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The Effects of a Ketogenic Diet on Rowers

Performance

Project Summary
Purpose
The purpose of this study is to determine if a ketogenic diet negatively affects the
performance of a rowing competitor. Most of the research on ketogenic diets in athletes
has been focused on its effects on reducing fat and/or body-weight, but studies
regarding ketogenic diets on performance are lacking. Research on ketogenic diets in
athletes is important because they oftentimes use unsafe methods for maintaining an
optimal body-weight which may result in negative health consequences. This study will
provide some knowledge about how an understudied population such as female rowers
can possibly benefit from a ketogenic diet.

Methods

This study will be a crossover design where 120 female long-distance (7km)
college rowing participants ages 18 to 25 years will be randomly selected to either start
the intervention (ketogenic diet) or the control arm (regular diet) of the study. The
participants will have a 3-week washout period regardless of which arm of the study
they started with. Participants aerobic performance will be tested using sport specific
testing equipment while they are following both the intervention and the control portion
of the study.

Results and Conclusions
Based on our research, the ketogenic diet will not negatively affect the
performance of the female rowing participants. The VO2max test will not be negatively
affected once the athlete has adapted to a ketogenic diet. This study will provide
athletes such as rowers a safe method for maintaining a lean body weight without
sacrificing performance. Information generated from this study will help create more
studies regarding ketogenic diets on other endurance sports lasting less than one hour.

Introduction
Human cells contain around a billion ATP molecules at any given time.1 The
human body has the ability to consume and resynthesize ATP in as little as three
minutes.1 Some cells have the ability to get energy from fatty acids, glucose, or ketones;
however, those that cannot get energy from fatty acids rely on glucose and ketones.1
There are also cells with minimal or no mitochondria and are only sustained by
glucose.1 When carbohydrates are restricted to extremely low levels, the body becomes
more adipo-centric rather than gluco-centric, meaning it relies more on fatty acids rather
than glucose.1

Studies have indicated that when the keto-adapted state has been reached, free
fatty acids (FFA) are the main source of fuel, and carbohydrate usage is decreased



during moderate level endurance exercise.2 Ketogenic diets are being used so that
glycogen can be saved and utilized during more intensive portions of exercise.2 If
activities which consist more intense bouts of exercise are utilized, a ketogenic diet may
not be sufficient since ATP breakdown needs to be high and has to be equal to the time
that it takes FFA to turn into ATP.2 Lipolysis is turned off and FFA become unavailable
to muscle tissue during highly intense exercise.2 Low-carbohydrate, high-fat diets
should be utilized in endurance athletes who are trained and who have become efficient
at metabolizing fat.2 The high-fat, low protein and carbohydrate diet offers skeletal
muscles as well as the brain with ketones as its source of fuel.2 A person with body fat
of 7-14% can still have around 30,000kcal of energy in the form of adipose tissue, which
exceeds carbohydrate reserves by far.3

Moreover, previous studies have demonstrated that rowing performance may be
enhanced by increasing muscle creatinine stores.4 Since the majority of food sources
that are high in creatinine consist of meat, poultry, turkey and likewise, following a
ketogenic diet that predominantly relies on protein and high fat intake, may increase
creatine muscle stores; therefore, improving performance.4 Additionally, since rowers
already consume a substantial amount of fat compared to carbohydrates, this study
may find that reducing their carb intake to even a lower amount than currently
consuming, and increasing or maintaining their fat intake, may increase their
performance while maintain muscle mass.4

