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

Alannah K.A. McKay, Peter Peeling, David B. Pyne, Marijke Welvaert, Nicolin Tee, Jill J. Leckey, Avish P. Sharma, Megan L.R. Ross, Laura A. Garvican-Lewis, Dorine W. Swinkels, Coby M. Laarakkers, Louise M. Burke

    Research output: Contribution to journalArticlepeer-review

    37 Citations (Scopus)


    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.

    Original languageEnglish
    Pages (from-to)548-555
    Number of pages8
    JournalMedicine and Science in Sports and Exercise
    Issue number3
    Publication statusPublished - 2019


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