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Waldman HS, O'Neal EK, Barker GA, Witt CR, Lara DA, Huber AK, Forsythe VN, Koutnik AP, D'Agostino DP, Staiano W, Egan B. A Ketone Monoester with Carbohydrate Improves Cognitive Measures Postexercise, but Not Performance in Trained Females. Med Sci Sports Exerc 2024; 56:725-736. [PMID: 38051034 DOI: 10.1249/mss.0000000000003352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE The acute ingestion of a ketone monoester with the coingestion of a carbohydrate (KME + CHO) compared with carbohydrate (CHO) was investigated on cycling performance and cognitive performance in trained females. METHODS Using a two condition, placebo-controlled, double-blinded and crossover design, 12 trained females (mean ± SD: age, 23 ± 3 yr; height, 1.64 ± 0.08 m; mass, 65.2 ± 12.7 kg) completed a baseline assessment of cognitive performance (psychomotor vigilance testing (PVT), task switching, and incongruent flanker), followed by 6 × 5-min intervals at 40%, 45%, 50%, 55%, 60%, and 65% of their maximal power output (W max ) and then a 10-km time trial, concluding with the same assessments of cognitive performance. Participants consumed either 375 mg·kg -1 body mass of KME with a 6% CHO solution (1 g·min -1 of exercise) or CHO alone, across three boluses (50:25:25). RESULTS Blood β-hydroxybutyrate concentrations averaged 1.80 ± 0.07 and 0.13 ± 0.01 mM during exercise in KME + CHO and CHO, respectively. Blood glucose decreased after drink 1 of KME + CHO (~15%; P = 0.01) but not CHO, and lactate concentrations were lower in KME + CHO at 50%, 55%, 60%, and 65% W max (all P < 0.05) compared with CHO. Despite these changes, no differences were found between conditions for time trial finishing times (KME + CHO, 29.7 ± 5.7 min; CHO, 29.6 ± 5.7 min; P = 0.92). However, only KME + CHO resulted in increases in psychomotor vigilance testing speed (~4%; P = 0.01) and faster reaction times (~14%; P < 0.01), speed (~15%; P < 0.01), and correct responses (~13%; P = 0.03) in the incongruent flanker during posttesting compared with CHO. CONCLUSIONS The acute ingestion of a KME + CHO elevated blood β-hydroxybutyrate and lowered glucose and lactate across multiple time points during exercise compared with CHO. Although these changes did not affect physical performance, several markers of cognitive performance were improved by the addition of a KME in trained females.
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Affiliation(s)
- Hunter S Waldman
- Department of Kinesiology, University of North Alabama, Florence, AL
| | - Eric K O'Neal
- Department of Kinesiology, University of North Alabama, Florence, AL
| | - Gaven A Barker
- Department of Kinesiology, University of North Alabama, Florence, AL
| | - Craig R Witt
- Department of Kinesiology, University of North Alabama, Florence, AL
| | - David A Lara
- Department of Kinesiology, University of North Alabama, Florence, AL
| | - Anna K Huber
- Department of Kinesiology, University of North Alabama, Florence, AL
| | | | | | | | - Walter Staiano
- Department of Physical Education and Sport, University of Valencia, Valencia, SPAIN
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Valenzuela PL, Santalla A, Alejo LB, Bustos A, Ozcoidi LM, Castellote-Bellés L, Ferrer-Costa R, Villarreal-Salazar M, Morán M, Barranco-Gil D, Pinós T, Lucia A. Acute ketone supplementation in the absence of muscle glycogen utilization: Insights from McArdle disease. Clin Nutr 2024; 43:692-700. [PMID: 38320460 DOI: 10.1016/j.clnu.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND & AIMS Ketone supplementation is gaining popularity. Yet, its effects on exercise performance when muscle glycogen cannot be used remain to be determined. McArdle disease can provide insight into this question, as these patients are unable to obtain energy from muscle glycogen, presenting a severely impaired physical capacity. We therefore aimed to assess the effects of acute ketone supplementation in the absence of muscle glycogen utilization (McArdle disease). METHODS In a randomized cross-over design, patients with an inherited block in muscle glycogen breakdown (i.e., McArdle disease, n = 8) and healthy controls (n = 7) underwent a submaximal (constant-load) test that was followed by a maximal ramp test, after the ingestion of a placebo or an exogenous ketone ester supplement (30 g of D-beta hydroxybutyrate/D 1,3 butanediol monoester). Patients were also assessed after carbohydrate (75 g) ingestion, which is currently considered best clinical practice in McArdle disease. RESULTS Ketone supplementation induced ketosis in all participants (blood [ketones] = 3.7 ± 0.9 mM) and modified some gas-exchange responses (notably increasing respiratory exchange ratio, especially in patients). Patients showed an impaired exercise capacity (-65 % peak power output (PPO) compared to controls, p < 0.001) and ketone supplementation resulted in a further impairment (-11.6 % vs. placebo, p = 0.001), with no effects in controls (p = 0.268). In patients, carbohydrate supplementation resulted in a higher PPO compared to ketones (+21.5 %, p = 0.001) and a similar response was observed vs. placebo (+12.6 %, p = 0.057). CONCLUSIONS In individuals who cannot utilize muscle glycogen but have a preserved ability to oxidize blood-borne glucose and fat (McArdle disease), acute ketone supplementation impairs exercise capacity, whereas carbohydrate ingestion exerts the opposite, beneficial effect.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of Hospital '12 de Octubre' ('imas12'), Madrid, Spain; Department of Systems Biology, University of Alcalá, Madrid, Spain.
