Studies & Research

On this page, you will find studies and references that support the use of low-carbohydrate diets, intermittent fasting, and other overall healthy lifestyle interventions.  These citations have been used by Dr. Tro to help educate other doctors, scientists, and dietitians on the power of diet & lifestyle on disease and symptom management.  This resource will be updated over time to reflect the literature as it changes.



-In type 2 diabetes, an intense low carb diet reduces the need for insulin and other oral diabetic medications

Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes. Nutr Metab (Lond). 2009;6:21. Haimoto H, Sasakabe T, Wakai K, Umegaki H. Published 2009 May 6. doi:10.1186/1743-7075-6-21

-Low carb diets reliably reduce triglycerides and increase HDL versus low-fat diets

Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HC. Arch Intern Med. 2006 Feb 13;166(3):285-93. doi: 10.1001/archinte.166.3.285.

-Giving low-income patients more fruits, vegetables, whole grains in a Food Bank does not help ANY endpoint in the management of Diabetes Type 2

Comprehensive Diabetes Self-Management Support From Food Banks: A Randomized Controlled Trial.  Seligman HK, Smith M, Rosenmoss S, Marshall MB, Waxman E. Am J Public Health. 2018;108(9):1227-1234. doi:10.2105/AJPH.2018.304528

-After two years of follow up, a low carbohydrate diet worked better at reducing the need for diabetes medications, despite equal a1c and weight loss

Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Tay J; et al. Diabetes, Obesity & Metabolism. 20(4):858-871, 2018 UI: 29178536

-Meta-analysis that shows that low carb performs better than low fat by about 4lbs

Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Mansoor N; Vinknes KJ; Veierod MB; Retterstol K. British Journal of Nutrition. 115(3):466-79, 2016 UI: 26768850

*Caloric restriction is not required in Low Carb diets to improve endothelial function, measured through brachial artery flow-mediated dilation

The Effect of Low-Carbohydrate Diet on Macrovascular and Microvascular Endothelial Function is Not Affected by the Provision of Caloric Restriction in Women with Obesity: A Randomized Study. Hwang CL, Ranieri C, Szczurek MR, et al. Nutrients. 2020;12(6):1649. Published 2020 Jun 2. doi:10.3390/nu12061649

Sugar & Fructose

-Greater sugar intake in children associated with greater energy intake, greater waist circumference, greater sugar intake was associated with decrease protein and several macronutrient intake

Total Sugar Intake and Macro and Micronutrients in Children Aged 6-8 Years: The ANIVA Study. Morales-Suarez-Varela M, Peraita-Costa I, Llopis-Morales A, Picó Y, Bes-Rastrollo M, Llopis-Gonzalez A. Nutrients. 2020;12(2):349. Published 2020 Jan 29. doi:10.3390/nu12020349

*Fructose notably impacts dyslipidemia specifically apoB, triglycerides, LDL-c, but the combination in HFCS more harmful for dyslipidemia in healthy males (BMI 25, even adjusted for BMI), comparator groups included glucose alone, fructose alone and HFCS

Synergistic effects of fructose and glucose on lipoprotein risk factors for cardiovascular disease in young adults. Hieronimus B, Medici V, Bremer AA, et al.  Metabolism. 2020;154356. doi:10.1016/j.metabol.2020.154356

-Added sugar associated with increased CV mortality in a dose-dependent manner

Added sugar intake and cardiovascular diseases mortality among US adults. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. JAMA Intern Med. 2014;174(4):516-524. doi:10.1001/jamainternmed.2013.13563

-Fructose and sucrose preferentially modulate fatty liver

Fructose- and sucrose- but not glucose-sweetened beverages promote hepatic de novo lipogenesis: A randomized controlled trial. J Hepatol. 2021 Mar 6;S0168-8278(21)00161-6. doi: 10.1016/j.jhep.2021.02.027.

