Paul Saladino· MD
what I would recommend would be something like a protein sparing modified fast wear because I think the maintenance of lean muscle mass is so important and I would not fear the protein in that person when if I have somebody with a BMI of 40 or 50 I want them to maintain their lean muscle mass and I probably still would not put them on a high or a classical ketogenic diet because I want them to maintain my muscle mass but we could do a protein sparing modified fast which is essentially rabbit starvation so it's it's moderate to high protein with very low fat and very low carbs this is a disaster long-term but if somebody has excess body fat storage it can lead to loss of that body fat and improvement an insulin sensitization very quickly