How do exogenous ketones affect athletic performance?

HVMN Ketone 

There are three published studies of HVMN Ketone in athletes (total n = 59). In one study, performance in a 30 minute cycling time trial (after 60 minutes of ‘pre-fatigue’) was measured. HVMN Ketone taken along with carbohydrate improved cycling time trial performance by 2.3% compared to the same amount of calories as multiple transportable carbohydrates. Blood BHB was 3 - 5 mM in all three athlete studies.

Other effects of HVMN Ketone found in these studies included:

  • Lower levels of blood lactic acid during exercise
  • Less use of muscle glycogen during exercise
  • One study saw faster muscle glycogen resynthesis after exercise with HVMN Ketone and IV glucose. A similar study of HVMN Ketone with a carb/protein drink did NOT see this effect.
  • Increased use of stored muscle fat during exercise
  • Less muscle protein breakdown during exercise

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Other Ketone Esters

You may have seen, recently a study of ketone esters (carried out in Australia) looked at the performance effects of ketone esters taken before a 31 km cycling time trial. This study found that many of the athletes felt sick after taking the ketone ester and that their performance got worse. Why might this have been different to the results using HVMN Ketone?

  • The ketone ester used was an Acetoacetate Diester (AcAc2 ester). This is a very different compound to the BHB monoester (BHB-ester) used in HVMN Ketone
  • The AcAc2 ester contains 3 'ketone equivalents': 2x AcAc and 1x racemic butanediol. BHB-ester in HVMN Ketone contains 1x BHB and 1x D-butanediol. Because of differences between the esters, the blood BHB levels were much lower after the AcAc ester: ~1.1 mM compared to 3 - 6 mM in the study of HVMN Ketone. This is significant if the main use of ketones is as a fuel.
  • Most importantly, the AcAc2 ester had only been tried in humans a few times. There were no other published human studies of the compound. This means that the actual formulation (i.e taste, texture) of the ester had not undergone very much refinement. In the Australian study the AcAc2 ester caused every participant GI distress. This is likely to be a HUGE confounder in relation to performance, athletes are never going to do well if they feel sick! HVMN Ketone does not cause side effects like this
  • AcAc is converted to BHB by an enzyme that is reversible NAD linked and operates to achieve equilibrium. That means some AcAc is converted to BHB. This conversion USES up a co-factor called NADH. The co-factor NADH is the proton end electron donor for the electron transport chain. If you use up NADH (vs giving BHB, which generates NADH when converted to AcAc) this could negatively affect energy production in the mitochondria, and therefore performance.

Ketone Salts

There are two published studies investigating the effects of ketone salts in athletes (total n = 22). Performance over 4 minute cycling time trial and a 150 kJ ( ~10 mins) cycling time trial were compared between ketone salts (without carbohydrate) vs. carbohydrate alone. In the 4 minute trial there was no change in performance, and in the 150 kJ test performance was decreased by 7%. Blood BHB levels peaked at 0.6 and 0.8 mM in these studies.

  1. Cox, P.J., Kirk, T., Ashmore, T., Willerton, K., Evans, R., Smith, A., Murray, Andrew J., Stubbs, B., West, J., McLure, Stewart W., et al. (2016). Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes. Cell Metabolism 24, 1-13.

  2. Vandoorne, T., De Smet, S., Ramaekers, M., Van Thienen, R., De Bock, K., Clarke, K., and Hespel, P. (2017). Intake of a Ketone Ester Drink during Recovery from Exercise Promotes mTORC1 Signaling but Not Glycogen Resynthesis in Human Muscle. Front. Physiol. 8, 310.

  3. Holdsworth, D.A., Cox, P.J., Kirk, T., Stradling, H., Impey, S.G., and Clarke, K. (2017). A Ketone Ester Drink Increases Postexercise Muscle Glycogen Synthesis in Humans. Med Sci Sports Exerc.

  4. Leckey, J.J., Ross, M.L., Quod, M., Hawley, J.A., and Burke, L.M. (2017). Ketone Diester Ingestion Impairs Time-Trial Performance in Professional Cyclists. Front. Physiol. 8, 806.

  5. Youm, Y.-H., Nguyen, K.Y., Grant, R.W., Goldberg, E.L., Bodogai, M., Kim, D., D'Agostino, D., Planavsky, N., Lupfer, C., Kanneganti, T.D., et al. (2015). The ketone metabolite [beta]-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat. Med. 21, 263-269.

  6. Forsythe, C.E., Phinney, S.D., Fernandez, M.L., Quann, E.E., Wood, R.J., Bibus, D.M., Kraemer, W.J., Feinman, R.D., and Volek, J.S. (2008). Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 43, 65-77.

  7. Rodger, S., Plews, D., Laursen, P., and Driller, M. (2017). The effects of an oral β-hydroxybutyrate supplement on exercise metabolism and cycling performance.

  8. O’Malley, T., Myette-Cote, E., Durrer, C., and Little, J.P. (2017). Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males. Applied Physiology, Nutrition, and Metabolism, 1-5.

  9. Braakhuis, A.J., and Hopkins, W.G. (2015). Impact of Dietary Antioxidants on Sport Performance: A Review. Sports Medicine 45, 939-955.

  10. Stubbs, B.Cox, P.; Evans, R.; Santer, P.; Miller, J.; Faull, O.; Magor-Elliott, S.; Hiyama, S.; Stirling, M.; Clarke, K. (2017). On the metabolism of exogenous ketones in humans. Front. Physiol.

  11. Pinckaers, P.J.M., Churchward-Venne, T.A., Bailey, D., and van Loon, L.J.C. (2017). Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype? Sports Medicine 47, 383-391.

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