A Low Carbohydrate Ketogenic Diet Reduces Body.10
A Low Carbohydrate Ketogenic Diet Reduces Body.10
ATHLETES
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W
optimum power-to-weight ratio. There is evidence that low car-
eight class sports require athletes to maximize
bohydrate diets might offer specific advantages for weight performance while carefully controlling body
reduction without the negative impact on strength and power weight to compete in a specific weight class
previously hypothesized to accompany carbohydrate restric- with an optimum power-to-weight ratio.
tion. Therefore, the purpose of this study was to determine Competing at the upper-end of a weight class is advanta-
whether a low-carbohydrate ketogenic diet (LCKD) could be geous, and most athletes therefore aim to transiently reduce
used as a weight reduction strategy for athletes competing in body weight to make weight for competition. Targeted
the weight class sports of powerlifting and Olympic weightlift- weight reduction can be accomplished by energy deficit
ing. Fourteen intermediate to elite competitive lifting athletes (34), but rapid weight loss strategies are also frequently used
(age 34 6 10.5, n = 5 female) consumed an ad libitum usual (15). Reducing weight is challenging, and weight-making
diet (UD) (.250 g daily intake of carbohydrates) and an ad strategies are not always effective for all athletes. Weight-
libitum LCKD (#50 g or #10% daily intake of carbohydrates) making strategies can also result in impaired performance
in random order, each for 3 months in a crossover design. (40), compromised lean body mass (LBM (12)), and delete-
Lifting performance, body composition, resting metabolic rate, rious health outcomes (10,15). Strategies that allow athletes
blood glucose, and blood electrolytes were measured at base- to effectively reduce body weight without compromising
line, 3 months, and 6 months. The LCKD phase resulted in health or performance are therefore of importance.
significantly lower body mass (23.26 kg, p = 0.038) and lean Recent studies in athletic and nonathletic populations
have shown weight loss without energy restriction using
mass (22.26 kg, p = 0.016) compared with the UD phase.
diets that reduce carbohydrate and increase fat intake
Lean mass losses were not reflected in lifting performances
(1,20,26,31,36,41). There is also some evidence that weight
that were not different between dietary phases. No other differ-
loss arises from reductions in fat mass with a concomitant
ences in primary or secondary outcome measures were found preservation of lean mass (3,26,38,41). Low-carbohydrate,
between dietary phases. Weight class athletes consuming an high-fat diets might therefore be a useful weight-making
ad libitum LCKD decreased body mass and achieved lifting strategy for athletes competing in weight class sports. How-
performances that were comparable with their UD. Coaches ever, before such dietary strategies could be recommended,
they would need to also demonstrate that they do not com-
promise performance. The impact of low-carbohydrate,
Address correspondence to David A. Greene, [email protected]. high-fat diets on athletic performance has been explored in
32(12)/3373–3382 a number of studies (20,26,41). Most studies have investi-
Journal of Strength and Conditioning Research gated aerobic performances in endurance-based sports.
Ó 2018 National Strength and Conditioning Association However, a few recent studies have examined the effects of
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Ketogenic Diet Reduces Body Mass, Not Performance
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Figure 1. CONSORT flow diagram. LCKD = low-carbohydrate ketogenic diet; UD = usual diet.
low-carbohydrate, high-fat diets on strength and power. Little is known about the mechanisms underlying weight
Sawyer et al. (31) showed maintenance in strength and reduction and body composition changes during LCKD.
power after short-term (7 days) carbohydrate restriction in Altering macronutrient intake could affect body weight
resistance training men and women. In resistance training through changes in fluid and fuel storage. Transitioning to an
men, increases in strength and power were comparable LCKD reduces fluid retention (25,29) and stored glycogen (16)
between an 8-week low-carbohydrate, ketogenic diet that would both contribute to reductions in weight. However,
(LCKD) group and a group consuming a high- the reductions in weight associated with these initial adapta-
carbohydrate, western diet (41). Paoli et al. (26) reported tions to LCKD are modest, and additional factors seem likely.
a preservation of strength in elite gymnasts after a 4-week An LCKD alter the efficiency of metabolic pathways (11), pro-
ketogenic diet. Collectively, these studies suggest that a low- mote the oxidation of fatty acids (37,39), and could alter resting
carbohydrate, high-fat diet or LCKD might be useful for and exercising energy expenditure (8), but additional studies are
reducing body weight without compromising strength and needed to better understand the contribution of these mecha-
power. However, with the exception of the study by Paoli nisms to weight loss during LCKD.