| | - Alfredo Santalla
- Department of Sport and Computer Science, Section of Physical Education and Sports, Faculty of Sport, Universidad Pablo de Olavide, Sevilla, Spain; EVOPRED Research Group, Universidad Europea de Canarias, Tenerife, Spain
| | - Lidia B Alejo
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of Hospital '12 de Octubre' ('imas12'), Madrid, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Asunción Bustos
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Laureano M Ozcoidi
- Hospital Reina Sofía de Tudela, Servicio Navarro de Salud, Navarra, Spain
| | - Laura Castellote-Bellés
- Department of Clinical Biochemistry, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Roser Ferrer-Costa
- Department of Clinical Biochemistry, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mónica Villarreal-Salazar
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain
| | - María Morán
- Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain; Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Tomàs Pinós
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain.
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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Robberechts R, Poffé C. Defining ketone supplementation: the evolving evidence for postexercise ketone supplementation to improve recovery and adaptation to exercise. Am J Physiol Cell Physiol 2024; 326:C143-C160. [PMID: 37982172 DOI: 10.1152/ajpcell.00485.2023] [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: 09/26/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
Over the last decade, there has been a growing interest in the use of ketone supplements to improve athletic performance. These ketone supplements transiently elevate the concentrations of the ketone bodies acetoacetate (AcAc) and d-β-hydroxybutyrate (βHB) in the circulation. Early studies showed that ketone bodies can improve energetic efficiency in striated muscle compared with glucose oxidation and induce a glycogen-sparing effect during exercise. As such, most research has focused on the potential of ketone supplementation to improve athletic performance via ingestion of ketones immediately before or during exercise. However, subsequent studies generally observed no performance improvement, and particularly not under conditions that are relevant for most athletes. However, more and more studies are reporting beneficial effects when ketones are ingested after exercise. As such, the real potential of ketone supplementation may rather be in their ability to enhance postexercise recovery and training adaptations. For instance, recent studies observed that postexercise ketone supplementation (PEKS) blunts the development of overtraining symptoms, and improves sleep, muscle anabolic signaling, circulating erythropoietin levels, and skeletal muscle angiogenesis. In this review, we provide an overview of the current state-of-the-art about the impact of PEKS on aspects of exercise recovery and training adaptation, which is not only relevant for athletes but also in multiple clinical conditions. In addition, we highlight the underlying mechanisms by which PEKS may improve exercise recovery and training adaptation. This includes epigenetic effects, signaling via receptors, modulation of neurotransmitters, energy metabolism, and oxidative and anti-inflammatory pathways.
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Affiliation(s)
- Ruben Robberechts
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Chiel Poffé
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
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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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Carr AJ, McKay AKA, Burke LM, Smith ES, Urwin CS, Convit L, Jardine WT, Kelly MK, Saunders B. Use of Buffers in Specific Contexts: Highly Trained Female Athletes, Extreme Environments and Combined Buffering Agents-A Narrative Review. Sports Med 2023; 53:25-48. [PMID: 37878211 PMCID: PMC10721675 DOI: 10.1007/s40279-023-01872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 10/26/2023]
Abstract
This narrative review evaluated the evidence for buffering agents (sodium bicarbonate, sodium citrate and beta-alanine), with specific consideration of three discrete scenarios: female athletes, extreme environments and combined buffering agents. Studies were screened according to exclusion and inclusion criteria and were analysed on three levels: (1) moderating variables (supplement dose and timing, and exercise test duration and intensity), (2) design factors (e.g., use of crossover or matched group study design, familiarisation trials) and (3) athlete-specific factors (recruitment of highly trained participants, buffering capacity and reported performance improvements). Only 19% of the included studies for the three buffering agents reported a performance benefit, and only 10% recruited highly trained athletes. This low transferability of research findings to athletes' real-world practices may be due to factors including the small number of sodium citrate studies in females (n = 2), no studies controlling for the menstrual cycle (MC) or menstrual status using methods described in recently established frameworks, and the limited number of beta-alanine studies using performance tests replicating real-world performance efforts (n = 3). We recommend further research into buffering agents in highly trained female athletes that control or account for the MC, studies that replicate the demands of athletes' heat and altitude camps, and investigations of highly trained athletes' use of combined buffering agents. In a practical context, we recommend developing evidence-based buffering protocols for individual athletes which feature co-supplementation with other evidence-based products, reduce the likelihood of side-effects, and optimise key moderating factors: supplement dose and timing, and exercise duration and intensity.
