Very Low Carbohydrate Ketogenic Diet Research Articles

Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials.

Very low carbohydrate/ketogenic diets (VLC/KDs) are popular but their role in managing pre-diabetes and type 2 diabetes (T2D) is uncertain. This study uses a systematic review and meta-analysis of randomized controlled trials to estimate the effect of these diets in this population. A systematic review identified randomized controlled trials of at least 6months duration comparing efficacy and safety of VLC/KDs (≤50 g carbohydrate or ≤10% total energy from carbohydrate per day) with a control diet (carbohydrate above the VLC/KD threshold) in adults with pre-diabetes or T2D. The primary outcome variable was glycated haemoglobin (HbA1c) after 12 months. The meta-analysis method was inverse variance weighting of mean values for continuous variables. Key word searches identified 2290 studies; 2221 were not in scope. A full text review of 69 studies identified eight meeting inclusion criteria; in total, it involved 606 participants. Six studies reported HbA1c (%) at 12 months; four as change from baseline with a fixed effects estimate (95% confidence interval): VLC/KD minus control of 0.01% (-0.22 to 0.25), p=.91; and two as change from baseline: -0.65% (-0.99; -0.31) [-7.1 mmol/mol (-10.8; -3.4)], p < .001. Serum triglycerides were lower with VLC/KD versus control: -0.28 mmol/L (-0.44 to -0.11), p < .001. High-density lipoprotein was higher with an estimate of 0.04 mmol/L (0.01 to 0.08), p=.03, in the five studies reporting 12-month summary data. A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited. More well-designed studies are required to provide certain evidence.

Severe type 2 diabetes (T2D) remission using a very low-calorie ketogenic diet (VLCKD).

SummaryThere is a close association between obesity and type 2 diabetes (T2D). The value of weight loss in the management of patients with T2D has long been known. Loss of 15% or more of body weight can have a disease-modifying effect in people with diabetes inducing remission in a large proportion of patients. Very low-carbohydrate ketogenic diets (VLCKDs) have been proposed as an appealing nutritional strategy for obesity management. The diet was shown to result in significant weight loss in the short, intermediate, and long terms and improvement in body composition parameters as well as glycemic and lipid profiles. The reported case is a 35-year-old man with obesity, dyslipidemia, and T2D for 5 years. Despite the use of five antidiabetic medications, including insulin, HbA1c was 10.1%. A VLCKD through a commercial multidisciplinary weight loss program (PnK method) was prescribed and all medications were discontinued. The method is based on high-biological-value protein preparations and has 5 steps, the first 3 steps (active stage) consist of a VLCKD (600–800 kcal/d) that is low in carbohydrates (<50 g daily from vegetables) and lipids. The amount of proteins ranged between 0.8 and 1.2 g/kg of ideal body weight. After only 3 months, the patient lost 20 kg with weight normalization and diabetes remission, and after 2 years of follow-up, the patient remained without the pathologies. Due to the rapid and significant weight loss, VLCKD emerges as a useful tool in T2D remission in patients with obesity.Learning pointsObesity and type 2 diabetes (T2D) are conditions that share key pathophysiological mechanisms.Loss of 15% or more of body weight can have a disease-modifying effect in people with T2D inducing remission in a large proportion of patients.Diabetes remission should be defined as a return of HbA1c to <6.5% and which persists for at least 3 months in the absence of usual glucose-lowering pharmacotherapy.The very low-carbohydrate ketogenic diet (VLCKD) is a nutritional approach that has significant beneficial effects on anthropometric and metabolic parameters.Due to the rapid and significant weight loss, VLCKD emerges as a useful tool in T2D remission in patients with obesity.

Reduction in Oxytocin levels predict body weight loss in patients with obesity after a very low carbohydrate ketogenic diet (VLCKD).

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Effects of very low-carbohydrate ketogenic diet on lipid metabolism in patients with type II diabetes mellitus: a meta-analysis.

Objective: to evaluate the lipid metabolism of patients with type 2 diabetes mellitus (T2DM) after very low-carbohydrate ketogenic (VLCK) diet treatment, so as to provide an evidence-based basis for better dietary management and comprehensive treatment of diabetic patients. Methods: PubMed, Cochrane Library, Embase, and Web of Science databases were searched for randomized controlled trial about VLCK diet on lipid metabolism of T2DM up to September 2021. The data were analyzed using the Stata 15.0; standardized mean difference (SMD) was used as effect size. Results: ten articles were included in this meta-analysis. There were no significant differences between the two groups in total cholesterol (SMD = -0.07, 95 % CI: -0.06-0.20, p > 0.05), HDL (SMD = 0.13, 95 % CI: -0.05-0.31, p > 0.05) and LDL (SMD = 0.07, 95 % CI: -0.06-0.20, p > 0.05) levels after treatment. No difference was found in total cholesterol, HDL, and LDL levels between the two groups after 3, 6, and 12 months of treatment (p > 0.05). Triglyceride levels decreased after VLCK diet compared with control (SMD = -0.49, 95 % CI: -0.82 to -0.17, p = 0.003). A marked reduction of triglyceride levels was identified after 3 months of VLCK diet treatment (SMD = -0.69, 95 % CI: -1.00 to -0.38), without significant difference after 6 and 12 months. Conclusion: T2DM patients who receive a VLCK diet to lower blood glucose are not associated with increased levels of total cholesterol and LDL, and decreased levels of HDL. Additionally, this diet can achieve a short-term reduction of triglyceride levels.

