Ketogenic diets found to undermine exercise efforts and lead to muscle shrinkage and bone loss.
Keto Diets: Muscle Growth and Bone Density
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic” effects of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means athletic performance-impairing.
For non-athletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of perceived effort and fatigue and mood disturbances during physical activity, suggesting that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.
I already mentioned the shrinkage of measured muscle size among CrossFit trainees. So, a ketogenic diet may not just blunt the performance of endurance athletics, but strength training as well. Have people do eight weeks of all the standard upper and lower body training protocols—bench press, pull-ups, squats, deadlifts, and, no surprise, you boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to the non-ketogenic diet added about three pounds of muscle, whereas the same amount of weightlifting on the keto diet tended to subtract muscle—an average loss of about 3.5 ounces of muscle. How else could you do eight weeks of weights and not gain a single ounce of muscle, but on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.”
What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plagues children placed on ketogenic diets, along with growth stunting and kidney stones. Ketogenic diets may cause a steady rate of bone loss, as measured in the spine, presumed to be because ketones are acidic; and so, keto diets can put people in what’s called a “chronic acidotic state.”
Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all—osteoporosis, bone fractures, kidney stones—and then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. A single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas. She had a rare genetic disorder called “glucose transporter deficiency syndrome,” where you’re born with a defect in ferrying blood sugar into your brain. This can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into their brains. So, a ketogenic diet can be a godsend for the one in 90,000 families stricken with this disorder.
As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs, and the alternatives aren’t pretty, including things like brain surgery. This can mean implanting deep electrodes through the skull, or even removing a lobe of your brain. This can obviously lead to serious side effects. But, so can having seizures every day. So, if a ketogenic diet helps with seizures, the pros can far outweigh the cons.
For those just choosing a diet to lose weight, though, the cost/benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet.
Remember that study that showed that the weight loss after being told to eat the low-carb Atkins diet for a year was almost identical to those told to eat the low-fat Ornish diet? The authors concluded: “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice. There are regimens out there, like “The Last Chance Diet which [evidently] consisted of a liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths.” Well, it did promise to change people’s lives. An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for deadly diet books.
It’s possible to construct a healthy low-carb diet—or an unhealthy low-fat diet (a diet of cotton candy would be zero fat), but the health effects of a typical low-carb ketogenic diet, like Atkins, are vastly different from a low-fat plant-based diet, like Ornish’s. Not only would they have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans, when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet, and diminished on a low-carb diet. Heart disease tends to progress on typical weight-loss diets, actively worsen on low-carb diets, but may be reversed by an Ornish-style diet.
Given that heart disease is the #1 killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss too, as can tuberculosis and a good meth habit, but the goal of weight loss is not to lighten the load for your pallbearers.
Please consider volunteering to help out on the site.
- Aragon AA, Schoenfeld BJ, Wildman R, et al. International society of sports nutrition position stand: diets and body composition. J Int Soc Sports Nutr. 2017;14:16.
- White AM, Johnston CS, Swan PD, Tjonn SL, Sears B. Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study. J Am Diet Assoc. 2007;107(10):1792-6.
- Kephart WC, Pledge CD, Roberson PA, et al. The Three-Month Effects of a Ketogenic Diet on Body Composition, Blood Parameters, and Performance Metrics in CrossFit Trainees: A Pilot Study. Sports (Basel). 2018;6(1).
- Burke LM, Ross ML, Garvican-lewis LA, et al. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol (Lond). 2017;595(9):2785-2807.
- Vargas S, Romance R, Petro JL, et al. Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. J Int Soc Sports Nutr. 2018;15(1):31.
- Paoli A, Bianco A, Grimaldi KA. The Ketogenic Diet and Sport: A Possible Marriage?. Exerc Sport Sci Rev. 2015;43(3):153-62.
- Groesbeck DK, Bluml RM, Kossoff EH. Long-term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol. 2006;48(12):978-81.
- Simm PJ, Bicknell-royle J, Lawrie J, et al. The effect of the ketogenic diet on the developing skeleton. Epilepsy Res. 2017;136:62-66.
- Nordli D. The ketogenic diet: uses and abuses. Neurology. 2002;58(12 Suppl 7):S21-4.
- Stewart WA, Gordon K, Camfield P. Acute pancreatitis causing death in a child on the ketogenic diet. J Child Neurol. 2001;16(9):682.
- Wijnen BFM, De kinderen RJA, Lambrechts DAJE, et al. Long-term clinical outcomes and economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy. Epilepsy Res. 2017;132:91-99.
- Liu G, Slater N, Perkins A. Epilepsy: Treatment Options. Am Fam Physician. 2017;96(2):87-96.
- Johnston BC, Kanters S, Bandayrel K, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014;312(9):923-33.
- Obert J, Pearlman M, Obert L, Chapin S. Popular Weight Loss Strategies: a Review of Four Weight Loss Techniques. Curr Gastroenterol Rep. 2017;19(12):61.