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Affiliation(s)
- Amelia J Carr
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Alannah K A McKay
- 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
| | - Ella S Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Charles S Urwin
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Lilia Convit
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - William T Jardine
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Monica K Kelly
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Bryan Saunders
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculdade de Medicina FMUSP, School of Physical Education and Sport, Universidade de São Paulo, University of São Paulo, São Paulo, Brazil
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
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ROBBERECHTS RUBEN, ALBOUY GENEVIÈVE, HESPEL PETER, POFFÉ CHIEL. Exogenous Ketosis Improves Sleep Efficiency and Counteracts the Decline in REM Sleep after Strenuous Exercise. Med Sci Sports Exerc 2023; 55:2064-2074. [PMID: 37259248 PMCID: PMC10581428 DOI: 10.1249/mss.0000000000003231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Available evidence indicates that ketone bodies may improve sleep quality. Therefore, we determined whether ketone ester (KE) intake could counteract sleep disruptions induced by strenuous exercise. METHODS Ten well-trained cyclists with good sleep quality participated in a randomized crossover design consisting of two experimental sessions each involving a morning endurance training and an evening high-intensity interval training ending 1 h before sleep, after which polysomnography was performed overnight. Postexercise and 30 min before sleeping time, subjects received either 25 g of KE (EX KE ) or a placebo drink (EX CON ). A third session without exercise but with placebo supplements (R CON ) was added to evaluate the effect of exercise per se on sleep. RESULTS Blood d -β-hydroxybutyrate concentrations transiently increased to ~3 mM postexercise and during the first part of the night in EX KE but not in EX CON or R CON . Exercise significantly reduced rapid eye movement sleep by 26% ( P = 0.001 vs R CON ) and increased wakefulness after sleep onset by 95% ( P = 0.004 vs R CON ). Interestingly, KE improved sleep efficiency by 3% ( P = 0.040 vs EX CON ) and counteracted the exercise-induced decrease in rapid eye movement sleep ( P = 0.011 vs EX CON ) and the increase in wakefulness after sleep onset ( P = 0.009 vs EX CON ). This was accompanied by a KE-induced increase in dopamine excretion ( P = 0.033 vs EX CON ), which plays a pivotal role in sleep regulation. In addition, exercise increased sleep spindle density by 36% ( P = 0.005 vs R CON ), suggesting an effect on neural plasticity processes during sleep. CONCLUSIONS These data indicate that KE ingestion improves sleep efficiency and quality after high-intensity exercise. We provide preliminary evidence that this might result from KE-induced increases in dopamine signaling.
