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Low Carbohydrate Renaissance

December 29, 2010 Written by JP    [Font too small?]

One of my favorite Christmas gifts this year came in the form of an article that my wife sent me via e-mail. The piece, “A Reversal on Carbs”, was written by Marnia Jameson and appeared in December 20th online edition of the Los Angeles Times. It features the voices of many of the leading nutritional scientists the world over. The general thrust of the publication is best summarized by Dr. Walter Willet, the chairman of the department of nutrition at the Harvard School of Public Health. He emphatically states that, “If Americans could eliminate sugary beverages, potatoes, white bread, pasta, white rice and sugar snacks, we would wipe out almost all of the problems we have with weight and diabetes and other metabolic diseases”. I would’ve added a few additional foods to that list, but otherwise I agree wholeheartedly. (1)

Anyone who regularly reads my columns knows that I frequently criticize foods and food products that contain high glycemic and/or refined carbohydrates. What’s more, many of you already know that I’ve lost over 90 lbs primarily by restricting my overall carbohydrate intake. But you may not be aware of the physiological underpinnings behind my general recommendation to follow suit. Here’s a brief overview of the importance of moderating carbohydrate consumption:

In the body, carbohydrates are converted into blood sugar. Certain carbs such as those rich in starches (grains, potatoes) and sugar (candy, fruit juice) lead to quicker and more dramatic elevations in blood glucose. In order to deal with this rapid rise in blood sugar, the pancreas must release insulin in order to transport sugar from the blood into cells to provide a form of stored energy known as glycogen.

The problem is that the human body isn’t well adapted to handle the estimated 250 to 300 grams of carbohydrates that are commonly consumed in the modern diet. Over time, our cells become tired of trying to keep up with this unnatural burden. This leads to a dangerous situation referred to as insulin resistance. In essence, the insulin the body produces becomes less effective. Then the pancreas attempts to compensate for this abnormality by producing excessive amounts of insulin.

The result of this destructive cycle is typically diabetes, obesity and several risk factors pertaining to heart disease known collectively as metabolic syndrome. The specific threats involved include abdominal obesity, high blood pressure and blood sugar, high triglycerides and low HDL (“good”) cholesterol. It is estimated that approximately 25% of the US population has at least three of these symptoms – the benchmark for establishing metabolic syndrome.

That’s the bad news. The good news is that a large body of research indicates that making modest changes in your diet can help reverse the danger that a high carbohydrate diet presents. Several recent studies attest to the safety and value of making this very shift. For instance, the latest issue of the British Journal of Nutrition reports that an egg-rich, high protein/high cholesterol diet improved antioxidant levels, blood sugar control and cardiovascular risk factors in a group with type 2 diabetes and impaired glucose tolerance. Another trial using a very low carbohydrate (ketogenic) diet found that this dietary intervention improved memory performance and reduced waist circumference and weight in a group of 23 older adults with mild cognitive impairment. The authors noted that chronic inflammation, high insulin (hyperinsulinemia) and problems relating to energy metabolism are frequently present in those most at risk for Alzhmeimer’s disease and other neurocognitive diseases. Ketogenic diets are documented as addressing all of these issues and more. (2,3)

Body Composition and Blood Marker Responses of Subjects at Baseline and Following the Two Low Carbohydrate Diets

Characteristic Baseline CRD-Saturated Fat
CRD-Unsaturated Fat
hs-CRP (mg/dl) 2.7 ± 2.3 1.8 ± 0.9 2.7 ± 1.8
IL-6 (pg/ml) 1.3 ± 1.1 0.9 ± 0.9 1.1 ± 1.2
IL-8 (pg/ml) 1.7 ± 0.6 1.5 ± 0.9 1.9 ± 1.1
TNF-a (pg/ml) 3.8 ± 1.5 3.4 ± 1.4 3.6 ± 1.6
MCP-1 (pg/ml) 251 ± 81 234 ± 94 269 ± 123
8-iso PGF2a (pg/mg creatinine) 629 ± 262 524 ± 146 425 ± 61

Source: Lipids. 2010 October; 45(10): 947–962. (link)

The question I’m most often asked in reference to carbohydrate restricted diets is: Are they really safe? The answer in most instances is ‘yes’. This point of view is increasingly shared by clinicians, as evidenced by the growing number of studies utilizing lower carbohydrate diets in vulnerable populations including pregnant women and young children. The general consensus is that higher protein diets that emphasize low sugar source carbohydrates tend to protect against obesity and the health concerns that accompany the current epidemic of overweight. I’m convinced that this is the trend of the future. If you haven’t already done so, I strongly suggest that you take a look at the number and type of carbs in your own diet. If you’re like most people, you’d do well to reduce the number of total carbohydrates and replace some of them with healthy sources of fat, fiber, low glycemic fruits, non-starchy vegetables and protein. (4,5,6)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Diet and Weight Loss, Food and Drink, Nutrition

44 Comments & Updates to “Low Carbohydrate Renaissance”

  1. Mark Says:

    I practice a low starch diet, actively eating more fresh veggies and fruits. But I’m confused on potatoes. What’s the difference between a white potato and a sweet potato. Is it a difference in nutrition or fiber? I read a lot of articles about the benefits of sweet potatoes.

  2. Tiffany Says:

    I’m pregnant, and a big advocate of a low carb diet. I’m still overweight, and I’m not sure how low I should go. The doctor and nurses kinda flip out when they find ketones in my urine. My main concern during this time is the health of my unborn child, and me- I can deal with me later. If you have any of these studies regarding pregnancy, I’d love to read them. I have yet to dig up any truly valuable information.

    Thanks for the info – great read.

  3. JP Says:


    There’s a pretty significant difference in terms of their glycemic index, load and nutrient density:

    http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2770/2 (potato)

    http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2667/2 (sweet potato)

    Sweet potatoes are clearly superior, IMO. They’re still too high in carbs for some low carbohydrate diets. But they can be enjoyed in moderation by many people.

    Be well!


  4. JP Says:


    I think your judgment is right on the money. Right now, you need to focus on your overall health and the health of your baby to come, IMO. I’d consider focusing on eating a low glycemic, whole food diet that contains a fair share of healthy fats, fiber and protein. Lots of non-starchy vegetables. I would also stay as active as your doctors will allow. Movement helps – not only in relation to weight but also re: insulin sensitivity. A few studies for you:






    Be well!


  5. Tiffany Says:

    Thank you JP –
    I felt like I was doing the right thing, but then yesterday I read a horrible tale of low birth weights and the mother starving her unborn child, but I really don’t think I’m in any danger of that!

    I’ll make my way through the links you posted – THANK YOU!

  6. JP Says:


    You’re most welcome! 🙂

    This is purely anecdotal … My sister-in-law recently gave birth to twin boys. She actually needed to modify her typical diet during the course of her pregnancy due to elevated blood sugar readings. For her, adopting a diet that contained fewer carbohydrates helped her stay well and avoid gestational diabetes. It wasn’t necessarily a low carbohydrate diet. But she did avoid many of the higher GI & GL foods and emphasized better options.

