List of Atkins Supporting Research w o Abstracts 12072011

8/3/2019 List of Atkins Supporting Research w o Abstracts 12072011

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List of Atkins Supporting Research (w/Abstracts) as of December 7, 2011

1. Accurso, Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutrition &

Metabolism, 2008. 10.1186/1743-7075-5-9

Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such

approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role

of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior

dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are

primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-

fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of

carbohydrate restriction do not require weight loss. Finally, the point is reiterated that carbohydrate restriction improves all of thefeatures of metabolic syndrome.

2. Arvio, Modified Atkins diet brought back the joy of life to a developmentally severely disabled youth. Duodecim, 2010. 126(5): p. 557-560

Ketogenic diet is worth considering for persons with refractory epilepsy who cannot be helped with conventional means, for instance patients

receiving gavage feeding are an ideal target group but patients eating normally have to adapt themselves to an unbalanced and fat-rich

diet. We describe a developmentally severely disabled man, whose epilepsy settled, autistic features were alleviated, behavioral

problems disappeared and whose weight and blood lipid and glucose values have remained normal for one year during a modified Atkins

diet.

3. Aude, The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat.

Arch Intern Med, 2004. 164: p. 2141-2146

Background: In the United States, obesity is a major clinical and public health problem causing diabetes, dyslipidemia, and hypertension, as well asincreasing cardiovascular and total mortality. Dietary restrictions of calories and saturated fat are beneficial. However, it remains unclear

whether replacement of saturated fat with carbohydrates (as in the US National Cholesterol Education Program [NCEP] diet) or protein

and monounsaturated fat (as in our isocaloric modified lowcarbohydrate [MLC] diet, which is lower in total carbohydrates but higher in

protein, monounsaturated fat, and complex carbohydrates) is optimal. Methods: We randomized 60 participants (29 women and 31 men

to the NCEP or the MLC diet and evaluated them every 2 weeks for 12 weeks. They were aged 28 to 71 years (mean age, 44 years in the

NCEP and 46 years in the MLC group). A total of 36% of participants from the NCEP group and 35% from the MLC group had a body mass

index (calculated as weight in kilograms divided by the square of height in meters) greater than 27. The primary end point was weight

loss, and secondary end points were blood lipid levels and waist-to-hip ratio.

Results: Weight loss was significantly greater in the MLC (13.6 lb) than in the NCEP group (7.5 lb), a difference of 6.1 lb (P=.02). There were no

significant differences between the groups for total, low density, and highdensity lipoprotein cholesterol, triglycerides, or the proportion

of small, dense low-density lipoprotein particles.

There were significantly favorable changes in all lipid levels within the MLC but not within the NCEP group. Waist-to-hip ratio was not significantly

reduced between the groups (P=.27), but it significantly decreased within the MLC group (P=.009).

Conclusions: Compared with the NCEP diet, the MLC diet, which is lower in total carbohydrates but higher in complex carbohydrates, protein, andmonounsaturated fat, caused significantly greater weight loss over 12 weeks. There were no significant differences between the groups

in blood lipid levels, but favorable changes were observed within the MLC diet group. Arch Intern Med.

4. Austin,A Very Low-carbohydrate Diet Improves Symptoms and Quality of Life in Diarrhea-Predominant Irritable Bowel Syndrome. Clin

Gastroenterol Hepatol, 2009. 7(6): p. 706-708

Background & AimsPatients with diarrhea-predominant IBS (IBS-D) anecdotally report symptom improvement after initiating a very low-

carbohydrate diet (VLCD). This is the first study to prospectively evaluate a VLCD in IBS-D.

MethodsParticipants with moderate to severe IBS-D were provided a 2-week standard diet, then 4 weeks of a VLCD (20 grams of

carbohydrates/day). A responder was defined as having adequate relief (AR) of gastrointestinal symptoms for 2 or more weeks during the

VLCD. Changes in abdominal pain, stool habits, and quality of life (QOL) were also measured.

ResultsOf the 17 participants enrolled, 13 completed the study and all met the responder definition, with 10 (77%) reporting AR for all 4 VLCD

weeks. Stool frequency decreased (2.6 0.8/

day to 1.4 0.6/day; p


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(High protein, Low CHO Diet), and (2) calorie restricted diet (Low Cal Diet). Anthropometric data were measured at baseline and at the 2

month follow up appointment.

Results: Thirty-seven children completed the study of whom 27 chose High Protein, Low CHO Diet and 10 chose Low Cal diet. No differences in

gender ratio, age, or BMI were observed at baseline. At 2 months, children in the High Protein, Low CHO Diet lost an average of 5.21

3.44 kg (p < 0.001) and decreased their BMI by 2.42 1.3 points (p < 0.001), compared to the children in the Low Cal Diet who gained an

average of 2.36 2.54 kg and 1.00 point on the BMI value (p < 0.001).

Conclusions: A high protein, low carbohydrate, unlimited calorie diet was superior to a restricted calorie protocol for weight loss in obese school

age children; moreover, compliance was better.

6. Ben-Avraham, Dietary strategies for patients with type 2 diabetes in the era of multi-approaches; review and results from the Dietary

Intervention Randomized Controlled Trial (DIRECT). Diabetes Research and Clinical Practice, 2009. 86(Supplement 1): p. S41-S48

Dietary intervention is recognized as a key component in prevention and management of type 2 diabetes (T2DM) and the debate persists: which

dietary strategy is most effective. In the Dietary Intervention Randomized Controlled Trial (DIRECT) 322 moderately obese participants

were randomized for 2 years to one of three diet groups: low-fat, Mediterranean and low-carbohydrate. Differential effects were

observed in the sub-group of patients with T2DM at 24 months: participants randomized to the Mediterranean diet, which had the

highest intake of previous termdietarynext term fibers and unsaturated to saturated fat ratio, achieved greater significant improvements

in fasting plasma glucose and insulin levels. Patients who were randomized to the low-carbohydrate diet, which had the minimal intake of

carbohydrates, achieved a significant reduction of hemoglobin A1C. Although improvements were observed in all groups, the low-fat diet

was likely to be less beneficial in terms of glycemic control and lipid metabolism. Interpretation of results from different studies on

previous termdietary strategiesnext term may be complex since there is often no consistency in diet compositions, calorie restriction,

intensity of intervention, previous termdietarynext term assessment or extent of adherence in the trial. Nevertheless, it seems that low

fat restricted calorie diets are effective for weight loss and are associated with some metabolic benefits; however, some recent trials

have shown that low carbohydrate diets are as eff icient in inducing weight loss and in some metabolic measures such as serum

triglycerides and HDL-cholesterol may be even superior to low fat diets. When addressing the issue of diet quality rather than quantityapplying the glycemic index may have some added benefits. Furthermore special features of the Mediterranean diet have apparent

additional favorable effects for patients with T2DM.

7. Boden, Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2

Diabetes. Annals of Internal Medicine, 2005. 142: p. 403-411

Background: It is not known how a low-carbohydrate, highprotein, high-fat diet causes weight loss or how it affects blood glucose levels in patients

with type 2 diabetes.

Objective: To determine effects of a strict low-carbohydrate diet on body weight, body water, energy intake and expenditure, glycemic control,

insulin sensitivity, and lipid levels in obese patients with type 2 diabetes.

Design: Inpatient comparison of 2 diets.

Setting: General clinical research center of a university hospital.

Patients: 10 obese patients with type 2 diabetes.

Intervention: Usual diets for 7 days followed by a low-carbohydrate diet for 14 days.Measurements: Body weight, water, and composition; energy intake and expenditure; diet satisfaction; hemoglobin A1c; insulin sensitivity; 24-hour

urinary ketone excretion; and plasma profiles of glucose, insulin, leptin, and ghrelin.

Results: On the low-carbohydrate diet, mean energy intake decreased from 3111 kcal/d to 2164 kcal/d. The mean energy deficit of 1027 kcal/d

(median, 737 kcal/d) completely accounted for the weight loss of 1.65 kg in 14 days (median, 1.34 kg in 14 days). Mean 24-hour plasma

profiles of glucose levels normalized, mean hemoglobin A1c decreased from 7.3% to 6.8%, and insulin sensitivity improved by

approximately 75%. Mean plasma triglyceride and cholesterol levels decreased (change, _35% and _10%, respectively).

Limitations: The study was limited by the short duration, small number of participants, and lack of a strict control group.

Conclusion: In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous

reduction in energy intake to a level appropriate to

their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin

sensitivity, and hemoglobin A1c; and decreased

plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain.

