Chronic Adherence to a Ketogenic Diet Modifies Iron Metabolism in Elite Athletes

Oct 27, 2018Medicine and science in sports and exercise

Long-Term Ketogenic Diet Changes Iron Use in Top Athletes

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Abstract

Serum ferritin decreased by 37% in athletes on a high-carbohydrate diet compared to a 23% decrease in those on a low-carbohydrate high-fat diet.

The high-carbohydrate group showed a significantly greater reduction in serum ferritin compared to the low-carbohydrate high-fat group.
Postexercise interleukin-6 levels increased more in athletes following the low-carbohydrate high-fat diet than in those on a high-carbohydrate diet.
Three hours after exercise, hepcidin levels decreased from baseline in the high-carbohydrate group but showed no significant change in the low-carbohydrate high-fat group.
Changes in hepcidin and interleukin-6 suggest that a high-carbohydrate diet may lead to a more adaptive iron regulatory response in elite athletes.

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PURPOSE: The short-term restriction of carbohydrate (CHO) can potentially influence iron regulation via modification of postexercise interleukin-6 (IL-6) and hepcidin levels. This study examined the effect of a chronic ketogenic low-CHO high-fat (LCHF) diet on iron status and iron-regulatory markers in elite athletes.

METHODS: International-level race walkers (n = 50) were allocated to one of three dietary interventions: (i) a high-CHO diet (n = 16), (ii) a periodized CHO availability (n = 17), or (iii) an LCHF diet (n = 17) while completing a periodized training program for 3 wk. A 19- to 25-km race walking test protocol was completed at baseline and after adaptation, and changes in serum ferritin, IL-6, and hepcidin concentrations were measured. Results from high-CHO and periodized CHO were combined into one group (CHO; n = 33) for analysis.

RESULTS: The decrease in serum ferritin across the intervention period was substantially greater in the CHO group (37%) compared with the LCHF (23%) group (P = 0.021). After dietary intervention, the postexercise increase in IL-6 was greater in LCHF (13.6-fold increase; 95% confidence interval [CI] = 7.1-21.4) than athletes adhering to a CHO-rich diet (7.6-fold increase; 95% CI = 5.5-10.2; P = 0.033). Although no significant differences occurred between diets, CI values indicate that 3 h postexercise hepcidin concentrations were lower after dietary intervention compared with baseline in CHO (β = -4.3; 95% CI = -6.6 to -2.0), with no differences evident in LCHF.

CONCLUSION: Athletes who adhered to a CHO-rich diet experienced favorable changes to the postexercise IL-6 and hepcidin response, relative to the LCHF group. Lower serum ferritin after 3 wk of additional dietary CHO might reflect a larger more adaptive hematological response to training.

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Chronic Adherence to a Ketogenic Diet Modifies Iron Metabolism in Elite Athletes

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