Nutrition: Differences between Unsaturated and Saturated Fats & ketosis and weight loss

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Curr Opin Endocrinol Diabetes Obes. 2017 Oct;24(5):315-319. doi: 10.1097/MED.0000000000000361.

Dietary guidelines in type 2 diabetes: the Nordic diet or the ketogenic diet? Magnusdottir OK , Gunnarsdottir I, Birgisdóttir BE.

Abstract To highlight recent developments in research regarding nutrition

therapies for type 2 diabetes mellitus (T2DM) with a focus on the different approaches of the Nordic diet and the ketogenic diet.

Recent short-term studies have revealed that similar beneficial outcomes are seen after different dietary treatments for T2DM, with different approaches resulting in comparable weight loss and impacts on metabolic factors.

More individualized approaches in nutrition therapy should be considered for T2DM patients and clinical guidelines should reflect this. More studies, especially long-term studies, are urgently needed on the impacts of the diets on different health parameters. Such studies should be prioritized because of the high and increasing prevalence of T2DM and because dietary changes may have greater benefits than previously thought. Furthermore, studies that focus on patient compliance to different types of diets, and personal and environmental factors that may affect compliance, are needed.

PMID: 28723705 DOI: 10.1097/MED.0000000000000361

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2. J Int Soc Sports Nutr. 2017 Jul 12;14:22. doi: 10.1186/s12970-017-0180-0. eCollection 2017.

Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes. Zinn C , Wood M , Williden M , Chatterton S , Maunder E .

Abstract Low-carbohydrate, high-fat and ketogenic diets are increasingly adopted by

athletes for body composition and sports performance enhancements. However, as yet, there is no consensus on their efficacy in improving performance. There is also no comprehensive literature on athletes' experiences while undertaking this diet. The purpose of this pilot work was two-fold: i. to examine the effects of a non-calorie controlled ketogenic diet on body composition and performance outcomes of endurance athletes, and ii. to evaluate the athletes' experiences of the ketogenic diet during the 10-week intervention.

Using a case study design, five New Zealand endurance athletes (4 females, 1 male) underwent a 10-week ketogenic dietary intervention. Body composition (sum of 8 skinfolds), performance indicators (time to exhaustion, VO max, peak power and ventilatory threshold), and gas exchange thresholds were measured at baseline and at 10 weeks. Mean change scores were calculated, and analysed using t-tests; Cohen's effect sizes and 90% confidence limits were applied to quantify change. Individual interviews conducted at 5 weeks and a focus group at 10 weeks assessed athletes' ketogenic diet experiences. Data was transcribed and analysed using thematic analysis.

All athletes increased their ability to utilise fat as a fuel source, including at higher exercise intensities. Mean body weight was reduced by 4 kg ± SD 3.1 (p = 0.046; effect size (ES):0.62), and sum of 8 skinfolds by 25.9 mm ± SD 6.9; ES: 1.27; p = 0.001). Mean time to exhaustion dropped by ~2 min (±SD 0.7; p = 0.004; ES: 0.53). Other performance outcomes showed mean reductions, with some increases or unchanged results in two individuals (VO2 Max: -1.69 ml.kg.min ± SD 3.4 (p = 0.63); peak power: -18 W ± SD 16.4 (p = 0.07), and VT2: -6 W ± SD 44.5 (p = 0.77). Athletes reported experiencing reduced energy levels initially, followed by a return of high levels thereafter, especially during exercise, but an inability to easily undertake high intense bouts. Each athlete reported experiencing enhanced well-being, included improved recovery, improvements in skin conditions and reduced inflammation.

Despite performance decrements and some negative experiences, athletes were keen to pursue a modified low-carbohydrate, high-fat eating style moving forward due to the unexpected health benefits they experienced.

ACTRN: ACTRN12617000613303. Registered 28 April 2017, retrospectively registered.

Endurance athletes; LCHF; Low-carbohydrate, high-fat; Performance; Well-being

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PMID: 28706467 PMCID: PMC5506682 DOI: 10.1186/s12970-017-0180-0

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J Int Soc Sports Nutr. 2017 Jun 14;14:16. doi: 10.1186/s12970-017-0174-y. eCollection 2017.

International society of sports nutrition position stand: diets and body composition. Aragon AA , Schoenfeld BJ , Wildman R , Kleiner S , VanDusseldorp T , Taylor L , Earnest CP , Arciero PJ , Wilborn C , Kalman DS , Stout JR , Willoughby DS , Campbell B , Arent SM , Bannock L , Smith-Ryan AE , Antonio J .