et al. (26), previous studies have used recreational athletes. The role of altered skeletal muscle metabolism during LCKD
Therefore, the efficacy of LCKD for performance and body and the impact on training, adaptation, and performance are
composition among athletes competing in weight class also unclear. Currently, sports dietary guidelines for strength
sports that require maximal strength and power remains and power performance emphasize a high-carbohydrate intake.
underexplored. This is related to concerns of the impact of glycogen depletion
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UD LCKD
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Ketogenic Diet Reduces Body Mass, Not Performance
Training sessions$wk 21 4.2 1.5 4.3 1.2 0.696 phase. Diets were prescriptive with
Training mins$wk21 324 116 332 98 0.630 regards to carbohydrate intake but
Training load 2003 705 2089 735 0.587 were ad libitum for total calories.
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Baseline UD LCKD
*UD = usual diet; LCKD = low-carbohydrate ketogenic diet; 1RM = 1 repetition maximum; RMR = resting metabolic rate;
RQ = respiratory quotient; CI = confidence interval.
†Values are presented as mean (95% CI) for 12 participants.
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LCKD phase, subjects crossing over to UD were instructed Lifting Performance. One repetition maximum (1RM) was
to ensure they consumed .250 g daily intake of carbohy- used as the primary performance variable. After a self-
drates. This amount of carbohydrate was a conservative es- selected warm-up, subjects performed either one or all of
timate based on the usual carbohydrate intake of subjects their competition lifts: snatch and clean and jerk (Olympic
during the UD phase. weightlifting), squat, bench press, and deadlift (power-
Total daily energy intake and macronutrient and lifting). Subjects self-selected the lifts for performance
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micronutrient composition were self-reported through the testing. This approach was used to minimize the learning
online smartphone application, MyFitnessPal. Researchers effect that would have occurred if subjects were required
administrated subject’s MyFitnessPal user accounts and to perform unfamiliar lifts. We believe this is the optimal
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therefore had the ability to assess and modify the subject’s method for assessing performance among well-trained
macronutrient and micronutrient intake throughout the athletes. Lifting performances were assessed in a weight-
intervention. MyFitnessPal has previously been used in clin- lifting facility using international competition standard
ical trials to track dietary intake (17). Subjects used digital bars and plates (Eleiko, Halmstad, Sweden) under the
kitchen scales to measure food portions for total energy supervision of a researcher qualified to officiate power-
intake estimates. Subjects in this study were experienced at lifting and Olympic weightlifting competitions. Perfor-
monitoring energy intake and macronutrient composition mance testing mimicked a competition environment with
because they were accustomed to doing this as part of their calls to time to completion. Highest lifts were used for
analysis. Athletes and researchers relied on established
usual practices in their respective weight class sports.
personal best lifting performances to gauge the reproduc-
ibility of lifting performances during research testing. All
Training. Being competitive athletes, subjects had varying subjects knew their personal best lifting performances that
individual training and competition schedules during the could be verified from competition records.
study period. Subjects were instructed to maintain their
normal training during both dietary phases of the study and
Body Composition. Body mass was measured using electronic
continued to compete according to their normal competi-
scales (SECA 813; Hamburg, Germany, 6 0.1 kg). Whole-
tion schedule. Consequently, subjects were in various phases body composition and estimates of fat and lean mass were
of their training cycle throughout the study. Because measured using dual-energy X-ray absorptiometry (DXA;
standardizing the competition and training schedule was Medilink Medix DR, 2D-Fan beam, Montpellier, France).
not possible or desirable, we ensured that athletes’ compet- Post-test analysis was performed using manufacturer soft-
itions did not coincide with the baseline, 3-month, and 6- ware (Medilink-Eazix Software). The coefficient of variation
month research testing. This was accomplished by altering (CV%) in our laboratory was obtained after the scanning of 9
either the research start date or negotiating changes to healthy university students twice, following repositioning.
individual athletes competition schedules. Therefore, Whole-body CV (%) was 1.3 for lean mass and 1.5 for fat
although training cycles varied during the study period, no mass.
