Low-carbohydrate diet

Short description: Diets restricting carbohydrate consumption

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An example of a low-carbohydrate dish, cooked kale and poached eggs

Low-carbohydrate diets restrict carbohydrate consumption relative to the average diet. Foods high in carbohydrates (e.g., sugar, bread, pasta) are limited, and replaced with foods containing a higher percentage of fat and protein (e.g., meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds), as well as low carbohydrate foods (e.g. spinach, kale, chard, collards, and other fibrous vegetables).

There is a lack of standardization of how much carbohydrate low-carbohydrate diets must have, and this has complicated research.[1] One definition, from the American Academy of Family Physicians, specifies low-carbohydrate diets as having less than 20% of calories from carbohydrates.[2]

There is no good evidence that low-carbohydrate dieting in general confers any particular health benefits apart from weight loss, where low-carbohydrate diets achieve outcomes similar to other diets, as weight loss is mainly determined by calorie restriction and adherence.[3]

One particular form of low-carbohydrate diet called the ketogenic diet was first established as a medical diet for treating epilepsy.[4] It became a popular diet for weight loss through celebrity endorsement, but there is no evidence of any distinctive benefit for this purpose and the diet carries a risk of adverse effects,[4][5] with the British Dietetic Association naming it one of the "top five worst celeb diets to avoid" in 2018.[4]

## Contents

* 1 Definition and classification
* 1.1 Macronutrient ratios
* 1.2 Foodstuffs
* 2 Authority opinions
* 2.1 Carbohydrate-insulin hypothesis
* 3 Health aspects
* 3.1 Adherence
* 3.2 Body weight
* 3.3 Cardiovascular health
* 3.4 Diabetes
* 3.5 Exercise and fatigue
* 3.6 Safety
* 4 History
* 4.1 First descriptions
* 4.2 Modern low-carbohydrate diets
* 4.2.1 Ketogenic diet
* 5 See also
* 6 References
* 7 Further reading

## Definition and classification

### Macronutrient ratios

The macronutrient ratios of low-carbohydrate diets are not standardized.[6][7] As of 2018[update], the conflicting definitions of "low-carbohydrate" diets have complicated research into the subject.[1][8]

The National Lipid Association Nutrition and Lifestyle Task Force define low-carbohydrate diets and those containing less than 25% of calories from carbohydrates, and very low carbohydrate diets being those containing less than 10% carbohydrates.[9] A 2016 review of low-carbohydrate diets classified diets with 50 g of carbohydrate per day (less than 10% of total calories) as "very low" and diets with 40% of calories from carbohydrates as "mild" low-carbohydrate diets.[10] The UK National Health Service recommend that "carbohydrates should be the body's main source of energy in a healthy, balanced diet."[11]

### Foodstuffs

Like other leafy vegetables, curly kale is a food that is low in carbohydrates.

There is evidence that the quality, rather than the quantity, of carbohydrate in a diet is important for health, and that high-fiber slow-digesting carbohydrate-rich foods are healthful while highly refined and sugary foods are less so.[12] A diet chosen to address health concerns should be tailored to the individual's specific needs.[13]

Most vegetables are low- or moderate-carbohydrate foods (in some low-carbohydrate diets, fiber is excluded because it is not a nutritive carbohydrate). Some vegetables, such as potatoes, carrots, maize (corn) and rice are high in starch. Most low-carbohydrate diet plans accommodate vegetables such as broccoli, spinach, kale, lettuce, cucumbers, cauliflower, Brussels sprouts, peppers and most green-leafy vegetables.

## Authority opinions

The National Academy of Medicine recommends a daily average of 130 g of carbohydrates per day.[14] The FAO and WHO similarly recommend that the majority of dietary energy come from carbohydrates.[15][16] Low-carbohydrate diets are not an option recommended in the 2015–2020 edition of Dietary Guidelines for Americans, which instead recommends a low-fat diet.

Carbohydrate has been wrongly accused of being a uniquely "fattening" macronutrient, misleading many dieters into compromising the nutritiousness of their diet by eliminating carbohydrate-rich food.[17] Low-carbohydrate diet proponents emphasize research saying that low-carbohydrate diets can initially cause slightly greater weight loss than a balanced diet, but any such advantage does not persist.[17][18] In the long-term successful weight maintenance is determined by calorie intake, and not by macronutrient ratios.[19][18]

The public[who?] has become confused by the way in which some diets, such as the Zone diet and the South Beach diet are promoted as "low-carbohydrate" when in fact they would more properly be termed "medium-carbohydrate" diets.[20]

### Carbohydrate-insulin hypothesis

Low-carbohydrate diet advocates including Gary Taubes and David Ludwig have proposed a "carbohydrate-insulin hypothesis" in which carbohydrates are said to be uniquely fattening because they raise insulin levels and cause fat to accumulate unduly.[21][22] The hypothesis appears to run counter to known human biology whereby there is no good evidence of any such association between the actions of insulin, fat accumulation, and obesity.[18] The hypothesis predicted that low-carbohydrate dieting would offer a "metabolic advantage" of increased energy expenditure equivalent to 400–600 kcal(kilocalorie)/day, in accord with the promise of the Atkin's diet: a "high calorie way to stay thin forever".[21]