Abstract Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of diet types (macronutrient composition; eating styles) and their influence on body composition. The ISSN has concluded the following. 1) There is a multitude of diet types and eating styles, whereby numerous subtypes fall under each major dietary archetype. 2) All body composition assessment methods have strengths and limitations. 3) Diets primarily focused on fat loss are driven by a sustained caloric deficit. The higher the baseline body fat level, the more aggressively the caloric deficit may be imposed. Slower rates of weight loss can better preserve lean mass (LM) in leaner subjects. 4) Diets focused primarily on accruing LM are driven by a sustained caloric surplus to facilitate anabolic processes and support increasing resistance-training demands. The composition and magnitude of the surplus, as well as training status of the subjects can influence the nature of the gains. 5) A wide range of dietary approaches (low-fat to low- carbohydrate/ketogenic, and all points between) can be similarly effective for improving body composition. 6) Increasing dietary protein to levels significantly beyond current recommendations for athletic populations may result in improved body composition. Higher protein intakes (2.3- 3.1 g/kg FFM) may be required to maximize muscle retention in lean, resistance-trained subjects under hypocaloric conditions. Emerging research on very high protein intakes (>3 g/kg) has demonstrated that the known thermic, satiating, and LM-preserving effects of dietary protein might be amplified in resistance-training subjects. 7) The collective body of intermittent caloric restriction research demonstrates no significant advantage over daily caloric restriction for improving body composition. 8) The long-term success of a diet depends upon compliance and suppression or circumvention of mitigating factors such as adaptive thermogenesis. 9) There is a

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paucity of research on women and older populations, as well as a wide range of untapped permutations of feeding frequency and macronutrient distribution at various energetic balances combined with training. Behavioral and lifestyle modification strategies are still poorly researched areas of weight management.

PMID: 28630601 PMCID: PMC5470183 DOI: 10.1186/s12970-017-0174-y

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Nutrients. 2017 May 19;9(5). pii: E517. doi: 10.3390/nu9050517.

Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. Kosinski C , Jornayvaz FR .

Abstract The treatment of obesity and cardiovascular diseases is one of the most difficult and important challenges nowadays. Weight loss is frequently offered as a therapy and is aimed at improving some of the components of the metabolic syndrome. Among various diets, ketogenic diets, which are very low in carbohydrates and usually high in fats and/or proteins, have gained in popularity. Results regarding the impact of such diets on cardiovascular risk factors are controversial, both in animals and humans, but some improvements notably in obesity and type 2 diabetes have been described. Unfortunately, these effects seem to be limited in time. Moreover, these diets are not totally safe and can be associated with some adverse events. Notably, in rodents, development of nonalcoholic fatty liver disease (NAFLD) and insulin resistance have been described. The aim of this review is to discuss the role of ketogenic diets on different cardiovascular risk factors in both animals and humans based on available evidence.

NAFLD; cardiovascular risk factors; fibroblast growth factor (FGF21); insulin resistance; ketogenic diets; obesity; type 2 diabetes

PMID: 28534852 PMCID: PMC5452247 DOI: 10.3390/nu9050517

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5. Int J Obes (Lond). 2017 Aug;41(8):1224-1231. doi: 10.1038/ijo.2017.96. Epub 2017 Apr 25.

Timeline of changes in appetite during weight loss with a ketogenic diet. Nymo S , Coutinho SR , Jørgensen J , Rehfeld JF , Truby H , Kulseng B , Martins C .

Abstract Diet-induced weight loss (WL) leads to increased hunger and

reduced fullness feelings, increased ghrelin and reduced satiety peptides concentration (glucagon-like peptide-1 (GLP-1), cholecystokinin (CCK) and peptide YY (PYY)). Ketogenic diets seem to minimise or supress some of these responses. The aim of this study was to determine the timeline over which changes in appetite occur during progressive WL with a ketogenic very- low-energy diet (VLED).

Thirty-one sedentary adults (18 men), with obesity (body mass index: 37±4.5 kg m ) underwent 8 weeks (wks) of a VLED followed by 4 wks of weight maintenance. Body weight and composition, subjective feelings of appetite and appetite-related hormones (insulin, active ghrelin (AG), active GLP-1, total PYY and CCK) were measured in fasting and postprandially, at baseline, on day 3 of the diet, 5 and 10% WL, and at wks 9 and 13. Data are shown as mean±s.d.