8. Brehm,A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascularrisk factors in healthy women. J Clin Endocrinol Metab, 2003. 88(4): p. 1617-23

Untested alternative weight loss diets, such as very low carbohydrate diets, have unsubstantiated efficacy and the potential to adversely affect

cardiovascular risk factors. Therefore, we designed a randomized, controlled trial to determine the effects of a very low carbohydrate die

on body composition and cardiovascular risk factors. Subjects were randomized to 6 months of either an ad libitum very low

carbohydrate diet or a calorie-restricted diet with 30% of the calories as fat. Anthropometric and metabolic measures were assessed at

baseline, 3 months, and 6 months. Fifty-three healthy, obese female volunteers (mean body mass index, 33.6 +/- 0.3 kg/m(2)) were

randomized; 42 (79%) completed the trial. Women on both diets reduced calorie consumption by comparable amounts at 3 and 6

months. The very low carbohydrate diet group lost more weight (8.5 +/- 1.0 vs. 3.9 +/- 1.0 kg; P < 0.001) and more body fat (4.8 +/- 0.67

vs. 2.0 +/- 0.75 kg; P < 0.01) than the low fat diet group. Mean levels of blood pressure, lipids, fasting glucose, and insulin were within

normal ranges in both groups at baseline. Although all of these parameters improved over the course of the study, there were no


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and individual dietary advice. Weight, glycaemic control, lipids and blood pressure were assessed at baseline and 3 months. Dietary

quality was assessed at the end of study. RESULTS: Weight loss was greater in the low-carbohydrate (LC) group (-3.55 +/- 0.63, mean +/-

sem) vs. -0.92 +/- 0.40 kg, P = 0.001) and cholesterol : high-density lipoprotein (HDL) ratio improved (-0.48 +/- 0.11 vs. -0.10 +/- 0.10, P =

0.01). However, relative saturated fat intake was greater (13.9 +/- 0.71 vs. 11.0 +/- 0.47% of dietary intake, P < 0.001), although absolute

intakes were moderate. CONCLUSIONS: Carbohydrate restriction was an effective method of achieving short-term weight loss compared

with standard advice, but this was at the expense of an increase in relative saturated fat intake.

13. Dansinger, Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction. Journal

of the American Medical Association, 2005. 293(1): p. 43-53

Context The scarcity of data addressing the health effects of popular diets is an important public health concern, especially since patients andphysicians are interested in using popular diets as individualized eating strategies for disease prevention.

Objective To assess adherence rates and the effectiveness of 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and

cardiac risk factor reduction.

Design, Setting, and Participants A single-center randomized trial at an academic medical center in Boston, Mass, of overweight or obese (body

mass index: mean, 35; range, 27-42) adults aged 22 to 72 years with known hypertension, dyslipidemia, or fasting hyperglycemia.

Participants were enrolled starting July 18, 2000, and randomized to 4 popular diet groups until January 24, 2002.

Intervention A total of 160 participants were randomly assigned to either Atkins (carbohydrate restriction, n=40), Zone (macronutrient balance,

n=40), Weight Watchers (calorie restriction, n=40), or Ornish (fat restriction, n=40) diet groups. After 2 months of maximum effort,

participants selected their own levels of dietary adherence.

Main Outcome Measures One-year changes in baseline weight and cardiac risk factors, and self-selected dietary adherence rates per self-report.

Results Assuming no change from baseline for participantswhodiscontinued the study, mean (SD) weight loss at 1 year was 2.1 (4.8) kg for Atkins

(21 [53%] of 40 participants completed, P=.009), 3.2 (6.0) kg for Zone (26 [65%] of 40 completed, P=.002), 3.0 (4.9) kg for Weight

Watchers (26 [65%] of 40 completed, P_.001), and 3.3 (7.3) kg for Ornish (20 [50%] of 40 completed, P=.007). Greater effects were

observed in study completers. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratioby approximately 10% (all P_.05), with no significant effects on blood pressure or glucose at 1 year. Amount of weight loss was associated

with selfreported dietary adherence level (r=0.60; P_.001) but not with diet type (r=0.07; P=.40).

For each diet, decreasing levels of total/HDL cholesterol, C-reactive protein, and insulin were significantly associated with weight loss (mean r=0.36,

0.37, and 0.39, respectively) with no significant difference between diets (P=.48, P=.57, P=.31, respectively).

Conclusions Each popular diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low,

although increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group.

14. Dashti, Ketogenic diet modifies the risk factors of heart disease in obese patients. Nutrition, 2003. 19(10): p. 901-2

It is generally believed that high-fat diets may lead to the development of obesity and several other diseases such as coronary heart disease,

diabetes, and cancer. This view is based on studies carried out in animals that were given a high-fat diet rich in polyunsaturated fatty

acids. However, various recent epidemiologic studies have not explained a specific causal relation between dietary fat and obesity or

obesity-associated diseases.1 Further, contrary to the common notion, a high intake of carbohydrates was found to increase the levels of

triacylglycerols,total cholesterol, and low-density lipoprotein (LDL) cholesterol and decrease the level of high-density lipoprotein (HDL) cholesterol. Elevated levels

of triacylglycerols and low levels of HDL were associated with hyperinsulinemia. Also, an elevated triacylglycerol level, particularly a high

ratio of triacylglycerols to HDL, is an important predictor of heart attack.2 Recent studies have quite evidently shown that the ketogenic

diet is a natural therapy for obesity and obesity-associated diseases. However, there are very few studies that have addressed the long-

term influence of a ketogenic diet in modifying various obesity-associated diseases. Hence, the purpose of this study was to investigate

the long-term effect of a ketogenic diet on the activation and modification of heart disease risk factors in obese patients.

15. Dashti, Long Term Effects of a Ketogenic Diet in Obese Patients. Clinical Cardiology, 2004. 9(3): p. 200-205

BACKGROUND: Although various studies have examined the short-term effects of a ketogenic diet in reducing weight in obese patients, its long-

term effects on various physical and biochemical parameters are not known.

OBJECTIVE: To determine the effects of a 24-week ketogenic diet (consisting of 30 g carbohydrate, 1 g/kg body weight protein, 20% saturated fat,

and 80% polyunsaturated and monounsaturated fat) in obese patients.

PATIENTS AND METHODS: In the present study, 83 obese patients (39 men and 44 women) with a body mass index greater than 35 kg/m2, andhigh glucose and cholesterol levels were selected. The body weight, body mass index, total cholesterol, low density lipoprotein (LDL)

cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, fasting blood sugar, urea and creatinine levels were determined

before and after the administration of the ketogenic diet.

Changes in these parameters were monitored after eight, 16 and 24 weeks of treatment.

RESULTS: The weight and body mass index of the patients decreased significantly (P


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patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously

demonstrated.

16. Davis, Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and

Glycemic Control in Type 2 Diabetes. Diabetes Care, 2009. 32(7): p. 1147-1152

OBJECTIVE To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in

patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS This study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were

weight and A1C. Secondary

outcomes included blood pressure and lipids. Outcome measures were obtained at 3, 6, and 12 months.RESULTS The greatest reduction in weight and A1C occurred within the first 3 months. Weight loss occurred faster in the low-carbohydrate group

than in the low-fat group (P_0.005),

but at 1 year a similar 3.4% weight reduction was seen in both dietary groups. There was no significant change in A1C in either group at 1 year.

There was no change in blood pressure, but

a greater increase in HDL was observed in the low-carbohydrate group (P _ 0.002).

CONCLUSIONS Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen

with a low-fat diet. There was no

significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol. Diabetes Care 32:11471152,

2009

17. Forsythe, Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids,

2008. 43(1):65-77

Abnormal distribution of plasma fatty acids and increased inflammation are prominent features of metabolic syndrome. We tested whether these

components of metabolic syndrome, like dyslipidemia and glycemia, are responsive to carbohydrate restriction. Overweight men andwomen with atherogenic dyslipidemia consumed ad libitum diets very low in carbohydrate (VLCKD) (1504 kcal:%CHO:fat:protein =

12:59:28) or low in fat (LFD) (1478 kcal:%CHO:fat:protein = 56:24:20) for 12 weeks. In comparison to the LFD, the VLCKD resulted in an

increased proportion of serum total n-6 PUFA, mainly attributed to a marked increase in arachidonate (20:4n-6), while its biosynthetic

metabolic intermediates were decreased. The n-6/n-3 and arachidonic/eicosapentaenoic acid ratio also increased sharply. Total

saturated fatty acids and 16:1n-7 were consistently decreased following the VLCKD. Both diets significantly decreased the concentration

of several serum inflammatory markers, but there was an overall greater anti-inflammatory effect associated with the VLCKD, as

evidenced by greater decreases in TNF-alpha, IL-6, IL-8, MCP-1, E-selectin, I-CAM, and PAI-1. Increased 20:4n-6 and the ratios of 20:4n-

6/20:5n-3 and n-6/n-3 are commonly viewed as pro-inflammatory, but unexpectedly were consistently inversely associated with

responses in inflammatory proteins. In summary, a very low carbohydrate diet resulted in profound alterations in fatty acid composition

and reduced inflammation compared to a low fat diet.