With funding from the Laura and John Arnold Foundation, in 2012, Taubes co-founded the Nutrition Science Initiative (NuSI), with the aim of raising over $200 million to undertake a "Manhattan Project For Nutrition" and validate the hypothesis.[23][24] Intermediate results, published in the American Journal of Clinical Nutrition did not provide convincing evidence of any advantage to a low-carbohydrate diet as compared to diets of other composition. This study revealed a marginal (~100 kcal/d) but statistically significant effect of the ketogenic diet to increase 24-hour energy expenditure measured in a respiratory chamber, but the effect waned over time. Ultimately a very low-calorie, ketogenic diet (of 5% carbohydrate) "was not associated with significant loss of fat mass" compared to a non-specialized diet with the same calories; there was no useful "metabolic advantage".[18][21] In 2017, Kevin Hall, a National Institutes of Health researcher hired to assist with the project, wrote that the carbohydrate-insulin hypothesis had been falsified by experiment.[22][21] Hall wrote "the rise in obesity prevalence may be primarily due to increased consumption of refined carbohydrates, but the mechanisms are likely to be quite different from those proposed by the carbohydrate–insulin model."[21]

## Health aspects

### Adherence

It has been repeatedly found that in the long-term, all diets with the same calorific value perform the same for weight loss, except for the one differentiating factor of how well people can faithfully follow the dietary programme.[20] A study comparing groups taking low-fat, low-carbohydrate and Mediterranean diets found at six months the low-carbohydrate diet still had most people adhering to it, but thereafter the situation reversed: at two years the low-carbohydrate group had the highest incidence of lapses and dropouts.[20] This may be due to the comparatively limited food choice of low-carbohydrate diets.[20]

### Body weight

In the short and medium term, people taking a low-carbohydrate diet can experience more weight loss than people taking a low-fat diet.[25][18] The Endocrine Society stated that "when calorie intake is held constant ... body-fat accumulation does not appear to be affected by even very pronounced changes in the amount of fat vs. carbohydrate in the diet". People on such a diet have very slightly more weight loss initially, equivalent to approximately 100kcal/day, but that advantage diminishes over time and is ultimately insignificant.[18] A Cochrane review from 2022 looked into longer periods of two years and found no benefit for adhering to a low-carbohydrate diet in comparison to balanced diets.[26]

Much of the research comparing low-fat vs. low-carbohydrate dieting has been of poor quality and studies which reported large effects have garnered disproportionate attention in comparison to those which are methodologically sound.[27] A 2018 review said "higher-quality meta-analyses reported little or no difference in weight loss between the two diets."[27] Low-quality meta-analyses have tended to report favourably on the effect of low-carbohydrate diets: a systematic review reported that 8 out of 10 meta-analyses assessed whether weight loss outcomes could have been affected by publication bias, and 7 of them concluded positively.[27] A 2017 review concluded that a variety of diets, including low-carbohydrate diets, achieve similar weight loss outcomes, which are mainly determined by calorie restriction and adherence rather than the type of diet.[3]

### Cardiovascular health

Eating a low-carbohydrate diet for less than two years was found to not worsen markers for cardiovascular health.[26][28][29] However, following a low-carb diet for many years is associated with dying from heart disease.[30] Low-carbohydrate diets in the long-term have detrimental effects on lipid parameters such as increase in total and LDL cholesterol.[31] This is because most people on low-carbohydrate diets eat more animal source foods and less fruits and vegetables rich in fiber and micronutrients.[31]

The American College of Cardiology recommends a clinician-patient discussion for people who want to go on a very low-carbohydrate diet. People on the diet should be informed that it may worsen LDL-C levels and cardiovascular health in the long-term. Those with atherosclerosis should be counseled to avoid low-carbohydrate diets.[32]

### Diabetes

There is limited evidence for the effectiveness of low-carbohydrate diets for people with type 1 diabetes.[1] For certain individuals, it may be feasible to follow a low-carbohydrate regime combined with carefully managed insulin dosing. This can be hard to maintain and there are concerns about potential adverse health effects caused by the diet.[1] In general, people with type 1 diabetes are advised to follow an individualized eating plan.[1]

The proportion of carbohydrate in a diet is not linked to the risk of type 2 diabetes, although there is some evidence that diets containing certain high-carbohydrate items – such as sugar-sweetened drinks or white rice – are associated with an increased risk.[33] Some evidence indicates that consuming fewer carbohydrate foods may reduce biomarkers of type 2 diabetes.[34][35]

