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Ketogenic diet

Keto was the most-Googled diet of 2018. It limits carb intake to under ~50 grams a day, and typically reduces appetite and intake of easy-to-overeat, hyperpalatable foods. However, most trials don't show a large weight loss advantage over higher carb diets, although individual results vary widely. Keto has therapeutic potential for a variety of health conditions. Stay tuned to this page, as 140+ trials are ongoing!

Our evidence-based analysis on ketogenic diet features 105 unique references to scientific papers.

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Looking for a no-hype guide to the ketogenic diet?

Whether you're already on keto or thinking about it, our Evidence-based Keto Guide will answer all your questions.

From keto's effects on exercise, fat, muscle, and disease to potential long-term health issues that are often overlooked, we take a science-based approach to help you get the most out of your keto diet.

Trust the science: this guide is light-years ahead of other reference material you'll find online.

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Research Breakdown on Ketogenic diet


1Background Information

1.1History

Humans have always used ketone bodies for fuel. Even if you've never "gone keto", you too have used ketone bodies. That's because they're present in low levels after a period of even short fasting, such as nightly sleep. After a typical period of sleep, ketone bodies supply 2–6% of your energy requirements, which bumps up to 30-40% after three days without any food.[23]

The official history of the ketogenic diets started in the 1920s as an epilepsy treatment, although ketone bodies themselves were first discovered in the mid 1800s, in the urine of patients with diabetes.[24] From the mid 1900s onwards, ketogenic diets were used less and less, as medications were used for epilepsy control.[25] They came back onto the scene in the early 2000s, in the form of a "modified Atkins" diet used for intractable seizures.[26]

In modern research studies, you may see keto interchangeably referred to as "ketogenic diet", "low-carb ketogenic diet" (LCKD),[27] or "very low-carb ketogenic diet" (VLCKD).[28] Occasionally, you may run into "targeted ketogenic diet" (TKD, where carb intake is concentrated into the hours around exercise) or "cyclical ketogenic diet" (CKD, where a few days of keto is followed by a day or two of higher carb intake). These are more typically referred to in online discussion of bodybuilding diets,[29] and the occasional animal study.[30]

1.2Sources

There are five major ways that ketones can become elevated.

First, and most simply, fasting will lead to increased ketone production as your body's glycogen stores are depleted.[31] 

Second, prolonged exercise results in increased ketone production, especially if you're already eating a low-carb diet.[32]

Third, diabetes can result in elevated levels of ketones, not only in insulin-dependent type 1 and type 2 diabetics, but also in non-insulin dependent type 2 diabetics.[33][34] Even if those who aren't yet diabetic, elevated levels of ketones can predict worse blood sugar control and development of diabetes in the following years.[35]

Fourth, supplementing with ketones themselves (i.e. exogenous ketones) or consuming large amounts of coconut fat (which contains medium chain triglyerides that can be broken down into ketones), will raise ketone levels even when not eating low-carb.[36][37]

Fifth, typical ketogenic diets will cause sustained ketone production due to low carb intake. Typical ketogenic diets can be supplemented with exogenous ketones as well, if higher ketone levels are desired, and MCT ketogenic diets with higher carb intake have been commonly used for epilepsy.[38] 

Some food groups are not feasible to include in a ketogenic diet on a regular basis due to carb content, such as grains. Other groups can be eaten ad libitum, such as animal products (other than honey). Many types of foods fall in a middle ground though, such as fruits and dairy. Too much of high-carb varieties can cause you to eclipse your carb limit and be kicked out of ketosis.

1.3Dietary adherence

Keto is only effective if you maintain it; occasional keto is fine but yo-yo dieting with keto followed by carb binges is not.

Keto dieters tend to eat less than higher carb dieters when given free reign to choose their food.[39] This is a boon for adherence. When looking at all trials measuring adherence, keto had a similar adherence rate as other diets, at around 24%.[40] That being said, carb intake, on average, creeps up over time in longer-term studies, with longer term studies having similar adherence as longer term non-keto studies.[41][42] This masks individual differences though - some stick to it strictly, others go way off track.