18. Forsythe, Limited Effect of Dietary Saturated Fat on Plasma Saturated Fat in the Context of a Low Carbohydrate Diet. Lipids, 2010. 45(10):

p. 947-962

We recently showed that a hypocaloric carbohydrate restricted diet (CRD) had two striking effects: (1) a reduction in plasma saturated fatty acids

(SFA) despite higher intake than a low fat diet, and (2) a decrease in inflammation despite a significant increase in arachidonic acid (ARA).

Here we extend these findings in 8 weight stable men who were fed two 6-week CRD (12%en carbohydrate) varying in quality of fat. One

CRD emphasized SFA (CRD-SFA, 86 g/d SFA) and the other, unsaturated fat (CRD-UFA, 47 g SFA/d). All foods were provided to subjects.

Both CRD decreased serum triacylglycerol (TAG) and insulin, and increased LDL-C particle size. The CRD-UFA significantly decreased

plasma TAG SFA (27.48 2.89 mol%) compared to baseline (31.06 4.26 mol%). Plasma TAG SFA, however, remained unchanged in the

CRD-SFA (33.14 3.49 mol%) despite a doubling in SFA intake. Both CRD significantly reduced plasma palmitoleic acid (16:1n-7) indicating

decreased de novo lipogenesis. CRD-SFA significantly increased plasma phospholipid ARA content, while CRD-UFA significantly increased

EPA and DHA. Urine 8-iso PGF2a, a free radical-catalyzed product of ARA, was significantly lower than baseline following CRD-UFA (-32%).

There was a significant inverse correlation between changes in urine 8-iso PGF2a and PL ARA on both CRD (r = -0.82 CRD-SFA; r = -0.62

CRD-UFA). These findings are consistent with the concept that dietary saturated fat is efficiently metabolized in the presence of low

carbohydrate, and that a CRD results in better preservation of plasma ARA.

19. Foster,A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med, 2003. 348(21): p. 2082-90

BACKGROUND: Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated

its efficacy. METHODS: We conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly

assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet.

Professional contact was minimal to replicate the approach used by most dieters. RESULTS: Subjects on the low-carbohydrate diet had

lost more weight than subjects on the conventional diet at 3 months (mean [+/-SD], -6.8+/-5.0 vs. -2.7+/-3.7 percent of body weight;

P=0.001) and 6 months (-7.0+/-6.5 vs. -3.2+/-5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (-

4.4+/-6.7 vs. -2.5+/-6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in

total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the

decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventiona

diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose


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load. CONCLUSIONS: The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did

the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was

associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in

both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein,

high-fat diets.

20. Foster, Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet: A Randomized Trial. Annals of Interna

Medicine, 2010. 153(3): p. 147-157

Background: Previous studies comparing low-carbohydrate and low-fat diets have not included a comprehensive behavioral treatment, resulting in

suboptimal weight loss.Objective: To evaluate the effects of 2-year treatment with a low-carbohydrate or low-fat diet, each of which was combined with a comprehensive

lifestyle modification program. Design: Randomized parallel-group trial. (ClinicalTrials.gov registration number: NCT00143936)

Setting: 3 academic medical centers. Patients.307 participants with a mean age of 45.5 years (SD, 9.7 years) and mean body mass index of 36.1

kg/m2 (SD, 3.5 kg/m2).

Intervention: A low-carbohydrate diet, which consisted of limited carbohydrate intake (20 g/d for 3 months) in the form of low.glycemic index

vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low-carbohydrate diet group increased

their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved. A low-fat diet consisted of limited energy intake

(1200 to 1800 kcal/d; 30% calories from fat). Both diets were combined with comprehensive behavioral treatment.

Measurements: Weight at 2 years was the primary outcome. Secondary measures included weight at 3, 6, and 12 months and serum lipid

concentrations, blood pressure, urinary ketones,

symptoms, bone mineral density, and body composition throughout the study.

Results: Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. There ere no differences in weight, body composition, or

bone mineral density between the groups at any time point. During the first 6 months, the low-carbohydrate diet group had greater

reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low-carbohydrate diet group had

greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years.

Limitation: tensive behavioral treatment was provided, patients with dyslipidemia and diabetes were excluded, and attrition at 2 years was high.

Conclusion: Successful weight loss can be achieved with either a low-fat or low-carbohydrate

diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at

2 years.

21. Gann,A low-carbohydrate diet in overweight patients undergoing stable statin therapy raises high-density lipoprotein and lowers

triglycerides substantially. Clin Cardiol, 2004. 27(10): p. 563-4

BACKGROUND: A low-carbohydrate diet remains controversial, especially in patients with arteriosclerotic heart disease. HYPOTHESIS: This study

was undertaken to evaluate the effect of a low-carbohydrate diet on the lipid levels in obese patients with known arteriosclerotic heart

disease on chronic statin therapy. METHODS: Thirty-eight overweight patients with angiographically documented arteriosclerotic heart

disease were followed in a private cardiology practice setting. All patients were undergoing stable statin therapy. Patients received a 15-min consultation and a 4-page pamphlet explaining a low-carbohydrate diet; no other diet instruction was given. Patients were followed

weekly for 2 weeks, then monthly for 3 months, then every third month. A fasting finger stick lipid panel (cholesterol, high-density and

low-density lipoprotein [HDL/ LDL], triglycerides, and glucose) was obtained with each visit and patients were weighed in street clothes.

RESULTS: The 38 patients were followed for a average of 11.8 months (range 6-22 months). Average body mass index declined from 33.5

kg/m2 before to 27.9 kg/m2 at the end of the study. Weight loss averaged 31 lbs (range 16-107 lbs). Triglyceride levels were lowered by

29.5%, HDL raised by 17.6%, and cholesterol decreased by 8.4%. The cholesterol/ HDL ratio changed from 5.31 to 3.78 and LDL

cholesterol decreased by 5%. CONCLUSION: The addition of a low-carbohydrate diet for overweight patients with known coronary artery

disease undergoing stable statin therapy causes significant weight loss and a favorable change in the lipid panel.

22. Gannon, Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes, 2004. 53(9): p.

2375-82

There has been interest in the effect of various types and amounts of dietary carbohydrates and proteins on blood glucose. On the basis of our

previous data, we designed a high-protein/low-carbohydrate, weight-maintaining, nonketogenic diet. Its effect on glucose control inpeople with untreated type 2 diabetes was determined. We refer to this as a low-biologically-available-glucose (LoBAG) diet. Eight men

were studied using a randomized 5-week crossover design with a 5-week washout period. The carbohydrate:protein:fat ratio of the

control diet was 55:15:30. The test diet ratio was 20:30:50. Plasma and urinary beta-hydroxybutyrate were similar on both diets. The

mean 24-h integrated serum glucose at the end of the control and LoBAG diets was 198 and 126 mg/dl, respectively. The percentage of

glycohemoglobin was 9.8 +/- 0.5 and 7.6 +/- 0.3, respectively. It was still decreasing at the end of the LoBAG diet. Thus, the final

calculated glycohemoglobin was estimated to be approximately 6.3-5.4%. Serum insulin was decreased, and plasma glucagon was

increased. Serum cholesterol was unchanged. Thus, a LoBAG diet ingested for 5 weeks dramatically reduced the circulating glucose

concentration in people with untreated type 2 diabetes. Potentially, this could be a patient-empowering way to ameliorate

hyperglycemia without pharmacological intervention. The long-term effects of such a diet remain to be determined.


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23. Gardner, Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight

premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA, 2007. 297(9):969-77

CONTEXT: Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate

diet for weight loss. Potential benefits and risks have not been tested adequately. OBJECTIVE: To compare 4 weight-loss diets

representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. DESIGN, SETTING,

AND PARTICIPANTS: Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311

free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. INTERVENTION: Participants were randomly

assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months

then an additional 10-month follow-up. MAIN OUTCOME MEASURES: Weight loss at 12 months was the primary outcome. Secondary

outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and

triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes wereassessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing. RESULTS: Weight loss was

greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was

significantly different between the Atkins and Zone diets (P


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carbohydrate. RESULTS: Compared to baseline diet, after 8 weeks of a 25% diet, subjects showed significantly improved glycemia as

evidenced by fasting blood glucose values (p


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The effects of a low-carbohydrate, ketogenic diet (LCKD) on sleepiness and other narcolepsy symptoms were studied. Nine patients with narcolepsy

were asked to adhere to the Atkins' diet plan, and their symptoms were assessed using the Narcolepsy Symptom Status Questionnaire

(NSSQ). The NSSQ-Total score decreased by 18% from 161.9 to 133.5 (p = 0.0019) over 8 weeks. Patients with narcolepsy experienced

modest improvements in daytime sleepiness on an LCKD.