    Be well!


  7. Tiffany Says:

    Perfect – I know I’m at a higher risk for GD. However, I think I’ll be fine, eating low enough to avoid GD, but high enough to avoid ketosis. I really think that’ll be the perfect balance and certainly a lot lower in carbs than the standard American diet. I’ve just been seeking that affirmation that I’m on the right track. Now I’m off to read more on the links.

  8. Bill Says:

    The LA Times article is significant. There is now a critical mass of respected nutritionists and researchers speaking up about the dangers of high-carb diets such that the media is starting to take notice.

    Gary Taubes really got the ball rolling in 2007 with “Good Calories, Bad Calories.” I’ve been allowing 10 years until 2017 before we see public policy revised to reflect reality. In the meantime, there will be many scientists, etc. that made their names by “proving” that fat is the enemy who will fight low-carb to the death.

    The real issue for people going low-carb is what to eat instead of white flour. The correct answer in my mind is to increase the consumption of high-quality fats, and because of the nature of our food supply, that is no easy task.

    As usual, thanks, JP, for sharing this.

    Good luck,


  9. Pradip Gharpure Says:

    Though low carb diet has its relevance it is unfair to always that kind of diet. We need to take all sorts of diet and not only low carb diet.

  10. JP Says:

    Thank you, Bill. I tend to agree. But I think it can be done – provided we have resolve and the necessary resources. I’m all about making this dietary shift practical.

    A practical example: I just brought over some gluten-free, low carb cookies to a holiday party. They were well accepted and didn’t have a grain of flour in them. Plenty of healthy fats as well. I’ll add a link to the recipe once it’s posted tomorrow.

    Be well!


  11. JP Says:


    I don’t think low carb diets are for everyone. But I do believe that high carb diets that are rich in starch and sugar do not promote health. Any movement away from the latter dietary trend would be a positive development, IMO.

    Be well!


  12. Bill Says:

    If your body responds to rapid glucose infusions by overproducing insulin, you will be a person who tends to easily put on weight from eating carbs, and you will be in danger of suffering from all the chronic maladies now being associated with chronic high insulin levels.

    If you are one of the unusual people who tolerates a high-carb diet well, I suspect you are a slender high-energy person.

    Good luck,


  13. Adriana Says:

    Even when low carbs diet do have excelent results on weight loss, I do have some concerns about high protein diets and the probably kidney failure ( If we think that Obeses have more risk to suffer high blodd pressure).
    Greetings from Venezuela.

  14. JP Says:


    Please keep in mind that many low-carbohydrate diets are not high in protein. The variety of low-carb eating I advocate is: high in healthy fats, fiber, non-starchy vegetables and select low-glycemic fruits; moderate in protein; and devoid of added sugar, refined carbohydrates and starches.

    I think you might enjoy my three-part interview with Dr. Richard Feinman. In that exchange, he explains away many misconceptions about what healthy low-carb dieting is and is not:




    Be well!


  15. Iggy Dalrymple Says:

    “Low-carbohydrate diet scores and risk of type 2 diabetes in men”

    Results: We documented 2689 cases of T2D during follow-up. After adjustments for age, smoking, physical activity, coffee intake, alcohol intake, family history of T2D, total energy intake, and body mass index, the score for high animal protein and fat was associated with an increased risk of T2D [top compared with bottom quintile: hazard ratio (HR): 1.37; 95% CI: 1.20, 1.58; P for trend < 0.01]. Adjustment for red and processed meat attenuated this association (HR: 1.11; 95% CI: 0.95, 1.30; P for trend = 0.20). A high score for vegetable protein and fat was not significantly associated with the risk of T2D overall but was inversely associated with T2D in men aged <65 y (HR: 0.78; 95% CI: 0.66, 0.92; P for trend = 0.01, P for interaction = 0.01).

    Conclusions: A score representing a low-carbohydrate diet high in animal protein and fat was positively associated with the risk of T2D in men. Low-carbohydrate diets should obtain protein and fat from foods other than red and processed meat.

  16. JP Says:

    Thanks for posting that, Iggy. I’d like to see the full text of the study to get a better handle on what they considered “low carbohydrate diets”.

    Be well!


  17. JP Says:

    Updated 07/20/15:


    Cureus. 2015 Feb 27;7(2):e251.

    The Efficacy of Ketogenic Diet and Associated Hypoglycemia as an Adjuvant Therapy for High-Grade Gliomas: A Review of the Literature.

    BACKGROUND: A high-fat, low-carbohydrate diet, often referred to as a ketogenic diet (KD), has been suggested to reduce frequency and severity of chronic pediatric and adult seizures. A hypoglycemic state, perpetuated by administration of a KD, has been hypothesized as a potential aid to the current standard treatments of high-grade gliomas.

    METHODS: To understand the effectiveness of the ketogenic diet as a therapy for malignant gliomas, studies analyzing components of a KD were reviewed. Both preclinical and clinical studies were included. The keywords “ketogenic diet, GBM, malignant glioma, hyperglycemia, hypoglycemia” were utilized to search for both abstracts and full articles in English. Overall, 39 articles were found and included in this review.

    RESULTS: Studies in animal models showed that a KD is able to control tumor growth and increase overall survival. Other pre-clinical studies have suggested that a KD sustains an environment in which tumors respond better to standard treatments, such as chemoradiation. In human cohorts, the KD was well tolerated. Quality of life was improved, compared to a standard, non-calorie or carbohydrate restricted diet. Hyperglycemia was independently associated with diminished survival.

    CONCLUSION: Recent clinical findings have demonstrated that induced hypoglycemia and ketogenic diet are tolerable and can potentially be an adjuvant to standard treatments, such as surgery and chemoradiation. Other findings have advocated for KD as a malignant cell growth inhibitor, and indicate that further studies analyzing larger cohorts of GBM patients treated with a KD are needed to determine the breadth of impact a KD can have on GBM treatment.

    Be well!


  18. JP Says:

    Updated 07/20/15:


    Am J Clin Nutr. 2015 Jul 15.

    Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial.

    BACKGROUND: Heart associations recommend limited intake of saturated fat. However, effects of saturated fat on low-density lipoprotein (LDL)-cholesterol concentrations and cardiovascular disease risk might depend on nutrients and specific saturated fatty acids (SFAs) in food.

    OBJECTIVE: We explored the effects of cheese and meat as sources of SFAs or isocaloric replacement with carbohydrates on blood lipids, lipoproteins, and fecal excretion of fat and bile acids.

    DESIGN: The study was a randomized, crossover, open-label intervention in 14 overweight postmenopausal women. Three full-diet periods of 2-wk duration were provided separated by 2-wk washout periods. The isocaloric diets were as follows: 1) a high-cheese (96-120-g) intervention [i.e., intervention containing cheese (CHEESE)], 2) a macronutrient-matched nondairy, high-meat control [i.e., nondairy control with a high content of high-fat processed and unprocessed meat in amounts matching the saturated fat content from cheese in the intervention containing cheese (MEAT)], and 3) a nondairy, low-fat, high-carbohydrate control (i.e., nondairy low-fat control in which the energy from cheese fat and protein was isocalorically replaced by carbohydrates and lean meat (CARB).