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Affiliation(s)
- RUBEN ROBBERECHTS
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
| | - GENEVIÈVE ALBOUY
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
- Leuven Brain Institute (LBI), KU Leuven, Leuven, BELGIUM
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT
| | - PETER HESPEL
- Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
| | - CHIEL POFFÉ
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, BELGIUM
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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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McCarthy DG, Bostad W, Bone J, Powley FJ, Richards DL, Gibala MJ. Effect of Acute Ketone Monoester Ingestion on Cardiorespiratory Responses to Exercise and the Influence of Blood Acidosis. Med Sci Sports Exerc 2023; 55:1286-1295. [PMID: 36849121 DOI: 10.1249/mss.0000000000003141] [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: 03/01/2023]
Abstract
PURPOSE This study aimed to examine the effect of KE ingestion on exercise cardiac output ( Q˙ ) and the influence of blood acidosis. We hypothesized that KE versus placebo ingestion would increase Q ˙, and coingestion of the pH buffer bicarbonate would mitigate this effect. METHODS In a randomized, double-blind, crossover manner, 15 endurance-trained adults (peak oxygen uptake (V̇O 2peak ), 60 ± 9 mL·kg -1 ·min -1 ) ingested either 0.2 g·kg -1 sodium bicarbonate or a salt placebo 60 min before exercise, and 0.6 g·kg -1 KE or a ketone-free placebo 30 min before exercise. Supplementation yielded three experimental conditions: basal ketone bodies and neutral pH (CON), hyperketonemia and blood acidosis (KE), and hyperketonemia and neutral pH (KE + BIC). Exercise involved 30 min of cycling at ventilatory threshold intensity, followed by determinations of V̇O 2peak and peak Q ˙. RESULTS Blood [β-hydroxybutyrate], a ketone body, was higher in KE (3.5 ± 0.1 mM) and KE + BIC (4.4 ± 0.2) versus CON (0.1 ± 0.0, P < 0.0001). Blood pH was lower in KE versus CON (7.30 ± 0.01 vs 7.34 ± 0.01, P < 0.001) and KE + BIC (7.35 ± 0.01, P < 0.001). Q ˙ during submaximal exercise was not different between conditions (CON: 18.2 ± 3.6, KE: 17.7 ± 3.7, KE + BIC: 18.1 ± 3.5 L·min -1 ; P = 0.4). HR was higher in KE (153 ± 9 bpm) and KE + BIC (154 ± 9) versus CON (150 ± 9, P < 0.02). V̇O 2peak ( P = 0.2) and peak Q ˙ ( P = 0.3) were not different between conditions, but peak workload was lower in KE (359 ± 61 W) and KE + BIC (363 ± 63) versus CON (375 ± 64, P < 0.02). CONCLUSIONS KE ingestion did not increase Q ˙ during submaximal exercise despite a modest elevation of HR. This response occurred independent of blood acidosis and was associated with a lower workload at V̇O 2peak .
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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
| | - Jack Bone
- Department of Kinesiology, McMaster University, Hamilton, ON, CANADA
| | - Fiona J Powley
- Department of Kinesiology, McMaster University, Hamilton, ON, CANADA
| | | | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON, CANADA
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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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Robberechts R, Poffe C, Hespel P. Exogenous ketosis suppresses diuresis and atrial natriuretic peptide during exercise. J Appl Physiol (1985) 2022; 133:449-460. [PMID: 35771216 DOI: 10.1152/japplphysiol.00061.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We have previously demonstrated that exogenous ketosis reduces urine production during exercise. However, the underlying physiological mechanism of this anti-diuretic effect remained unclear. Therefore, we investigated whether acute exogenous ketosis by oral ingestion of ketone ester (KE) during a simulated cycling race (RACE) affects the hormonal pathways implicated in fluid balance regulation during exercise. In a double-blind crossover design, 11 well-trained male cyclists participated in RACE consisting of a 3-h submaximal intermittent cycling (IMT180') bout followed by a 15-minute time trial (TT15') in an environmental chamber set at 28 °C and 60 % relative humidity. Fluid intake was adjusted to maintain euhydration. Before and during RACE, the subjects received either a control drink (CON) or the ketone ester (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (KE), which elevated blood β-hydroxybutyrate to ~2-4 mM. Urine output during IMT180' was ~20% lower in KE (1172 ± 557 ml) than in CON (1431 ± 548 ml, p < 0.05). Compared with CON, N-terminal pro-atrial natriuretic peptide (NT-pro ANP) concentration during RACE was ~20% lower in KE (p < 0.05). KE also raised plasma noradrenaline concentrations during RACE. Performance in TT15' was similar between CON and KE. In conclusion, exogenous ketosis suppresses diuresis and downregulates α-natriuretic peptide activity during exercise.