In a two-year open-label (non-randomized) study, dropout rates were 35% for the keto group and 28% for the control group.[43]

2Safety

2.1Side Effects and Adverse Events

The most reliable data for side effects and adverse events come from large trials in children with epilepsy. These show varying rates of a variety of possible side effects, from infrequent gallstones and elevated liver enzymes to more frequent elevated lipids and gastrointestinal upset.[44] Some side effects such as nausea and vomiting may be more likely in the first weeks of the diet, as you adapt to higher ketone levels.[45] Also, acetone can be exhaled and is a fairly accurate marker of ketosis,[46] but can unfortunately also be perceived as "bad breath" by some.

Certain electrolytes (specifically calcium, magnesium, sodium, and potassium) can be low on keto diets.[47][48][49][50] If you're low on any of these, supplementation or changing your food choices to more nutrient-dense foods can reduce side effects.

There are several health conditions for which keto is absolutely contraindicated, such as Porphyria and genetic deficiencies like fatty acid beta-oxidation defects.[51] Other contexts haven't had much if any keto research, and caution is warranted, such as with pregnancy and eating disorders.

For those undergoing a keto diet for serious medical conditions such as epilepsy, accidentally ingesting too much carbohydrate via medication or supplement can disrupt ketosis and indirectly cause danger through reduced diet efficacy. Chewable and liquid medication may have relatively high carb levels, not all of which are accurately labeled.[52][53][54]

2.2Theoretical safety considerations

Several objections have been raised to low-carb diets including keto, positing theories of harm but not yet showing it through trial evidence.

One such objection is that a lack of carbohydrate could be detrimental to gut and immune health.[55] This doesn't appear to be born out in trials, which rather often show either a neutral or beneficial effect for gut health.[56] However, there is much uncertainty here. Researchers have found that ketogenic diets in children with epilepsy reduces levels of certain beneficial bacteria. Whether this has any health implications, though, is uncertain.[57]

Because keto has also been proposed as a general strategy for weight loss and diabetes prevention, some researchers have recommended a more moderate low-carb diet (100-150 grams of carbs) given the relative lack of long-term safety data for ketogenic diets.[58]

There is a perception that micronutrient intake will be low on ketogenic diets. That is not necessarily the case, as keto diets that are well-formulated (similar to the case for any other diet) can meet all micronutrient requirements.[59] A ketogenic diet that's consistently high in red meat, though, could theoretically contribute to iron overload in those who are genetically susceptible. Too much iron is implicated in Alzheimer’s, heart disease, and colorectal cancer.[60][61][62] Nearly one million Americans who have genetic susceptibility due to having hereditary hemochromatosis, a condition where you absorb too much dietary iron.[63]

3Effects on Food Intake

3.1Appetite

In most studies, keto diets decrease hunger and desire to eat.[42] The most important factor in this may be swapping refined carbohydrate for protein, as protein is the most satiating macronutrient.[64] Ketone bodies themselves may also reduce appetite, although this is still an open research question.[65][43]

4Effects on Body Composition

4.1Fat Mass

There are two types of studies looking at fat mass: free-living studies (where you assign one group a keto diet and another non-keto, and track their fat loss over time) and metabolic ward studies (where you consign participants in each group to a metabolic ward, to tightly control their diet). The former can be much longer than the latter, but lack of dietary control can make results less reliable. Free-living studies do, however, reflect real-world adherence and regular life better.

Metabolic ward studies show similar fat loss in keto dieters as non-keto dieters, over the course of 2-4 weeks.[3] This is also the result of a well-designed two month metabolic ward study.[66] Free-living studies tend to show slightly greater fat loss in keto dieters, although results aren't consistent.[67] 

4.2Muscle Mass

Out of studies that paired exercise with keto diets, and compared them to non-keto diets plus exercise, the findings are mixed.[68][27][69] While the non-keto groups often appear to show better mass retention, much of that may be due to keto groups losing water weight, which is counted as lean mass in body composition measurements.[70][71]

4.3Water Weight

Initial weight loss on a keto diet (meaning the first week) is nearly entirely water and glycogen, rather than fat. You simply cannot lose several pounds of fat in one week absent extreme situations.

