{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:00:41Z","timestamp":1789696841606,"version":"4.0.1"},"reference-count":31,"publisher":"Aerospace Medical Association","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["aerosp med hum perform"],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:p>\n                    <jats:bold>BACKGROUND:<\/jats:bold>\n                    During hypoxia an operators cognitive performance may decline. This decline is linked to altered brain metabolism, resulting in decreased adenosine triphosphate (ATP) production. Ketone bodies are an alternative substrate to glucose for brain metabolic requirements;\n previous studies have shown that the presence of elevated ketone bodies in the blood maintains brain ATP levels and reduces cerebral glycolysis during hypoxia. Thus, ketones may be a strategy to mitigate cognitive decline in hypoxia. Ketone ester (KE) consumption allows rapid elevation of\n blood ketone levels; therefore, we investigated the effects of consuming a KE drink on cognitive performance during hypoxia. Here, we report results of a pilot study.\n                    <jats:bold>METHODS:<\/jats:bold>\n                    There were 11 subjects who completed a cognitive performance test battery under conditions of normoxia and\n hypoxia following consumption of a KE drink and a placebo control drink.\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    Significant hypoxia effects (O\n                    <jats:sub>2<\/jats:sub>\n                    saturation minimum was found to range between 63 and 88 in subjects) were found for blink duration (Ph2 0.665) and blink rate (Ph2 0.626), indicating that\n the hypoxia condition was associated with longer blink durations and lower blink rates. Significant hypoxia effects were likewise observed for a code substitution task (Ph2 0.487), indicating that performance on the task was significantly disrupted by the hypoxia stressor. KE consumption had\n a significant effect on blink duration (Ph2 0.270) and the code substitution task (Ph2 0.309).\n                    <jats:bold>DISCUSSION:<\/jats:bold>\n                    These finding suggest that some effects of acute hypoxia can be mitigated by nutritional ketosis.\n                    <jats:bold>\n                      Coleman K, Phillips J, Sciarini M, Stubbs B, Jackson O, Kernagis D.\n                      <jats:italic>A\n metabolic intervention for improving human cognitive performance during hypoxia<\/jats:italic>\n                      . Aerosp Med Hum Perform. 2021; 92(7):556562.\n                    <\/jats:bold>\n                  <\/jats:p>","DOI":"10.3357\/amhp.5767.2021","type":"journal-article","created":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T07:26:05Z","timestamp":1631258765000},"page":"556-562","source":"Crossref","is-referenced-by-count":23,"title":["A Metabolic Intervention for Improving Human Cognitive Performance During Hypoxia"],"prefix":"10.3357","volume":"92","author":[{"given":"Kody","family":"Coleman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Sciarini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianna","family":"Stubbs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Kernagis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1911","reference":[{"issue":"11","key":"B1","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.3357\/ASEM.3661.2013","article-title":"Cognition at altitude: impairment in executive and memory processes under hypoxic conditions","volume":"84","author":"Asmaro","year":"2013","journal-title":"Aviat Space Environ Med"},{"issue":"4","key":"B2","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1002\/jimd.12217","article-title":"Nutritional ketosis improves exercise metabolism in patients with very long-chain acyl-CoA dehydrogenase deficiency","volume":"43","author":"Bleeker","year":"2020","journal-title":"J Inherit Metab Dis."},{"issue":"1","key":"B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.nutr.26.061505.111258","article-title":"Fuel metabolism in starvation","volume":"26","author":"Cahill","year":"2006","journal-title":"Annu Rev Nutr."},{"issue":"3","key":"B4","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.yrtph.2012.04.008","article-title":"Kinetics, safety and tolerability of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate in healthy adult subjects","volume":"63","author":"Clarke","year":"2012","journal-title":"Regul Toxicol Pharmacol."