The Very Low Calorie Ketogenic Diet (VLCKD)

Calories & Kilojoules Calories and kilojoules are units of energy associated with food Calories and kilojoules are difficult to measure as a number of things affect energy availability, such as : food preparation (chopping, dicing, raw, cooked etc.) Health status Daily requirements Growth Exercise status etc. Calculating daily energy requirements via total daily energy expenditure (TDEE) is also highly problematic as the calculation is inflexible and unable to be varied for race, significant weight loss history or any other variable than exercise The errors associated with energy calculations (both in food and TDEE) are so significant that it makes the process worthless So why are we doing it?

Energy Calculations BMR Calculation (Harris Benedict 1984) Men BMR = 88.362 + (13.397 × weight in kg) + (4.799 × height in cm) - (5.677 × age in years) Women BMR = 447.593 + (9.247 × weight in kg) + (3.098 × height in cm) - (4.330 × age in years) Mifflin St. Jeor Equation For men: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) + 5 For women: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) – 161 Calculating Intake to maintain weight Little to no exercise Daily kilocalories needed = BM% x 1.2 Light exercise (1–3 days per week) Daily kilocalories needed = BMR x 1.375 Moderate exercise (3–5 days per week) Daily kilocalories needed = BMR x 1.55 Heavy exercise (6–7 days per week) Daily kilocalories needed = BMR x 1.725 Very heavy exercise (2 x day, high intensity) Daily kilocalories needed = BMR x 1.9 TDEE = RMR + thermogenic influences (i.e. thermic effect of food) + energy associated with exercise RDEE = 370 + 21.6 (FFM kg) (McArdle, Katch & Katch, 2001)

When Calorie Counting Works When energy intake is sufficiently low, fasting benefits ensue However, calorie restriction must be short otherwise metabolism can be affected Fasting is able to improve a number of significant health markers, very rapidly Blood lipid profile Glycaemic control HbA1c in diabetics Homocysteine Inflammation (hs-CRP, ESR) Waist circumference/Body composition Hormone sensitivity 800 calories is able to induce these effects REMEMBER: Calculating 800 calories is not an exact science so do not tie yourself up in knots trying to be spot on REMEMBER: The number 800 is to give you a target more so than for any other reason (i.e. it would be hard to follow a low food diet) REMEMBER: Energy intake simply needs to be very low

Very Low Calorie Diets Very low calorie diets (VLCD) have been shown to have significant health benefits in the short term They improve blood lipid profile, glycaemic control, blood pressure, waist circumference and more VLCD induce ketosis which increases lipolysis There are significant problems though People are hungry (all the time) Poor adherence rates An increase in low fat, processed foods and shakes to try and stay full but keep calories low Rebound weight gain for most people (hormonal dysfunction and loss of LBM)

Very Low Calorie Ketogenic Diet VLCKD has been shown to be superior to the VLCD in a number of recent studies Study by Moreno et. al. (2014) concluded that “The VLCK diet was well tolerated and the side effects were moderate and transitory. In a group of obese patients, the VLCK diet was significantly more effective than a standard LC diet. At one year follow-up in the group with VLCK diet, most of the patients loss more than 10 % of their initial weight and lean mass was well preserved.” Study by Merra and colleagues (2016) concluded that “Our pilot study showed that a VLCKD was highly effective in terms of body weight reduction without to induce lean body mass loss, preventing the risk of sarcopenia.” They suggested that the mode of action lies in part, with the protein inducing high levels of satiety

Very Low Calorie Ketogenic Diet VLCKD has a number of distinct advantages over the VLCD Fat adaption which reduces hunger and makes adherence easier Inclusion of full fat products which also ease hunger Focus on adequate protein intake which increases satiety Focus on unprocessed food Greater improvements than the VLCD in HbA1c Glycaemic control Blood lipid profile (TG:HDL) Hormone sensitivity (insulin in particular) Adherence rates Long term success (preservation of LBM) The ketogenic diet has been shown to be superior to the low fat diet across numerous markers so it makes sense that the low calorie ketogenic diet would also be more effective than the traditional low calorie (low fat) diet at improving health markers

How Long Should I Do the VLCKD? It depends  Weight loss history Hormonal resistance Exercise status We recommend no longer than 4 weeks with a period of normal LCHF eating in-between. This is for two significant reasons 1. it’s tough going and difficult to stick to for long periods of time 2. protection of LBM and metabolic rate The VLCKD can be cycled intermittently until desired weight loss is achieved

Rationale for the VLCKD A significant number of women (in particular) do not respond to LCHF If you understand that obesity is a metabolic/hormone disorder and not a caloric disorder then the focus for weight loss needs to be hormonal Fasting is one of the best strategies for improving hormone sensitivity Fasting can only be done intermittently VLCKD can be done for weeks at a time and induce the same benefits as fasting This is especially important for people who need to lose weight but have been unable to do so even when severely restricting calories The ketogenic diet has different metabolic effects than traditional low calorie (i.e. low fat) and is able to preserve lean mass and therefore protect metabolic rate VLCKD induces significant improvements in a number of health markers VLCKD works well with adequate protein, high intensity exercise to preserve muscle mass and when done for short periods of time (or intermittently)

REMEMBER!! 800 calories is somewhat arbitrary but is associated with a sufficiently low intake of food to induce fasting benefits Ensure your macronutrient ratios are in alignment with LCHF/keto You don’t have to sit on 800 calories exactly – if you go over, it’s not a fail If you feel jittery, shaky, unwell etc. then this is your body telling you to eat. DO NOT ignore these messages You are not failing if you eat additional food on a particular day – you are successfully listening to you body Weight loss is due to long term consistency (i.e. nothing gets undone or completely fixed in a day) The end is near 

Research Goday et. al. (2016) Moreno et. al. (2016) Gomez-Arbelaez et. al. (2016) Brehm et. al. (2013) Hussain et. al. (2012) Bueno et. al. (2013) Cicero et. al. (2015)