Effect of a very low-carbohydrate ketogenic diet vs recommended diets in patients with type 2 diabetes: a meta-analysis.

There is renewed interest in using very low-carbohydrate ketogenic (VLCK) diets to manage diabetes. Many clinical trials have been published, often with mixed results. This meta-analysis compares the effect of a VLCK diet on glycemic control, body weight, lipid profile, medication use, and dropouts with that of recommended diets for 12 weeks or longer in people with type 2 diabetes. Ovid MEDLINE, Ovid Embase, CENTRAL, and CINAHL databases were searched (January 1980 through September 2019). Two authors independently reviewed search results to select randomized controlled trials (RCTs) comparing a VLCK diet (carbohydrate intake < 50 g/d or < 10% of total energy) with any recommended diet for type 2 diabetes in adults. Discrepancies were resolved after consulting with the third author. Eight RCTs with 648 participants were identified. Compared with control diets, the VLCK diet resulted in a greater decrease in hemoglobin A1c after 3 months (weighted mean difference[WMD]: -6.7 mmol/mol; 95%CI, -9.0 to -4.4) (WMD: -0.61%; 95%CI, -0.82 to -0.40; P < 0.001; moderate-certainty evidence) and after 6 months (WMD: -6.3 mmol/mol; 95%CI, -9.3 to -3.5) (WMD: -0.58%; 95%CI, -0.85 to -0.32; low-certainty evidence). There was a significantly greater weight loss with the VLCK diet after 3 months (WMD: -2.91 kg; 95%CI, -4.88 to -0.95; low-certainty evidence) and after 6 months (WMD: -2.84 kg; 95%CI, -5.29 to -0.39; low-certainty evidence). The VLCK diet was not better than a control diet after 12 months. It was superior in decreasing triglyceride levels, increasing high-density lipoprotein cholesterol levels, and reducing the use of antidiabetic medications for up to 12 months. The VLCK diet appears to control glycemia and decrease body weight for up to 6 months in people with obesity and diabetes. Beneficial changes in serum triglycerides and high-density lipoprotein cholesterol, along with reductions in antidiabetic medications, continued in the VLCK group until 12 months. However, the quality of currently available evidence is not sufficient to recommend VLCK diets. A major limitation of the VLCK diet is patients' lack of adherence to carbohydrate restriction. PROSPERO registration number CRD42020154700.

A Pragmatic Approach to Translating Low- and Very Low-Carbohydrate Diets Into Clinical Practice for Patients With Obesity and Type 2 Diabetes.

Across all eating patterns, individuals demonstrate marked differences in treatment response; some individuals gain weight and others lose weight with the same approach. Policy makers and research institutions now call for the development and use of personalized nutrition counseling strategies rather than one-size-fits-all dietary recommendations. However, challenges persist in translating some evidence-based eating patterns into the clinical practice due to the persistent notion that certain dietary approaches—regardless of individuals' preferences and health outcomes—are less healthy than others. For example, low- and very low-carbohydrate ketogenic diets (VLCKDs)—commonly defined as 10–26% and <10% total daily energy from carbohydrate, respectively—are recognized as viable lifestyle change options to support weight loss, glycemic control, and reduced medication use. Yet, critics contend that such eating patterns are less healthy and encourage general avoidance rather than patient-centered use. As with all medical treatments, the potential benefits and risks must be considered in the context of patient-centered, outcome-driven care; this is the cornerstone of evidence-based medicine. Thus, the critical challenge is to identify and safely support patients who may prefer and benefit from dietary carbohydrate restriction. In this Perspective, we propose a pragmatic, 4-stepped, outcome-driven approach to help health professionals use carbohydrate-restricted diets as one potential tool for supporting individual patients' weight loss and metabolic health.

EFFECT ON WEIGHT LOSS OF VERY-LOW KETOGENIC DIET BEFORE LAPAROSCOPIC SLEEVE GASTRECTOMY: EXPERIENCE OF ONE YEAR FOLLOW-UP.

