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Fasting and Exercise

Fasting

General

  1. Golbidi S, Daiber A, Korac B, Li H, Essop MF, Laher I. Health Benefits of Fasting and Caloric Restriction. Curr Diab Rep. 2017;17(12):123. doi:10.1007/s11892-017-0951-7    PDF
  2. Hofer, S. et al (2021) ‘The ups and downs of caloric restriction and fasting: from molecular effects to clinical application’, EMBO Molecular Medicine, n/a(n/a), p. e14418. doi:10.15252/emmm.202114418

  3. Pietzner, M. et al. (2024) ‘Systemic proteome adaptions to 7-day complete caloric restriction in humans’, Nature Metabolism, pp. 1–14. Available at: https://doi.org/10.1038/s42255-024-01008-9. ABSTRACT

  4. Grundler, F. et al. (2024) ‘Long-Term Fasting-Induced Ketosis in 1610 Subjects: Metabolic Regulation and Safety’, Nutrients, 16(12), p. 1849. Available at: https://doi.org/10.3390/nu16121849

  5. Patterson RE, Laughlin GA, Sears DD, et al. INTERMITTENT FASTING AND HUMAN METABOLIC HEALTH. J Acad Nutr Diet. 2015;115(8):1203-1212. doi:10.1016/j.jand.2015.02.018     PDF 
  6. de Azevedo FR, Ikeoka D, Caramelli B. Effects of intermittent fasting on metabolism in men. 2013. https://core.ac.uk/reader/81965297
  7. Longo VD, Mattson MP. Fasting: Molecular Mechanisms and Clinical Applications. Cell Metab. 2014;19(2):181-192. doi:10.1016/j.cmet.2013.12.008 PDF
  8. Wilhelmi de Toledo F, Grundler F, Bergouignan A, Drinda S, Michalsen A. Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects. PLoS One. 2019;14(1). doi:10.1371/journal.pone.0209353 
  9. Heilbronn LK, Smith SR, Martin CK, Anton SD, Ravussin E. Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism. Am J Clin Nutr. 2005;81(1):69-73. doi:10.1093/ajcn/81.1.69  
  10. Stekovic S, Hofer SJ, Tripolt N, et al. Alternate Day Fasting Improves Physiological and Molecular Markers of Aging in Healthy, Non-obese Humans. Cell Metabolism. August 2019. doi:10.1016/j.cmet.2019.07.016  ABSTRACT
  11. Correia JM, Santos I, Pezarat-Correia P, Minderico C, Mendonca GV. Effects of Intermittent Fasting on Specific Exercise Performance Outcomes: A Systematic Review Including Meta-Analysis. Nutrients. 2020;12(5):1390. doi:10.3390/nu12051390

Fasting and weight loss

Systematic Reviews and Meta-Anayses

  1. Patikorn, C. et al. (2021) ‘Intermittent Fasting and Obesity-Related Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials’, JAMA Network Open, 4(12), p. e2139558. doi:10.1001/jamanetworkopen.2021.39558.
  2. Yan S, Wang C, Zhao H, et al. Effects of fasting intervention regulating anthropometric and metabolic parameters in subjects with overweight or obesity: a systematic review and meta-analysis. Food Funct. Published online April 27, 2020. doi:10.1039/D0FO00287A
  3. Harris L, Hamilton S, Azevedo LB, et al. Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2018;16(2):507-547. doi:10.11124/JBISRIR-2016-003248
  4. He S, Wang J, Zhang J, Xu J. Intermittent Versus Continuous Energy Restriction for Weight Loss and Metabolic Improvement: A Meta-Analysis and Systematic Review. Obesity. 2021;29(1):108-115. doi:https://doi.org/10.1002/oby.23023
  5. Cui Y, Cai T, Zhou Z, et al. Health Effects of Alternate-Day Fasting in Adults: A Systematic Review and Meta-Analysis. Front Nutr. 2020;7. doi:10.3389/fnut.2020.586036
  6. Cioffi I, Evangelista A, Ponzo V, et al. Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials. Journal of Translational Medicine. 2018;16(1):371. doi:10.1186/s12967-018-1748-4
  7. Bagudu K, Noreen S, Rizwan B, et al. Intermittent Fasting Effect on Weight Loss: A Systematic Review. BIOSCIENCE RESEARCH, 2021 18(1): 622-631. Online ISSN: 2218-3973  (Nice table of studies)
  8. Welton S, Minty R, O’Driscoll T, et al. Intermittent fasting and weight loss: Systematic review. Canadian Family Physician. 2020;66(2):117-125.

Trials/Studies

  1. Trepanowski JF, Kroeger CM, Barnosky A, et al. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med. 2017;177(7):930-938. doi:10.1001/jamainternmed.2017.0936 
  2. Aksungar FB, Sarıkaya M, Coskun A, Serteser M, Unsal I. Comparison of Intermittent Fasting Versus Caloric Restriction in Obese Subjects: A Two Year Follow-Up. J Nutr Health Aging. 2017;21(6):681-685. doi:10.1007/s12603-016-0786-y ABSTRACT  
  3. Catenacci VA, Pan Z, Ostendorf D, et al. A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity (Silver Spring). 2016;24(9):1874-1883. doi:10.1002/oby.21581 PDF
  4. Varady KA, Bhutani S, Klempel MC, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12:146. doi:10.1186/1475-2891-12-146  
  5. Kalam F, Gabel K, Cienfuegos S, et al. Alternate day fasting combined with a low‐carbohydrate diet for weight loss, weight maintenance, and metabolic disease risk reduction. Obes Sci Pract. 2019;5(6):531-539. doi:10.1002/osp4.367
  6. Klempel MC, Bhutani S, Fitzgibbon M, Freels S, Varady KA. Dietary and physical activity adaptations to alternate day modified fasting: implications for optimal weight loss. Nutrition Journal. 2010;9(1):35. doi:10.1186/1475-2891-9-35  
  7. Li C, Ostermann T, Hardt M, et al. Metabolic and Psychological Response to 7-Day Fasting in Obese Patients with and without Metabolic Syndrome. CMR. 2013;20(6):413-420. doi:10.1159/000353672   
  8. Klempel MC, Kroeger CM, Bhutani S, Trepanowski JF, Varady KA. Intermittent fasting combined with calorie restriction is effective for weight loss and cardio-protection in obese women. Nutrition Journal. 2012;11(1):98. doi:10.1186/1475-2891-11-98   
  9. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019;11(10):2442. doi:10.3390/nu11102442
  10. Domaszewski P, Konieczny M, Pakosz P, Bączkowicz D, Sadowska-Krępa E. Effect of a Six-Week Intermittent Fasting Intervention Program on the Composition of the Human Body in Women over 60 Years of Age. International Journal of Environmental Research and Public Health. 2020;17(11):4138. doi:10.3390/ijerph17114138

Fasting and Therapeutic Benefits

General

  1. F Y, C L, X L, et al. Effect of Epidemic Intermittent Fasting on Metabolic Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Published online February 24, 2021. doi:10.21203/rs.3.rs-214009/v1
  2. Jiang Y, Yang X, Dong C, et al. Five-day water-only fasting decreased metabolic-syndrome risk factors and increased anti-aging biomarkers without toxicity in a clinical trial of normal-weight individuals. Clinical and Translational Medicine. 2021;11(8):e502. doi:10.1002/ctm2.502

  3. Almabruk, B.A. et al. (2024) ‘The Role of Intermittent Fasting on Metabolic Syndrome: A Systematic Review and Meta-Analysis’, Cureus, 16(10), p. e71623. Available at: https://doi.org/10.7759/cureus.71623.

