There are similarities between sarcopenia and KD that may make this study of interest to us.
The full paper can be obtained through https://sci-hub.hk/ using the doi.
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A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: A double-blind randomized controlled trial.
Bo Y, Liu C, Ji Z, Yang R, An Q, Zhang X, You J, Duan D, Sun Y, Zhu Y, Cui H, Lu Q.
Clin Nutr. 2018 Jan 9. pii: S0261-5614(18)30007-4. doi: 10.1016/j.clnu.2017.12.020. [Epub ahead of print]
PMID: 29395372
Abstract
OBJECTIVE:
Sarcopenia, an age-related decline of muscle mass, strength, and physical function, was associated with falls, frailty, and poor quality of life. The aim of the current study is to examine the effect of nutritional supplement containing whey protein, vitamin D and E on measures of sarcopenia.
METHODS:
A total of 60 sarcopenic older adult subjects participated in the current randomized, double-blind, placebo-controlled (iso-caloric control product) trial for 6 months. Muscle mass [Relative skeletal mass index (RSMI) measured by bioimpedance analysis (BIA)], muscle strength (handgrip strength), physical function (6-m gait speed, chair stand test, and timed-up-and-go test, TUG), quality of life (measured by Short-Form 36-Item Health Survey, SF-36), and blood biochemical indexes were measured before and after the 6-month intervention.
RESULTS:
Compared to placebo group, nutritional supplementation improves RSMI (mean difference: 0.18 kg/m2, 95%CI: 0.01-0.35, P = 0.040), handgrip strength (mean difference: 2.68 kg, 95%CI: 0.71-4.65, P = 0.009), SF-36 mental component summary (SF-36 MCS) (mean difference: 11.26, 95%CI: 3.86-18.65, P = 0.004), SF-36 physical component summary (SF-36 PCS) (mean difference: 20.21, 95%CI: 11.30-29.12, P < 0.001), serum IGF-1 (mean difference: 14.34 ng/mL, 95%CI: 2.06-26.73), IL-2 (mean difference: -575.32 pg/mL, 95%CI: -1116.94 ∼ -33.70, P = 0.038), serum vitamin D3 (mean difference: 11.01 ng/mL, 95%CI: 6.44-15,58, P < 0.001), and serum vitamin E (mean difference: 4.17 ng/L, 95%CI: 1.89-6.45, P = 0.001).
CONCLUSION:
The current study demonstrated that the combined supplementation of whey protein, vitamin D and E can significantly improve RSMI, muscle strength, and anabolic markers such as IGF-I and IL-2 in older adults with sarcopenia. Further larger well-designed studies are warranted to evaluate whether long-term whey protein supplementation can blunt the declines of muscle function and mass in older adults with sarcopenia.

Thank you for posting this!

You are welcome.

I speculate based on my limited understanding of biology and some personal experimentation that the effectiveness of the whey protein significantly depends on the insulin sensitivity of the skeletal muscle. Unfortunately for those of us with KD that is often poor probably due to the accumulation of intramuscular fat. In healthy people intramuscular fat is perhaps 1 or 2 percent of total body fat and there is high turnover. A few hours of intense physical activity can largely deplete it. But as KD progresses the muscle mitochondria are increasingly dysfunctional and our ability to burn off intramuscular fat decreases. I suspect many like myself have aggravated this further with eating patterns that stimulate chronic hyperinsulinemia and high blood triglycerides which likely accelerates intramuscular fat accumulation.

I've managed to greatly improve my metabolic health, fix my fatty liver, slash blood triglycerides, revert my pre-diabetic blood sugar to low normal, restore normal GH/IGF1 levels, etc. but lowering the intramuscular fat is still hugely challenging. I recently did a 3 month experiment of eating very high protein and managed to gain roughly 3 lbs of muscle by dexa scan but also gained 4.5 lbs of fat the majority of which appears to be intramuscular fat though I can't measure it precisely.

Hi Todd!

That's great you were able to add so much muscle!

Are you doing a ketogenic diet at the moment, or just high protein?

I wonder if a high protein ketogenic diet would help with muscle gain and mitigate the intramuscular fat accumulation?

The muscle gain isn't as great as it sounds. The previous 3 months I did an aggressive weight loss phase with a lot of fasting and dropped 20 lbs but a third was lean tissue though I didn't realize it until the scan because my performance (mostly body weight exercise) improved slightly. So the recent gain was just a partial bounce back after the loss. Also, the dexa scans aren't as accurate as the numbers they report. They measure density and then calculate the fat and muscle but changes in hydration/muscle glycogen can effect the result. Over long periods of time and lots of scans this noise in the data should largely cancel out but it's likely some of my loss and some of the gain of these particular scans was just glycogen or water. If I sustain gains for consecutive scans it will be more meaningful.

I've been eating keto for 17 months and was fairly low carb for 5 months before keto. Though by eating keto I really just mean I've been in ketosis, targeting >= 0.5 mmol/L blood ketones. But I've been doing lots of experimenting with diet during that time varying things like the total amount of calories, the amounts and types of fats and proteins and a variety of fasting regimens. When I realized my blood sugar homeostasis was poor (high fasting blood sugar and long/large post prandial swings) I went through a period of being very strict with carbohydrates - rarely exceeding 20 g net/daily, but now my blood sugar is good especially when fasted and I've been averaging 50 g +/- 20 g net carbs daily.

During the recent 3 month period where I scanned for the muscle gain and intramuscular fat gain I started off eating fairly high protein and a modest caloric surplus. By skin fold calipers I didn't appear to be gaining fat (at least not the subcutaneous fat which the calipers measure) and I was gaining weight and strength and I assumed I was mostly gaining muscle. And I got excited/greedy and pushed up both the calories and protein bumping my gain from roughly 0.4 lbs/week to about 0.75 lbs/week. But then the scan indicated much of the gain was fat. I'm increasingly confident I can continue to improve body composition but it's not easy, two steps forward and a step back, and I need more experimenting to improve the process. The visceral fat dropped quickly with fasting and there were big improvements in liver, heart and kidney function. I'm hoping a similar big drop in intramuscular fat would result in a comparable improvement in muscle function. The short term fat gain didn't appear to be detrimental, but I think it gets worse with time. Intramuscular fat is supposed to be a modest fuel depot with high turnover and like an over stuffed refrigerator or pantry with slow turnover the contents go increasingly bad with time.

This message has been edited. Last edited by: ToddAllen,