Interpretting DEXA Results - Stronger but somehow with less muscle?



HI folks,

I wanted to get your take on how one might interpret these DEXA scan results. I have 3, one from Feb, July, and Oct (last Saturday). All units are in pounds.

I’m noticing lean mass increase and fat mass decrease everywhere EXCEPT my legs, which I find weird.

I workout with weights every second day repeating the same muscle groups every 6 days like clockwork. So in the case of legs, they are stronger then they were, but somehow with less muscle?:

Since Jul Since Feb 10-Oct 04-Jul-20 07-Feb-20
Total Mass -4.1 -2.5 84.9 89 87.4
Lean -0.7 -2.7 54.7 55.4 57.4
Fat -3.4 -0.5 26.5 29.9 27
BMC 0 0.6 3.7 3.7 3.1

I didn’t drop that much in fat mass, so I can’t say that some of the lean mass was extra connective tissue, as much as I’d like to believe it. Any way you slice it, losing 2.7 lbs of lean mass since Feb while only losing .5 lbs of fat isn’t a good trade.

I do intermittent fasting, either 18/4 or OMAD. I do eat over 100g of protein on weight training days, which (I thought) should satisfy the requirement for strengthening and rebuilding. I do however on occasion fast for 24-72 hours where I have zero protein. Not often, but maybe that’s where my lean mass is going?

My main concern is losing body fat (BF% is > 30%) , my secondary is getting stronger.


Most of us lifting for strength gains go by the very unofficial g/lb of bodyweight. Key to protein is consistency. For me, from both my own experience and lot of others anecdotal evidence it’s not surprising given the fasting and not so high of protein intake that you’ve lost some muscle mass. Fasting and trying to get stronger wasted about a year of my life. Couldn’t get stronger by much, getting fat off was a nightmare.


This is where I get confused. I’ve heard 1g-1.5g of protein for every kg of lean body mass, and strive to be on the upper limit of that, especially on lifting days. I’ve also heard of 1g for every pound of total mass as the most liberal number, but my personal results seem to point to requiring more protein.

I think I’ll experiment… I’ll use the 1g / lbs of total mass number for the next 2-3 months and test again and see where I land.

It’s weird that I’m stronger yet the muscle is smaller. I don’t get it.


I tried this…

This definitely works better for me


Ya, I always read the per lbm thing too, then I noticed I only saw that in keto and weight loss type conversations, but in any weight lifting forum it was always per bodyweight. Don’t forget, using muscles a lot lets us access more of their strength. Kinda how you can always lift more 2/3 way through your workout than you could cold. Using them all the time is probably the bump you’re getting, unless it’s severe. Plus, when it comes to legs, you gotta train them hard! Quads and Hams are BIG muscles. Mine were at a standstill until I brought back the big compounds like squats and deadlifts. Those also brought my weights up on the isolated movements as well. My legs extensions and curls were both around 150lbs or so for over a year, now they’re both around 220lbs, and my leg presses which I was doing the whole time was stuck in the 400’s and now almost at 700! Only thing that changed was the squats and deads! To be fair, I’m also doing plate loaded hip thrusts now which has also helped the deads on the hip drive portion. But then those help everything else :+1:


Since my main concern was to lose fat, I figured that I should stay on the 1-1.5g / kg of lean mass. It’s working but losing 2.7 lbs of hard earned muscle is a difficult pill to swallow. The numbers are telling me to increase protein, so that I shall. It might cause fat loss to slow down, but it’s a risk I’m willing to take for the time being.

Nice gains on your end btw! 150 --> 220 and 400 to 700 is freaken awesome! Congrats!

You’re right about being able to lift more 2/3 of the way through. I try and time my heaviest lift for when the muscle is ‘primed’. I’ve been able to increase weights for the past little while but as of late I’d hit a max. Not due to me, but because of the equipment that I’m using.

I workout at home on a Blowflex Extreme 2 SE with the max resistance bars installed (410lbs). It’s not a real 410. I theorize it’s at least 10% lighter then real weights. I judge this from having used this machine then going to a real gym and feeling that I have to go down in weight by 10% in order to get the same resistance.

