Abstract
Ketogenic diet has been introduced in therapeutic areas for more than a century, but the role of ketones in exercise performance has only been explored in the past decade. One of the main reasons that allows the investigation of the role of ketones in exercise performance is the emergence of exogenous ketones, allowing athletes to achieve the state of ketosis acutely, and independent of their metabolic states. While there are mixed results showing either exogenous ketones improve exercise performance or no effect, the mechanisms of action are still being heavily researched. Moreover, these early data from exercise physiology studies suggested that exogenous ketones may play a more prominent role in post-exercise recovery, leading to a more pronounced cumulative impact over subsequent exercise performance. This review will look at existing evidence on the role of ketones in recovery and attempt to identify the current best practices and potential mechanisms that drive improved recovery.
Highlights
IntroductionThe impact of ketosis, induced endogenously via a ketogenic diet (Prado et al, 2011; Huang et al, 2018; Ma et al, 2018a,b) or exogenously through exogenous ketones (Cox et al, 2016; Evans and Egan, 2018; Evans et al, 2019; Poffe et al, 2020a,b) on physical performance is an active, quickly evolving area of inquiry
This was associated with a 2-fold increase in insulin concentration in the ketone monoester group compared with control group, indicating when glucose and ketones are present together after exercise, ketones may play a role in increasing insulin secretion (Beylot et al, 1986) and directly increasing activity of glucose transporter type 4 (GLUT4; Yu et al, 2016) to help cells take in more glucose for recovery and repair
The current data suggests that exogenous ketones taken after exercise in conjunction with carbohydrate and/or protein exerts an ergogenic effect in post-exercise recovery
Summary
The impact of ketosis, induced endogenously via a ketogenic diet (Prado et al, 2011; Huang et al, 2018; Ma et al, 2018a,b) or exogenously through exogenous ketones (Cox et al, 2016; Evans and Egan, 2018; Evans et al, 2019; Poffe et al, 2020a,b) on physical performance is an active, quickly evolving area of inquiry. Most studies to date have focused on probing a potential ergogenic impact of acute exogenous ketone ingestion pre-exercise. Some early animal studies showed that endogenous ketones, achieved by feeding animals with ketogenic diet, may be protective against oxidative damage and improve recovery (Huang et al, 2018; Ma et al, 2018a), there are concerns that the lack of carbohydrates in the body may hinder performance, especially in the higher intensity bouts of exercise (Cox et al, 2016). As per Randle cycle, the increase in fatty acid oxidation decreases the glucose metabolic pathway (Randle et al, 1965), and ketogenic diet upregulating fatty acid metabolism may inhibit glycolytic rates and, subsequently, the capacity to produce ATP independent of oxygen availability
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