At the end of the study, plasma beta-hydroxybutyrate was elevated ~3-fold above fasting (to ~0.6 mM) 3 hours after ketone monoester supplementation. However, ketone supplements did not prevent a performance decline or reduce inflammation markers post-exercise. It is probably best to hold off on buying ketone supplements until further research can validate their effectiveness.
Ketone supplement benefits have been advocated to improve cognitive function, enhance fat burning, and improve performance.
Exogenous ketone supplement use has been inconclusive for performance enhancement.
The best ketone supplement is a ketone ester based product.
Ketone supplements for weight loss are a scam.
10/17 RESEARCH UPDATE; SUPPLEMENT/EXOGENOUS KETONES: NO CONCLUSIVE EVIDENCE FOR USE.
Ketones supplements are used heavily in endurance events to improve performance, increase fat burning and weight loss, and improve recovery despite inconclusive evidence that they are effective. Many people mistakenly believe that keto diets (i.e., ketogenic diets) burn more calories than similar calorie diets.
Supplemental ketones are often used with a high-fat keto diet to boost ketone levels and induce a higher state of ketosis. The sales of ketone supplements for weight loss have increased dramatically over the past few years. Many supplement companies will sell ketone ester supplements and ketone supplement drink to boost ketone levels.
How to Measure Ketones
Many people will often buy ketone test kits (i.e., ketone tests) to measure ketones in the blood/urine. The ketone bodies acetoacetate (AcAc) and β-hydroxybutyrate (β HB) have wide-ranging metabolic and molecular effects on organs such as the brain, heart, and skeletal muscle, some of which are suggestive of benefits to athletes in terms of performance and recovery. An excellent review article titled Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future examined the research on exogenous ketone research and its potential benefits and applications for sports.
Ketone bodies naturally increase with low-carbohydrate diets. However, introducing exogenous ketones can raise blood ketone levels more quickly and to a higher degree than dietary changes alone. Many dietary supplements, such as medium-chain triglycerides (MCTs), and ketone supplements, such as 1,3‑Butanediol (BD), and ketone salts, can raise ketones by ~0.3 to 1 mM; however, there is very little evidence that these supplements are effective.
There is little evidence overall for the ergogenic effects of acute ingestion of ketone salts, MCTs, and BD, as the data consistently found that these products result in very small increases in ketones.
Ketone esters supplements are much more effective in raising ketones by 3 to 6 mM. Historically, ketone esters were employed to boost the physical and cognitive capabilities of warfighters. However, their use has since evolved to enhance athletic performance. Despite the greater increase in ketones with ketone esters, most studies have shown a lack of an ergogenic effect despite greater physiological levels of ketone bodies in the blood.
KETONE DIETARY SUPPLEMENTS
Exogenous ketone supplements exhibit various physiological impacts that can boost performance. These include conserving muscle glycogen, minimizing muscle tissue breakdown, and amplifying muscle protein synthesis. Supplements are believed to serve as an alternative fuel source, potentially reducing reliance on carbohydrates and maximizing ATP generation.
Contrary to the popular belief that exogenous ketones boost lipolysis or increase fat use, research consistently indicates a decrease in lipolysis with these supplements. They might enhance muscular efficiency during workouts, resulting in a “glycogen-sparing” effect.
However, despite this potential benefit, many studies report a decline in performance during high-intensity workouts. Notably, high doses of ketones (exceeding 30 grams) often lead to gastrointestinal issues, which can hinder performance during intense exercise.
The authors of the paper concluded, “Despite having wide-ranging metabolic and molecular effects on organs such as the brain, heart, and skeletal muscle, the commercial availability of ingestible exogenous ketone supplements has led to the recent interest in ketone bodies in athletic contexts, and resurgent interest in ketone bodies in therapeutic contexts.
KETONE SUPPLEMENTS FOR WEIGHT LOSS
Despite the mechanistic bases for potential beneficial effects of exogenous ketone supplements, the evidence is overwhelmingly against exogenous ketone supplements being an ergogenic aid for athletic performance. Yet questions remain about whether there are optimal dosing strategies (especially using ketone esters), specific athletic populations, or specific exercise challenges in which acute ingestion of exogenous ketone supplements may provide a performance benefit.(8)
KETONE SUPPLEMENT BENEFITS
Only a few studies with small sample sizes have shown the ability of ketone supplements to improve performance.
