Background/Objectives: While traditional sports nutrition emphasizes high carbohydrate intake for endurance athletes, trained athletes may achieve metabolic adaptation to low-carbohydrate and ketogenic diets with maintained or improved performance outcomes. This systematic review and meta-analysis synthesize evidence on the effects of low-carbohydrate (≤130 g·day−1 or ≤25% total energy) and ketogenic (1 week consistently demonstrated maintained or improved performance. Conclusions: Low-carbohydrate diets reliably induce metabolic adaptation characterized by dramatically increased fat oxidative capacity. However, aerobic performance responses are nuanced, with preserved maximal aerobic power, transient submaximal efficiency impairments, and context-dependent endurance effects. Adaptation involves initial acute-phase decrements (≤7 days) followed by recovery. Evidence supports periodized carbohydrate strategies balancing metabolic adaptation benefits from low-carbohydrate training phases with carbohydrate requirements during competition.
Gawelczyk et al. (Wed,) studied this question.