Ketone bodies and exercise performance: The next magic bullet or merely hype?

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

doi:10.1007/s40279-016-0577-y

Cited by 113Diet and metabolism studiesMuscle metabolism and nutritionSports Performance and Training

Ketone bodies and exercise performance: The next magic bullet or merely hype?

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Pinckaers, Philippe J. M., Churchward-Venne, Tyler A., Bailey, David, van Loon, Luc J. C.·2017·Sports Medicine

DOI 10.1007/s40279-016-0577-yPMC PMC5309297

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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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Ketone bodies are normally found in circulation in relatively small quantities ranging between 0.1 to 0.5 mmol/L.
“Ketone bodies are lipid-derived low molecular weight hydrophilic molecules, and are normally found in circulation in relatively small quantities ranging between 0.1 to 0.5 mmol/L [190].”
From Regulation of Energy Substrate Metabolism in Endurance Exercise (2021) · cites this paper as [190]

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[68]Balasse EO Fery F Neef MA Changes induced by exercise in rates of turnover and oxidation of ketone bodies in fasting man J Appl Physiol Respir Environ Exerc Physiol. 1978 44 1 5 11 627499

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Metabolism of ketone bodies during exercise and training: physiological basis for exogenous supplementation
Evans, M., Cogan, K. E., & Egan, B. (2017) · The Journal of Physiology · doi:10.1113/jp273185 · Cited by 414 · see citing works
Toward a Common Understanding of Diet–Exercise Strategies to Manipulate Fuel Availability for Training and Competition Preparation in Endurance Sport
Burke, L. M., Hawley, J. A., Jeukendrup, A., Morton, J. P., Stellingwerff, T., & Maughan, R. J. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0289 · Cited by 132 · see citing works
Ketogenic low-CHO, high-fat diet: The future of elite endurance sport?
Burke, L. M. (2021) · The Journal of Physiology · doi:10.1113/jp278928 · Cited by 133 · see citing works
Ketone Diester Ingestion Impairs Time-Trial Performance in Professional Cyclists
Leckey, J. J., Ross, M. L., Quod, M., Hawley, J. A., & Burke, L. M. (2017) · Frontiers in Physiology · doi:10.3389/fphys.2017.00806 · Cited by 129 · see citing works
Nutrition for Ultramarathon Running: Trail, Track, and Road
Costa, R. J. S., Knechtle, B., Tarnopolsky, M., & Hoffman, M. D. (2019) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0255 · Cited by 118 · see citing works
Intermittent Running and Cognitive Performance after Ketone Ester Ingestion
EVANS, M., & EGAN, B. (2018) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001700 · Cited by 116 · see citing works
Regulation of Energy Substrate Metabolism in Endurance Exercise
Alghannam, A. F., Ghaith, M. M., & Alhussain, M. H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094963 · Cited by 104 · see citing works
Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males
O’Malley, T., Myette-Cote, E., Durrer, C., & Little, J. P. (2017) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2016-0641 · Cited by 106 · see citing works
No Benefit of Ingestion of a Ketone Monoester Supplement on 10-km Running Performance
EVANS, M., MCSWINEY, F. T., BRADY, A. J., & EGAN, B. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002065 · Cited by 82 · see citing works

Authors: Pinckaers, P. J. M., Churchward-Venne, T. A., Bailey, D., & van Loon, L. J. C.
Affiliations: Maastricht University Medical Centre (NL)
ORCID: Pinckaers, Philippe J. M.
Venue: Sports Medicine
Publisher: Springer Science and Business Media LLC
Published: 2016-07-18
Volume: 47
Issue: 3
Pages: 383-391
ISSN: 0112-1642 (ISSN-L)
1179-2035
DOI: 10.1007/s40279-016-0577-y
PMC: PMC5309297
OpenAlex: W2476262144
Cited by: 113
References: 88
Citations by year: 2026: 4 · 2025: 8 · 2024: 9 · 2023: 10 · 2022: 9 · 2021: 14 · 2020: 22 · 2019: 14 · 2018: 15 · 2017: 6 · 2016: 2
FWCI: 9.92
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: Sports Medicine (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, cc-by)
Research Bank (Australian Catholic University) (submittedVersion)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Physiology › Diet and metabolism studies
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
Keywords: ketone bodies, exercise performance, ketogenic diet, nutritional ketosis, ketone salts, ketone esters, carbohydrate metabolism, lipid metabolism, endurance exercise, skeletal muscle bioenergetics, professional cyclists, sports nutrition
MeSH terms: Dietary Carbohydrates, Energy Metabolism, Humans, Ketone Bodies, Physical Endurance, Exercise, Muscle, Skeletal, Dietary Supplements, Athletic Performance, Athletes

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Ketone bodies and exercise performance: The next magic bullet or merely hype?

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