Dietary Choices and the Control of Obesity
Roy J. Shephard in Obesity: A Kinesiologist’s Perspective, 2018
Another form of low-carbohydrate diet that became very popular during the first decade of the twenty-first century was the Atkins diet. The main feature of this commercially backed regimen was an extremely low intake of carbohydrates (20 g/day, increasing gradually to 50 g/day), with corresponding increases in the intake of fat and protein to produce satiety. Since adherents relied mainly on eating slowly digested fat, the onset of hunger following a meal occurred much later with the Atkins diet than with an equal energy intake in the form of carbohydrate, and the greater satiety achieved with the Atkins diet was claimed to address the main reason for poor adherence to carbohydrate-based diets [5]. However, some of the claims of the Atkins regimen are now discredited. Supposed advantages such as the greater energy cost of metabolizing fat rather than carbohydrate have proven incorrect (see the comments below on the thermogenic effect of foods). Moreover, although a rapid initial weight loss is usual among those following the Atkins diet, much of the initial decrease in body mass is due to water loss (including glycogen-bound water) rather than the metabolism of fat [46].
The Atkins Diet
Caroline Apovian, Elizabeth Brouillard, Lorraine Young in Clinical Guide to Popular Diets, 2018
Despite the fact that there are well over 1000 published weight-loss diets in the lay literature, few have attracted as much attention as the Atkins Diet. The late Dr. Robert C. Atkins developed this low-carbohydrate, high-protein weight-loss plan which was publicized in his best-selling book, The Atkins Diet Revolution.1 Dr. Atkins promoted the plan as not only a quick weight-loss diet but as a change in eating for a lifetime. The diet was extremely popular allowing individuals to consume large quantities of meat and high-fat foods without considering caloric restrictions. Critics referred to the diet as a high-protein, high-fat, low-carbohydrate ketogenic diet which could be potentially harmful. Early claims on both sides were often fueled by perception and personal biases without scientific evidence. Eventually, the emergence of numerous clinical trials appeared in the scientific literature demonstrating the efficacy and safety of the Atkins Diet.
Medical Nutrition Therapy for Patients with Type-2 Diabetes
Jeffrey I. Mechanick, Elise M. Brett in Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
The majority of persons who start the Atkins Diet lose a significant amount of weight in the first few weeks primarily due to fluid loss and secondarily due to calorie restriction, since carbohydrates account for the bulk of calories in a normal diet. However, this effect is short-lived, as evidenced by a study comparing the Atkins Diet with a conventional diet over a year [110]. In this study of 63 obese, nondiabetic subjects, there was a 7% loss of body weight by 3–6 months in the low-carbohydrate, high-protein, high-fat (treatment) group, compared with 3% in the conventional diet group—but only 4% loss of body weight by 1 year in the treatment group compared with 3% in the conventional diet group [110]. There was a greater decrease in triglycerides and increase in HDL cholesterol in the Atkins group at 3 months, which was sustained at 1 year [114]. There were no differences in LDL-c at 6 or 12 months [114]. Both groups showed evidence of sustained improvement in insulin sensitivity [114]. Urinary ketones were increased with the Atkins Diet through 3 months, but showed no subsequent significant difference compared with the conventional diet group [114]. In a similar study of 132 persons comparing low-fat and low-carbohydrate diets, of which 39% of participants had T2DM, there was a greater fall in fasting glucose in those randomized to the low-carbohydrate diet. [121]. Since many patients were lost to follow-up in these studies, compromising “intention-to-treat” analyses, the subtle benefits gleaned from the data, particularly early benefits, are weakly substantiated [122].
