Acute and Intermittent Exogenous Ketosis to Support Recovery From Exercise and Adaptations to Exercise Training: A Narrative Review

This narrative review describes the rationale and proposed mechanisms for acute and intermittent exogenous ketosis, produced by ketogenic precursors such as 1,3-butanediol and medium-chain fatty acids and by ketone salts and ketone esters, on exercise recovery and training adaptation. It notes that ingestion produces a transient increase in circulating acetoacetate and beta-hydroxybutyrate lasting 1 to 2 hours. Many studies have failed to observe benefits on exercise capacity and performance, while a small number of recent studies suggest beneficial effects on recovery, sleep, overreaching and adaptation to training. The authors describe the literature as largely exploratory and in need of more human studies with ecologically valid designs.