Cited by 172Diet and metabolism studiesMuscle metabolism and nutritionSports Performance and Training

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Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes

McSwiney, Fionn T., Wardrop, Bruce, Hyde, Parker N., Lafountain, Richard A., Volek, Jeff S., Doyle, Lorna·2018·Metabolism

DOI 10.1016/j.metabol.2017.10.010

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Abstract

Background Low-carbohydrate diets have recently grown in popularity among endurance athletes, yet little is known about the long-term (>4wk) performance implications of consuming a low-carbohydrate high fat ketogenic diet (LCKD) in well-trained athletes.Methods Twenty male endurance-trained athletes (age 33±11y, body mass 80±11kg; BMI 24.7±3.1kg/m 2) who habitually consumed a carbohydrate-based diet, self-selected into a high-carbohydrate (HC) group (n=11, %carbohydrate:protein:fat=65:14:20), or a LCKD group (n=9, 6:17:77). Both groups performed the same training intervention (endurance, strength and high intensity interval training (HIIT)). Prior to and following successful completion of 12-weeks of diet and training, participants had their body composition assessed, and completed a 100km time trial (TT), six second (SS) sprint, and a critical power test (CPT). During post-intervention testing the HC group consumed 30-60g/h carbohydrate, whereas the LCKD group consumed water, and electrolytes.Results The LCKD group experienced a significantly greater decrease in body mass (HC -0.8kg, LCKD -5.9kg; P=0.006, effect size (ES): 0.338) and percentage body fat percentage (HC -0.7%, LCKD -5.2%; P=0.008, ES: 0.346). Fasting serum beta-hydroxybutyrate (βHB) significantly increased from 0.1 at baseline to 0.5mmol/L in the LCKD group (P=0.011, ES: 0.403) in week 12. There was no significant change in performance of the 100km TT between groups (HC -1.13min·s, LCKD -4.07min·s, P=0.057, ES: 0.196). SS sprint peak power increased by 0.8 watts per kilogram bodyweight (w/kg) in the LCKD group, versus a -0.1w/kg reduction in the HC group (P=0.025, ES: 0.263). CPT peak power decreased by -0.7w/kg in the HC group, and increased by 1.4w/kg in the LCKD group (P=0.047, ES: 0.212). Fat oxidation in the LCKD group was significantly greater throughout the 100km TT.Conclusions Compared to a HC comparison group, a 12-week period of keto-adaptation and exercise training, enhanced body composition, fat oxidation during exercise, and specific measures of performance relevant to competitive endurance athletes.