-Meta-analysis of fructose leading to increased LDL

Yu Hui Zhang, Tao An, Rong Cheng Zhang, Qiong Zhou, Yan Huang, Jian Zhang, Very High Fructose Intake Increases Serum LDL-Cholesterol and Total Cholesterol: A Meta-Analysis of Controlled Feeding Trials, The Journal of Nutrition, Volume 143, Issue 9, September 2013, Pages 1391–1398,

Metabolic Syndrome

*Calorie controlled hypocaloric study showing that HDL, blood pressure and triglycerides preferentially improved versus low fat

Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Volek JS, Phinney SD, Forsythe CE, et al. Lipids. 2009;44(4):297-309. doi:10.1007/s11745-008-3274-2

*Calorie-controlled study showing that triglycerides, HDL and blood pressure improve on lower carb diets versus medium and high carb diets, independent of weight loss

Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. Hyde PN; et al. Jci Insight. 4(12), 2019 UI: 31217353

*Meta-analysis shows that decreased carbohydrate, increased fat intake, and increased protein was most related to weight loss, whereas fiber was not associated with weight loss

Effects of macronutrient intake in obesity: a meta-analysis of low-carbohydrate and low-fat diets on markers of the metabolic syndrome. Willems AEM, Sura-de Jong M, van Beek AP, Nederhof E, van Dijk G. Nutr Rev. 2020;nuaa044. doi:10.1093/nutrit/nuaa044


-Evidence of increased mitochondrial respiration and uncoupling in mice that was also confirmed on human fat biopsy

Ketones Elicit Distinct Alterations in Adipose Mitochondrial Bioenergetics. Walton CM, Jacobsen SM, Dallon BW, et al. Int J Mol Sci. 2020;21(17):E6255. Published 2020 Aug 29. doi:10.3390/ijms21176255

*When weight-controlled, low carb diets increase REE versus moderate or high carb diets

Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. Ebbeling CB; et al. BMJ. 363:k4583, 2018 UI: 30429127

*Total blood energy is depleted 2 hours following a high carb versus a low carb meal

Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State, Journal of the Endocrine Society, Volume 4, Issue 7, July 2020, bvaa062, Kim J Shimy, Henry A Feldman, Gloria L Klein, Lisa Bielak, Cara B Ebbeling, David S Ludwig.

Hormones / Appetite

-Protein greatly suppresses ghrelin, somewhat by fat, much less with carbohydrate

Acyl and total ghrelin are suppressed strongly by ingested proteins, weakly by lipids, and biphasically by carbohydrates. Foster-Schubert KE, Overduin J, Prudom CE, et al. J Clin Endocrinol Metab. 2008;93(5):1971-1979. doi:10.1210/jc.2007-2289
*Ketosis suppresses ghrelin & subjective appetite, whereas refeeding habitual diet increased both in weight reduced patients

Ketosis and appetite-mediating nutrients and hormones after weight loss. Sumithran P; Prendergast LA; Delbridge E; Purcell K; Shulkes A; Kriketos A; Proietto J. European Journal of Clinical Nutrition. 67(7):759-64, 2013 UI: 23632752

-Ketosis maintains post-prandial CCK and reduces appetite

Effect of weight loss and ketosis on postprandial cholecystokinin and free fatty acid concentrations. Chearskul S; Delbridge E; Shulkes A; Proietto J; Kriketos A. American Journal of Clinical Nutrition. 87(5):1238-46, 2008 UI: 18469245

-NPYY is specifically preserved on a low carbohydrate diet versus a low fat diet

The effects of a low-carbohydrate diet on appetite: A randomized controlled trial. Hu T, Yao L, Reynolds K, et al. Nutr Metab Cardiovasc Dis. 2016;26(6):476–488. doi:10.1016/j.numecd.2015.11.011

-The lowest ad-lib intake is exhibited at under 20% calories from carbohydrate, in the setting of high protein and moderate fat

Protein leverage and energy intake. Gosby AK, Conigrave AD, Raubenheimer D, Simpson SJ. Obes Rev. 2014;15(3):183-191. doi:10.1111/obr.12131

-The hypertriglyceridemia of metabolic syndrome drives central insulin resistance leading to increased appetite

Triglycerides cross the blood-brain barrier and induce central leptin and insulin receptor resistance. Banks WA, Farr SA, Salameh TS, et al. Int J Obes (Lond). 2018;42(3):391-397. doi:10.1038/ijo.2017.231

-Food imagery and stress drives hunger, anxiety, food intake, and junk food intake, preferentially in overweight/obese versus normal-weight patients

A Laboratory-Based Study of the Priming Effects of Food Cues and Stress on Hunger and Food Intake in Individuals with Obesity. Obesity (Silver Spring). Chao AM, Fogelman N, Hart R, Grilo CM, Sinha R. 2020 Sep 11. doi: 10.1002/oby.22952. PMID: 32918391.