Very-low Carbohydrate Ketogenic Diet (VLCKD) is widely employed to achieve a fast, significant weight loss before obesity surgery, in order to reduce the risk surgical complications. With this retrospective pilot study, we investigate whether pre-operative VLCKD modifies the weight loss obtained through laparoscopic sleeve gastrectomy (LSG) We analyzed the weight of 35 subjects with severe obesity, consecutively treated with VLCKD + LSG by the Multidisciplinary Unit for the Treatment of Obesity at the University Hospital of Perugia (Italy). A control group of 45 subjects treated with LSG only, matched for age, sex and body mass index (BMI), was randomly selected among patients treated by the same Unit. Parameters were collected at prescription of VLCKD, during pre-operative visit, and 1 year after the intervention Subjects treated with VLCKD + LSG experienced a significantly larger weight loss than subjects treated with LSG only (24.9 +/- 9.6 vs 20.0 +/- 11.0 % of baseline weight, p= 0.039). Nonetheless, the average weight loss before and after LSG was not significantly different between the two groups and the overall difference between the two groups is comparable to the weight loss achieved through the VLCKD Pre-operative VLCKD does not modify the weight loss obtained through LSG intervention. Although a difference has been observed between the groups, it can be attributed to the weight loss achieved through the VLCKD. However, since the target of treating obesity is the durable weight loss, the combination of VLCKD and LSG could be considered more effective than LSG alone

VERY LOW-CARBOHYDRATE KETOGENIC DIET FOR THE TREATMENT OF SEVERE OBESITY AND ASSOCIATED NON-ALCOHOLIC FATTY LIVER DISEASE: THE ROLE OF SEX DIFFERENCES

Very low-carbohydrate ketogenic diets (VLCKDs) are a new type of weight loss (WL) intervention for severe obesity and are associated with a significant improvement in non-alcoholic fatty liver disease (NAFLD).Little is known about the effect of sex differences on weight loss induced by following a VLCKD.The aim of this study was to investigate the effects of sex differences on weight loss and NAFLD improvement in patients with severe obesity undergoing a VLCKD. Seventy-three patients (42 females and 28males) with morbid obesity (BMI 40kg/m2 or 35 kg/m2+comorbidity) eligible for sleeve gastrectomy underwent a 25-day-long VLCKD.Anthropometric parameters, peripheral BP, bioimpedentiometry, degree of liver steatosis measured by ultrasonography, liver function tests, and glucose homeostasis were measured before and after the VLCKD. Males experienced a significantly larger excess body weight loss (EBWL, 14.5 vs11.7% respectively,p=0.018) and a greater reduction in y-glutamyl transferase (ϒ-GT, 17 vs6 IU/L respectively,p=0.003) than females. Dividing the female group by menopausal status, a significant difference between males and pre-menopausal females was found for both EBWL (14.5 vs10.8% respectively,p=0.017) and ϒ-GT (17 vs3 IU/L respectively,p<0.001). No significant difference was observed for EBWL and ϒ-GT between males and post-menopausal women and between sexes for improvement in the Edmonton stage or in the degree of steatosis. The efficacy of VLCKD in severe obesity is influenced by sex differences and, for females, by menopausal status. Males seem to experience larger benefits than females in terms of EBWL and NAFLD improvement. These differences seems attenuated after menopause, probably because of changes in hormonal profile and body composition.

Study of Glycemic Control by Ketogenic Diet Supplemented with Different Oils in Type II Diabetic Rats