BEST KETONE SUPPLEMENT
The supplement realm is notorious for promoting products without substantial evidence, making grandiose claims about increased strength, muscle growth, fat reduction, and enhanced athletic performance. Ketone supplements, in particular, have been promoted as enhancers of athletic performance. The body naturally generates beta-hydroxybutyrate, a type of ketone, in situations such as carbohydrate restriction, extended fasting, or long-duration exercises that exhaust glycogen reserves. (1)
Follow-up studies involving intravenous ketones have indicated a decrease in muscle tissue breakdown, an uptick in increased muscle protein synthesis, and a reduction in muscle inflammation. (2-4) Additionally, some research has shown that exogenous ketones can diminish inflammatory cytokines. (5) The curbing of inflammation might aid in post-exercise recovery, suggesting that exogenous ketones could potentially enhance athletic performance.
KETONE ESTER SUPPLEMENT
Researchers had 16 healthy subjects perform an intense bout of eccentric exercise and documented recovery and inflammation responses with and without exogenous ketone supplementation. Participants performed 300 (10 sets of 30 repetitions) voluntary maximal, eccentric contractions of the knee extensors.
The protocol was shown to negatively affect muscle function and initiate inflammatory signaling in skeletal muscle within a 24-hour period.(6)
During the study, participants consumed either a ketone ester or a placebo drink three times daily, starting on the day of the eccentric contractions and continuing for the subsequent two days. They took the ketone drinks immediately after the eccentric contractions, then after functional tests at three and six hours post-exercise on the fourth day, and at the same intervals on days five and six. This totaled nine drinks, designed to elevate blood beta-hydroxybutyrate levels throughout the waking recovery hours, while staying within the safety and tolerability limits of the ketone drink.
Blood samples were taken at the beginning of the study, then at 3, 6, 24, 48, and 72 hours post-eccentric contractions. These samples were analyzed for plasma ketone concentrations and circulating inflammatory cytokines.
The results showed that, three hours after consuming the ketone monoester drink, plasma beta-hydroxybutyrate levels had risen to approximately three times the fasting level, reaching around 0.6 mM.
However, ketone supplements did not prevent a performance decline or reduce inflammation markers post-exercise.(7) It is best to hold off on buying ketone supplements until further research can validate their effectiveness.
3. Vandoorne T, De Smet S, Ramaekers M, Van Thienen R, De Bock K, Clarke K, et al. Intake of a Ketone Ester Drink during Recovery from Exercise Promotes mTORC1 Signaling but Not Glycogen Resynthesis in Human Muscle. Front Physiol. 2017;8:310.
4. Thomsen HH, Rittig N, Johannsen M, Møller AB, Jørgensen JO, Jessen N, et al. Effects of 3-hydroxybutyrate and free fatty acids on muscle protein kinetics and signaling during LPS-induced inflammation in humans: anticatabolic impact of ketone bodies. Am J Clin Nutr. 2018;108(4):857-67.
5. Bae HR, Kim DH, Park MH, Lee B, Kim MJ, Lee EK, et al. β-Hydroxybutyrate suppresses inflammasome formation by ameliorating endoplasmic reticulum stress via AMPK activation. Oncotarget. 2016;7(41):66444-54.
6. Jameson TSO, Pavis GF, Dirks ML, Lee BP, Abdelrahman DR, Murton AJ, et al. Reducing NF-κB Signaling Nutritionally is Associated with Expedited Recovery of Skeletal Muscle Function After Damage. J Clin Endocrinol Metab. 2021;106(7):2057-76.
7. Jameson TSO, Islam H, Wall BT, Little JP, Stephens FB. Oral ketone monoester supplementation does not accelerate recovery of muscle force or modulate circulating cytokine concentrations after muscle-damaging eccentric exercise in healthy males and females. Exp Physiol. 2022.