Very-low-calorie diet

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Very-low-calorie diets mostly consist of liquid drinks, although very-low-calorie meals also exist.

Very-low-calorie diet (VLCD), also known as starvation diet[1][2] and crash diet,[3][4][5][6][7][8] is a type of fad diets with very or extremely low daily food energy consumption. They are defined as a diet of 800 kilocalories (3,300 kJ) per day or less. Modern medically supervised VLCDs use total meals replacements, with regulated formulations in Europe and Canada to contain the recommended daily requirements for vitamins, minerals, trace elements, fatty acids, protein and electrolyte balance. Carbohydrate may be entirely absent, or substituted for a portion of the protein; this choice has important metabolic effects.[9][10] These have specific therapeutic applications for rapid weight loss in critical illnesses, such as morbid obesity or before a bariatric surgery, using formulated, nutritionally complete liquid meals containing 800 kilocalories or less per day for a maximum of 12 weeks.[11][12][13][14][15]

Unmonitored VLCDs with insufficient or unbalanced nutrients can cause sudden death.[16][17]

Health effects[edit]

The routine use of VLCDs is not recommended due to safety concerns, but this approach can be used under medical supervision if there is a clinical rationale for rapid weight loss in obese individuals, as part of a «multi-component weight management strategy» with continuous support and for a maximum of 12 weeks according to the NICE 2014 guidelines and the US dietary guidelines do not recommend VLCDs due to low evidence.[13][14][15] Indeed, there are considerable risks of starvation with an inadequately composed or supervised VLCD, hence people attempting these diets must be monitored closely by a physician to prevent complications.[18]

VLCDs appears to be more effective than behavioral weight loss programs or other diets, achieving approximately 4 kg more weight loss at 1 year and greater sustained weight loss after several years.[9][19] When used in routine care, there is evidence that VLCDs achieve average weight loss at 1 year around 10 kg.[20] or about 4% more weight loss over the short term.[21] VLCDs can achieve higher short-term weight loss compared to other more modest calorie restricted diets, and on the long-term the weight loss is similar or greater.[9][22] VLCDs were shown to reduce lean body mass.[23][24]

VLCDs are efficient for liver fat reduction and weight loss before bariatric surgery.[11][12]

Low-calorie and very-low-calorie diets may produce initially faster weight loss within the first 1-2 weeks of starting compared to other diets, but this superficially faster loss is due to glycogen depletion and water loss in the lean body mass and regained quickly afterward.[9]

Previous formulations (medical or commercial) of very low calorie diets provided 200–800 kcal/day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances.[18] Total diet replacement programs are the modern formulations regulated in Europe and Canada to ensure the recommended daily intake of necessary nutrients, vitamins and electrolyte balance. Compared to older VLCDs formulas, the total diet replacements better preserve lean body mass, reduces known side effects and improve the nutritional status[clarify].[9]

In about one in four individuals following a VLCD for a few months, gallstones develop. However, these gallstones may be small enough to not cause discomfort, and often disappear when a normal eating pattern is resumed.[25][26][27] Gallstone formation is facilitated by the more concentrated bile fluid and reduced flow as a result of a VLCD.[28]

Another potential side effect is constipation (depending on the fiber content of the diet).[23][29]

Unmonitored VLCDs with insufficient macronutrient and mineral intake have the potential to cause sudden death via ventricular tachycardia.[16][17]

See also[edit]


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