In recent years, very low carbohydrate ketogenic diets (VLCKD) have been emphasized. While commonly debated and often opposed, these are clearly successful as a method for treating obesity, hyperlipidemia and diabetes at least in the short to medium term. Therefore, this research was conducted to investigate the impact of ketogenic diet (KD) supplemented with oil of either grape seed or fish and virgin olive on diabetic rats. Forty eight male albino rats weighing 200 to 210 g, were assigned into two main groups. The first group (n=8) was control negative group (-ve), the second main group (n=40) were intraperitoneally injected with a single dose of streptozotocin (STZ) [60 mg/kg b.w.] for induction of diabetes, then these rats were divided into five subgroups. Subgroup one was fed on the basal diet and served as a control positive group, while subgroup 2 was fed on KD only and subgroups from 3 to 5 were fed on KD supplemented with 4% oil of either grape seed or fish and virgin olive, respectively for 8 weeks. The results indicated that, STZ treated rats showed significant reduction (P≤0.05) in serum insulin concentration and increased glucose levels compared to normal rats. KD supplemented with oil of either grape seed or fish and virgin olive improved the biochemical changes due to diabetes. Furthermore, the intervention caused favorable changes in blood lipids and restored liver and kidney functions of the treated rats compared to the control positive group. In conclusion, the ketogenic diet and KD supplemented with oil of either grape seed or fish or virgin olive are potentially promising diets for diabetic patients دراسة التحکم في نسبة جلوکوز الدم بواسطة النظام الغذائي الکيتونى المدعم بالزيوت المختلفة في الفئران المصابة بمرض السکرى من النوع الثاني في السنوات الأخيرة ، کان هناک ترکيز متزايد على النظم الغذائية الکيتونية المنخفضة جدا فى الکربوهيدرات ، في حين يتم مناقشتها بشکل شائع ومعارضتها في کثير من الأحيان ، فمن الواضح أنها ناجحة کوسيلة لعلاج السمنة وفرط الدهون والسکرى على الأقل على المدى القصير إلى المتوسط. لذلک أجريت هذه الدراسة للتحقق من تأثير النظام الغذائي الکيتوني المدعم اما بزيت بذر العنب أوالسمک أوالزيتون البکر على الفئران المصابة بداء السکرى. تم استخدام عدد 48 من ذکور الفئران التي تزن 200 إلى 210 جم ، تم تقسيمهم الى مجموعتين رئيسيتين. تم الاحتفاظ بالمجموعة الرئيسية الأولى (ن = 8) کمجموعة ضابطة سالبة ، المجموعة الرئيسية الثانية تم استخدام عدد 40 من الفئران واستخدمت کمجموعة ضابطة موجبة تم حقنهم بمادة الاستربتوزوتين (60ملجم/کجم من وزن الجسم) لاحداث السکرى، ثم قسمت هذه الفئران إلى خمس مجموعات فرعية .تم تغذية المجموعة الفرعية الأولى على النظام الغذائي الأساسي واستخدمت کمجموعة ضابطة موجبة ، في حين تم تغذية المجموعة الفرعية 2 على النظام الغذائي الکيتوني فقط بينما تم تغذية المجموعات الفرعية من 3 إلى 5 على النظام الغذائي الکيتوني المدعم بنسبة 4% اما بزيت بذر العنب أوالسمک أوالزيتون البکر على التوالي . بعد 8 أسابيع ، تم ذبح الفئران وجمع عينات الدم للحصول على السيرم . اوضحت النتائج أن الفئران المعاملة بـالاستربتوزوتين أظهرت انخفاض معنوي (P≤0.05) في ترکيز الأنسولين في الدم وزيادة مستويات الجلوکوز مقارنة بالفئران الطبيعية. ادى النظام الغذائي الکيتوني المدعم بزيت بذر العنب أوالسمک أوالزيتون البکر في تحسين النتائج البيوکيميائية الناتجة عن مرض السکرى .علاوة على ذلک ، أدى التدخل إلى إحداث تغييرات إيجابية في صورة دهون الدم وتحسين وظائف الکبد والکلى للفئران المعالجة مقارنة بالمجموعة الضابطة الموجبة. الخلاصة إن النظام الغذائي الکيتوني والکيتونى المدعم بزيت بذر العنب أوالسمک أوالزيتون البکر هو نظام غذائي واعد محتمل لمرضى السکرى.

Current opinion on dietary advice in order to preserve fat-free mass during a low-calorie diet

The loss of fat-free mass (FFM) that occurs during weight loss secondary to low-calorie diet can lead to numerous and deleterious consequences. We performed a review to evaluate the state of the art on metabolic and nutritional correlates of loss of fat free mass during low calorie diet and treatment for maintaining fat free mass. This review included 44 eligible studies. There are various diet strategies to maintain FFM during a low-calorie diet, including adoption of a very low carbohydrate ketogenic diet (VLCKD) and taking an adequate amount of specific nutrients (vitamin D, leucine, whey protein). Regarding the numerous and various low-calorie diet proposals for achieving weight loss, the comparison of VLCKD with prudent low-calorie diet found that FFM was practically unaffected by VLCKD. There are numerous possible mechanisms for this, involving insulin and the insulin-like growth factor-1-growth hormone axis, which acts by stimulating protein synthesis. Considering protein and amino acids intake, an adequate daily intake of leucine (4 g/d) and whey protein (20 g/d) is recommended. Regarding vitamin D, if the blood vitamin D has low values (<30 ng/mL), it is mandatory that adequate supplementation is provided, specifically calcifediol, because in the obese patient this form is recommended to avoid seizure in the adipose tissue; 3 to 4 drops/d or 20 to 30 drops/wk of calcifediol are generally adequate to restore normal 25(OH)D plasma levels in obese patients.