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Affiliation(s)
- Ruben Robberechts
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven,, Leuven, Belgium
| | - Chiel Poffe
- 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.,DBakala Academy-Athletic Performance Center, KU Leuven, Leuven, Belgium
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11
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Bielik V, Hric I, Ugrayová S, Kubáňová L, Putala M, Grznár Ľ, Penesová A, Havranová A, Šardzíková S, Grendar M, Baranovičová E, Šoltys K, Kolisek M. Effect of High-intensity Training and Probiotics on Gut Microbiota Diversity in Competitive Swimmers: Randomized Controlled Trial. SPORTS MEDICINE - OPEN 2022; 8:64. [PMID: 35536489 PMCID: PMC9091066 DOI: 10.1186/s40798-022-00453-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/20/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Physical exercise has favorable effects on the structure of gut microbiota and metabolite production in sedentary subjects. However, little is known whether adjustments in an athletic program impact overall changes of gut microbiome in high-level athletes. We therefore characterized fecal microbiota and serum metabolites in response to a 7-week, high-intensity training program and consumption of probiotic Bryndza cheese. METHODS Fecal and blood samples and training logs were collected from young competitive male (n = 17) and female (n = 7) swimmers. Fecal microbiota were categorized using specific primers targeting the V1-V3 region of 16S rDNA, and serum metabolites were characterized by NMR-spectroscopic analysis and by multivariate statistical analysis, Spearman rank correlations, and Random Forest models. RESULTS We found higher α-diversity, represented by the Shannon index value (HITB-pre 5.9 [± 0.4]; HITB-post 6.4 [± 0.4], p = 0.007), (HIT-pre 5.5 [± 0.6]; HIT-post 5.9 [± 0.6], p = 0.015), after the end of the training program in both groups independently of Bryndza cheese consumption. However, Lactococcus spp. increased in both groups, with a higher effect in the Bryndza cheese consumers (HITB-pre 0.0021 [± 0.0055]; HITB-post 0.0268 [± 0.0542], p = 0.008), (HIT-pre 0.0014 [± 0.0036]; HIT-post 0.0068 [± 0.0095], p = 0.046). Concomitant with the increase of high-intensity exercise and the resulting increase of anaerobic metabolism proportion, pyruvate (p[HITB] = 0.003; p[HIT] = 0.000) and lactate (p[HITB] = 0.000; p[HIT] = 0.030) increased, whereas acetate (p[HITB] = 0.000; p[HIT] = 0.002) and butyrate (p[HITB] = 0.091; p[HIT] = 0.019) significantly decreased. CONCLUSIONS Together, these data demonstrate a significant effect of high-intensity training (HIT) on both gut microbiota composition and serum energy metabolites. Thus, the combination of intensive athletic training with the use of natural probiotics is beneficial because of the increase in the relative abundance of lactic acid bacteria.
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Grants
- 1/0554/19 The Ministry of Education, Science, Research and Sport of the Slovak Republic
- 1/0129/20 The Ministry of Education, Science, Research and Sport of the Slovak Republic
- 1/0260/21 The Ministry of Education, Science, Research and Sport of the Slovak Republic
- APVV-17-0099 Agentúra Ministerstva Školstva, Vedy, Výskumu a Športu SR
- APVV-19-0222 Agentúra Ministerstva Školstva, Vedy, Výskumu a Športu SR
- The Ministry of Education, Science, Research and Sport of the Slovak Republic
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Affiliation(s)
- Viktor Bielik
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, 814 69, Bratislava, Slovakia.
| | - Ivan Hric
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, 814 69, Bratislava, Slovakia
| | - Simona Ugrayová
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, 814 69, Bratislava, Slovakia
| | - Libuša Kubáňová
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, 814 69, Bratislava, Slovakia
- Biomedical Center, Institute of Clinical and Translational Research, Slovak Academy of Sciences, 845 05, Bratislava, Slovakia
| | - Matúš Putala
- Department of Outdoor Sports and Swimming, Faculty of Physical Education and Sport, Comenius University in Bratislava, 814 69, Bratislava, Slovakia
| | - Ľuboš Grznár
- Department of Outdoor Sports and Swimming, Faculty of Physical Education and Sport, Comenius University in Bratislava, 814 69, Bratislava, Slovakia
| | - Adela Penesová
- Biomedical Center, Institute of Clinical and Translational Research, Slovak Academy of Sciences, 845 05, Bratislava, Slovakia
| | - Andrea Havranová
- Biomedical Center, Institute of Clinical and Translational Research, Slovak Academy of Sciences, 845 05, Bratislava, Slovakia
| | - Sára Šardzíková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 842 15, Bratislava, Slovakia
| | - Marián Grendar
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01, Martin, Slovakia
| | - Eva Baranovičová
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01, Martin, Slovakia
| | - Katarína Šoltys
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 842 15, Bratislava, Slovakia
- Comenius University Science Park, Comenius University in Bratislava, 841 04, Bratislava, Slovakia
| | - Martin Kolisek
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01, Martin, Slovakia
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12
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Ketone Monoester Ingestion Alters Metabolism and Simulated Rugby Performance in Professional Players. Int J Sport Nutr Exerc Metab 2022; 32:334-341. [PMID: 35487576 DOI: 10.1123/ijsnem.2021-0346] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
Abstract
Ketone ingestion can alter metabolism but effects on exercise performance are unclear, particularly with regard to the impact on intermittent-intensity exercise and team-sport performance. Nine professional male rugby union players each completed two trials in a double-blind, randomized, crossover design. Participants ingested either 90 ± 9 g carbohydrate (CHO; 9% solution) or an energy matched solution containing 20 ± 2 g CHO (3% solution) and 590 mg/kg body mass β-hydroxybutyrate monoester (CHO + BHB-ME) before and during a simulated rugby union-specific match-play protocol, including repeated high-intensity, sprint and power-based performance tests. Mean time to complete the sustained high-intensity performance tests was reduced by 0.33 ± 0.41 s (2.1%) with CHO + BHB-ME (15.53 ± 0.52 s) compared with CHO (15.86 ± 0.80 s) placebo (p = .04). Mean time to complete the sprint and power-based performance tests were not different between trials. CHO + BHB-ME resulted in blood BHB concentrations that remained >2 mmol/L during exercise (p < .001). Serum lactate and glycerol concentrations were lower after CHO + BHB-ME than CHO (p < .05). Coingestion of a BHB-ME with CHO can alter fuel metabolism (attenuate circulating lactate and glycerol concentrations) and may improve high-intensity running performance during a simulated rugby match-play protocol, without improving shorter duration sprint and power-based efforts.