    RESULTS: The CHEESE diet caused a 5% higher high-density lipoprotein (HDL)-cholesterol concentration (P = 0.012), an 8% higher apo A-I concentration (P < 0.001), and a 5% lower apoB:apo A-I ratio (P = 0.008) than with the CARB diet. Also, the MEAT diet caused an 8% higher HDL-cholesterol concentration (P < 0.001) and a 4% higher apo A-I concentration (P = 0.033) than with the CARB diet. Total cholesterol, LDL cholesterol, apoB, and triacylglycerol were similar with the 3 diets. Fecal fat excretion was 1.8 and 0.9 g higher with the CHEESE diet than with CARB and MEAT diets (P < 0.001 and P = 0.004, respectively) and 0.9 g higher with the MEAT diet than with the CARB diet (P = 0.005). CHEESE and MEAT diets caused higher fecal bile acid excretion than did the CARB diet (P < 0.05 and P = 0.006, respectively). The dominant type of bile acids excreted differed between CHEESE and MEAT diets. CONCLUSIONS: Diets with cheese and meat as primary sources of SFAs cause higher HDL cholesterol and apo A-I and, therefore, appear to be less atherogenic than is a low-fat, high-carbohydrate diet. Also, our findings confirm that cheese increases fecal fat excretion. Be well! JP

  19. JP Says:

    Updated 07/20/15:


    J Diabetes Complications. 2015 Jun 9.

    Effects of a high-protein/low carbohydrate versus a standard hypocaloric diet on adipocytokine levels and insulin resistance in obese patients along 9months.

    OBJECTIVE: Recent dietary trials and observational studies have focused on the effects of diet on health outcomes such as improvement in levels of surrogate biomarkers. The aim of our study was to examine the changes in weight, adipocytokines levels and insulin resistance after a high-protein/low carbohydrate hypocaloric diet vs. a standard hypocaloric diet during an intervention of 9months.

    SUBJECTS AND METHODS: 331 obese subjects were randomly allocated to one of two diets for a period of 9months. Diet HP (n=168) (high-protein hypocaloric diet) consisted in a diet of 1050cal/day, 33% of carbohydrates, 33% of fats and 34% of proteins. Diet S (n=163) (standard protein hypocaloric diet) consisted in a diet of 1093cal/day, 53% carbohydrates, 27%fats, and 20% proteins.

    RESULTS: With the diets HP and S, BMI, weight, fat mass, waist circumference, waist-to-hip ratio, systolic blood pressure, total cholesterol, LDL-cholesterol, insulin and HOMA decreased. The decrease at 9months of (BMI: -2.6±1.3kg/m2 vs. -2.1±1.2kg/m2:p<0.05), weight (-8.4±4.2kg vs. -5.0±4.1kg: p<0.05), fat mass (-5.1±4.1kg vs. -3.4±4.2kg: p<0.05), systolic blood pressure (-5.1±7.1mmHg vs. -3.1±2.1mmHg: p<0.05), (insulin levels -4.0±4.8 UI/L vs. -2.2±2.4 UI/L; p<0.05) and HOMA (-0.8±1.0 units vs. -0.3±1.0 units; p<0.05) was higher in diet HP than Diet S. With both diets, leptin levels decreased.

    CONCLUSION: A high-protein/low carbohydrate hypocaloric diet shows a higher weight loss, insulin and HOMA-R decreased after 9months than a standard hypocaloric diet. The improvement in adipokine levels was similar with both diets.

    Be well!


  20. JP Says:

    Updated 07/20/15:


    Am J Clin Nutr. 2015 Jun 24.

    High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative.

    BACKGROUND: The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load.

    OBJECTIVE: We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression.

    DESIGN: This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Women’s Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954).

    RESULTS: We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth vs. first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth vs. first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression.

    CONCLUSIONS: The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women.

    Be well!


  21. JP Says:

    Updated 07/20/15:


    High Blood Press Cardiovasc Prev. 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.

    INTRODUCTION: 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.

    AIM: 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).

    METHODS: 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.

    RESULTS: 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). CONCLUSION: 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. Be well! JP

  22. JP Says:

    Updated 09/22/15:


    Nutrients 2015, 7(9), 7978-7994

    The Effects of a Low-Carbohydrate Diet vs. a Low-Fat Diet on Novel Cardiovascular Risk Factors: A Randomized Controlled Trial

    Increasing evidence supports a low-carbohydrate diet for weight loss and improvement in traditional cardiovascular disease (CVD) markers. Effects on novel CVD markers remain unclear. We examined the effects of a low-carbohydrate diet (<40 g/day; n = 75) versus a low-fat diet (<30% kcal/day from total fat, <7% saturated fat; n = 73) on biomarkers representing inflammation, adipocyte dysfunction, and endothelial dysfunction in a 12 month clinical trial among 148 obese adults free of diabetes and CVD. Participants met with a study dietitian on a periodic basis and each diet group received the same behavioral curriculum which included dietary instruction and supportive counseling. Eighty percent of participants completed the intervention. At 12 months, participants on the low-carbohydrate diet had significantly greater increases in adiponectin (mean difference in change, 1336 ng/mL (95% CI, 342 to 2330 ng/mL); p = 0.009) and greater decreases in intercellular adhesion molecule-1 concentrations (−16.8 ng/mL (−32.0 to −1.6 ng/mL); p = 0.031) than those on the low-fat diet. Changes in other novel CVD markers were not significantly different between groups. In conclusion, despite the differences in weight changes on diets, a low-carbohydrate diet resulted in similar or greater improvement in inflammation, adipocyte dysfunction, and endothelial dysfunction than a standard low-fat diet among obese persons.

    Be well!


  23. JP Says:

    Updated 12/05/15:


    Medicine (Baltimore). 2015 Nov;94(47):e2181.

    Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes: A Randomized Trial.