31. Ito, Modified Atkins diet therapy for a case with glucose transporter type 1 deficiency syndrome. Brain and Development, 2008. 30(3): p.

226-228

Glucose transporter type 1 deficiency syndrome (GLUT-1 DS), giving rise to impaired glucose transport across the bloodbrain barrier, is

characterized by infantile seizures, complex motor disorders, global developmental delay, acquired microcephaly, and hypoglycorrhachia.GLUT-1 DS can be treated effectively with a ketogenic diet because it can provide an alternative fuel for brain metabolism; however, the

excessive restriction of food intake involved frequently makes it difficult for patients to initiate or continue the diet. Recently, the

modified Atkins diet, which is much less restrictive in terms of the total calorie and protein intake than the classical ketogenic diet, has

been shown to be effective and well tolerated in children with intractable epilepsy. We successfully introduced the modified Atkins diet

to a 7-year-old boy with GLUT-1 DS, whose caregivers refused ketogenic diet treatment because of strong concerns over restricting the

diet. The modified Atkins diet should be considered for patients with GLUT-1 DS as an alternative to the traditional ketogenic diet.

32. Kang, Use of a Modified Atkins Diet in Intractable Childhood Epilepsy. Epilepsia, 2007. 48(1): p. 182-186

Purpose: To evaluate the efficacy, safety and tolerability of a modified Atkins diet in intractable childhood epilepsy.

Methods: Fourteen children with epilepsy were treated prospectively with a modified Atkins diet. Outcome measures included seizure frequency,

adverse reactions and tolerability to the diet; blood -hydroxybutyrate and urine ketones were also measured.

Results: Six months after diet initiation, seven (50%) remained on the diet, five (36%) had >50% seizure reduction, and three (21%) were seizure

free. The dietwas well tolerated by 12 (86%) patients. Most complications were transient and were successfully managed by carefulfollow-up and conservative strategies. Aconsistently strong ketosis (-hydroxybutyrate of>3 mmol/L)

seemed to be important for maintaining the efficacy of the diet therapy.

Conclusions: The modified Atkins diet was well tolerated and sometimes a modified Atkins diet can be substituted for the conventional ketogenic

diet. Serious complications were rare, but long-term complications remain to be determined.

33. Kima, Various indications for a modified Atkins diet in intractable childhood epilepsy. Brain and Development, 2011

Purpose: We reviewed retrospectively our experiences with children with intractable epilepsy who were indicated for a modified Atkins diet (MAD)

Methods: Twenty children (8 female, 12 male) who were aged 217 years with intractable epilepsy and tried the MAD between

September 2008 and December 2010 were enrolled. Outcome measures included seizure frequency, adverse reactions and tolerability of

the diet.

Results: Finally 9 patients maintained the MAD with favorable seizure outcomes (a reduction of seizure frequency by over 50%) or successfully

completed the diet therapy. Two patients who required a long-term trial of the diet therapy respectively due to Leighs syndrome and

uncategorized mitochondrial cytopathy derived from cytochrome c oxidase defect, respectively, successfully maintained the diet

treatment without any significant complications. In 7 patients, the ketogenic diet (KD) was not only effective but also too restrictive orcaused serious unwanted events. Five of them maintained the seizure outcome previously achieved by the KD with the MAD. Ten

patients began the MAD because they were reluctant to start the KD. Unfortunately, only 2 patients maintained the MAD with favorable

seizure outcomes. One patient who chose the MAD to bridge the KD and complete discontinuation of the treatment successfully

completed the diet therapy.

Conclusion: A long-term treatment with the MAD was well tolerated. Moreover, the MAD can successfully substitute the classic KD in patients who

showed improvement in seizure outcomes by the KD but could not tolerate it.

34. Kossoff, Efficacy of the Atkins diet as therapy for intractable epilepsy. Neurology, 2003. 61(12): p. 1789-91

The ketogenic diet is effective for treating seizures in children with epilepsy. The Atkins diet can also induce a ketotic state, but has fewer protein

and caloric restrictions, and has been used safely by millions of people worldwide for weight reduction. Six patients, aged 7 to 52 years,

were started on the Atkins diet for the treatment of intractable focal and multifocal epilepsy. Five patients maintained moderate to large

ketosis for periods of 6 weeks to 24 months; three patients had seizure reduction and were able to reduce antiepileptic medications. This

provides preliminary evidence that the Atkins diet may have a role as therapy for patients with medically resistant epilepsy.

35. Kossoff, When do seizures usually improve with the ketogenic diet?Epilepsia, 2008. 49(2): p. 329-33

Purpose: Parents often expect immediate seizure improvement after starting the ketogenic diet

(KD) for their children. The purpose of this study was to determine the typical time to seizure reduction as well as the time after which it was

unlikely to be helpful in those children started on the KD.

Methods: Records of all children started on the KD at Johns Hopkins Hospital, Baltimore (n=83) andChildrensMemorialHospital, Chicago (n = 35)

from November 2003 to December 2006 were examined to determine the first day in which seizures were reportedly improved.

Results: Of the 118 children started on the KD, 99 (84%) had documented seizure reduction. The overall median time to first improvement was

5days (range: 165 days). Seventy-five percent of children improved within 14 days. In those children who were fasted at KD onset, the


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time to improvement was quicker (median 5 vs. 14 days, p < 0.01) with a higher percentage improving within 5 days (60% vs. 31%, p =

0.01). No difference was identified between fasting and nonfasting in regards to long-term outcomes, however.

Discussion: The KD works quickly when effective, typically within the first 12 weeks. Starting the KD after a fasting periodmay lead to a more rapid

but equivalent long-term seizure reduction, confirming prior reports. If the KD has not led to seizure reduction after 2 months, it can

probably be discontinued.

36. Kossoff, Ketogenic diets: evidence for short- and long-term efficacy. Neurotherapeutics, 2009. 6(2): p. 406-14

The use of dietary treatments for epilepsy (ketogenic, modified Atkins, and low glycemic index diets) has been in continuous use since 1921. These

treatments have been well studied in the short term, with approximately half of children having at least a 50% reduction in seizures after

6 months. Approximately one third will attain >90% reduction in their seizures. Animal studies confirm these findings, with broadevidence demonstrating acute anticonvulsant effects of the diet. Furthermore, the diet appears to maintain its efficacy in humans when

provided continuously for several years. Interestingly, benefits may be seen long term even when the diet is discontinued after only a few

months of use, suggesting neuroprotective effects. This potential antiepileptogenic activity has been recently demonstrated in some

animal studies as well. This review discusses the animal and human evidence for both short- and long-term benefits of dietary therapies.

37. Kossoff, Use of the modified Atkins diet for adolescents with chronic daily headache. Cephalalgia, 2010. 30(8): p. 1014-1016

Chronic daily headache is a difficult problem to treat for many adolescents, with a natural tendency for parents to look into alternative treatments

such as acupuncture, herbal remedies, biofeedback and relaxation techniques ( 1). Data on food trigger avoidance are controversial and

not universally recommended even as an adjunctive treatment ( 2 4). Obesity may be a factor in frequent migraines ( 5) and therefore

weight loss through exercise and diets may be theoretically beneficial ( 6). The modified Atkins diet (MAD) is a high-fat, very low

carbohydrate diet used in the treatment of children and adults with intractable epilepsy ( 7). This diet creates a ketotic state similar to the

traditional ketogenic diet, but is started as an out-patient without a fast, or calorie, fluid or protein restriction ( 7). Weight loss can occur

as well. Similar to anticonvulsant drugs, there has been recent interest in the potential benefits of ketogenic diets for the treatment ofneurological conditions other than epilepsy, including Alzheimer disease, amyotrophic lateral sclerosis, brain tumours and autism ( 8). In

2006, a single case report was published regarding a 43-year-old woman with daily migraines who completely responded to a ketosis-

inducing diet containing several high-protein and low-carbohydrate shakes per day ( 9).

38. Kossoff, Will seizure control improve by switching from the modified Atkins diet to the traditional ketogenic diet?Epilepsia, 2010. 51(12):

p. 2496-2499

It has been reported that children can maintain seizure control when the ketogenic diet (KD) is transitioned to the less-restrictive modified Atkins

diet (MAD). What is unknown, however, is the likelihood of additional seizure control from a switch from the MAD to the KD.