Can baseline cardiometabolic markers predict the efficacy of carbohydrate restriction in healthy adults? A pilot study

**Background.** Low-carbohydrate diets are frequently used and are effective for improving a range of health outcomes. There is some evidence to suggest that certain individuals will achieve greater results from higher- or lower-carbohydrate diets but at this time there is little evidence to indicate the relative ‘appropriateness’ of diets differing in carbohydrate content for an individual. This study explores associations between baseline and changes in blood measures of cardiometabolic health, relative to carbohydrate allocation. **Methods.** Seventy-seven healthy, non-diabetic participants (25 males, 52 females; mean age: 39 years, range: 25 to 49; mean body mass index (BMI) 27 kg/m2, range: 20-39) participated in a 12-week, randomised, clinical intervention study. Participants completed baseline testing of blood measures and basic anthropometric measures and a lead-in week to identify habitual calorie intake. Participants were assigned to one of three low-carbohydrate diet plans which advised intakes of either 5%, 15%, or 25% of energy derived from carbohydrate, individualised to the participant and standardised for protein, at 1.4 g per kg of body weight (bw) per day. For the final nine weeks of the intervention they were advised to eat ad libitum but to adhere as closely as possible to the carbohydrate energy limit for their treatment group. Participants were instructed to continue habitual exercise patterns. Blood measures of cardiometabolic health (glucose, insulin, c-peptide, total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides (TG)) and anthropometric measures (height, weight, and waist and hip girth) were measured at baseline and at the conclusion of the 12-week dietary intervention. The associations between baseline blood and anthropometric measures and the changes in these measures were made by undertaking multiple linear regression for the baseline measure and treatment group as independent variables with the change in outcome measures as dependent variables. **Results.** There was a greater improvement in participants who had more adverse baseline cardiometabolic measures from a greater carbohydrate restriction, with 7 of 11 measures most benefiting from a very low carbohydrate ketogenic diet (VLCKD) intervention relative to baseline measurements. Only HDL cholesterol reached between-group significance, with every 1 mmol/L higher HDL cholesterol at baseline associated with a 0.5 and 0.2 mmol/L improvement in HDL cholesterol for the moderate-low carbohydrate diet and low-carbohydrate diet groups respectively, and a 0.4 mmol/L worsening for VLCKD (_p_ = 0.0006). **Conclusions.** Overall, there is a consistent association between baseline markers of cardiometabolic health and changes in these markers relative to the amount of carbohydrate included in the diet. However, low HDL cholesterol might be improved most by a moderate restriction of carbohydrate to ~25% of TE when compared to greater carbohydrate restriction. Because most results were not significant due to the small sample size and preliminary nature of this study, further research is required with larger cohorts to investigate this hypothesis further.

Lysosomal Acid Lipase as a Molecular Target of the Very Low Carbohydrate Ketogenic Diet in Morbidly Obese Patients: The Potential Effects on Liver Steatosis and Cardiovascular Risk Factors.

A very low carbohydrate ketogenic diet (VLCKD) is an emerging technique to induce a significant, well-tolerated, and rapid loss of body weight in morbidly obese patients. The low activity of lysosomal acid lipase (LAL) could be involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), which is a common feature in morbidly obese patients. Fifty-two obese patients suitable for a bariatric surgery intervention underwent a 25-day-long VLCKD. The biochemical markers of glucose and lipid metabolism, and flow-mediated dilation (FMD) of the brachial artery were measured before and after VLCKD. LAL activity was measured using the dried blood spot technique in 20 obese patients and in a control group of 20 healthy, normal-weight subjects. After VLCKD, we observed a significant reduction in body mass index, fasting glucose, insulinemia, and lipid profile parameters. No significant variation in FMD was observed. The number of patients with severe liver steatosis significantly decreased. LAL activity significantly increased, although the levels were not significantly different as compared to the control group. In conclusion, VLCKD induces the activity of LAL in morbidly obese subjects and reduces the secretion of all circulating lipoproteins. These effects could be attributed to the peculiar composition of the diet, which is particularly poor in carbohydrates and relatively rich in proteins.

Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: A randomised clinical trial.