A significant increase in fasting hunger was observed by day 3 (2±1% WL), (P<0.01), 5% WL (12±8 days) (P<0.05) and wk 13 (17±2% WL) (P<0.05). Increased desire to eat was observed by day 3 (P<0.01) and 5% WL (P<0.05). Postprandial prospective food consumption was significantly reduced at wk 9 (16±2% WL) (P<0.01). Basal total PYY was significantly reduced at 10% WL (32±8 days) (P<0.05). Postprandial active GLP-1 was increased at 5% WL (P<0.01) and CCK reduced at 5 and 10% WL (P<0.01, for both) and wk 9 (P<0.001). Basal and postprandial AG were significantly increased at wk 13 (P<0.001, both).

WL with a ketogenic VLED transiently increases the drive to eat up to 3 weeks (5% WL). After that, and while participants are ketotic, a 10-17% WL is not associated with increased appetite. However, hunger feelings and AG concentrations increase significantly from baseline, once refeeding occurs.

PMID: 28439092 PMCID: PMC5550564 DOI: 10.1038/ijo.2017.96

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Endocrine. 2016 Oct;54(1):111-122. Epub 2016 Apr 27.

Effect of DHA supplementation in a very low-calorie ketogenic diet in the treatment of obesity: a randomized clinical trial. de Luis D , Domingo JC , Izaola O , Casanueva FF , Bellido D , Sajoux I .

Abstract A VLCK diet supplemented with DHA, commercially available, was tested against an isocaloric VLCK diet without DHA. The main purpose of this study was to compare the effect of DHA supplementation in classic cardiovascular risk factors, adipokine levels, and inflammation- resolving eicosanoids. A total of obese patients were randomized into two groups: a group supplemented with DHA (n = 14) (PnK-DHA group) versus a group with an isocaloric diet free of supplementation (n = 15) (control group). The follow-up period was 6 months. The average weight loss after 6 months of treatment was 20.36 ± 5.02 kg in control group and 19.74 ± 5.10 kg in PnK-DHA group, without statistical differences between both groups. The VLCK diets induced a significant change in some of the biological parameters, such as insulin, HOMA-IR, triglycerides, LDL cholesterol, C-reactive protein, resistin, TNF alpha, and leptin. Following DHA supplementation, the DHA-derived oxylipins were significantly increased in the intervention group. The ratio of proresolution/proinflammatory lipid markers was increased in plasma of the intervention group over the entire study. Similarly, the mean ratios of AA/EPA and AA/DHA in erythrocyte membranes were dramatically reduced in the PnK-DHA group and the anti- inflammatory fatty acid index (AIFAI) was consistently increased after the DHA treatment (p < 0.05). The present study demonstrated that a very low-calorie ketogenic diet supplemented with DHA was significantly superior in the anti-inflammatory effect, without statistical differences in weight loss and metabolic improvement.

DHA; Ketosis; PnK method; Pronokal method; Protein diet; Weight loss

PMID: 27117144 DOI: 10.1007/s12020-016-0964-z

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7. J Clin Endocrinol Metab. 2017 Feb 1;102(2):488-498. doi: 10.1210/jc.2016-2385.

Body Composition Changes After Very-Low-Calorie Ketogenic Diet in Obesity Evaluated by 3 Standardized Methods. Gomez-Arbelaez D , Bellido D , Castro AI , Ordoñez-Mayan L , Carreira J , Galban C , Martinez-Olmos MA , Crujeiras AB , Sajoux I , Casanueva FF .

Abstract Common concerns when using low-calorie diets as a treatment for obesity are the

reduction in fat-free mass, mostly muscular mass, that occurs together with the fat mass (FM) loss, and determining the best methodologies to evaluate body composition changes.

This study aimed to evaluate the very-low-calorie ketogenic (VLCK) diet-induced changes in body composition of obese patients and to compare 3 different methodologies used to evaluate those changes.

Twenty obese patients followed a VLCK diet for 4 months. Body composition assessment was performed by dual-energy X-ray absorptiometry (DXA), multifrequency bioelectrical impedance (MF-BIA), and air displacement plethysmography (ADP) techniques. Muscular strength was also assessed. Measurements were performed at 4 points matched with the ketotic phases (basal, maximum ketosis, ketosis declining, and out of ketosis).

