Ketogenic Endurance Performance

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2 Ketogenic Endurance Performance Taylor Collins PT, FAAOMPT Background Manual Physical Therapist, Outpatient Orthopedic Clinic Founder of EPIC bar Low Carbohydrate Endurance Athlete

3 Prolific Low Carbohydrate Paleo Endurance Athlete Western States st 2012, Western States st 2013, UTMB th 2013, Bandera 50KM- 1 st 2013

4 1 Tim s Metabolic Fuel Tanks Carbohydrate Tank g of stored glycogen in Tim s body kcal Fat Tank 145# 5% fat 7.25# fat 3,402g fat 30,618 Kcal >40,000 kcal average athlete

5 Slide 4 1 Katie Forrest, 10/7/2014

6 Carbohydrate Dependency High carb diets bias your metabolism towards carb dependency. High carb inhibits fat mobilization and utilization. High carb approach produces unreliable results during prolonged exercise.

7 Low Carb vs Ketogenic Diet Low carb diet increases fat utilization but it is never fully realized without going into ketosis Low Carb Diet is a vague term and has variation in definition Emphasize dietary protein & fat intake Ketogenic Diets emphasize dietary fat intake Ketosis- Process in which majority of energy is derived from ketones in the blood Ketogenic Diets are measurable and take time

8 Fat Utilization Fat utilization can be increased by training but never fully maximized until keto-adaptation Previously held beliefs about exercise intensity and fat burning need to be reconsidered in context of keto-adaptation

9 The Butter Ceiling Peak fat burning occurs 50-65% of VO2 Max on average Peak fat oxidation ranges 25-80% at individual levels Range from 10-60g per hour 540 Kcal/hour Super Fat Burners Ketogenic Athletes Range from g per hour Kcal/hour

10 Keto-adaptation Keto-adaptation Process in which body adapts to burn fat as primary fuel source Fat burned directly & ketones derived from fat Full adaptation occurs in 2-4 weeks Metabolic flexibility Difficult to accomplish Change in nutritional paradigm Attention to macronutrients Change in diet Temporary low energy Temporary brain fog

11 Ketogenic Diet Carbohydrate Intake Limit carbohydrates to <30g/day female and <50g/day male Protein Intake Necessary, but in moderation Aim for between g/lb of body weight Fat Intake Most important fuel 65-80% of total calories derived from fat

12 Tim s Daily Intake Calories 4,000Kcal, Carbohydrates Kcal, Protein 580Kcal, Fat 3,195Kcal Carbohydrates 50g, Protein 145g, Fat 355g

13 Physiology of Ketosis Keto-adaptation involves increase in production and utilization of ketones Ketones produced in liver Increased fatty acids Depletion of hepatic glycogen reserves Ketones are transported through circulation

14 Skeletal Muscle During keto-adaptation muscles rely on both ketones plus fatty acids Once fully adapted, muscles rely heavily on fatty acids, NOT ketones Adipose Intra-muscular triglycerides Circulating very low density lipoproteins

15 Brain Tissue Brain can ONLY burn glucose or ketones During keto-adaptation brain competes with skeletal muscle for ketones Once fully adapted, ketones are devoted to the brain

16 Metabolic Benefits of Keto-adaptation 1. Brain Fuel Steady and sustained source of fuel for the brain High blood ketone concentration increases transport through blood-brain barrier Maintaining mental focus Carbohydrate dependent athlete will eventually exhaust liver glycogen reserves Muscles and brain compete for small amounts of glucose derived from gluconeogenesis from protein Protecting athletes from hitting the wall Bonking, blowing up, running with the buffalo spirit, transcending time and space

17 Metabolic Benefits of Keto-adaptation 2. Insulin Sensitivity Improved insulin sensitivity Exercise increases production of oxygen free radicals OFR specifically damage fatty acids in cell membranes High insulin sensitivity is associated with less damage to cell membranes (HUFA) Improved recovery from exercise Inflammation, immune, coagulation, and fibrinolytic processes

