The impact of keto-adaptation on exercise performance and the role of metabolic-regulating cytokines

Am J Clin Nutr. 2019 Sep 1;110(3):562-573. doi: 10.1093/ajcn/nqz145.


The ketogenic diet (KD) is a normocaloric diet composed of high-fat, low-carbohydrate, and adequate protein that induces fasting-like effects and results in the production of ketone bodies. Initially used widely for children with refractory epilepsy, the KD gained popularity due to its beneficial effects on weight loss, diabetes, and cancer. In recent years, there has been a resurgence in interest surrounding the KD and exercise performance. This review provides new insights into the adaptation period necessary for enhancement in skeletal muscle fat and ketone oxidation after sustained nutritional ketosis. In addition, this review highlights metabolically active growth factors and cytokines, which may function as important regulators of keto-adaptation in the setting of exercise and the KD.

Keywords: FGF21; IL-6; adiponectin; exercise; keto-adaptation; ketogenic diet; low-carbohydrate high-fat diet; microbiome; skeletal muscle.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adaptation, Physiological*
  • Cytokines / genetics
  • Cytokines / metabolism*
  • Diet, Ketogenic*
  • Dietary Fats / administration & dosage*
  • Exercise / physiology*
  • Gene Expression Regulation / drug effects
  • Gene Expression Regulation / physiology
  • Humans


  • Cytokines
  • Dietary Fats