  4. Finnell JS, Saul BC, Goldhamer AC, Myers TR. Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting. BMC Complement Altern Med. 2018;18. doi:10.1186/s12906-018-2136-6  
  5. Mattson MP, Longo VD, Harvie M. Impact of intermittent fasting on health and disease processes. Ageing Res Rev. 2017;39:46-58. doi:10.1016/j.arr.2016.10.005  background
  6. Anton S, Moehl K, Donahoo W, et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting: Flipping the Metabolic Switch. Obesity. 2017;26. doi:10.1002/oby.22065  
  7. Toledo FW de, Buchinger A, Burggrabe H, et al. Fasting Therapy – an Expert Panel Update of the 2002 Consensus Guidelines. CMR. 2013;20(6):434-443. doi:10.1159/000357602
  8. Drinda S, Grundler F, Neumann T, et al. Effects of Periodic Fasting on Fatty Liver Index—A Prospective Observational Study. Nutrients. 2019;11(11):2601. doi:10.3390/nu11112601
  9. Eight-hour Time-restricted Feeding Improves Endocrine and Metabolic Profiles in Women With Anovulatory Polycystic Ovary Syndrome. Published online February 4, 2021. doi:10.21203/rs.3.rs-169057/v1
  10. Morales-Suarez-Varela M, Collado Sánchez E, Peraita-Costa I, Llopis-Morales A, Soriano JM. Intermittent Fasting and the Possible Benefits in Obesity, Diabetes, and Multiple Sclerosis: A Systematic Review of Randomized Clinical Trials. Nutrients. 2021;13(9):3179. doi:10.3390/nu13093179
  11. Babu S, Vaish A, Vaishya R, Agarwal A. Can intermittent fasting be helpful for knee osteoarthritis? Journal of Clinical Orthopaedics & Trauma. 2021;16:70-74. doi:10.1016/j.jcot.2020.12.020 ABSTRACT
  12. Różański, G. et al. (2022) ‘Effect of Different Types of Intermittent Fasting on Biochemical and Anthropometric Parameters among Patients with Metabolic-Associated Fatty Liver Disease (MAFLD)—A Systematic Review’, Nutrients, 14(1), p. 91. doi:10.3390/nu14010091.

Cardiovascular Disease

  1. Chair, S.Y. et al. (2022) ‘Intermittent Fasting in Weight Loss and Cardiometabolic Risk Reduction: A Randomized Controlled Trial’, Journal of Nursing Research, 30(1), p. e185. doi:10.1097/jnr.0000000000000469.
  2. Alam I, Gul R, Chong J, et al. Recurrent circadian fasting (RCF) improves blood pressure, biomarkers of cardiometabolic risk and regulates inflammation in men. Journal of Translational Medicine. 2019;17(1):272. doi:10.1186/s12967-019-2007-z
  3. Antoni R, Johnston KL, Collins AL, Robertson MD. Effects of intermittent fasting on glucose and lipid metabolism. Proceedings of the Nutrition Society. 2017;76(3):361-368. doi:10.1017/S0029665116002986 PDF   
  4. Nematy M, Alinezhad-Namaghi M, Rashed MM, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutrition Journal. 2012;11(1):69. doi:10.1186/1475-2891-11-69 
  5. Dong TA, Sandesara PB, Dhindsa DS, et al. Intermittent Fasting: A Heart Healthy Dietary Pattern? Am J Med. 2020;133(8):901-907. doi:10.1016/j.amjmed.2020.03.030
  6. Guo Y, Luo S, Ye Y, Yin S, Fan J, Xia M. Intermittent Fasting Improves Cardiometabolic Risk Factors and Alters Gut Microbiota in Metabolic Syndrome Patients. J Clin Endocrinol Metab. Published online October 6, 2020. doi:10.1210/clinem/dgaa644
  7. Maifeld A, Bartolomaeus H, Löber U, et al. Fasting alters the gut microbiome reducing blood pressure and body weight in metabolic syndrome patients. Nature Communications. 2021;12(1):1970. doi:10.1038/s41467-021-22097-0
  8. Luke K, Ferona NA, Putri HLAS, et al. THE EFFECT OF RAMADAN FASTING TO BLOOD PRESSURE IN HYPERTENSIVE PATIENTS: A META-ANALYSIS. Journal of Community Medicine and Public Health Research. 2021;2(2):53-59. doi:10.20473/jcmphr.v2i2.26821    PDF
  9. Koutouroushis, C. and Sarkar, O. (2021) ‘Role of Autophagy in Cardiovascular Disease and Aging’, Cureus, 13(11). doi:10.7759/cureus.20042.

Inflammation/Autoimmune Disease

  1. Adawi M, Damiani G, Bragazzi NL, et al. The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study. Nutrients. 2019;11(3). doi:10.3390/nu11030601
  2. Venetsanopoulou AI, Voulgari PV, Drosos AA. Fasting mimicking diets: A literature review of their impact on inflammatory arthritis. Mediterr J Rheumatol. 2020;30(4):201-206. doi:10.31138/mjr.30.4.201
  3. Tavakoli, A. et al. (2025) ‘The effects of intermittent fasting on antioxidant and inflammatory markers and liver enzymes in postmenopausal, overweight and obese women with rheumatoid arthritis: a randomized controlled trial’, Scientific Reports, 15(1), p. 2357. Available at: https://doi.org/10.1038/s41598-025-86734-0.
  4. Omar, S.I. et al. (2024) ‘The effects of Ramadan fasting on acne vulgaris: clinical, immunological, and oxidative status considerations’, Archives of Dermatological Research, 317(1), p. 97. Available at: https://doi.org/10.1007/s00403-024-03561-5.
  5. Faris “Mo’ez Al-Islam” E., Kacimi S, Al-Kurd RA, et al. Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutrition Research. 2012;32(12):947-955. doi:10.1016/j.nutres.2012.06.021 ABSTRACT
  6. Fuhrman JM, Sarter B, Calabro DJ. Brief case reports of medically supervised, water-only fasting associated with remission of autoimmune disease. Alternative therapies in health and medicine. 2002;8(4):112, 110-111. PDF

Immune Function

  1. Wilhelm C, Surendar J, Karagiannis F. Enemy or ally? Fasting as an essential regulator of immune responses. Trends Immunol. Published online April 14, 2021. doi:10.1016/j.it.2021.03.007 
  2. Ealey KN, Phillips J, Sung H-K. COVID-19 and obesity: Fighting two pandemics with intermittent fasting. Trends in Endocrinology & Metabolism. Published online June 25, 2021. doi:10.1016/j.tem.2021.06.004    PDF 
  3. Bhatti, S.I. and Mindikoglu, A.L. (2021) ‘The impact of dawn to sunset fasting on immune system and its clinical significance in Covid-19 pandemic’, Metabolism Open, p. 100162. doi:10.1016/j.metop.2021.100162.