Retrospective information was obtained from 27 patients who made this dietary change from four different institutions. Ten (37%)

patients had .10% additional seizure reduction with the KD over the MAD, of which five became seizure-free. The five children who did

not improve on the MAD failed to improve when transitioned to the KD. A higher incidence of improvement with the KD occurred for

those with myoclonic.astatic epilepsy (70% vs. 12% for all other etiologies, p = 0.004), including all who became seizure-free. These

results suggest that the KD probably represents a ghigher dose h of dietary therapy than the MAD, which may parcularly benefit thosewith myoclonic.astatic epilepsy.

39. Kossoff,A pilot study of the modified Atkins diet for SturgeWeber syndrome. Epilepsy Research, 2010. 92(2): p. 240-243

The modified Atkins diet (MAD) is a dietary treatment for epilepsy which does not restrict fluids or calories. This theoretically makes the MAD safer

than the ketogenic diet for children with SturgeWeber syndrome (SWS). Five children aged 418 years with SWS and at least monthly

intractable seizures were started prospectively on the MAD for 6 months. All children had urinary

ketosis and seizure improvement, including 3 with >50% seizure reduction.

40. Kossoff, Prospective Study of the Modified Atkins Diet in Combination With a Ketogenic Liquid Supplement During the Initial Month.

Journal of Child Neurology, 2011. 26(2): p. 147-151

The modified Atkins diet is a high-fat, low-carbohydrate treatment for intractable childhood epilepsy. As data suggest that a stricter diet onset can

be more effective, we added a ketogenic supplement to the modified Atkins diet during its initial month. Thirty children with intractableepilepsy were prospectively started on the modified Atkins diet in combination with a daily 400-calorie KetoCal shake. At 1 month, 24

(80%) children had >50% seizure reduction, of which 11 (37%) had >90% seizure reduction. There was no significant loss of efficacy during

the second month after KetoCal was discontinued. The use of this ketogenic supplement increased daily fat intake and thus the ketogenic

ratio (1.8:1 versus 1.0:1 in the modified Atkins diet alone, P = .0002), but did not change urinary or serum ketosis. The addition of a

ketogenic supplement to the modified Atkins diet during its initial month appears to be beneficial.

41. Kossoff, E.H., More fat and fewer seizures: dietary therapies for epilepsy. Lancet Neurol, 2004. 3(7): p. 415-420

The ketogenic diet is a high-fat, adequate protein, low carbohydrate diet that has been used for the treatment of intractable childhood epilepsy

since the 1920s. The diet mimics the biochemical changes associated with starvation, which create ketosis. Although less commonly used

in later decades because of the increased availability of anticonvulsants, the ketogenic diet has re-emerged as a therapeutic option. Only


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a decade ago the ketogenic diet was seen as a last resort; however, it has become more commonly used in academic centres throughout

the world even early in the course of epilepsy. The Atkins diet is a recently used, less restrictive, therapy that also creates ketosis and can

lower the number of seizures. Dietary therapies may become even more valuable in the therapy of epilepsy when the mechanisms

underlying their success are understood.

42. Krebs, Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. J Pediatr, 2010

OBJECTIVE: To evaluate the efficacy and safety of a carbohydrate restricted versus a low fat diet on weight loss, metabolic markers, body

composition, and cardiac function tests in severely obese adolescents. STUDY DESIGN: Subjects were randomly assigned to 1 of 2 diets: a

high protein, low carbohydrate (20 g/d) diet (high protein, low carbohydrate, HPLC) or low fat (30% of calories) regimen for 13 weeks;

close monitoring was maintained to evaluate safety. After the intervention, no clinical contact was made until follow-up measurements

were obtained at 24 and 36 weeks from baseline. The primary outcome was change in body mass index Z-score for age and sex (BMI-Z) at13, 24, and 36 weeks. RESULTS: Forty-six subjects (24 HPLC, 22 in low fat) initiated and 33 subjects completed the intervention; follow-up

data were available on approximately half of the subjects. Significant reduction in (BMI-Z) was achieved in both groups during

intervention and was significantly greater for the HPLC group (P = .03). Both groups maintained significant BMI-Z reduction at follow-up;

changes were not significantly different between groups. Loss of lean body mass was not spared in the HPLC group. No serious adverse

effects were observed related to metabolic profiles, cardiac function, or subjective complaints. CONCLUSIONS: The HPLC diet is a safe and

effective option for medically supervised weight loss in severely obese adolescents. Copyright 2010 Mosby, Inc. All rights reserved.

PMID: 20304413 [PubMed - as supplied by publisher]

43. Kumada, Modified Atkins Diet for the Treatment of Nonconvulsive Status Epilepticus in Children. Journal of Child Neurology, 2010. 25(4):

p. 485-489

The authors describe the use of a modified Atkins diet for the treatment of 2 children with nonconvulsive status epilepticus. Patient 1 was a 4-year-

and-11-month-old girl diagnosed with frontal lobe epilepsy. Since the age of 3 years and 10 months, she had daily nonconvulsive status

epilepticus resistant to antiepileptic agents. Patient 2 was a 5-year-and-5-month-old girl with subcortical band heterotopia. She hadnonconvulsive status epilepticus daily since the age of 5 years. They were treated with the modified Atkins diet, in which carbohydrate

intake was restricted to 10 g/d without restriction on protein, caloric, or fluid intake. The nonconvulsive status epilepticus disappeared 5

and 10 days after the initiation of the diet treatment, respectively. They have been on the diet treatment and free from nonconvulsive

status epilepticus for 19 and 4 months, respectively. The modified Atkins diet appears to be very effective for the treatment of

nonconvulsive status epilepticus.

44. Kumada, Efficacy and tolerability of modified Atkins diet in Japanese children with medication-resistant epilepsy. Brain and Development,

2011

Ten Japanese patients aged 1.517 years with medication-resistant epilepsy were placed on the modified Atkins diet (MAD) for 3 weeks during

admission to our hospital. Dietary carbohydrate was restricted to 10 g per day. We studied the efficacy of the diet regarding the seizure

frequency and tolerability of the diet at the end of the 3 weeks on the diet. Those who decided to continue the MAD at the time of

discharge were followed up in the out-patient clinic to observe the effect of the diet on the seizure frequency. Three of the 10 patients

could not continue the diet during the 3-week admission; one had rotavirus enterocolitis and the other 2 disliked the diet. Among the

remaining 7 patients who could continue the diet for 3 weeks, 3 achieved the seizure reduction; 2 became seizure-free and 1 showedabout 75% reduction in the seizure frequency within 10 days on the diet. All of these 3 patients continued the diet after the 3-week

admission. The other 4 patients did not show a reduction of the seizure frequency by the end of the 3 weeks on the diet. Two of them

discontinued the diet on discharge. The remaining 2 still continued the diet at home and one became seizure-free 3 months after the

start of the diet. In total, 4 of 10 patients achieved >75% reduction in the seizure frequency, although relapse occurred in 2 of the

patients, at 5 months and 2 years after seizure reduction, respectively. The MAD was effective and well-tolerated in children with

medication-resistant epilepsy in Japan.

45. Martin, Change in food cravings, food preferences, and appetite during a low-carbohydrate and low-fat diet. Obesity, 2011. 19(10): p.

1963-1970

The study objective was to evaluate the effect of prescribing a low-carbohydrate diet (LCD) and a low-fat diet (LFD) on food cravings, food

preferences, and appetite. Obese adults were randomly assigned to a LCD (n=134) or a LFD (n=136) for two years. Cravings for specific

types of foods (sweets, high-fats, fast-food fats, carbohydrates/starches); preferences for high-sugar, highcarbohydrate, and low-

carbohydrate/high-protein foods; and appetite were measured during the trial and evaluated during this secondary analysis of trial data.Differences between the LCD and LFD on change in outcome variables were examined with mixed linear models. Compared to the LFD,

the LCD had significantly larger decreases in cravings for carbohydrates/starches and preferences for high-carbohydrate and high-sugar

foods. The LCD group reported being less bothered by hunger compared to the LFD group. Compared to the LCD group, the LFD group

had significantly larger decreases in cravings for high-fat foods and preference for low-carbohydrate/high-protein foods. Men had larger

decreases in appetite ratings compared to women. Prescription of diets that promoted restriction of specific types of foods resulted in

decreased cravings and preferences for the foods that were targeted for restriction. The results also indicate that the LCD group was less

bothered by hunger compared to the LFD group and that men had larger reductions in appetite compared to women.

46. Mavropoulos, The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutrition and

Metabolism, 2005. 2(35)

Background


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Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age and is associated with obesity,

hyperinsulinemia, and insulin resistance. Because low carbohydrate diets have been shown to reduce insulin resistance, this pilot study

investigated the six-month metabolic and endocrine effects of a low-carbohydrate, ketogenic diet (LCKD) on overweight and obese

women with PCOS.