BackgroundLow-carbohydrate, high-fat (LCHF) diets are useful for treating a range of health conditions, but there is little research evaluating the degree of carbohydrate restriction on outcome measures. This study compares anthropometric and cardiometabolic outcomes between differing carbohydrate-restricted diets.ObjectiveOur hypothesis was that moderate carbohydrate restriction is easier to maintain and more effective for improving cardiometabolic health markers than greater restriction.DesignA total of 77 healthy participants were randomised to a very low-carbohydrate ketogenic diet (VLCKD), low-carbohydrate diet (LCD), or moderate-low carbohydrate diet (MCD), containing 5%, 15% and 25% total energy from carbohydrate, respectively, for 12-weeks. Anthropometric and metabolic health measures were taken at baseline and at 12 weeks. Using ANOVA, both within and between-group outcomes were analysed.ResultsOf 77 participants, 39 (51%) completed the study. In these completers overall, significant reductions in weight and body mass index occurred ((mean change) 3.7 kg/m2; 95% confidence limits (CL): 3.8, 1.8), along with increases in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, (0.49 mmol/L; 95% CL; 0.06, 0.92; p = 0.03), and total cholesterol concentrations (0.11 mmol/L; 95% CL; 0.00, 0.23; p = 0.05). Triglyceride (TG) levels were reduced by 0.12 mmol/L (95% CL; −0.20, 0.02; p = 0.02). No significant changes occurred between groups. The largest improvements in high density lipoprotein cholesterol (HDL-c) and TG and anthropometric changes occurred for the VLCKD group.ConclusionsLow-carbohydrate, high-fat diets have a positive effect on markers of health. Adherence to the allocation of carbohydrate was more easily achieved in MCD, and LCD groups compared to VLCKD and there were comparable improvements in weight loss and waist circumference and greater improvements in HDL-c and TG with greater carbohydrate restriction.

Effects of differing levels of carbohydrate restriction on mood achievement of nutritional ketosis, and symptoms of carbohydrate withdrawal in healthy adults: A randomized clinical trial

ObjectivesTo our knowledge, minimal research exists on the effects of diets differing in carbohydrate restriction on symptoms of carbohydrate withdrawal and mood, and the achievement of nutritional ketosis (NK). The aim of this study was to compare ketonaemia, symptoms of carbohydrate withdrawal, and mood. We hypothesized that a moderate carbohydrate restriction would result in fewer symptoms and a reduced effect on mood. MethodsSeventy-seven healthy participants (25 men and 52 women; mean age: 39 y, range: 25–49; mean body mass index 27 kg/m2, range: 20–39) were randomized to receive either a very-low-carbohydrate ketogenic diet (VLCKD), low-carbohydrate diet (LCD), or moderately low-carbohydrate diet (MCD), containing 5%, 15%, and 25% total energy (TE) from carbohydrate, respectively, for 3 wk. Fasting blood ketone measures were recorded daily upon waking along with a data from symptom questionnaire and a 5-point mood-state scale. Using analysis of variance and a 5% two-sided α level to determine statistical significance, between-group outcomes were analyzed. Additional association and analyses were conducted by multiple linear regression. ResultsIn 75 of 77 initial participants included for analysis, mean serum levels of β-hydroxybutyrate (βOHB) were increased by 0.27 ± 0.32, 0.41 ± 0.38, and 0.62 ± 0.49 mmol/L for MCD, LCD, and VLCKD, respectively (P = 0.013). The achievement of NK was consistent for both VLCKD and LCD groups and sporadic for the MCD group. Only the VLCKD group exhibited 95% confidence interval levels that were consistently ≥0.5 mmol/L.The overall mean change in sum of symptoms scores (SOSS) from baseline was 0.81 ± 2.84 (P < 0.001). Changes in SOSS were highest in the VLCKD group (1.49 ± 2.47), followed by LCD (0.65 ± 2.70) and MCD (0.18 ± 3.3; P = 0.264). Small, statistically significant increases were seen for headache severity, constipation, diarrhea, halitosis, muscle cramps and muscle weakness, and light-headedness, whereas intestinal bloating and craving for sugar and starch improved from baseline. Only halitosis (P = 0.039) and muscle weakness (P = 0.005) differed significantly between the groups. Mood improved significantly from baseline overall, but there was no significant difference between groups (P = 0.181) ConclusionsDiets containing 5% TE from carbohydrates are ketogenic, but diets containing between 15% and 25% TE from carbohydrates can also result in mean βOHB ≥0.5 mmol/L. There was no meaningful difference in symptoms of carbohydrate withdrawal between diets that contain 5% to 25% TE from carbohydrate, and mood was improved overall, with no significant difference between interventions. Our conclusion, therefore, is that reduced carbohydrate diets should be prescribed by need rather than the desire to mitigate symptoms of carbohydrate withdrawal.

