A new study has found that taking a ketone supplement after high-intensity training can significantly improve how blood vessels recover and can promote signals for new blood vessel growth, with benefits seen both at normal oxygen levels and in simulated high-altitude conditions.
Regular physical activity is known to improve vascular function and promote angiogenesis and erythropoiesis, effects that are further enhanced by hypoxia. Earlier research had pointed to potential benefits from long-term exogenous ketosis, but how the body responds to it acutely was unclear. Researchers set out to test whether acute exogenous ketosis, using the commercial ketone precursor Ketone-IQ, could enhance these processes during post-exercise recovery.
In a randomised, placebo-controlled, crossover trial, 13 male and two female participants completed four experimental sessions. Each involved a high-intensity interval training bout followed by recovery in either normoxia or normobaric hypoxia, equivalent to a simulated altitude of 3,000 metres with an inspired oxygen fraction of 14.5%. Participants received either a placebo or Ketone-IQ during recovery.
Macrovascular and microvascular function were assessed throughout a vascular occlusion protocol, measuring femoral artery blood flow and muscle oxygenation after 2.5 and 5.5 hours of recovery. Researchers also evaluated serum erythropoietin and endothelin-1 concentrations, along with skeletal muscle expression of pro-angiogenic and vascular integrity markers.
In both normoxia and hypoxia, ketone supplementation increased post-occlusion blood velocity by 15% and muscle reoxygenation rate by 9%. Muscle expression of key pro-angiogenic and vascular integrity markers rose, including vascular endothelial growth factor, peroxisome proliferator-activated receptor gamma coactivator 1-alpha, and angiopoietin-1.
Serum erythropoietin concentrations increased by 15% with exogenous ketosis, while serum endothelin-1 levels decreased by 13%. Researchers believe the vascular improvements are likely linked to this drop in endothelin-1 and that the rise in erythropoietin, a hormone that supports red blood cell production and oxygen-carrying capacity, combined effectively with hypoxia.
Lead researcher Chiel Poffé and colleagues said exogenous ketosis “appears as a promising strategy to enhance vascular function and integrity, angiogenic signalling, and circulating erythropoietin in response to exercise and hypoxia”. They added that this could facilitate beneficial adaptive responses important for athletes and those training in challenging environments.
The study, published in The Journal of Physiology, adds to growing interest in ketone supplements for performance and recovery. Ketone-IQ, a butanediol-based precursor, was used to induce ketosis without dietary carbohydrate restriction. Previous work by the same team had already shown longer-term benefits during endurance training overload, including greater muscle capillary growth.
Experts note that improved vascular function supports better nutrient delivery and waste removal in muscles, while elevated erythropoietin may aid training adaptations, particularly when combined with altitude exposure. Reduced endothelin-1, a potent vasoconstrictor, likely contributes to the observed improvements in blood flow.
The participant group was relatively small and predominantly male, though the rigorous crossover design strengthens confidence in the acute effects observed. Further research is needed in larger, more diverse populations and over longer periods, along with practical applications for athletes preparing for competition at altitude or seeking faster recovery.
The findings underscore the potential of targeted nutritional strategies to amplify the body’s natural responses to exercise. As interest in exogenous ketones grows within sports science, this research offers insight into how they may support cardiovascular adaptations without replacing established training methods.