Food Addiction / Food Intake

-Added fat, processed carbs and sugar are associated with “food addiction”

Which foods may be addictive? The roles of processing, fat content, and glycemic load. Schulte EM; Avena NM; Gearhardt AN. PLoS ONE.  10(2):e0117959, 2015. UI: 25692302

-While carbohydrates do activate the reward/addiction centers of the brain, the combination of fats & carbs activate this the most

Supra-Additive Effects of Combining Fat and Carbohydrate on Food Reward. DiFeliceantonio AG; et al. Cell Metabolism. 28(1):33-44.e3, 2018 UI: 29909968

*When calories are controlled and macronutrients are controlled, processed food leads to increased intake

Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Hall KD; et al. Cell Metabolism. 30(1):67-77.e3, 2019 UI: 31105044

-Review of food addiction, stress, and obesity

Role of addiction and stress neurobiology on food intake and obesity. Sinha R. Biol Psychol. 2018;131:5-13. doi:10.1016/j.biopsycho.2017.05.001

-100% of late-night binge-eating is with ultra-processed food

Ultra-processed foods and binge eating: A retrospective observational study. Agnes Ayton, Ali Ibrahim, James Dugan, Eimear Galvin, Wroe Wright et al. Nutrition. 2020. 111023. ISSN 0899-9007.

-higher carb meals activate the reward areas of the brain with greater affinity

Diets Varying in Carbohydrate Content Differentially Alter Brain Activity in Homeostatic and Reward Regions in Adults, Laura M Holsen, W Scott Hoge, Belinda S Lennerz, Hilâl Cerit, Taryn Hye, Priyanka Moondra, Jill M Goldstein, Cara B Ebbeling, David S Ludwig, The Journal of Nutrition, 2021;, nxab090,

-Carbohydrate-based foods will lead to increased subsequent intake versus fat-based foods, when controlled for calories and taste

Melanson KJ, Westerterp-Plantenga MS, Saris WH, Smith FJ, Campfield LA. Blood glucose patterns and appetite in time-blinded humans: carbohydrate versus fat. Am J Physiol. 1999 Aug;277(2):R337-45. doi: 10.1152/ajpregu.1999.277.2.R337. PMID: 10444538.


*Calorie-controlled study showing decreased carbohydrates independent of weight loss and caloric intake drives every marker of glycemia and gylcemic variability

The clinical effects of a carbohydrate-reduced high-protein diet on glycaemic variability in metformin-treated patients with type 2 diabetes mellitus: A randomised controlled study. Thomsen MN, Skytte MJ, Astrup A, et al. Clin Nutr ESPEN. 2020;39:46-52. doi:10.1016/j.clnesp.2020.07.002

*Carbohydrate restriction decreases cravings and increases restraint unrelated to body weight

Changes in Food Cravings and Eating Behavior after a Dietary Carbohydrate Restriction Intervention Trial. Anguah KO, Syed-Abdul MM, Hu Q, et al. Nutrients. 2019;12(1):52. Published 2019 Dec 24. doi:10.3390/nu12010052

-Glycemia and degree of ketonemia are directly related to appetite and desire to eat
Ketonemia and Glycemia Affect Appetite Levels and Executive Functions in Overweight Females During Two Ketogenic Diets. Lodi A, Zarantonello L, Bisiacchi PS, Cenci L, Paoli A. Obesity (Silver Spring). 2020;10.1002/oby.22934. doi:10.1002/oby.22934

-Increased blood sugar associated with increased microvascular and macrovascular complications

Impact of Glucose Level on Micro- and Macrovascular Disease in the General Population: A Mendelian Randomization Study. Emanuelsson F, Marott S, Tybjærg-Hansen A, Nordestgaard BG, Benn M. Diabetes Care. 2020;43(4):894-902. doi:10.2337/dc19-1850