I have no problem doing 410lbs (Bowflex) squats anymore, went from 8 reps per set to 12 per set and now have to increase sets to 5. I was thinking about hanging a kettlebell around my neck attached by a belt (yeah looks weird) to get more resistance.

For leg raises I recently switched to one leg at a time since 410 lbs for both legs started to get easy so now I have a challenge again, which is nice. Too bad I can’t balance myself well enough to do 1 legged squats. Tried but couldn’t manage it.

I then top it off with Standing Low back extensions which really hit the gluts and back of the quads. Again 410 isn’t enough so I just added in more reps and an extra set. I don’t think I can safely do the kettlebell thing here so I might have to look at another exercise.

(Kenny Croxdale) #7


While this is considered to be one of the better methods of measuring body fat, like other methods, it has flaws.

As per Kreiger’s article, “Despite the fact that DEXA represents a 3-compartment model, its error rates are no better than hydrostatic weighing, and in some cases is worse. Like other techniques, DEXA does well when looking at group averages, but not so well when looking at individuals.”

Another interesting fact in regard to measuring Lean Mass is…

The Effects of Ketogenic Dieting on Body Composition, Strength, Power, and Hormonal Profiles in Resistance Training Males

Here is what Dr Jake Wilson’s research determined when athletes on a Ketogenic Diet Carb Loaded for a week…

“… the KD condition gained 5 kg of mass from weeks 10-11.** Of these, 3 kg were driven by changes in lean mass. It has been demonstrated that reintroduction of carbohydrates after restricted carbohydrate intake increases muscle glycogen levels above baseline, a phenomenon termed glycogen supercompensation.”

The reason for this is that 70% of a muscle is composed of water. Carb Loading increased
“Cell Volumininzing”, like when weight gain occurs with individual taking Creatine.

Creatine produces “Cell Voluminizing”, which increase water in the muscles. This not only increases body weight but strength, as well.

When an individual stop taking Creatine, weight loss usually occurs. That weight loss is usually water weight (water stored in the muscles).

In this situation, there is not fat loss or muscle mass loss. It’s just water weight loss.

BIA, Bioelectrical Impedance

This method of measuring body fat and lean muscle mass is also very reliant on your hydration level.

That is one of the reason that taking a reading upon waking (when you a bit dehydrated) show you have more fat mass and less muscle mass than taking a reading in the afternoon, when you are more hydrated.

BIA has other issues, as well, that make it unreliable.

Dehydration and Superhydration

Research shows that dehydration reduces an athletes strength and performance.

The reverse is true when the muscle is Superhydrated via Carb Loading or taking Creatine. Also, certain type of anabolic steroids cause Superhydration elicit that increase in strength.

Car Tire Analogy

Think of Dehydration and Superhydration like this.

If you drive on deflated car tires, you are not going to get good mileage.

If your tires are inflated beyond the recommended level, you are going to get really good mileage.

Mitsubishi Motors was fine by the government for overrating their car’s mileage. Their mileage ratings were based on over inflated air pressure. The failed to mention that.

Increase In Leg Strength

The fact that your leg strength increased indicates you did NOT really have any muscle loss in your legs.

Lean Muscle Mass Loss

I doubt that you lost much if any lean muscle mass.

Based on Wilson’s research, it appears the decrease in muscle was water weight loss which led DEXA to the incorrect conclusion the you’d lost lean muscle mass.

Protein Per Meal

First, let look at the amount of protein per meal that you consume.

Research shows that approximately 30 - 40 gram of quality protein per meal is required to turn on the anabolic/muscle building (mTOR) process; research Drs Layne Norton and Donald Layman.

Secondly, research by Phinney and Volek recommend protein intake based you lean body mass (as you know). Determining lean body mass is difficult; it a guessing game.

I realize that your program is more about fat/weight loss.

However, this is something to consider.

How to Bulk and Gain Weight (Muscle) on Keto

DeLauer provide some interesting information an inciteful method of increasing muscle mass while decreasing body fat.

DeLauer quote Wilson research in this video.

The research DeLauer presents demonstrates that consuming a protein intake that is approximately 2 gram per kilo of body weight led to an increase in muscle mass.