    To compare the long-term effects of a very low carbohydrate, high-protein, low saturated fat (LC) diet with a traditional high unrefined carbohydrate, low-fat (HC) diet on markers of renal function in obese adults with type 2 diabetes (T2DM), but without overt kidney disease.One hundred fifteen adults (BMI 34.6 ± 4.3 kg/m, age 58 ± 7 years, HbA1c 7.3 ± 1.1%, 56 ± 12 mmol/mol, serum creatinine (SCr) 69 ± 15 μmol/L, glomerular filtration rate estimated by the Chronic Kidney Disease Epidemiology Collaboration formula (eGFR 94 ± 12 mL/min/1.73 m)) were randomized to consume either an LC (14% energy as carbohydrate [CHO < 50 g/day], 28% protein [PRO], 58% fat [<10% saturated fat]) or an HC (53% CHO, 17% PRO, 30% fat [<10% saturated fat]) energy-matched, weight-loss diet combined with supervised exercise training (60 min, 3 day/wk) for 12 months. Body weight, blood pressure, and renal function assessed by eGFR, estimated creatinine clearance (Cockcroft-Gault, Salazar-Corcoran) and albumin excretion rate (AER), were measured pre- and post-intervention.Both groups achieved similar completion rates (LC 71%, HC 65%) and reductions in weight (mean [95% CI]; -9.3 [-10.6, -8.0] kg) and blood pressure (-6 [-9, -4]/-6[-8, -5] mmHg), P ≥ 0.18. Protein intake calculated from 24 hours urinary urea was higher in the LC than HC group (LC 120.1 ± 38.2 g/day, 1.3 g/kg/day; HC 95.8 ± 27.8 g/day, 1 g/kg/day), P < 0.001 diet effect. Changes in SCr (LC 3 [1, 5], HC 1 [-1, 3] μmol/L) and eGFR (LC -4 [-6, -2], HC -2 [-3, 0] mL/min/1.73 m) did not differ between diets (P = 0.25). AER decreased independent of diet composition (LC --2.4 [-6, 1.2], HC -1.8 [-5.4, 1.8] mg/24 h, P = 0.24); 6 participants (LC 3, HC 3) had moderately elevated AER at baseline (30-300 mg/24 h), which normalized in 4 participants (LC 2, HC 2) after 52 weeks.Compared with a traditional HC weight loss diet, consumption of an LC high protein diet does not adversely affect clinical markers of renal function in obese adults with T2DM and no preexisting kidney disease. Be well! JP

  24. JP Says:

    Updated 03/11/16:


    Appl Physiol Nutr Metab. 2016 Mar 10:1-6.

    Influence of a low-carbohydrate diet on endothelial microvesicles in overweight women.

    Low-carbohydrate diets (LCD) are increasing in popularity, but their effect on vascular health has been questioned. Endothelial microvesicles (EMV) are membrane-derived vesicles with the potential to act as a sensitive prognostic biomarker of vascular health and endothelial function. The aim of this study was to examine the influence of a LCD on EMV and other endothelial biomarkers of protein origin. Twenty-four overweight women (age, 48.4 ± 0.6 years; height, 1.60 ± 0.07 m; body mass, 76.5 ± 9.1 kg; body mass index, 28.1 ± 2.7 kg·m-2; waist circumference, 84.1 ± 7.4 cm; mean ± standard deviation) were randomised to either 24 weeks on their normal diet (ND) or a LCD, after which they crossed over to 24 weeks on the alternative diet. Participants were assisted in reducing carbohydrate intake, but not below 40 g·day-1. Body composition and endothelial biomarkers were assessed at the crossover point and at the end of the study. Daily carbohydrate intake (87 ± 7 versus 179 ± 11 g) and the percentage of energy derived from carbohydrate (29% versus 44%) were lower (p < 0.05) on the LCD compared to the ND, but absolute fat and saturated fat intake were unchanged. Body mass and waist circumference were 3.7 ± 0.8 kg and 3.5 ± 1.0 cm lower (p < 0.05), respectively, after the LCD compared with the ND phases. CD31+CD41-EMV, soluble (s) thrombomodulin, sE-selectin, sP-selectin, serum amyloid A and C-reactive protein were lower (p < 0.05) after the LCD compared to the ND, but serum lipids and apolipoproteins were not different. EMV along with a range of endothelial and inflammatory biomarkers are reduced by a LCD that involves modest weight loss. Be well! JP

  25. JP Says:

    Updated 05/21/16:


    Epilepsy Behav. 2016 May 17;60:153-157.

    Cognitive and behavioral impact of the ketogenic diet in children and adolescents with refractory epilepsy: A randomized controlled trial.

    PURPOSE: The ketogenic diet (KD) is increasingly used for the treatment of refractory epilepsy in childhood because of the beneficial effect on seizure reduction. The aim of the current study was to objectively assess cognition and aspects of behavior during the first 4months of a randomized controlled study in children and adolescents.

    METHODS: Participants from a tertiary epilepsy center were randomized to a KD group (intervention) or a care-as-usual (CAU) group (control). Follow-up assessments on cognition and behavior were performed approximately 4months after initiation of the KD with a combination of parent report questionnaires and individually administered psychological tests for the children.

    RESULTS: A total of 50 patients were enrolled in this study, 28 patients from the KD group and 22 patients from the CAU group. The KD group showed lower levels of anxious and mood-disturbed behavior and was rated as more productive. Cognitive test results showed an improvement of activation in the KD group.

    CONCLUSIONS: This study showed a positive impact of the KD on behavioral and cognitive functioning in children and adolescents with refractory epilepsy. More specifically, an activated mood and cognitive activation were observed in patients treated with the KD.

    Be well!


  26. JP Says:

    Updated 06/04/16:


    EXCLI J. 2016 Feb 23;15:166-76.

    The improvement of large High-Density Lipoprotein (HDL) particle levels, and presumably HDL metabolism, depend on effects of low-carbohydrate diet and weight loss.

    Depressed levels of atheroprotective large HDL particles are common in obesity and cardiovascular disease (CVD). Increases in large HDL particles are favourably associated with reduced CVD event risk and coronary plaque burden. The objective of the study is to compare the effectiveness of low-carbohydrate diets and weight loss for increasing blood levels of large HDL particles at 1 year. This study was performed by screening for body mass index (BMI) and metabolic syndrome in 160 consecutive subjects referred to our out-patient Metabolic Unit in South Italy. We administered dietary advice to four small groups rather than individually. A single team comprised of a dietitian and physician administered diet-specific advice to each group. Large HDL particles at baseline and 1 year were measured using two-dimensional gel electrophoresis. Dietary intake was assessed via 3-day diet records. Although 1-year weight loss did not differ between diet groups (mean 4.4 %), increases in large HDL particles paralleled the degree of carbohydrate restriction across the four diets (p<0.001 for trend). Regression analysis indicated that magnitude of carbohydrate restriction (percentage of calories as carbohydrate at 1 year) and weight loss were each independent predictors of 1-year increases in large HDL concentration. Changes in HDL cholesterol concentration were modestly correlated with changes in large HDL particle concentration (r=0.47, p=.001). In conclusion, reduction of excess dietary carbohydrate and body weight improved large HDL levels. Comparison trials with cardiovascular outcomes are needed to more fully evaluate these findings.

    Be well!


  27. JP Says:

    Updated 06/13/16:


    Dev Med Child Neurol. 2016 Jun 8.

    Use of modified Atkins diet in glucose transporter type 1 deficiency syndrome.

    AIM: Glucose transporter type 1 deficiency syndrome (GLUT1-DS) results from impaired glucose transport into the brain, and is treated with a ketogenic diet. A few reports have suggested effectiveness of treatment using the modified Atkins diet (MAD). We aimed to assess the efficacy of MAD as a treatment for GLUT1-DS.

    METHOD: We evaluated the efficacy of MAD in 10 patients (four males, six females; mean age at diagnosis [SD] 6.2y [1.7], min-max: 4mo-12y) with GLUT1-DS.

