Maintaining Lean Body Mass on a Ketogenic Diet

Introduction to Ketogenic Diets and Lean Body Mass

The ketogenic diet acts as a "protein sparing modified fast" that preserves skeletal muscle mass compared to simple fasting, but this preservation effect requires adequate protein intake and resistance stimulus, as recommended by the American College of Sports Medicine 1

Ensure adequate protein intake to support the protein-sparing effect of ketosis, with a recommendation from the Academy of Nutrition and Dietetics 1
The diet increases risk of insufficient energy, fat, and protein intake if not meticulously planned, according to the National Academy of Sciences 1, 2
Monitor for deficiencies in calcium, vitamin A, thiamine, vitamin C, vitamin D, folate, and pantothenic acid, as suggested by the American Heart Association 1, 2

Monitor body composition monthly for 3 months, then quarterly, to ensure weight loss comes predominantly from fat rather than muscle, as recommended by the American College of Sports Medicine 5
Initial rapid weight loss is primarily water weight due to glycogen depletion, which may create false expectations about fat loss rates, according to the National Academy of Sciences 1, 5

Do not use in patients with or at risk of malnutrition, as stated by the American College of Nutrition 1, 5
The American Heart Association concluded that ketogenic approaches do not meet criteria for cardiovascular health due to excessive total fat, saturated fat, and severely restricted carbohydrates 2
Elevations in atherogenic lipoproteins, including LDL cholesterol, occur despite weight loss, as reported by the American College of Cardiology 2
The Mediterranean dietary pattern is recommended as first-line for cardiovascular risk reduction, according to the American Heart Association 2