As you ratchet down carbs, you use up liver glycogen. Since each gram of glycogen is paired with about 2.4 grams of water,[72] a full male liver is heavier by 289–432 grams (0.6–1.0 lb), and a full female liver is heavier by 241–364 grams (0.5–0.8 lb).[73][74][75] Eventually, you'll tap more and more into your muscle glycogen and empty those stores as well, to the tune of 1.1-1.4 kg (2.4-3.2 lb)PMID: 60579979. Adding this to your liver glycogen, it's easy to lose at least 2-3 kg (5-7 lb) or more of glycogen and water weight.

5Aesthetics

5.1Skin

The ketogenic diet hasn't been tested in randomized trials for acne, eczema, and other common skin conditions. Researchers have proposed that keto may help skin conditions such as acne and psoriasis, and case studies have been reported, but human trials are currently lacking.[76][77]

On the flip side, two case studies have been published on increased carbs helping treat Prurigo pigmentosa (a rare inflammatory dermatitis) in two people who had been on keto diets.[78][79] Ketosis was proposed to be involved in the initiation of the condition.[80]

References

  1. ^ Gomez-Arbelaez D, et al. Body Composition Changes After Very-Low-Calorie Ketogenic Diet in Obesity Evaluated by 3 Standardized Methods. J Clin Endocrinol Metab. (2017)
  2. ^ Johnstone AM, et al. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr. (2008)
  3. ^ a b Hall KD, Guo J. Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. Gastroenterology. (2017)
  4. ^ Ludwig DS, et al. Dietary carbohydrates: role of quality and quantity in chronic disease. BMJ. (2018)
  5. ^ Hall KD, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. (2019)
  6. ^ Fiolet T, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. (2018)
  7. ^ Puchalska P, Crawford PA. Multi-dimensional Roles of Ketone Bodies in Fuel Metabolism, Signaling, and Therapeutics. Cell Metab. (2017)
  8. ^ Sedej S. Ketone bodies to the rescue for an aging heart?. Cardiovasc Res. (2018)
  9. ^ Wood TR, Stubbs BJ, Juul SE. Exogenous Ketone Bodies as Promising Neuroprotective Agents for Developmental Brain Injury. Dev Neurosci. (2018)
  10. ^ Qi Q, et al. CETP genotype and changes in lipid levels in response to weight-loss diet intervention in the POUNDS LOST and DIRECT randomized trials. J Lipid Res. (2015)
  11. ^ von Geijer L, Ekelund M. Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report. J Med Case Rep. (2015)
  12. ^ Ullah W, et al. Another "D" in MUDPILES? A Review of Diet-Associated Nondiabetic Ketoacidosis. J Investig Med High Impact Case Rep. (2018)
  13. ^ Robey IF. Examining the relationship between diet-induced acidosis and cancer. Nutr Metab (Lond). (2012)
  14. ^ Westman EC. Is dietary carbohydrate essential for human nutrition?. Am J Clin Nutr. (2002)
  15. ^ Jayedi A, et al. Fish consumption and risk of all-cause and cardiovascular mortality: a dose-response meta-analysis of prospective observational studies. Public Health Nutr. (2018)
  16. ^ Sirot V, Leblanc JC, Margaritis I. A risk-benefit analysis approach to seafood intake to determine optimal consumption. Br J Nutr. (2012)
  17. ^ Larsson SC, Orsini N. Red meat and processed meat consumption and all-cause mortality: a meta-analysis. Am J Epidemiol. (2014)
  18. ^ Farvid MS, et al. Consumption of red and processed meat and breast cancer incidence: A systematic review and meta-analysis of prospective studies. Int J Cancer. (2018)
  19. ^ O'Connor LE, Kim JE, Campbell WW. Total red meat intake of ≥0.5 servings/d does not negatively influence cardiovascular disease risk factors: a systemically searched meta-analysis of randomized controlled trials. Am J Clin Nutr. (2017)
