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Utility of Ketone Supplementation to Enhance Physical Performance: A Systematic Review

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U.S. Army Research Institute of Environmental Medicine Natick

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Ingesting exogenous ketone bodies has been touted as producing ergogenic effects by altering substrate metabolism however, research findings from recent studies appear inconsistent. This systematic review aimed to aggregate data from the current literature to examine the impact of consuming ketone supplements on enhancing physical performance. A systematic search was performed for randomized controlled trials that measured physical performance outcomes in response to ingesting exogenous ketone supplements compared with a control nutritive or non-nutritive in humans. A total of 161 articles were screened. Data were extracted from 10 eligible studies 112 participants 109 men, 3 women containing 16 performance outcomes lower-body power n 8 and endurance performance n 8. Ketone supplements were grouped as ketone esters n 8 or ketone saltsprecursors n 8. Of the 16 performance outcomes identified by the systematic review, 3 reported positive, 10 reported null, and 3 reported negative effects of ketone supplementation on physical performance compared with controls. Heterogeneity was detected for lower-body power Q 40, I2 83 percent, P less than 0.01 and endurance performance Q 95, I2 93 percent, P less than 0.01 between studies. Similarly high levels of heterogeneity were detected in studies providing ketone esters Q 111, I2 93 percent, P less than 0.01, and to a lesser extent studies with ketone saltsprecursors Q 25, I2 72 percent, P less than 0.01. Heterogeneity across studies makes it difficult to conclude any benefit or detriment to consuming ketone supplements on physical performance. This systematic review discusses factors within individual studies that may contribute to discordant outcomes across investigations to elucidate if there is sufficient evidence to warrant recommendation of consuming exogenous ketone supplements to enhance physical performance.

Subject Categories:

  • Organic Chemistry
  • Personnel Management and Labor Relations
  • Food, Food Service and Nutrition

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