A 2019 consensus report on nutrition therapy for adults with diabetes and prediabetes the American Diabetes Association (ADA) states "Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia (blood sugar) and may be applied in a variety of eating patterns that meet individual needs and preferences." However, another source states that there is no good evidence that low-carbohydrate diets are better than a conventional healthy diet in which carbohydrates typically account for more than 40% of calories consumed.[36] Low-carbohydrate dieting has no effect on the kidney function of people who have type 2 diabetes.[37]

Limiting carbohydrate consumption generally results in improved glucose control, although without long-term weight loss.[34] Low-carbohydrate diets can be useful to help people with type 2 diabetes lose weight, but "no single approach has been proven to be consistently superior."[38] According to the ADA, people with diabetes should be "developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods." They recommended that the carbohydrates in a diet should come from "vegetables, legumes, fruits, dairy (milk and yogurt), and whole grains", while highly refined foods and sugary drinks should be avoided.[38] For individuals with type 2 diabetes who can't meet the glycemic targets or where reducing anti-glycemic medications is a priority, the ADA says that low or very-low carbohydrate diets are a viable approach.[39]

A 2021 umbrella review found that low-carbohydrate diets are no better for weight loss than higher-carbohydrate or low-fat diets in diabetic patients.[40]

### Exercise and fatigue

A low-carbohydrate diet has been found to reduce endurance capacity for intense exercise efforts,[41][42] and depleted muscle glycogen following such efforts is only slowly replenished if a low-carbohydrate diet is taken. Inadequate carbohydrate intake during athletic training causes metabolic acidosis, which may be responsible for the impaired performance which has been observed.[43]

### Safety

A low-carbohydrate diet causes extensive metabolism of fatty acids, which are used by the liver to make ketone bodies, which provide energy to important organs, including the brain, heart, and kidneys, in a condition called ketosis. Ketosis can have other causes such as alcoholism and diabetes. Excessive accumulation of ketone bodies occurs when its production is greater than consumption, leading to ketoacidosis, a potentially life-threatening condition. Rarely, a low-carbohydrate ketogenic diet can also give rise to ketoacidosis, especially in patients with comorbid conditions.[44] There are infrequent case reports of ketoacidosis occurring in people who follow low-carbohydrate diets such as the Atkins and South Beach diets.[1] This has led to the suggestion that ketoacidosis should be considered a potential hazard of low-carbohydrate dieting.[27]

High- and low-carbohydrate diets that are rich in animal-derived proteins and fats may be associated with increased mortality. Conversely, with plant-derived proteins and fats, there may be a decrease of mortality.[45] A 2021 study from Japan looked at the long-term aspects of low-carb eating. The study included 90,171 participants with a median 17 years of follow-up. The study found that a high adherence to low-carb eating was associated with increased overall cancer risk. Looking at the diet composition the authors found that eating more animals foods was associated with an increased cancer risk while plant fat consumption was not.[46]

As of 2018[update], research has paid insufficient attention to the potential adverse effects of carbohydrate restricted dieting, particularly for micronutrient sufficiency, bone health and cancer risk.[27] One low-quality meta-analysis reported that adverse effects could include "constipation, headache, halitosis, muscle cramps and general weakness".[27]

In a comprehensive systematic review of 2018, Churuangsuk and colleagues reported that other case reports give rise to concerns of other potential risks of low-carbohydrate dieting including hyperosmolar coma, Wernicke's encephalopathy, optic neuropathy from thiamine deficiency, acute coronary syndrome and anxiety disorder.[27]

Significantly restricting the proportion of carbohydrate in diet risks causing malnutrition, and can make it difficult to get enough dietary fiber to stay healthy.[11]

As of 2014, it appeared that with respect to the risk of death for people with cardiovascular disease, the kind of carbohydrates consumed are important; diets relatively higher in fiber and whole grains lead to reduced risk of death from cardiovascular disease compared to diets high in refined grains.[47]

## History

A low-carbohydrate diet restricts the amount of carbohydrate-rich foods – such as bread – in the diet.

### First descriptions

In 1797, John Rollo reported on the results of treating two diabetic Army officers with a low-carbohydrate diet and medications. A very low-carbohydrate diet was the standard treatment for diabetes throughout the nineteenth century.[48][49]

In 1825, Jean Brillat-Savarin promoted a low-carb diet in his book, The Physiology of Taste.[50]

In 1863, William Banting, a formerly obese English undertaker and coffin maker, published "Letter on Corpulence Addressed to the Public", in which he described a diet for weight control giving up bread, butter, milk, sugar, beer, and potatoes.[51] His booklet was widely read, so much so that some people used the term "Banting" for the activity now called "dieting".[52]

Physicians who advocated a low-carbohydrate diet consisting of large amounts of animal fat and protein to treat diabetes in the late 1800s include James Lomax Bardsley, Apollinaire Bouchardat and Frederick William Pavy.[53][54] Arnaldo Cantani isolated his diabetic patients in locked rooms and prescribed them an exclusive animal-based diet.[55][56]

