Exogenous ketone monoester supplementation: a potential alternative strategy to mitigate altitude sickness?

This perspective article discusses whether exogenous ketone monoester (KME) could help with acute mountain sickness (AMS) at high altitude. It notes that acetazolamide, the most prescribed drug for AMS, works by inducing a renal metabolic acidosis, and that KME has been shown to increase resting ventilation at sea level and at high altitude, thought to be linked to a similar acidosis response. It also mentions preliminary evidence that KME may improve sleep architecture and efficiency at altitude. The authors outline mechanisms, knowledge gaps and future research directions.