Rationale and Significance
Ketogenic diets have been used in sports where an athlete needs to maintain a
certain body-weight to maintain optimal performance.2 Ketogenic diets require a high fat
(approximately 55% of daily calories) and low carbohydrate (4.5% or <30g CHO of daily
calories per day) and moderate protein intake (40.7% of daily calories per day).2,5
Ketogenic diets result in fatty acid utilization for energy instead of glucose, which can
increase performance.2 Rowing involves non-weight bearing physical activity where an
increased body weight can cause drag of the boat.2 Some athletes such as rowers want
to maintain a consistent body weight and lean body composition without sacrificing the
performance.2,5 Through this study, rowers on ketogenic diets will be discussed along
with the possible benefits on the athletes performance. A standard diet will be
compared to a ketogenic diet for rowers in this study. Rowers will be studied because
there have not been research studies on rowers and the effects of a ketogenic diet on
their performance. Studies focused mainly on cyclists and gymnasts as well as the
majority of the participants being males. With this stated, this study will focus on female
rowing athletes.
Our hypothesis may be proved to be correct only when the activity performed is
at a moderate intensity and for a short period of time.2,6 Studies have shown that fat
oxidation is stimulated with moderate intensity activities2. However, a ketogenic diet will
not be able to sustain a high intensity exercise due to a lack of carbohydrate reserves;
thus, affecting performance.2,6 Due to this, only athletes involved in submaximal
endurance sports should consider following a ketogenic diet weeks prior to a sports



event in order to increase their performance during the event. Furthermore, results can
be referenced in order to conduct future studies on ketosis and sports performance.
The study merits funding because the study will shed light on the effects of the
ketogenic diet on short duration activities of moderate intensity, which has not been
studied before. Through this study, future research can be developed in order to
reinforce the idea that a ketogenic diet benefits an athletes performance. Moreover, this
study will educate health professionals to better advise athletes on the diet that would
benefit them the most as well as prevent certain athletes from following a diet that may
possibly lead to detrimental results in performance and cause adverse effects on the
body.

Study Design
The study will be a crossover study, using the t-test with numerical data. The T-
test will be utilized since only two groups are involved in the study. The two groups
consist of the same participants that are involved in two different interventions. The
participants that will be recruited are college females between the ages of 18-25 years
that are involved in the rowing sport on three different campuses-Ohio State University,
Washington State University, and University of Texas at Austin. The participants will be
recruited during the off-season. One-hundred-twenty participants will be recruited with
the expectation of 50% completing the study.
The two interventions consist of participants being on the ketogenic diet and the
other on their regular diet. Participants will be randomly assigned to start the ketogenic
diet intervention first, followed by the regular diet intervention or vice versa. Intervention
one will involve the ketogenic diet and the second intervention will consist of the regular
diet. Meals will not be provided. For the the ketogenic diet, participants will attend a 30-
minute educational session that will inform them about the foods they can eat while on
the ketogenic diet. Calories were determined for each participant using the Mifflin St.
Jeor equation and the following breakdown of macronutrients will be applied for the
intervention arm of the study: high fat (approximately 55% of daily calories) and low
carbohydrate (4.5% or <30g CHO of daily calories per day) and moderate protein intake
(40.7% of daily calories per day). They will also be provided a handout with a list of
acceptable foods and a sample menu. In regards to the regular diet, it will not be
controlled. Participants will eat as they usually did before the ketogenic diet.
Furthermore, each intervention will be four weeks long, with two test sessions, one hour
long each, at week 2 and week 4. A 4-week washout will be implemented only on the
intervention group that started with the ketogenic diet intervention first. A 4-week
washout period was deemed sufficient to get out of the ketosis state by the conduction
of a pilot study. For the pilot study, eight volunteer participants performed the exercise
sport in a ketosis state and non-ketosis state. After the ketogenic diet, the 4-week
washout was implemented, and all participants involved on the pilot study had returned
to their normal state before ketosis.
Participants will perform a 12-hour fast before the blood draws are taken to test
ketosis levels as indicated in mmol/L(<0.5mmol/L=not ketosis, 0.5-1.5mmol/L=light