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13
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Falkenhain K, Daraei A, Forbes SC, Little JP. Effects of Exogenous Ketone Supplementation on Blood Glucose: A Systematic Review and Meta-analysis. Adv Nutr 2022; 13:1697-1714. [PMID: 35380602 PMCID: PMC9526861 DOI: 10.1093/advances/nmac036] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/04/2022] [Accepted: 04/01/2022] [Indexed: 01/28/2023] Open
Abstract
Recently developed ketone (monoester or salt) supplements acutely elevate blood β-hydroxybutyrate (BHB) exogenously without prolonged periods of fasting or carbohydrate restriction. Previous (small-scale) studies have found a blood glucose-lowering effect of exogenous ketones. This study aimed to systematically review available evidence and conduct meta-analyses of studies reporting on exogenous ketones and blood glucose. We searched 6 electronic databases on 13 December 2021 for randomized and nonrandomized trials of any length that reported on the use of exogenous ketones. We calculated raw mean differences (MDs) in blood BHB and glucose in 2 main analyses: 1) after compared with before acute ingestion of exogenous ketones and 2) following acute ingestion of exogenous ketones compared with a comparator supplement. We pooled effect sizes using random-effects models and performed prespecified subgroup analyses to examine the effect of potential explanatory factors, including study population, exercise, blood BHB, and supplement type, dosing, and timing. Risk of bias was examined using Cochrane's risk-of-bias tools. Studies that could not be meta-analyzed were summarized narratively. Forty-three trials including 586 participants are summarized in this review. Following ingestion, exogenous ketones increased blood BHB (MD = 1.73 mM; 95% CI: 1.26, 2.21 mM; P < 0.001) and decreased mean blood glucose (MD = -0.54 mM; 95% CI: -0.68, -0.40 mM; P < 0.001). Similarly, when compared with placebo, blood BHB increased (MD = 1.98 mM; 95% CI: 1.52, 2.45 mM; P < 0.001) and blood glucose decreased (MD = -0.47 mM; 95% CI: -0.57, -0.36 mM; P < 0.001). Across both analyses, significantly greater effects were seen with ketone monoesters compared with salts (P < 0.001). The available evidence indicates that acute ingestion of exogenous ketones leads to increased blood BHB and decreased blood glucose. Limited evidence on prolonged ketone supplementation was found.
