ArticleSports medicine (Auckland, N.Z.)2020
Exogenous Ketone Supplementation and Keto-Adaptation for Endurance Performance: Disentangling the Effects of Two Distinct Metabolic States.
Article in Sports medicine (Auckland, N.Z.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Symptoms during initiation of a ketogenic diet: a scoping review of occurrence rates, mechanisms and relief strategies.Frontiers in nutrition · 2025Pooled it
- Body composition changes in physically active individuals consuming ketogenic diets: a systematic review.Journal of the International Society of Sports Nutrition · 2021Pooled it
- Do Lower-Carbohydrate Diets Increase Total Energy Expenditure? An Updated and Reanalyzed Meta-Analysis of 29 Controlled-Feeding Studies.The Journal of nutrition · 2021Pooled it
- Substrate Oxidation Does Not Influence Middle Distance Running Performance: A Randomized Controlled Crossover Trial.Nutrients · 2025Trial
- Natural killer cell subset count and antigen-stimulated activation in response to exhaustive running following adaptation to a ketogenic diet.Experimental physiology · 2023Trial
- Effects of a Ketogenic Diet on Muscle Fatigue in Healthy, Young, Normal-Weight Women: A Randomized Controlled Feeding Trial.Nutrients · 2020Trial
- Trial
- A Randomized Open-Label, Observational Study of the Novel Ketone Ester, Bis Octanoyl (R)-1,3-Butanediol, and Its Acute Effect on ß-Hydroxybutyrate and Glucose Concentrations in Healthy Older Adults.Journal of nutrition in gerontology and geriatricsTrial
- The Biochemical Role of Bitter Melon (Food science & nutrition · 2026Article
- Nutrition meets nephrology in head and neck cancer: the predictive impact of body composition on the onset of acute kidney disease.Frontiers in oncology · 2026Article
- Pharmacokinetics and metabolic effects of ketone monoester supplementation: The first simultaneous CKM and CGM study under normal diet and activities.Metabolism open · 2025Article
- Ketone body supplementation in keto-adapted mice reveals metabolic adaptations and glycogen-independent exercise capacity.Physiological reports · 2025Article
- Ketone body β-hydroxybutyrate-mediated histone β-hydroxybutyrylation upregulates lipolysis and attenuates metabolic syndrome.American journal of physiology. Cell physiology · 2025Article
- Article
- International society of sports nutrition position stand: ketogenic diets.Journal of the International Society of Sports Nutrition · 2024Review
- A randomized open-label, observational study of the novel ketone ester, bis octanoyl (R)-1,3-butanediol, and its acute effect on ß-hydroxybutyrate and glucose concentrations in healthy older adults.medRxiv : the preprint server for health sciences · 2024Article
- High-fat ketogenic diets and ketone monoester supplements differentially affect substrate metabolism during aerobic exercise.American journal of physiology. Cell physiology · 2023Review
- β-hydroxybutyrate administration improves liver injury and metabolic abnormality in postnatal growth retardation piglets.Frontiers in veterinary science · 2023Article
- Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future.Sports medicine (Auckland, N.Z.) · 2022Review
- Mechanism of reduced muscle atrophy via ketone body (D)-3-hydroxybutyrate.Cell & bioscience · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Ketone bodies (KB) provide an alternative energy source and uniquely modulate substrate metabolism during endurance exercise. Nutritional ketosis (blood KBs > 0.5 mM) can be achieved within minutes via exogenous ketone supplementation or days-to-weeks via conforming to a very low-carbohydrate, ketogenic diet (KD). In contrast to short-term (< 2 weeks) KD ingestion, chronic adherence (> 3 weeks) leads to a state of keto-adaptation. However, despite elevating blood KBs to similar concentrations, exogenous ketone supplementation and keto-adaptation are not similar metabolic states as they elicit diverse and distinct effects on substrate availability and metabolism during exercise; meaning that their influence on endurance exercise performance is different. In contrast to contemporary, high(er)-carbohydrate fuelling strategies, inducing nutritional ketosis is rarely ergogenic irrespective of origin and, in fact, can impair endurance performance. Nonetheless, exogenous ketone supplementation and keto-adaptation possess utility for select endurance events and individuals, thus warranting further research into their performance effects and potential strategies for their optimisation. It is critical, however, that future research considers the limitations of measuring blood KB concentrations and their utilisation, and assess the effect of nutritional ketosis on performance using exercise protocols reflective of real-world competition. Furthermore, to reliably assess the effects of keto-adaptation, rigorous dietary-training controls of sufficient duration should be prioritised.
Indexed as
Identifiers
31820376What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.