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Comparison of energy-restricted very low-carbohydrate and low-fat diets on
weight loss and body composition in overweight men and women
Nutrition & Metabolism 2004, 1:13 doi:10.1186/1743-7075-1-13.
Volek JS, Sharman MJ, Gomez AL, Judelson DA, Rubin MR, Watson G, Sokmen B, Silvestre R, French DN, Kraemer WJ.
PMID: 15533250
Introduction
Recent reports showing a greater weight loss with a free-living very low-carbohydrate
ketogenic (VLCK) than a low-fat diet after 3 and 6 months has generated
interest in mechanisms that may account for these responses. Earlier work that involved
comparison of isocaloric formula VLCK and low-fat (LF) diets, indicated that weight loss
was greater with a VLCK, suggesting a metabolic advantage (i.e., a greater weight loss with one
diet over another with different macronutrient distribution but the same energy content).
Although several studies have shown that VLCK diets result in greater reductions in body
mass, it remains unclear how these diets affect the composition of weight loss and the
distribution of fat loss. Some early reports show that VLCK diets result in preferential loss of fat
and preservation of lean body mass, suggestive of a nutrient partitioning effect. In
accordance with this notion, we recently reported that a free-living 6-week VLCK diet prescribed
to be isoenergetic resulted in significant decreases in fat mass and increases in lean body mass in
normal-weight men. [ErGs]
However, other studies have not shown a preferential loss of fat on a
VLCK diet.
DESIGN
Randomized, balanced, two diet period clinical intervention study. Subjects were prescribed two energy-restricted
(-500 kcal/day) diets: a VLCK diet with a goal to decrease carbohydrate levels below 10% of energy and induce
ketosis and a LF diet with a goal similar to national recommendations (%carbohydrate:fat:protein = ~60:25:15%).
Subjects
15 healthy, overweight/obese men (mean s.e.m.: age 33.2 2.9 y, body mass 109.1 4.6 kg, body mass index 34.1 1.1 kg/m2)
and 13 premenopausal women (age 34.0 2.4 y, body mass 76.3 3.6 kg, body mass index 29.6 1.1 kg/m2).
RESULTS
Actual nutrient intakes from food records during the VLCK (%carbohydrate:fat:protein = ~9:63:28%) and the LF
(~58:22:20%) were significantly different. Dietary energy was restricted, but was slightly higher during the VLCK
(1855 kcal/day) compared to the LF (1562 kcal/day) diet for men. Both between and within group comparisons revealed
a distinct advantage of a VLCK over a LF diet for weight loss, total fat loss, and trunk fat loss for men (despite
significantly greater energy intake).
The majority of women also responded more favorably to the VLCK diet, especially in terms of trunk fat loss. The
greater reduction in trunk fat was not merely due to the greater total fat loss, because the ratio of trunk fat/total
fat was also significantly reduced during the VLCK diet in men and women.
Absolute REE (kcal/day) was decreased with both diets as expected, but REE expressed relative to body mass (kcal/kg),
was better maintained on the VLCK diet for men only. Individual responses clearly show the majority of men and women
experience greater weight and fat loss on a VLCK than a LF diet.
This study shows a clear benefit of a VLCK over LF diet for short-term body weight and fat loss, especially in men.
A preferential loss of fat in the trunk region with a VLCK diet is novel and potentially clinically significant but
requires further validation. These data provide additional support for the concept of metabolic advantage with diets
representing extremes in macronutrient distribution.
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[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance."
(Wilmore and Costill) 