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Affiliation(s)
| | - Ali Daraei
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Scott C Forbes
- Department of Physical Education Studies, Faculty of Education, Brandon University, Brandon, Manitoba, Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
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14
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de Oliveira LF, Dolan E, Swinton PA, Durkalec-Michalski K, Artioli GG, McNaughton LR, Saunders B. Extracellular Buffering Supplements to Improve Exercise Capacity and Performance: A Comprehensive Systematic Review and Meta-analysis. Sports Med 2022; 52:505-526. [PMID: 34687438 DOI: 10.1007/s40279-021-01575-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Extracellular buffering supplements [sodium bicarbonate (SB), sodium citrate (SC), sodium/calcium lactate (SL/CL)] are ergogenic supplements, although questions remain about factors which may modify their effect. OBJECTIVE To quantify the main effect of extracellular buffering agents on exercise outcomes, and to investigate the influence of potential moderators on this effect using a systematic review and meta-analytic approach. METHODS This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were searched for articles that were screened according to inclusion/exclusion criteria. Bayesian hierarchical meta-analysis and meta-regression models were used to investigate pooled effects of supplementation and moderating effects of a range of factors on exercise and biomarker responses. RESULTS 189 articles with 2019 participants were included, 158 involving SB supplementation, 30 with SC, and seven with CL/SL; four studies provided a combination of buffering supplements together. Supplementation led to a mean estimated increase in blood bicarbonate of + 5.2 mmol L-1 (95% credible interval (CrI) 4.7-5.7). The meta-analysis models identified a positive overall effect of supplementation on exercise capacity and performance compared to placebo [ES0.5 = 0.17 (95% CrI 0.12-0.21)] with potential moderating effects of exercise type and duration, training status and when the exercise test was performed following prior exercise. The greatest ergogenic effects were shown for exercise durations of 0.5-10 min [ES0.5 = 0.18 (0.13-0.24)] and > 10 min [ES0.5 = 0.22 (0.10-0.33)]. Evidence of greater effects on exercise were obtained when blood bicarbonate increases were medium (4-6 mmol L-1) and large (> 6 mmol L-1) compared with small (≤ 4 mmol L-1) [βSmall:Medium = 0.16 (95% CrI 0.02-0.32), βSmall:Large = 0.13 (95% CrI - 0.03 to 0.29)]. SB (192 outcomes) was more effective for performance compared to SC (39 outcomes) [βSC:SB = 0.10 (95% CrI - 0.02 to 0.22)]. CONCLUSIONS Extracellular buffering supplements generate large increases in blood bicarbonate concentration leading to positive overall effects on exercise, with sodium bicarbonate being most effective. Evidence for several group-level moderating factors were identified. These data can guide an athlete's decision as to whether supplementation with buffering agents might be beneficial for their specific aims.
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Affiliation(s)
- Luana Farias de Oliveira
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | - Paul A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Krzysztof Durkalec-Michalski
- Department of Sports Dietetics, Poznań University of Physical Education, Poznań, Poland
- Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Poznań, Poland
| | - Guilherme G Artioli
- Department of Life Sciences, Manchester Metropolitan University, John Dalton Building, Manchester, M1 5GD, UK
| | - Lars R McNaughton
- Sports Nutrition and Performance Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Bryan Saunders
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.
- Department of Sports Dietetics, Poznań University of Physical Education, Poznań, Poland.
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.
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15
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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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16
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Waldman HS, Bryant AR, Shepherd BD, Egan B, McAllister MJ. No Effect of a Ketone Monoester on Markers of Stress and Performance in a Live-Burn Search and Rescue in Firefighters. J Strength Cond Res 2022; 36:763-771. [DOI: 10.1519/jsc.0000000000004194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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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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18
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Poffé C, Robberechts R, Podlogar T, Kusters M, Debevec T, Hespel P. Exogenous ketosis increases blood and muscle oxygenation but not performance during exercise in hypoxia. Am J Physiol Regul Integr Comp Physiol 2021; 321:R844-R857. [PMID: 34668436 DOI: 10.1152/ajpregu.00198.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Available evidence indicates that elevated blood ketones are associated with improved hypoxic tolerance in rodents. From this perspective, we hypothesized that exogenous ketosis by oral intake of the ketone ester (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (KE) may induce beneficial physiological effects during prolonged exercise in acute hypoxia. As we recently demonstrated KE to deplete blood bicarbonate, which per se may alter the physiological response to hypoxia, we evaluated the effect of KE both in the presence and absence of bicarbonate intake (BIC). Fourteen highly trained male cyclists performed a simulated cycling race (RACE) consisting of 3-h intermittent cycling (IMT180') followed by a 15-min time-trial (TT15') and an all-out sprint at 175% of lactate threshold (SPRINT). During RACE, fraction of inspired oxygen ([Formula: see text]) was gradually decreased from 18.6% to 14.5%. Before and during RACE, participants received either 1) 75 g of ketone ester (KE), 2) 300 mg/kg body mass bicarbonate (BIC), 3) KE + BIC, or 4) a control drink in addition to 60 g of carbohydrates/h in a randomized, crossover design. KE counteracted the hypoxia-induced drop in blood ([Formula: see text]) and muscle oxygenation by ∼3%. In contrast, BIC decreased [Formula: see text] by ∼2% without impacting muscle oxygenation. Performance during TT15' and SPRINT were similar between all conditions. In conclusion, KE slightly elevated the degree of blood and muscle oxygenation during prolonged exercise in moderate hypoxia without impacting exercise performance. Our data warrant to further investigate the potential of exogenous ketosis to improve muscular and cerebral oxygenation status, and exercise tolerance in extreme hypoxia.
