exercise sufficiently increase blood β-OHB concentrations, but do not benefit metabolic shifts in fuel utilization or improve time trial performance.
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Affiliation(s)
- Daniel Clark
- Laboratory of Environmental Exercise Physiology, School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada.,Southwest College of Naturopathic Medicine and Health Sciences, Tempe, AZ, United States
| | - Stephanie Munten
- Laboratory of Environmental Exercise Physiology, School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada.,Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, ON, Canada
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine, Medical Research Center, University of Oulu, Oulu, Finland.,Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
| | - Dominique D Gagnon
- Laboratory of Environmental Exercise Physiology, School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada.,Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, ON, Canada.,Department of Sports and Exercise Medicine, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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11
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POFFÉ CHIEL, WYNS FELIX, RAMAEKERS MONIQUE, HESPEL PETER. Exogenous Ketosis Impairs 30-min Time-Trial Performance Independent of Bicarbonate Supplementation. Med Sci Sports Exerc 2021; 53:1068-1078. [PMID: 33196605 PMCID: PMC8048725 DOI: 10.1249/mss.0000000000002552] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE We recently demonstrated that coingestion of NaHCO3 to counteract ketoacidosis resulting from oral ketone ester (KE) intake improves mean power output during a 15-min time trial (TT) at the end of a 3-h cycling race by ~5%. This ergogenic effect occurred at a time when blood ketone levels were low, as ketosis was only induced during the initial ~2 h of the race. Therefore, in the current study, we investigated whether performance also increases if blood ketone levels are increased in the absence of ketoacidosis during high-intensity exercise. METHODS In a double-blind crossover design, 14 well-trained male cyclists completed a 30-min TT (TT30') followed by an all-out sprint at 175% of lactate threshold (SPRINT). Subjects were randomized to receive (i) 50 g KE, (ii) 180 mg·kg-1 body weight NaHCO3 (BIC), (iii) KE + BIC, or (iv) a control drink (CON). RESULTS KE ingestion increased blood d-ß-hydroxybutyrate to ~3-4 mM during the TT30' and SPRINT (P < 0.001 vs CON). In KE, blood pH and bicarbonate concomitantly dropped, causing 0.05 units lower pH and 2.6 mM lower bicarbonate in KE compared with CON during the TT30' and SPRINT (P < 0.001 vs CON). BIC coingestion resulted in 0.9 mM higher blood d-ß-hydroxybutyrate (P < 0.001 vs KE) and completely counteracted ketoacidosis during exercise (P > 0.05 vs CON). Mean power output during TT30' was similar between CON and BIC at 281 W, but was 1.5% lower in the KE conditions (main effect of KE: P = 0.03). Time to exhaustion in the SPRINT was ~64 s in CON and KE and increased by ~8% in the BIC conditions (main effect of BIC: P < 0.01). DISCUSSION Neutralization of acid-base disturbance by BIC coingestion is insufficient to counteract the slightly negative effect of KE intake during high-intensity exercise.
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Affiliation(s)
- CHIEL POFFÉ
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
| | - FELIX WYNS
- Bakala Academy-Athletic Performance Center, KU Leuven, Leuven, BELGIUM
| | - MONIQUE RAMAEKERS
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
| | - PETER HESPEL
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
- Bakala Academy-Athletic Performance Center, KU Leuven, Leuven, BELGIUM
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Shaw DM, Merien F, Braakhuis A, Maunder E, Dulson DK. Exogenous Ketone Supplementation and Keto-Adaptation for Endurance Performance: Disentangling the Effects of Two Distinct Metabolic States. Sports Med 2021; 50:641-656. [PMID: 31820376 DOI: 10.1007/s40279-019-01246-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ketone bodies (KB) provide an alternative energy source and uniquely modulate substrate metabolism during endurance exercise. Nutritional ketosis (blood KBs > 0.5 mM) can be achieved within minutes via exogenous ketone supplementation or days-to-weeks via conforming to a very low-carbohydrate, ketogenic diet (KD). In contrast to short-term (< 2 weeks) KD ingestion, chronic adherence (> 3 weeks) leads to a state of keto-adaptation. However, despite elevating blood KBs to similar concentrations, exogenous ketone supplementation and keto-adaptation are not similar metabolic states as they elicit diverse and distinct effects on substrate availability and metabolism during exercise; meaning that their influence on endurance exercise performance is different. In contrast to contemporary, high(er)-carbohydrate fuelling strategies, inducing nutritional ketosis is rarely ergogenic irrespective of origin and, in fact, can impair endurance performance. Nonetheless, exogenous ketone supplementation and keto-adaptation possess utility for select endurance events and individuals, thus warranting further research into their performance effects and potential strategies for their optimisation. It is critical, however, that future research considers the limitations of measuring blood KB concentrations and their utilisation, and assess the effect of nutritional ketosis on performance using exercise protocols reflective of real-world competition. Furthermore, to reliably assess the effects of keto-adaptation, rigorous dietary-training controls of sufficient duration should be prioritised.
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Affiliation(s)
- David M Shaw
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand.
| | - Fabrice Merien
- AUT-Roche Diagnostics Laboratory, School of Science, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Braakhuis
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ed Maunder
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Deborah K Dulson
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
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WHITFIELD JAMIE, BURKE LOUISEM, MCKAY ALANNAHKA, HEIKURA IDAA, HALL REBECCA, FENSHAM NIKITA, SHARMA AVISHP. Acute Ketogenic Diet and Ketone Ester Supplementation Impairs Race Walk Performance. Med Sci Sports Exerc 2021; 53:776-784. [PMID: 33027214 PMCID: PMC7969177 DOI: 10.1249/mss.0000000000002517] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to determine if LCHF and ketone ester (KE) supplementation can synergistically alter exercise metabolism and improve performance. METHODS Elite race walkers (n = 18, 15 males and 3 females; V˙O2peak, 62 ± 6 mL·min-1·kg-1) undertook a four-stage exercise economy test and real-life 10,000-m race before and after a 5-d isoenergetic high-CHO (HCHO, ~60%-65% fat; CHO, 20% fat; n = 9) or LCHF (75%-80% fat, <50 g·d-1 CHO, n = 9) diet. The LCHF group performed additional economy tests before and after diet after supplementation with 573 mg·kg-1 body mass KE (HVMN; HVMN Inc., San Francisco, CA), which was also consumed for race 2. RESULTS The oxygen cost of exercise (relative V˙O2, mL·min-1·kg-1) increased across all four stages after LCHF (P < 0.005). This occurred in association with increased fat oxidation rates, with a reciprocal decrease in CHO oxidation (P < 0.001). Substrate utilization in the HCHO group remained unaltered. The consumption of KE before the LCHF diet increased circulating KB (P < 0.05), peaking at 3.2 ± 0.6 mM, but did not alter V˙O2 or RER. LCHF diet elevated resting circulating KB (0.3 ± 0.1 vs 0.1 ± 0.1 mM), but concentrations after supplementation did not differ from the earlier ketone trial. Critically, race performance was impaired by ~6% (P < 0.0001) relative to baseline in the LCHF group but was unaltered in HCHO. CONCLUSION Despite elevating endogenous KB production, an LCHF diet does not augment the metabolic responses to KE supplementation and negatively affects race performance.
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Affiliation(s)
- JAMIE WHITFIELD
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
| | - LOUISE M. BURKE
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
- Australian Institute of Sport, Canberra, ACT, AUSTRALIA
| | - ALANNAH K. A. MCKAY
- Australian Institute of Sport, Canberra, ACT, AUSTRALIA
- School of Human Sciences (Exercise and Sport Science) University of Western Australia, Crawley, WA, AUSTRALIA
- Western Australian Institute of Sport, Mt Claremont, WA, AUSTRALIA
| | - IDA A. HEIKURA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
- Australian Institute of Sport, Canberra, ACT, AUSTRALIA
| | - REBECCA HALL
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
| | - NIKITA FENSHAM
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
| | - AVISH P. SHARMA
- Griffith Sports Physiology and Performance, Griffith University, Gold Coast, QLD, AUSTRALIA
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McCarthy DG, Bostad W, Powley FJ, Little JP, Richards DL, Gibala MJ. Increased cardiorespiratory stress during submaximal cycling after ketone monoester ingestion in endurance-trained adults. Appl Physiol Nutr Metab 2021; 46:986-993. [PMID: 33646860 DOI: 10.1139/apnm-2020-0999] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is growing interest in the effect of exogenous ketone body supplementation on exercise responses and performance. The limited studies to date have yielded equivocal data, likely due in part to differences in dosing strategy, increase in blood ketones, and participant training status. Using a randomized, double-blind, counterbalanced design, we examined the effect of ingesting a ketone monoester (KE) supplement (600 mg/kg body mass) or flavour-matched placebo in endurance-trained adults (n = 10 males, n = 9 females; V̇O2peak = 57 ± 8 mL/kg/min). Participants performed a 30-min cycling bout at ventilatory threshold intensity (71 ± 3% V̇O2peak), followed 15 min later by a 3 kJ/kg body mass time-trial. KE versus placebo ingestion increased plasma β-hydroxybutyrate concentration before exercise (3.9 ± 1.0 vs 0.2 ± 0.3 mM, p < 0.0001, dz = 3.4), ventilation (77 ± 17 vs 71 ± 15 L/min, p < 0.0001, dz = 1.3) and heart rate (155 ± 11 vs 150 ± 11 beats/min, p < 0.001, dz = 1.2) during exercise, and rating of perceived exertion at the end of exercise (15.4 ± 1.6 vs 14.5 ± 1.2, p < 0.01, dz = 0.85). Plasma β-hydroxybutyrate concentration remained higher after KE vs placebo ingestion before the time-trial (3.5 ± 1.0 vs 0.3 ± 0.2 mM, p < 0.0001, dz = 3.1), but performance was not different (KE: 16:25 ± 2:50 vs placebo: 16:06 ± 2:40 min:s, p = 0.20; dz = 0.31). We conclude that acute ingestion of a relatively large KE bolus dose increased markers of cardiorespiratory stress during submaximal exercise in endurance-trained participants. Novelty: Limited studies have yielded equivocal data regarding exercise responses after acute ketone body supplementation. Using a randomized, double-blind, placebo-controlled, counterbalanced design, we found that ingestion of a large bolus dose of a commercial ketone monoester supplement increased markers of cardiorespiratory stress during cycling at ventilatory threshold intensity in endurance-trained adults.