Results

Eleven women with a body mass index >27 kg/m2 and a clinical diagnosis of PCOS were recruited from the community. They were instructed to

limit their carbohydrate intake to 20 grams or less per day for 24 weeks. Participants returned every two weeks to an outpatient research

clinic for measurements and reinforcement of dietary instruction. In the 5 women who completed the study, there were significantreductions from baseline to 24 weeks in body weight (-12%), percent free testosterone (-22%), LH/FSH ratio (-36%), and fasting insulin (-

54%). There were non-significant decreases in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body hair. Two women

became pregnant despite previous infertility problems.

Conclusion

In this pilot study, a LCKD led to significant improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with

obesity and PCOS over a 24 week period.

47. McAuley, Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. Diabetologia,

2005. 48(1): p. 8-16

AIMS/HYPOTHESIS: A diet low in saturated fatty acids and rich in wholegrains, vegetables and fruit is recommended in order to reduce the risk of

obesity, cardiovascular disease and type 2 diabetes mellitus. However there is widespread interest in high-fat ("Atkins Diet") and high-protein ("Zone Diet") alternatives to the conventional high-carbohydrate, high-fibre approach. We report on a randomised trial that

compared these two alternative approaches with a conventional diet in overweight insulin-resistant women. METHODS: Ninety-six

normoglycaemic, insulin-resistant women (BMI >27 kg/m(2)) were randomised to one of three dietary interventions: a high-

carbohydrate, high-fibre (HC) diet, the high-fat (HF) Atkins Diet, or the high-protein (HP) Zone Diet. The experimental approach was

designed to mimic what might be achieved in clinical practice: the recommendations involved advice concerning food choices and were

not prescriptive in terms of total energy. There were supervised weight loss and weight maintenance phases (8 weeks each), but there

was no contact between the research team and the participants during the final 8 weeks of the study. Outcome was assessed in terms of

body composition and indicators of cardiovascular and diabetes risk. RESULTS: Body weight, waist circumference, triglycerides and insulin

levels decreased with all three diets but, apart from insulin, the reductions were significantly greater in the HF and HP groups than in the

HC group. These observations suggest that the popular diets reduced insulin resistance to a greater extent than the standard dietary

advice did. When compared with the HC diet, the HF and HP diets were shown to produce significantly (p10% increase in LDL cholesterol, whereas this occurred in only 13% of subjects on the HC diet and

3% of those on the HP diet. CONCLUSIONS/INTERPRETATION: In routine practice a reduced-carbohydrate, higher protein diet may be the

most appropriate overall approach to reducing the risk of cardiovascular disease and type 2 diabetes. To achieve similar benefits on a HC

diet, it may be necessary to increase fibre-rich wholegrains, legumes, vegetables and fruits, and to reduce saturated fatty acids to a

greater extent than appears to be achieved by implementing current guidelines. The HF approach appears successful for weight loss in

the short term, but lipid levels should be monitored. The potential deleterious effects of the diet in the long term remain a concern.

48. McClellan, Clinical Calorimetry. XLV: Prolonged Meat Diets with a Study Kidney Function & Ketosis. The Journal of Biological Chemistry,

1930

49. McClellan, Clinical calorimetry. XLV: Prolonged Meat Diets with a Study of the Metabolism of Nitrogen, Calcium and Phosphorous. The

Journal of Biological Chemistry, 1930

50. Meckling, Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes andcardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab, 2004. 89(6): p. 2717-23

Overweight and obese men and women (24-61 yr of age) were recruited into a randomized trial to compare the effects of a low-fat (LF) vs. a low-

carbohydrate (LC) diet on weight loss. Thirty-one subjects completed all 10 wk of the diet intervention (retention, 78%). Subjects on the

LF diet consumed an average of 17.8% of energy from fat, compared with their habitual intake of 36.4%, and had a resulting energy

restriction of 2540 kJ/d. Subjects on the LC diet consumed an average of 15.4% carbohydrate, compared with habitual intakes of about

50% carbohydrate, and had a resulting energy restriction of 3195 kJ/d. Both groups of subjects had significant weight loss over the 10 wk

of diet intervention and nearly identical improvements in body weight and fat mass. LF subjects lost an average of 6.8 kg and had a

decrease in body mass index of 2.2 kg/m(2), compared with a loss of 7.0 kg and decrease in body mass index of 2.1 kg/m(2) in the LC

subjects. The LF group better preserved lean body mass when compared with the LC group; however, only the LC group had a significant

decrease in circulating insulin concentrations. Group results indicated that the diets were equally effective in reducing systolic blood


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pressure by about 10 mm Hg and diastolic pressure by 5 mm Hg and decreasing plasminogen activator inhibitor-1 bioactivity. Blood beta-

hydroxybutyrate concentrations were increased in the LC only, at the 2- and 4-wk time points. These data suggest that energy restriction

achieved by a very LC diet is equally effective as a LF diet strategy for weight loss and decreasing body fat in overweight and obese adults

51. Miranda, Danish study of a Modified Atkins diet for medically intractable epilepsy in children: Can we achieve the same results as with the

classical ketogenic diet. Seizure, 2011. 20(2): p. 151-155

Modified Atkins diet (MAD) is a less restrictive variety of the classical ketogenic diet (KD), used for treating patients with medically resistant

epilepsy. There are only few reports comparing the two types of diets in terms of seizure reduction and tolerability. We compared the

effect of a MAD evaluated prospectively on 33 consecutive children with medically resistant epilepsy, with a group of 50 patients,

previously treated with KD. Patients who had >50% seizure reduction were considered responders. After 3 months on the MAD, 17patients (52%) were responders, including 14 (42%) who had >90% seizure reduction. After 6 months, 13 patients (39%) were responders.

Seventeen patients (52%) remained on the MAD at least 12 months with excellent overall tolerance and compliance, including 9 patients

(27%) who were responders, 4 of them (12%) having >90% seizure reduction. Although there was a trend for higher incidence of

responders in the KD group, this failed to reach the level of significance: after 6 months 39% on MAD and 60% on KD were responders.

However, this trend was not observed when the two groups were adjusted for difference in age (patients in the MAD group were older

than the KD group). In conclusion, our experience suggests that the MAD is similarly effective as the KD in reducing seizure frequency in

children with medically resistant epilepsy.

52. Morgan, Comparison of the effects of four commercially available weight-loss programmes on lipid-based cardiovascular risk factors.

Public Health Nutrition, 2008. 12(6): p. 799-807

Objective: To investigate the relative efficacy of four popular weight-loss programmes on plasma lipids and lipoproteins as measures of CVD risk.

Design: A multi-centred, randomised, controlled trial of four diets Dr Atkins New Diet Revolution, The Slim-Fast Plan, Weight Watchers Pure

Points programme and Rosemary Conleys Eat yourself Slim Diet and Fitness Plan against a control diet, in parallel for 6 months.Setting and subjects: The trial was conducted at five universities across the UK (Surrey, Nottingham, Ulster (Coleraine), Bristol and

Edinburgh (Queen Margaret University College)) and involved the participation of 300 overweight and obese males and females aged 21

60 years in a community setting.

Results: Significant weight loss was achieved by all dieting groups (59 kg at 6 months) but no significant difference was observed between diets at

6 months. The Weight Watchers and Rosemary Conley ( low-fat) diets were followed by significant reductions in plasma LDL cholesterol

(both 212?2% after 6 months, P,0?01), whereas the Atkins (low-carbohydrate) and Weight Watchers diets were followed by marked

reductions in plasma TAG (38?2% and 22?6% at 6 months respectively, P,0?01). These latter two diets were associated with an

increase in LDL particle size, a change that has been linked to reduced CVD risk.

Conclusions: Overall, these results demonstrate the favourable effects of weight loss on lipid-mediated CVD risk factors that can be achieved

through commercially available weight-loss programmes. No detrimental effects on lipid-based CVD risk factors were observed in

participants consuming a low-carbohydrate diet.

53. Nickols-Richardson. Premenopausal women following a low-carbohydrate/high-protein diet experience greater weight loss and less

hunger compared to a high-carbohydrate/low-fat diet. in Experiemental Biology 2004. 2004. Washington, D.C.54. Nielsen, Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up.

Nutrition and Metabolism, 2008. 5(14): p. 1-6

Background: Low-carbohydrate diets, due to their potent antihyperglycemic effect, are an intuitively attractive approach to the management of

obese patients with type 2 diabetes. We previously reported that a 20% carbohydrate diet was significantly superior to a 5560%

carbohydrate diet with regard to bodyweight and glycemic control in 2 groups of obese diabetes patients observed closely over 6 months

(intervention group, n = 16; controls, n = 15) and we reported maintenance of these gains after 22 months. The present study documents

the degree to which these changes were preserved in the low-carbohydrate group after 44 months observation time, without close

follow-up. In addition, we assessed the performance of the two thirds of

control patients from the high-carbohydrate diet group that had changed to a low-carbohydrate diet after the initial 6 month observation period.

