A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise

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Heikura, Ida A
Burke, Louise M
Hawley, John A
Ross, Megan L
Garvican-Lewis, Laura
Sharma, Avish P
McKay, Alannah KA
Leckey, Jill J
Welvaert, Marijke
McCall, Lauren
Ackerman, Kathryn E
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2020
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Abstract

Objectives: To investigate diet-exercise interactions related to bone markers in elite endurance athletes after a 3.5-week ketogenic low-carbohydrate, high-fat (LCHF) diet and subsequent restoration of carbohydrate (CHO) feeding. Methods: World-class race walkers (25 male, 5 female) completed 3.5-weeks of energy-matched (220 kJ·kg·d-1) high CHO (HCHO; 8.6 g·kg·d-1 CHO, 2.1 g·kg·d-1 protein, 1.2 g·kg·d-1 fat) or LCHF (0.5 g·kg·d-1 CHO, 2.1 g·kg·d-1 protein, 75-80% of energy from fat) diet followed by acute CHO restoration. Serum markers of bone breakdown (cross-linked C-terminal telopeptide of type I collagen, CTX), formation (procollagen 1 N-terminal propeptide, P1NP) and metabolism (osteocalcin, OC) were assessed at rest (fasting and 2 h post meal) and after exercise (0 and 3 h) at Baseline, after the 3.5-week intervention (Adaptation) and after acute CHO feeding (Restoration). Results: After Adaptation, LCHF increased fasting CTX concentrations above Baseline (p = 0.007, Cohen's d = 0.69), while P1NP (p < 0.001, d = 0.99) and OC (p < 0.001, d = 1.39) levels decreased. Post-exercise, LCHF increased CTX concentrations above Baseline (p = 0.001, d = 1.67) and above HCHO (p < 0.001, d = 0.62), while P1NP (p < 0.001, d = 0.85) and OC concentrations decreased (p < 0.001, d = 0.99) during exercise. Exercise-related area under curve (AUC) for CTX was increased by LCHF after Adaptation (p = 0.001, d = 1.52), with decreases in P1NP (p < 0.001, d = 1.27) and OC (p < 0.001, d = 2.0). CHO restoration recovered post-exercise CTX and CTX exercise-related AUC, while concentrations and exercise-related AUC for P1NP and OC remained suppressed for LCHF (p = 1.000 compared to Adaptation). Conclusion: Markers of bone modeling/remodeling were impaired after short-term LCHF diet, and only a marker of resorption recovered after acute CHO restoration. Long-term studies of the effects of LCHF on bone health are warranted.

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Frontiers in Endocrinology

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10

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© 2020 Heikura, Burke, Hawley, Ross, Garvican-Lewis, Sharma, McKay, Leckey, Welvaert, McCall and Ackerman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Clinical sciences

Nutrition and dietetics

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Life Sciences & Biomedicine

Endocrinology & Metabolism

ketogenic diet

bone health

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Heikura, IA; Burke, LM; Hawley, JA; Ross, ML; Garvican-Lewis, L; Sharma, AP; McKay, AKA; Leckey, JJ; Welvaert, M; McCall, L; Ackerman, KE, A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise, Frontiers in Endocrinology, 2020, 10, pp. 880:1-880:10

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