Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future

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.

Intravenous and Oral Whole Body Ketone Dosimetry, Biodistribution, Metabolite Correction and Kinetics Studied by (R)-[1-11C]ß-Hydroxybutyrate ([11C]OHB) PET in Healthy Humans

“…[ 11 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) was trapped on a "cyanide trap" as previously reported (22), to facilitate the removal of ammonia, the presence of which would otherwise lead to hampering of the following hydrolysis step and formation of side products. ]β-hydroxybutyrate (Fig.…”

“…It is therefore unknown whether cardiac ketone metabolism can be satisfactorily determined using simple 1-or 2-tissue compartmental modeling. Finally, although various ketone ester drinks are becoming increasingly popular both to enhance athletic performance (19) and to treat patients with e.g. heart failure (20), no PET studies using oral ingestion of PET tracers have been performed.…”

Martial arts training, competition and sports nutrition: A future beneficial alliance

“…Sports supplements have grown in awareness and use exponentially over the last four decades [15,16,17]. Historically, supplements have had the earliest push to sports where strength and power have a critical role in performance, with the prime examples being football and basketball.…”

Diet and Nutraceuticals for Mental and Physical Performance in Athletes

“…Finally, the knowledge gained from emerging technological advances such as continuous glucose monitoring is likely to further fine tune carbohydrate dietary recommendations. The second paper in this supplement examines the immense interest in ingesting ketone supplements in athletic settings [ 2 ]. The recent commercial availability of ingestible exogenous ketone supplements in the form of ketone salts and ketone esters, and other ketogenic compounds, results in an acute transient increase in circulating acetoacetate and β-hydroxybutyrate levels, which has been termed “acute nutritional ketosis” or “intermittent exogenous ketosis”.…”

“…While a few studies suggested that exogenous ketone supplements may improve endurance performance, recovery, and over-reaching, most studies have failed to observe benefits of acute nutritional ketosis on performance or recovery. It is also clear that these exogenous ketone supplements are not a viable fuel for athletes engaging in intense exercise [ 2 ].…”