**2. The ketogenic diet in the community older skeletal muscle sarcopenia**

The key aspect of the ketogenic diet is a high proportion of fats, adequate levels of protein, a low proportion of carbohydrates primarily used to treatment difficultto-control aging chronic diseases [14]. The ketogenic diet is now used to treat in the community older groups for rapidly burning more fat when there is a low carbohydrate intake [15]. The ketogenic diet, low carbohydrate intake, can lead to elevated blood ketone bodies. Measured blood ketones levels can allow for adjustment of the ketogenic diet to meet the user's needs [16]. But now new technologies are being researched in the breath acetone sensors are becoming more popular due to less invasiveness and convenience [17–19]. Future technologies are very promising but are still in the early development stages. The ketogenic diet became popular as a therapy for epilepsy in the 1920s and 30s. Recently, it was developed to provide an alternative to anti-aging, which had demonstrated success as an aging therapy [20]. However, the ketogenic diet interventions are eventually largely abandoned due to the mitochondrial dysfunction and excessive inflammatory responses to induce

pathology in age-related diseases in the community older groups. There are several theories about the mechanism of action of the ketogenic diet intervention including increased acidity in the blood.

## **2.1 The Ketogenic diet is converted to ketone bodies**

The ketogenic diets forces to burn off of fats rather than carbohydrates [21]. A ketogenic diet, a high fat, in food is converted triglyceride (TG). The liver converts triacylglycerol (TAG) into fatty acid and ketone bodies. An elevated ketone body in the blood eventually lowers the aging-related diseases [22]. We hoped that ketogenic diet therapy could be maintained ketone bodies by the liver in the community older groups. Blood ketone bodies were produced β-hydroxybutyrate, acetoacetate, and acetone. They consumed a very low-carbohydrate, and excess high-fat diet [23]. Ketone bodies (KBs) are considered as an alternative source of energy supply [24]. When a person eats a regular ketogenic diet, food is converted into glucose, which is transported around the body and used by various cells as an energy source [25], but when too little carbohydrates are available, the liver processes fats to provide the brain with energy in the form of fatty acids and ketone bodies. An increased blood level of ketone bodies is referred to as ketosis. These ketone bodies are thought to possess anti-aging properties in the community older groups, as β-hydroxybutyrate supplementary has been shown to protect old human health [26]. In 1921, endocrinologists demonstrated that ketone bodies were produced by the liver including three water-soluble compounds, acetone, β-hydroxybutyrate, and acetoacetate, as they eat a diet rich in fat and low in carbohydrates.

The key aspect of the ketogenic diet involves the restriction of carbohydrates, which are no longer able to be converted to glucose and provide for the body's metabolic and energy needs . To compensate for this, fatty acids are converted into fuel sources through a process of oxidation in the mitochondria. To detect acetoacetate in blood, but does not react with β-hydroxybutyrate which is the predominant circulating ketone body. In the community older groups' bodies can become more strongly positive as the metabolic derangements improve β-hydroxybutyrate is converted to acetoacetate . The ketogenic diet mimics aspects of starvation, the body is forced to burn fats rather than carbohydrates, when this is combined with a low intake of carbohydrates which causes the body to produce ketones . The stabilization of the ketogenic diet may occur as a result of the efficiency of the ketone bodies as a fuel source. The ketogenic diet is converted fatty acids to ketone bodies for energy to increase the number of mitochondria as the body adapts [27]. However, this is of no consequence provided the ketogenic diet converted ketone bodies (β-hydroxybutyrate and acetoacetate) are closing in community older groups and the patient is continuing to improve clinically (**Figure 3A**).

## **2.2 The β-hydroxybutyrate (BHB) ketone supplements interventions in the community older skeletal muscle sarcopenia**

It is not surprising that sarcopenia obesity or obese sarcopenia is linked to many adverse health outcomes, such as ketogenic diet and exercise training. Thus, skeletal muscle is the largest organ making up around 40% of body weight. It is essential for metabolic functions regulating blood glucose levels in the body. Furthermore, we discuss the role of β-hydroxybutyrate (BHB) supplementary interventions exercise factors released by the liver [28]. Walking exercise training may be able to increase their blood β-hydroxybutyrate (BHB) concentrations in the community older groups and be increased in ketosis. Endogenous production of high levels of the ketone body β-hydroxybutyrate (BHB) is regarded as 5 mM blood BHB for

*Combined Ketogenic Diet and Walking Exercise Interventions in Community Older Frailty… DOI: http://dx.doi.org/10.5772/intechopen.101579*

