In a double‑blind, crossover trial, acute supplementation with bis‑octanoyl (R)‑1,3‑butanediol (BO‑BD) raised blood ketones and modestly increased deep‑sleep time. Compared with placebo, BO‑BD improved the primary shooting metric (Hit Factor) by about 8% and shortened task completion time, while accuracy and decision‑making were unchanged.
Study and findings
Thirty‑two healthy adults (half women) completed two 4‑night periods of 50 % sleep restriction in a randomized, double‑blind, placebo‑controlled crossover design. Each period involved nine doses of either 25 g BO‑BD or an isocaloric flavor‑matched placebo administered before, twice daily during, and once after the restriction. Capillary β‑hydroxybutyrate rose above 1.0 mM with BO‑BD, confirming a transient state of nutritional ketosis. Sleep monitoring showed a 13 % increase in deep‑sleep proportion under BO‑BD versus placebo (P = 0.042). The virtual‑reality shooting task measured Hit Factor [(hits‑misses)/time] as the primary outcome. BO‑BD produced an 8 % higher Hit Factor (P < 0.001), a 7 % faster completion time (P < 0.001), a 1 % rise in accuracy (P = 0.023), and a 7 % increase in throughput (P < 0.001) relative to placebo, independent of the sleep restriction. Marksmanship and decision‑making scores were not significantly altered, although a trend toward reduced vertical rifle steadiness was noted with sleep loss (P = 0.052).
Clinical interpretation
The data suggest that acute BO‑BD supplementation can sustain or modestly enhance certain aspects of motor performance—specifically shooting speed and efficiency—when individuals are subjected to short‑term sleep loss. The observed increase in deep‑sleep time may reflect a ketone‑mediated effect on sleep architecture, which could contribute to the performance benefit, although the study did not isolate the relative contributions of ketosis versus sleep changes. Importantly, the improvement was limited to speed‑related metrics; accuracy and higher‑order decision‑making remained unchanged, indicating that ketone‑induced ketosis does not uniformly boost all cognitive‑motor domains under sleep restriction.
Limitations and open questions
The trial was limited to a laboratory‑based virtual‑reality task and a short 4‑night sleep restriction; external validity to real‑world combat or prolonged sleep deprivation is uncertain. The sample size (n = 32) restricts detection of smaller effects and precludes subgroup analyses (e.g., sex differences). Only one ketone precursor and dose were tested, so dose‑response relationships remain unknown. Finally, the mechanism linking elevated ketones, deeper sleep, and faster shooting performance was not explored; future studies should measure neurophysiological markers and compare BO‑BD with other ketogenic strategies.
Source
Buga A, Stoner JT, Sapper TN, Crabtree CD, Decker DD, Robinson BT, et al. Supplementation With Ketogenic Precursors Enhances Virtual Reality Shooting Performance During Sleep Restriction: A Randomized, Placebo-Controlled, Crossover Trial. Mil Med. 2026:usag429. doi: 10.1093/milmed/usag429. PMID: 42753265.