A review of the ketogenic diet for endurance athletes: performance enhancer or placebo effect?

Figures & data

Table 1 Descriptive results

Table 2 Study outcomes: VO₂ max and secondary outcomes. Dashes indicate that studies did not assess the specified variable(s)

Fig. 1 Flow chart depicting the literature search and review process to arrive at the final analytic sample (n = 7). Arrows pointing right indicate the number of articles excluded and for what reason

BurkeLM et al Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkersJ Physiol2017595 9 2785 2807 1:CAS:528:DC%2BC2sXis1Wqtrs%3D 28012184 5407976

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CarrAJ et al Chronic ketogenic low carbohydrate high fat diet has minimal effects on acid-base status in elite athletesNutrients201810 2 236 5852812

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HeatherlyAJ et al Effects of ad libitum low-carbohydrate high-fat dieting in middle-age male runnersMed Sci Sports Exerc201850 3 570 579 1:CAS:528:DC%2BC1cXivVaisLk%3D 29112626

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McSwineyFT et al Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletesMetabolism201881 25 34 1:CAS:528:DC%2BC2sXhvFWgsLvE 29108901

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PhinneySD et al The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidationMetabolism198332 8 769 776 1:CAS:528:DyaL3sXktlOns70%3D 6865776

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ShawDM et al Effect of a ketogenic diet on submaximal exercise capacity and efficiency in runnersMed Sci Sports Exerc201951 10 2135 2146 1:CAS:528:DC%2BC1MXhvFWksrrM 31033901

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ZinnC et al Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletesJ Int Soc Sports Nutr201714 22 28706467 5506682

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Availability of data and materials

All data analyzed in this review are included in the following published articles.

Burke, L.M., et al., Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol, 2017. 595(9): p. 2785-2807.Carr, A.J., et al., Chronic Ketogenic Low Carbohydrate High Fat Diet Has Minimal Effects on Acid-Base Status in Elite Athletes. Nutrients, 2018. 10(2).

Heatherly, A.J., et al., Effects of Ad libitum Low-Carbohydrate High-Fat Dieting in Middle-Age Male Runners. Med Sci Sports Exerc, 2018. 50(3): p. 570–579.

McSwiney, F.T., et al., Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. Metabolism, 2018. 81: p. 25–34.

Phinney, S.D., et al., The human metabolic response to chronic ketosis without caloric restriction: Preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism, 1983. 32(8): p. 769–776.

Shaw, D.M., et al., Effect of a Ketogenic Diet on Submaximal Exercise Capacity and Efficiency in Runners. Med Sci Sports Exerc, 2019. 51(10): p. 2135–2146.

Zinn, C., et al., Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes. J Int Soc Sports Nutr, 2017. 14: p. 22.