The lived experience of healthy adults following a ketogenic diet: A qualitative study

Background. Very-low-carbohydrate ketogenic diets (VLCKDs) promote benefits for a range of health conditions. However, there is little research elucidating the ‘lived experience’ of individuals undertaking these diets, and the effects of keto-induction, during adaptation to these diets. Objective. This study aimed to evaluate the subjective experiences of people following a very low carbohydrate, ketogenic diet. Design. This paper describes the qualitative experiences of twenty-eight non-obese, non-diabetic participants, (2 males, 26 females: age ± SD: 35 ± 4 y) in a randomised controlled trial to test the effects of medium chain triglyceride (MCT) supplementation in a VLCKD on time to nutritional ketosis (NK), symptoms of keto-induction, and mood. The experience provided by the diet was rated by a free-form daily diary entry and post-study focus group. Diary entries and focus group transcription were coded inductively and grouped into common themes. Results. Twenty-three participants completed the 3-week study. Physical effects accounted for over 28% of references. Other results were categorised as; mood, energy and cognition (23%), satiety and hunger (16%), cravings and temptation (11%), and sleep (8%). Overall, 49% of references were classified as ‘positive’ with 8% neutral, and 43% negative. Positive impressions were higher after participants had achieved nutritional ketosis and negative impressions higher during keto-induction. Negative impressions, both concerning physical symptoms and feelings of mood and well-being, tended towards improvement over the course of the study, and positive impressions improved. However, there was a large variation in responses, and several respondents reported adverse effects throughout the study. Conclusion. Despite challenges, especially gastrointestinal effects, the overall perception of the diet was positive, and it provided benefits for wellbeing, mood, sleep, and sugar cravings which tended towards improvement over the course of the study. Negative experiences decreased as participants adapted to the VLCKD. Most participants continued post-study, using a lower-carbohydrate diet, due to these perceived benefits. Our findings suggest that the experience of a VLCKD is positive but variable. Further research on individual tolerance and response to low carbohydrate diets is warranted.

Clinical Effect of Low Carbohydrate Diet (LCD): Case Report

Background: The discussion concerning calorie restriction (CR) and low carbohydrate diet (LCD) has been continued for long yeas. As to LCD, we have reported lots of experience and research for glucose variability and ketone bodies. Subjects and methods: Three cases with type 2 diabetes mellitus (T2DM) were on LCD and studied. Methods included 3 patterns of LCD meal which are super, standard and petit LCD, with including carbohydrate ratio 12%, 26% and 40%, respectively. Case 1 (61, M) showed hyperglycemia about 150 mg/dL to 300 mg/dL in daily profile with 12.5% in HbA1c. Starting super LCD therapy, the glucose profile decreased to less than 150 mg/dL and HbA1c decreased to 6.7% in 3 months. Case 2 (53, M) revealed HbA1c 8.3%, weight 110 kg and body mass index 34.5. By super LCD, his weight was decreased 17 kg in 5 months, with normalized HbA1c and elevated serum 3-hydroxybutyric acid (3-OHBA). Case 3 (72, M) had always extremely elevated fasting triglyceride for 5 years. Starting petit LCD for 2 years, triglyceride and weight were decreased moderately. Successively, changing to standard LCD for 1 year, weight was decreased 6 kg, and triglyceride was normalized. Discussion and conclusion: Each case suggests the characteristic beneficial effect of LCD. From our clinical experience and research, super LCD method, which is one of the very low-carbohydrate ketogenic diet (VLCKD), has evident efficacy of weight reduction. Super-LCD is characterized by strictly limitation for carbohydrate. Standard-LCD and petit-LCD method can be useful and applicable in response to the status of the patients. Thus, LCD treatment have beneficial effects for patients with various status.

Biology of Human Aging and Recent Nutrition Therapy

Discussion concerning Calorie Restriction (CR) and low carbohydrate diet (LCD) has continued for years. Authors have developed research of LCD using super LCD with 12% of carbohydrate. The biology of human aging includes study between human and mammalian such as mice, rhesus monkeys. Moderate CR reduced age-related mortality, incidence of diabetes, cancer, cardiovascular disease. By very low calorie diet (VLCD), body weight can be reduced, but the diabetic pathological state remains. Besides CR and LCD, Zone, Ornish, LEARN Diets and Mediterranean style can be applicable. There are very low-carbohydrate ketogenic diet (VLCKD), Moderate-LCD, High- Carbohydrate Diet, as related with the definition of LCD. Morbus (M) value was investigated for clinical practice of LCD, in which M value was remarkably improved by LCD treatment.

Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study.

