Very-Low-Carbohydrate Ketogenic Diets for Weight Loss and Maintenance: Looking at the Evidence

After following a very-low-carb ketogenic diet (VLCKD) consistently for the past year and a half, I'm happy to report that I have only positive things to say about my experience. Better energy, excellent blood glucose control, effortless weight maintenance, and more satisfaction with this way of eating than I've ever observed in the past. I truly enjoy eating meat, poultry, fish, eggs, vegetables, nuts, butter, cream, and a half cup of raspberries or  blackberries with sour cream every day.  Some days I have more of an appetite than others, and although I don't track my food intake online very often, I seem to naturally consume somewhere between 1600-2000 calories every day when eating to satiety. This is in sharp contrast to the way I used to eat: consciously limiting calories and often feeling hungry due to reduced protein and fat intake with reactive hypoglycemia.

Earlier this year, researchers from Australia published a study regarding the relationship between ketosis, appetite, and weight regain in formerly obese people. I didn't have a chance to read the entire article until now, and it confirms what other studies have suggested and many weight-reduced folks have been saying for years: Keeping carbohydrates low enough to induce and maintain ketosis results in suppression of appetite, leading to a spontaneous reduction in calories. Appetite is complicated and involves a variety of factors, including interactions between many hormones and nutrients. Grehlin is a hunger-stimulating hormone, while cholecystokinin (CCK) promotes satiety. Grehlin typically increases following weight loss, while CCK decreases, resulting in difficulty eating at a caloric level low enough to prevent weight regain. However, ketosis appears to alter this response. The researchers measured levels of these and other hormones at baseline, after eight weeks on a ketogenic diet, and at two weeks after reintroduction of carbohydrates. They found that grehlin remained low and post-meal CCK high after weight loss as long as the subjects remained in ketosis. However, once carbohydrates were reintroduced, grehlin increased, CCK decreased, and people reported being hungrier and less satisfied.

Recently, US News released their list of the Top Rated Diets for 2014.  Ketogenic diets per se weren't mentioned at all, although the Atkins diet -- which is ketogenic in the Induction and sometimes the Ongoing Weight Loss phases -- came in at #29 out of 31, accompanied by comments questioning its safety and effectiveness for long-term weight loss (I addressed these concerns in an earlier post). The top three?  The DASH Diet, TLC (Therapeutic Lifestyle Changes), and Mayo Clinic Diet -- all low-fat, high-carbohydrate diets. Even the Slim Fast diet and diets containing packaged foods like Jenny Craig and Nutristystem were ranked ahead of Atkins. Aside from the study above and earlier research on VLCKDs, there's a growing number of anecdotal reports online --  including those from some members of two of the largest online low-carb support forums, Active Low Carber Forums and Low Carb Friends -- attesting to the power of carb restriction for weight loss and long-term maintenance. Can everyone who follows a VLCKD get down to his or her ideal weight and maintain it relatively easily? No, not at all. However, many people can and do. Regardless of weight, low-carbers usually enjoy their way of eating and experience other health benefits that accompany carb restriction: improved lipid profiles, better blood glucose control, lower insulin levels, lower blood pressure, etc.

Continuing to advise people to follow low-fat, high-carbohydrate, low-satiety diets in order to achieve and maintain weight loss while characterizing VLCKDs as dangerous and unsustainable is extremely misguided. When more than 90% of people regain all or most of the weight they lose within five years due to hormonal influences that drive appetite, shouldn't a diet that modulates this situation at least be considered, if not strongly encouraged and promoted?

* Although VLCKDs are safe and healthy for most people, it's important to speak with your doctor prior to adopting a low-carb diet or making other dietary changes.


1. Sumithran P, et al. Ketosis and appetite-mediating nutrients and hormones after weight loss. Eur J Clin Nutr 2013 Jul;67(7):759-64
2. Paoli A, et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate ketogenic diets. Eur J Clin Nutr 2013 Aug;67(8):789-96
3. Mc Clemon FJ, et al. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring) 2007 Jan;15(1):182-7
4. Dashti HM, et al. Beneficial effects of ketogenic diet in obese diabetic subjects. Mol Cell Biochem 2007;302:249-256
5. Boden G, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with Type 2 diabetes. Ann Intern Med. 2005 142:403-411

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