We report cardiovascular outcome for the lowcarbohydrate group as well as the control patients who did not change to a low-

carbohydrate diet.

Method: Retrospective follow-up of previously studied subjects on a low carbohydrate diet.

Results: The mean bodyweight at the start of the initial study was 100.6 14.7 kg. At six months it was 89.2 14.3 kg. From 6 to 22 months, meanbodyweight had increased by 2.7 4.2 kg to an average of 92.0 14.0 kg. At 44 months average weight has increased from baseline g to

93.1 14.5 kg. Of the sixteen patients, five have retained or reduced bodyweight since the 22 month point and all but one have lower

weight at 44 months than at start. The initial mean HbA1c was 8.0 1.5%. After 6, 12 and 22 months, HbA1c was 6.1 1.0%, 7.0 1.3%

and 6.9 1.1% respectively. After 44 months mean HbA1c is 6.8 1.3%. Of the 23 patients who have used a low-carbohydrate diet and

for whom we have long-term data, two have suffered a cardiovascular event while four of the six controls who never changed diet have

suffered several cardiovascular events.

Conclusion: Advice to obese patients with type 2 diabetes to follow a 20% carbohydrate diet with some caloric restriction has lasting effects on

bodyweight and glycemic control.

55. OBrien, Diet-Induced Weight Loss Is Associated with Decreases in Plasma Serum Amyloid A and C-Reactive Protein Independent of Dietary

Macronutrient Composition in Obese Subjects. The Journal of Clinical Endocrinology & Metabolism, 2005. 90(4): p. 2244-2249


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Elevated levels of serum amyloid A (SAA) and C-reactive protein (CRP) have been associated with increased cardiovascular risk. Although levels of

CRP decrease with weight loss, it is not known whether SAA decreases with weight loss or whether dietary macronutrient composition

affects levels of either SAA or CRP. SAA and CRP levels were measured retrospectively on baseline and 3-month plasma samples from

41obese (mean body mass index 33.63 _ 1.86 kg/m2) women completing a randomized trial comparing a low-fat diet (n _ 19)and a very

low-carbohydrate diet (n _ 22). For the 41 participants, there were significant decreases from baseline to 3 months in both LogSAA (P _

0.049) and LogCRP (P _ 0.035). The very low-carbohydrate dieters had a significantly greater decrease in LogSAA (P _ 0.04), but their

weight loss also was significantly greater (_7.6 _ 3.2 vs. _4.3 _ 3.5 kg, P < 0.01). In this study, the decreases in inflammatory markers

correlated significantly with weight loss (r _ 0.44, P _ 0.004 vs. LogSAA and r _ 0.35, P _ 0.03 vs. LogCRP). Also, change in LogSAA

correlated with change in insulin resistance (r _ 0.35, P _0.03). Thus, in otherwise healthy, obese women, weight loss was associated with

significant decreases in both SAA and CRP. These effects were proportional to the amount of weight lost but independent of dietarymacronutrient composition. (J Clin Endocrinol Metab 90: 22442249, 2005)

56. Phinney, The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation. Metabolism,

1983. 32(8): p. 757-68

To study the metabolic effects of ketosis without weight loss, nine lean men were fed a eucaloric balanced diet (EBD) for one week providing 35-50

kcal/kg/d, 1.75 g of protein per kilogram per day and the remaining kilocalories as two-thirds carbohydrate (CHO) and one-third fat. This

was followed by four weeks of a eucaloric ketogenic diet (EKD)--isocaloric and isonitrogenous with the EBD but providing less than 20 g

CHO daily. Both diets were appropriately supplemented with minerals and vitamins. Weight and whole-body potassium estimated by

potassium-40 counting (40K) did not vary significantly during the five-week study. Nitrogen balance (N-Bal) was regained after one week

of the EKD. The fasting blood glucose remained lower during the EKD than during the control diet (4.4 mmol/L at EBD, 4.1 mmol/L at EKD-

4, P less than 0.01). The fasting whole-body glucose oxidation rate determined by a 13C-glucose primed constant infusion technique fell

from 0.71 mg/kg/min during the control diet to 0.50 mg/kg/min (P less than 0.01) during the fourth week of the EKD. The mean serum

cholesterol level rose (from 159 to 208 mg/dL) during the EKD, while triglycerides fell from 107 to 79 mg/dL. No disturbance of hepatic orrenal function was noted at EKD-4. These findings indicate that the ketotic state induced by the EKD was well tolerated in lean subjects;

nitrogen balance was regained after brief adaptation, serum lipids were not pathologically elevated, and blood glucose oxidation at rest

was measurably reduced while the subjects remained euglycemic.

57. Porta, Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet. Seizure, 2009.

18(1): p. 359-364

The ketogenic diet (KD) and the modified Atkins diet are effective therapies for intractable epilepsy. We compared retrospectively the KD and

modified Atkins diet in 27 children and also assessed serum long chain fatty acid profiles. After 3 months, using an intent-to-treat

analysis, the KD was more successful, with >50% seizure reduction in 11/17 (65%) vs. 2/10 (20%) with the modified Atkins diet, p = 0.03.

After 6 months, however, the difference was no longer significant: 7/17 (41%) vs. 2/10 (20%) (p = 0.24). We observed a preventive effect

of both diets on the occurrence of status epilepticus. After 1 and 3 months of either diet, responders experienced a significant decrease

in serum arachidonic acid concentration compared to non-responders. The KD and modified Atkins diet led to seizure reduction in this

small pilot series, with slightly better results after 3 months with the KD, but not after 6 months. The decrease of serum arachidonic acidlevels might be involved in the anticonvulsive effects of KD or modified Atkins diet.

58. Samaha,A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med, 2003. 348(21): p. 2074-81

BACKGROUND: The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed.

METHODS: We randomly assigned 132 severely obese subjects (including 77 blacks and 23 women) with a mean body-mass index of 43

and a high prevalence of diabetes (39 percent) or the metabolic syndrome (43 percent) to a carbohydrate-restricted (low-carbohydrate)

diet or a calorie- and fat-restricted (low-fat) diet. RESULTS: Seventy-nine subjects completed the six-month study. An analysis including al

subjects, with the last observation carried forward for those who dropped out, showed that subjects on the low-carbohydrate diet lost

more weight than those on the low-fat diet (mean [+/-SD], -5.8+/-8.6 kg vs. -1.9+/-4.2 kg; P=0.002) and had greater decreases in

triglyceride levels (mean, -20+/-43 percent vs. -4+/-31 percent; P=0.001), irrespective of the use or nonuse of hypoglycemic or lipid-

lowering medications. Insulin sensitivity, measured only in subjects without diabetes, also improved more among subjects on the low-

carbohydrate diet (6+/-9 percent vs. -3+/-8 percent, P=0.01). The amount of weight lost (P


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PURPOSE: To compare the effects of a low-carbohydrate diet and a conventional (fat- and calorie-restricted) diet on lipoprotein subfractions and

inflammation in severely obese subjects. METHODS: We compared changes in lipoprotein subfractions and C-reactive protein levels in 78

severely obese subjects, including 86% with either diabetes or metabolic syndrome, who were randomly assigned to either a low-

carbohydrate or conventional diet for 6 months. RESULTS: Subjects on a low-carbohydrate diet experienced a greater decrease in large

very low-density lipoprotein (VLDL) levels (difference = -0.26 mg/dL, P = 0.03) but more frequently developed detectable chylomicrons

(44% vs. 22%, P = 0.04). Both diet groups experienced similar decreases in the number of low-density lipoprotein (LDL) particles

(difference = -30 nmol/L, P = 0.74) and increases in large high-density lipoprotein (HDL) concentrations (difference = 0.70 mg/dL, P =

0.63). Overall, C-reactive protein levels decreased modestly in both diet groups. However, patients with a high-risk baseline level (>3

mg/dL, n = 48) experienced a greater decrease in C-reactive protein levels on a low-carbohydrate diet (adjusted difference = -2.0 mg/dL, P

= 0.005), independent of weight loss. CONCLUSION: In this 6-month study involving severely obese subjects, we found an overall

favorable effect of a low-carbohydrate diet on lipoprotein subfractions, and on inflammation in high-risk subjects. Both diets had similareffects on LDL and HDL subfractions.

61. Shai, Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. The New England Journal of Medicine, 2008. 359(3): p. 229-

241

Background Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout

rates.

Methods In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age,

52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets:

low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, nonrestricted-calorie.