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Affiliation(s)
- Devin G McCarthy
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - William Bostad
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Fiona J Powley
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | | | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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DEARLOVE DAVIDJ, HARRISON OLIVIAK, HODSON LEANNE, JEFFERSON ANDREW, CLARKE KIERAN, COX PETEJ. The Effect of Blood Ketone Concentration and Exercise Intensity on Exogenous Ketone Oxidation Rates in Athletes. Med Sci Sports Exerc 2021; 53:505-516. [PMID: 32868580 PMCID: PMC7886359 DOI: 10.1249/mss.0000000000002502] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Exogenous ketones potentially provide an alternative, energetically advantageous fuel to power exercising skeletal muscle. However, there is limited evidence regarding their relative contribution to energy expenditure during exercise. Furthermore, the effect of blood ketone concentration and exercise intensity on exogenous ketone oxidation rates is unknown. METHODS Six athletes completed cycling ergometer exercise on three occasions within a single-blind, random-order controlled, crossover design study. Exercise duration was 60 min, consisting of 20-min intervals at 25%, 50%, and 75% maximal power output (WMax). Participants consumed (i) bitter flavored water (control), (ii) a low-dose β-hydroxybutyrate (βHB) ketone monoester (KME; 252 mg·kg BW-1, "low ketosis"), or (iii) a high-dose βHB KME (752 mg·kg BW-1, "high ketosis"). The KME contained a 13C isotope label, allowing for the determination of whole-body exogenous βHB oxidation rates through sampled respiratory gases. RESULTS Despite an approximate doubling of blood βHB concentrations between low- and high-ketosis conditions (~2 mM vs ~4.4 mM), exogenous βHB oxidation rates were similar at rest and throughout exercise. The contribution of exogenous βHB oxidation to energy expenditure peaked during the 25% WMax exercise intensity but was relatively low (4.46% ± 2.71%). Delta efficiency during cycling exercise was significantly greater in the low-ketosis (25.9% ± 2.1%) versus control condition (24.1% ± 1.9%; P = 0.027). CONCLUSIONS Regardless of exercise intensity, exogenous βHB oxidation contributes minimally to energy expenditure and is not increased by elevating circulating concentrations greater than ~2 mM. Despite low exogenous βHB oxidation rates, exercise efficiency was significantly improved when blood βHB concentration was raised to ~2 mM.
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Affiliation(s)
- DAVID J. DEARLOVE
- The Department of Physiology, Anatomy and Genetics, The University of Oxford, Oxford, UNITED KINGDOM
| | - OLIVIA K. HARRISON
- The Department of Physiology, Anatomy and Genetics, The University of Oxford, Oxford, UNITED KINGDOM
| | - LEANNE HODSON
- Oxford Centre for Diabetes, Endocrinology and Metabolism, and the Oxford NIHR Biomedical Research Centre, The University of Oxford, Oxford, UNITED KINGDOM
| | - ANDREW JEFFERSON
- Micron Advanced Imaging Consortium, The University of Oxford, Oxford, UNITED KINGDOM
| | - KIERAN CLARKE
- The Department of Physiology, Anatomy and Genetics, The University of Oxford, Oxford, UNITED KINGDOM
| | - PETE J. COX
- The Department of Physiology, Anatomy and Genetics, The University of Oxford, Oxford, UNITED KINGDOM
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16
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POFFÉ CHIEL, RAMAEKERS MONIQUE, BOGAERTS STIJN, HESPEL PETER. Bicarbonate Unlocks the Ergogenic Action of Ketone Monoester Intake in Endurance Exercise. Med Sci Sports Exerc 2021; 53:431-441. [PMID: 32735112 PMCID: PMC7803447 DOI: 10.1249/mss.0000000000002467] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE We recently reported that oral ketone ester (KE) intake before and during the initial 30 min of a 3 h 15 min simulated cycling race (RACE) transiently decreased blood pH and bicarbonate without affecting maximal performance in the final quarter of the event. We hypothesized that acid-base disturbances due to KE overrules the ergogenic potential of exogenous ketosis in endurance exercise. METHODS Nine well-trained male cyclists participated in a similar RACE consisting of 3 h submaximal intermittent cycling (IMT180') followed by a 15-min time trial (TT15') preceding an all-out sprint at 175% of lactate threshold (SPRINT). In a randomized crossover design, participants received (i) 65 g KE, (ii) 300 mg·kg-1 body weight NaHCO3 (BIC), (iii) KE + BIC, or (iv) a control drink (CON), together with consistent 60 g·h-1 carbohydrate intake. RESULTS KE ingestion transiently elevated blood D-ß-hydroxybutyrate to ~2-3 mM during the initial 2 h of RACE (P < 0.001 vs CON). In KE, blood pH concomitantly dropped from 7.43 to 7.36 whereas bicarbonate decreased from 25.5 to 20.5 mM (both P < 0.001 vs CON). Additional BIC resulted in 0.5 to 0.8 mM higher blood D-ß-hydroxybutyrate during the first half of IMT180' (P < 0.05 vs KE) and increased blood bicarbonate to 31.1 ± 1.8 mM and blood pH to 7.51 ± 0.03 by the end of IMT180' (P < 0.001 vs KE). Mean power output during TT15' was similar between KE, BIC, and CON at ~255 W but was 5% higher in KE + BIC (P = 0.02 vs CON). Time to exhaustion in the sprint was similar between all conditions at ~60 s (P = 0.88). Gastrointestinal symptoms were similar between groups. DISCUSSION The coingestion of oral bicarbonate and KE enhances high-intensity performance at the end of an endurance exercise event without causing gastrointestinal distress.
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Affiliation(s)
- CHIEL POFFÉ
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
| | - MONIQUE RAMAEKERS
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
| | - STIJN BOGAERTS
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, BELGIUM
- Locomotor and Neurological Disorders, Faculty of Medicine, Department of Development and Regeneration, KU Leuven, Leuven, BELGIUM
| | - PETER HESPEL
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
- Bakala Academy-Athletic Performance Center, KU Leuven, Leuven, BELGIUM
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17
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An Alternative Enzymatic Route to the Ergogenic Ketone Body Ester (R)-3-Hydroxybutyl (R)-3-Hydroxybutyrate. Catalysts 2021. [DOI: 10.3390/catal11010140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Recent studies have highlighted the therapeutic and ergogenic potential of the ketone body ester, (R)-3-hydroxybutyl-(R)-3-hydroxybutyrate. In the present work, the enzymatic synthesis of this biological active compound is reported. The (R)-3-hydroxybutyl-(R)-3-hydroxybutyrate has been produced through the transesterification of racemic ethyl 3-hydroxybutyrate with (R)-1,3-butanediol by exploiting the selectivity of Candida antarctica lipase B (CAL-B). The needed (R)-1,3-butanediol was in turn obtained from the kinetic resolution of the racemate achieved by acetylation with vinyl acetate, also in this case, thanks to the enantioselectivity of the CAL-B used as catalyst. Finally, the stereochemical inversion of the unreacted (S) enantiomers of the ethyl 3-hydroxybutyate and 1,3-butanediol accomplished by known procedure allowed to increase the overall yield of the synthetic pathway by incorporating up to 70% of the starting racemic reagents into the final product.
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18
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Yang C, Ma Q, Zhang H, Wu F, Wu M, Yang C, Chen Y, Xiong J, Liu W, Wang H, Wu R, Dai Z, Li Y. Ten days of complete fasting affected subjective sensations but not cognitive abilities in healthy adults. Eur J Nutr 2021; 60:2747-2758. [PMID: 33389084 DOI: 10.1007/s00394-020-02450-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE People may be unable to obtain anything edible for days under some circumstances, but they must maintain their calmness and cognition to navigate solutions. Our aim was to study changes in subjective sensations and cognition in healthy adults during a 10-day complete fasting experiment. METHODS Thirteen healthy male volunteers voluntarily participated in the 22-day experiment comprising 4 phases: 3 days of baseline consumption, 10 days of complete fasting (only water ad libitum), 4 days of calorie restriction, and a 5-day recovery period. The volunteers' subjective sensations, cognitive performance, and serum energy substances were measured at 6 time points. RESULTS Across the 6 time points, the trajectories of subjective sensations in response to fasting were "U"- or " ∩ "-shaped curves instead of progressive discomfort or mood enhancement. A significant fasting time effect was found on depression-dejection (baseline: 16.85 ± 2.88; highest score on the third day of completing fasting: 17.69 ± 3.97, P = 0.04) and self-rated anxiety (baseline: 26.23 ± 4.75; highest score on the sixth day of completing fasting: 30.85 ± 5.58, P = 0.01), and the change curves were consistent with the inflection point of the energy substrates shifting from serum glucose to ketone. In addition, basic cognitive functions appeared to be unaffected during the 10-day fast. CONCLUSIONS Our study showed strong influences on the sensations from the third to sixth days of the prolonged fasting period but no significant effects on basic cognitive abilities associated with the energy substance switch. These findings could contribute to the development and understanding of survival strategies in food-shortage emergencies or of intermittent fasting programmes.