Neurology

  1. Phillips MCL. Fasting as a Therapy in Neurological Disease. Nutrients. 2019;11(10):2501. doi:10.3390/nu11102501
  2. Ooi TC, Meramat A, Rajab NF, et al. Intermittent Fasting Enhanced the Cognitive Function in Older Adults with Mild Cognitive Impairment by Inducing Biochemical and Metabolic changes: A 3-Year Progressive Study. Nutrients. 2020;12(9):2644. doi:10.3390/nu12092644
  3. Fond G, Macgregor A, Leboyer M, Michalsen A. Fasting in mood disorders: neurobiology and effectiveness. A review of the literature. Psychiatry Research. 2013;209(3):253-258. doi:10.1016/j.psychres.2012.12.018   PDFtable
  4. Martin B, Mattson MP, Maudsley S. Caloric restriction and intermittent fasting: Two potential diets for successful brain aging. Ageing Res Rev. 2006;5(3):332-353. doi:10.1016/j.arr.2006.04.002    PDF 
  5. Morales-Suarez-Varela M, Collado Sánchez E, Peraita-Costa I, Llopis-Morales A, Soriano JM. Intermittent Fasting and the Possible Benefits in Obesity, Diabetes, and Multiple Sclerosis: A Systematic Review of Randomized Clinical Trials. Nutrients. 2021;13(9):3179. doi:10.3390/nu13093179
  6. Stapel, B. et al. (2022) ‘Impact of fasting on stress systems and depressive symptoms in patients with major depressive disorder: a cross-sectional study’, Scientific Reports, 12, p. 7642. doi:10.1038/s41598-022-11639-1.

Fasting and Type 2 Diabetes

  1. Wang X, Li Q, Liu Y, Jiang H, Chen W. Intermittent fasting versus continuous energy-restricted diet for patients with type 2 diabetes mellitus and metabolic syndrome for glycemic control: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. Published online August 12, 2021:109003. doi:10.1016/j.diabres.2021.109003 ABSTRACT
  2. Borgundvaag E, Mak J, Kramer CK. Metabolic impact of intermittent fasting in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of interventional studies. J Clin Endocrinol Metab. Published online December 15, 2020. doi:10.1210/clinem/dgaa926
  3. Albosta M, Bakke J. Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians. Clinical Diabetes and Endocrinology. 2021;7(1):3. doi:10.1186/s40842-020-00116-1
  4. Grajower MM, Horne BD. Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus. Nutrients. 2019;11(4):873. doi:10.3390/nu11040873
  5. Furmli S, Elmasry R, Ramos M, Fung J. Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. Case Reports. 2018;2018:bcr-2017-221854. doi:10.1136/bcr-2017-221854  
  6. Li C, Sadraie B, Steckhan N, et al. Effects of A One-week Fasting Therapy in Patients with Type-2 Diabetes Mellitus and Metabolic Syndrome – A Randomized Controlled Explorative Study. Exp Clin Endocrinol Diabetes. 2017;125(9):618-624. doi:10.1055/s-0043-101700 ABSTRACT
  7. Gabel K, Kroeger CM, Trepanowski JF, et al. Differential Effects of Alternate-Day Fasting Versus Daily Calorie Restriction on Insulin Resistance. Obesity. 0(0). doi:10.1002/oby.22564
  8. DiNicolantonio JJ, McCarty M. Autophagy-induced degradation of Notch1, achieved through intermittent fasting, may promote beta cell neogenesis: implications for reversal of type 2 diabetes. Open Heart. 2019;6(1):e001028. doi:10.1136/openhrt-2019-001028
  9. Lichtash C, Fung J, Ostoich KC, Ramos M. Therapeutic use of intermittent fasting and ketogenic diet as an alternative treatment for type 2 diabetes in a normal weight woman: a 14-month case study. BMJ Case Reports CP. 2020;13(7):e234223. doi: 10.1136/bcr-2019-234223
  10. Zubrzycki A, Cierpka-Kmiec K, Kmiec Z, Wronska A. The role of low-calorie diets and intermittent fasting in the treatment of obesity and type-2 diabetes. J Physiol Pharmacol. 2018;69(5). doi:10.26402/jpp.2018.5.02  

Fasting and Cancer

  1. de Groot S, Pijl H, van der Hoeven JJM, Kroep JR. Effects of short-term fasting on cancer treatment. J Exp Clin Cancer Res. 2019;38. doi:10.1186/s13046-019-1189-9      
  2. Turbitt WJ, Demark-Wahnefried W, Peterson CM, Norian LA. Targeting Glucose Metabolism to Enhance Immunotherapy: Emerging Evidence on Intermittent Fasting and Calorie Restriction Mimetics. Front Immunol. 2019;10. doi:10.3389/fimmu.2019.01402        
  3. Bauersfeld SP, Kessler CS, Wischnewsky M, et al. The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study. BMC Cancer. 2018;18. doi:10.1186/s12885-018-4353-2     
  4. Wilson RL, Kang D-W, Christopher CN, Crane TE, Dieli-Conwright CM. Fasting and Exercise in Oncology: Potential Synergism of Combined Interventions. Nutrients. 2021;13(10):3421. doi:10.3390/nu13103421
  5. Zhang J, Deng Y, Khoo BL. Fasting to enhance Cancer treatment in models: the next steps. Journal of Biomedical Science. 2020;27(1):58. doi:10.1186/s12929-020-00651-0
  6. Antunes F, Erustes AG, Costa AJ, et al. Autophagy and intermittent fasting: the connection for cancer therapy? Clinics (Sao Paulo). 2018;73. doi:10.6061/clinics/2018/e814s    
  7. Klement RJ. Fasting, Fats, and Physics: Combining Ketogenic and Radiation Therapy against Cancer. CMR. 2018;25(2):102-113. doi:10.1159/000484045    
  8. Fanale D, Maragliano R, Perez A, Russo A. Effects of Dietary Restriction on Cancer Development and Progression. In: Preedy V, Patel VB, eds. Handbook of Famine, Starvation, and Nutrient Deprivation: From Biology to Policy. Cham: Springer International Publishing; 2017:1-19. doi:10.1007/978-3-319-40007-5_72-1    
  9. Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol. 2016;2(8):1049-1055. doi:10.1001/jamaoncol.2016.0164
  10. Dorff TB, Groshen S, Garcia A, et al. Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer. 2016;16. doi:10.1186/s12885-016-2370-6 
  11. de Groot S, Vreeswijk MP, Welters MJ, et al. The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study. BMC Cancer. 2015;15. doi:10.1186/s12885-015-1663-5
  12. Zorn S, Ehret J, Schäuble R, et al. Impact of modified short-term fasting and its combination with a fasting supportive diet during chemotherapy on the incidence and severity of chemotherapy-induced toxicities in cancer patients – a controlled cross-over pilot study. BMC Cancer. 2020;20(1):578. doi:10.1186/s12885-020-07041-7
  13. Safdie FM, Dorff T, Quinn D, et al. Fasting and cancer treatment in humans: A case series report. Aging (Albany NY). 2009;1(12):988-1007. doi: 10.18632/aging.100114    
  14. Raffaghello L, Safdie F, Bianchi G, Dorff T, Fontana L, Longo VD. Fasting and differential chemotherapy protection in patients. Cell Cycle.9,22. 4474-4476. (2010) PDF
  15. Kleckner A, Reschke JE, Altman BJ, et al. A 10-hour time-restricted eating intervention to address cancer-related fatigue among cancer survivors. JCO. 2021;39(15_suppl):12109-12109. doi:10.1200/JCO.2021.39.15_suppl.12109 ABSTRACT