},{"issue":"2","key":"B5","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.cmet.2016.07.010","article-title":"Nutritional ketosis alters fuel preference and thereby endurance performance in athletes","volume":"24","author":"Cox","year":"2016","journal-title":"Cell Metab."},{"issue":"3","key":"B6","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1096\/fj.10-171983","article-title":"Short-term consumption of a high-fat diet impairs whole-body efficiency and cognitive function in sedentary men","volume":"25","author":"Edwards","year":"2011","journal-title":"FASEB J."},{"issue":"11","key":"B7","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1249\/MSS.0000000000001700","article-title":"Intermittent running and cognitive performance after ketone ester ingestion","volume":"50","author":"Evans","year":"2018","journal-title":"Med Sci Sports Exerc."},{"issue":"12","key":"B8","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1177\/088307380001501203","article-title":"The ketogenic diet: seizure control correlates better with serum -hydroxybutyrate than with urine ketones","volume":"15","author":"Gilbert","year":"2000","journal-title":"J Child Neurol."},{"issue":"1","key":"B9","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.expneurol.2007.12.029","article-title":"Antioxidant capacity contributes to protection of ketone bodies against oxidative damage induced during hypoglycemic conditions","volume":"211","author":"Haces","year":"2008","journal-title":"Exp Neurol."},{"issue":"9","key":"B10","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1249\/MSS.0000000000001292","article-title":"A ketone ester drink increases postexercise muscle glycogen synthesis in humans","volume":"49","author":"Holdsworth","year":"2017","journal-title":"Med Sci Sports Exerc."},{"issue":"9","key":"B11","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1038\/jcbfm.2010.49","article-title":"MRI estimation of global brain oxygen consumption rate","volume":"30","author":"Jain","year":"2010","journal-title":"J Cereb Blood Flow Metab."},{"issue":"2","key":"B12","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1161\/01.STR.15.2.319","article-title":"Hypoxia induced preferential ketone utilization by rat brain slices","volume":"15","author":"Kirsch","year":"1984","journal-title":"Stroke."},{"issue":"5","key":"B13","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1161\/01.STR.11.5.506","article-title":"Butanediol induced ketosis increases tolerance to hypoxia in the mouse","volume":"11","author":"Kirsch","year":"1980","journal-title":"Stroke."},{"key":"B14","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/0065-2571(66)90027-6","article-title":"The regulation of the release of ketone bodies by the liver","volume":"4","author":"Krebs","year":"1966","journal-title":"Adv Enzyme Regul."},{"issue":"12","key":"B15","doi-asserted-by":"crossref","first-page":"4021","DOI":"10.1096\/fj.201600773R","article-title":"Novel ketone diet enhances physical and cognitive performance","volume":"30","author":"Murray","year":"2016","journal-title":"FASEB J."},{"issue":"8","key":"B16","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1002\/bies.201400042","article-title":"How wasting is saving: weight loss at altitude might result from an evolutionary adaptation","volume":"36","author":"Murray","year":"2014","journal-title":"BioEssays."},{"issue":"51","key":"B17","first-page":"870.3","article-title":"The acute effect of a ketone monoester supplement on metabolic control in individuals with obesity","volume":"33","author":"MyetteCt","year":"2019","journal-title":"FASEB J."},{"issue":"10","key":"B18","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1172\/JCI105650","article-title":"Brain metabolism during fasting","volume":"46","author":"Owen","year":"1967","journal-title":"J Clin Invest."},{"issue":"5","key":"B19","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.2337\/db08-1557","article-title":"Medium-chain fatty acids improve cognitive function in intensively treated type 1 diabetic patients and support in vitro synaptic transmission during acute hypoglycemia","volume":"58","author":"Page","year":"2009","journal-title":"Diabetes."