IntroductionObesity is a constantly growing illness in developed countries and it is strictly related to cardiovascular (CV) diseases, i.e. the main cause of mortality throughout industralised areas.Aimto test the ability of trained general physician to safely and effectively prescribe a very-low carbohydrate ketogenic (VLCK) diet in clinical practice, with a specific attention to the effect of this approach on overweight related CV risk factors (anthropometric measures) blood pressure, lipid levels, glucose metabolism).MethodsThe study has been carried out on a group of 377 patients scattered across Italy and monitored during 1 year. The proposed VLCK diet is a nutritional regimen characterized by low-fat and low- carbohydrates formulations and a protein content of 1.2/1.5 g/kg of ideal body weight, followed by a period of slow re-insertion and alimentary re-education.ResultsAll the predetermined goals—namely safety, reduction of body weight and CV risk factors levels—have been reached with a significant reduction of body weight (from baseline to 4 weeks (−7 ± 5 kg, p < 0.001), from 4 to 12 weeks (−5 ± 3 kg, p < 0.001), no changes from 12 weeks to 12 months; waistline (from baseline to 4 weeks (−7 ± 4 cm, p < 0.001), from 4 to 12 weeks (−5 ± 7 cm, p < 0.001), no changes from 12 weeks to 12 months; fatty mass (from baseline to 4 weeks (−3.8 ± 3.8 %, p < 0.001), from 4 to 12 weeks (−3.4 ± 3.5 %, p < 0.001), no changes from 12 weeks to 12 months; SBP from baseline to 3 months (−10.5 ± 6.4 mmHg, p < 0.001), no further changes after 1 year of observation).Conclusionthe tested VLCD diet suggested by trained general physicians in the setting of clinical practice seems to be able to significantly improve on the middle-term a number of anthropometric, haemodynamic and laboratory with an overall good tolerability.

Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials

The role of very-low-carbohydrate ketogenic diets (VLCKD) in the long-term management of obesity is not well established. The present meta-analysis aimed to investigate whether individuals assigned to a VLCKD (i.e. a diet with no more than 50 g carbohydrates/d) achieve better long-term body weight and cardiovascular risk factor management when compared with individuals assigned to a conventional low-fat diet (LFD; i.e. a restricted-energy diet with less than 30% of energy from fat). Through August 2012, MEDLINE, CENTRAL, ScienceDirect,Scopus, LILACS, SciELO, ClinicalTrials.gov and grey literature databases were searched, using no date or language restrictions, for randomised controlled trials that assigned adults to a VLCKD or a LFD, with 12 months or more of follow-up. The primary outcome was bodyweight. The secondary outcomes were TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), systolic and diastolic blood pressure,glucose, insulin, HbA1c and C-reactive protein levels. A total of thirteen studies met the inclusion/exclusion criteria. In the overall analysis,five outcomes revealed significant results. Individuals assigned to a VLCKD showed decreased body weight (weighted mean difference -0·91 (95% CI -1·65, -0·17) kg, 1415 patients), TAG (weighted mean difference -0·18 (95% CI -0·27, -0·08) mmol/l, 1258 patients)and diastolic blood pressure (weighted mean difference -1·43 (95% CI -2·49, -0·37) mmHg, 1298 patients) while increased HDL-C(weighted mean difference 0·09 (95% CI 0·06, 0·12) mmol/l, 1257 patients) and LDL-C (weighted mean difference 0·12 (95% CI 0·04,0·2) mmol/l, 1255 patients). Individuals assigned to a VLCKD achieve a greater weight loss than those assigned to a LFD in the longterm; hence, a VLCKD may be an alternative tool against obesity.

Ketogenic diet does not affect strength performance in elite artistic gymnasts.

BackgroundDespite the increasing use of very low carbohydrate ketogenic diets (VLCKD) in weight control and management of the metabolic syndrome there is a paucity of research about effects of VLCKD on sport performance. Ketogenic diets may be useful in sports that include weight class divisions and the aim of our study was to investigate the influence of VLCKD on explosive strength performance.Methods8 athletes, elite artistic gymnasts (age 20.9 ± 5.5 yrs) were recruited. We analyzed body composition and various performance aspects (hanging straight leg raise, ground push up, parallel bar dips, pull up, squat jump, countermovement jump, 30 sec continuous jumps) before and after 30 days of a modified ketogenic diet. The diet was based on green vegetables, olive oil, fish and meat plus dishes composed of high quality protein and virtually zero carbohydrates, but which mimicked their taste, with the addition of some herbal extracts. During the VLCKD the athletes performed the normal training program. After three months the same protocol, tests were performed before and after 30 days of the athletes’ usual diet (a typically western diet, WD). A one-way Anova for repeated measurements was used.ResultsNo significant differences were detected between VLCKD and WD in all strength tests. Significant differences were found in body weight and body composition: after VLCKD there was a decrease in body weight (from 69.6 ± 7.3 Kg to 68.0 ± 7.5 Kg) and fat mass (from 5.3 ± 1.3 Kg to 3.4 ± 0.8 Kg p < 0.001) with a non-significant increase in muscle mass.ConclusionsDespite concerns of coaches and doctors about the possible detrimental effects of low carbohydrate diets on athletic performance and the well known importance of carbohydrates there are no data about VLCKD and strength performance. The undeniable and sudden effect of VLCKD on fat loss may be useful for those athletes who compete in sports based on weight class. We have demonstrated that using VLCKD for a relatively short time period (i.e. 30 days) can decrease body weight and body fat without negative effects on strength performance in high level athletes.