After 4 months the VLCK diet induced a -20.2 ± 4.5 kg weight loss, at expenses of reductions in fat mass (FM) of -16.5 ± 5.1 kg (DXA), -18.2 ± 5.8 kg (MF-BIA), and -17.7 ± 9.9 kg (ADP). A substantial decrease was also observed in the visceral FM. The mild but marked reduction in fat-free mass occurred at maximum ketosis, primarily as a result of changes in total body water, and was recovered thereafter. No changes in muscle strength were observed. A strong correlation was evidenced between the 3 methods of assessing body composition.

The VLCK diet-induced weight loss was mainly at the expense of FM and visceral mass; muscle mass and strength were preserved. Of the 3 body composition techniques used, the MF-BIA method seems more convenient in the clinical setting.

Copyright © 2017 by the Endocrine Society

PMID: 27754807 DOI: 10.1210/jc.2016-2385

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8. Nutr Diabetes. 2016 Sep 19;6(9):e230. doi: 10.1038/nutd.2016.36.

Short-term safety, tolerability and efficacy of a very low-calorie- ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Goday A , Bellido D , Sajoux I , Crujeiras AB , Burguera B , García-Luna PP , Oleaga A , Moreno B , Casanueva FF .

Abstract Brackground:The safety and tolerability of very low-calorie-ketogenic (VLCK) diets are a current concern in the treatment of obese type 2 diabetes mellitus (T2DM) patients.

Evaluating the short-term safety and tolerability of a VLCK diet (<50 g of carbohydrate daily) in an interventional weight loss program including lifestyle and behavioral modification support (Diaprokal Method) in subjects with T2DM.

Eighty-nine men and women, aged between 30 and 65 years, with T2DM and body mass index between 30 and 35 kg m(-)(2) participated in this prospective, open-label, multi- centric randomized clinical trial with a duration of 4 months. Forty-five subjects were randomly assigned to the interventional weight loss (VLCK diet), and 44 to the standard low-calorie diet.

No significant differences in the laboratory safety parameters were found between the two study groups. Changes in the urine albumin-to-creatinine ratio in VLCK diet were not significant and were comparable to control group. Creatinine and blood urea nitrogen did not change significantly relative to baseline nor between groups. Weight loss and reduction in waist circumference in the VLCK diet group were significantly larger than in control subjects (both P<0.001). The decline in HbA1c and glycemic control was larger in the VLCK diet group (P<0.05). No serious adverse events were reported and mild AE in the VLCK diet group declined at last follow-up.

The interventional weight loss program based on a VLCK diet is most effective in reducing body weight and improvement of glycemic control than a standard hypocaloric diet with safety and good tolerance for T2DM patients.

PMID: 27643725 PMCID: PMC5048014 DOI: 10.1038/nutd.2016.36

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9. Int J Food Sci Nutr. 2016 Sep;67(6):696-706. doi: 10.1080/09637486.2016.1186157. Epub 2016 May 18.

An observational study of sequential protein-sparing, very low- calorie ketogenic diet (Oloproteic diet) and hypocaloric Mediterranean-like diet for the treatment of obesity. Castaldo G , Monaco L , Castaldo L , Galdo G , Cereda E .

Abstract The impact of a rehabilitative multi-step dietary program consisting in different diets has been scantily investigated. In an open-label study, 73 obese patients underwent a two-phase weight loss (WL) program: a 3-week protein-sparing, very low-calorie, ketogenic diet (<500 kcal/day; Oloproteic(®) Diet) and a 6-week hypocaloric (25-30 kcal/kg of ideal body weight/day), low glycemic index, Mediterranean-like diet (hypo-MD). Both phases improved visceral adiposity, liver enzymes, GH levels, blood pressure and glucose and lipid metabolism. However, the hypo- MD was responsible for a re-increase in blood lipids and glucose tolerance parameters. Changes in visceral adiposity and glucose control-related variables were more consistent in patients with metabolic syndrome. However, in these patients the hypo-MD did not result in a consistent re- increase in glucose control-related variables. A dietary program consisting in a ketogenic regimen followed by a balanced MD appeared to be feasible and efficacious in reducing cardiovascular risk, particularly in patients with metabolic syndrome.

Ketogenic diet; Mediterranean diet; obesity; weight loss

PMID: 27193396 DOI: 10.1080/09637486.2016.1186157

[Indexed for MEDLINE]

Lung. 2015 Dec;193(6):939-45. doi: 10.1007/s00408-015-9806-7. Epub 2015 Sep 26.

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10. Effects of Twenty Days of the Ketogenic Diet on Metabolic and Respiratory Parameters in Healthy Subjects. Rubini A , Bosco G , Lodi A , Cenci L , Parmagnani A , Grimaldi K , Zhongjin Y , Paoli A .