    RESULTS: MAD was started at diagnosis in eight patients, including two infants. The mean duration (SD) under MAD was 2.5 [0.6] years (range 6mo-6y). Seven patients with epilepsy started MAD at GLUT1-DS diagnosis, and all experienced improvements in their epilepsy: five out of seven were seizure-free at M1, and three out of six at M3 and M6. The initiation of MAD allowed symptoms to be controlled in the three patients with movement disorders but without seizures. Two patients switched from the ketogenic diet to MAD. This switch was not responsible for the recurrence of any symptoms, and led to improvements in both physical abilities and growth parameters.

    INTERPRETATION: MAD, which is a less restrictive and more palatable diet than the ketogenic diet, seems to have comparable effectiveness. Moreover, a switch from the ketogenic diet to MAD appears to be beneficial for patients with GLUT1-DS.

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  28. JP Says:

    Updated 09/23/16:


    Nutr Diabetes. 2016 Sep 19;6(9):e230.

    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.

    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.

    OBJECTIVE: 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.

    METHODS: 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.

    RESULTS: 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.

    CONCLUSIONS: 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.

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  29. JP Says:

    Updated 10/06/16:


    Drug Des Devel Ther. 2016 Sep 14;10:2939-2946.

    Effects of low-carbohydrate diet therapy in overweight subjects with autoimmune thyroiditis: possible synergism with ChREBP.

    The thyroid is one of the metabolism regulating glands. Its function is to determine the amount of calories that the body has to burn to maintain normal weight. Thyroiditides are inflammatory processes that mainly result in autoimmune diseases. We have conducted the present study in order to have a clear picture of both autoimmune status and the control of body weight. We have evaluated the amount of either thyroid hormones, or antithyroid, or anti-microsomal, or anti-peroxidase antibodies (Abs) in patients with high amounts of Abs. In a diet devoid of carbohydrates (bread, pasta, fruit, and rice), free from goitrogenic food, and based on body mass index, the distribution of body mass and intracellular and extracellular water conducted for 3 weeks gives the following results: patients treated as above showed a significant reduction of antithyroid (-40%, P<0.013), anti-microsomal (-57%, P<0.003), and anti-peroxidase (-44%, P<0,029) Abs. Untreated patients had a significant increase in antithyroid (+9%, P<0.017) and anti-microsomal (+30%, P<0.028) Abs. Even the level of anti-peroxidase Abs increased without reaching statistical significance (+16%, P>0064). With regard to the body parameters measured in patients who followed this diet, reduction in body weight (-5%, P<0.000) and body mass index (-4%, P<0.000) were observed. Since 83% of patients with high levels of autoantibodies are breath test positive to lactase with a lactase deficit higher than 50%, this fact led us to hypothesize a correlation with carbohydrate-responsive element-binding protein and therefore a possible role of carbohydrate metabolism in the development and maintenance of autoimmune thyroiditis associated with body weight increase and slower basic metabolism.

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  30. JP Says:

    Updated 11/28/16:


    Br J Nutr. 2016 Nov 23:1-9.

    A randomised-controlled trial of the effects of very low-carbohydrate and high-carbohydrate diets on cognitive performance in patients with type 2 diabetes.

    This study compared the longer-term effects of a very low-carbohydrate, high-fat diet with a high-carbohydrate, low-fat diet on cognitive performance in individuals with type 2 diabetes (T2D). In total, 115 obese adults with T2D (sixty-six males, BMI: 34·6 (sd 4·3) kg/m2, age: 58 (sd 7) years, HbA1c: 7·3 (sd 1·1) %, diabetes duration: 8 (sd 6) years) were randomised to consume either an energy-restricted, very low-carbohydrate, low-saturated-fat (LC) diet or an energy-matched high unrefined carbohydrate, low-fat (HC) diet with supervised aerobic/resistance exercise (60 min, 3 d/week) for 52 weeks. Body weight, HbA1c and cognitive performance assessing perceptual speed, reasoning speed, reasoning ability, working memory, verbal fluency, processing speed, short-term memory, inhibition and memory scanning speed were assessed before and after intervention. No differences in the changes in cognitive test performance scores between the diet groups were observed for any of the cognitive function outcomes assessed (P≥0·24 time×diet). Percentage reduction in body weight correlated with improvements with perceptual speed performance. In obese adults with T2D, both LC and HC weight-loss diets combined with exercise training had similar effects on cognitive performance. This suggests that an LC diet integrated within a lifestyle modification programme can be used as a strategy for weight and diabetes management without the concern of negatively affecting cognitive function.

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  31. JP Says:

    Updated 12/10/16:


    Acta Neurol Belg. 2016 Dec 7.

    The efficacy of the ketogenic diet in infants and young children with refractory epilepsies using a formula-based powder.

    To evaluate the efficacy, safety, and tolerability of a classic 4:1 ketogenic diet using a formula-based powder in infants and children with refractory seizures who are reluctant to eat homemade foods. We conducted an open label trial and administered a ketogenic diet using formula-based power (Ketocal®). Twenty-seven infants and children aged between 12 months and 5 years were enrolled who had refractory seizures and were reluctant to eat homemade foods. Of 27 children, 5 were lost to follow-up and 22 were remained at the end of the study. After 4 months, the median frequency of seizures per week was reduced >50% in 68.2% of patients, while 9/22 children (40.9%) showed a 50-90% reduction in seizure frequency per week, and 6/22 children (27.3%) showed more than 90% reduction in seizure frequency per week. Over the study course, 6/22 (27%) children who continued to receive the diet developed constipation, one child developed gastroesophageal reflux, and one child developed hypercholesterolemia. None of these children discontinued the diet because of the complications. Thirteen children and their parents (59%) reported that the diet was palatable and tolerable enough. The ketogenic diet using a formula-based powder (Ketocal®) is effective, safe, and tolerable in infants and children with refractory seizures who are reluctant to eat homemade foods according to the rules of the ketogenic diet.

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  32. JP Says:

    Updated 02/28/17:


    Nutr Metab (Lond). 2017 Feb 20;14:17.

    Impact of a 6-week non-energy-restricted ketogenic diet on physical fitness, body composition and biochemical parameters in healthy adults.

    BACKGROUND: The ketogenic diet (KD) is a very low-carbohydrate, high-fat and adequate-protein diet that without limiting calories induces different metabolic adaptations, eg, increased levels of circulating ketone bodies and a shift to lipid metabolism. Our objective was to assess the impact of a 6-week non-energy-restricted KD in healthy adults beyond cohorts of athletes on physical performance, body composition, and blood parameters.

    METHODS: Our single arm, before-and-after comparison study consisted of a 6-week KD with a previous preparation period including detailed instructions during classes and individual counselling by a dietitian. Compliance with the dietary regimen was monitored by measuring urinary ketones daily, and 7-day food records. All tests were performed after an overnight fast: cardiopulmonary exercise testing via cycle sprioergometry, blood samples, body composition, indirect calorimetry, handgrip strength, and questionnaires addressing complaints and physical sensations.

