Timeline of changes in appetite during weight loss with a ketogenic diet

Abstract

BACKGROUND/OBJECTIVE: Diet-induced weight loss (WL) leads to increased hunger and reduced fullness feelings, increased ghrelin and reduced satiety peptides concentration (glucagon-like peptide-1 (GLP-1), cholecystokinin (CCK) and peptide YY (PYY)). Ketogenic diets seem to minimise or supress some of these responses. The aim of this study was to determine the timeline over which changes in appetite occur during progressive WL with a ketogenic very-low-energy diet (VLED). SUBJECTS/METHODS: Thirty-one sedentary adults (18 men), with obesity (body mass index: 37 ± 4.5 kg m − 2 ) underwent 8 weeks (wks) of a VLED followed by 4 wks of weight maintenance. Body weight and composition, subjective feelings of appetite and appetite-related hormones (insulin, active ghrelin (AG), active GLP-1, total PYY and CCK) were measured in fasting and postprandially, at baseline, on day 3 of the diet, 5 and 10% WL, and at wks 9 and 13. Data are shown as mean ± s.d. RESULTS: A significant increase in fasting hunger was observed by day 3 (2 ± 1% WL), (P o 0.01), 5% WL (12 ± 8 days) (P o0.05) and wk 13 (17 ± 2% WL) (P o 0.05). Increased desire to eat was observed by day 3 (P o 0.01) and 5% WL (P o 0.05). Postprandial prospective food consumption was significantly reduced at wk 9 (16 ± 2% WL) (P o 0.01). Basal total PYY was significantly reduced at 10% WL (32 ± 8 days) (P o 0.05). Postprandial active GLP-1 was increased at 5% WL (P o 0.01) and CCK reduced at 5 and 10% WL (P o0.01, for both) and wk 9 (P o 0.001). Basal and postprandial AG were significantly increased at wk 13 (Po 0.001, both). CONCLUSIONS: WL with a ketogenic VLED transiently increases the drive to eat up to 3 weeks (5% WL). After that, and while participants are ketotic, a 10-17% WL is not associated with increased appetite. However, hunger feelings and AG concentrations increase significantly from baseline, once refeeding occurs. INTRODUCTIONObesity has reached epidemic proportions worldwide and is associated with negative public health consequences and large socioeconomic costs. 1 A weight loss (WL) between 5 and 10% of baseline weight, if sustained, can have large health benefits by preventing or improving several obesity-related risk factors and comorbidities. 2 Even though this can be achieved in the shortterm with lifestyle interventions, 3 most adults will experience weight regain in the long term. [3][4][5] Maintaining lost weight is physiologically challenging, as dietinduced WL is associated with compensatory responses on both sides of the energy balance equation. 6 These responses are driven by a cross talk between the gut and the brain, leading to an increase in appetite and reduction in satiety, 7-9 concomitant with an overall reduction in energy expenditure. [10][11][12] These mechanisms can reduce WL rate and increases the risk of relapse. 9 An increase in ghrelin plasma concentration [13][14][15] and a reduction in the concentration of several satiety hormones, such as peptide YY (PYY), glucagon-like peptide-1 (GLP-1) 13,[16][17][18] and cholecystokinin (...

Comparison of surgical versus diet‐induced weight loss on appetite regulation and metabolic health outcomes

“…We also did not measure ketone body production, which could have occurred in participants and played a role in the alterations seen in appetite indices (Nymo et al. ). However, the diets provided do not meet standard ketogenic diet guidelines (Freeman et al.…”

Physiological Predictors of Weight Regain at 1‐Year Follow‐Up in Weight‐Reduced Adults with Obesity

“…Participants underwent an 8‐week supervised very‐low‐energy diet (VLED), followed by a 4‐week refeeding phase and a 1‐year weight‐maintenance program. This analysis represents a secondary analysis of the main study .…”

“…For 8 weeks, participants followed a VLED (Allévo, Karo Pharma AS, Stockholm, Sweden) with 550 and 660 kcal/d for females and males, respectively (carbohydrates 42%, protein 36%, fat 18%, and fiber 4%), plus no‐energy fluids and low‐starch vegetables (maximum 100 g/d). For more information regarding this phase, please see Nymo et al .…”

The Effect of Periodic Ketogenic Diet on Newly Diagnosed Overweight or Obese Patients with Type 2 Diabetes

“…Ketogenic diet because of its low carbohydrate content, to simulate the body state of hunger, the formation of hunger ketosis, change into the body's energy supply mode is given priority to with ketone bodies replace is given priority to with glucose, in the form of energy supply mode, the energy supply modes of promoting fat catabolism reduced fat synthesis, increased energy consumption increased sugar dysplasia, that does not dissolve in water turn triglycerides in water soluble ketone body (acetoacetate, betahydroxybutyric acid soluble in water, acetone insoluble in water), so can the excretion of urine ketone body ruled out further in vitro [17] take energy at the same time. In addition, the increase of ketone body in the body can suppress appetite [18] , so the principle of reducing fat in ketogenic diet is cut in multiple ways [19] . This also explains why the ketogenic diet, although consuming foods with a high percentage of fat, can reduce lipid metabolic indicators such as triglycerides, total cholesterol and low-density lipoprotein.…”