The ketones space continues to evolve with new interest in forms like ketone diols and BHB, interesting if not compelling science and marketing to new demographics—all cast against a somewhat inconclusive shimmer around usage and efficacy in elite sport, especially cycling.
In that elite cycling space, the elusiveness comes from few teams confirming their use despite rumors more than half of the riders in the World Tour peloton consume ketones, with some observers laying the recent surge in pro-level speeds and performance at the door of ketones.
But with little clarity around how and why top-level riders and teams use them—or how much they use and when—it’s hard to tell. Only Visma-Lease a Bike, Soudal Quick-Step, XDS Astana, and Alpecin-Deceuninck have official partnerships with ketone suppliers.
There is a trend—backed by a 2024 review—away from glucose sparing toward recovery. For athletes at least. There is also a rise in the use of alternates to ketone mono-esters like the aforementioned ketone salt BHB (Beta-hydroxybutyrate) and a proliferation of lifestyle marketing away from sports and into health outcomes like cognition, sleep, energy and mood.
Direct performance effects?
Brendan Egan, associate professor of sport and exercise physiology at Dublin City University, has conducted much ketone ester-based research over many years. In summarizing the evidential state of play he told NutraIngredients-USA, “what we have at the moment is a lack of data for what I would call a direct performance effect—recovery aside—like you might get in the case of say caffeine or carbohydrates. There’s no way you can say ketones are there yet.”
Professor Egan sees promise in research into conditions like hypoxia (low oxygen levels in bodily tissues) and cognitive health—and recovery.
Visma-Lease a Bike’s Californian ketones partner, Ketone-IQ (formerly HVMN), markets shot drinks with 5 g of BHB precursor R-1,3-Butanediol, plus 100 mg of green tea-derived caffeine and B vitamins. The drinks, typically cheaper than ketone ester products at about $5 per shot, are marketed as a “clean source of energy…Think: high-tech, non-GMO kombucha.”
BHB and the brain
Indiana-based Ketone Labs is another firm working with BHB-based formulations and claiming the form “as the brain’s best energy source” as VP of sales Bonnie Barnes told NutraIngredients-USA.
She said aside from its cognition-based marketing efforts, the firm was working with endurance athletes including ultramarathon runners where BHBs were being blended with glucose and yielding positive anecdotal results in terms of the stoking the mitochondrial energy source, ATP.
“They burn at a high level through their ATP,” she said. “They need a high level of ATP.”
Despite a dearth of clinical data for BHB, professor Egan agreed some research around ketone salts was interesting and, “producing fairly impressive changes in BHB concentrations in the blood.”
“There’ll be continued interest in innovation around some of these products and ingredients. As the BHB salts become more pure, they’re going to be potentially more useful.”
Price, dosage, claims…
All players in the space face the ongoing headwinds of upper-premium pricing that has only become more challenging in a cost-of-living crisis, coupled with an acrid taste that disgusts many, although manufacturers have worked hard to improve flavor profiles. Ketone ester products typically cost around $30 a bottle.
Some of the bigger firms in the ketone esters space like KetoneAid and Delta G maker TDeltaS have toyed with formulations and recommended dosages to bring retail prices into the reasonable realm most sports nutrition supplements exist in.
Perhaps reflecting the relatively nascent scientific base, ketones possess no health claims anywhere in the world. In the European Union, ketone esters are yet to achieve novel food approval and hence are not approved for sale in any of the bloc’s 27 nations, which includes the powerhouses of France, Italy, Spain, Belgium and the Netherlands that are the epicentre of global cycling.
Key market: peloton prerogatives
In that elite cycling space, an anti-doping group called the Mouvement Pour un Cyclisme Crédible (MPCC) comprising seven European pro cycling outfits plus the U.S.-based EF Education EasyPost, recently urged pro cycling’s Swiss-based governing body the UCI to publish its view on ketones use it said had been a “source of suspicion for many years.”
The UCI has been investigating ketone use in cycling for some years but is yet to deliver any findings, something the MPCC wants resolved.
It warns its member outfits away from ketones, citing, “health risks and the potential performance enhancement that the use of this compound could bring.”
But a UCI stance on ketones is unlikely in 2025.
In the meantime, high profile athletes like now-retired English sprinter Mark Cavendish and Belgium’s former world champion, reigning Olympic road race and time trial champion, and 2024 Tour de France podium finisher Remco Evenepoel swears by them. Soudal Quick-Step’s Evenepoel can regularly be seen chugging little bottles from the team’s Virginia-based partner brand KetoneAid.