The issue is when protein intake is increased, fat intake needs to dramatically increase, as well. That means more calories, which leads to weight gain.

DeLauer’s approach is to offset the increase in calorie intake from consuming more protein and fat, with Intermittent Fasting.

To ensure you are in a calorie deficit, count the total number of calories consumed in one week and adjust accordingly.

Kenny Croxdale

(Bob M) #8

Dave Feldman said he did DEXA scans a few days apart that changed quite a bit, I believe he thought because of muscle glycogen. He and Ted Naiman (I think) were discussing how one can gain (or lose) 5+ pounds of glycogen in a short time.

I have found this to be true, as when I fast, I can lose 5 pounds in a day. That’s not fat.

I have gained strength and muscle while fasting, though. I don’t think @lfod14’s experience is the way everyone reacts.

I have too many injuries to do squats and deadlifts. Also, now I only do body weight exercises. I’m also too old to be concerned about how much I can lift. I just like to lift because I always have.

(Bacon is a many-splendoured thing) #9

It is always important, before gathering data, to know what you are going to do with the information once you have it.

DEXA scans, while good, are not perfectly accurate. My understanding is that the scan can show different results, depending on the subject’s level of hydration. There is also a margin of error involved, and it seems to me that the numbers you report could be well within that margin. The numbers you report for total mass and lean mass are within 5% of each other; only the fat numbers look truly significant. So I would question your assertion that you have lost lean mass. In any case, these numbers are markers for your condition, and you would be well advised to work at maintaining your health, and letting the numbers fall where they may, rather than trying to manipulate the numbers.

Also bear in mind that when we are obese, we need more muscle, simply to haul all that fat around. So as we lose fat, we have less need for all that muscle, and therefore we will lose some. This is not unhealthy.

If you are keeping your carbohydrate under 20 g/day and eating enough food to keep your body out of famine mode, then the lowered insulin that results should allow your body to shed its excess stored fat. If you are eating to some predetermined calorie target, consider eating to satisfy your hunger instead, and see if that helps.

If you are trying to add muscle mass, 100 g protein / 54.7 kg of lean mass is a goodly amount, but make sure that the food you eat contains plenty of the essential branched-chain amino acids, which are leucine, iso-leucine, and valine. But beware that if you are not trying to add muscle, then you don’t want to overdo the BCAA’s, because they can cause fatty liver disease.

(Bob M) #10

These are my results from 2017/2018, after recovering from shoulder surgery (late 2016):

My lean mass was about 127.4/2.2 = 57.9kg. I haven’t done DEXA scans since then, as they are too expensive (over $150/each where I live, and I have to drive several hours to get them).

I’m way stronger and somewhat more muscular now. I would think that if you’re stronger, you’d have more muscle.

As for protein, I just eat mainly meat, and typically eat lower fat meat, though I do occasionally combine lower fat and higher fat meats. I sometimes eat dairy. I don’t worry about how much protein I’m getting.

Tried a TKD of higher carbs the meal after working out, as part of testing a high saturated fat diet. That might work, but I found my body doesn’t like a lot of the carbs I was trying to feed it. So, I stopped. I might try that again, with different carbs and lower fat.


You may be surprised, I’ve 100% thrown out the idea of higher protein slowing fat loss, the BS fears of GNG, all of it. Upping protein has done me wonders across the board.


I appreciate the insightful response.

I remember that I was a little dehydrated during the 2nd dexa scan, I went for a 10 km walk before my scan since I had time to kill. I didn’t drink anything more than a glass of water in the morning but the test was at around noon. During the 3rd test, I started the day with some keto aide (which I drink every morning) and a cup of green tea. Morning test. Both tests show less lean mass then my first test. But it could be attributable to the error in measuring that you pointed out. After all, I’m not weaker than before.

I think I saw that Delauer video before (which I will revisit). I think he stated having a severe calorie deficit on non-lifting days but still consume some lean protein.


I’ve experienced this as well. If I have a cheat day (rarely do) then I might be up to 5 lbs heavier the next day. I know this isn’t fat, since I know that I didn’t consume (3,500 kcal/lb x 5lbs) = 16,500 calories :slight_smile: and it’s definitely glycogen/water. I would typically fast the next day and be back to normal the day after without missing a beat.