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The VegPlate for Sports: A Plant-Based Food Guide for Athletes
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Case Study: Long-Term Low-Carbohydrate, High-Fat Diet Impairs Performance and Subjective Well-Being in a World-Class Vegetarian Long-Distance Triathlete
Mujika, I. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0124 · Cited by 28
Is Water-Only Fasting Safe?
Ogłodek, E. A., & Pilis, W. (2021) · Global Advances in Health and Medicine · doi:10.1177/21649561211031178 · Cited by 28
No Modification in Blood Lipoprotein Concentration but Changes in Body Composition After 4 Weeks of Low Carbohydrate Diet (LCD) Followed by 7 Days of Carbohydrate Loading in Basketball Players
Michalczyk, M. M., Zając, A., Mikołajec, K., Zydek, G., & Langfort, J. (2018) · Journal of Human Kinetics · doi:10.2478/hukin-2018-0102 · Cited by 31
“Till now athletes most often experiment with the low fat diets (LFD), low carbohydrate diets (LCD), and high protein diets (HPD) (Creighton et al., 2018; Greene et al., 2018; McSwiney et al., 2018; Paoli et al., 2013; Zajac et al., 2014).”
Background
Effects of Ketone Bodies on Endurance Exercise
Sansone, M., Sansone, A., Borrione, P., Romanelli, F., Luigi, L. D., & Sgrò, P. (2018) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000542 · Cited by 28
Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial
Buga, A., Harper, D. G., Sapper, T. N., Hyde, P. N., Fell, B., Dickerson, R. M., Stoner, J. T., Kackley, M. L., Crabtree, C. D., Decker, D. D., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0296523 · Cited by 26
“Participants were encouraged to increase their sodium intake by 1–2 g/day by liberally salting foods, drinking bouillon or broth daily, or making an electrolyte beverage to avoid hyponatremia while in nutritional ketosis [37].”
Effects of a Ketogenic Diet Containing Medium-Chain Triglycerides and Endurance Training on Metabolic Enzyme Adaptations in Rat Skeletal Muscle
Fukazawa, A., Koike, A., Karasawa, T., Tsutsui, M., Kondo, S., & Terada, S. (2020) · Nutrients · doi:10.3390/nu12051269 · Cited by 26
Carbohydrate ingestion eliminates hypoglycemia and improves endurance exercise performance in triathletes adapted to very low- and high-carbohydrate isocaloric diets
Prins, P., Noakes, T. D., Buga, A., Gerhart, H. D., Cobb, B. M., D’Agostino, D. P., Volek, J. S., Buxton, J. D., Heckman, K., Plank, E. N., et al. (2025) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00583.2024 · Cited by 28
Reliability and diagnostic performance of a new blood ketone and glucose meter in humans
Moore, A. R., Holland, A. M., Ansley, J., Boone, E. D. H., & Schulte, M. K. O. (2021) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00404-2 · Cited by 25
Ketogenic diets initiated in late mid-life improved measures of spatial memory in male mice
Zhou, Z., Kim, K., Ramsey, J. J., & Rutkowsky, J. M. (2023) · GeroScience · doi:10.1007/s11357-023-00769-7 · Cited by 25
Development of Obesity: The Driver and the Passenger
Kopp, W. (2020) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s280146 · Cited by 25
High fat diet improves metabolic flexibility during progressive exercise to exhaustion (VO 2 max testing) and during 5km running time trials
Prins, P., Noakes, T. D., Buxton, J. D., Welton, G. L., Raabe, A., Scott, K., Atwell, A. D., Haley, S., Esbenshade, N., & Abraham, J. (2022) · Biology of Sport · doi:10.5114/biolsport.2023.116452 · Cited by 25
Carbohydrate supplementation: A critical review of recent innovations
Baur, D. A., & Saunders, M. J. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-020-04534-y · Cited by 22
International society of sports nutrition position stand: ketogenic diets
Leaf, A., Rothschild, J. A., Sharpe, T. M., Sims, S. T., Macias, C. J., Futch, G. G., Roberts, M. D., Stout, J. R., Ormsbee, M. J., Aragon, A. A., et al. (2024) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2024.2368167 · Cited by 23
“The four other studies reported increases in fat-free mass of 0.2 [46], 0.4 [41], 0.7 [112], and 0.8 kg [36] with a ketogenic diet relative to a control diet, despite these studies’ also reporting reductions in body weight and fat mass in the ketogenic diet group relative to the control group.”
BackgroundResultInfluential
Changes in body composition and substrate utilization after a short-term ketogenic diet in endurance-trained males
McSwiney, F. T., Fusco, B., McCabe, L., Lombard, A., Crowley, P., Walsh, J., Hone, M., & Egan, B. (2020) · Biology of Sport · doi:10.5114/biolsport.2020.98448 · Cited by 20
Self-citation
The Effects of Fasting or Ketogenic Diet on Endurance Exercise Performance and Metabolism in Female Mice
Holcomb, L. E., O’Neill, C. C., DeWitt, E. A., & Kolwicz, S. C. (2021) · Metabolites · doi:10.3390/metabo11060397 · Cited by 24
Effects of the ketogenic diet on performance and body composition in athletes and trained adults: a systematic review and Bayesian multivariate multilevel meta-analysis and meta-regression