    RESULTS: Forty-two subjects aged 37 ± 12 years with a BMI of 23.9 ± 3.1 kg/m2 completed the study. Urinary ketosis was detectable on 97% of the days, revealing very good compliance with the KD. Mean energy intake during the study did not change from the habitual diet and 71.6, 20.9, and 7.7% of total energy intake were from fat, protein, and carbohydrates, respectively. Weight loss was -2.0 ± 1.9 kg (P < 0.001) with equal losses of fat-free and fat mass. VO2peak and peak power decreased from 2.55 ± 0.68 l/min to 2.49 ± 0.69 l/min by 2.4% (P = 0.023) and from 241 ± 57 W to 231 ± 57 W by 4.1% (P < 0.001), respectively, whereas, handgrip strength rose slightly from 40.1 ± 8.8 to 41.0 ± 9.1 kg by 2.5% (P = 0.047). The blood lipids TG and HDL-C remained unchanged, whereas total cholesterol and LDL-C increased significantly by 4.7 and 10.7%, respectively. Glucose, insulin, and IGF-1 dropped significantly by 3.0, 22.2 and 20.2%, respectively. CONCLUSIONS: We detected a mildly negative impact from this 6-week non-energy-restricted KD on physical performance (endurance capacity, peak power and faster exhaustion). Our findings lead us to assume that a KD does not impact physical fitness in a clinically relevant manner that would impair activities of daily living and aerobic training. However, a KD may be a matter of concern in competitive athletes. Be well! JP

  33. JP Says:

    Updated 03/05/17:


    Epilepsy Res. 2017 Feb 20;131:51-57.

    Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.

    OBJECTIVE: To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy.

    METHODS: Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD).

    RESULTS: Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; p<0.001] per child per year. Compared with the no KD children, children on the diet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [p<0.001].

    SIGNIFICANCE: Patients initiated on ketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada.

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  34. JP Says:

    Updated 04/01/17:


    Clin Nutr ESPEN. 2017 Feb;17:33-37.

    Short-term impact of a classical ketogenic diet on gut microbiota in GLUT1 Deficiency Syndrome: A 3-month prospective observational study.

    BACKGROUND&AIMS: The classical ketogenic diet (KD) is a high-fat, very low-carbohydrate normocaloric diet used for drug-resistant epilepsy and Glucose Transporter 1 Deficiency Syndrome (GLUT1 DS). In animal models, high fat diet induces large alterations in microbiota producing deleterious effects on gut health. We carried out a pilot study on patients treated with KD comparing their microbiota composition before and after three months on the diet.

    METHODS: Six patients affected by GLUT1 DS were asked to collect fecal samples before and after three months on the diet. RT – PCR analysis was performed in order to quantify Firmicutes, Bacteroidetes, Bifidobacterium spp., Lactobacillus spp., Clostridium perfringens, Enterobacteriaceae, Clostridium cluster XIV, Desulfovibrio spp. and Faecalibacterium prausnitzii.

    RESULTS: Compared with baseline, there were no statistically significant differences at 3 months in Firmicutes and Bacteroidetes. However fecal microbial profiles revealed a statistically significant increase in Desulfovibrio spp. (p = 0.025), a bacterial group supposed to be involved in the exacerbation of the inflammatory condition of the gut mucosa associated to the consumption of fats of animal origin.

    CONCLUSIONS: A future prospective study on the changes in gut microbiota of all children with epilepsy started on a KD is warranted. In patients with dysbiosis demonstrated by fecal samples, it my be reasonable to consider an empiric trial of pre or probiotics to potentially restore the «ecological balance» of intestinal microbiota.

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  35. JP Says:

    Updated 05/28/17:


    Eur Rev Med Pharmacol Sci. 2017 May;21(9):2274-2289.

    Efficacy and safety of very-low-calorie ketogenic diet: a double blind randomized crossover study.

    OBJECTIVE: To verify safety respect to weight loss, cardiometabolic diseases of short-term Very low-calorie ketogenic diets (VLCKDs, <800 kcal day-1).

    PATIENTS AND METHODS: Randomized cross-over trial with placebo. The study had no. 2 dietary treatment (DT), conducted in two arms: (1) VLCKD1 in which 50% of protein intake is replaced with synthetic amino acids; (2) VLCKD2 with placebo. The VLCKDs (<800 kcal day-1) were different in term of protein content and quality each arm lasted three weeks (wks). Between the two arms a 3-wks washout period was performed to avoid additive effects on DT to follow. At the baseline, at start and end of each arm, all the subjects were evaluated for their health and nutritional status, by anthropometric analysis, body composition (Dual X-ray Absorptiometry (DXA), Bioimpedentiometry, biochemical evaluation, and Peroxisome Proliferator-Activated Receptor γ (PPAR) γ expression by transcriptomic analysis.

    RESULTS: After VLCKD1 were reduced: Body Mass Index (BMI) (Δ%=-11.1%, p=0.00), Total Body Water (TBW) (p<0.05); Android Fat Percentage (AFP) (Δ%=-1.8%, p=0.02); Android Fat Mass (AFM) (Δ%=-12.7%, p=0.00); Gynoid Fat Mass (GFM) (Δ%=-6.3%, p=0.01); Intermuscular Adipose Tissue (IMAT) (Δ%= -11.1%, p=0.00); Homeostasis Model Assessment of Insulin Re-sistance (HOMA-IR) (Δ%=-62.1%, p=0.01). After VLCKD1 a significant increase of uricemia, cre-atinine and aspartate aminotransferase (AST) (respectively Δ%=35%, p=0.01; Δ%=5.9%, p=0.02; Δ%=25.5%, p=0.03). After VLCKD2 were reduced: BMI (Δ%=-11.2%, p=0.00); AFM (Δ%=-14.3%, p=0.00); GFM (Δ%=-6.3%, p=0.00); Appendicular Skeletal Muscle Mass Index (ASMMI) (Δ%=-17.5%, p=0.00); HOMA-IR (Δ%=-59,4%, p=0.02). After VLCKD2, uricemia (Δ%=63.1%, p=0.03), and Vitamin D levels (Δ%=25.7%, p=0.02) were increased. No significant changes of car-diovascular disease (CVD) indexes were observed after DTs. No significant changes of PPARγ lev-el in any DTs.

    CONCLUSIONS: 21-days VLCKDs not impair nutritional state; not cause negative changes in global measurements of nutritional state including sarcopenia, bone mineral content, hepatic, renal and lipid profile.

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  36. JP Says:

    Updated 07/13/17:


    Appl Physiol Nutr Metab. 2017 Jul 12.

    A 12-week low carbohydrate, high fat (LCHF) diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel.

    INTRODUCTION: Overweight, obesity and poor health is becoming a global concern for defence force personnel. Conventional nutrition guidelines are being questioned for their efficacy in achieving optimal body composition and long-term health. This study compared the effects of a 12-week low-carbohydrate, high-fat diet with a conventional, high-carbohydrate, low-fat diet on weight reduction and metabolic health outcomes in at-risk New Zealand Defence Force personnel.