In the early 1900s Frederick Madison Allen developed a highly restrictive short term regime which was described by Walter R. Steiner at the 1916 annual convention of the Connecticut State Medical Society as The Starvation Treatment of Diabetes Mellitus.[57]: 176–177 [58][59] This diet was often administered in a hospital in order to better ensure compliance and safety.[57]: 179

### Modern low-carbohydrate diets

Other low-carbohydrate diets in the 1960s included the Air Force diet,[60] "Martinis & Whipped Cream" in 1966,[61] and the Drinking Man's Diet.[62][63] In 1972, Robert Atkins published Dr. Atkins' Diet Revolution, which advocated the low-carbohydrate diet he had successfully used in treating people in the 1960s.[64] The book was a publishing success, but was widely criticized by the mainstream medical community as being dangerous and misleading, thereby limiting its appeal at the time.[65]

The concept of the glycemic index was developed in 1981 by David Jenkins to account for variances in speed of digestion of different types of carbohydrates. This concept classifies foods according to the rapidity of their effect on blood sugar levels - with fast-digesting simple carbohydrates causing a sharper increase and slower-digesting complex carbohydrates, such as whole grains, a slower one.[66] Jenkins's research laid the scientific groundwork for subsequent low-carbohydrate diets.[67]

In 1992, Atkins published an update from his 1972 book, Dr. Atkins' New Diet Revolution, and other doctors began to publish books based on the same principles.[68] During the late 1990s and early 2000s, low-carbohydrate diets became some of the most popular diets in the US. By some accounts, up to 18% of the population was using one type of low-carbohydrate diet or another at the peak of their popularity.[69] Food manufacturers and restaurant chains noted the trend, as it affected their businesses.[70] Parts of the mainstream medical community have denounced low-carbohydrate diets as being dangerous to health, such as the AHA in 2001[71] and the American Kidney Fund in 2002.[72]

#### Ketogenic diet

For the epilepsy treatment, see Chemistry:Ketogenic diet.

The original ketogenic diet is a high-fat, low-carbohydrate diet developed in the 1920s and used to treat drug-resistant childhood epilepsy.[73][74] Most epilepsy specialists order these children to eat 80% of the diet from fat by weight (90% of calories), plus carbohydrate-free vitamins and minerals to prevent vitamin deficiency.[75] Although this extreme diet plan can be life-saving compared to the alternative, it is not a harmless diet.[76] Children on this diet are at risk of broken bones, stunted growth, kidney stones, high cholesterol, and micronutrient deficiency.[76][77]

The fad diet that adopted the same name is also a high-fat, low-carb diet, but with a lower fat content. A typical version of this keto diet for adults has about 50% of food by weight coming from fat (70% of calories).[78] Proponents claim that it induces weight loss. The premise of the weight-loss ketogenic diet is that if the body is deprived of glucose obtained from carbohydrate foods, it will produce energy from stored fat.[79] There are some different approaches to a keto diet, including:

* ketogenic diet (KD) – usually less than 50 grams of carbohydrates per day (assuming total intake of 2,000 calories).[80]
* very low-calorie ketogenic diet (VLCKD) – same as KD, but limits total calories to a maximum of 800 calories per day.[80]
* ketogenic low-carbohydrate high-fat diet (K-LCHF) – same as KD, with the additional restriction of 60 to 80% of calories coming from fat.[80]
* modified Atkins diet (MAD) – fewer carbohydrates than K-LCHF (less than 10 grams per day), and encourages high-fat foods without specifying a specific required amount.[80]

A very low calorie ketogenic diet that is high in fat but low in protein is an effective means for weight loss in those who are overweight or obese, yielding an average weight loss of 10 kg over four weeks, with maintenance of the weight loss for up to two years. However, concerns about serum sodium levels led researchers to propose the diet only be used in "selected" people, and under strict medical supervision.[81]

In 2021 the American Heart Association issued a scientific statement on dietary guidance to improve cardiovascular health which noted that "there is insufficient evidence to support any existing popular or fad diets such as the ketogenic diet and intermittent fasting to promote heart health".[82]

## See also

| Wikivoyage has a travel guide for Travelling on a low-carbohydrate diet.

|

* Chemistry:Atkins diet - Low-carbohydrate fad diet devised by Robert Atkins
* Food pyramid
* Biology:Gluconeogenesis
* Chemistry:KE diet - Fad diet using a feeding tube