Koerich, A. C. C., Borszcz, F. K., Mello, A. T., de Lucas, R. D., & Hansen, F. (2022) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2090894 · Cited by 24
“In some NCRTs, the subjects could choose which diet they would follow (Burke et al. 2017, 2020; Kephart et al. 2018; McSwiney et al. 2018; Dostal et al. 2019; LaFountain et al. 2019).”
BackgroundMethodInfluential
A sustainability analysis of environmental impact, nutritional quality, and price among six popular diets
Bach, L. Y., Jana, B., Egwatu, C. F. A., Orndorff, C. J., Alanakrih, R., Okoro, J. C., & Gahl, M. K. (2023) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2023.1021906 · Cited by 27
“The ketogenic diet is a low-carbohydrate, moderate-protein, and high-fat diet that focuses on the consumption of meat, fatty fish, eggs, butter, cheese, nuts, healthy oils, and elimination of sugary foods, grains, starches, and alcohol (Hamdy et al., 2018; McSwiney et al., 2018; O’Neill and Raggi, 2020).”
Background
Perspective: Ketone Supplementation in Sports—Does It Work?
Valenzuela, P. L., Castillo‐García, A., Morales, J. S., & Lucía, A. (2020) · Advances in Nutrition · doi:10.1093/advances/nmaa130 · Cited by 20
Ketogenic Diet: from the Historical Records to Use in Elite Athletes
Kaspar, M. B., Austin, K. E., Huecker, M. R., & Sarav, M. (2019) · Current Nutrition Reports · doi:10.1007/s13668-019-00294-0 · Cited by 17
Body composition changes in physically active individuals consuming ketogenic diets: a systematic review
Coleman, J. L., Carrigan, C. T., & Margolis, L. M. (2021) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-021-00440-6 · Cited by 21
Physical Activity, Dietary Patterns, and Glycemic Management in Active Individuals with Type 1 Diabetes: An Online Survey
Colberg, S. R., Kannane, J., & Diawara, N. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18179332 · Cited by 23
“Many endurance athletes with and without T1D have claimed to perform well with a lower, or at least moderate, intake of this macronutrient [57,87] and to maintain a better glycemic balance [31], although the consensus remains that carbohydrates are necessary to perform well at higher intensities and durations of activ…”
Background
Metabolic adaptations to endurance training and nutrition strategies influencing performance
Earnest, C. P., Rothschild, J. A., Harnish, C., & Naderi, A. (2018) · Research in Sports Medicine · doi:10.1080/15438627.2018.1544134 · Cited by 17
“…2001; McSwiney et al., 2018; Rowlands & Hopkins, 2002); others show no change (Burke et al., 2000, 2002; Carey et al., 2001; Havemann et al., 2006; McSwiney et al., 2018) or performance decrements (Havemann et al., 2006; Helge, Richter, & Kiens, 1996; Zajac et al., 2014; Zinn,Wood,Williden,…”
Background
Application of nutrient essentiality criteria to dietary carbohydrates
Tondt, J., Yancy, W. S., & Westman, E. C. (2020) · Nutrition Research Reviews · doi:10.1017/s0954422420000050 · Cited by 19
The effect of omega3 fatty acid supplementation on PPARγ and UCP2 expressions, resting energy expenditure, and appetite in athletes
Moradi, S., Alivand, M., Khajebishak, Y., Jafarabadi, M. A., Alipour, M., Chilibeck, P. D., & Alipour, B. (2021) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-021-00266-4 · Cited by 17
The Effects of Carbohydrate versus Fat Restriction on Lipid Profiles in Highly Trained, Recreational Distance Runners: A Randomized, Cross-Over Trial
Buga, A., Welton, G. L., Scott, K., Atwell, A. D., Haley, S., Esbenshade, N., Abraham, J., Buxton, J. D., Ault, D. L., Raabe, A., et al. (2022) · Nutrients · doi:10.3390/nu14061135 · Cited by 18
“To ensure that mineral status was met for LCHF, we recommended including an additional 1–2 g/day of iodized table salt to offset the additional loss of sodium associated with a reduction in total carbohydrate intake [28].”
Method
Effects of a four-week very low-carbohydrate high-fat diet on biomarkers of inflammation: Non-randomised parallel-group study
Cipryan, L., Maffetone, P. B., Plews, D. J., & Laursen, P. B. (2020) · Nutrition and Health · doi:10.1177/0260106020903206 · Cited by 17
Affective and Enjoyment Responses to Short-Term High-Intensity Interval Training with Low-Carbohydrate Diet in Overweight Young Women
Kong, Z., Hu, M., Liu, Y., Shi, Q., Zou, L., Sun, S., Zhang, H., & Nie, J. (2020) · Nutrients · doi:10.3390/nu12020442 · Cited by 19
“We hypothesized that perceptions of HIIT may change to be more positive than MICT chronically after keto-adaption, in which the body would have shifted from glucocentric to adipocentric means of energy production, thereby accelerating fat oxidation to break through the constraint of scarcity of endogenous glucose stor…”
Background
Effects of a Very Low-Carbohydrate High-Fat Diet and High-Intensity Interval Training on Visceral Fat Deposition and Cardiorespiratory Fitness in Overfat Individuals: A Randomized Controlled Clinical Trial
