The Role of Ketogenic Diet and β-Hydroxybutyrate in the Prevention of Muscle Catabolism and Sarcopenia in Aging Populations: Mechanisms, Evidence, and Clinical Perspectives

This review summarizes evidence on ketogenic diets and beta-hydroxybutyrate in relation to muscle mass and function in older adults. It reports that nutritional ketosis in humans typically gives circulating beta-hydroxybutyrate of about 0.5 to 3.0 mM, and that preclinical studies indicate long-term ketogenic diets preserve muscle mass, strength and mitochondrial function in aging models. Limited clinical evidence, largely from people with sarcopenic obesity or metabolic comorbidities, suggests protein-adequate ketogenic diets used alongside exercise may help preserve fat-free mass, while exogenous ketones show potential to augment post-exercise anabolic signaling. The authors state that well-designed long-term randomized controlled trials are required to define efficacy, safety and optimal clinical application.