# Ketogenic Diet Plus Resistance Training Applied to Physio-Pathological Conditions: A Brief Review
## 6 Practical Recommendations to Combine Ketogenic Diet and Resistance Training  
In 2020, the \"keto diet\" ranked as the most searched diet on Google in the United States of America [96]. Recent data further confirm the popularity of the KD, high-fat, and low-carbohydrate diets in the United States, as reported by the International Food Information Council (2023) [97]. Aware that ketone bodies constitute a double-edged sword for mammalian life spans [98], we also recognize that one nutritional intervention, such as a carbohydrate-rich diet, is not the sole option and it should be adjusted on an individual basis. In any case, it should be understood that any intervention cannot overlook the improvement in muscle status, and clinical evidence shows that individuals who adhere to a KD might achieve similar results compared to other conventional macronutrient distributions (see above). Additionally, it is well known that physical exercise, especially resistance training, should be incorporated into daily activities to enhance well-being, quality of life, and cardiometabolic health in patients with chronic diseases. Likewise, individuals who benefit from following a KD regimen, such as those with epilepsy [24; 99], lipedema [16; 84; 85], GLUT1 deficiency [100; 101; 102], and PCOS [15; 103], may also experience an improved quality of life by combining the nutritional strategy with a resistance exercise program. It is possible that the combination of a KD and resistance training results in fewer pathological symptoms, lower drug concentrations, and, consequently, fewer side effects, but further research is needed to consolidate clinical applications. It is relevant to consider the following points:  
* Ensure the energy balance or caloric surplus (if needed) to properly manage the pathological condition. In this sense, practitioners should pay attention to higher satiety due to high fat and protein intake. * Ensure an adequate daily protein intake of at least 1.5-1.6 g per kg of body mass. Physicians should consider the restrictions in protein intake for certain pathologies (e.g., kidney diseases). Protein of high biological value is recommended, including a combination of plant-based proteins, in order to ensure 8-10 g of essential amino acids and 2-3 g of leucine [68] are consumed. * Administer creatine monohydrate as a safe, effective, and conditionally essential nutrient (with vast evidence) to improve muscle strength and hypertrophy, as well as quality of life, cognitive function, and metabolic health when combined with resistance training. A daily dosage of 0.1 g per kilogram of body mass is recommended [104; 105]. * Consider vitamin C, N-acetylcysteine, and/or polyphenol supplementation. The KD program is limited to fruit and some vegetables; therefore, optimizing the antioxidant status could contribute to post-training recovery and overall health [106; 107]. * Nutritionists and dietitians should develop intervention strategies to improve adherence to the KD, since this is a key factor to have successful results [108]. * Establish a low-load power-based training program based on objectives, population, and following non-linear (undulating) periodization focused on multi-joint exercises [71]. It should be noted that high-speed resistance training using a cluster set configuration might be suitable to avoid high fatigue levels, even in frail populations [80]. * Prescribe and adjust resistance training workload (2-3 days/week) using the OMNIRES perception scale, repetitions in reserve, and movement velocity (actual or perceived) [92]. * Monitor the stress-response process and overall adaptation process using the allostatic load index as a composite of ten well-established biomarkers that correspond to four primary domains: the cardiovascular, endocrine, inflammatory, and metabolic systems. Readers are encouraged to refer to [PERSON] et al. (2022) for recommendations to measure allostatic load [109].