Ketones for recovery and adaptation to exercise - the current scientific evidence π
The latest science on ketones.
Acute and Intermittent Exogenous Ketosis to Support Recovery From Exercise and Adaptations to Exercise Training: A Narrative Review
Study Details
This new review paper examined the science on exogenous ketone supplements forβ¦
π Glycogen resynthesis
πͺ Protein synthesis
π₯ Muscle damage
π€ Sleep
π§ Fluid balance
π©Έ EPO and angiogenesis
Here are the key findings β¬οΈ
Key Findings
POST-EXERCISE GLYCOGEN RESYNTHESIS π
π¬ Greater glycogen resynthesis reported in hyperglycaemic clamp studies and rodent models
π₯€ No enhancement when CHO-protein feeding was used over 3β5 h of real-world recovery
π΄ββοΈ No improvement in subsequent cycling time-trial or running time-to-exhaustion performance
β³ Unclear whether effects depend on dose, muscle fibre type, or longer recovery windows (β₯4β24 h; two-a-day sessions)
MUSCLE PROTEIN SYNTHESIS & SIGNALLING π¬
𧬠Anabolic signalling proteins activated after ketone monoester ingestion and in skeletal-muscle cell studies
π‘οΈ Ketones demonstrate anti-catabolic effects in mechanistic models
π Daily ketone monoester ingestion reduces symptoms of short-term overreaching
βοΈ No preservation of lean mass during prolonged energy restriction despite daily ingestion
β Uncertain whether post-exercise ketones enhance MPS, improve long-term adaptations, or support recovery in injury, surgery or weight-loss contexts
EXERCISE-INDUCED MUSCLE DAMAGE π₯
β No effects on soreness, muscle function, inflammation, or muscle-damage markers
β οΈ Consistent null findings with weak mechanistic rationale for further research
SLEEP QUANTITY & QUALITY π΄
π Pre-bed ketone monoester counters sleep disruption caused by late-evening intense exercise
π Effects need validation in more ecologically valid, real-world sleep environments
FLUID BALANCE π§
π₯€ Ketone monoesters consistently reduce urine output during exercise (~20β40%), indicating an antidiuretic effect
π§ Post-exercise, ketones show little to no impact on urine output or rehydration when fluid intake is controlled
π« Ketones may reduce thirst, potentially impairing rehydration when drinking is ad libitum
β It remains unclear whether ketones can improve rehydration when combined with best-practice fluid strategies
EPO & ANGIOGENESIS π©Έ
π©Έ Some studies show increased serum EPO after intermittent exogenous ketosis, though others report no change due to differences in design
β±οΈ Larger EPO responses appear when circulating Ξ²HB is elevated for β₯4β7 h post-exercise
𧬠Repeated post-exercise ketone ingestion during training has been linked with greater skeletal-muscle angiogenesis, though confounded by differences in training load and energy balance
β Unclear whether ketone-induced EPO increases are consistent, meaningful for erythropoiesis, or capable of improving endurance adaptations in athletes
Conclusion
Exogenous ketones may be useful in narrow contexts such as late-evening training that disrupts sleep or short blocks of intensified training where overreaching is likely π
However, most athletes will gain far more from optimising carb intake, protein distribution, hydration, sleep, and load management than from adding ketone supplements β
Reference
https://pubmed.ncbi.nlm.nih.gov/41231045/
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