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 "The ups and downs of low-carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes". Diabetic Medicine 36 (3): 326–334. March 2019. doi:10.1111/dme.13845. PMID 30362180. "Low‐carbohydrate diets are of interest for improving glycaemic outcomes in the management of Type 1 diabetes. There is limited evidence to support their routine use in the management of Type 1 diabetes.".
2. ↑ "Low-carbohydrate diets". American Family Physician 73 (11): 1942–1948. June 2006. PMID 16770923. http://www.aafp.org/link_out?pmid=16770923. Retrieved 23 February 2010.
3. ↑ 3.0 3.1 "Is There an Optimal Diet for Weight Management and Metabolic Health?". Gastroenterology 152 (7): 1739–1751. May 2017. doi:10.1053/j.gastro.2017.01.056. PMID 28214525. http://eprints.gla.ac.uk/137779/7/137779.pdf. Retrieved 24 October 2019.
4. ↑ 4.0 4.1 4.2 "Top 5 worst celeb diets to avoid in 2018". British Dietetic Association. 7 December 2017. https://www.bda.uk.com/resource/top-5-worst-celeb-diets-to-avoid-in-2018.html. "The British Dietetic Association (BDA) today revealed its much-anticipated annual list of celebrity diets to avoid in 2018. The line-up this year includes Raw Vegan, Alkaline, Pioppi and Ketogenic diets as well as Katie Price's Nutritional Supplements."
5. ↑ "Dietary therapies for epilepsy". Biomedical Journal 36 (1): 2–8. 2013. doi:10.4103/2319-4170.107152. PMID 23515147. http://biomedj.cgu.edu.tw/pdfs/2013/36/1/images/BiomedJ_2013_36_1_2_107152.pd.
6. ↑ "Low-carbohydrate nutrition and metabolism". The American Journal of Clinical Nutrition 86 (2): 276–284. August 2007. doi:10.1093/ajcn/86.2.276. PMID 17684196.
7. ↑ "Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base". Nutrition 31 (1): 1–13. January 2015. doi:10.1016/j.nut.2014.06.011. PMID 25287761.
8. ↑ "Dietary and nutritional approaches for prevention and management of type 2 diabetes". BMJ 361. June 2018. doi:10.1136/bmj.k2234. PMID 29898883.
9. ↑ "Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force". Journal of Clinical Lipidology 13 (5): 689–711.e1. 2019. doi:10.1016/j.jacl.2019.08.003. PMID 31611148.
10. ↑ "Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies". Obesity Reviews 17 (6): 499–509. June 2016. doi:10.1111/obr.12405. PMID 27059106.
11. ↑ 11.0 11.1 "Healthy Weight—The truth about carbs". National Health Service. 19 December 2018. https://www.nhs.uk/live-well/healthy-weight/why-we-need-to-eat-carbs/.
12. ↑ "Carbohydrate quality and human health: a series of systematic reviews and meta-analyses". Lancet 393 (10170): 434–445. February 2019. doi:10.1016/S0140-6736(18)31809-9. PMID 30638909. Bibcode: 2019Lanc..393..434R. https://discovery.dundee.ac.uk/ws/files/30375889/Final_Lancet_for_John.pdf. Retrieved 27 September 2019.
13. ↑ "More sugar? No, thank you! The elusive nature of low carbohydrate diets". Endocrine 61 (3): 383–387. September 2018. doi:10.1007/s12020-018-1580-x. PMID 29556949.
14. ↑ "Dietary Reference Intakes (DRIs)". National Academy of Medicine. http://iom.nationalacademies.org/~/media/Files/Activity Files/Nutrition/DRIs/New Material/3_RDA AI AMDR Values_Total Water and Macronutr.pdf.
15. ↑ Food and Nutrition Board (2005). "Macronutrients and Healthful Diets". Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C.: National Academy Press. p. 769. ISBN 978-0-309-08537-3. http://newton.nap.edu/books/0309085373/html/769.html.
16. ↑ Diet, Nutrition and the Prevention of Chronic Diseases. Geneva: World Health Organization. 2003. pp. 55–56. ISBN 978-92-4-120916-8. https://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf.
17. ↑ 17.0 17.1 Nutrition Concepts and Controversies (14th ed.). Brooks Cole. 2016. pp. 119, 367. ISBN 978-0-495-22011-4.
18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 "Obesity Pathogenesis: An Endocrine Society Scientific Statement". Endocrine Reviews 38 (4): 267–296. August 2017. doi:10.1210/er.2017-00111. PMID 28898979.
19. ↑ "Behavioral approaches to the treatment of obesity". Textbook of Obesity. John Wiley & Sons. 2012. p. 259. ISBN 978-0-470-65588-7. "Taken together, these findings indicate that calorie intake, not macronutrient composition, determines long-term weight loss maintenance."
20. ↑ 20.0 20.1 20.2 20.3 Dietary intervention approaches to the treatment of obesity. John Wiley & Sons. 2012. pp. 295–309. ISBN 978-0-470-65588-7.