KetoneAid owner Frank Llosa told us riders from more than half the pro peloton’s highest echelon of 18 teams were using ketones at varying levels, often in a clandestine way.
Soudal-QuickStep posted during the Tour de France that ketone esters helped its riders perform and recover better over the event’s gruelling three weeks.
“It can enhance recovery when there is really a lot of exercise—it can enhance sleep,” said the team’s doctor, Philip Jansen.
Pro team view: Ketones and performance plans
Performance nutritionist Martijn Redegeld from Dutch outfit Visma-Lease a Bike told us ketones formed part of some of its rider’s nutrition regimes, although their 2022 and 2023 Tour de France winner Jonas Vingegaard said he does not use them.
“Just like any other supplement or other performance-enhancing strategy ketones can be part of individual performance plans,” Redegeld said. “On an individual basis it will be determined whether this can provide a benefit for the specific athlete. Furthermore, its use is always strategically periodised across a season.”
Of performance outcomes, Redegeld said a “general shift in ketone use in recovery could be observed in public over the last years. The optimal dose can differ individually and will depend on several factors. However, most products contain about 25 g of ketones.”
No rider had ever reported an adverse reaction to ketone consumption, he said. The team’s riders won all three Grand Tours in 2023 (Giro d’Italia, Tour de France, Vuelta a Espana).
Has the traditional sponsorship ship sailed?
KetoneAid’s Llosa said team and athlete sponsorships could be problematic with high-cost products like ketone esters. Mirroring the divide between the performance needs and financial capacity of elite and amateur athletes, he said elite level endorsements did not always translate into boosted sales for his firm.
“I appreciate when Remco Evenepoel is in the hot seat at the Olympics time trial, and he chugs a KetoneAid on live TV and there are news stories on it, but if I look at the actual sales numbers, these kinds of events rarely lead to a blip in sales,” he said.
“Meanwhile, I can get an Instagram influencer to do a story and our sales go up 5x for three or four days. Maybe because that is more relatable to a regular consumer.”
Llosa said few amateur athletes were willing to fork out for typical elite level doses of one or two little bottles per day of its best-selling variant, KE4 (60 ml, 30 mg ketone esters, $30).
The ‘WADA-compliant’ drink is accompanied by KetoneAid’s guidance that, “Many customers consume as little as 5 ml of Ke4 daily, about $2.50 a day.”
“All researchers seem to want to max out the dosage, blow it out of the water, but more is not always better. Too much ketone ester can in fact drop blood sugar levels and impede performance,” Llosa said, cautioning, “Never take ketones for the first time during a race.”
He added that exogenous ketone supplementation could reduce other nutrition product costs for any athlete, by substituting for gels and bars, for instance.
What does ketones data actually say (and not say)?...
Dr. Chiel Poffé, assistant professor in muscle physiology, morphology and metabolism at the Universiteit Hasselt in Belgium, co-authored the above-cited review that observed the research shift toward recovery.
Referring to a growing body of data that emerged around 2012, Dr. Poffé and Dr. Ruben Robberechts wrote in the January 2024 edition of the American Journal of Physiology: Cell Physiology that, “…most research has focused on the potential of ketone supplementation to improve athletic performance via ingestion of ketones immediately before or during exercise.”
They added that, “…subsequent studies generally observed no performance improvement, and particularly not under conditions that are relevant for most athletes. However, more and more studies are reporting beneficial effects when ketones are ingested after exercise.”
“Currently the ketone companies primarily focus their advertising on exercise performance,” Dr. Poffé told us. “To me the most interesting ketone science is primarily related to its—largely unexplored—clinical potential.”
Such outcomes included sleep dysregulation, cognitive deterioration, muscle protein synthesis and rehabilitation, and mountain sickness.
Whose willing to pay for marginal gains?
Professor Egan acknowledged marginal performance benefits at the elite level might not translate to amateurs.
“It brings us back to that whole thing about professional cycling and professional sports, in that there’s a huge amount of money invested behind the scenes, and tiny percentages really matter,” he said.
“In many other sports and team sports, and amateur sports, such tiny percentages might not really matter. In terms of recovery, maybe there is something there but then the cost factor comes into play. They are so expensive they would want to have a phenomenal evidence base but that is not really the case. So they become a luxury item in that way.”
If an entrepreneur approached him, what advice would he give?
“I’d say there remain good physiological mechanisms as to why ketones will be able to do certain things that are beneficial, like recovery, for example. The question there is whether those scenarios are all too niche for it to be a successful business.”
“But there are definitely some open questions from the research point of view—and if they were to show cause and effect then there is a potential marketing tool there.”
