exogenous ketones and human performance

brain health

claimed to improve brain network stability by 87%

endurance

claimed 15% boost in power output

heart health

claimed improved cardiac efficiency by 36%

weight control

claimed decreased appetite by lowering ghrelin by 17%

maintained focus

claimed improved cognitive performance by 7%

increased performance

claimed power improvements and decreased lactate production

faster recovery

claimed boosts protein synthesis

harder training

claimed improves muscle glycogen resynthesis

ketones

lipid-derived, water soluble organic compounds

• alternative fuel source produced in liver after metabolic stressors

ketone metabolism plan a

carbs, fats, protein

ketone metabolism plan b

alternative fuel source (ketone bodies)

ketone metabolism

produced by liver mitochondria using acetyl-coa → enter blood → goes to tissues, heart, brain → reconverted to acetyl-coa → produce ATP

why not just a keto diet

• restrictive

• difficult to maintain long term

• potential to limit body’s ability to perform high-intensity efforts that rely on carbs

ketone salts

BHB bound to minerals

• powders/capsules

• fast

• medium tolerance

• $30-60

ketone esters

BHB or AcAc bound to alcohol backbone

• fast

• high GI tolerance

• $120-300

ketone oils

caprylic acid or capric acid (fatty acids)

• medium chain tgs

• low onset time

• low-medium GI tolerance

• $25-70

ketone precursors

alcohol-based compounds

• 1,3 butanediol

• moderate onset time

• high GI tolerance

• $60-100

supplemental ketone market value

$23.10 billion USD (2023)

$5.7 billion USD (2025)

prior to exercise

consume one bottle ~30 min before along with carbs

prolonged exercise

consume another bottle 90 min after first

following exercise

consume one bottle within 30 min of exercising with carbs and protein

effects on performance

• mixed findings

• raises ketone levels from .5mmol/L up to 5+

• may spare muscle glycogen

• potential cognitive benefits

carbs + ketone ester throughout cycling race

• no significant performance improvements during normal cycling stages or high intensity efforts

• no impact on muscle glycogen breakdown or intramyocellular triglyceride content

brain

20% of energy at rest

• uses ketones for energy when glucose isnt readily available

  • able to cross BBB

blood glucose

decreases in low carb states

preference for ketones in low carb states

• spares protein

  • keeps lean tissues

• give more ATP per O2 molecule

• avoids blood sugar crashes

  • helps with focus and attention

• reduces oxidative stress

  • less damage to cells

  • decreased inflammation

cognition and recovery

• could provide cognitive benefits under stress, sleep deprivation, and caloric restrictions

• keto diet increased cognitive function in rats with alzheimers

• proposed to expedite recovery time after exercise

side effects and limitation

• costly

• lack of FDA reg

• GI disturbances

  • nausea/reflux

  • dizziness

• bitter taste

summary

• more research needed to fully conclude if exogenous ketones are beneficial for performance

• supplements are costly : carbs pre, during, and post would be more beneficial