nutritional ketosis, 1.5-3 mmol/L=optimal ketosis, and >3 mmol/L=will achieve neither
better or worse results). After the blood draws are taken, the participant will be given a
protein shake (11oz 35g protein and 4g carbohydrates) since they will be fasting for 12
hours before blood draws are taken. Furthermore, in each intervention, participants will
begin a warm-up on the rowing ergometer until heart rate reaches 140 bpm.
Participants will then start to row, while resistance of the ergometer is increased every 3
minutes by 40 Watts on the resistance dial on the ergometer, until VO2max is reached.
VO2max is reached when maximum heart rate in bpm is achieved (208 bpm-age) and the
participant will be stopped by one of the researchers participating in the study. The
same procedure will be implemented for both visits in both interventions. Additionally,
participants will wear same clothing and shoes in all visits of both interventions to
account for any weight changes that different clothing may cause. Temperature of the
exercise laboratory where physical testing will occur will remain at 20 degrees celsius.
Participants will also be asked to not engage in any strenuous physical activity 24 hours
prior to each visit.
Individuals with eating disorders, diabetes, respiratory and heart issues will be
excluded as well as any rowing female athlete that is currently following a ketogenic
diet. Athletes using performance enhancing drugs will also not be included in the study.
Males will be excluded since sufficient research studies have already been conducted
on men analyzing the effects that a ketogenic diet has on their sports performance. On
the other hand, not much research exists that analyzes females and the effect of a
ketogenic diet on their sports performance. Potential participants will be recruited via all
3 universitys campus updates, flyers on bulletin boards on campuses, and through
community pages. The study sessions will be conducted by graduate students under
the supervision of the primary investigators in each of the universities that are in the
departments of Food and Nutrition and Exercise Physiology along with trained
undergraduate volunteer students in the same departments.
Performance will be studied by using the VO2max test with the CardioCoach
machine, which will be hooked up to the participant while on the rowing concept II
ergometer. The participant will perform a warm-up on the Concept II ergometer until a
heart rate of 140 bpm is reached. The participant will start the VO2max test and every 3
minutes, the resistance will be increased by one increment (40Watts) until the time that
VO2max is achieved. RER will be taken from the VO2max test completed in the exercise
physiology laboratory located on each of the campuses. RER values will be used to
determine what the primary fuel source is used during performance testing. Urinalysis
dip sticks will be used in order to test the sample of urine for the presence of ketones in
the participants urine at each of the three testing periods in both arms of the study. A
blood sample will also be taken via the NovaMax ketone and glucometer to test the
level of ketones in the body. VO2max will be measured by having the participants wear a
mask with a breathing tube attached to an oxygen and carbon dioxide headspace gas
analyzer. Urine specimens will be collected from participants and measured with urine
analysis strips to indicate if ketosis has been met. If ketosis is not reached by week 2 of
the ketogenic diet, participant will still perform on the rowing machine on week 2. By



week 4 of the ketogenic diet, it is guaranteed that the participant will reach ketosis,
based on a Pilot study performed in our previous study. It is estimated that it takes
approximately 7 days for an individual to become keto-adapted, while after 3-4 weeks
with daily carbohydrates at <30g/d, complete nutritional ketosis is achieved.3,4 Due to
the possibility of a participant not reaching complete ketosis by week 2, this is the
reason why participants will be on the ketogenic diet for 4 weeks and evaluated twice
during that time. Moreover, the participants state of ketosis will be measured at
baseline, week 2, and week 4 on both the ketogenic diet and regular diet interventions.
Furthermore, meals will be kept track via ASA-24 hour recall for three days in each
intervention, including the washout period, which will include 2 weekdays and 1
weekend day. Additionally, participants will keep a physical activity log on the same
days that meals are tracked. Lastly, height and weight will be measure using an
electronic scale and height will be measured using the Harpenden portable stadiometer
while body fat percentage will be measured using the bioelectrical impedance analysis
machine. Weight, body fat percentage, and food will also be evaluated at each visit.
These variables will be measured to ensure a stable weight. If a participant has lost or
gained a significant amount of weight during either intervention, the participant will be
advised to eat more or eat less and further education will be provided on the amount
and types of food the participant should consume.
Cons that should be taken into account are technical issues that may occur while
the participant is performing on the rowing machine and diet and physical activity
analysis may be incorrect due to falsification of data. Prior to the participants
performance on the rowing machine, the rowing ergometer will be assessed in order to
ensure that it is working properly and will not malfunction while the study is being
conducted. To address falsification of data in regards to diet and physical activity,
participants will be asked specific questions by the investigators in order to get the most
accurate meal types and portions as well as the time, intensity, and type of physical
activity. If there are technical issues mid-performance, study session will have to be
stopped and rescheduled for another day. On the other hand, pros consist of nutrition
professionals being available to enforce adherence and for educational and counseling
purposes. Utilizing the VO2max is a pro because it is the superior method in measuring
maximal aerobic capacity. The urinalysis sample is a harmless and easy method to
measure for ketosis. Moreover, since the study is a crossover design and has never
been done before, makes it a strong and valuable study.