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Affiliation(s)
- Chao Yang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, No. 26, Beiqing Road, Haidian District, P.O. Box 5132-15, Beijing, 100094, China
| | - Qianying Ma
- Department of Psychology, Beihang University, No. 37, Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Hongyu Zhang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, No. 26, Beiqing Road, Haidian District, P.O. Box 5132-15, Beijing, 100094, China
| | - Feng Wu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, No. 26, Beiqing Road, Haidian District, P.O. Box 5132-15, Beijing, 100094, China
| | - Manrui Wu
- Department of Psychology, Beihang University, No. 37, Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Chengjia Yang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, No. 26, Beiqing Road, Haidian District, P.O. Box 5132-15, Beijing, 100094, China
| | - Ying Chen
- Lab of Epigenetics and Health Technology, SPACEnter Space Science and Technology Institute, Shenzhen, China
| | - Jianghui Xiong
- Lab of Epigenetics and Health Technology, SPACEnter Space Science and Technology Institute, Shenzhen, China
| | - Wenjuan Liu
- Beijing Ziyuan Fasting Training Center, Beijing, China
| | - Hailong Wang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, No. 26, Beiqing Road, Haidian District, P.O. Box 5132-15, Beijing, 100094, China
| | - Ruilin Wu
- Department of Psychology, Beihang University, No. 37, Xueyuan Road, Haidian District, Beijing, 100083, China.
| | - Zhongquan Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, No. 26, Beiqing Road, Haidian District, P.O. Box 5132-15, Beijing, 100094, China.
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, No. 26, Beiqing Road, Haidian District, P.O. Box 5132-15, Beijing, 100094, China.
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Leonard TGA. The physiology of ketosis and the ketogenic diet. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.6.s3.2547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ketones are an important fuel source for the body during periods of starvation and are readily used by the brain, the heart, and skeletal muscle. Ketones may also be produced in response to certain diets. Interest in the use of a diet high in fat and low in carbohydrates in order to induce a state of ketosis has increased in recent years. This review will cover the physiology of ketosis and examine the effects of the ketogenic diet.
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20
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Walsh JJ, Myette-Côté É, Neudorf H, Little JP. Potential Therapeutic Effects of Exogenous Ketone Supplementation for Type 2 Diabetes: A Review. Curr Pharm Des 2020; 26:958-969. [PMID: 32013822 DOI: 10.2174/1381612826666200203120540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
Abstract
Type 2 diabetes (T2D) is among the most prevalent non-communicable lifestyle diseases. We propose that overnutrition and low levels of physical activity can contribute to a vicious cycle of hyperglycemia, inflammation and oxidative stress, insulin resistance, and pancreatic β-cell dysfunction. The pathophysiological manifestations of T2D have a particular impact on the vasculature and individuals with T2D are at high risk of cardiovascular disease. Targeting aspects of the vicious cycle represent therapeutic approaches for improving T2D and protecting against cardiovascular complications. The recent advent of exogenous oral ketone supplements represents a novel, non-pharmacological approach to improving T2D pathophysiology and potentially protecting against cardiovascular disease risk. Herein, we review the emerging literature regarding the effects of exogenous ketone supplementation on metabolic control, inflammation, oxidative stress, and cardiovascular function in humans and highlight the potential application for breaking the vicious cycle of T2D pathophysiology.
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Affiliation(s)
- Jeremy J Walsh
- Exercise, Metabolism and Inflammation Laboratory, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Étienne Myette-Côté
- Exercise, Metabolism and Inflammation Laboratory, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Helena Neudorf
- Exercise, Metabolism and Inflammation Laboratory, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Jonathan P Little
- Exercise, Metabolism and Inflammation Laboratory, University of British Columbia Okanagan, Kelowna, BC, Canada
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Jo E, Silva Ms SC, Auslander PhD AT, Arreglado Ms JP, Elam PhD ML, Osmond Ms AD, Steinberg Ms R, Wong Ms MWH. The Effects of 10-Day Exogenous Ketone Consumption on Repeated Time Trial Running Performances: A Randomized-Control Trial. J Diet Suppl 2020; 19:34-48. [PMID: 33111587 DOI: 10.1080/19390211.2020.1838022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The effects of ketone salt supplementation on repeated short-distance running time trial (TT) performance in well-trained subjects remain unknown. PURPOSE To determine the effects of 10-day exogenous ketone salt supplementation on two consecutive 800 m running TTs in endurance-trained subjects. METHODS Male and female subjects were randomly allocated to one of the following groups: Ketone (KET) (n = 16) or placebo (CON) (n = 16) (8 m, 8f per group). Subjects underwent two consecutive 800 m TTs before and after a 10-day treatment on a self-propelled treadmill. Time-to-completion of the first (TT1) and second (TT2) TT, the average time-to-completion (TTAVG), and blood lactate response during each TT was measured pre-post-treatment. Changes in blood ketone levels in response to a single dosing were measured pre- and post-treatment. Data was analyzed with a mixed factorial ANOVA with significance set to p < 0.05. RESULTS KET demonstrated a faster TTAVG from pre- to post-treatment (-6.1 ± 8.9 s; p = 0.02) while CON showed no change. At pre- and post-treatment, CON showed no acute changes in blood ketones after a single-dosing while KET demonstrated a significant increases (Pretreatment = +0.4 ± 0.3 mmol/L; p < 0.001; Post-Treatment = +0.4 ± 0.4 mmol/L; p < 0.001). These acute single-dosing responses in blood ketone levels for KET did not change between pre- and post-treatment. There were no interactions for blood lactate response to exercise or fatigue index. CONCLUSIONS In trained subjects, 10 days of ketone salt supplementation does not affect performance in an initial bout of short-distance running, such as during TT1. However, ergogenic effects may be observed under fatigue conditions for example during a repeated running bout.
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Affiliation(s)
- Edward Jo
- Department of Kinesiology and Health Promotion, Human Performance Research Laboratory, California State Polytechnic University Pomona, Pomona, CA, USA
| | - Samantha C Silva Ms
- Department of Kinesiology and Health Promotion, Human Performance Research Laboratory, California State Polytechnic University Pomona, Pomona, CA, USA
| | - Alexandra T Auslander PhD
- Department of Kinesiology and Health Promotion, Human Performance Research Laboratory, California State Polytechnic University Pomona, Pomona, CA, USA
| | - John P Arreglado Ms
- Department of Kinesiology and Health Promotion, Human Performance Research Laboratory, California State Polytechnic University Pomona, Pomona, CA, USA
| | - Marcus L Elam PhD
- Department of Human Nutrition and Food Science, California State Polytechnic University Pomona, Pomona, CA, USA
| | - Adam D Osmond Ms
- Department of Kinesiology and Health Promotion, Human Performance Research Laboratory, California State Polytechnic University Pomona, Pomona, CA, USA
| | - Ross Steinberg Ms
- Department of Kinesiology and Health Promotion, Human Performance Research Laboratory, California State Polytechnic University Pomona, Pomona, CA, USA
| | - Michael W H Wong Ms
- Department of Kinesiology and Health Promotion, Human Performance Research Laboratory, California State Polytechnic University Pomona, Pomona, CA, USA
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22
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Norwitz NG, Dearlove DJ, Lu M, Clarke K, Dawes H, Hu MT. A Ketone Ester Drink Enhances Endurance Exercise Performance in Parkinson's Disease. Front Neurosci 2020; 14:584130. [PMID: 33100965 PMCID: PMC7556340 DOI: 10.3389/fnins.2020.584130] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives Routine exercise is thought to be among the only disease-modifying treatments for Parkinson's disease; however, patients' progressive loss of physical ability limits its application. Therefore, we sought to investigate whether a ketone ester drink, which has previously been shown to enhance endurance exercise performance in elite athletes, could also improve performance in persons with Parkinson's disease. Participants 14 patients, aged 40-80 years, with Hoehn and Yahr stage 1-2 Parkinson's disease. Intervention A randomized, placebo-controlled, crossover study in which each participant was administered a ketone ester drink or an isocaloric carbohydrate-based control drink on separate occasions prior to engaging in a steady state cycling test at 80 rpm to assess endurance exercise performance. Outcomes Measures The primary outcome variable was length of time participants could sustain a therapeutic 80 rpm cadence. Secondary, metabolic outcomes measures included cardiorespiratory parameters as well as serum β-hydroxybutyrate, glucose, and lactate. Results The ketone ester increased the time that participants were able to sustain an 80 rpm cycling cadence by 24 ± 9% (p = 0.027). Correspondingly, the ketone ester increased β-hydroxybutyrate levels to >3 mmol/L and decreased respiratory exchange ratio, consistent with a shift away from carbohydrate-dependent metabolism. Conclusion Ketone ester supplementation improved endurance exercise performance in persons with Parkinson's disease and may, therefore, be useful as an adjunctive therapy to enhance the effectiveness of exercise treatment for Parkinson's disease.