*mild hypoglycemia in the presence of hyperinsulinemia stimulates food reward and appetite in obese/overweight but not normal-weight patients

Circulating glucose levels modulate neural control of desire for high-calorie foods in humans. Page KA, Seo D, Belfort-DeAguiar R, et al. J Clin Invest. 2011;121(10):4161-4169. doi:10.1172/JCI57873

*Glycemic Variability leads to increased hunger and increased food intake 

Postprandial glycaemic dips predict appetite and energy intake in healthy individuals. Wyatt, P., Berry, S.E., Finlayson, G. et al. Nat Metab 3, 523–529 (2021).

Fatty Liver

*A low carb Mediterranean diet improves fatty liver over a comparable low-fat diet even controlling for weight loss

The beneficial effects of the Mediterranean diet over a low-fat diet may be mediated by decreasing hepatic fat content. Gepner Y, Shelef I, Komy O, et al. J Hepatol. 2019;71(2):379-388. doi:10.1016/j.jhep.2019.04.013

*Weight-controlled, calorie-controlled diet, low carb improves liver fat over low carb

Effects of a carbohydrate-restricted diet on hepatic lipid content in adolescents with non-alcoholic fatty liver disease: A pilot, randomized trial. Goss AM, Dowla S, Pendergrass M, et al. Pediatr Obes. 2020;15(7):e12630. doi:10.1111/ijpo.12630

*Iso-caloric substitution of starch for fructose results in decreased liver fat INDEPENDENT of calories and weight loss

Effects of Dietary Fructose Restriction on Liver Fat, De Novo Lipogenesis, and Insulin Kinetics in Children With Obesity. Schwarz JM; et al. Gastroenterology. 153(3):743-752, 2017 UI: 28579536

-A ketogenic diet reduces hepatic steatosis in 6 days, before clinically significant weight loss

Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease. Luukkonen PK, Dufour S, Lyu K, et al. Proc Natl Acad Sci U S A. 2020;117(13):7347-7354. doi:10.1073/pnas.1922344117

-A carbohydrate-restricted diet lowers liver fat

An Integrated Understanding of the Rapid Metabolic Benefits of a Carbohydrate-Restricted Diet on Hepatic Steatosis in Humans. Mardinoglu A, Wu H, Bjornson E, et al. Cell Metab. 2018;27(3):559-571.e5. doi:10.1016/j.cmet.2018.01.005

*In patients with insulin resistance, low carb diets preferentially decrease viseral fat and skeletal intramuscluar fat compared to a low fat diet

Goss, A.M., Gower, B., Soleymani, T. et al. Effects of weight loss during a very low carbohydrate diet on specific adipose tissue depots and insulin sensitivity in older adults with obesity: a randomized clinical trial. Nutr Metab (Lond) 17, 64 (2020).

Eating Disorders

-While dieting, in general, is associated with disordered eating, other psychosocial factors like thin idealization and body image seem to be more strongly associated

Risk factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females. Stice E, Gau JM, Rohde P, Shaw H. J Abnorm Psychol. 2017;126(1):38-51. doi:10.1037/abn0000219

-Severe dietary restriction does not induce acutely induce binge eating

Does severe dietary energy restriction increase binge-eating in overweight or obese individuals? A systematic review. da Luz FQ, Hay P, Gibson AA, et al. Obes Rev. 2015;16(8):652-665. doi:10.1111/obr.12295

-The only eating disorder prevention programs demonstrating efficacy in high-risk patients employ “healthy diet” concepts which encourage eating “whole, real foods” and snacks

Preventing eating disorder pathology: common and unique features of successful eating disorders prevention programs. Ciao AC, Loth K, Neumark-Sztainer D. Curr Psychiatry Rep. 2014;16(7):453. doi:10.1007/s11920-014-0453-0

-Healthy Weight program reduces weight gain and eating disorders through sensible dieting, reducing the thin-idealization, improving self-confidence and body image

Efficacy trial of a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students. Stice E, Rohde P, Shaw H, Marti CN. J Consult Clin Psychol. 2012;80(1):164-170. doi:10.1037/a0026484