Cipryan, L., Dostal, T., Litschmannová, M., Hofmann, P., Maffetone, P. B., & Laursen, P. B. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.785694 · Cited by 16
“Although carbohydrate restricted diets combined with HIIT were shown to enhance aerobic capacity in various populations (54) as well as in the obese (55), this rapid body mass reduction effect on relative V̇O2peak values is not usually considered (56).”
Background
The efficacy of a home-use metabolic device (Lumen) in response to a short-term low and high carbohydrate diet in healthy volunteers
Roberts, J., Dugdale-Duwell, D., Lillis, J. B., Pinto, J. M., Willmott, A. G. B., Yeshurun, S., Mor, M., & Souren, T. (2023) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2023.2185537 · Cited by 15
“an increase in fat oxidation) leading to improved body composition [57,58], particularly in overweight individuals [47,59], this may not necessarily confer performance benefits (e.”
Background
Bridging the gap: Evidence-based practice guidelines for sports nutritionists
Ritson, A. J., Hearris, M. A., & Bannock, L. G. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1118547 · Cited by 15
Impact of the ketogenic diet on body fat, muscle mass, and exercise performance: a review
Chung, N. (2023) · Physical Activity and Nutrition · doi:10.20463/pan.2023.0031 · Cited by 16
“McSwiney et al. 44 investigated the KD in endurance athletes over 12 weeks and conducted various performance tests, including a 100 km timed trial, a 6-second sprint, and a critical power test.”
BackgroundMethod
Effects of a Low-Carbohydrate High-Fat Diet Combined with High-Intensity Interval Training on Body Composition and Maximal Oxygen Uptake: A Systematic Review and Meta-Analysis
Hu, J., Wang, Z., Lei, B., Li, J., & Wang, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182010740 · Cited by 15
The gut microbiome as possible mediator of the beneficial effects of very low calorie ketogenic diet on type 2 diabetes and obesity: a narrative review
Defeudis, G., Rossini, M., Khazrai, Y. M., Pipicelli, A., Brucoli, G., Veneziano, M., Strollo, F., On behalf of the AMD-SID-SIEDP-Lifestyle Study Group Lazio, Bellia, A., Bitterman, O., et al. (2022) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-022-01434-2 · Cited by 15
A ketogenic diet for reducing obesity and maintaining capacity for physical activity
Murphy, E. A., & Jenkins, T. J. (2019) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000572 · Cited by 14
Keeping the beat against time: Mitochondrial fitness in the aging heart
Mendoza, A., & Karch, J. M. (2022) · Frontiers in Aging · doi:10.3389/fragi.2022.951417 · Cited by 13
“Nonetheless, there is no current consensus on whether ketosis is truly a cardioprotective mechanism to prolong cardiomyocyte life (Nilsson et al., 2016; McSwiney et al., 2018).”
Background
Low-Carbohydrate Ketogenic Diets in Male Endurance Athletes Demonstrate Different Micronutrient Contents and Changes in Corpuscular Haemoglobin over 12 Weeks
McSwiney, F. T., & Doyle, L. (2019) · Sports · doi:10.3390/sports7090201 · Cited by 12
“Baseline subject characteristics of HC and LCKD groups [3].”
BackgroundMethodResultInfluentialSelf-citation
Nutrition and Exercise Performance in Adults With Type 1 Diabetes
Colberg, S. R. (2020) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2020.05.014 · Cited by 12
The Effects of Concurrent Training Combined with Low-Carbohydrate High-Fat Ketogenic Diet on Body Composition and Aerobic Performance: A Systematic Review and Meta-Analysis
Wang, Y., Zhou, K., Wang, V., Bao, D., & Zhou, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811542 · Cited by 17
“Specifically, two studies used 100 km total time and 10 km total Time, respectively [26,32]; one only used Yo-Yo total distance [46]; one used total fatigue time [47]; one used total performance time [48].”
BackgroundMethodResultInfluential
Longer-Term Effects of the Glycaemic Index on Substrate Metabolism and Performance in Endurance Athletes
Moitzi, A. M., & König, D. (2023) · Nutrients · doi:10.3390/nu15133028 · Cited by 14
“Possible explanations for changes in VO2max include changes in oxidative metabolic processes [59,60], the production of certain metabolic byproducts [16], such as tryptophan and ammonium, or reduced energy intake [52].”
Background
Physiological Responses and Nutritional Intake during a 7-Day Treadmill Running World Record
BERGER, N. J. A., Cooley, D., Graham, M., Harrison, C., & Best, R. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17165962 · Cited by 12
Ketone body β-hydroxybutyrate-mediated histone β-hydroxybutyrylation upregulates lipolysis and attenuates metabolic syndrome
Aryal, S., Mell, B., Manandhar, I., Yeoh, B. S., Mei, X., Akinola, O. M., Ahlidja, W., & Joe, B. (2025) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00453.2025 · Cited by 12
Ketogenic Diets Are Not Beneficial for Athletic Performance
Burke, L. M., & Whitfield, J. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003344 · Cited by 12