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Affiliation(s)
- Chiel Poffé
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Ruben Robberechts
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Tim Podlogar
- Department for Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia.,Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Martijn Kusters
- Bakala Academy-Athletic Performance Center, KU Leuven, Leuven, Belgium
| | - Tadej Debevec
- Department for Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia.,Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - 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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19
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Burke LM. Nutritional approaches to counter performance constraints in high-level sports competition. Exp Physiol 2021; 106:2304-2323. [PMID: 34762329 PMCID: PMC9299184 DOI: 10.1113/ep088188] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022]
Abstract
New Findings What is the topic of this review? The nutritional strategies that athletes use during competition events to optimize performance and the reasons they use them. What advances does it highlight? A range of nutritional strategies can be used by competitive athletes, alone or in combination, to address various event‐specific factors that constrain event performance. Evidence for such practices is constantly evolving but must be combined with understanding of the complexities of real‐life sport for optimal implementation.
Abstract High‐performance athletes share a common goal despite the unique nature of their sport: to pace or manage their performance to achieve the highest sustainable outputs over the duration of the event. Periodic or sustained decline in the optimal performance of event tasks, involves an interplay between central and peripheral phenomena that can often be reduced or delayed in onset by nutritional strategies. Contemporary nutrition practices undertaken before, during or between events include strategies to ensure the availability of limited muscle fuel stores. This includes creatine supplementation to increase muscle phosphocreatine content and consideration of the type, amount and timing of dietary carbohydrate intake to optimize muscle and liver glycogen stores or to provide additional exogenous substrate. Although there is interest in ketogenic low‐carbohydrate high‐fat diets and exogenous ketone supplements to provide alternative fuels to spare muscle carbohydrate use, present evidence suggests a limited utility of these strategies. Mouth sensing of a range of food tastants (e.g., carbohydrate, quinine, menthol, caffeine, fluid, acetic acid) may provide a central nervous system derived boost to sports performance. Finally, despite decades of research on hypohydration and exercise capacity, there is still contention around their effect on sports performance and the best guidance around hydration for sporting events. A unifying model proposes that some scenarios require personalized fluid plans while others might be managed by an ad hoc approach (ad libitum or thirst‐driven drinking) to fluid intake.
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Affiliation(s)
- Louise M Burke
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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20
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Stavitzski NM, Landon CS, Hinojo CM, Poff AM, Rogers CQ, D'Agostino DP, Dean JB. Exogenous ketone ester delays CNS oxygen toxicity without impairing cognitive and motor performance in male Sprague-Dawley rats. Am J Physiol Regul Integr Comp Physiol 2021; 321:R100-R111. [PMID: 34132115 DOI: 10.1152/ajpregu.00088.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
Hyperbaric oxygen (HBO2) is breathing >1 atmosphere absolute (ATA; 101.3 kPa) O2 and is used in HBO2 therapy and undersea medicine. What limits the use of HBO2 is the risk of developing central nervous system (CNS) oxygen toxicity (CNS-OT). A promising therapy for delaying CNS-OT is ketone metabolic therapy either through diet or exogenous ketone ester (KE) supplement. Previous studies indicate that KE induces ketosis and delays the onset of CNS-OT; however, the effects of exogeneous KE on cognition and performance are understudied. Accordingly, we tested the hypothesis that oral gavage with 7.5 g/kg induces ketosis and increases the latency time to seizure (LSz) without impairing cognition and performance. A single oral dose of 7.5 g/kg KE increases systemic β-hydroxybutyrate (BHB) levels within 0.5 h and remains elevated for 4 h. Male rats were separated into three groups: control (no gavage), water-gavage, or KE-gavage, and were subjected to behavioral testing while breathing 1 ATA (101.3 kPa) of air. Testing included the following: DigiGait (DG), light/dark (LD), open field (OF), and novel object recognition (NOR). There were no adverse effects of KE on gait or motor performance (DG), cognition (NOR), and anxiety (LD, OF). In fact, KE had an anxiolytic effect (OF, LD). The LSz during exposure to 5 ATA (506.6 kPa) O2 (≤90 min) increased 307% in KE-treated rats compared with control rats. In addition, KE prevented seizures in some animals. We conclude that 7.5 g/kg is an optimal dose of KE in the male Sprague-Dawley rat model of CNS-OT.
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Affiliation(s)
- Nicole M Stavitzski
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Carol S Landon
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Christopher M Hinojo
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Angela M Poff
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Christopher Q Rogers
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Dominic P D'Agostino
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, Florida
- Institute of Human Machine and Cognition, Ocala, Florida
| | - Jay B Dean
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, Florida
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21
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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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