-Case-series that demonstrates ketogenic diet can decrease binge-eating symptoms

Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series. J Eat Disord. 2020;8:2. Carmen M, Safer DL, Saslow LR, et al. Published 2020 Jan 29. doi:10.1186/s40337-020-0278-7

-Describes the relationship of modern hyper-palatable, ultra-processed food, and eating disorders

The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research. Ayton A, Ibrahim A. TNutr Rev. 2020;78(7):579-596. doi:10.1093/nutrit/nuz089


-An intensive dietary regimen of a ketogenic diet improves symptoms of autism versus controls

Ketogenic diet versus gluten-free casein-free diet in autistic children: a case-control study. El-Rashidy O, El-Baz F, El-Gendy Y, Khalaf R, Reda D, Saad K. Metab Brain Dis. 2017;32(6):1935-1941. doi:10.1007/s11011-017-0088-z

-A ketogenic diet improves behavior scores in autism

A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder. Lee RWY, Corley MJ, Pang A, et al. Physiol Behav. 2018;188:205-211. doi:10.1016/j.physbeh.2018.02.006

Depression / Mental Health

-a dietary intervention improves depression symptoms

A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. PLoS One. 2019;14(10):e0222768. Published 2019 Oct 9. doi:10.1371/journal.pone.0222768

-a dietary intervention improves depression symptoms

A randomized controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial) Jacka FN, O’Neil A, Opie R, et al. BMC Med. 2017;15(1):23. Published 2017 Jan 30. doi:10.1186/s12916-017-0791-y

-Exercise improves depression symptoms

Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Morres ID, Hatzigeorgiadis A, Stathi A, et al. Depress Anxiety. 2019;36(1):39-53. doi:10.1002/da.22842

-Low Carb Diet improves depression symptoms

Ren M, Zhang H, Qi J, et al. An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial. Nutrients. 2020;12(10):E3036. Published 2020 Oct 3. doi:10.3390/nu12103036

-Ketogenic Diet reduces alcohol cravings and need for withdrawal medications

Wiers CE, Vendruscolo LF, van der Veen JW, Manza P, Shokri-Kojori E, Kroll DS, Feldman DE, McPherson KL, Biesecker CL, Zhang R, Herman K, Elvig SK, Vendruscolo JCM, Turner SA, Yang S, Schwandt M, Tomasi D, Cervenka MC, Fink-Jensen A, Benveniste H, Diazgranados N, Wang GJ, Koob GF, Volkow ND. Ketogenic diet reduces alcohol withdrawal symptoms in humans and alcohol intake in rodents. Sci Adv. 2021 Apr 9;7(15):eabf6780. doi: 10.1126/sciadv.abf6780. PMID: 33837086; PMCID: PMC8034849.


-A ketogenic diet improves treatment-resistant headaches

Efficacy of Modified Atkins Ketogenic Diet in Chronic Cluster Headache: An Open-Label, Single-Arm, Clinical Trial. Di Lorenzo C, Coppola G, Di Lenola D, et al. Front Neurol. 2018;9:64. Published 2018 Feb 12. doi:10.3389/fneur.2018.00064

-A ketogenic diet improves the treatment of migraine headaches

A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones?.  Di Lorenzo C, Pinto A, Ienca R, et al. Nutrients. 2019;11(8):1742. Published 2019 Jul 28. doi:10.3390/nu11081742

-A ketogenic diet improves treatment-resistant migraine headaches

Migraine improvement during short-lasting ketogenesis: a proof-of-concept study. Di Lorenzo C, Coppola G, Sirianni G, et al. Eur J Neurol. 2015;22(1):170-177. doi:10.1111/ene.12550


-A ketogenic diet improves seizures

Ketogenic Diet and Epilepsy: What We Know So Far. D’Andrea Meira I, Romão TT, Pires do Prado HJ, Krüger LT, Pires MEP, da Conceição PO. Front Neurosci. 2019;13:5. Published 2019 Jan 29. doi:10.3389/fnins.2019.00005

