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low carbohydrate diet; ketogenic diet (Atkin's diet, Eco-Atkin's diet)

Diet limits carbohydrate intake to 25 g/day initially, then 50 g/day after 40% of the weight loss has been achieved. Calorie intake is not limited. Indications: Beneficial effects: 1) weight loss: a) average 10% (9 kg) over 6 months b) 6% fat loss (37% to 31% body fat) c) mean weight loss 6 kg in obese patients mean BMI 36 [14] 2) decreased total cholesterol (214 to 203 mg/dL)* 3) decreased LDL cholesterol (136 to 126 mg/dL)* 4) increase HDL cholesterol (52 to 62 mg/dL)* 5) may improve fasting glucose [2] - 6-month reduction of 10 mg/dL in obese patients mean BMI 36 [14] 6) 6-month reduction of Hgb A1c of 0.23% in obese patients mean BMI 36 [14] 7) may reduce risk for all-cause mortality by up to 24% [16] - does not increase risk for cardiovascular death despite content associated with higher risk for cardiovascular diseases [16] - plant-based low-carbohydrate diet associated with decreased long-term mortality [7] 8) might be more effective for both weight loss & for improving several metabolic parameters, even if high infat content [9] 9) may be useful in control of seizures 10) health benefits depend more on specific foods than carbohydrate-fat distribution [13] * mean values from study [1] Adverse effects: 1) constipation (68%) 2) hallitosis (63%) 3) headache [5] 4) myalgias [5] 5) diarrhea 6) muscle weakness 7) rash 8) concerns for long-term effects [2] a) heart disease (high fat) b) low carbohydrate, high protein diet linked to increased risk for cardiovascular disease in women [8] c) renal failure (high protein) d) osteoporosis (high protein) 9) meat-based low-carbohydrate diet associated with increased long-term mortality [7] 10) may be associated with risk of cognitive impairment among older adults [14] Mechanism of action: - diet mimics starvation - brain uses the fatty acids as its fuel source - ketonuria develops as a sign of reduced carbohydrate intake

Specific

Atkin's diet South Beach diet

General

weight loss diet

References

  1. Journal Watch 22(17):131, 2002 - Westman EC et al, Effect of 6-month adherence to a very low carbohydrate diet program. J Med 113:30, 2002 PMID: 12106620
  2. Prescriber's Letter 10(6):32 2003
  3. Journal Watch 23(13):103, 2003 Samaha FF et al, A low-carbohydrate as compared with a low-fat diet in severe obesity. NEJM 348(21):2074, 2003 PMID: 12761364 - Foster GD et al, A randomized trial of a low-carbohydrate diet for obesity. NEJM 348(21):2082, 2003 PMID: 12761365
  4. Journal Watch 24(1):5, 2004
  5. Journal Watch 24(14):114, 2004 Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004 May 18;140(10):769-77. PMID: 15148063 - Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004 May 18;140(10):778-85. PMID: 15148064 - Willett WC. Reduced-carbohydrate diets: no roll in weight management? Ann Intern Med. 2004 May 18;140(10):836-7. No abstract available. PMID: 15148073
  6. Jenkins DJA et al The effect of a plant-based low-carbohydrate ('Eco-Atkins') diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med 2009 Jun 8; 169:1046. PMID: 19506174 - Tuttle KR and Milton JE The 'Eco-Atkins' diet: New twist on an old tale. Arch Intern Med 2009 Jun 8; 169:1027. PMID: 19506171
  7. Fung TT et al, Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality Two Cohort Studies Annals of Internal Medicine 2010, 153:289-298 PMID: 20820038 http://www.annals.org/content/153/5/289.abstract - Yancy WS Jr et al. Animal, vegetable, or . . . clinical trial? Ann Intern Med 2010 Sep 7; 153:337 PMID: 20820043
  8. Lagiou P et al Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study BMJ 2012;344:e4026 PMID: 22735105 http://www.bmj.com/content/344/bmj.e4026 - Floegel A Low carbohydrate-high protein diets BMJ 2012;344:e3801 PMID: 22718914 http://www.bmj.com/content/344/bmj.e3801
  9. Ebbeling CB et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012 Jun 27; 307:2627 PMID: 22735432
  10. Bazzano LA et al Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial. Ann Intern Med. 2014;161(5):309-318 PMID: 25178568 http://annals.org/article.aspx?articleid=1900694
  11. Thibert RL et al Case 34-2014 - A 7-year-Old Boy with Focal Seizures and Progressive Weakness. N Engl J Med 2014; 371:1737-1746. October 30, 2014 http://www.nejm.org/doi/full/10.1056/NEJMcpc1305993
  12. Abbasi J Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes. JAMA. 2018;319(3):215-217. PMID: 29340675 https://jamanetwork.com/journals/jama/fullarticle/2669724
  13. Shan Z, Guo Y, Hu FB et al. Association of low-carbohydrate and low-fat diets with mortality among US adults. JAMA Intern Med 2020 Jan 21 PMID: 31961383 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2759134
  14. Dorans KS, Bazzano LA, Qi L et al Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c. A Randomized Clinical Trial. JAMA Netw Open. 2022;5(10):e2238645 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797714
  15. Wang H, Lv Y, Yi G, Ren G Association of low-carbohydrate-diet score and cognitive performance in older adults: National Health and Nutrition Examination Survey (NHANES). BMC Geriatrics 2022. 22:983. Dec 20. PMID: 36539697 PMCID: PMC9764565 Free PMC article https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03607-1
  16. Qu X, Huang L, Rong J. The ketogenic diet has the potential to decrease all-cause mortality without a concomitant increase in cardiovascular-related mortality. Sci Rep. 2024 Oct 1;14(1):22805. PMID: 39353986 PMCID: PMC11445255 Free PMC article.