#### **Figure 3.**

*The ketone body converses. (A) The ketogenic diet foods. (B) Ketogenic diet raised ketone body levels. Blood ketone bodies (<0.6 mmole/L) are markers specifically* β*-hydroxybutyrate (BHB), acetoacetate (AcAc), and acetone. The breath acetone level is lower compared to blood BHB. Direct measurement of beta-hydroxybutyrate circumvents this problem. Therefore, the* β*-hydroxybutyrate (BHB) blood test may underestimate the true circulating ketone bodies.*

120 min after walking exercise in the older men (**Figure 3B**) [29]. This ketogenic diet has long been used as a treatment in the community of older men focused on the therapeutic effects of the ketone body β-hydroxybutyrate (BHB). Recent reports demonstrate that developed ketone can help significantly increase the blood circulating β-hydroxybutyrate in the community older humans [30]. Ketone supplements can efficiently attenuate age-related diseases in older humans. We argue this inflection point affects older human health. Some reports indicated that one of the ketone bodies, β-hydroxybutyrate (BHB), in the community older humans can inhibit aging-related diseases, such as sarcopenia or Alzheimer's disease (AD) . The favorable aspect of ketosis in both ketogenic diet and ketogenic supplements in aging-related diseases has been discussed. We summarize and suggest that aging research is entering a new milestone that has unique medical, commercial, and societal implications.

## **2.3 The different types of ketogenic diet intervention regimens in the community older skeletal muscle sarcopenia**

Many foods and drugs used to treat these conditions can contribute to sarcopenia, as they can cause an imbalance in muscle metabolic and disrupt the pathways that control muscle mass. Nutritional ketogenic diet factors are also important for maintaining muscle and muscle growth in community older patients who may be sarcopenia and frailty. With an adequate intake of protein each day, most people should aim to lean meat, poultry, fish, seafood, eggs, nuts, seeds, and legumes (**Figure 2A**). The ketogenic diet intervention regimens are a special diet designed to help the community older groups that fail to respond adequately to aging-related diseases [31]. In the absence of glucose due to lack of carbohydrates in the ketogenic diet interventions, the community older groups are no longer able to be converted to glucose and provide the body's metabolic and energy needs, fatty acids are the majored converted into the fuel sources through synthesized the ketone bodies β-hydroxybutyrate, acetoacetate and acetone [32, 33]. The ketogenic diet is a mixed

diet containing low carbohydrates, consisting primarily of proteins and fat. Some healthy foods are eaten on a ketogenic diet, for example, seafood, low-carb vegetables, cheese, eggs, meat, poultry, coffee, and tea (**Figure 3A**) [34]. The importance of high fat in aging-related diseases reducing regimens on different walking exercise training models is shown by comparing the effects of four different types of ketogenic dietary regimens. A typical ketogenic diet interventions regimens are made up of the following: (I). A standard keto diet (SKD): typically contains a very low, only 5% carbohydrate, 15% moderate proteins, and 80% high fat diet. This classic SKD contains a 3:1 ratio to combined protein and carbohydrate. (II) The high protein keto diet (HPKD): this contains 5% carbohydrates, 35% protein, and 60% fat. HPKD is about the same as the standard keto diet but includes more protein. (III) The cyclical keto diet (CKD): this ketogenic diet feeds like 5 ketogenic days of periods of higher-carbs feeds, and then 2 high carbohydrate days. (IV) The targeted keto diet (TKD): this type of ketogenic diet allows you to add more around carbohydrates workouts. Although this keto diet is usually safe for diabetes, epilepsy, and aging-related diseases, they may be had some initial body adaptation. Be sure to consume a balanced optimized ketogenic diet to support your fitness program. All food groups are necessary to sustain healthy energy levels and get the most out of your workout [35]. A ketogenic diet contains 5% carbohydrates, carbohydrates are vital, as they can fuel your muscles before exercise [36]. Carbohydrates are also important after walking exercise training to replenish glycogen stores and assist with the absorption of amino acids into your muscles during recovery [37]. Up to 35% protein helps to improve muscle recovery after walking exercise training, repairs tissue damage, and builds muscle mass [38]. Up to 60% of consuming healthy fats has been shown to help burn body fat and preserve muscle fuel during workouts, making your energy last longer [39]. The ketogenic diet interventions contain adequate amounts of protein for body growth. The total protein in the ketogenic diet is also sufficient to maintain health for a given older age. In the classic ketogenic diet, the ratio of fats to carbohydrates and proteins combined is 4:1 [40]. Although it emerged in the community older groups of aging-related diseases could be effectively controlled using these interventions. They may still fail to achieve aging control in the community older groups [41]. For these intervention individuals, the ketogenic diet interventions were re-introduced as a technique for managing the condition. However, the ketogenic diet has been shown in a study of rats to have anti-aging properties and inhibit the development of aging-related diseases in the community older groups.