    MATERIALS AND METHODS: In this randomised controlled trial, 41 overweight personnel were assigned to intervention and control groups. Weight, waist circumference, fasting lipids and glycaemic control were assessed at baseline and at 12 weeks. Within-group change scores were analysed using the t-statistic and interpreted using a p<0.05 level of statistical significance. Between-group mean differences and confidence intervals were analysed using effect sizes and magnitude-based inferences.

    RESULTS: Twenty-six participants completed the trial (14, intervention; 12, control). Both groups showed statistically significant weight and waist circumference reductions; the intervention group significantly reduced triglycerides and serum glucose, and significantly increased HDL cholesterol. Relative to control, the intervention group showed small, possibly-to-likely beneficial effects for weight, triglycerides, glucose, insulin and HOMA-IR, moderate, likely beneficial effects for HDL cholesterol and triglyceride: HDLc ratio and HbA1C, and a small, likely harmful effect for LDL cholesterol.

    DISCUSSION: This dietary approach shows promise for short-term weight loss and improved metabolic health outcomes conditions, compared to mainstream recommendations. It should be offered to defence force personnel at least as a viable alternative means to manage their weight and health.

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  37. JP Says:

    Updated 08/01/17:


    Nutrients 2017, 9(8), 822; doi:10.3390/nu9080822

    Effects of Popular Diets without Specific Calorie Targets on Weight Loss Outcomes: Systematic Review of Findings from Clinical Trials

    The present review examined the evidence base for current popular diets, as listed in the 2016 U.S. News & World Report, on short-term (≤six months) and long-term (≥one year) weight loss outcomes in overweight and obese adults. For the present review, all diets in the 2016 U.S. News & World Report Rankings for “Best Weight-Loss Diets”, which did not involve specific calorie targets, meal replacements, supplementation with commercial products, and/or were not categorized as “low-calorie” diets were examined. Of the 38 popular diets listed in the U.S. News & World Report, 20 met our pre-defined criteria. Literature searches were conducted through PubMed, Cochrane Library, and Web of Science using preset key terms to identify all relevant clinical trials for these 20 diets. A total of 16 articles were identified which reported findings of clinical trials for seven of these 20 diets: (1) Atkins; (2) Dietary Approaches to Stop Hypertension (DASH); (3) Glycemic-Index; (4) Mediterranean; (5) Ornish; (6) Paleolithic; and (7) Zone. Of the diets evaluated, the Atkins Diet showed the most evidence in producing clinically meaningful short-term (≤six months) and long-term (≥one-year) weight loss. Other popular diets may be equally or even more effective at producing weight loss, but this is unknown at the present time since there is a paucity of studies on these diets.

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  38. JP Says:

    Updated 11/03/17:


    Nutr Hosp. 2017 Jul 28;34(4):792-798.

    The effects of a low-carbohydrate diet on oxygen saturation in heart failure patients: a randomized controlled clinical trial.

    INTRODUCTION: Nutritional therapy in heart failure (HF) patients has been focused on fluid and sodium restriction with the aim of decreasing volume overload. However, these recommendations are not well established and sometimes controversial.

    OBJECTIVE: To evaluate the effect of the consumption of a low-carbohydrate diet on oxygen saturation, body composition and clinical variables during two months of follow-up in chronic, stable heart failure patients.

    METHODS: In a parallel group randomized controlled clinical trial, 88 ambulatory patients were randomly assigned to a low-carbohydrate diet group (40% carbohydrates, 20% protein and 40% fats [12% saturated, 18% monounsaturated and 10% polyunsaturated]) or a standard diet group (50% carbohydrates, 20% protein and 30% fats [10% saturated, 10% monounsaturated and 10% polyunsaturated]) for two months. Diets were normocaloric in both groups. At baseline and at two months of follow-up, the variables evaluated were: oxygen saturation, dietary intake, body composition and handgrip strength.

    RESULTS: After two months of follow-up, the low-carbohydrate diet group decreased the carbohydrate consumption and had improved oxygen saturation (93.0 ±4.4 to 94.6 ± 3.2, p = 0.02), while the standard diet group had decreased (94.90 ± 2.4 to 94.0 ± 2.9, p = 0.03). There were also differences between the groups at the end of the study (p = 0.04). No significant differences showed in handgrip strength in both groups, low-carbohydrate diet group (26.4 ± 8.3 to 27.2 ± 8.3 kg, p = 0.07) and standard diet group (25.4 ± 8.9 to 26.1 ± 9.5 kg, p = 0.14).

    CONCLUSIONS: Low-carbohydrate diet may improve the oxygen saturation in patients with chronic stable heart failure.

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  39. JP Says:

    Updated 12/19/17:


    Epilepsy Behav. 2017 Dec 15;79:82-86.

    Impact of the modified Atkins diet on cardiovascular health in adults with epilepsy.

    AIM: The current study investigated biochemical and vascular markers of cardiovascular health in adult patients with epilepsy treated with long-term (greater than 1year) ketogenic diet therapy compared with controls.

    METHOD: Anthropometric measures, serum fasting lipid panel, apolipoproteins A-1 and B, lipoprotein sub-fractions as well as common carotid intima-media thickness (cIMT), and plaque presence were assessed in 20 adult patients with epilepsy on a modified Atkins diet (MAD) for >1year started as an adult compared with 21 adult patients with epilepsy naïve to diet therapy.

    RESULTS: Patients treated with MAD had significantly lower weight, body mass index, waist and hip circumference, percent body fat, and serum triglyceride levels when compared with control patients. In contrast, they had significantly higher serum levels of small low-density-lipoprotein (LDL) particles and were significantly more likely to have LDL pattern B in which small LDL particles predominate when compared with controls. However, there was no significant difference in cIMT or plaque presence between groups.

    CONCLUSION: Our results provide clinical evidence demonstrating the cardiovascular safety of a high-fat, low-carbohydrate diet used in adults with epilepsy for at least 12months. It also highlights potential markers of cardiovascular risk – small dense LDL particles – that should be closely monitored in adults treated with diet therapy long-term.

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  40. JP Says:

    Updated 08/14/18:


    Am J Clin Nutr. 2018 Aug 1;108(2):256-265.

    Effect of combined use of a low-carbohydrate, high-protein diet with omega-3 polyunsaturated fatty acid supplementation on glycemic control in newly diagnosed type 2 diabetes: a randomized, double-blind, parallel-controlled trial.

    Background: The combined effect of a low-carbohydrate, high-protein (LCHP) diet and omega-3 (n-3) polyunsaturated fatty acid (PUFA) supplementation on patients with type 2 diabetes (T2D) is not known.

    Objective: The aim of this study was to evaluate the effect of an LCHP diet combined with ω-3 (LCHP+ω-3) on glycemic control in patients with T2D.

    Design: In this randomized, double-blind, parallel-controlled trial, 122 newly diagnosed participants with T2D were randomly assigned to receive a high-carbohydrate, low-protein diet with low ω-3 PUFAs [control (CON)], an LCHP, ω-3, or LCHP+ω-3 diet for 12 wk. The ratio of carbohydrate to protein was 42:28 in the LCHP and LCHP+ω-3 diet and 54:17 in the CON and ω-3 diet. The participants were given 6 g fish oil/d (containing 3.65 g docosahexaenoic acid, eicosapentaenoic acid, and docosapentaenoic acid/d) in the ω-3 and LCHP+ω-3 diet groups or 6 g corn oil/d (placebo) in the CON and LCHP diet groups.