21. ↑ 21.0 21.1 21.2 21.3 21.4 "A review of the carbohydrate-insulin model of obesity". European Journal of Clinical Nutrition 71 (3): 323–326. March 2017. doi:10.1038/ejcn.2016.260. PMID 28074888.
22. ↑ 22.0 22.1 "We've long blamed carbs for making us fat. What if that's wrong?". Vox. 20 February 2018. https://www.vox.com/2018/2/21/17036004/do-low-carb-diets-work.
23. ↑ "Billionaires Fund A 'Manhattan Project' For Nutrition And Obesity". WBUR News. 20 September 2012. https://www.wbur.org/npr/161444045/billionaires-fund-a-manhattan-project-for-nutrition-and-obesity.
24. ↑ "The Struggles of a $40 Million Nutrition Science Crusade". Wired. 8 August 2018. https://www.wired.com/story/how-a-dollar40-million-nutrition-science-crusade-fell-apart/. Retrieved 23 December 2018.
25. ↑ "Dietary fat: From foe to friend?". Science 362 (6416): 764–770. November 2018. doi:10.1126/science.aau2096. PMID 30442800. Bibcode: 2018Sci...362..764L.
26. ↑ 26.0 26.1 "Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk". The Cochrane Database of Systematic Reviews 1 (1). January 2022. doi:10.1002/14651858.CD013334.pub2. PMID 35088407.
27. ↑ 27.0 27.1 27.2 27.3 27.4 27.5 27.6 "Low-carbohydrate diets for overweight and obesity: a systematic review of the systematic reviews". Obesity Reviews 19 (12): 1700–1718. December 2018. doi:10.1111/obr.12744. PMID 30194696. http://eprints.gla.ac.uk/168899/1/168899.pdf. Retrieved 4 October 2019.
28. ↑ "The Effect of Low-Fat and Low-Carbohydrate Diets on Weight Loss and Lipid Levels: A Systematic Review and Meta-Analysis". Nutrients 12 (12). December 2020. doi:10.3390/nu12123774. PMID 33317019.
29. ↑ "The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis". PLOS ONE 15 (1). 14 January 2020. doi:10.1371/journal.pone.0225348. PMID 31935216. Bibcode: 2020PLoSO..1525348D.
30. ↑ "Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies". European Heart Journal 40 (34): 2870–2879. September 2019. doi:10.1093/eurheartj/ehz174. PMID 31004146.
31. ↑ 31.0 31.1 "Effects of Popular Diets on Anthropometric and Cardiometabolic Parameters: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials". Advances in Nutrition 11 (4): 815–833. July 2020. doi:10.1093/advances/nmaa006. PMID 32059053.
32. ↑ "Very Low Carbohydrate and Ketogenic Diets and Cardiometabolic Risk". https://www.acc.org/latest-in-cardiology/articles/2020/10/07/13/54/http://www.acc.org/latest-in-cardiology/articles/2020/10/07/13/54/very-low-carbohydrate-and-ketogenic-diets-and-cardiometabolic-risk.
33. ↑ Public Health England (2015). ﻿Carbohydrates and Health﻿ (Report). Scientific Advisory Council on Nutrition. pp. 57, 85. https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report. Retrieved 21 December 2018. "No significant association was found between total carbohydrate intake as g/day and incidence of type 2 diabetes mellitus."
34. ↑ 34.0 34.1 "Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials". Diabetes Research and Clinical Practice 131: 124–131. September 2017. doi:10.1016/j.diabres.2017.07.006. PMID 28750216.
35. ↑ "Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments". The American Journal of Clinical Nutrition 108 (2): 300–331. August 2018. doi:10.1093/ajcn/nqy096. PMID 30007275.
36. ↑ "Overweight and diabetes prevention: is a low-carbohydrate-high-fat diet recommendable?". European Journal of Nutrition 57 (4): 1301–1312. June 2018. doi:10.1007/s00394-018-1636-y. PMID 29541907.
37. ↑ "Effect of low-carbohydrate diet on markers of renal function in patients with type 2 diabetes: A meta-analysis". Diabetes/Metabolism Research and Reviews 34 (7). October 2018. doi:10.1002/dmrr.3032. PMID 29904998.
38. ↑ 38.0 38.1 "5. Lifestyle Management: Standards of Medical Care in Diabetes-2019". Diabetes Care 42 (Suppl 1): S46–S60. January 2019. doi:10.2337/dc19-S005. PMID 30559231. http://care.diabetesjournals.org/content/42/Supplement_1/S46. Retrieved 18 December 2018.
39. ↑ "Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report". Diabetes Care 42 (5): 731–754. May 2019. doi:10.2337/dci19-0014. PMID 31000505.
40. ↑ "Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission". Diabetologia 65 (1): 14–36. January 2022. doi:10.1007/s00125-021-05577-2. PMID 34796367.
41. ↑ "Crisis of confidence averted: Impairment of exercise economy and performance in elite race walkers by ketogenic low carbohydrate, high fat (LCHF) diet is reproducible". PLOS ONE 15 (6). 4 June 2020. doi:10.1371/journal.pone.0234027. PMID 32497061. Bibcode: 2020PLoSO..1534027B.
