M. Gawelczyk, M. Kaszuba, A. Zając and A. Maszczyk (2026). Effects of Low-Carbohydrate and Ketogenic Diets on Aerobic Performance in Trained Athletes: A Systematic Review and Meta-Analysis. Nutrients, 18(5). https://doi.org/10.3390/nu18050740

PubMed 41829910

[Abstract]
BACKGROUND/OBJECTIVES: While traditional sports nutrition emphasizes high carbohydrate intake for endurance athletes, trained athletes may achieve metabolic adaptation to low-carbohydrate and ketogenic diets with maintained or improved performance outcomes. This systematic review and meta-analysis synthesize evidence on the effects of low-carbohydrate (≤130 g·day-1 or ≤25% total energy) and ketogenic (<50 g·day-1 or <10% total energy) diets on aerobic performance variables in trained athletes.

METHODS: A comprehensive search of five electronic databases (PubMed, SCOPUS, Web of Science, SPORTDiscus, and Cochrane Central Register of Controlled Trials) identified 33 aerobic-focused studies meeting comprehensive inclusion criteria. Selected studies examined trained athletes (≥6 months structured training, age 18-45 years) randomized to low-carbohydrate, ketogenic, or high-carbohydrate control conditions with outcome data on aerobic performance variables (VO2max, time trial performance, time to exhaustion, and exercise economy) and metabolic markers (fat oxidation and substrate utilization). Quality assessment employed Newcastle-Ottawa Scale methodology.

RESULTS: Maximal aerobic capacity (VO2max) was preserved in 50.0% of studies, with 11.1% documenting improvements. Submaximal exercise economy showed the greatest sensitivity, with 50.0% documenting impaired efficiency. Time to exhaustion demonstrated context-dependent effects, with 69.2% maintaining performance. All 30 studies measuring fat oxidation demonstrated consistent increases (+28% to +200%). Critically, temporal analysis identified a 1-week adaptation threshold: studies measuring outcomes within ≤7 days documented performance impairment, while studies measuring at >1 week consistently demonstrated maintained or improved performance.

CONCLUSIONS: Low-carbohydrate diets reliably induce metabolic adaptation characterized by dramatically increased fat oxidative capacity. However, aerobic performance responses are nuanced, with preserved maximal aerobic power, transient submaximal efficiency impairments, and context-dependent endurance effects. Adaptation involves initial acute-phase decrements (≤7 days) followed by recovery. Evidence supports periodized carbohydrate strategies balancing metabolic adaptation benefits from low-carbohydrate training phases with carbohydrate requirements during competition.