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

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

doi:10.3389/fendo.2019.00880

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

Front Endocrinol (Lausanne). 2020 Jan 21:10:880. doi: 10.3389/fendo.2019.00880. eCollection 2019.

Authors

Ida A Heikura^{1

2}, Louise M Burke^{1

2}, John A Hawley², Megan L Ross^{1

2}, Laura Garvican-Lewis^{1

2}, Avish P Sharma^{1

3}, Alannah K A McKay^{1

4}, Jill J Leckey², Marijke Welvaert^{1

5

6}, Lauren McCall⁷, Kathryn E Ackerman^{7

8}

Affiliations

¹ Australian Institute of Sport, Canberra, ACT, Australia.
² Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
³ Griffith Sports Physiology and Performance, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.
⁴ School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia.
⁵ University of Canberra Research Institute for Sport and Exercise, Canberra, ACT, Australia.
⁶ Statistical Consulting Unit, Australian National University, Canberra, ACT, Australia.
⁷ Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.
⁸ Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

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.

Keywords: bone health; endurance athletes; exercise; ketogenic diet; nutrition.