Results The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The

Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P


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PMID: 20194883 [PubMed - indexed for MEDLINE]

63. Sharma, Use of the modified Atkins diet in infantile spasms refractory to first-line treatment. Seizure, 2011

This prospective, open label, uncontrolled study was performed to evaluate the efficacy and tolerability of the modified Atkins diet in children with

refractory infantile spasms. Fifteen consecutive children aged six months to three years having daily infantile spasms in clusters with

electroencephalographic evidence of hypsarrhythmia despite treatment with hormonal treatment (oral

corticosteroids/adrenocorticotrophic hormone) and/or vigabatrin, and at least one additional anti-epileptic drug were enrolled. Children

with known or suspected inborn errors of metabolism or systemic illnesses were excluded. Carbohydrate intake was restricted to ten

grams/day. Among these 12 boys and three girls (median age-24 months), 13 had symptomatic etiology. After three months of diet, six

children were spasm free. The time to spasm freedom after diet initiation ranged from two days to two months. The most frequentadverse effect observed was constipation. The modified Atkins diet was found to be effective and well tolerated in children with

refractory infantile spasms (ClinicalTrials.gov identifier: NCT01006811).

64. Sharman,A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr, 2002. 132(7): p.

1879-85

Very low-carbohydrate (ketogenic) diets are popular yet little is known regarding the effects on serum biomarkers for cardiovascular disease (CVD).

This study examined the effects of a 6-wk ketogenic diet on fasting and postprandial serum biomarkers in 20 normal-weight,

normolipidemic men. Twelve men switched from their habitual diet (17% protein, 47% carbohydrate and 32% fat) to a ketogenic diet

(30% protein, 8% carbohydrate and 61% fat) and eight control subjects consumed their habitual diet for 6 wk. Fasting blood lipids, insulin,

LDL particle size, oxidized LDL and postprandial tr iacylglycerol (TAG) and insulin responses to a fat-rich meal were determined before and

after treatment. There were significant decreases in fasting serum TAG (-33%), postprandial lipemia after a fat-rich meal (-29%), and

fasting serum insulin concentrations (-34%) after men consumed the ketogenic diet. Fasting serum total and LDL cholesterol and oxidized

LDL were unaffected and HDL cholesterol tended to increase with the ketogenic diet (+11.5%; P = 0.066). In subjects with a predominanceof small LDL particles pattern B, there were significant increases in mean and peak LDL particle diameter and the percentage of LDL-1

after the ketogenic diet. There were no significant changes in blood lipids in the control group. To our knowledge this is the first study to

document the effects of a ketogenic diet on fasting and postprandial CVD biomarkers independent of weight loss. The results suggest tha

a short-term ketogenic diet does not have a deleterious effect on CVD risk profile and may improve the lipid disorders characteristic of

atherogenic dyslipidemia.

65. Sharman, Very low-carbohydrate and low-fat diets affect fasting lipids and postprandial lipemia differently in overweight men. J Nutr,

2004. 134(4): p. 880-5

Hypoenergetic very low-carbohydrate and low-fat diets are both commonly used for short-term weight loss; however, few studies have directly

compared their effect on blood lipids, with no studies to our knowledge comparing postprandial lipemia, an important independently

identified cardiovascular risk factor. The primary purpose of this study was to compare the effects of a very low-carbohydrate and a low-

fat diet on fasting blood lipids and postprandial lipemia in overweight men. In a balanced, randomized, crossover design, overweight men

(n = 15; body fat >25%; BMI, 34 kg/m(2)) consumed 2 experimental diets for 2 consecutive 6-wk periods. One was a very low-carbohydrate (


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These data suggest that in the short-term weight loss is primarily the driving force underlying the reductions in most of the inflammatory

biomarkers.

67. Siegel,A 6-Month, Office-Based, Low-Carbohydrate Diet Intervention in Obese Teens. Clinical Pediatrics, 2009. 48(7): p. 745-749

Background. Previous studies have shown the success of a low-carbohydrate diet (LCD) in adults. In one study, the LCD has also been shown as safe

and effective in teens, the study period was only 12 weeks. Furthermore, there is no information on whether the LCD is a practical

intervention in a pediatric office setting. Objective. The object of this study was to demonstrate the effectiveness of a LCD in obese

children in a primary care pediatric setting. Design/Methods . The study was done in 11 community pediatric practices. Children ages 12

to 18 years with a body mass index (BMI) greater than 95th percentile were put on a LCD of less than 50 grams of carbohydrate daily.

Results . A total of 38 of the 63 teens finished the 6-month study and 32 (84%) lost weight (range from a gain of 5.5 kg to a loss of 23.9kg). There was also a significant decrease in mean BMI (34.9 to 32.5). Conclusions. The LCD appears to an effective and practical office-

based intervention in obese teenagers.

68. Siri-Tarino, Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American

Journal of Clinical Nutrition, 2010. 91(3): p. 535-546

Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health.

Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of

coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemiologic studies.

Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study.

A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD.

Results: During 523 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an

increased risk of CHD, stroke, or CVD. The pooled relative r isk estimates that compared extreme quantiles of saturated fat intake were

1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD.Consideration of age, sex, and study quality did

not change the results.

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary

saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be

influenced by the specific nutrients used to replace saturated fat.

69. Siri-Tarino, Saturated fat, carbohydrate, and cardiovascular disease. American Journal of Clinical Nutrition, 2010. 91(3): p. 502-509

A focus of dietary recommendations for cardiovascular disease (CVD) prevention and treatment has been a reduction in saturated fat intake,

primarily as a means of lowering LDL-cholesterol concentrations. However, the evidence that supports a reduction in saturated fat intake

must be evaluated in the context of replacement by other macronutrients. Clinical trials that replaced saturated fat with polyunsaturated

fat have generally shown a reduction in CVD events, although several studies showed no effects. An independent association of saturated

fat intake with CVD risk has not been consistently shown in prospective epidemiologic studies, although some have provided evidence of

an increased risk in young individuals and in women. Replacement of saturated fat by polyunsaturated or monounsaturated fat lowersboth LDL and HDL cholesterol. However, replacement with a higher carbohydrate intake, particularly refined carbohydrate, can

exacerbate the atherogenic dyslipidemia associated with insulin resistance and obesity that includes increased triglycerides, small LDL

particles, and reduced HDL cholesterol. In summary, although substitution of dietary polyunsaturated fat for saturated fat has been

shown to lower CVD risk, there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with

carbohydrate. Furthermore, particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of

larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic

dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.

70. Smith, Efficacy and tolerability of the Modified Atkins Diet in adults with pharmacoresistant epilepsy: A prospective observational study.

Epilepsia, 2011. 52(4): p. 775-780

Purpose: Evidence from the pediatric population exists for the efficacy of ketogenic diets in reducing seizure frequency in patients with intractable

epilepsy. Recent evidence suggests that a Modified Atkins Diet may be a beneficial form of cotherapy for adult patients with

pharmacoresistant epilepsy.Methods: A prospective, open-label study was performed of adults >18 years of age with pharmacoresistant epilepsy. Carbohydrates were

restricted to 20 g/day. Fluids and calories from protein and fat were allowed ad libitum.

Key Findings: Eighteen patients, ages 1855 years, were initially enrolled. Using an intent-to-treat analysis, 12% had a >50% seizure reduction after

3 months; 28% after 6 months, and 21% after 12 months. Response at 3 months predicted response at 12 months in 79% of patients. The

mean decrease in weight was 10.9 kg and the mean decrease in body mass index (BMI) was 3.8, p = 0.01. Fourteen of 18 patients (78%)

completed 12 months of this diet. Patients experienced a decrease in triglycerides from (mean) 1.22 to 0.9 mM (p = 0.02).

Significance: The Modified Atkins Diet demonstrates modest efficacy as cotherapy for some adults with pharmacoresistant epilepsy and may be

also helpful for weight loss. Financial and logistical barriers were significant factors for those who declined enrollment and for those who

discontinued the study.


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71. Sondike, Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr, 2003.

142(3): p. 253-8

OBJECTIVES: To compare the effects of a low-carbohydrate (LC) diet with those of a low-fat (LF) diet on weight loss and serum lipids in overweight

adolescents. DESIGN: A randomized, controlled 12-week trial. SETTING: Atherosclerosis prevention referral center. METHODS: Random,

nonblinded assignment of participants referred for weight management. The study group (LC) (n = 16) was instructed to consume


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77. Volek, Fasting lipoprotein and postprandial triacylglycerol responses to a low-carbohydrate diet supplemented with n-3 fatty acids. J Am

Coll Nutr, 2000. 19(3): p. 383-91

BACKGROUND: The effects of a prolonged low-carbohydrate diet rich in n-3 fatty a

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