  20. ^ Mazidi M, et al. Egg Consumption and Risk of Total and Cause-Specific Mortality: An Individual-Based Cohort Study and Pooling Prospective Studies on Behalf of the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. J Am Coll Nutr. (2019)
  21. ^ Shin JY, et al. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. (2013)
  22. ^ Khawaja O, et al. Egg Consumption and Incidence of Heart Failure: A Meta-Analysis of Prospective Cohort Studies. Front Nutr. (2017)
  23. ^ Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. (1999)
  24. ^ VanItallie TB, Nufert TH. Ketones: metabolism's ugly duckling. Nutr Rev. (2003)
  25. ^ Wheless JW. History of the ketogenic diet. Epilepsia. (2008)
  26. ^ Kossoff EH, et al. A decade of the modified Atkins diet (2003–2013): Results, insights, and future directions. Epilepsy Behav. (2013)
  27. ^ a b Greene DA, et al. A Low-Carbohydrate Ketogenic Diet Reduces Body Mass Without Compromising Performance in Powerlifting and Olympic Weightlifting Athletes. J Strength Cond Res. (2018)
  28. ^ Caprio M, et al. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). J Endocrinol Invest. (2019)
  29. ^ Shilpa J, Mohan V. Ketogenic diets: Boon or bane?. Indian J Med Res. (2018)
  30. ^ Newman JC, et al. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. (2017)
  31. ^ Balasse EO, Féry F. Ketone body production and disposal: effects of fasting, diabetes, and exercise. Diabetes Metab Rev. (1989)
  32. ^ Evans M, Cogan KE, Egan B. Metabolism of ketone bodies during exercise and training: physiological basis for exogenous supplementation. J Physiol. (2017)
  33. ^ Harano Y, et al. Ketone bodies as markers for type 1 (insulin-dependent) diabetes and their value in the monitoring of diabetic control. Diabetologia. (1984)
  34. ^ Avogaro A, et al. High blood ketone body concentration in type 2 non-insulin dependent diabetic patients. J Endocrinol Invest. (1996)
  35. ^ Mahendran Y, et al. Association of ketone body levels with hyperglycemia and type 2 diabetes in 9,398 Finnish men. Diabetes. (2013)
  36. ^ Stubbs BJ, et al. On the Metabolism of Exogenous Ketones in Humans. Front Physiol. (2017)
  37. ^ Vandenberghe C, et al. Tricaprylin Alone Increases Plasma Ketone Response More Than Coconut Oil or Other Medium-Chain Triglycerides: An Acute Crossover Study in Healthy Adults. Curr Dev Nutr. (2017)
  38. ^ Liu YM, Wang HS. Medium-chain triglyceride ketogenic diet, an effective treatment for drug-resistant epilepsy and a comparison with other ketogenic diets. Biomed J. (2013)
  39. ^ Westman EC, et al. Low-carbohydrate nutrition and metabolism. Am J Clin Nutr. (2007)
  40. ^ Wylie-Rosett J, et al. Health effects of low-carbohydrate diets: where should new research go?. Curr Diab Rep. (2013)
  41. ^ Baccala LA, et al. Structural analysis of neural circuits using the theory of directed graphs. Comput Biomed Res. (1991)
  42. ^ a b Gibson AA, et al. Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obes Rev. (2015)
  43. ^ a b Stubbs BJ, et al. A Ketone Ester Drink Lowers Human Ghrelin and Appetite. Obesity (Silver Spring). (2018)
  44. ^ Cross JH, et al. The ketogenic diet in childhood epilepsy: where are we now?. Arch Dis Child. (2010)
  45. ^ Keene DL. A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol. (2006)
  46. ^ Musa-Veloso K, Likhodii SS, Cunnane SC. Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. Am J Clin Nutr. (2002)
  47. ^ Calton JB. Prevalence of micronutrient deficiency in popular diet plans. J Int Soc Sports Nutr. (2010)
  48. ^ Churuangsuk C, et al. Impacts of carbohydrate-restricted diets on micronutrient intakes and status: A systematic review. Obes Rev. (2019)
  49. ^ Ma Y, et al. A dietary quality comparison of popular weight-loss plans. J Am Diet Assoc. (2007)