Time Restricted Eating

  1. Moon S, Kang J, Kim SH, et al. Beneficial Effects of Time-Restricted Eating on Metabolic Diseases: A Systemic Review and Meta-Analysis. Nutrients. 2020;12(5):1267. doi:10.3390/nu12051267
  2. Świątkiewicz I, Woźniak A, Taub PR. Time-Restricted Eating and Metabolic Syndrome: Current Status and Future Perspectives. Nutrients. 2021;13(1):221. doi:10.3390/nu13010221
  3. Pavlou, V. et al. (2023) ‘Effect of Time-Restricted Eating on Weight Loss in Adults With Type 2 Diabetes’, JAMA Network Open, 6(10), p. e2339337. Available at: https://doi.org/10.1001/jamanetworkopen.2023.39337.
  4. Che T, Yan C, Tian D, Zhang X, Liu X, Wu Z. Time-restricted feeding improves blood glucose and insulin sensitivity in overweight patients with type 2 diabetes: a randomised controlled trial. Nutr Metab (Lond). 2021;18(1):88. doi:10.1186/s12986-021-00613-9
  5. Xie, Z. et al. (2022) ‘Randomized controlled trial for time-restricted eating in healthy volunteers without obesity’, Nature Communications, 13(1), p. 1003. doi:10.1038/s41467-022-28662-5.
  6. Moro T, Tinsley G, Pacelli FQ, Marcolin G, Bianco A, Paoli A. Twelve Months of Time-restricted Eating and Resistance Training Improve Inflammatory Markers and Cardiometabolic Risk Factors. Med Sci Sports Exerc. Published online July 7, 2021. doi:10.1249/MSS.0000000000002738 ABSTRACT
  7. Christensen RAG, High S, Wharton S, et al. Sequential diets and weight loss: Including a low-carbohydrate high-fat diet with and without time-restricted feeding. Nutrition. 2021;91-92:111393. doi:10.1016/j.nut.2021.111393
  8. Chow LS, Manoogian ENC, Alvear A, et al. Time-Restricted Eating Effects on Body Composition and Metabolic Measures in Humans with Overweight: A Feasibility Study. Obesity (Silver Spring). Published online April 9, 2020. doi:10.1002/oby.22756 Secondary Analysis – Quality of Life doi:10.3390/nu13051430
  9. Kotarsky CJ, Johnson NR, Mahoney SJ, et al. Time-restricted eating and concurrent exercise training reduces fat mass and increases lean mass in overweight and obese adults. Physiological Reports. 2021;9(10):e14868. doi:https://doi.org/10.14814/phy2.14868
  10. Ravussin E, Beyl RA, Poggiogalle E, Hsia DS, Peterson CM. Early Time-Restricted Feeding Reduces Appetite and Increases Fat Oxidation But Does Not Affect Energy Expenditure in Humans. Obesity. 2019;27(8):1244-1254. doi:10.1002/oby.22518
  11. Jamshed H, Beyl RA, Della Manna DL, Yang ES, Ravussin E, Peterson CM. Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients. 2019;11(6):1234. doi:10.3390/nu11061234
  12. Chowdhury EA, Richardson JD, Tsintzas K, Thompson D, Betts JA. Effect of extended morning fasting upon ad libitum lunch intake and associated metabolic and hormonal responses in obese adults. Int J Obes (Lond). 2016;40(2):305-311. doi:10.1038/ijo.2015.154
  13. abel K, Hoddy KK, Varady KA. Safety of 8-h time restricted feeding in adults with obesity. Appl Physiol Nutr Metab. 2018;44(1):107-109. doi:10.1139/apnm-2018-0389      PDF
  14. Dote-Montero M, Sevilla-Lorente R, Merchan-Ramirez E, et al. Feasibility of Three Different 8h Time-Restricted Eating Schedules Over 4 Weeks in Spanish Adults With Overweight/Obesity: A Pilot Randomized Controlled Trial. Current Developments in Nutrition. 2021;5(Supplement_2):466-466. doi:10.1093/cdn/nzab039_002
  15. Falak Z, Xiaoyue W, Qing F. Effect of Time Restricted Feeding on Metabolic Risk and Circadian Rhythm Associated With Gut Microbiome in Healthy Males. Current Developments in Nutrition. 2021;5(Supplement_2):476-476. doi:10.1093/cdn/nzab039_012
  16. Park S-J, Yang J-W, Song Y-J. The Effect of Four Weeks Dietary Intervention with 8-Hour Time-Restricted Eating on Body Composition and Cardiometabolic Risk Factors in Young Adults. Nutrients. 2021;13(7):2164. doi:10.3390/nu13072164
  17. Nakamura K, Tajiri E, Hatamoto Y, Ando T, Shimoda S, Yoshimura E. Eating Dinner Early Improves 24-h Blood Glucose Levels and Boosts Lipid Metabolism after Breakfast the Next Day: A Randomized Cross-Over Trial. Nutrients. 2021;13(7):2424. doi:10.3390/nu13072424
  18. McAllister MJ, Gonzalez AE, Waldman HS. Time Restricted Feeding Reduces Inflammation and Cortisol Response to a Firegrounds Test in Professional Firefighters. J Occup Environ Med. 2021;63(5):441-447. doi:10.1097/JOM.0000000000002169 ABSTRACT
  19. Zhao, L. et al. (2022) ‘Time restricted eating improves glycaemic control and dampens energy-consuming pathways in human adipose tissue’, Nutrition, p. 111583. doi:10.1016/j.nut.2021.111583. ABSTRACT
  20. Kleckner A, Reschke JE, Altman BJ, et al. A 10-hour time-restricted eating intervention to address cancer-related fatigue among cancer survivors. JCO. 2021;39(15_suppl):12109-12109. doi:10.1200/JCO.2021.39.15_suppl.12109 ABSTRACT