- Appleton H. The First Amendment: Is the Freedom of Speech More Important Than the Protection of Human Life, 12 Loy. L.A. Ent. L. Rev. 1992;585.
- Jenkins DJ, Wong JM, Kendall CW, et al. The effect of a plant-based low-carbohydrate ("Eco-Atkins") diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009;169(11):1046-54.
- Anderson JW, Konz EC, Jenkins DJ. Health advantages and disadvantages of weight-reducing diets: a computer analysis and critical review. J Am Coll Nutr. 2000;19(5):578-90.
- Miller M, Beach V, Sorkin JD, et al. Comparative effects of three popular diets on lipids, endothelial function, and C-reactive protein during weight maintenance. J Am Diet Assoc. 2009;109(4):713-7.
- Fleming RM. The effect of high-protein diets on coronary blood flow. Angiology. 2000;51(10):817-26.
- Ornish D. Comparison of diets for weight loss and heart disease risk reduction. JAMA. 2005;293(13):1589-90.
- Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-7.
- Smolders L, Mensink RP, Plat J. An acute intake of theobromine does not change postprandial lipid metabolism, whereas a high-fat meal lowers chylomicron particle number. Nutr Res. 2017;40:85-94.
Image credit: Dmitry Lobanov via adobe stock photos. Image has been modified.
Motion graphics by Avocado Video
- artery function
- athletes
- Atkins diet
- blood sugar
- body fat
- bone fractures
- bone health
- bone loss
- caloric restriction
- calories
- children
- cigarettes
- Dr. Dean Ornish
- epilepsy
- exercise
- fat
- glucose
- heart disease
- insulin
- keto diet
- kidney stones
- lifespan
- longevity
- low-carb diets
- mortality
- muscle health
- obesity
- osteoporosis
- pancreas health
- pancreatitis
- Plant-Based Diets
- protein
- seizures
- smoking
- vegans
- vegetarians
- weight loss
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic” effects of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means athletic performance-impairing.
For non-athletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of perceived effort and fatigue and mood disturbances during physical activity, suggesting that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.
I already mentioned the shrinkage of measured muscle size among CrossFit trainees. So, a ketogenic diet may not just blunt the performance of endurance athletics, but strength training as well. Have people do eight weeks of all the standard upper and lower body training protocols—bench press, pull-ups, squats, deadlifts, and, no surprise, you boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to the non-ketogenic diet added about three pounds of muscle, whereas the same amount of weightlifting on the keto diet tended to subtract muscle—an average loss of about 3.5 ounces of muscle. How else could you do eight weeks of weights and not gain a single ounce of muscle, but on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.”
What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plagues children placed on ketogenic diets, along with growth stunting and kidney stones. Ketogenic diets may cause a steady rate of bone loss, as measured in the spine, presumed to be because ketones are acidic; and so, keto diets can put people in what’s called a “chronic acidotic state.”
Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all—osteoporosis, bone fractures, kidney stones—and then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. A single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas. She had a rare genetic disorder called “glucose transporter deficiency syndrome,” where you’re born with a defect in ferrying blood sugar into your brain. This can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into their brains. So, a ketogenic diet can be a godsend for the one in 90,000 families stricken with this disorder.
As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs, and the alternatives aren’t pretty, including things like brain surgery. This can mean implanting deep electrodes through the skull, or even removing a lobe of your brain. This can obviously lead to serious side effects. But, so can having seizures every day. So, if a ketogenic diet helps with seizures, the pros can far outweigh the cons.
For those just choosing a diet to lose weight, though, the cost/benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet.
Remember that study that showed that the weight loss after being told to eat the low-carb Atkins diet for a year was almost identical to those told to eat the low-fat Ornish diet? The authors concluded: “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice. There are regimens out there, like “The Last Chance Diet which [evidently] consisted of a liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths.” Well, it did promise to change people’s lives. An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for deadly diet books.
It’s possible to construct a healthy low-carb diet—or an unhealthy low-fat diet (a diet of cotton candy would be zero fat), but the health effects of a typical low-carb ketogenic diet, like Atkins, are vastly different from a low-fat plant-based diet, like Ornish’s. Not only would they have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans, when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet, and diminished on a low-carb diet. Heart disease tends to progress on typical weight-loss diets, actively worsen on low-carb diets, but may be reversed by an Ornish-style diet.
Given that heart disease is the #1 killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss too, as can tuberculosis and a good meth habit, but the goal of weight loss is not to lighten the load for your pallbearers.
Please consider volunteering to help out on the site.
- Aragon AA, Schoenfeld BJ, Wildman R, et al. International society of sports nutrition position stand: diets and body composition. J Int Soc Sports Nutr. 2017;14:16.
- White AM, Johnston CS, Swan PD, Tjonn SL, Sears B. Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study. J Am Diet Assoc. 2007;107(10):1792-6.