  50. ^ Miller BV, et al. An evaluation of the atkins' diet. Metab Syndr Relat Disord. (2003)
  51. ^ Kossoff EH, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. (2018)
  52. ^ McGhee B, Katyal N. Avoid unnecessary drug-related carbohydrates for patients consuming the ketogenic diet. J Am Diet Assoc. (2001)
  53. ^ McElhiney LF, et al. Calculating carbohydrate content of compounded medications for patients on a ketogenic diet. Int J Pharm Compd. (2010)
  54. ^ Feldstein TJ. Carbohydrate and alcohol content of 200 oral liquid medications for use in patients receiving ketogenic diets. Pediatrics. (1996)
  55. ^ Daïen CI, et al. Detrimental Impact of Microbiota-Accessible Carbohydrate-Deprived Diet on Gut and Immune Homeostasis: An Overview. Front Immunol. (2017)
  56. ^ Reddel S, Putignani L, Del Chierico F. The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions. Nutrients. (2019)
  57. ^ Lindefeldt M, et al. The ketogenic diet influences taxonomic and functional composition of the gut microbiota in children with severe epilepsy. NPJ Biofilms Microbiomes. (2019)
  58. ^ Brouns F. Overweight and diabetes prevention: is a low-carbohydrate-high-fat diet recommendable?. Eur J Nutr. (2018)
  59. ^ Zinn C, Rush A, Johnson R. Assessing the nutrient intake of a low-carbohydrate, high-fat (LCHF) diet: a hypothetical case study design. BMJ Open. (2018)
  60. ^ Kell DB. Towards a unifying, systems biology understanding of large-scale cellular death and destruction caused by poorly liganded iron: Parkinson's, Huntington's, Alzheimer's, prions, bactericides, chemical toxicology and others as examples. Arch Toxicol. (2010)
  61. ^ Fang X, et al. Dietary intake of heme iron and risk of cardiovascular disease: a dose-response meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis. (2015)
  62. ^ Qiao L, Feng Y. Intakes of heme iron and zinc and colorectal cancer incidence: a meta-analysis of prospective studies. Cancer Causes Control. (2013)
  63. ^ Steinberg KK, et al. Prevalence of C282Y and H63D mutations in the hemochromatosis (HFE) gene in the United States. JAMA. (2001)
  64. ^ Paddon-Jones D, et al. Protein, weight management, and satiety. Am J Clin Nutr. (2008)
  65. ^ Paoli A, et al. Ketosis, ketogenic diet and food intake control: a complex relationship. Front Psychol. (2015)
  66. ^ Hall KD, et al. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. (2016)
  67. ^ Bueno NB, et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. (2013)
  68. ^ Vargas S, et al. Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. J Int Soc Sports Nutr. (2018)
  69. ^ LaFountain RA, et al. Extended Ketogenic Diet and Physical Training Intervention in Military Personnel. Mil Med. (2019)
  70. ^ Roumelioti ME, et al. Fluid balance concepts in medicine: Principles and practice. World J Nephrol. (2018)
  71. ^ Tinsley GM, Willoughby DS. Fat-Free Mass Changes During Ketogenic Diets and the Potential Role of Resistance Training. Int J Sport Nutr Exerc Metab. (2016)
  72. ^ Nilsson LH. Liver glycogen content in man in the postabsorptive state. Scand J Clin Lab Invest. (1973)
  73. ^ Molina DK, DiMaio VJ. Normal Organ Weights in Women: Part II-The Brain, Lungs, Liver, Spleen, and Kidneys. Am J Forensic Med Pathol. (2015)
  74. ^ Molina DK, DiMaio VJ. Normal organ weights in men: part II-the brain, lungs, liver, spleen, and kidneys. Am J Forensic Med Pathol. (2012)
  75. ^ Cahill GF Jr. Fuel metabolism in starvation. Annu Rev Nutr. (2006)
  76. ^ Paoli A, et al. Nutrition and acne: therapeutic potential of ketogenic diets. Skin Pharmacol Physiol. (2012)
  77. ^ Castaldo G, et al. Very low-calorie ketogenic diet may allow restoring response to systemic therapy in relapsing plaque psoriasis. Obes Res Clin Pract. (2016)
