Exogenous ketosis suppresses diuresis and atrial natriuretic peptide during exercise

We have previously demonstrated that exogenous ketosis reduces urine production during exercise. However, the underlying physiological mechanism of this antidiuretic effect remained unclear. Therefore, we investigated whether acute exogenous ketosis by oral ingestion of ketone ester (KE) during a simulated cycling race (RACE) affects the hormonal pathways implicated in fluid balance regulation during exercise. In a double-blind crossover design, 11 well-trained male cyclists participated in RACE consisting of a 3-h submaximal intermittent cycling (IMT_180') bout followed by a 15-min time trial (TT_15') in an environmental chamber set at 28°C and 60% relative humidity. Fluid intake was adjusted to maintain euhydration. Before and during RACE, the subjects received either a control drink (CON) or the ketone ester (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (KE), which elevated blood β-hydroxybutyrate to ∼2-4 mM. Urine output during IMT_180' was ∼20% lower in KE (1,172 ± 557 mL) than in CON (1,431 ± 548 mL, P < 0.05). Compared with CON, N-terminal proatrial natriuretic peptide (NT-pro ANP) concentration during RACE was ∼20% lower in KE (P < 0.05). KE also raised plasma noradrenaline concentrations during RACE. Performance in TT_15' was similar between CON and KE. In conclusion, exogenous ketosis suppresses diuresis and downregulates NT-pro ANP secretion during exercise.NEW & NOTEWORTHY We previously demonstrated that exogenous ketosis reduces urine production during exercise, however, the underlying physiological mechanism remained unclear. Here, we, for the first time demonstrate that exogenous ketosis suppresses the exercise-induced release of atrial natriuretic peptide (ANP). However, given the limited effects of ANP on renal haemodynamics during exercise, the underlying physiological mechanism remains unknown. But downregulation of ANP might explain a new physiological mechanism by which exogenous ketosis lowers blood-free fatty acid levels.