Exercise and Diabetes

Exercise and Type 2 Diabetes

  1. Shah SZA, Karam JA, Zeb A, et al. Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Ther. Published online February 5, 2021. doi:10.1007/s13300-021-01005-1
  2. Yuing T, Lizana PA, Berral FJ, Yuing T, Lizana PA, Berral FJ. Effects of physical training in patients with type 2 diabetes mellitus: a systematic review. Revista médica de Chile. 2019;147(4):480-489. doi:10.4067/S0034-98872019000400480
  3. Aqeel M, Forster A, Richards EA, et al. The Effect of Timing of Exercise and Eating on Postprandial Response in Adults: A Systematic Review. Nutrients. 2020;12(1):221. doi:10.3390/nu12010221
  4. Myette-Côté É, Durrer C, Neudorf H, et al. The effect of a short-term low-carbohydrate, high-fat diet with or without postmeal walks on glycemic control and inflammation in type 2 diabetes: a randomized trial. Am J Physiol Regul Integr Comp Physiol. 2018;315(6):R1210-R1219. doi:10.1152/ajpregu.00240.2018
  5. Borror A, Zieff G, Battaglini C, Stoner L. The Effects of Postprandial Exercise on Glucose Control in Individuals with Type 2 Diabetes: A Systematic Review. Sports Med. 2018;48(6):1479-1491. doi:10.1007/s40279-018-0864-x ABSTRACT
  6. Francois ME, Myette-Cote E, Bammert TD, et al. Carbohydrate restriction with postmeal walking effectively mitigates postprandial hyperglycemia and improves endothelial function in type 2 diabetes. Am J Physiol Heart Circ Physiol. 2018;314(1):H105-H113. doi:10.1152/ajpheart.00524.2017
  7. Savikj M, Zierath JR. Train like an athlete: applying exercise interventions to manage type 2 diabetes. Diabetologia. 2020;63(8):1491-1499. doi:10.1007/s00125-020-05166-9
  8. Ooi TC, Mat Ludin AF, Loke SC, et al. A 16-Week Home-Based Progressive Resistance Tube Training Among Older Adults With Type-2 Diabetes Mellitus: Effect on Glycemic Control. Gerontol Geriatr Med. 2021;7:23337214211038788. doi:10.1177/23337214211038789
  9. Bellini A, Nicolò A, Bazzucchi I, Sacchetti M. Effects of Different Exercise Strategies to Improve Postprandial Glycemia in Healthy Individuals. Medicine & Science in Sports & Exercise. 2021;Publish Ahead of Print. doi:10.1249/MSS.0000000000002607 ABSTRACT

Exercise and Type 1 Diabetes

  1. Nolan J, Rush A, Kaye J. Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet. Diabet Med. June 2019. doi:10.1111/dme.14049
  2. Scott SN, Anderson L, Morton JP, Wagenmakers AJM, Riddell MC. Carbohydrate Restriction in Type 1 Diabetes: A Realistic Therapy for Improved Glycaemic Control and Athletic Performance? Nutrients. 2019;11(5):1022. doi:10.3390/nu11051022

Exercise and Carbohydrate Restriction

This is an emerging and controversial area. Individual physiology/response to carbohydrate restriction/unique demands across different sports add to the challenge of determining the best approach, especially in the elite athlete. The balance between metabolic health markers and performance goals may be less pressured for the recreational sportsman, nevertheless, self experimentation with regard to carbohydrate restriction and performance outcomes is currently the best approach. This narrative review of 5 popular diets (endurance/performance subset) illustrates the main points of discussion.

General

  1. Lee HS, Lee J. Influences of Ketogenic Diet on Body Fat Percentage, Respiratory Exchange Rate, and Total Cholesterol in Athletes: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021;18(6):2912. doi:10.3390/ijerph18062912
  2. Noakes, T.D. (2024) ‘Ketogenic Diets Are Beneficial for Athletic Performance: Response to Burke and Whitfield’, Medicine & Science in Sports & Exercise, 56(4), p. 760. Available at: https://doi.org/10.1249/MSS.0000000000003345. (Burke, L.M. and Whitfield, J. (2024) – Against)
  3. Coleman JL, Carrigan CT, Margolis LM. Body composition changes in physically active individuals consuming ketogenic diets: a systematic review. J Int Soc Sports Nutr. 2021;18:41. doi:10.1186/s12970-021-00440-6
  4. McSwiney FT, Doyle L, Plews DJ, Zinn C. Impact Of Ketogenic Diet On Athletes: Current Insights. Open Access J Sports Med. 2019;10:171-183. doi:10.2147/OAJSM.S180409
  5. Noakes, T.D. (2022) ‘What Is the Evidence That Dietary Macronutrient Composition Influences Exercise Performance? A Narrative Review’, Nutrients, 14(4), p. 862. doi:10.3390/nu14040862.
  6. Paoli A, Bianco A, Grimaldi KA. The Ketogenic Diet and Sport: A Possible Marriage? Exercise and Sport Sciences Reviews. 2015;43(3):153. doi:10.1249/JES.0000000000000050 
  7. Coleman JL, Carrigan CT, Margolis LM. Body composition changes in physically active individuals consuming ketogenic diets: a systematic review. J Int Soc Sports Nutr. 2021;18(1):41. doi:10.1186/s12970-021-00440-6
  8. Phinney SD, Horton ES, Sims EAH, Hanson JS, Danforth E, Lagrange BM. Capacity for Moderate Exercise in Obese Subjects after Adaptation to a Hypocaloric, Ketogenic Diet. J Clin Invest. 1980;66(5):1152-1161. doi:10.1172/JCI109945 PDF 
  9. Mano, Y. and Fukuda, N. (2025) ‘Effect of ketosis induced by on delayed-onset muscle soreness, inflammation and redox status: a randomized, open-label, crossover pilot study’, The Journal of Sports Medicine and Physical Fitness [Preprint]. Available at: https://doi.org/10.23736/S0022-4707.24.16137-3.
  10. Durkalec-Michalski K, Nowaczyk PM, Siedzik K. Effect of a four-week ketogenic diet on exercise metabolism in CrossFit-trained athletes. J Int Soc Sports Nutr. 2019;16(1):16. doi:10.1186/s12970-019-0284-9 
  11. O’Neal EK, Smith AF, Heatherly AJ, et al. Effects of a 3-week High-Fat-Low-Carbohydrate Diet on Lipid and Glucose Profiles in Experienced, Middle-age Male Runners. Int J Exerc Sci. 2019;12(2):786-799. PMCID: PMC6533093 
  12. Longland TM, Oikawa SY, Mitchell CJ, Devries MC, Phillips SM. Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss: a randomized trial. Am J Clin Nutr. 2016;103(3):738-746. doi:10.3945/ajcn.115.119339
  13. Creighton BC, Hyde PN, Maresh CM, Kraemer WJ, Phinney SD, Volek JS. Paradox of hypercholesterolaemia in highly trained, keto-adapted athletes. BMJ Open Sport Exerc Med. 2018;4(1):e000429. doi:10.1136/bmjsem-2018-000429 
  14. Manninen AH. Very-low-carbohydrate diets and preservation of muscle mass. Nutr Metab (Lond). 2006;3:9. doi:10.1186/1743-7075-3-9 
  15. Webster CC, van Boom KM, Armino N, et al. Reduced Glucose Tolerance and Skeletal Muscle GLUT4 and IRS1 Content in Cyclists Habituated to a Long-Term Low-Carbohydrate, High-Fat Diet. Int J Sport Nutr Exerc Metab. Published online February 28, 2020:1-8. doi:10.1123/ijsnem.2019-0359

  16. Emamdoost, S. (2024) ‘Can the ketogenic diet improve the hamstring muscle rupture? A narrative review’. Available at: https://www.jsportrs.com/article_201640_a8fcfb3c02003d10a6e4829319b41789.pdf