18 Metabolic Benefits of Keto-adaptation 3. Protein-Sparing Prevents protein from being oxidized BOHB increases in keto-adaptation and is associated with increases in concentration and maintenance of BCAA BCAA is critical for body to synthesize protein to repair muscle and RBC In keto-adapted athletes, BCAA is not oxidized as fuel, rather ketones are used Preserves lean tissue

19 Metabolic Benefits of Keto-adaptation 4. Lactate Metabolism Decreased accumulation of lactate Increased fat oxidation and decreased glycolysis during exercise is associated with less accumulation of lactate & hydrogen ions Better control of ph and respiratory function Acidity (decreased ph) associated w/ hydrogen ion levels cause force production and work capacity to decrease Increased fat oxidation produces less lactate and thus elevates threshold intensity

20 Sports Implications Direct metabolic benefits of keto-adaptation translate into three performance enhancing categories 1. Improved body composition Increased power-to-weight ratio 2. Improved prolonged endurance performance Better sustained fuel delivery 3. Improved recovery Increased training capacity and intensity Increased muscle building

21 Sports Implications Improved Body Composition Decrease fat while maintain or build muscle Increased quickness, agility, and performance Maintain specific body weight for sport Wrestling, boxing, powerlifting, martial arts Bodybuilding, gymnastics, dance, fitness modeling Improved self-perception Better mental state going into competition

22 Sports Implications Improved Endurance Performance & Cognition Fat oxidation is a sustainable and reliable fuel source for skeletal muscles No gastro-intestinal distress Ketones are a sustainable and reliable fuel source for the brain No bonking Most obvious performance advantage would be >2 hours of exercise Marathons, triathlons, ultra-endurance events

23 Sports Implications Improved Exercise Recovery Fat oxidation lessens the stress response to exercise Less metabolic stress less inflammation, immunosupression, gastrointestinal distress, muscle damage, soreness Less generation of reactive oxygen species Preservation of highly unsaturated fatty acids in cell membranes

24 Monitoring Ketones Blood Ketone Tests Gold standard Precision Xtra and Nova Max Plus (~$20.00) Blood Ketone Strips (~$1.50/strip) The Ketone Zone Athletes range from millimolar millimolar increased fat oxidation >3.0 millimolar no benefit

25 Ketogenic Meal Examples Breakfast - Scrambled eggs w/ spinach & bacon 2-3 large free range eggs + 1 Tbsp. butter or coconut oil 1 oz. of shredded feta or mozzarella cheese 4-6 pieces of uncured bacon 2 cups of fresh organic spinach Tbsp. butter or coconut oil

26 Ketogenic Meal Examples Lunch - Grilled Chicken Salad 3 ½ cups romaine lettuce 3 oz. chicken breast (with skin) 1 whole avocado 4 Tbsp. Blue Cheese Dressing 3 pieces of cooked uncured bacon

27 Ketogenic Meal Examples Dinner - Paleo Lamb Tacos 3 oz. ground grass fed lamb + 1 Tbsp. olive oil 2 Tbsp. guacamole ¼ cup diced red tomatoes Chopped chives 1 ½ cup leaf lettuce

28 Ketogenic Meal Examples Snack - Mocha Smoothie 4 oz. coffee ice ¼ cup heavy cream 1 Tbsp. cocoa powder 1 Tbsp. Olive Oil 2 Tbsp. whey protein (delactosed) 1 Tbsp. calorie free sweetener

29 Special Considerations Low carb diets increase sodium and water loss by the kidneys Failure to replace sodium adversely affects potassium balance Fatigue, fainting, headache, loss of muscle Consume extra 1-2g of sodium/day

30 Keto-adaptation Summarized Limit Carbohydrates <50g/day Insulin spikes are quickest way to get out of ketosis Emphasize Dietary Fats 65-80% of daily calories from fats Eat monos and saturates for fuel Protein limitation Takes on average 4 weeks for full adaptation Test blood ketones to monitor your progress Blood ketone concentration should be >0.5 millimolar Mineral Management Supplement 2g sodium/day When in doubt, eat more fat

31 References Taylor Collins The Art and Science of Low Carbohydrate Performance Jeff Volek, PhD & Stephen Phinney, MD, PhD Keto Clarity Jimmy Moore

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