Roberto Cannataro1,2
Diego A. Bonilla2,3,4
Maria Cristina Caroleo5
Giuseppe Cerullo6
Richard B. Kreider7
Erika Cione8*- 1Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
- 2Research Group in Sports Nutrition (DBSS-Nut), Dynamical Business & Science Society—DBSS International SAS, Bogotá, Colombia
- 3Hologenomiks Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain
- 4Grupo de Investigación NUTRAL, Facultad Ciencias Alimentarias y Farmacéuticas, Universidad CES, Medellín, Colombia
- 5Department of Health Sciences, University of Magna Graecia Catanzaro, Catanzaro, Italy
- 6Department of Biomedical Sciences, University of Padua, Padua, Italy
- 7Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University College Station, Killeen, TX, United States
- 8Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
Editorial on the Research Topic
Integrating ketogenic diet with physical exercise: implications for athletes and chronic conditions
Studies on the ketogenic diet date back almost 100 years, but most studies are no older than 15 years, demonstrating that this nutritional plan has recently received significant attention from the scientific community; the ketogenic diet is a program that usually allows no more than 20–30 g of carbohydrates per day or 5% of the overall caloric intake; in this condition, ketosis is triggered. The ratio of lipids to proteins can vary depending on the specific goals of the diet (1).
In recent years, ketogenic diets have been used to treat conditions such as epilepsy as well as to support chemotherapy (2) or chronic conditions such as lipedema (3). In this instances, the ketogenic diet seems to be effective (4).
In treating health conditions, there is also a need to combine the diet with physical activity; physical activity is important for achieving long-term results, especially if losing weight is the final goal (5).
We have shown that exercise, particularly with resistance training, has a significant impact on mitochondrial biogenesis, a key aspect of the ketogenic diet (6).
Findings on athletic performance appear inconsistent (7). Furthermore, there is a scarcity of research concerning pathological conditions, highlighting the need for more data; caloric intake likely represents the key variable (8).Using animal models, Kim et al. have shown that a ketogenic diet combined with aerobic exercise results in an activation of mitochondrial biogenesis, lipolysis, and thermogenesis, resulting in a browning of white adipose tissue (WAT).
The case report presented by Russell and Schwartz highlights the different recruitment of energy substrates based on exercise intensity. This confirms what we see in high-level sports practice: the ability to maintain ketosis even with a carbohydrate intake higher than the typical 20–30 g per day. This is an important indication of the effectiveness of the synergy between a ketogenic diet and exercise.
Carrera-Juliá's group demonstrated that short-chain fatty acid supplementation, specifically coconut oil, promoted moderate ketogenesis in patients with amyotrophic lateral sclerosis (ALS). This effect could be beneficial, as ketogenic diets could be effective in supporting this disease. However, compliance with a high fat intake can be poor, whereas with the support of MCTs, a more palatable protein-to-fat ratio could be used.
Finally, an important point is emphasized by Silva et al. regarding the evaluation of the results obtained, which is too often inconsistent; this manuscript highlights how even a method considered the gold standard can yield misleading results, especially in specific populations such as adolescent athletes.
The right combination of exercise and diet should always be considered, especially when considering a nutritional program that severely restricts a single nutrient However, this should not be a limiting factor in combining the two, as they work together to provide better, longer-lasting results.
Author contributions
RC: Conceptualization, Writing – original draft. DB: Writing – review & editing. MC: Writing – review & editing. GC: Writing – review & editing. RK: Writing – review & editing. EC: Writing – original draft.
Acknowledgments
We thank the authors and reviewers who participated in this Research Topic.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) RC, DB, MC, GC, and EC declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Cannataro R. Ketogenic diet: possible mechanism, old and new applications. Exp Physiol. (2023) 108:327–8. doi: 10.1113/EP090858
2. Weber DD, Aminzadeh-Gohari S, Tulipan J, Catalano L, Feichtinger RG, Kofler B. Ketogenic diet in the treatment of cancer - where do we stand? Mol Metab. (2020) 33:102–21. doi: 10.1016/j.molmet.2019.06.026
3. Cannataro R, Michelini S, Ricolfi L, Caroleo MC, Gallelli L, De Sarro G, et al. Management of lipedema with ketogenic diet: 22-month follow-Up. Life (Basel). (2021) 11:1402. doi: 10.3390/life11121402
4. Abrego-Guandique DM, Cione E, Caroleo MC, Bonilla DA, Cannataro R. Ketogenic diet and microRNAs: focus on cognitive function. Front Nutr. (2025) 12:1545832. doi: 10.3389/fnut.2025.1545832
5. Swift DL, McGee JE, Earnest CP, Carlisle E, Nygard M, Johannsen NM. The effects of exercise and physical activity on weight loss and maintenance. Prog Cardiovasc Dis. (2018) 61:206–13. doi: 10.1016/j.pcad.2018.07.014
6. Abrego-Guandique DM, Aguilera Rojas NM, Chiari A, Luciani F, Cione E, Cannataro R. The impact of exercise on mitochondrial biogenesis in skeletal muscle: a systematic review and meta-analysis of randomized trials. Biomol Concepts. (2025) 16:55. doi: 10.1515/bmc-2025-0055
7. Vargas-Molina S, Murri M, Gonzalez-Jimenez A, Gómez-Urquiza JL, Benítez-Porres J. Effects of the ketogenic diet on strength performance in trained men and women: a systematic review and meta-analysis. Nutrients. (2024) 16:2200. doi: 10.3390/nu16142200
8. Vargas-Molina S, García-Sillero M, Bonilla DA, Petro JL, García-Romero J, Benítez-Porres J. The effect of the ketogenic diet on resistance training load management: a repeated-measures clinical trial in trained participants. J Int Soc Sports Nutr. (2024) 21:2306308. doi: 10.1080/15502783.2024.2306308
Keywords: athletes, ketogenic diet, ketosis, mitochondrial biogenesis, physical exercise
Citation: Cannataro R, Bonilla DA, Caroleo MC, Cerullo G, Kreider RB and Cione E (2026) Editorial: Integrating ketogenic diet with physical exercise: implications for athletes and chronic conditions. Front. Nutr. 13:1785548. doi: 10.3389/fnut.2026.1785548
Received: 11 January 2026; Accepted: 13 January 2026;
Published: 27 January 2026.
Edited and reviewed by: David Christopher Nieman, Appalachian State University, United States
Copyright © 2026 Cannataro, Bonilla, Caroleo, Cerullo, Kreider and Cione. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Erika Cione, ZXJpa2EuY2lvbmVAdW5pY2FsLml0