  17. Howard EE, Margolis LM. Intramuscular Mechanisms Mediating Adaptation to Low-Carbohydrate, High-Fat Diets during Exercise Training. Nutrients. 2020;12(9):2496. doi:10.3390/nu12092496
  18. Delli Paoli G, van de Laarschot D, Friesema ECH, et al. Short-Term, Combined Fasting and Exercise Improves Body Composition in Healthy Males. Int J Sport Nutr Exerc Metab. Published online September 30, 2020:1-10. doi:10.1123/ijsnem.2020-0058
  19. Moro T, Tinsley G, Longo G, et al. Time-restricted eating effects on performance, immune function, and body composition in elite cyclists: a randomized controlled trial. Journal of the International Society of Sports Nutrition. 2020;17(1):65. doi:10.1186/s12970-020-00396-z
  20. Paoli A, Cenci L, Pompei P, et al. Effects of Two Months of Very Low Carbohydrate Ketogenic Diet on Body Composition, Muscle Strength, Muscle Area, and Blood Parameters in Competitive Natural Body Builders. Nutrients. 2021;13(2):374. doi:10.3390/nu13020374 
  21. Durkalec-Michalski K, Nowaczyk PM, Siedzik K. Effect of a four-week ketogenic diet on exercise metabolism in CrossFit-trained athletes. J Int Soc Sports Nutr. 2019;16. doi:10.1186/s12970-019-0284-9
  22. Ratia N, Pietiläinen KH, Auranen M, et al. Modified Atkins diet modifies cardiopulmonary exercise characteristics and promotes hyperventilation in healthy subjects. Journal of Functional Foods. 2021;81:104459. doi:10.1016/j.jff.2021.104459

Endurance

  1. Gejl KD, Nybo L. Performance effects of periodized carbohydrate restriction in endurance trained athletes – a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2021;18(1):37. doi:10.1186/s12970-021-00435-3
  2. Cao J, Lei S, Wang X, Cheng S. The Effect of a Ketogenic Low-Carbohydrate, High-Fat Diet on Aerobic Capacity and Exercise Performance in Endurance Athletes: A Systematic Review and Meta-Analysis. Nutrients. 2021;13(8):2896. doi:10.3390/nu13082896

  3. Noakes, T.D. and Prins, P.J. (2025) ‘Are very high rates of exogenous carbohydrate ingestion (>90 g/hr) sufficient or indeed necessary to run a sub-2hr marathon? An analysis of the model predictions of Lukasiewicz and colleagues’, Frontiers in Nutrition, 11. Available at: https://doi.org/10.3389/fnut.2024.1507572.

  4. Prins, P.J. et al. (2025) ‘Carbohydrate Ingestion Eliminates Hypoglycemia & Improves Endurance Exercise Performance in Triathletes Adapted to Very Low & High Carbohydrate Isocaloric Diets’, American Journal of Physiology. Cell Physiology [Preprint]. Available at: https://doi.org/10.1152/ajpcell.00583.2024.

  5. Bailey CP, Hennessy E. A review of the ketogenic diet for endurance athletes: performance enhancer or placebo effect? Journal of the International Society of Sports Nutrition. 2020;17(1):33. doi:10.1186/s12970-020-00362-9
  6. Volek JS, Freidenreich DJ, Saenz C, et al. Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism. 2016;65(3):100-110. doi:10.1016/j.metabol.2015.10.028   
  7. Burke LM. Ketogenic low‐CHO, high‐fat diet: the future of elite endurance sport? J Physiol. 2021;599(3):819-843. doi:10.1113/JP278928
  8. Cox PJ, Kirk T, Ashmore T, et al. Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes. Cell Metabolism. 2016;24(2):256-268. doi:10.1016/j.cmet.2016.07.010
  9. Burke LM, Whitfield J, Heikura IA, et al. Adaptation to Low Carbohydrate High Fat diet is rapid but impairs endurance exercise metabolism and performance despite enhanced glycogen availability. The Journal of Physiology. n/a(n/a). doi:10.1113/JP280221
  10. McSwiney FT, Wardrop B, Hyde PN, Lafountain RA, Volek JS, Doyle L. Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. Metab Clin Exp. 2018;81:25-34. doi:10.1016/j.metabol.2017.10.010 ABSTRACT 
  11. Maunder E, Dulson DK, Shaw DM. Autonomic and Perceptual Responses to Induction of a Ketogenic Diet in Free-Living Endurance Athletes: A Randomized, Crossover Trial. Int J Sports Physiol Perform. Published online April 19, 2021:1-7. doi:10.1123/ijspp.2020-0814
  12. Ma S, Suzuki K. Keto-Adaptation and Endurance Exercise Capacity, Fatigue Recovery, and Exercise-Induced Muscle and Organ Damage Prevention: A Narrative Review. Sports (Basel). 2019;7(2). doi:10.3390/sports7020040 
  13. Zinn C, Wood M, Williden M, Chatterton S, Maunder E. Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes. J Int Soc Sports Nutr. 2017;14:22. doi:10.1186/s12970-017-0180-0 
  14. Volek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. European Journal of Sport Science. 2015;15(1):13-20. doi:10.1080/17461391.2014.959564 ABSTRACT
  15. Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: Preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism. 1983;32(8):769-776. doi:10.1016/0026-0495(83)90106-3 ABSTRACT
  16. Gillen JB, West DW, Williamson EP, Fung HJW, Moore DR. Low-Carbohydrate Training Increases Protein Requirements of Endurance Athletes. Med Sci Sports Exerc. May 2019. doi:10.1249/MSS.0000000000002036  ABSTRACT
  17. Shaw DM, Merien F, Braakhuis A, Maunder E, Dulson DK. Effect of a Ketogenic Diet on Submaximal Exercise Capacity and Efficiency in Runners. Med Sci Sports Exerc. April 2019. doi:10.1249/MSS.0000000000002008 ABSTRACT 
  18. Brady AJ, Langton HM, Mulligan M, Egan B. Effects of Eight Weeks of 16: 8 Time-restricted Eating in Male Middle- and Long-Distance Runners. Medicine & Science in Sports & Exercise. 2020;Publish Ahead of Print. doi:10.1249/MSS.0000000000002488
  19. Waldman HS, Heatherly AJ, Killen LG, Hollingsworth A, Koh Y, OʼNeal EK. A 3-Week, Low-Carbohydrate, High-Fat Diet Improves Multiple Serum Inflammatory Markers in Endurance-Trained Males. J Strength Cond Res. Published online August 18, 2020. doi:10.1519/JSC.0000000000003761 ABSTRACT
  20. Devrim-Lanpir A, Hill L, Knechtle B. Efficacy of Popular Diets Applied by Endurance Athletes on Sports Performance: Beneficial or Detrimental? A Narrative Review. Nutrients. 2021;13(2):491. doi:10.3390/nu13020491