  78. ^ Michaels JD, et al. Prurigo pigmentosa after a strict ketogenic diet. Pediatr Dermatol. (2015)
  79. ^ Maco MW, et al. Treatment of Prurigo Pigmentosa with Diet Modification: A Medical Case Study. Hawaii J Med Public Health. (2018)
  80. ^ Teraki Y, et al. Ketosis is involved in the origin of prurigo pigmentosa. J Am Acad Dermatol. (1996)
  81. Rosenbaum M, et al. Glucose and Lipid Homeostasis and Inflammation in Humans Following an Isocaloric Ketogenic Diet. Obesity (Silver Spring). (2019)
  82. Hyde PN, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. (2019)
  83. Phillips SA, et al. Benefit of low-fat over low-carbohydrate diet on endothelial health in obesity. Hypertension. (2008)
  84. Bisschop PH, et al. The effects of carbohydrate variation in isocaloric diets on glycogenolysis and gluconeogenesis in healthy men. J Clin Endocrinol Metab. (2000)
  85. Myette-Côté É, et al. The effect of a short-term low-carbohydrate, high-fat diet with or without postmeal walks on glycemic control and inflammation in type 2 diabetes: a randomized trial. Am J Physiol Regul Integr Comp Physiol. (2018)
  86. Johnston CS, et al. Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. Am J Clin Nutr. (2006)
  87. Vazquez JA, Kazi U. Lipolysis and gluconeogenesis from glycerol during weight reduction with very-low-calorie diets. Metabolism. (1994)
  88. Phillips MCL, et al. Low-fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial. Mov Disord. (2018)
  89. Ranjan A, et al. Short-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: A randomized open-label crossover trial. Diabetes Obes Metab. (2017)
  90. Noakes M, et al. Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk. Nutr Metab (Lond). (2006)
  91. Volek JS, et al. Comparison of a very low-carbohydrate and low-fat diet on fasting lipids, LDL subclasses, insulin resistance, and postprandial lipemic responses in overweight women. J Am Coll Nutr. (2004)
  92. Varady KA, et al. Improvements in vascular health by a low-fat diet, but not a high-fat diet, are mediated by changes in adipocyte biology. Nutr J. (2011)
  93. Kirk E, et al. Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Gastroenterology. (2009)
  94. Francois ME, et al. Carbohydrate restriction with postmeal walking effectively mitigates postprandial hyperglycemia and improves endothelial function in type 2 diabetes. Am J Physiol Heart Circ Physiol. (2018)
  95. Hernandez TL, et al. Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet. Am J Clin Nutr. (2010)
  96. Athinarayanan SJ, et al. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Front Endocrinol (Lausanne). (2019)
  97. Keogh JB, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr. (2008)
  98. Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. (2003)
  99. Sharman MJ, et al. Very low-carbohydrate and low-fat diets affect fasting lipids and postprandial lipemia differently in overweight men. J Nutr. (2004)
  100. Partsalaki I, Karvela A, Spiliotis BE. Metabolic impact of a ketogenic diet compared to a hypocaloric diet in obese children and adolescents. J Pediatr Endocrinol Metab. (2012)
  101. Cohen CW, et al. A Ketogenic Diet Reduces Central Obesity and Serum Insulin in Women with Ovarian or Endometrial Cancer. J Nutr. (2018)
  102. Urbain P, et al. Impact of a 6-week non-energy-restricted ketogenic diet on physical fitness, body composition and biochemical parameters in healthy adults. Nutr Metab (Lond). (2017)
  103. Yancy WS Jr, et al. A randomized trial of a low-carbohydrate diet vs orlistat plus a low-fat diet for weight loss. Arch Intern Med. (2010)
  104. 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)
  105. Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. (2003)