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Affiliation(s)
- Nicholas G Norwitz
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - David J Dearlove
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Meng Lu
- Department of Sport and Health Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Helen Dawes
- Department of Sport and Health Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Michele T Hu
- Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom
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23
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β-Hydroxybutyrate Increases Exercise Capacity Associated with Changes in Mitochondrial Function in Skeletal Muscle. Nutrients 2020; 12:nu12071930. [PMID: 32610627 PMCID: PMC7400376 DOI: 10.3390/nu12071930] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
β-hydroxybutyrate is the main ketone body generated by the liver under starvation. Under these conditions, it can sustain ATP levels by its oxidation in mitochondria. As mitochondria can modify its shape and function under different nutritional challenges, we study the chronic effects of β-hydroxybutyrate supplementation on mitochondrial morphology and function, and its relation to exercise capacity. Male C57BL/6 mice were supplemented with β-hydroxybutyrate mineral salt (3.2%) or control (CT, NaCl/KCl) for six weeks and submitted to a weekly exercise performance test. We found an increase in distance, maximal speed, and time to exhaustion at two weeks of supplementation. Fatty acid metabolism and OXPHOS subunit proteins declined at two weeks in soleus but not in tibialis anterior muscles. Oxygen consumption rate on permeabilized fibers indicated a decrease in the presence of pyruvate in the short-term treatment. Both the tibialis anterior and soleus showed decreased levels of Mitofusin 2, while electron microscopy assessment revealed a significant reduction in mitochondrial cristae shape in the tibialis anterior, while a reduction in the mitochondrial number was observed only in soleus. These results suggest that short, but not long-term, β-hydroxybutyrate supplementation increases exercise capacity, associated with modifications in mitochondrial morphology and function in mouse skeletal muscle.
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24
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Pasiakos SM. Nutritional Requirements for Sustaining Health and Performance During Exposure to Extreme Environments. Annu Rev Nutr 2020; 40:221-245. [PMID: 32530730 DOI: 10.1146/annurev-nutr-011720-122637] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dietary guidelines are formulated to meet minimum nutrient requirements, which prevent deficiencies and maintain health, growth, development, and function. These guidelines can be inadequate and contribute to disrupted homeostasis, lean body mass loss, and deteriorated performance in individuals who are working long, arduous hours with limited access to food in environmentally challenging locations. Environmental extremes can elicit physiological adjustments that alone alter nutrition requirements by upregulating energy expenditure, altering substrate metabolism, and accelerating body water and muscle protein loss. The mechanisms by which the environment, including high-altitude, heat, and cold exposure, alters nutrition requirements have been studied extensively. This contemporary review discusses physiological adjustments to environmental extremes, particularly when those adjustments alter dietary requirements.
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Affiliation(s)
- Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts 01760, USA;
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25
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Selvaraj S, Kelly DP, Margulies KB. Implications of Altered Ketone Metabolism and Therapeutic Ketosis in Heart Failure. Circulation 2020; 141:1800-1812. [PMID: 32479196 DOI: 10.1161/circulationaha.119.045033] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite existing therapy, patients with heart failure (HF) experience substantial morbidity and mortality, highlighting the urgent need to identify novel pathophysiological mechanisms and therapies, as well. Traditional models for pharmacological intervention have targeted neurohormonal axes and hemodynamic disturbances in HF. However, several studies have now highlighted the potential for ketone metabolic modulation as a promising treatment paradigm. During the pathophysiological progression of HF, the failing heart reduces fatty acid and glucose oxidation, with associated increases in ketone metabolism. Recent studies indicate that enhanced myocardial ketone use is adaptive in HF, and limited data demonstrate beneficial effects of exogenous ketone therapy in studies of animal models and humans with HF. This review will summarize current evidence supporting a salutary role for ketones in HF including (1) normal myocardial ketone use, (2) alterations in ketone metabolism in the failing heart, (3) effects of therapeutic ketosis in animals and humans with HF, and (4) the potential significance of ketosis associated with sodium-glucose cotransporter 2 inhibitors. Although a number of important questions remain regarding the use of therapeutic ketosis and mechanism of action in HF, current evidence suggests potential benefit, in particular, in HF with reduced ejection fraction, with theoretical rationale for its use in HF with preserved ejection fraction. Although it is early in its study and development, therapeutic ketosis across the spectrum of HF holds significant promise.
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Affiliation(s)
- Senthil Selvaraj
- Division of Cardiovascular Medicine, Department of Medicine (S.S., K.B.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel P Kelly
- Cardiovascular Institute and Department of Medicine (D.P.K., K.B.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kenneth B Margulies
- Division of Cardiovascular Medicine, Department of Medicine (S.S., K.B.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Cardiovascular Institute and Department of Medicine (D.P.K., K.B.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Heart Failure and Transplant Program, Smilow Center for Translational Research (K.B.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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26
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Poffé C, Ramaekers M, Bogaerts S, Hespel P. Exogenous ketosis impacts neither performance nor muscle glycogen breakdown in prolonged endurance exercise. J Appl Physiol (1985) 2020; 128:1643-1653. [PMID: 32407242 PMCID: PMC7311686 DOI: 10.1152/japplphysiol.00092.2020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Available evidence indicates that ketone bodies inhibit glycolysis in contracting muscles. Therefore, we investigated whether acute exogenous ketosis by oral ketone ester (KE) intake early in a simulated cycling race can induce transient glycogen sparing by glycolytic inhibition, thereby increasing glycogen availability in the final phase of the event. In a randomized crossover design, 12 highly trained male cyclists completed a simulated cycling race (RACE), which consisted of 3-h intermittent cycling (IMT180′), a 15-min time trial (TT15′), and a maximal sprint (SPRINT). During RACE, subjects received 60 g carbohydrates/h combined with three boluses (25, 20, and 20 g) (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (KE) or a control drink (CON) at 60 and 20 min before and at 30 min during RACE. KE intake transiently increased blood d-β-hydroxybutyrate to ~3 mM (range: 2.6–5.2 mM) during the first half of RACE (P < 0.001 vs. CON). Blood pH concomitantly decreased from approximately 7.42 to 7.36 (range: 7.29–7.40), whereas bicarbonate dropped from 26.0 to 21.6 mM (range: 20.1–23.7; both P < 0.001 vs. CON). Net muscle glycogen breakdown during IMT180′ [KE: −78 ± 30 (SD); CON: −60 ± 22 mmol/kg wet wt; P = 0.08] and TT15′ (KE: −9 ± 18; CON: −18 ± 18 mmol/kg wet wt; P = 0.35) was similar between KE and CON. Accordingly, mean power output during TT15′ (KE: 273 ± 38; CON: 272 ± 37 W; P = 0.83) and time-to-exhaustion in the SPRINT (KE: 59 ± 16; CON: 58 ± 17 s; P = 0.66) were similar between conditions. In conclusion, KE intake during a simulated cycling race does not cause glycogen sparing, nor does it affect all-out performance in the final stage of a simulated race. NEW & NOTEWORTHY Exogenous ketosis produced by oral ketone ester ingestion during the early phase of prolonged endurance exercise and against the background of adequate carbohydrate intake neither causes muscle glycogen sparing nor improves performance in the final stage of the event. However, such exogenous ketosis may decrease buffering capacity in the approach of the final episode of the event. Furthermore, ketone ester intake during exercise may reduce appetite immediately after exercise.
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Affiliation(s)
- Chiel Poffé
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Monique Ramaekers
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Stijn Bogaerts
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.,Locomotor and Neurological Disorders, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Peter Hespel
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium.,Bakala Academy-Athletic Performance Center, KU Leuven, Leuven, Belgium
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27
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Kackley ML, Short JA, Hyde PN, LaFountain RA, Buga A, Miller VJ, Dickerson RM, Sapper TN, Barnhart EC, Krishnan D, McElroy CA, Maresh CM, Kraemer WJ, Volek JS. A Pre-Workout Supplement of Ketone Salts, Caffeine, and Amino Acids Improves High-Intensity Exercise Performance in Keto-Naïve and Keto-Adapted Individuals. J Am Coll Nutr 2020; 39:290-300. [PMID: 32330107 DOI: 10.1080/07315724.2020.1752846] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Acute ingestion of ketone supplements alters metabolism and potentially exercise performance. No studies to date have evaluated the impact of co-ingestion of ketone salts with caffeine and amino acids on high intensity exercise performance, and no data exists in Keto-Adapted individuals.Methods: We tested the performance and metabolic effects of a pre-workout supplement containing beta-hydroxybutyrate (BHB) salts, caffeine, and amino acids (KCA) in recreationally-active adults habitually consuming a mixed diet (Keto-Naïve; n = 12) or a ketogenic diet (Keto-Adapted; n = 12). In a randomized and balanced manner, subjects consumed either the KCA consisting of ∼7 g BHB (72% R-BHB and 28% S-BHB) with ∼100 mg of caffeine, and amino acids (leucine and taurine) or Water (control condition) 15 minutes prior to performing a staged cycle ergometer time to exhaustion test followed immediately by a 30 second Wingate test.Results: Circulating total BHB concentrations increased rapidly after KCA ingestion in KN (154 to 732 μM) and KA (848 to 1,973 μM) subjects and stayed elevated throughout recovery in both groups. Plasma S-BHB increased >20-fold 15 minutes after KCA ingestion in both groups and remained elevated throughout recovery. Compared to Water, KCA ingestion increased time to exhaustion 8.3% in Keto-Naïve and 9.8% in Keto-Adapted subjects (P < 0.001). There was no difference in power output during the Wingate test between trials. Peak lactate immediately after exercise was higher after KCA (∼14.9 vs 12.7 mM).Conclusion: These results indicate that pre-exercise ingestion of a moderate dose of R- and S-BHB salts combined with caffeine, leucine and taurine improves high-intensity exercise performance to a similar extent in both Keto-Adapted and Keto-Naïve individuals.