Erratum in Erratum to: Effects of Twenty Days of the Ketogenic Diet on Metabolic and Respiratory Parameters in Healthy Subjects. [Lung. 2017]

Abstract The effects of the ketogenic diet (KD) on weight loss, metabolic, and respiratory

parameters were investigated in healthy subjects.

Thirty-two healthy subjects were randomized into two groups. The KD group followed a ketogenic diet for 20 days (KD t 0-t 20), then switched to a low-carbohydrate, no-ketogenic diet for 20 days (KD t 20-t 40), and finally was on a Mediterranean diet (MD) for 2 more months (KD t 40-t 2m). The MD group followed a MD for 20 days (MD t 0-t 20), then followed a MD of 1400 kcal over the next 20 days (MD t 20-t 40), and completed the study with the MD for 2 months (MD t 40-t 2m). Body weight, body fat, respiratory rate, and respiratory gas parameters (including respiratory exchange ratio (RER) and carbon dioxide end-tidal partial pressure (PETCO2), oxygen uptake (VO2), carbon dioxide production (VCO2), and resting energy expenditure (REE)) were measured at each point.

A significant decrease (p < 0.05) in RER was observed after 20 and 40 days in the KD group, but not in the MD group. In the KD group, significant reductions were observed for both carbon dioxide output and PETCO2, however, there was no significant change in VO2, VCO2, and REE. While both diets significantly decreased body fat mass, the KD diet overall proved to have a higher percentage of fat loss versus the MD diet.

The KD may significantly decrease carbon dioxide body stores, which may theoretically be beneficial for patients with increased carbon dioxide arterial partial pressure due to respiratory insufficiency or failure.

Ketogenic diet; Metabolism; Respiration parameters; Resting energy expenditure

PMID: 26410589 DOI: 10.1007/s00408-015-9806-7

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Int J Sport Nutr Exerc Metab. 2016 Feb;26(1):78-92. doi: 10.1123/ijsnem.2015-0070. Epub 2015 Aug 12.

Fat-Free Mass Changes During Ketogenic Diets and the Potential Role of Resistance Training. Tinsley GM , Willoughby DS.

Abstract Low-carbohydrate and very-low-carbohydrate diets are often used as weight-loss strategies by exercising individuals and athletes. Very-low-carbohydrate diets can lead to a state of ketosis, in which the concentration of blood ketones (acetoacetate, 3-β-hydroxybutyrate, and acetone) increases as a result of increased fatty acid breakdown and activity of ketogenic enzymes. A potential concern of these ketogenic diets, as with other weight-loss diets, is the potential loss of fat-free mass (e.g., skeletal muscle). On examination of the literature, the majority of studies report decreases in fat-free mass in individuals following a ketogenic diet. However, some confounding factors exist, such as the use of aggressive weight-loss diets and potential concerns with fat-free mass measurement. A limited number of studies have examined combining resistance training with ketogenic diets, and further research is needed to determine whether resistance training can effectively slow or stop the loss of fat-free mass typically seen in individuals following a ketogenic diet. Mechanisms underlying the effects of a ketogenic diet on fat-free mass and the results of implementing exercise interventions in combination with this diet should also be examined.

PMID: 26284291 DOI: 10.1123/ijsnem.2015-0070

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High Blood Press Cardiovasc Prev. 2015 Dec;22(4):389-94. doi: 10.1007/s40292-015-0096-1. Epub 2015 May 19.

Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross- Sectional, Clinical Study. Cicero AF , Benelli M , Brancaleoni M , Dainelli G , Merlini D , Negri R .

Abstract

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Obesity 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.

to 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).

The 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.

All 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).

the 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.

Cardiovascular risk factors; General practice; Ketogenic diet; Safety

PMID: 25986079 PMCID: PMC4666896 DOI: 10.1007/s40292-015-0096-1

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Exerc Sport Sci Rev. 2015 Jul;43(3):109. doi: 10.1249/JES.0000000000000053.

Ketogenic Diets for Fat Loss and Exercise Performance: Benefits and Safety? Kiens B , Astrup A.

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Comment on The Ketogenic Diet and Sport: A Possible Marriage? [Exerc Sport Sci Rev. 2015]

PMID: 25906429 DOI: 10.1249/JES.0000000000000053

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Obes Rev. 2015 Jan;16(1):64-76. doi: 10.1111/obr.12230. Epub 2014 Nov 17.

Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Gibson AA , Seimon RV, Lee CM, Ayre J, Franklin J, Markovic TP, Caterson ID, Sainsbury A.

Abstract Very-low-energy diets (VLEDs) and ketogenic low-carbohydrate diets (KLCDs) are two dietary strategies that have been associated with a suppression of appetite. However, the results of clinical trials investigating the effect of ketogenic diets on appetite are inconsistent. To evaluate quantitatively the effect of ketogenic diets on subjective appetite ratings, we conducted a systematic literature search and meta-analysis of studies that assessed appetite with visual analogue scales before (in energy balance) and during (while in ketosis) adherence to VLED or KLCD. Individuals were less hungry and exhibited greater fullness/satiety while adhering to VLED, and individuals adhering to KLCD were less hungry and had a reduced desire to eat. Although these absolute changes in appetite were small, they occurred within the context of energy restriction, which is known to increase appetite in obese people. Thus, the clinical benefit of a ketogenic diet is in preventing an increase in appetite, despite weight loss, although individuals may indeed feel slightly less hungry (or more full or satisfied). Ketosis appears to provide a plausible explanation for this suppression of appetite. Future studies should investigate the minimum level of ketosis required to achieve appetite suppression during ketogenic weight loss diets, as this could enable inclusion of a greater variety of healthy carbohydrate-containing foods into the diet.

Appetite; ketogenic diet; low carbohydrate; very-low-energy diet

PMID: 25402637 DOI: 10.1111/obr.12230

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Endocrine. 2014 Dec;47(3):793-805. doi: 10.1007/s12020-014-0192-3. Epub 2014 Mar 4.

Comparison of a very low-calorie-ketogenic diet with a standard low-calorie diet in the treatment of obesity. Moreno B , Bellido D, Sajoux I, Goday A, Saavedra D, Crujeiras AB, Casanueva FF.

Abstract The global prevalence of obesity has significantly increased in most industrialized countries. Anti- obesity drugs are scarce, and indications to change their life style are impractical. Therefore, to identify diets able to produce significantly and maintained weight loss is mandatory. The present work evaluated the efficacy of a very low-calorie-ketogenic (VLCK) diet in obesity. A group of obese patients were randomized into two groups: the VLCK diet group and a standard low- calorie diet (LC group). The follow-up period was 12 months. Both groups received external support, counseling, to perform physical activity and adhered to the diet. The VLCK diet induced a 30-45 days of mild ketosis and significant effects on body weight within 15 days. At 2 months, the weight reductions in the VLCK diet and LC diet groups were 13.6 ± 3.9 and 4.8 ± 2.7 kg, respectively (p < 0.0001). At the end of the study, at 12 months, the weight reductions were 19.9 ± 12.3 and 7.0 ± 5.6 kg, respectively (p < 0.0001), and more than 88 % of patients in the VLCK diet group lost more of 10 % of their initial weight. Lean mass was practically unaffected. The VLCK diet was well tolerated and the side effects were moderate and transitory. In a group of obese patients, the VLCK diet was significantly more effective than a standard LC diet. At one year follow-up in the group with VLCK diet, most of the patients loss more than 10 % of their initial weight and lean mass was well preserved.

PMID: 24584583 DOI: 10.1007/s12020-014-0192-3

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7/29/2018 Clipboard - PubMed - NCBI

https://www.ncbi.nlm.nih.gov/pubmed 15/15

16. Eur J Clin Nutr. 2013 Aug;67(8):789-96. doi: 10.1038/ejcn.2013.116. Epub 2013 Jun 26.

Beyond weight loss: a review of the therapeutic uses of very-low- carbohydrate (ketogenic) diets. Paoli A , Rubini A, Volek JS, Grimaldi KA.

Erratum in Eur J Clin Nutr. 2014 May;68(5):641.

Abstract Very-low-carbohydrate diets or ketogenic diets have been in use since the 1920s as a therapy for epilepsy and can, in some cases, completely remove the need for medication. From the 1960s onwards they have become widely known as one of the most common methods for obesity treatment. Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors. The possibility that modifying food intake can be useful for reducing or eliminating pharmaceutical methods of treatment, which are often lifelong with significant side effects, calls for serious investigation. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possible mechanisms for the therapeutic actions of the ketogenic diet on different diseases. The present review also questions whether there are still some preconceived ideas about ketogenic diets, which may be presenting unnecessary barriers to their use as therapeutic tools in the physician's hand.

PMID: 23801097 PMCID: PMC3826507 DOI: 10.1038/ejcn.2013.116

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