By Steve Blechman

A most recent study on June 11, 2019 in the Journal of Medicine, Science, Sports and Exercise found that exogenous ketone supplements did not improve exercise performance. This study was a double-blind, randomized crossover trial with endurance-trained runners. The researchers concluded that a ketone monoester supplement did not improve exercise performance or cognitive ability.  Over the past few years, ketogenic supplements have been hyped to improve performance, prevent fatigue, enhance lean body mass, and enhance weight loss/fat loss. Unfortunately, the research has not panned out as the hype continues! The most popular ketone supplement is beta-hydroxybutyrate (BHB) salts such as calcium BHB and sodium BHB. Ketone monoesters are more bioavailable and more efficacious than ketone salts for raising blood levels and the preferred form of ketone supplements based on the scientific research.

Most of the research, such as this study from the Journal of Applied Physiology, Nutrition and Metabolism (July 2017), shows that nutritional ketone salts can impair high-intensity exercise performance. The study, conducted at the University of British Columbia’s Okanagan campus, suggests that sports nutrition supplements that contain high doses of ketones can hurt athletic performance gravely.

Ketone supplements in the form of BHB salts and ketone esters only provide a temporary increase in blood ketone levels. Ingesting exogenous ketones may briefly interrupt your body’s natural production of ketones. BHB salts do not stimulate ketogenesis. Ketone supplementation reduces lipolysis and free fatty acids availability and may inhibit the body’s natural ability to burn its own body fat for fuel. A most recent study has shown that feeding ketone BHB supplements to healthy humans may have an undesirable effect by activating the innate immune response and increasing inflammation. If you want to get the anti-catabolic and fat-loss effects of a ketogenic diet, ketone supplements are not desirable. Also, ketone supplements such as calcium BHB are high in calcium; people on ketogenic diets are at higher risk of kidney stones. High serum calcium levels can increase the risk of kidney stones in susceptible individuals. High calcium supplementation has also been linked to an increase risk of cardiovascular disease. Ketone supplements do not build muscle, lean body mass, or enhance weight loss, fat burning or cognitive function, according to the recent research (Applied Physiology, Nutrition and Metabolism, 2018; Frontiers in Physiology, 2017). Medium-chain triglycerides (MCT) naturally increase production of ketones in the liver and stimulate ketogenesis in humans. Research has shown that MCTs do not cause feedback inhibition or reduced ketone production. MCT stimulate the body’s natural ketone generation.

Often, supplements are marketed as a way of improving athletic performance— but the data obtained from this study says something much different. Despite ketone supplement popularity, definitive scientific proof of their effectiveness is lacking! At present, there is no data available to suggest that ingestion of ketone supplements during exercise increases exercise performance. As for making the body “think” it is a constant state of starvation by increasing blood ketone levels artificially, the results of this strategy are completely unknown.

In conclusion, ketone supplements do not provide any substantial benefit to justify their cost, given the potential drawbacks, based on the latest scientific research.

References: 

1. Pinckaers PJM, Churchward-Venne TA, Bailey D et al. Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype? Sports Med (2017) 47: 383. https://doi.org/10.1007/s40279-016-0577-y

2. Trevor O’Malley, Etienne Myette-Cote, Cody Durrer, Jonathan P Little. Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males. Applied Physiology, Nutrition, and Metabolism, 2017, 42:1031-1035, https://doi.org/10.1139/apnm-2016-0641 

3. Evans Mark, McSwiney Fionn T, Brady Aidan J, Egan Brendan. No Benefit of Ingestion of a Ketone Monoester Supplement on 10-km Running Performance. Medicine & Science in Sports & Exercise: June 11, 2019 - Volume Publish Ahead of Print – Issue - p. doi: 10.1249/MSS.0000000000002065

4. Neudorf H, Durrer C, Myette‐Cote E, Makins C, O'Malley T and Little J P. (2019). Oral Ketone Supplementation Acutely Increases Markers of NLRP3 Inflammasome Activation in Human Monocytes. Mol Nutr Food Res, Accepted Author Manuscript. doi:10.1002/mnfr.201801171

5. Hunter S Waldman, Steven A Basham, Ffi G Price, JohnEric W Smith, Harish Chander, Adam C Knight, Ben M Krings, Matthew J McAllister. Exogenous ketone salts do not improve cognitive responses after a high-intensity exercise protocol in healthy college-aged males. Applied Physiology, Nutrition, and Metabolism, 2018, 43(7): 711-717, https://doi.org/10.1139/apnm-2017-0724

6. O’Malley T, Myette-Cote E, Durrer C and Little, JP. (2017). Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males. Applied Physiology, Nutrition, and Metabolism, 42(10), 1031-1035. https://doi.org/10.1139/apnm-2016-0641

7. Evans M and Egan B. (2018). Intermittent Running and Cognitive Performance after Ketone Ester Ingestion. Medicine and Science in Sports and Exercise. https://doi.org/10.1249/MSS.0000000000001700

8. Stubbs B.J, Cox PJ, Evans RD, Santer P, Miller JJ, Faull OK, Clarke K. (2017). On the Metabolism of Exogenous Ketones in Humans. Frontiers in Physiology. Retrieved from https://www.frontiersin.org/article/10.3389/fphys.2017.00848 

9. Reid IR, Gamble GD, Bolland MJ. Circulating calcium concentrations, vascular disease and mortality: a systematic review. J Intern Med 2016;279(6):524 

10. Wang L, Manson JE, Sesso HD. Calcium intake and risk of cardiovascular disease: a review of prospective studies and randomized clinical trials. Am J Cardiovasc Drugs. 2012;12(2):105-116. doi:10.2165/11595400-000000000-00000