-A ketogenic diet improves seizures

Efficacy of Ketogenic Diet, Modified Atkins Diet, and Low Glycemic Index Therapy Diet Among Children With Drug-Resistant Epilepsy: A Randomized Clinical Trial. Sondhi V, Agarwala A, Pandey RM, et al. JAMA Pediatr. 2020;e202282. doi:10.1001/jamapediatrics.2020.2282

Athletes / Exercise

-A ketogenic diet does not decrease performance in gymnasts

The ketogenic diet does not affect strength performance in elite artistic gymnasts. Paoli, A., Grimaldi, K., D’Agostino, D. et al. J Int Soc Sports Nutr 9, 34 (2012)

-A Ketogenic diet does not compromise the performance of Olympic weight lifters

A Low-Carbohydrate Ketogenic Diet Reduces Body Mass Without Compromising Performance in Powerlifting and Olympic Weightlifting Athletes. Greene DA, Varley BJ, Hartwig TB, Chapman P, Rigney M. J Strength Cond Res. 2018;32(12):3373-3382. doi:10.1519/JSC.0000000000002904

-A self-selected, ketogenic diet improves endurance performance

Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. McSwiney FT, Wardrop B, Hyde PN, Lafountain RA, Volek JS, Doyle L. Metabolism. 2018;81:25-34. doi:10.1016/j.metabol.2017.10.010

– A Ketogenic diet does not decrease performance in CrossFit athletes while improving body composition

Three-Month Effects of a Ketogenic Diet on Body Composition, Blood Parameters, and Performance Metrics in CrossFit Trainees: A Pilot Study. Sports (Basel). 2018;6(1):1. Published 2018 Jan 9. doi:10.3390/sports6010001

-HIIT performance does not decrease on a ketogenic diet

Effects of a 4-Week Very Low-Carbohydrate Diet on High-Intensity Interval Training Responses. Cipryan L, Plews DJ, Ferretti A, Maffetone PB, Laursen PB. J Sports Sci Med. 2018;17(2):259-268. Published 2018 May 14.

-HIIT performance does not decrease on a ketogenic diet

The Effects Of A Six-week Ketogenic Diet On The Performance Of Short-duration, High-intensity Exercise, Medicine & Science in Sports & Exercise: Miele, Emily M.1; Vitti, Steven1; Christoph, Laura2; O’Neill, Elizabeth C.1; Matthews, Tracey D.1; Wood, Richard J. May 2018 – Volume 50 – Issue 5S – p 792 doi: 10.1249/01.mss.0000538607.63990.a9

-Athletes consuming a standard diet often experience pre-diabetic level of glycemia

Blood Glucose Levels of Subelite Athletes During 6 Days of Free Living. Thomas F, Pretty CG, Desaive T, Chase JG. J Diabetes Sci Technol. 2016;10(6):1335-1343. Published 2016 Nov 1. doi:10.1177/1932296816648344

-Power output is improved in endurance cyclists on a ketogenic diet

Effects of a low-carbohydrate diet on body composition and performance in road cycling: a randomized, controlled trial. Sitko S, Cirer-Sastre R, Corbi F, López Laval I. Nutr Hosp. 2020;10.20960/nh.03103. doi:10.20960/nh.03103


-A low carbohydrate diet improves GERD

A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Austin GL, Thiny MT, Westman EC, Yancy WS Jr, Shaheen NJ. Dig Dis Sci. 2006;51(8):1307-1312. doi:10.1007/s10620-005-9027-7

-Carb intake is associated with increased GERD

Dietary carbohydrate intake, insulin resistance, and gastro-oesophageal reflux disease: a pilot study in European- and African-American obese women. Pointer SD, Rickstrew J, Slaughter JC, Vaezi MF, Silver HJ. Aliment Pharmacol Ther. 2016;44(9):976-988. doi:10.1111/apt.13784

-Dietary sugar promotes Barrets, GERD, and reflux disease

Dietary sugar and Barrett’s esophagus. Riegler M, Kristo I, Asari R, Rieder E, Schoppmann SF.  Eur Surg. 2017;49(6):279-281. doi:10.1007/s10353-017-0494-9


-Low fat, low-calorie diets decrease gallbladder motility and increase gallstones