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Affiliation(s)
- Madison L Kackley
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jay A Short
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Parker N Hyde
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | | | - Alex Buga
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Vincent J Miller
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Ryan M Dickerson
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Teryn N Sapper
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Emily C Barnhart
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Deepa Krishnan
- College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Craig A McElroy
- College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Carl M Maresh
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jeff S Volek
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
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28
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Why a d-β-hydroxybutyrate monoester? Biochem Soc Trans 2020; 48:51-59. [PMID: 32096539 PMCID: PMC7065286 DOI: 10.1042/bst20190240] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
Abstract
Much of the world's prominent and burdensome chronic diseases, such as diabetes, Alzheimer's, and heart disease, are caused by impaired metabolism. By acting as both an efficient fuel and a powerful signalling molecule, the natural ketone body, d-β-hydroxybutyrate (βHB), may help circumvent the metabolic malfunctions that aggravate some diseases. Historically, dietary interventions that elevate βHB production by the liver, such as high-fat diets and partial starvation, have been used to treat chronic disease with varying degrees of success, owing to the potential downsides of such diets. The recent development of an ingestible βHB monoester provides a new tool to quickly and accurately raise blood ketone concentration, opening a myriad of potential health applications. The βHB monoester is a salt-free βHB precursor that yields only the biologically active d-isoform of the metabolite, the pharmacokinetics of which have been studied, as has safety for human consumption in athletes and healthy volunteers. This review describes fundamental concepts of endogenous and exogenous ketone body metabolism, the differences between the βHB monoester and other exogenous ketones and summarises the disease-specific biochemical and physiological rationales behind its clinical use in diabetes, neurodegenerative diseases, heart failure, sepsis related muscle atrophy, migraine, and epilepsy. We also address the limitations of using the βHB monoester as an adjunctive nutritional therapy and areas of uncertainty that could guide future research.
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29
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Dąbek A, Wojtala M, Pirola L, Balcerczyk A. Modulation of Cellular Biochemistry, Epigenetics and Metabolomics by Ketone Bodies. Implications of the Ketogenic Diet in the Physiology of the Organism and Pathological States. Nutrients 2020; 12:nu12030788. [PMID: 32192146 PMCID: PMC7146425 DOI: 10.3390/nu12030788] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
Ketone bodies (KBs), comprising β-hydroxybutyrate, acetoacetate and acetone, are a set of fuel molecules serving as an alternative energy source to glucose. KBs are mainly produced by the liver from fatty acids during periods of fasting, and prolonged or intense physical activity. In diabetes, mainly type-1, ketoacidosis is the pathological response to glucose malabsorption. Endogenous production of ketone bodies is promoted by consumption of a ketogenic diet (KD), a diet virtually devoid of carbohydrates. Despite its recently widespread use, the systemic impact of KD is only partially understood, and ranges from physiologically beneficial outcomes in particular circumstances to potentially harmful effects. Here, we firstly review ketone body metabolism and molecular signaling, to then link the understanding of ketone bodies’ biochemistry to controversies regarding their putative or proven medical benefits. We overview the physiological consequences of ketone bodies’ consumption, focusing on (i) KB-induced histone post-translational modifications, particularly β-hydroxybutyrylation and acetylation, which appears to be the core epigenetic mechanisms of activity of β-hydroxybutyrate to modulate inflammation; (ii) inflammatory responses to a KD; (iii) proven benefits of the KD in the context of neuronal disease and cancer; and (iv) consequences of the KD’s application on cardiovascular health and on physical performance.
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Affiliation(s)
- Arkadiusz Dąbek
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland; (A.D.); (M.W.)
| | - Martyna Wojtala
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland; (A.D.); (M.W.)
| | - Luciano Pirola
- INSERM Unit 1060, CarMeN Laboratory, 165 Chemin du Grand Revoyet - BP12, F-69495 Pierre Bénite CEDEX, France;
| | - Aneta Balcerczyk
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland; (A.D.); (M.W.)
- Correspondence: ; Tel.: +48 42 635 45 10
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30
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Margolis LM, O'Fallon KS. Utility of Ketone Supplementation to Enhance Physical Performance: A Systematic Review. Adv Nutr 2020; 11:412-419. [PMID: 31586177 PMCID: PMC7442417 DOI: 10.1093/advances/nmz104] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/30/2019] [Accepted: 08/30/2019] [Indexed: 11/14/2022] Open
Abstract
Ingesting exogenous ketone bodies has been touted as producing ergogenic effects by altering substrate metabolism; however, research findings from recent studies appear inconsistent. This systematic review aimed to aggregate data from the current literature to examine the impact of consuming ketone supplements on enhancing physical performance. A systematic search was performed for randomized controlled trials that measured physical performance outcomes in response to ingesting exogenous ketone supplements compared with a control (nutritive or non-nutritive) in humans. A total of 161 articles were screened. Data were extracted from 10 eligible studies (112 participants; 109 men, 3 women ) containing 16 performance outcomes [lower-body power (n = 8) and endurance performance (n = 8)]. Ketone supplements were grouped as ketone esters (n = 8) or ketone salts/precursors (n = 8). Of the 16 performance outcomes identified by the systematic review, 3 reported positive, 10 reported null, and 3 reported negative effects of ketone supplementation on physical performance compared with controls. Heterogeneity was detected for lower-body power ( Q = 40, I2 = 83%, P < 0.01) and endurance performance (Q = 95, I2 = 93%, P < 0.01) between studies. Similarly high levels of heterogeneity were detected in studies providing ketone esters (Q = 111, I2 = 93%, P < 0.01), and to a lesser extent studies with ketone salts/precursors (Q = 25, I2 = 72%, P < 0.01). Heterogeneity across studies makes it difficult to conclude any benefit or detriment to consuming ketone supplements on physical performance. This systematic review discusses factors within individual studies that may contribute to discordant outcomes across investigations to elucidate if there is sufficient evidence to warrant recommendation of consuming exogenous ketone supplements to enhance physical performance.
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Affiliation(s)
- Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA,Address correspondence to LMM (e-mail: )
| | - Kevin S O'Fallon
- Soldier Performance Optimization Directorate, Combat Capabilities Development Command Soldier Center, Natick, MA, USA
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31
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Chakravarthy MV, Waddell T, Banerjee R, Guess N. Nutrition and Nonalcoholic Fatty Liver Disease: Current Perspectives. Gastroenterol Clin North Am 2020; 49:63-94. [PMID: 32033765 DOI: 10.1016/j.gtc.2019.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis are diseases in their own right as well as modifiable risk factors for cardiovascular disease and type 2 diabetes. With expanding knowledge on NAFLD pathogenesis, insights have been gleaned into molecular targets for pharmacologic and nonpharmacologic approaches. Lifestyle modifications constitute a cornerstone of NAFLD management. This article reviews roles of key dietary macronutrients and micronutrients in NAFLD pathogenesis and their effects on molecular targets shared with established or emerging pharmacotherapies. Based on current evidence, a recommendation for a dietary framework as part of the comprehensive management strategy for NAFLD is provided.
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Affiliation(s)
| | - Thomas Waddell
- Perspectum Diagnostics, 23-38 Hythe Bridge Street, Oxford OX1 2ET, UK
| | - Rajarshi Banerjee
- Perspectum Diagnostics, 23-38 Hythe Bridge Street, Oxford OX1 2ET, UK; Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Nicola Guess
- King's College London, 150 Stamford Street, London SE1 9NH, UK; University of Westminster, 101 New Cavendish St, Fitzrovia, London W1W 6XH, United Kingdom
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32
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Kang J, Ratamess NA, Faigenbaum AD, Bush JA. Ergogenic Properties of Ketogenic Diets in Normal-Weight Individuals: A Systematic Review. J Am Coll Nutr 2020; 39:665-675. [PMID: 32039654 DOI: 10.1080/07315724.2020.1725686] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ketogenic diets (KDs) have received increasing attention among athletes and physically active individuals. However, the question as to whether and how the diet could benefit this healthy cohort remains unclear.Purpose: This study was designed to systematically review the existing evidence concerning the effect of KDs on body composition, aerobic and anaerobic capacity, muscle development, and sports performance in normal-weight individuals including athletes.Methods: A systematic search of English literature was conducted through electronic databases including PubMed, EBSCOhost, and Google Scholar. Upon the use of search criteria, 23 full-text original human studies involving non-obese participants were included in this review. For more stratified and focused analysis, these articles were further categorized based on the outcomes being examined including 1) body mass (BM) and %fat, 2) substrate utilization, 3) blood substrate and hormonal responses, 4) aerobic capacity and endurance performance, and 5) strength, power, and anaerobic capacity.Results: Our review indicates that a non-calorie-restricted KD carried out for ≥3 weeks can produce a modest reduction in BM and %fat, while maintaining fat-free mass. This diet leads to augmented use of fat as fuel, but this adaptation doesn't seem to improve endurance performance. Additionally, ad libitum KDs combined with resistance training will pose no harm to developing strength and power, especially when protein intake is increased modestly.Conclusions: It appears that a non-calorie-restricted KD provides minimal ergogenic benefits in normal-weight individuals including athletes, but can be used for optimizing BM and body composition without compromising aerobic and anaerobic performance. Key teaching pointsKetogenic diets have received increasing attention among athletes and physically active individuals.It remains elusive as to whether ketogenic diets could confer ergogenic benefits for those who are normal weight but want to use the diet to improve fitness and performance.An interesting dilemma exists in that ketogenic diets can reduce body mass and %fat and increase fat oxidation, but they can also decrease glycogen stores and limit sports performance.This review concludes that a non-calorie-restricted ketogenic diet provides minimal ergogenic benefits in normal-weight individuals, but can be used to optimize body mass and composition without compromising athletic performance.This finding can be important for esthetic or weight-sensitive athletes because the diet may allow them to reach a target body mass without having to sacrifice athletic performance.The ketogenic diet-induced metabolic adaptations require a state of ketosis, and thus caution should be taken because an excessive increase in ketone bodies can be detrimental to health.