Gotta love being fat adapted.


Very true. When I was much heavier (~ 320lbs) I would imagine that my legs would have a workout daily as I moved around throughout the day just supporting my movements. But I would have hoped that working out those legs, with resistance training, would have kept the strength up , if not increase it.

I can see myself losing connective tissue as I was losing fat, not a bad thing at all since I don’t need it anymore and it accounts as lean mass.

I don’t suppose you know of a formula that tells you were calorie restriction ends and famine mode begins?

I typically eat till satisfied. Sometimes a little more if I feel that I am a little low on protein.

I’m currently around 240-243 lbs, and according to my last DEXA, 152 lbs of that is lean (still a ways to go). On lifting days I do supplement with Leucine during a meal(s). Nothing more than a teaspoon at a time. I was debating getting all 3 BCAAs or just leucine, since I eat a fair bit of clean protein when I do eat (steak/fish/pork chops) I figured I just need leucine since you need 2x as many molecules for every molecule of iso-leucine and valine, which figure I’m getting from the meat.


Just bought some whey protein earlier today and had some with dinner. I’ll test again in a couple of months and we’ll see what the numbers say. I’ll be sure to update this post with the info in case it helps out someone else.

(Bacon is a many-splendoured thing) #16

It’s too different from person to person to say. But I can say that eating 1800 calories on a well-formulated ketogenic diet because you are satisfied and not hungry is no problem. Eating 1800 calories on purpose when you are hungry for more risks causing trouble, ketogenic diet or not.

(Kenny Croxdale) #17

Muscle Mass Loss

Research indicates that individual who go from a Standard American Diet to a Ketogenic Diet my initially lose a little muscle mass. The because the body is in starved for glucose and will convert protein from muscle to glucose; gluconeogenesis.

Once Keto Adaptation occurs the majority obese individual increase muscle mass on a exercise program while decreasing body fat and weight.

Kenny Croxdale

(Bacon is a many-splendoured thing) #18

This I have not heard, except in the context of large fat loss. I have heard, however, of people eating a well-formulated ketogenic diet, who have added lean mass (muscle and bone) while simultaneously shedding excess fat (and not from exercise, either, but from eating ad libitum after years of previous calorie restriction). While there is always a certain irreducible amount of nitrogen loss, my understanding is that the body’s need for glucose is so slight that gluconeogenesis is not a burden in the switch to a ketogenic diet. Of course, in the context of fasting, things are different.

(Kenny Croxdale) #19


Leucine is the anabolic, mTOR switch that build muscle mass.

Individual over twenty need around 3.0 gram of Leucine per meal/serving to trigger the anabolic probess.

Good quality proteins of at over 30 gram per serving is the minimum; optimal is around 40 grams per serving.

Quality Protein are meats, dairy, and eggs.

These proteins contain approximately 0.08 gram of Leucine.

A meal with 30 gram of quality protein provide 2.4 gram of Luecine

A meal with 40 gram of quality protein provides 3.2 grams of Leucine.

Leucine Supplementation

If you are consuming enough protein, adding Leucine to you meal in some form of fashion is effective.

Kenny Croxdale

(Kenny Croxdale) #20

Some short term studies have show initial muscle loss when individuals go from the Standard American Diet to the Ketogenic Diet.

These short term studies are the foundation for the misconception that muscle loss occurs on a Ketogenic Diet, long term.

As Wilson’s research showed, as well as other, hydration if fundamental in measuring Lean Muscle Mass.

As per Wilson’s research, “… the KD condition gained 5 kg of mass from weeks 10-11.”

No one is going to gain 5kg/11 lbs of muscle in a week.

The issue is hydration.

As you know, high carbohydrate intake increases hydration levels.

High protein intake acts as a diuretic when carbohydrate intake is low.

Cyclical Keto Diet

I did this back years ago. As you know, it is 5 days of Keto and 2 days of carb loading.

Like Bob, everyone, I drop around 6 pounds in 5 days of Keto. On the two days carb loading, I’d gain 6 - 7 lbs back.

As per Wilson’s research, Cyclical Keto produced more gains in fat mass.

Kenny Croxdale