Gallbladder motility and gallstone formation in obese patients following very low-calorie diets. Use it (fat) to lose it (well). Festi, D., Colecchia, A., Orsini, M. et al. Int J Obes 22, 592–600 (1998)

-Diets high in fat prevent gallbladder stone formation

Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Stokes CS, Gluud LL, Casper M, Lammert F. Clin Gastroenterol Hepatol. 2014;12(7):1090-e61. doi:10.1016/j.cgh.2013.11.031

-Low fat, low-calorie meals favor gallbladder stasis and thus gallstone formation

Gallbladder kinetics in obese patients. Effect of a regular meal and low-calorie meal. Marzio L, Capone F, Neri M, Mezzetti A, De Angelis C, Cuccurullo F. Dig Dis Sci. 1988;33(1):4-9. doi:10.1007/BF01536623

-Dietary carbohydrates and GI are associated with increase gallstone disease in men

Dietary carbohydrates and glycaemic load and the incidence of symptomatic gallstone disease in men. Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Gut. 2005;54(6):823-828. doi:10.1136/gut.2003.031435


-In UKPDS, insulin and insulin-secreting medications are associated with hypoglycemia and weight gain

The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48(5):643–648. DOI:10.1046/j.1365-2125.1999.00092.x

-In ADOPT, insulin and insulin-secreting medications are associated with hypoglycemia and weight gain

A Diabetes Outcome Progression Trial (ADOPT). Diabetes Care Oct 2002, 25 (10) 1737-1743. DOI: 10.2337/diacare.25.10.1737

-In ACCORD, insulin and insulin-secreting medications are associated with hypoglycemia and weight gain

Determinants of Weight Gain in the Action to Control Cardiovascular Risk in Diabetes Trial. Diabetes Care Aug 2013, 36 (8) 2162-2168; DOI: 10.2337/dc12-1391

Hyperlipidemia & Hypertriglyceridemia

-Hyperlipidemia in fasting

Radhakishun N, Blokhuis C, van Vliet M, et al. Intermittent fasting during Ramadan causes a transient increase in total, LDL, and HDL cholesterols and hs-CRP in ethnic obese adolescents. Eur J Pediatr. 2014;173(8):1103-1106. doi:10.1007/s00431-014-2276-8

-Hyperlipidemia in anorexia

Rigaud D, Tallonneau I, Vergès B. Hypercholesterolaemia in anorexia nervosa: frequency and changes during refeeding. Diabetes Metab. 2009;35(1):57-63. doi:10.1016/j.diabet.2008.08.004

-CETP modulates hyperlipidemia in anorexia

Ohwada R, Hotta M, Oikawa S, Takano K. Etiology of hypercholesterolemia in patients with anorexia nervosa. Int J Eat Disord. 2006;39(7):598-601. doi:10.1002/eat.20298

-Meta-analysis of hyperlipidemia of starvation and anorexia, describing several possible mechanisms

Hussain AA, Hübel C, Hindborg M, et al. Increased lipid and lipoprotein concentrations in anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord. 2019;52(6):611-629. doi:10.1002/eat.23051

-Massive triglyceride drop with low carb diet and intermittent fasting

Das S, McCreary J, Shamim S, Kalayjian T. Reversal of severe hypertriglyceridemia with intermittent fasting and a very low-carbohydrate ketogenic diet: a case series. Curr Opin Endocrinol Diabetes Obes. 2020;27(5):308-311. doi:10.1097/MED.0000000000000566

Chronic Pain & Osteoarthritis

-Low Carb Diets improve pain from knee osteoarthritis versus low-fat diets

Strath LJ, Jones CD, Philip George A, Lukens SL, Morrison SA, Soleymani T, Locher JL, Gower BA, Sorge RE. The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis. Pain Med. 2020 Jan 1;21(1):150-160. doi: 10.1093/pm/pnz022

-Low Carb Diets improve chronic pain versus a low-fat diet 

Field R, Pourkazemi F, Rooney K. Effects of a low-carbohydrate ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain: A pilot randomised clinical trial. Pain Med. 2021 Sep 17:pnab278. doi: 10.1093/pm/pnab278.