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Affiliation(s)
- Jie Kang
- Human Performance Laboratory, The College of New Jersey, Ewing, New Jersey, USA
| | - Nicholas A Ratamess
- Human Performance Laboratory, The College of New Jersey, Ewing, New Jersey, USA
| | - Avery D Faigenbaum
- Human Performance Laboratory, The College of New Jersey, Ewing, New Jersey, USA
| | - Jill A Bush
- Human Performance Laboratory, The College of New Jersey, Ewing, New Jersey, USA
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33
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Vandenberghe C, St-Pierre V, Fortier M, Castellano CA, Cuenoud B, Cunnane SC. Medium Chain Triglycerides Modulate the Ketogenic Effect of a Metabolic Switch. Front Nutr 2020; 7:3. [PMID: 32083091 PMCID: PMC7005013 DOI: 10.3389/fnut.2020.00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
Ketones provide an alternative brain fuel and may be neuroprotective in older people. Little is known of how to optimize the ketogenic effect of C8:0–C10:0 medium chain triglyceride supplement (kMCT). Metabolic switching (MS) from glucose to ketones as a fuel may have metabolic benefits but has not been extensively studied in humans. The objective of the present study was to use an 8 h metabolic study day protocol to assess the influence of typical components of MS, including a kMCT supplement, low-carbohydrate meal and meal timing, on blood ketones, glucose, insulin and free fatty acids (FFA). In one test, the effect of age was also investigated. Over the 8 h metabolic study day, two 10 g doses of the kMCT increased the plasma ketone response by 19% while reducing overall glycemia by 12% without altering insulin or FFA levels. Moreover, a single early meal (breakfast but no lunch) potentiated the ketogenic effect of MS over 8 h, compared to a single delayed meal (lunch but no breakfast). Age and the low carbohydrate meal did not affect the ketones response. We conclude that an 8-h test period can be used to assess metabolic changes during short-term MS. kMCT provide a robust short-term increase in ketones and might enhance the metabolic effectiveness of short-term or intermittent fasting as a component of MS.
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Affiliation(s)
| | | | | | | | | | - Stephen C Cunnane
- Research Center on Aging, Sherbrooke, QC, Canada.,Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
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34
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Edwards KH, Elliott BT, Kitic CM. Carbohydrate intake and ketosis in self-sufficient multi-stage ultramarathon runners. J Sports Sci 2019; 38:366-374. [PMID: 31835963 DOI: 10.1080/02640414.2019.1702269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ultra-endurance athletes accumulate an energy deficit throughout their events and those competing in self-sufficient multi-stage races are particularly vulnerable due to load carriage considerations. Whilst urinary ketones have previously been noted in ultra-endurance exercise and attributed to insufficient carbohydrate (CHO) availability, not all studies have reported concomitant CHO intake. Our aim was to determine changes in blood glucose and β-hydroxybutyrate concentrations over five days (240 km) of a self-sufficient multi-stage ultramarathon in combination with quantification of energy and macronutrient intakes, estimated energy expenditure and evaluation of energy balance. Thirteen runners (8 male, 5 female, mean age 40 ± 8 years) participated in the study. Glucose and β-hydroxybutyrate were measured every day immediately post-running, and food diaries completed daily. CHO intakes of 301 ± 106 g·day-1 (4.3 ± 1.8 g·kg-1·day-1) were not sufficient to avoid ketosis (5-day mean β-hydroxybutyrate: 1.1 ± 0.6 mmol.L-1). Furthermore, ketosis was not attenuated even when CHO intake was high (9 g·kg-1·day-1). This suggests that competing in a state of ketosis may be inevitable during multi-stage events where load reduction is prioritised over energy provisions. Attenuating negative impacts associated with such a metabolic shift in athletes unaccustomed to CHO and energy restriction requires further exploration.
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Affiliation(s)
- Kate H Edwards
- Translational Physiology Research Group, School of Life Sciences, University of Westminster, London, UK.,Sports Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Bradley T Elliott
- Translational Physiology Research Group, School of Life Sciences, University of Westminster, London, UK
| | - Cecilia M Kitic
- Sports Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Launceston, Australia
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Cabrera-Mulero A, Tinahones A, Bandera B, Moreno-Indias I, Macías-González M, Tinahones FJ. Keto microbiota: A powerful contributor to host disease recovery. Rev Endocr Metab Disord 2019; 20:415-425. [PMID: 31720986 PMCID: PMC6938789 DOI: 10.1007/s11154-019-09518-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gut microbiota (GM) is a key contributor to host metabolism and physiology. Data generated on comparing diseased and healthy subjects have reported changes in the GM profile between both health states, suggesting certain bacterial composition could be involved in pathogenesis. Moreover, studies reported that reshaping of GM could contribute actively to disease recovery. Interestingly, ketogenic diets (KD) have emerged recently as new economic dietotherapeutic strategy to combat a myriad of diseases (refractory epilepsy, obesity, cancer, neurodegenerative diseases…). KD, understood in a broad sense, refers to whatever dietetic approximation, which causes physiological ketosis. Therefore, high fat-low carbs diets, fasting periods or caloric restriction constitute different strategies to produce an increase of main ketones bodies, acetoacetate and β-hydroxybutyrate, in blood. Involved biological mechanisms in ketotherapeutic effects are still to be unravelled. However, it has been pointed out that GM remodelling by KD, from now on "keto microbiota", may play a crucial role in patient response to KD treatment. In fact, germ-free animals were resistant to ketotherapeutic effects; reinforcing keto microbiota may be a powerful contributor to host disease recovery. In this review, we will comment the influence of gut microbiota on host, as well as, therapeutic potential of ketogenic diets and keto microbiota to restore health status. Current progress and limitations will be argued too. In spite of few studies have defined applicability and mechanisms of KD, in the light of results, keto microbiota might be a new useful therapeutic agent.
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Affiliation(s)
- Amanda Cabrera-Mulero
- Deparment of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA) and University of Malaga, Campus de Teatinos s/n, 29010, Malaga, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Alberto Tinahones
- Deparment of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA) and University of Malaga, Campus de Teatinos s/n, 29010, Malaga, Spain
| | - Borja Bandera
- Deparment of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA) and University of Malaga, Campus de Teatinos s/n, 29010, Malaga, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Isabel Moreno-Indias
- Deparment of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA) and University of Malaga, Campus de Teatinos s/n, 29010, Malaga, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Manuel Macías-González
- Deparment of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA) and University of Malaga, Campus de Teatinos s/n, 29010, Malaga, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain.
| | - Francisco J Tinahones
- Deparment of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA) and University of Malaga, Campus de Teatinos s/n, 29010, Malaga, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
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Tiller NB, Roberts JD, Beasley L, Chapman S, Pinto JM, Smith L, Wiffin M, Russell M, Sparks SA, Duckworth L, O'Hara J, Sutton L, Antonio J, Willoughby DS, Tarpey MD, Smith-Ryan AE, Ormsbee MJ, Astorino TA, Kreider RB, McGinnis GR, Stout JR, Smith JW, Arent SM, Campbell BI, Bannock L. International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing. J Int Soc Sports Nutr 2019; 16:50. [PMID: 31699159 PMCID: PMC6839090 DOI: 10.1186/s12970-019-0312-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background In this Position Statement, the International Society of Sports Nutrition (ISSN) provides an objective and critical review of the literature pertinent to nutritional considerations for training and racing in single-stage ultra-marathon. Recommendations for Training. i) Ultra-marathon runners should aim to meet the caloric demands of training by following an individualized and periodized strategy, comprising a varied, food-first approach; ii) Athletes should plan and implement their nutrition strategy with sufficient time to permit adaptations that enhance fat oxidative capacity; iii) The evidence overwhelmingly supports the inclusion of a moderate-to-high carbohydrate diet (i.e., ~ 60% of energy intake, 5–8 g·kg− 1·d− 1) to mitigate the negative effects of chronic, training-induced glycogen depletion; iv) Limiting carbohydrate intake before selected low-intensity sessions, and/or moderating daily carbohydrate intake, may enhance mitochondrial function and fat oxidative capacity. Nevertheless, this approach may compromise performance during high-intensity efforts; v) Protein intakes of ~ 1.6 g·kg− 1·d− 1 are necessary to maintain lean mass and support recovery from training, but amounts up to 2.5 g.kg− 1·d− 1 may be warranted during demanding training when calorie requirements are greater; Recommendations for Racing. vi) To attenuate caloric deficits, runners should aim to consume 150–400 Kcal·h− 1 (carbohydrate, 30–50 g·h− 1; protein, 5–10 g·h− 1) from a variety of calorie-dense foods. Consideration must be given to food palatability, individual tolerance, and the increased preference for savory foods in longer races; vii) Fluid volumes of 450–750 mL·h− 1 (~ 150–250 mL every 20 min) are recommended during racing. To minimize the likelihood of hyponatraemia, electrolytes (mainly sodium) may be needed in concentrations greater than that provided by most commercial products (i.e., > 575 mg·L− 1 sodium). Fluid and electrolyte requirements will be elevated when running in hot and/or humid conditions; viii) Evidence supports progressive gut-training and/or low-FODMAP diets (fermentable oligosaccharide, disaccharide, monosaccharide and polyol) to alleviate symptoms of gastrointestinal distress during racing; ix) The evidence in support of ketogenic diets and/or ketone esters to improve ultra-marathon performance is lacking, with further research warranted; x) Evidence supports the strategic use of caffeine to sustain performance in the latter stages of racing, particularly when sleep deprivation may compromise athlete safety.
