Ketones and Performance II: Post-Exercise Beneficial Effects

Last week's blog (read here: https://www.thethreshold.coach/single-post/optimizing-fitness-with-ketones-science-backed-insights) discussed the different types of ketones on the market, and its benefits during exercise looking at a well-designed double-blind placebo study.

This week we continue on that road to look at Ketone use after exercise and some of the interesting studies that have come out showing significant POTENTIAL performance benefits

Questions we will answer:

1.What is Erythropoietin (EPO)?

-Physiology of Red Blood cells and Hemoglobin

2.Acute EPO production and Ketone use

-A study recently published on the short-term use of the impact of ketones and EPO production

3.Chronic Ketone use and its impact on performance benefits

-EPO and muscle capillary density increases

-Nutritional Intervention

4.Summary

1.What is Erythropoietin (EPO)?

First some physiology

Within the cycling community, EPO is widely known for its association with boosting performance and engaging in a prohibited method known as blood doping, (the classic method involves the reinfusion of red blood cells through intravenous means). This practice typically utilizes recombinant DNA technology to stimulate the production of red blood cells in the bone marrow, leading to an increase in red blood numbers (known as hematocrit) and hemoglobin levels. The concentration of hemoglobin (Hb) is closely linked to oxygen transport (O2), a relationship quantifiable through the CaO2 equation of (Hb) x 1.34ml O2 per gram of Hb. In males, normal hemoglobin levels range from 130 to 180 grams per liter of blood; in females, the range is approximately 120 to 150 grams per liter. Refer to Figure 1 for an illustration depicting the structure of a red blood cell with its hemoglobin component.

Now we understand why red blood cells are so important, especially in endurance sports (and using oxygen to create energy). Let's look at a study that shows using ketones significantly boosts EPO production.

2.Acute EPO production and Ketone use

Let's have a look at a study published by Evans et al. 2023. that looked at the impact ketones have on EPO production

Results summarized below:

9 Cyclists (Age 25 years old, VO2max +-55)

First Lab visit: Ingestion of Ketones (0.29 g.kg