},{"key":"B20","doi-asserted-by":"crossref","DOI":"10.1007\/0-387-26206-7_8","article-title":"Adaptation to chronic hypoxia during diet-induced ketosis","author":"Puchowicz","year":"2005"},{"issue":"Pt. 18","key":"B21","doi-asserted-by":"crossref","first-page":"3161","DOI":"10.1242\/jeb.204.18.3161","article-title":"Frontiers of hypoxia research: acute mountain sickness","volume":"204","author":"Roach","year":"2001","journal-title":"J Exp Biol."},{"issue":"8","key":"B22","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1096\/fasebj.9.8.7768357","article-title":"Insulin, ketone bodies, and mitochondrial energy transduction","volume":"9","author":"Sato","year":"1995","journal-title":"FASEB J."},{"issue":"10","key":"B23","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1038\/jcbfm.2013.128","article-title":"Why does brain metabolism not favor burning of fatty acids to provide energy? Reflections on disadvantages of the use of free fatty acids as fuel for brain","volume":"33","author":"Schnfeld","year":"2013","journal-title":"J Cereb Blood Flow Metab."},{"issue":"6116","key":"B24","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1126\/science.1227166","article-title":"Supression of oxidative stress by -hydroxybutyrate, an endogenous histone deactetylase inhibitor","volume":"339","author":"Shimazu","year":"2013","journal-title":"Science."},{"issue":"3","key":"B25","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1208\/s12248-016-9879-0","article-title":"The population pharmacokinetics of d--hydroxybutyrate following administration of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate","volume":"18","author":"Shivva","year":"2016","journal-title":"AAPS J."},{"key":"B26","doi-asserted-by":"crossref","first-page":"e15092","DOI":"10.7554\/eLife.15092","article-title":"Exercise promotes the expression of brain derived neurotrophic factor (BDNF) through the action of the ketone body b-hydroxybutyrate","volume":"5","author":"Sleiman","year":"2016","journal-title":"Elife."},{"key":"B27","doi-asserted-by":"crossref","first-page":"848","DOI":"10.3389\/fphys.2017.00848","article-title":"On the metabolism of exogenous ketones in humans","volume":"8","author":"Stubbs","year":"2017","journal-title":"Front Physiol."},{"issue":"2","key":"B28","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1254\/jjp.87.143","article-title":"Effect of beta-hydroxybutyrate, a cerebral function improving agent, on cerebral hypoxia, anoxia and ischemia in mice and rats","volume":"87","author":"Suzuki","year":"2001","journal-title":"Jpn J Pharmacol."},{"issue":"1","key":"B29","doi-asserted-by":"crossref","first-page":"7677","DOI":"10.1038\/s41598-017-08055-1","article-title":"Beta-hydroxybutyrate, an endogenic NLRP3 inflammasome inhibitor, attenuates stress-induced behavioral and inflammatory responses","volume":"7","author":"Yamanashi","year":"2017","journal-title":"Sci Rep."},{"issue":"3","key":"B30","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1038\/nm.3804","article-title":"The ketone metabolite -hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease","volume":"21","author":"Youm","year":"2015","journal-title":"Nat Med."},{"issue":"3","key":"B31","doi-asserted-by":"crossref","first-page":"e0174477","DOI":"10.1371\/journal.pone.0174477","article-title":"Ketogenic diet improves the spatial memory impairment caused by exposure to hypobaric hypoxia through increased acetylation of histones in rats","volume":"12","author":"Zhao","year":"2017","journal-title":"PLoS One."}],"container-title":["Aerospace Medicine and Human Performance"],"original-title":[],"link":[{"URL":"https:\/\/asma.kglmeridian.com\/view\/journals\/amhp\/92\/7\/article-p556.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/asma.kglmeridian.com\/downloadpdf\/journals\/amhp\/92\/7\/article-p556.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/asma.kglmeridian.com\/downloadpdf\/journals\/amhp\/92\/7\/article-p556.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T19:01:33Z","timestamp":1740078093000},"score":1,"resource":{"primary":{"URL":"https:\/\/asma.kglmeridian.com\/view\/journals\/amhp\/92\/7\/article-p556.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":31,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.3357\/amhp.5767.2021","relation":{},"ISSN":["2375-6314","2375-6322"],"issn-type":[{"value":"2375-6314","type":"print"},{"value":"2375-6322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,1]]}}}