Cox · Cell metabolism 2016 · Randomized controlled trials · n=39

Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes.

Cited 534 times in the scientific literature.

Level 2 - randomized trial

Randomized controlled trials across five sub-studies in humans

PubMed 27475046 · doi:10.1016/j.cmet.2016.07.010 · record verified 2026-08-30

What was done

Across five separate studies involving a total of 39 high-performance athletes, researchers investigated the metabolic and endurance effects of acute nutritional ketosis induced by an exogenous ketone ester supplement without caloric or carbohydrate restriction.

What was found

The abstract reports no numerical values, effect sizes, or statistical confidence intervals. Directionally, ketone ester ingestion improved physical endurance by altering oxidative fuel selection. Ketosis decreased muscle glycolysis and plasma lactate concentrations while providing an alternative substrate for oxidative phosphorylation. It also increased intramuscular triacylglycerol oxidation during exercise, even in the presence of normal muscle glycogen, co-ingested carbohydrate, and elevated insulin.

Why it matters

This study demonstrates that exogenous ketone supplementation can acutely alter muscle substrate competition and enhance endurance performance without requiring chronic carbohydrate deprivation.

Limits

The abstract provides no numerical data, baseline metrics, or statistical significance values. The total sample size is small (39 athletes across five separate sub-studies), limited to elite performers, and does not evaluate chronic adaptation, gastrointestinal tolerance, or non-athletic populations.

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