42. ↑ "Ketogenic low-CHO, high-fat diet: the future of elite endurance sport?". The Journal of Physiology 599 (3): 819–843. February 2021. doi:10.1113/JP278928. PMID 32358802.
43. ↑ "Diet composition and the performance of high-intensity exercise". Journal of Sports Sciences 15 (3): 265–275. June 1997. doi:10.1080/026404197367272. PMID 9232552.
44. ↑ "Another "D" in MUDPILES? A Review of Diet-Associated Nondiabetic Ketoacidosis". Journal of Investigative Medicine High Impact Case Reports 6. January 2018. doi:10.1177/2324709618796261. PMID 30151400.
45. ↑ "Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis". The Lancet. Public Health 3 (9): e419–e428. September 2018. doi:10.1016/S2468-2667(18)30135-X. PMID 30122560.
46. ↑ "Low-carbohydrate diet and risk of cancer incidence: The Japan Public Health Center-based prospective study". Cancer Science 113 (2): 744–755. February 2022. doi:10.1111/cas.15215. PMID 34821435.
47. ↑ "The low-carbohydrate diet and cardiovascular risk factors: evidence from epidemiologic studies". Nutrition, Metabolism, and Cardiovascular Diseases 24 (4): 337–343. April 2014. doi:10.1016/j.numecd.2013.12.008. PMID 24613757.
48. ↑ Diabetes mellitus: its history, chemistry, anatomy, pathology, physiology, and treatment. Homoeopathic Publishing Company. 1877. https://archive.org/details/diabetesmellitu00morggoog.
49. ↑ Lectures on dietetics. Saunders. 1905. https://archive.org/details/lecturesondiete00einhgoog. Retrieved 15 March 2020.
50. ↑ Renee, Lynch (2015-02-28). "A brief timeline shows how we're gluttons for diet fads" (in en-US). https://www.latimes.com/health/la-he-diet-timeline-20150228-story.html.
51. ↑ Letter On Corpulence, Addressed to the Public (4th ed.). London, England: Harrison. 1869. http://2020ok.com/books/25/letter-on-corpulence-addressed-to-the-public-19925.htm. Retrieved 2 January 2008.
52. ↑ "William Banting Father of the Low-Carbohydrate Diet". The Weston A. Price Foundation. 2002. http://www.westonaprice.org/knowyourfats/banting.html.
53. ↑ "Chapter Six. Diabetic Specialists And Their Patients In The Long Nineteenth Century: Competition For A Cure". Fatal Thirst: Diabetes in Britain Until Insulin. Leiden: Brill. 2009. pp. 125, 138–139. doi:10.1163/ej.9789004172500.i-195.11. ISBN 978-90-04-17250-0.
54. ↑ "Diabetes in Ancient Times: The Long and Winding Road to Insulin". Unveiling Diabetes: Historical Milestones in Diabetology. Frontiers in Diabetes. 29. Basel: Karger. 2020. p. 11. doi:10.1159/000506554. ISBN 978-3-318-06733-0.
55. ↑ Diabetic retinopathy: clinical evaluation and management. St. Louis: Mosby. 1981. p. 118. ISBN 978-0-8016-2948-8.
56. ↑ "Nutrition, Starvation and Diabetic Diets: A Century of Change in the United States". Proteins, Pathologies and Politics Dietary Innovation and Disease from the Nineteenth Century. London New York Oxford New Delhi Sydney: Bloomsbury Academic. 2019. p. 27. ISBN 978-1-350-05686-2.
57. ↑ 57.0 57.1 "The Starvation Treatment of Diabetes Mellitus". Proceedings of the Connecticut State Medical Society: 176–184. 1916. https://archive.org/details/starvationtreat00steigoog. Retrieved 30 October 2016. "124th Annual Convention".
58. ↑ Total dietary regulation in the treatment of diabetes. New York: The Rockefeller Institute for Medical Research. 1919. https://babel.hathitrust.org/cgi/pt?id=iau.31858034875488;view=2up;seq=8. Retrieved 31 October 2016.
59. ↑ Another publication of similar regimen was  The Starvation Treatment of Diabetes with a series of graduated diets as used at the Massachusetts General Hospital. Boston: W.M. Leonard. 1915. https://archive.org/details/starvationtreatm00hilliala.
60. ↑ Air Force Diet. Toronto, Canada: Air Force Diet Publishers. 1960.
61. ↑ Martinis & Whipped Cream. Parker Publishing. 1966.
62. ↑ The Martini Diet. Fair Winds. 2004. ISBN 978-1-61059-380-9. https://books.google.com/books?id=4Si5TDpKwtsC.
63. ↑ The Drinking Man's Diet. San Francisco: Cameron. 2004. ISBN 978-0-918684-65-3.
64. ↑ "A New Concept in the Treatment of Obesity". JAMA 186 (1): 50–60. October 1963. doi:10.1001/jama.1963.63710010013014. PMID 14046659.
65. ↑ Council on Foods and Nutrition (June 1973). "A critique of low-carbohydrate ketogenic weight reduction regimens. A review of Dr. Atkins' diet revolution". JAMA 224 (10): 1415–1419. doi:10.1001/jama.1973.03220240055018. PMID 4739993. https://jamanetwork.com/journals/jama/article-abstract/348550. Retrieved 17 June 2022.