    Results: Compared with the CON diet group, greater decreases in glycated hemoglobin (HbA1c) and fasting glucose were observed in all of the other 3 diet groups at 12 wk. Of note, HbA1c reduction in the LCHP+ω-3 diet group (-0.51%; 95% CI: -0.64%, -0.37%) was greater than that in the LCHP (P = 0.03) and ω-3 (P = 0.01) diet groups at 12 wk. In terms of fasting glucose, only the LCHP+ω-3 diet group showed a significant decrease at 4 wk (P = 0.03 compared with CON). Moreover, the reduction in fasting glucose in the LCHP+ω-3 diet group (-1.32 mmol/L; 95% CI: -1.72, -0.93 mmol/L) was greater than that in the LCHP (P = 0.04) and ω-3 (P = 0.03) diet groups at 12 wk.

    Conclusions: The LCHP+ω-3 diet provided greater effects on HbA1c and fasting glucose and faster effects on fasting glucose than both the LCHP and ω-3 diets, indicating the potential necessity of combining an LCHP diet with ω-3 PUFAs in T2D control.

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  41. JP Says:

    Updated 11/07/18:


    Anticancer Res. 2018 Nov;38(11):6519-6527.

    The Potential Use of a Ketogenic Diet in Pancreatobiliary Cancer Patients After Pancreatectomy.

    BACKGROUND/AIM: High-carbohydrate diets are generally provided to post-pancreatectomy cancer patients. Low energy density of this diet may obstruct proper energy intake and recovery. This study aimed to assess the effects of high-fat, high-energy ketogenic diet (KD) in these patients.

    PATIENTS AND METHODS: After pancreatectomy, 9 patients were provided with general diet (GD) while 10 were served KD. Meal compliance, energy intake rate, meal satisfaction and presence of complications were monitored throughout hospital stay. Data on nutritional status, serum lipids and body composition were collected and compared between groups.

    RESULTS: Meal compliance, energy intake rate and meal satisfaction score were higher in KD. There were no differences in complications, nutritional status and serum lipids. The decrease in body cell mass (BCM) was greater in GD.

    CONCLUSION: Post-pancreatectomy cancer patients who consumed KD had a higher energy intake and BCM. These results suggest the potential use of KD as an adjuvant anti-cancer therapy.

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  42. JP Says:

    Updated 11/27/18:


    Microrna. 2018 Nov 25.

    Ketogenic diet acts on body remodeling and microRNAs expression profile.

    BACKGROUND: The ketogenic diet (KD) promotes metabolic changes and optimizes energy metabolism. It is unknown if microRNAs (miRs) are influenced by KD in obese subjects.

    OBJECTIVES: The aim of this study was to evaluate 6 weeks of biphasic KD in obese subjects. We enrolled 36 obese subjects (18 females and 18 males) in stage 1 of Edmonton Obesity Staging System (EOSS) parameter. Blood biochemical parameters were dosed by ADVIA 1800.

    RESULT: The screening of circulating miRs was performed with the FDA approved platform n-counter flex. Only three miRs, hsa-let-7b-5p, hsa-miR-143-3p and hsa-miR-504-5p were influenced in an equal manner in both sexes. The KD was safe ameliorating both biochemical and anthropometric factors in obese subjects re-collocating them into stage 0 of EOSS parameters.

    CONCLUSION: The miRs identified here might be a useful tool to monitor low carbohydrate nutritional regimens reflecting indirectly the regulatory biochemical mechanisms and cell signaling to the orchestration of metabolic and signaling pathways.

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  43. JP Says:

    Updated 01/17/19:


    Am J Clin Nutr. 2019 Jan 16.

    Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial.

    Background: For low-carbohydrate diets, a public health approach has focused on the replacement of carbohydrates with unsaturated fats. However, little research exists on the impacts of saturated fat intake on the lipid profile in the context of whole-food-based low-carbohydrate weight-loss diets.

    Objectives: The primary aim of this secondary analysis of the DIETFITS weight loss trial was to evaluate the associations between changes in percentage of dietary saturated fatty acid intake (%SFA) and changes in low-density lipoproteins, high-density lipoproteins, and triglyceride concentrations for those following a healthy low-carbohydrate (HLC) diet. The secondary aim was to examine these associations specifically for HLC dieters who had the highest 12-month increases in %SFA.

    Methods: In the DIETFITS trial, 609 generally healthy adults, aged 18-50 years, with body mass indices of 28-40 kg/m2 were randomly assigned to a healthy low-fat (HLF) or HLC diet for 12 months. In this analysis, linear regression, both without and with adjustment for potential confounders, was used to measure the association between 12-month change in %SFA and blood lipids in 208 HLC participants with complete diet and blood lipid data.

    Results: Participants consumed an average of 12-18% of calories from SFA. An increase of %SFA, without significant changes in absolute saturated fat intake, over 12 months was associated with a statistically significant decrease in triglycerides in the context of a weight-loss study in which participants simultaneously decreased carbohydrate intake. The association between increase in %SFA and decrease in triglycerides was no longer significant when adjusting for 12-month change in carbohydrate intake, suggesting carbohydrate intake may be a mediator of this relationship.

    Conclusions: Those on a low-carbohydrate weight-loss diet who increase their percentage intake of dietary saturated fat may improve their overall lipid profile provided they focus on a high-quality diet and lower their intakes of both calories and refined carbohydrates.

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  44. JP Says:

    Updated 04/09/19:


    Seizure. 2019 Mar 26;69:41-43.

    Initiating the ketogenic diet in infants with treatment refractory epilepsy while maintaining a breast milk diet.

    PURPOSE: The ketogenic diet has been found to be safe and effective in the treatment of drug resistant epilepsy in childhood. The age range of children undergoing this treatment has steadily been going down. There is strong evidence that it is a safe alternative in infants with drug resistant seizures. The American Academy of Pediatrics strongly supports continuing a breast milk diet until infants are at least six months of age. The purpose of this study is to evaluate the safety and efficacy of the ketogenic diet in infants while maintaining a breast milk diet.

    METHOD: This is a cohort study of 9 infants between the ages of 1 and 13 months with drug resistant epilepsy treated with the ketogenic diet while maintained on breast milk. The data from the first two patients was gathered retrospectively while the other seven were studied prospectively.

    RESULTS: We show that all nine infants achieved and maintained ketosis effectively. While one infant had no change in seizure frequency, three were seizure free at the first follow-up visit and four had a burden of seizure reduction greater than 50%. The diet was overall well tolerated, although one child required a hospital stay for dehydration and metabolic acidosis.

    CONCLUSION: The ketogenic diet can be safely and effectively initiated in infants while continuing human breast milk feedings.

    Be well!


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