Authors: McSwiney, F. T., Wardrop, B., Hyde, P. N., Lafountain, R. A., Volek, J. S., & Doyle, L.
Affiliations: Waterford Institute of Technology (IE)
The Ohio State University (US)
Corresponding author: Doyle, Lorna
ORCID: McSwiney, Fionn T.
Hyde, Parker N.
Lafountain, Richard A.
Volek, Jeff S.
Doyle, Lorna
Venue: Metabolism
Publisher: Elsevier BV
Published: 2018-04
Volume: 81
Pages: 25-34
ISSN: 0026-0495 (ISSN-L)
DOI: 10.1016/j.metabol.2017.10.010
OpenAlex: W2766646500
Cited by: 172
References: 45
Citations by year: 2026: 5 · 2025: 12 · 2024: 17 · 2023: 15 · 2022: 13 · 2021: 31 · 2020: 27 · 2019: 30 · 2018: 20
FWCI: 15.78
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Metabolism (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
Keywords: ketogenic diet, low-carbohydrate diet, endurance athletes, body composition, fat oxidation, beta-hydroxybutyrate, exercise performance, high-intensity interval training, resistance training, time trial performance, sprint power, critical power, carbohydrate intake, energy substrate utilization, weight loss, fat loss, well-trained athletes
MeSH terms: Adaptation, Physiological, Adult, Body Composition, Dietary Carbohydrates, Humans, Male, Physical Endurance, Exercise, Diet, Ketogenic, Athletes

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Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes

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