Ketone ester research highlights insights into athletic performance

But sometimes serendipity strikes.

As it turned out, Richard Veech, whose work appeared in Ketones, The Fourth Fuel: Warburg to Krebs to Veech, the 250 Year Journey to Find the Fountain of Youth​ was the godfather of Llosa’s wife.

“He spent 40 years at the National Institutes of Health developing ketones to replicate the benefits of the ketogenic diet without changing what people eat,” Llosa said.

It was Veech’s influence that spurred Llosa in 2016 to found Virginia-based KetoneAid, one of two companies that manufacturer 'real' ketone monoesters, according to Llosa. The company’s goal is not only to help elite athletes train better but also provide a boost to the “weekend warrior,” Llosa added.

Ketones for recovery​

When the body goes into starvation mode because it doesn’t have enough carbohydrates (or glucose), it will then resort to burning its own fat reserves to make ketones, a process commonly understood as ketosis. This can occur during fasting or participating in lengthy periods of exercise.

People’s relationship with ketones are as old as time.

“So, when humans were trying to kill the woolly mammoth, they'd eat well for a week but then they wouldn't eat for a couple of weeks,” Llosa said. “Ketones were pretty much the emergency fuel source so that your brain is super sharp in order to get the next meal.”

Now, with fast food around every corner and available to many, tapping into a ketone reserve is unlikely for most people. That’s where contemporary science comes into action.

More and more elite athletes who want to augment carbohydrates see the benefits of supplementing their diets with what Llosa’s company has to offer.

Exogenously consumed ketones will put ketones directly into the bloodstream, bypassing the fat burning step that a ketogenic diet would require. Exogenous ketone monoesters, often referred to as ketone esters, are substances that can mimic the end state of ketosis where ketones appear in the blood.

Nine out of 10 cycling teams competing in the Tour de France take KetoneAid’s KE4, a ketone monoester-infused drink, Llosa said. Cyclists report it helps with their recovery when they consume a KetoneAid drink immediately after a race. In another clinical trial​ that mimicked a multi-week race where participants took ketone monoester daily for recovery, cyclists were 15% faster than a control group in the final time trial.  

In a European study​ published last summer, ketone monoester consumption might have boosted plasma dopamine levels. Recreational runners were given 25 grams of KetoneAid each hour during a run, and then the same dose five times over the next 24 hours. After 36 hours, participants didn’t experience slower visual reaction times and movement execution times as compared to the placebo group.

The researchers noted: “Oral ketone ester ingestion elevates circulating dopamine concentration during ultra-endurance exercise. This is associated with improved mental alertness.”  

KE4 in Duke basketball trial​

In the US, university researchers are exploring the impact ketones have on student athletes.

Last season, Duke University men’s basketball players participated in a ketone study conducted by the Duke Cardiovascular Performance and Innovation Lab in partnership with the Duke University Medical Center, School of Medicine and Duke University athletics.

Jeroen Molinger is senior lead clinical medical exercise physiologist at Duke University Medical Center, School of Medicine. He led the study on basketball players use of ketones. Last athletic season, Molinger said they gave players a low dose of KetoneAid's KE4, which can put the body in what is scientifically known as acute ketosis, not to be confused with fat burning ketosis.

Molinger and his team administered KetoneAid to players during the middle of the athletic season so they could compare post-game muscle recovery to earlier in the season when ketones were not used.

Like the study of Tour de France cyclists, the aim of Duke’s research, which is yet to be published, was to see how well the basketball players could recover after exercise and ketone use.

“How can you make sure they can recover well in a period of 15 hours for the next game?” Molinger said of the players. “Is muscle glycogen still depleted after the game? Is muscle not refueled?”

Ultrasound pictures were taken of players’ muscles right after each game. Active players were given ketones three hours later. The next morning, additional ultrasounds showed an increase in muscle and that their bodies had chosen ketones as a direct source of fuel over carbohydrates.

“Ketone monoester showed to enhance muscle recovery post-game significantly,” Molinger said. “I can’t give a best player a placebo anymore. Post study, they’re all taking it now in preparation for the [current] season.”

Coincidentally, the Duke University men’s basketball team won the 2023 ACC Tournament title.