Nutrition science has confirmed that the quality of dietary macronutrients fats, carbohydrates, and proteins significantly impacts biomarkers and hard endpoints for coronary heart disease CHD. These data have led to evidence-based recommendations to restrict dietary saturated fats SFAs, refined carbohydrate CHO foods, and protein from animal sources, and to replace these with unsaturated fats, unprocessed CHO in the form of whole grains, fruits and vegetables, and proteins from plant sources. These diets restrict CHO intake to varying degrees, liberalize fat intake, and side-step many of the dietary recommendations above. However, recent reviews and summaries of randomized controlled trials RCTs and cohort data with long-term follow-up, including by the National Lipid Association, 3 provide important perspective. This review will help you understand and recognize VLCDs, determine whether they are truly ketogenic, and identify potential risks or benefits for individual patients. Severe dietary CHO-restriction induces marked and rapid effects on intermediary metabolism. Glycogen stores become rapidly depleted, insulin levels fall, and free fatty acids FFAs are mobilized from peripheral fat stores. A wide range of CHO-restricted diets exists Table 1. However, VLCDs that are too high in protein cannot be ketogenic, as several amino acids are glucogenic and suppress ketogenesis. Individuals on VLCDs who report eating large quantities of beef, pork, chicken, fish, eggs, and dairy products are unlikely achieving ketosis. Individuals usually report high intakes of butter, cheese, coconut oil, beef and pork which are high in SFAs, olive, canola, or avocado oils high in mono- and poly-unsaturated fats, and whole eggs high in cholesterol.
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