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Affiliation(s)
- Nicholas B Tiller
- Division of Pulmonary and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA. .,Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
| | - Justin D Roberts
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK.
| | - Liam Beasley
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
| | - Shaun Chapman
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
| | - Jorge M Pinto
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
| | - Melanie Wiffin
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
| | - Mark Russell
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - S Andy Sparks
- Sport Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire, UK
| | | | - John O'Hara
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Louise Sutton
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Jose Antonio
- College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Darryn S Willoughby
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX, USA
| | - Michael D Tarpey
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Abbie E Smith-Ryan
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Michael J Ormsbee
- Institute of Sports Sciences & Medicine, Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL, USA.,Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Todd A Astorino
- Department of Kinesiology, California State University San Marcos, San Marcos, CA, USA
| | - Richard B Kreider
- Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA
| | - Graham R McGinnis
- Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV, USA
| | - Jeffrey R Stout
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - JohnEric W Smith
- Department of Kinesiology, Mississippi State University, Mississippi, MS, USA
| | - Shawn M Arent
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Bill I Campbell
- Exercise Science Program, Performance & Physique Enhancement Laboratory, University of South Florida, Tampa, FL, USA
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Buse J, Robinson JL, Shyne R, Chi Q, Affleck D, Duce D, Seiden-Long I. Rising above helium: A hydrogen carrier gas chromatography flame ionization detection (GC-FID) method for the simultaneous quantification of toxic alcohols and ethylene glycol in human plasma specimens. Clin Biochem 2019; 73:98-104. [PMID: 31425671 DOI: 10.1016/j.clinbiochem.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
Here we validate a GC, Flame Ionization Detection (GC-FID), liquid injection method using hydrogen as a carrier gas combining analysis of toxic volatile alcohols (VA): methanol, ethanol, isopropanol, acetone, as well as glycols, ethylene glycol (EG) and propylene glycol (PG), in a single method. METHODOLOGY 200 μL of calibrator, QC, or patient specimen were deproteinized with 400 μL of acetonitrile containing internal standards (10 mmol/L N-propyl alcohol for VA and 2.5 mmol/L 1,2-butanediol for glycols). GC-FID analysis using hydrogen carrier gas and nitrogen makeup gas utilized an Agilent 7890 system equipped with Agilent 7683 liquid autosampler on a 30 m × 530 μm RTX-200 fused silica column. Method validation included repeatability, recovery, carryover, linearity, lower limit of quantification (LLOQ), accuracy, selectivity and measurement uncertainty. RESULTS The 8.3 min from injection to injection reduced time of analysis by 45% over a previously reported method using Helium carrier gas with no loss in resolution. Within-run and Between-run variability were ≤1.4% and ≤6.8% respectively. Recovery was 100% within a 95% confidence interval. Carryover was negligible for all but EG. LLOQ was <1 mmol/L for all analytes. The upper range of linearity was 120 mmol/L for methanol, ethanol and isopropanol, 100 mmol/L for acetone and 50 mmol/L for EG. Analytes demonstrated acceptable accuracy and measurement uncertainty using College of American Pathologists (CAP) criteria. Toluene can cause a false positive EG, while benzene, xylene and 1,3 butanediol can cause false negative EG. CONCLUSIONS Converting from Helium to Hydrogen carrier gas benefits patient care through a reduction in turnaround time and provides a cost savings to the laboratory.
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Affiliation(s)
- Joshua Buse
- Saskatchewan Health Authority, Regina, SK, Canada
| | - Jason L Robinson
- Alberta Public Laboratories, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, AB, Canada
| | | | - Qingli Chi
- Alberta Public Laboratories, Calgary, AB, Canada
| | | | - Donna Duce
- Alberta Public Laboratories, Calgary, AB, Canada
| | - Isolde Seiden-Long
- Alberta Public Laboratories, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, AB, Canada.
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39
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Detecting creatine excreted in the urine of swimming athletes by means of Raman spectroscopy. Lasers Med Sci 2019; 35:455-464. [DOI: 10.1007/s10103-019-02843-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/08/2019] [Indexed: 01/09/2023]
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40
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Dostal T, Plews DJ, Hofmann P, Laursen PB, Cipryan L. Effects of a 12-Week Very-Low Carbohydrate High-Fat Diet on Maximal Aerobic Capacity, High-Intensity Intermittent Exercise, and Cardiac Autonomic Regulation: Non-randomized Parallel-Group Study. Front Physiol 2019; 10:912. [PMID: 31379612 PMCID: PMC6652046 DOI: 10.3389/fphys.2019.00912] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this non-randomized parallel group study was to examine the 12 week effects of a very low-carbohydrate high-fat diet (VLCHF) on maximal cardiorespiratory capacity, high-intensity interval training (HIIT) performance, and cardiac autonomic regulation. Methods Twenty-four recreationally trained participants allocated to either a VLCHF (N = 12) or a habitual diet (HD; N = 12) group completed 12 weeks of a diet and exercise (VLCHF) or an exercise only intervention (HD). Maximal graded exercise tests (GXT) were performed at baseline, after 4, 8, and 12 weeks. A supervised HIIT session and the 30-15 Intermittent Fitness Test (30-15IFT) were conducted once a week. Results Total time to exhaustion (TTE) in both GXT and 30-15IFTlargely increased in both VLCHF (p = 0.005, BF10 = 11.30 and p = 0.001, BF10 ≥ 100, respectively) and HD (p = 0.018, BF10 = 3.87 and p = 0.001, BF10 ≥ 100, respectively) groups after 12 weeks. Absolute maximal oxygen uptake (V˙O2max) was not changed in both groups but relative V˙O2max increased in VLCHF in concert with reductions in body mass (66.7 ± 10.2–63.1 ± 8.5 kg). Cardiac autonomic regulation did not reveal any between-group differences after 12 weeks. VLCHF diet induced an increase in β-hydroxybutyrate, which tended to normalize during the intervention period. Conclusion The 12 week VLCHF diet did not impair high-intensity continuous or intermittent exercise lasting up to 25 min, nor did it impair maximal cardiorespiratory performance or autonomic nervous system (ANS) activity.
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Affiliation(s)
- Tomas Dostal
- Department of Human Movement Studies, Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czechia
| | - Daniel J Plews
- Sport Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Paul B Laursen
- Sport Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Lukas Cipryan
- Department of Human Movement Studies, Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czechia
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Scott BE, Laursen PB, James LJ, Boxer B, Chandler Z, Lam E, Gascoyne T, Messenger J, Mears SA. The effect of 1,3-butanediol and carbohydrate supplementation on running performance. J Sci Med Sport 2019; 22:702-706. [DOI: 10.1016/j.jsams.2018.11.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/31/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
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Poffé C, Ramaekers M, Van Thienen R, Hespel P. Ketone ester supplementation blunts overreaching symptoms during endurance training overload. J Physiol 2019; 597:3009-3027. [PMID: 31039280 PMCID: PMC6851819 DOI: 10.1113/jp277831] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/25/2019] [Indexed: 12/19/2022] Open
Abstract
Key points Overload training is required for sustained performance gain in athletes (functional overreaching). However, excess overload may result in a catabolic state which causes performance decrements for weeks (non‐functional overreaching) up to months (overtraining). Blood ketone bodies can attenuate training‐ or fasting‐induced catabolic events. Therefore, we investigated whether increasing blood ketone levels by oral ketone ester (KE) intake can protect against endurance training‐induced overreaching. We show for the first time that KE intake following exercise markedly blunts the development of physiological symptoms indicating overreaching, and at the same time significantly enhances endurance exercise performance. We provide preliminary data to indicate that growth differentiation factor 15 (GDF15) may be a relevant hormonal marker to diagnose the development of overtraining. Collectively, our data indicate that ketone ester intake is a potent nutritional strategy to prevent the development of non‐functional overreaching and to stimulate endurance exercise performance.
Abstract It is well known that elevated blood ketones attenuate net muscle protein breakdown, as well as negate catabolic events, during energy deficit. Therefore, we hypothesized that oral ketones can blunt endurance training‐induced overreaching. Fit male subjects participated in two daily training sessions (3 weeks, 6 days/week) while receiving either a ketone ester (KE, n = 9) or a control drink (CON, n = 9) following each session. Sustainable training load in week 3 as well as power output in the final 30 min of a 2‐h standardized endurance session were 15% higher in KE than in CON (both P < 0.05). KE inhibited the training‐induced increase in nocturnal adrenaline (P < 0.01) and noradrenaline (P < 0.01) excretion, as well as blunted the decrease in resting (CON: −6 ± 2 bpm; KE: +2 ± 3 bpm, P < 0.05), submaximal (CON: −15 ± 3 bpm; KE: −7 ± 2 bpm, P < 0.05) and maximal (CON: −17 ± 2 bpm; KE: −10 ± 2 bpm, P < 0.01) heart rate. Energy balance during the training period spontaneously turned negative in CON (−2135 kJ/day), but not in KE (+198 kJ/day). The training consistently increased growth differentiation factor 15 (GDF15), but ∼2‐fold more in CON than in KE (P < 0.05). In addition, delta GDF15 correlated with the training‐induced drop in maximal heart rate (r = 0.60, P < 0.001) and decrease in osteocalcin (r = 0.61, P < 0.01). Other measurements such as blood ACTH, cortisol, IL‐6, leptin, ghrelin and lymphocyte count, and muscle glycogen content did not differentiate KE from CON. In conclusion, KE during strenuous endurance training attenuates the development of overreaching. We also identify GDF15 as a possible marker of overtraining. Overload training is required for sustained performance gain in athletes (functional overreaching). However, excess overload may result in a catabolic state which causes performance decrements for weeks (non‐functional overreaching) up to months (overtraining). Blood ketone bodies can attenuate training‐ or fasting‐induced catabolic events. Therefore, we investigated whether increasing blood ketone levels by oral ketone ester (KE) intake can protect against endurance training‐induced overreaching. We show for the first time that KE intake following exercise markedly blunts the development of physiological symptoms indicating overreaching, and at the same time significantly enhances endurance exercise performance. We provide preliminary data to indicate that growth differentiation factor 15 (GDF15) may be a relevant hormonal marker to diagnose the development of overtraining. Collectively, our data indicate that ketone ester intake is a potent nutritional strategy to prevent the development of non‐functional overreaching and to stimulate endurance exercise performance.
