I was one of the very early clinical sites for the Emsculpt (started using the prototype in 2016)- so I've performed among the most treatments in the Country. I have played with diet and some supplementation to see if there is a significant impact on the treatment results. I did not perform a controlled study, but used observation of clinical outcome. Highly subjective stuff eh! After doing a ton of treatments with no significant modification of diet, I can say that the treatment works regardless. However, I do think patient that are getting adequate or higher protein do a bit better. I don't think higher carbs are required. One of the mechanisms of action involves liberating free fatty acids from the localized fat as an energy source. This process speeds up in a lower carbohydrate environment (this is during treatment). Post treatment, muscle is replenished/restored which requires amino acids (protein) and carbohydrate/insulin (ideally). Maximum muscle gain seems to be with a moderate high protein and moderate carbohydrate diet. If your goal is primarily fat reduction, keto will likely be of benefit. If your goal is maximum muscle gain, Keto may put you at a disadvantage. Hope this helps. Cheers, Dr. JD McCoy