Data Analysis
A paired T test will be used to compare outcomes between the ketogenic diet
intervention and the regular diet intervention. Significance will be set at p<0.05 and SEM
will be reported. The SPSS software will be used to analyze results and compare
variables in order to find possible correlations between the degree of ketosis and
performance outcomes.




Anticipated Results
Since rowing is a sport that lasts less than an hour, it is expected that
participants performance will not be negatively affected on the ketogenic diet
intervention compared to the regular diet intervention. This will demonstrate that
ketones will offer a steady supply of energy to brain and skeletal muscles; therefore,
preventing a decrease in the participants VO2max. The effect of ketones as energy
instead of carbohydrates will prevent the participant from fatigue as a high-carbohydrate
diet normally would when glycogen reserves plummet.

Conclusion
Conducting this study will add knowledge to the limited research that is currently
available in regards to the effects of a ketogenic diet on female athletes performance. If
the hypothesis is supported by the results, new data pertaining to rowers and the affects
a ketogenic diet has on their performance will be available for reference and review.
This study can be used to generalize findings to athletes in sports similar in time and
type, so funding for such a study is critical in order to present the results that will
possibly be revealed from the study.















References

1. Westman EC, Mavropoulos J, Yancy WS, Volek JS. A review of low-carbohydrate


ketogenic diets. Current Atherosclerosis Reports. 2003;5(1):476-483.

2. Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk ., Zydek G. The
effects of a ketogenic diet on exercise metabolism and physical performance in off-
road cyclists. Nutrients. June 2014;6(1):2493-2508.

3. Volek JS, Noakes T, Phinney SD. Rethinking fat as fuel for endurance exercise. Eur J
Sport Sci. Oct 2014; 15(1):13-20.

4. Shephard, RJ. Science and medicine of rowing: a review, J of Sprts Sciences,
16(1):603-620.

5. Paoli A, Grimaldi K, DAgostino D, Cenci L, Moro T, Bianco A, Palma A. Ketogenic
diet does not affect strength performance in elite artistic gymnasts. J Int Soc
Sports. 2012. 9(34).

6. Burke LM, Hawley JA, et al. Adaptations to short-term high-fat diet persist
during exercise despite high carbohydrate availability. J Sci Med Sport. Jan 2002.
83-91.











Budget


Budget Justification

Personnel: Partial salaries for three professors and three grad students will be paid
from this grant. The professors, Jane, John, and Bill work a 10 month, academic year.
We submit that 15% of their salary plus vacation time will be paid from this grant. This
comes to approximately $31,500. The three graduate students Terrance, Maria, and
Lori will commit to the study 15% of their time plus be paid for vacation time. This
comes to $13,500.

Supplies: Specimen containers and ketone testing strips are needed to test the urine
samples for ketones. Along with those items, ketone monitoring testing systems, testing
strips, gloves, cotton balls, and band-aids will be needed. The cost for these items will
cost approximately $1,030. Pure protein shakes will provide 30 grams of protein after a
12 hour fasting period. This will cost around $780. Each subject of the study will be
provided with a notebook to write dietary recall. Total cost of supplies is approximately
$1,980.

Participant payments: Each participant will receive $25 x 120 to start and $25 x 120
when complete (allowing for dropouts) = $6,000

Travel: $6,000 for travel to a training seminar on ketogenic diets and training. Each
professor will learn techniques for VO2max testing. Graduate students will be trained on
urine and blood collection.

Equipment: 15 rowing machines will be purchased, totaling $4,500.

Other: Advertising (flyers to recruit participants) will cost approximately $361.