Resistance Training

  1. Ashtary-Larky D, Bagheri R, Asbaghi O, et al. Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. Published online February 24, 2021:1-16. doi:10.1080/10408398.2021.1890689 ABSTRACT
  2. Valenzuela PL, Castillo-García A, Lucia A, Naclerio F. Effects of Combining a Ketogenic Diet with Resistance Training on Body Composition, Strength, and Mechanical Power in Trained Individuals: A Narrative Review. Nutrients. 2021;13(9). doi:10.3390/nu13093083
  3. Wrzosek M, Woźniak J, Włodarek D. The effect of high-fat versus high-carb diet on body composition in strength-trained males. Food Science & Nutrition. 2021.03. doi:https://doi.org/10.1002/fsn3.2204
  4. Galbreath M, Campbell B, La Bounty P, et al. Effects of Adherence to a Higher Protein Diet on Weight Loss, Markers of Health, and Functional Capacity in Older Women Participating in a Resistance-Based Exercise Program. Nutrients. 2018;10(8). doi:10.3390/nu10081070 
  5. Hadizadeh M, Gan WY, Mohafez H, Sugajima Y. Impact of Ketogenic Diet on Body Composition during Resistance Training among Untrained Individuals. The Open Sports Sciences Journal. 2020;13(1). doi:10.2174/1875399X02013010114
  6. Jabekk PT, Moe IA, Meen HD, Tomten SE, Høstmark AT. Resistance training in overweight women on a ketogenic diet conserved lean body mass while reducing body fat. Nutr Metab (Lond). 2010;7:17. doi:10.1186/1743-7075-7-17
  7. Vargas-Molina S, Petro JL, Romance R, et al. Effects of a ketogenic diet on body composition and strength in trained women. Journal of the International Society of Sports Nutrition. 2020;17(1):19. doi:10.1186/s12970-020-00348-7
  8. Keenan S, Cooke MB, Belski R. The Effects of Intermittent Fasting Combined with Resistance Training on Lean Body Mass: A Systematic Review of Human Studies. Nutrients. 2020;12(8):2349. doi:10.3390/nu12082349
  9. Kreider RB, Rasmussen C, Kerksick CM, et al. A carbohydrate-restricted diet during resistance training promotes more favorable changes in body composition and markers of health in obese women with and without insulin resistance. Phys Sportsmed. 2011;39(2):27-40. doi:10.3810/psm.2011.05.1893 ABSTRACT
  10. Waldman HS, Krings BM, Basham SA, Smith JEW, Fountain BJ, McAllister MJ. Effects of a 15-Day Low Carbohydrate, High-Fat Diet in Resistance-Trained Men. J Strength Cond Res. 2018;32(11):3103-3111. doi:10.1519/JSC.0000000000002282 ABSTRACT 
  11. Krings B, Waldman H, Shepherd BD, et al. The metabolic and performance effects of carbohydrate timing in resistance trained males undergoing a carbohydrate restricted diet. Appl Physiol Nutr Metab. Published online December 10, 2020. doi:10.1139/apnm-2020-0830 ABSTRACT
  12. Vidić V, Ilić V, Toskić L, Janković N, Ugarković D. Effects of calorie restricted low carbohydrate high fat ketogenic vs. non-ketogenic diet on strength, body-composition, hormonal and lipid profile in trained middle-aged men. Clinical Nutrition. Published online February 26, 2021. doi:10.1016/j.clnu.2021.02.028 ABSTRACT
  13. Vargas-Molina S, Carbone L, Romance R, et al. Effects of a low-carbohydrate ketogenic diet on health parameters in resistance-trained women. Eur J Appl Physiol. Published online May 18, 2021. doi:10.1007/s00421-021-04707-3 ABSTRACT
  14. Nardon, M. et al. (2022) ‘Fasting-Mimicking-Diet does not reduce skeletal muscle function in healthy young adults: a randomized control trial’, European Journal of Applied Physiology [Preprint]. doi:10.1007/s00421-021-04867-2.

Performance

  1. Vargas-Molina, S. et al. (2024) ‘Effects of the Ketogenic Diet on Strength Performance in Trained Men and Women: A Systematic Review and Meta-Analysis’, Nutrients, 16(14), p. 2200. Available at: https://doi.org/10.3390/nu16142200.

  2. Prins P, Noakes TD, Welton GL, Haley SJ, Esbenshade NJ, Adam D. Atwell AD, Scott KE, Abraham J, Raabe AS, Buxton JD, Ault DL. High Rates of Fat Oxidation Induced by a Low-Carbohydrate, High-Fat Diet, Do Not Impair 5-km Running Performance in Competitive Recreational Athletes.Journal of Sports Science and Medicine. 2019;18, 738 – 750  https://www.jssm.org/mob/mobresearch.php?id=jssm-18-738.xml. PDF
  3. Sitko S, Cirer-Sastre R, Corbi F, López Laval I. Effects of a low-carbohydrate diet on body composition and performance in road cycling: a randomized, controlled trial. Nutr Hosp. Published online 2020. doi:10.20960/nh.03103
  4. Dostal T, Plews DJ, Hofmann P, Laursen PB, Cipryan L. Effects of a 12-Week Very-Low Carbohydrate High-Fat Diet on Maximal Aerobic Capacity, High-Intensity Intermittent Exercise, and Cardiac Autonomic Regulation: Non-randomized Parallel-Group Study. Front Physiol. 2019;10. doi:10.3389/fphys.2019.00912  
  5. Cipryan L, Plews DJ, Ferretti A, Maffetone PB, Laursen PB. Effects of a 4-Week Very Low-Carbohydrate Diet on High-Intensity Interval Training Responses. J Sports Sci Med. 2018;17(2):259-268. PMCID: PMC5950743 
  6. Urbain P, Strom L, Morawski L, Wehrle A, Deibert P, Bertz H. Impact of a 6-week non-energy-restricted ketogenic diet on physical fitness, body composition and biochemical parameters in healthy adults. Nutr Metab (Lond). 2017;14:17. doi:10.1186/s12986-017-0175-5
  7. Paoli A, Grimaldi K, D’Agostino D, et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. J Int Soc Sports Nutr. 2012;9(1):34. doi:10.1186/1550-2783-9-34 
  8. Antonio Paoli A, Mancin L, Caprio M, et al. Effects of 30 days of ketogenic diet on body composition, muscle strength, muscle area, metabolism, and performance in semi-professional soccer players. Journal of the International Society of Sports Nutrition. 2021;18(1):62. doi:10.1186/s12970-021-00459-9
  9. Phinney SD. Ketogenic diets and physical performance. Nutr Metab (Lond). 2004;1:2. doi:10.1186/1743-7075-1-2 
  10. Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The Effects of a Ketogenic Diet on Exercise Metabolism and Physical Performance in Off-Road Cyclists. Nutrients. 2014;6(7):2493-2508. doi:10.3390/nu6072493 
  11. Greene DA, Varley BJ, Hartwig TB, Chapman P, Rigney M. A Low-Carbohydrate Ketogenic Diet Reduces Body Mass Without Compromising Performance in Powerlifting and Olympic Weightlifting Athletes. J Strength Cond Res. 2018;32(12):3373-3382. doi:10.1519/JSC.0000000000002904 ABSTRACT 
  12. Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: Preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism. 1983;32(8):769-776. doi:10.1016/0026-0495(83)90106-3 ABSTRACT 
  13. Michalczyk MM, Chycki J, Zajac A, Maszczyk A, Zydek G, Langfort J. Anaerobic Performance after a Low-Carbohydrate Diet (LCD) Followed by 7 Days of Carbohydrate Loading in Male Basketball Players. Nutrients. 2019;11(4). doi:10.3390/nu11040778 
  14. Whitfield J, Burke LM, McKay AKA, et al. Acute Ketogenic Diet and Ketone Ester Supplementation Impairs Race Walk Performance. Medicine & Science in Sports & Exercise. 2020;Publish Ahead of Print. doi:10.1249/MSS.0000000000002517
  15. Correia JM, Santos I, Pezarat-Correia P, Minderico C, Mendonca GV. Effects of Intermittent Fasting on Specific Exercise Performance Outcomes: A Systematic Review Including Meta-Analysis. Nutrients. 2020;12(5):1390. doi:10.3390/nu12051390
  16. Waldman HS, Smith JW, Lamberth J, Fountain BJ, McAllister MJ. A 28-Day Carbohydrate-Restricted Diet Improves Markers of Cardiometabolic Health and Performance in Professional Firefighters. J Strength Cond Res. August 2019. doi:10.1519/JSC.0000000000003354  ABSTRACT
  17. Whitfield J, Burke LM, McKay AKA, et al. Acute Ketogenic Diet and Ketone Ester Supplementation Impairs Race Walk Performance. Medicine & Science in Sports & Exercise. 2020;Publish Ahead of Print. doi:10.1249/MSS.0000000000002517
  18. Bestard MA, Rothschild JA, Crocker GH. Effect of low- and high-carbohydrate diets on swimming economy: a crossover study. J Int Soc Sports Nutr. 2020;17(1):64. doi:10.1186/s12970-020-00392-3