A reappraisal of atypical absence seizures in children and adults: therapeutic implications
Published in Expert Opinion on Pharmacotherapy, 2019
Francesco Brigo, Pasquale Striano, Vicenzo Belcastro
GLUT-1 deficiency syndrome (GLUT-1 DS) is a genetic glucose metabolism dysfunction caused by an abnormality in cerebral glucose transportation. The classic phenotype of GLUT-1 DS, first described by De Vivo in 1991, includes an infantile epileptic encephalopathy with developmental delay, cognitive decline, movement disorder, and acquired microcephaly [17]. Atypical absences have been reported as a feature of GLUT-1 DS [18,19] and in particular, this disorder has been claimed as the main cause of early-onset absence seizure (EOAS). Seizures in GLUT-1 DS typically begin before age 6 months. However, mutations in SLC2A1 are usually not found in patients with EOAS [20], if strict electroclinical criteria are applied [4]. Ketogenic diet is also highly effective in controlling epilepsy and improving gait disturbance and is generally quite well tolerated, but patients on ketogenic diet must avoid valproic acid (VPA) because of the increased risk for Reye-like illness [21]. The modified Atkins diet is also effective for GLT-1 DS and is increasingly used instead of other types of ketogenic diet [22].
Severe anion gap metabolic acidosis associated with initiation of a very low-carbohydrate diet
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Sijan Basnet, Niranjan Tachamo, Salik Nazir, Rashmi Dhital, Asad Jehangir, Anthony Donato
Different low carbohydrate diets such as Atkins Diet, the South Beach Diet, and the Zone Diet have been tried effectively for weight loss [3]. The carbohydrate content in these diets is less than 200 grams per day. In very low carbohydrate diet, carbohydrates are greatly reduced to ≤ 20–50 grams per day with an increase in dietary fats and proteins. These diets are believed to promote weight loss through various mechanisms. High-fat content promotes early satiety [1]. Limitation of choices with low carbohydrate diet decreases appetite [4]. Low carbohydrate diet increases glucagon levels and decreases insulin levels which, in turn, activates phosphoenolpyruvate carboxykinase, fructose 1,6-biphosphatase, and glucose 6-phosphatase that favor gluconeogenesis and inhibits pyruvate kinase, 6-phosphofructo-1-kinase, and glucokinase that slow down the glycolytic pathway [5]. This maintains a steady glucose supply to tissues with an obligatory glucose requirement such as red blood cells and brain [1,3]. There is increased protein turnover to provide amino acids as substrates for glucose production. This requires increased energy expenditure contributing to weight loss [3].
Trial watch: dietary interventions for cancer therapy
Published in OncoImmunology, 2019
Sarah Lévesque, Jonathan G. Pol, Gladys Ferrere, Lorenzo Galluzzi, Laurence Zitvogel, Guido Kroemer
Very few trials testing the ability of nutritional interventions to boost the efficacy of cancer therapy have been reported in the peer-reviewed literature so far. A series of anecdotal cases of self-imposed starvation during chemotherapy suggested an improvement of subjective well-being suggestive of a reduction of side-effects.73 In the same line, fasting for 48 h prior and 24 h after platinum-based chemotherapy proved its safety and feasibility in patients treated for diverse cancer types.74 A Phase I trial confirmed that STS for 60 h (from 36 h prior to chemotherapy to 24 h post-chemotherapy) improves quality of life and fatigue in patients with gynecological cancer.75 In breast cancer patients treated with neoadjuvant multimodal chemotherapy,76 a 48-h starvation period (from 24 h before to 24 h after chemotherapy) reduced hematological toxicity and accelerated recovery from DNA damage in circulating leukocytes.77 Women with ovarian and endometrial cancer following a ketogenic diet for 12 weeks reported higher physical and energy status compared to the control group, highlighting the feasibility of this regimen.78 A special ketogenic diet, the so-called ‘modified Atkins diet’, reportedly reduces the progression of some advanced cancer patients, especially individuals experience robust weight reduction.79 Similarly, a ketogenic regimen has been reported to induce objective responses in 6 out of 7 patients with recurrent glioblastoma that simultaneously were treated with the antiangiogenic drug bevacizumab.80–82 This effect appeared particularly strong in patients with stable ketosis.80
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