66. ↑ "Glycemic index of foods: a physiological basis for carbohydrate exchange". The American Journal of Clinical Nutrition 34 (3): 362–366. March 1981. doi:10.1093/ajcn/34.3.362. PMID 6259925.
67. ↑ "Why the man who brought us the glycemic index wants us to go vegan". The Globe And Mail. 17 July 2018. https://www.theglobeandmail.com/life/health-and-fitness/health/the-not-so-simple-reasons-for-becoming-vegan/article23123391/.
68. ↑ "PBS News Hour: Low Carb Craze". Pbs.org. https://www.pbs.org/newshour/bb/health/jan-june04/carb_04-23.html.
69. ↑ "Americans Look for Health on the Menu: Survey finds nutrition plays increasing role in dining-out choices". http://healthlink.uhseast.com/healthyliving/nutrition/sept06americans.htm.
70. ↑ "Low-Carb Diets Trim Krispy Kreme's Profit Line". National Public Radio. 22 June 2004. https://www.npr.org/templates/story/story.php?storyId=1968804.
71. ↑ "Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association". Circulation 104 (15): 1869–1874. October 2001. doi:10.1161/hc4001.096152. PMID 11591629. "These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal sources. ... Beneficial effects on blood lipids and insulin resistance are due to the weight loss, not to the change in caloric composition. ... High-protein diets may also be associated with increased risk for coronary heart disease due to intakes of saturated fat, cholesterol, and other associated dietary factors.".
72. ↑ The American Kidney Fund: American Kidney Fund Warns About Impact of High-Protein Diets on Kidney Health: 25 April 2002
73. ↑ "The ketogenic diet: one decade later". Pediatrics 119 (3): 535–43. March 2007. doi:10.1542/peds.2006-2447. PMID 17332207.
74. ↑ "Ketogenic diets for drug-resistant epilepsy". The Cochrane Database of Systematic Reviews 2020 (6). June 2020. doi:10.1002/14651858.CD001903.pub5. PMID 32588435.
75. ↑ MD, Eric H. Kossoff; LDN, Zahava Turner, RD, CSP; MD, Mackenzie C. Cervenka; LDN, Bobbie J. Barron, RD (28 December 2020) (in en). Ketogenic Diet Therapies for Epilepsy and Other Conditions, Seventh Edition. Springer Publishing Company. p. 51. ISBN 978-0-8261-4959-6. https://books.google.com/books?id=gJAEEAAAQBAJ&dq=ketogenic+""most+children+ages+2+to+12+years+old+are+started+on+a""&pg=PA51.
76. ↑ 76.0 76.1 Jaminet, Paul; Jaminet, Shou-Ching (11 December 2012) (in en). Perfect Health Diet: Regain Health and Lose Weight by Eating the Way You Were Meant to Eat. Simon and Schuster. p. 156. ISBN 978-1-4516-9916-6. https://books.google.com/books?id=ABnIi7zVTYgC&dq="ketogenic+diet+for+epilepsy"+stunted+growth&pg=PA156.
77. ↑ Swaiman, Kenneth F.; Ashwal, Stephen; Ferriero, Donna M.; Schor, Nina F.; Finkel, Richard S.; Gropman, Andrea L.; Pearl, Phillip L.; Shevell, Michael (21 September 2017) (in en). Swaiman's Pediatric Neurology E-Book: Principles and Practice. Elsevier Health Sciences. p. 80. ISBN 978-0-323-37481-1. https://books.google.com/books?id=PJ9tDgAAQBAJ&dq="ketogenic+diet+for+epilepsy"++growth&pg=SL5-PA1467.
78. ↑ (in en) Keto Diet For Dummies. John Wiley & Sons. 23 July 2019. pp. 10–11. ISBN 978-1-119-57892-5. https://books.google.com/books?id=I_mdDwAAQBAJ&dq="on+the+standard+american+diet,+you+get+about+30+percent+of+calories+from+fat"&pg=PA11. Retrieved 8 September 2022.
79. ↑ "Diet review: Ketogenic diet for weight loss". TH Chan School of Public Health, Harvard University. 2019. https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/.
80. ↑ 80.0 80.1 80.2 80.3 "Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials". BMC Medicine 21 (1). May 2023. doi:10.1186/s12916-023-02874-y. PMID 37231411.
81. ↑ "Efficacy and safety of very low calorie ketogenic diet (VLCKD) in patients with overweight and obesity: A systematic review and meta-analysis". Reviews in Endocrine & Metabolic Disorders 21 (1): 5–16. March 2020. doi:10.1007/s11154-019-09514-y. PMID 31705259.
82. ↑ "2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association". Circulation 144 (23): e472–e487. December 2021. doi:10.1161/CIR.0000000000001031. PMID 34724806.

## Further reading

* The Ketogenic Bible: The Authoritative Guide to Ketosis (1st ed.). Victory Belt Publishing. 2017. ISBN 978-1-62860-104-6.

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