athletes engaged in any other form of weight-reducing
strategy within 2 weeks of research testing. Subjects Resting Energy Expenditure and Fuel Utilization. Resting
recorded the quality and quantity of training undertaken in metabolic rate was estimated by indirect calorimetry using
both study phases by reporting training session frequency, breath-by-breath gas analysis with a ventilated hood canopy
duration, and intensity using a 10-point scale. (QUARK CPET; COSMED, Rome, Italy). After 30 minutes
TABLE 4. Post hoc pairwise comparisons with Bonferroni adjustment for outcomes with main effects.*†
Adjusted within-subject
factors Mean difference SE 95% CI p Partial p2
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Ketogenic Diet Reduces Body Mass, Not Performance
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Figure 2. Change in (A) total body mass in kg, (B) lean mass in kg, (C) fat mass in kg, (D) power-to-mass ratio in %, and (E) lifting performance in % during the
2 dietary phases. Changes are relative to baseline measurements. Solid bars indicate mean group change. Connected dots indicate individual changes. Total
body mass (p = 0.038) and lean mass (p = 0.016) were significantly different in the 2 diets. Power-to-mass ratio = lifting performance (kg)/body mass (kg); UD =
usual diet; LCKD = low-carbohydrate ketogenic diet.
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of rest in a supine position, expired gases were measured in (4). Two subjects were excluded from RMR analysis because
awake subjects for 20 minutes. Room temperature was their tests exceeded the maximum CV for gas variables. All
thermoneutral, between 22 and 258 C, and lights were statistical analyses were performed using IBM SPSS Statistics
dimmed. The first 5 minutes of data were discarded, and (V.24.0 for Windows).
a CV of ,10% for oxygen (V_ O2) and carbon dioxide (V_ CO2)
was set as the criteria for a test to be accepted as valid, as per RESULTS
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standard practice for RMR measurement (5). V_ O2 and V_ CO2 There were significant differences in carbohydrate
were used to calculate respiratory quotient (RQ) to deter- (p = 0.001) and fat (p = 0.001) intake during LCKD com-
mine resting fuel utilization. pared to UD with no differences in total energy intake or
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Ketogenic Diet Reduces Body Mass, Not Performance
losses, the mass loss experienced by most subjects in this mates of the distribution of water between intracellular and
study was greater than expected based on subjects’ energy extracellular compartments (32), which are perturbed during
intake and energy expenditure. Greater than expected mass carbohydrate restriction. This has limited our interpretation of
loss during ad libitum LCKD has previously been reported. the LBM losses observed in this study. A 4-compartment
For a recent review, see Noakes et al. (23). A reduced energy model of body composition such as that used by Wilson
intake as a result of a greater satiating effect of LCKD has et al. (42) could account for changes in total body water and
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previously been proposed as a mechanism contributing to would be a superior approach for assessing the impact of
weight loss during LCKD (13). However, in this study, sub- LCKD on body composition. Additional studies are needed
jects’ reported energy intakes were similar during the 2 die- to determine the effect of LCKD on LBM in resistance-trained
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a fuel during endurance exercise (30,37), but the role of ke- are not universally effective for reducing weight and can be
tones as a fuel during resistance exercise is unknown. In this associated with a number of negative side effects. In this
study, there was some evidence of a shift in fuel utilization study, a 12-week ad libitum LCKD resulted in practically
during LCKD, but the findings were not clear. There was meaningful reductions in body weight without compromis-
a trend toward greater fat oxidation at rest during LCKD, ing training or performance and therefore seems safe and
but differences were not significant. Fasting blood ketones suitable to resistance trained athletes who desire lower body
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(b-hydroxybutyrate) during LCKD were elevated mass. We have thus demonstrated an alternate weight-
(mean = 0.4 mmol$L21; range 0.2–1.7) to levels comparable making strategy for weight class athletes involved in power-
with previous studies of very low dietary carbohydrate diets lifting and Olympic weightlifting. An LCKD might also be
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(39,43), but in some individual subjects, ketone levels did not applicable to other popular weight class sports including
rise beyond levels expected during normal carbohydrate combat sports, but this needs to be explored in future studies.
availability. Therefore, the role of altered fuel utilization in Coaches and athletes should consider using an LCKD to
this study is unclear. achieve targeted weight reduction goals in favor of either
This study provides an important first step in informing energy restriction or rapid weight loss strategies.
evidence-based dietary approaches for weight class lifting
athletes. Implementing dietary interventions in a real-world ACKNOWLEDGMENTS
setting presents a number of challenges. To overcome some This project was not funded by any company or manufac-
of these challenges, subjects in this study were prescribed ad turer. The results of this study do not constitute endorse-
libitum diets in both dietary phases that differed only in the ment by the authors or the National Strength and
relative proportions of macronutrients and were specifically Conditioning Association. No authors have any competing
instructed to not engage in energy restriction. Underreport- interests to declare. The authors thank K. Urban and J.
ing energy intake, a major challenge in energy restriction Raubenheimer for their statistical advice.
(33), was therefore largely eliminated and thus overcame
some of the limitations of self-reporting of dietary intake.
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