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I am so pleased to introduce Dr. William Lagakos who has accepted my request to write an article for my blog! He is an expert in obesity, inflammation, and insulin resistance. In this post, Bill will present the findings from three recent controlled trials focused on the effects of low-carbohydrate vs low-calorie diets on appetite and weight loss. Bill runs his own blog and has authored his best-selling book, The poor, misunderstood calorie, which is one of the best resources on human energy metabolism. As most of you who follow the ketogenic diet know, "calorie is not a calorie" but calories are not insignificant: caloric intake definitely plays a role in weight loss.

The regulation of appetite is a complicated thing, with many players and many, MANY moving parts. One of these parts is diet composition. That is, ‘what’ you eat impacts ‘how much food’ or ‘how many calories’ for which you’re hungry. One theory is that carbohydrates are a major driver; as restricting them is very effective at reducing appetite in obese populations.

Exhibit A In 2008, Westman and colleagues compared two diets of vastly different macronutrient compositions in a population of obese type 2 diabetic patients (Westman et al., 2008). Participants assigned to the first diet were instructed to limit their carbohydrate intake to fewer than 20 grams per day, but they could eat as much of whatever else they wanted (a ketogenic diet). Those assigned to the second diet were instructed to actively restrict food and fat intake by 500 kilocalories (calorie restricted diet, “CR”). Prior to starting the study, calorie intake for participants in both groups was ~2128 kilocalories per day. After 24 weeks, calorie intake by those assigned to the ketogenic diet spontaneously declined by almost 600, or 30%. Calorie intake in the CR group declined by almost 800, ~40%, via monitoring, calorie counting, and actively restricting intake. Interestingly, despite undergoing a greater reduction in food intake, the CR group lost significantly less weight than the ketogenic group (24 vs. 15 pounds, or 10 vs. 7% of starting body weight). This may have been due to the ability of carbohydrate restriction to preserve energy expenditure to a greater degree than fat restriction, as demonstrated by Ebbeling and colleagues (Ebbeling et al., 2012). Thus, reducing carbohydrate intake spontaneously decreased appetite and this was accompanied by accelerated weight loss. Furthermore, 3 of the 29 participants (10%) in the CR group were able to reduce or eliminate their diabetic medications whereas 8 out of 21 ketogenic (38%) dieters were able to do so.

Exhibit B In 2010, Yancy and colleagues did a variation on this by comparing a ketogenic diet to a calorie restricted, low fat diet supplemented with the weight loss drug Orlistat (Yancy et al., 2010). Orlistat works by inhibiting fat absorption, leading to steatorrhea (fatty diarrhea) if dietary fat isn’t adequately restricted. After 48 weeks, dieters in both groups reduced calorie intake by approximately 30%. In this study, reducing dietary carbohydrates led to a spontaneous reduction in intake that matched what the participants were able to achieve by actively ‘counting calories’ and restricting food and fat intake. And interestingly, yet again, the ketogenic dieters lost slightly more weight (25 vs. 21 pounds). The #1 Keto Diet App Free Download 1,500+ delicious keto recipes Trialed & tested for best results Optimized for nutrition Never feel hungry Planner & tracker Track all macros including net carbs Scan products Create your own meals Advanced tracking Track ketones, blood glucose & lipids Stay hydrated with water tracking Track your mood & energy levels Macro calculator Calculate your ideal fat, protein & carb intake Set any goal: weight loss, maintenance or weight gain Your macros update based on your progress Progress Monitor your macros, water intake, mood & energy Body weight, body fat and body measurements Ketones, blood glucose & lipids Evidence-based content Expert articles to help you make informed choices Guides & free diet plans New daily content And so much more...! Complete Keto Diet guide Integrated shopping basket Restaurants & guide to eating out Free Download App Store Google Play App Store Also available on Google Play Google Play Also available on App Store Furthermore, Orlistat reduces fat absorption, so, similar to the Westman study (above), the energy deficit may have been greater in the low fat diet group, yet still, weight loss was greater in the ketogenic diet group (speculatively, due to the impact of carbohydrate restriction on energy expenditure mentioned above). Lastly, the need for antidiabetic medications decreased for 81% of the ketogenic dieters and 68% of the Orlistat + low fat diet group.

Exhibit C In 2014, Saslow and colleagues compared a ‘moderate carbohydrate, calorie restricted (MCCR)’ to a ketogenic diet in diabetic patients for 3 months and showed similar results (Saslow et al., 2014). Those assigned to the ketogenic diet spontaneously reduced intake by ~700 kilocalories per day whereas those actively restricting fat and food intake achieved a slightly greater reduction, 800. However, similar to the findings of Westman (Exhibit A) and Yancy (Exhibit B), ketogenic dieters lost significantly more weight (12 vs. 6 pounds). And similar to Westman’s findings, significantly more of the ketogenic dieters reduced or eliminated their anti-diabetic medications: Follow us 134.8k

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Bill Lagakos, Ph.D. Nutritional sciences researcher, consultant and blogger Hi, I’m Bill. I have a Ph.D. in Nutritional Biochemistry and Physiology from Rutgers University where my dissertation focused on fatty acid-binding proteins and energy metabolism. I studied inflammation and diabetes at UCSD. And most recently, I studied circadian biology at the Mayo Clinic. I have a broad range of knowledge about health, wellness, sickness, and disease... and I’m learning more every day! More posts by Bill Lagakos, Ph.D. Bill Lagakos, Ph.D. Expert Article This article was written by Bill Lagakos, Ph.D. who is a qualified expert. At KetoDiet we work with a team of health professionals to ensure accurate and up-to-date information. You can find out more on the About us page. Evidence Based Evidence-Based articles are based on medical research, and scientific evidence. Our expert authors focus on hard evidence alone and include relevant research references from trusted sources to support their articles. We always aim to deliver relevant, trustworthy and up-to-date information based on trusted evidence and proven research.