Exogenous Ketones in Sport

  1. Valenzuela PL, Morales JS, Castillo-García A, Lucia A. Acute Ketone Supplementation and Exercise Performance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Sports Physiol Perform. Published online February 10, 2020:1-11. doi:10.1123/ijspp.2019-0918 ABSTRACT

  2. Sun, K. et al. (2024) ‘The Effects of Ketogenic Diets and Ketone Supplements on the Aerobic Performance of Endurance Runners: A Systematic Review’, Sports Health, p. 19417381241271547. Available at: https://doi.org/10.1177/19417381241271547. ABSTRACT

  3. Margolis LM, O’Fallon KS. Utility of Ketone Supplementation to Enhance Physical Performance: A Systematic Review. Adv Nutr. doi:10.1093/advances/nmz104
  4. Prins PJ, Koutnik AP, D’Agostino DP, et al. Effects of an Exogenous Ketone Supplement on Five-Kilometer Running Performance. J Hum Kinet. 2020;72:115-127. doi:10.2478/hukin-2019-0114
  5. Poffé C, Ramaekers M, Bogaerts S, Hespel P. Exogenous ketosis impacts neither performance nor muscle glycogen breakdown in prolonged endurance exercise. J Appl Physiol. Published online May 14, 2020. doi:10.1152/japplphysiol.00092.2020 PDF
  6. Whitfield J, Burke LM, McKay AKA, et al. Acute Ketogenic Diet and Ketone Ester Supplementation Impairs Race Walk Performance. Medicine & Science in Sports & Exercise. 2020;Publish Ahead of Print. doi:10.1249/MSS.0000000000002517
  7. Jo E, Silva Ms SC, Auslander PhD AT, et al. The Effects of 10-Day Exogenous Ketone Consumption on Repeated Time Trial Running Performances: A Randomized-Control Trial. J Diet Suppl. Published online October 28, 2020:1-15. doi:10.1080/19390211.2020.1838022 ABSTRACT
  8. Prins, P.J. et al. (2021) ‘Ketone Bodies Impact on Hypoxic CO2 Retention Protocol During Exercise’, Frontiers in Physiology, 12. doi:10.3389/fphys.2021.780755.
  9. Mansor LS, Woo GH. Ketones for Post-exercise Recovery: Potential Applications and Mechanisms. Front Physiol. 2021;11. doi:10.3389/fphys.2020.613648
  10. Evans M, Cogan KE, Egan B. Metabolism of ketone bodies during exercise and training: physiological basis for exogenous supplementation. J Physiol. 2017;595(9):2857-2871. doi:10.1113/JP273185
  11. Kackley ML, Short JA, Hyde PN, et al. A Pre-Workout Supplement of Ketone Salts, Caffeine, and Amino Acids Improves High-Intensity Exercise Performance in Keto-Naïve and Keto-Adapted Individuals. Journal of the American College of Nutrition. 2020;0(0):1-11. doi:10.1080/07315724.2020.1752846
  12. Evans M, McSwiney FT, Brady AJ, Egan B. No Benefit of Ingestion of a Ketone Monoester Supplement on 10-km Running Performance. Med Sci Sports Exerc. 2019;51(12):2506-2515. doi:10.1249/MSS.0000000000002065 ABSTRACT

Military Applications

Gulf War Syndrome and PTSD can be found in the Mental Health section.

  1. Henderson, L., van den Berg, M. and Shaw, D.M. (2022) ‘The Effect of a 2-Week Ketogenic Diet, versus a Carbohydrate-Based Diet, on Cognitive Performance, Mood and Subjective Sleepiness during 36 Hours of Extended Wakefulness in Military Personnel’, Medical Sciences Forum, 9(1), p. 22. doi:10.3390/msf2022009022.
  2. Lafountain R, Hyde P, Volek J. Ketogenic Diet Potential Benefits to Warfighter Health and Performance. March 2019. PDF
  3. Stubbs BJ, Koutnik AP, Volek JS, Newman JC. From bedside to battlefield: intersection of ketone body mechanisms in geroscience with military resilience. GeroScience. Published online October 2, 2020. doi:10.1007/s11357-020-00277-y 
  4. LaFountain RA, Miller VJ, Barnhart EC, et al. Extended Ketogenic Diet and Physical Training Intervention in Military Personnel. Mil Med. March 2019. doi:10.1093/milmed/usz046 ABSTRACT
  5. Kayla-Anne Lenferna De La Motte, BSR, Grant Schofield, PhD, Helen Kilding, MSc, Caryn Zinn, PhD, RD (2021) ‘An Alternate Approach to Military Rations for Optimal Health and Performance’. doi: 10.1093/milmed/usab498/6462370. ABSTRACT
  6. Shaw, D.M., Henderson, L. and van den Berg, M. (2022) ‘Cognitive, Sleep, and Autonomic Responses to Induction of a Ketogenic Diet in Military Personnel: A Pilot Study’, Aerospace Medicine and Human Performance, 93(6), pp. 507–516. Available at: https://doi.org/10.3357/AMHP.6015.2022.  ABSTRACT

  7. Stalmans, M. et al. (2024) ‘Exogenous ketosis attenuates acute mountain sickness and mitigates normobaric high-altitude hypoxemia’, Journal of Applied Physiology (Bethesda, Md.: 1985) [Preprint]. Available at: https://doi.org/10.1152/japplphysiol.00190.2024. ABSTRACT

Updated 07.2024

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