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Affiliation(s)
- Chiel Poffé
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Monique Ramaekers
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Ruud Van Thienen
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Peter Hespel
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium.,Bakala Academy-Athletic Performance Center, KU Leuven, Leuven, Belgium
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Wood TR, Stubbs BJ, Juul SE. Exogenous Ketone Bodies as Promising Neuroprotective Agents for Developmental Brain Injury. Dev Neurosci 2019; 40:451-462. [PMID: 31085911 DOI: 10.1159/000499563] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/12/2019] [Indexed: 11/19/2022] Open
Abstract
Ketone bodies are a promising area of neuroprotection research that may be ideally suited to the injured newborn. During normal development, the human infant is in significant ketosis for at least the first week of life. Ketone uptake and metabolism is upregulated in the both the fetus and neonate, with ketone bodies providing at least 10% of cerebral metabolic energy requirements, as well as being the preferred precursors for the synthesis of fatty acids and cholesterol. At the same time, ketone bodies have been shown to have multiple neuroprotective effects, including being anticonvulsant, decreasing oxidative stress and inflammation, and epigenetically upregulating the production of neurotrophic factors. While ketogenic diets and exogenous ketosis are largely being investigated in the setting of adult brain injury, the adaptation of the neonate to ketosis suggests that developmental brain injury may be the area most suited to the use of ketones for neuroprotection. Here, we describe the mechanisms by which ketone bodies exert their neuroprotective effects, and how these may translate to benefits within each of the phases of neonatal asphyxial brain injury.
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Affiliation(s)
- Thomas R Wood
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA, .,Institute for Human and Machine Cognition, Pensacola, Florida, USA,
| | - Brianna J Stubbs
- HVMN Inc., San Francisco, California, USA.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Sandra E Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Holland AM, Qazi AS, Beasley KN, Bennett HR. Blood and cardiovascular health parameters after supplementing with ketone salts for six weeks. JOURNAL OF INSULIN RESISTANCE 2019. [DOI: 10.4102/jir.v4i1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tsuda Y, Yamaguchi M, Noma T, Okaya E, Itoh H. Combined Effect of Arginine, Valine, and Serine on Exercise-Induced Fatigue in Healthy Volunteers: A Randomized, Double-Blinded, Placebo-Controlled Crossover Study. Nutrients 2019; 11:nu11040862. [PMID: 30999554 PMCID: PMC6549401 DOI: 10.3390/nu11040862] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/16/2022] Open
Abstract
Although several kinds of amino acids (AAs) are known to affect physiological actions during exercise, little is known about the combined effects of a mixture of several AAs on fatigue during exercise. The aim of the present study was to investigate the effect of an AA mixture supplement containing arginine, valine, and serine on exercise-induced fatigue in healthy volunteers. These AAs were selected because they were expected to reduce fatigue during exercise by acting the positive effects synergistically. A randomized, double-blinded, placebo-controlled crossover trial was conducted. Thirty-nine males ingested an AA mixture containing 3600 mg of arginine, 2200 mg of valine, and 200 mg of serine or a placebo each day for 14 days. On the 14th day, the participants completed an exercise trial on a cycle ergometer at 50% of VO2max for 120 min. After the two-week washout period, the participants repeated the same trial with the other test sample. The participant's feeling of fatigue based on a visual analog scale (VAS) and a rating of perceived exertion (RPE), as well as blood and physical parameters were evaluated. The feeling of fatigue based on VAS and RPE were significantly improved in AA compared to those in placebo. In the blood analysis, the increase in serum total ketone bodies during exercise and plasma tryptophan/branched-chain amino acids were significantly lower in AA than those in placebo. The present study demonstrated that supplementation with an AA mixture containing arginine, valine, and serine reduced the feeling of fatigue during exercise. The AA mixture also changed several blood parameters, which may contribute to the anti-fatigue effect.
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Affiliation(s)
- Yuichi Tsuda
- R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan.
| | - Makoto Yamaguchi
- R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan.
| | - Teruyuki Noma
- R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan.
| | - Eiji Okaya
- R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan.
| | - Hiroyuki Itoh
- R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan.
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Da Costa D, Bangalee V, Subban K, Naidoo R. Ketone body supplement label claims: what supplement has been supplemented? SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2019; 31:v31i1a6369. [PMID: 36818000 PMCID: PMC9924521 DOI: 10.17159/2078-516x/2019/v31i1a6369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background There is a keen interest in performance-enhancing supplementation and the associated benefits, despite reports of incorrect label claims made by manufacturers and the questionable efficacy of the supplements. The use of ketone body supplements as a source of fuel during exercise and sporting performance, in particular, is of interest to sportspeople. By increasing blood ketone body levels, with an accompanying decrease in blood glucose, may indicate a state of nutritional ketosis, whereby the body no longer relies on glucose metabolism but rather the metabolism of ketone bodies. This could be beneficial for long, slow steady-state endurance exercise. Discussion There are numerous ketone body supplements on the market manufactured in South Africa and internationally. However, unlike medicines, the sports supplementation industry is poorly regulated. Furthermore, ketone body supplementation with regard to its effects on improving exercise and athletic performance is still unconvincing. Conclusion Within the ever-changing sports supplementation industry, ketone body supplements are being used despite controversies regarding the accuracy and scientific merit of label claims. The ingredients and their quantities, as well as the performance benefits, need to be objectively validated.
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Affiliation(s)
- D Da Costa
- Discipline of Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal, College of Health Sciences,
South Africa
| | - V Bangalee
- Discipline of Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal, College of Health Sciences,
South Africa
| | - K Subban
- Prime Human Performance Institute, 44 Isaiah Ntshangase Road, Durban,
South Africa
| | - R Naidoo
- Discipline of Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal, College of Health Sciences,
South Africa
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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.
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48
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Maunder E, Kilding AE, Plews DJ. Substrate Metabolism During Ironman Triathlon: Different Horses on the Same Courses. Sports Med 2018; 48:2219-2226. [DOI: 10.1007/s40279-018-0938-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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49
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Abstract
The ability of athletes to train day after day depends in large part on adequate restoration of muscle glycogen stores, a process that requires the consumption of sufficient dietary carbohydrates and ample time. Providing effective guidance to athletes and others wishing to enhance training adaptations and improve performance requires an understanding of the normal variations in muscle glycogen content in response to training and diet; the time required for adequate restoration of glycogen stores; the influence of the amount, type, and timing of carbohydrate intake on glycogen resynthesis; and the impact of other nutrients on glycogenesis. This review highlights the practical implications of the latest research related to glycogen metabolism in physically active individuals to help sports dietitians, coaches, personal trainers, and other sports health professionals gain a fundamental understanding of glycogen metabolism, as well as related practical applications for enhancing training adaptations and preparing for competition.
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Affiliation(s)
- Bob Murray
- Sports Science Insights, LLC, Crystal Lake, Illinois, USA
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50
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Waldman HS, Basham SA, Price FG, Smith JW, Chander H, Knight AC, Krings BM, McAllister MJ. Exogenous ketone salts do not improve cognitive responses after a high-intensity exercise protocol in healthy college-aged males. Appl Physiol Nutr Metab 2018; 43:711-717. [PMID: 29451991 DOI: 10.1139/apnm-2017-0724] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined the effects of a d-β-hydroxybutyrate (βHB) containing beverage on cognitive and performance measures during a bout of repeated Wingates. Fifteen healthy, college-aged males (mean ± SD; age: 23.1 ± 2.4 years, height: 165.4 ± 2.0 cm, mass: 81.4 ± 9.2 kg) volunteered for the present study. Trial 1 consisted of baseline measures and familiarization for the protocol. During trials 2 and 3, subjects reported to the laboratory, after a 10-h fast, and ingested 11.38 g of βHB or a placebo (PLA) beverage 30 min before exercise. Participants then completed a cognitive challenge (CC), consisting of a 5-min FitLight response task while cycling. At the cessation of the test, participants then completed four 15-s repeated Wingates with 4 min of rest between, followed by another 5-min CC response task. Blood ketones, glucose, and lactate were measured pre-CC and post-Wingates. βHB levels were significantly higher compared with PLA (0.53 vs. 0.21 mmol/L), respectively. A significant order effect was observed across trials 2 and 3 for total FitLight misses and hits, regardless of treatment. Further, there were no significant differences among Wingate power output between treatments, although fatigue index was higher in the βHB group compared with PLA (32.3 vs. 29.4 W/s), respectively. In conclusion, βHB did not improve high-intensity cycling or cognitive performance measures; however, these findings might be partially explained by the absolute dosing protocol used for βHB in the present study as opposed to a relative (g/kg) dosing protocol used in previous research.
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Affiliation(s)
- Hunter S Waldman
- a Applied Physiology Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
| | - Steven A Basham
- a Applied Physiology Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
| | - Ffi G Price
- a Applied Physiology Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
| | - JohnEric W Smith
- a Applied Physiology Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
| | - Harish Chander
- b Neuromechanics Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
| | - Adam C Knight
- b Neuromechanics Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
| | - Ben M Krings
- a Applied Physiology Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
| | - Matthew J McAllister
- a Applied Physiology Lab, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA
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