- Kephart WC, Pledge CD, Roberson PA, et al. The Three-Month Effects of a Ketogenic Diet on Body Composition, Blood Parameters, and Performance Metrics in CrossFit Trainees: A Pilot Study. Sports (Basel). 2018;6(1).
- Burke LM, Ross ML, Garvican-lewis LA, et al. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol (Lond). 2017;595(9):2785-2807.
- Vargas S, Romance R, Petro JL, et al. Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. J Int Soc Sports Nutr. 2018;15(1):31.
- Paoli A, Bianco A, Grimaldi KA. The Ketogenic Diet and Sport: A Possible Marriage?. Exerc Sport Sci Rev. 2015;43(3):153-62.
- Groesbeck DK, Bluml RM, Kossoff EH. Long-term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol. 2006;48(12):978-81.
- Simm PJ, Bicknell-royle J, Lawrie J, et al. The effect of the ketogenic diet on the developing skeleton. Epilepsy Res. 2017;136:62-66.
- Nordli D. The ketogenic diet: uses and abuses. Neurology. 2002;58(12 Suppl 7):S21-4.
- Stewart WA, Gordon K, Camfield P. Acute pancreatitis causing death in a child on the ketogenic diet. J Child Neurol. 2001;16(9):682.
- Wijnen BFM, De kinderen RJA, Lambrechts DAJE, et al. Long-term clinical outcomes and economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy. Epilepsy Res. 2017;132:91-99.
- Liu G, Slater N, Perkins A. Epilepsy: Treatment Options. Am Fam Physician. 2017;96(2):87-96.
- Johnston BC, Kanters S, Bandayrel K, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014;312(9):923-33.
- Obert J, Pearlman M, Obert L, Chapin S. Popular Weight Loss Strategies: a Review of Four Weight Loss Techniques. Curr Gastroenterol Rep. 2017;19(12):61.
- Appleton H. The First Amendment: Is the Freedom of Speech More Important Than the Protection of Human Life, 12 Loy. L.A. Ent. L. Rev. 1992;585.
- Jenkins DJ, Wong JM, Kendall CW, et al. The effect of a plant-based low-carbohydrate ("Eco-Atkins") diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009;169(11):1046-54.
- Anderson JW, Konz EC, Jenkins DJ. Health advantages and disadvantages of weight-reducing diets: a computer analysis and critical review. J Am Coll Nutr. 2000;19(5):578-90.
- Miller M, Beach V, Sorkin JD, et al. Comparative effects of three popular diets on lipids, endothelial function, and C-reactive protein during weight maintenance. J Am Diet Assoc. 2009;109(4):713-7.
- Fleming RM. The effect of high-protein diets on coronary blood flow. Angiology. 2000;51(10):817-26.
- Ornish D. Comparison of diets for weight loss and heart disease risk reduction. JAMA. 2005;293(13):1589-90.
- Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-7.
- Smolders L, Mensink RP, Plat J. An acute intake of theobromine does not change postprandial lipid metabolism, whereas a high-fat meal lowers chylomicron particle number. Nutr Res. 2017;40:85-94.
Image credit: Dmitry Lobanov via adobe stock photos. Image has been modified.
Motion graphics by Avocado Video
- artery function
- athletes
- Atkins diet
- blood sugar
- body fat
- bone fractures
- bone health
- bone loss
- caloric restriction
- calories
- children
- cigarettes
- Dr. Dean Ornish
- epilepsy
- exercise
- fat
- glucose
- heart disease
- insulin
- keto diet
- kidney stones
- lifespan
- longevity
- low-carb diets
- mortality
- muscle health
- obesity
- osteoporosis
- pancreas health
- pancreatitis
- Plant-Based Diets
- protein
- seizures
- smoking
- vegans
- vegetarians
- weight loss
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Title
Keto Diets: Muscle Growth and Bone Density
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
The video I mentioned is The Weight Loss Program that Got Better with Time.
This was the sixth video in a seven-part series on keto diets. If you missed any of the previous videos, see:
- Is Keto an Effective Cancer-Fighting Diet?
- Keto Diet Theory Put to the Test
- Keto Diet Results for Weight Loss
- Is Weight Loss on Ketosis Sustainable?
- Are Keto Diets Safe?
The series wraps up with Does a Ketogenic Diet Help Diabetes or Make It Worse? next.
So what does help athletic performance? Check out:
- Reducing Muscle Fatigue with Citrus
- Reducing Muscle Soreness with Berries
- Preventing Exercise-Induced Oxidative Stress with Watercress
- “Veg-Table” Dietary Nitrate Scoring Method
- Fennel Seeds to Improve Athletic Performance
- Foods to Improve Athletic Performance and Recovery
- Ground Ginger to Reduce Muscle Pain
- The Gladiator Diet: How Vegetarian Athletes Stack Up
Correction: The graph at 2:48 is incorrectly titled as Mean Changes in Serum apoA-1. It should be Mean Changes in Triglyceride Concentrations.
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