“Ketogenic diet and skeletal muscle hypertrophy: a frenemy relationship?”

You can say that again!

Hot off the presses (Paoli et al., 2019).

[Patron link]

Good paper. Nice background with information about muscle protein balance, anabolic & catabolic factors, and signaling pathways.

At one point the authors seem to have confused a study on starvation ketosis with nutritional ketosis, but in all fairness they also acknowledged the study showing beta-hydroxybutyrate can inhibit AKT which is important for skeletal muscle hypertrophy (Yamada et al., 2010).

Let’s dive right in to Table 1 which is a summary of human studies on keto & lean mass:

Starting with the study by Wood and colleagues (2010), who studied: a low fat diet, low fat + exercise, keto, and keto + exercise. Everyone lost weight. The low fat group lost significantly more lean mass than any other group. The authors interpreted this to mean keto “had a protective effect on muscle mass.”

LFD+ex, Keto, & Keto+ex all lost the same amount of lean mass although the keto groups were getting 50% more protein.

Another interpretation, one could say that 50% more protein and even resistance exercise weren’t enough to prevent keto-induced muscle loss. They lost just as much lean mass as LFD+ex and Keto.

Jabekk and colleagues compared resistance exercise + usual diet with resistance exercise on keto (Jabekk et al., 2010).

The authors concluded: “a general conservation of muscle mass.”

That’s OK, but the control group gained lean mass! Thus, an alternate interpretation could be that keto blunted muscle gains.

Not acknowledging the control groups, as in Table 1, is a not-so-subtle-way of shifting goal posts imo.

Similar issues in the study by Paoli and colleagues (Paoli et al., 2010)…

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