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Very-low-calorie diet

A very-low-calorie diet (VLCD), also known as semistarvation diet and crash diet, is a type of diet with very or extremely low daily food energy consumption. Often described as a fad diet, it is defined as a diet of 800 kilocalories (3,300 kJ) per day or less. Modern medically supervised VLCDs use total meal replacements, with regulated formulations in Europe and Canada which contain the recommended daily requirements for vitamins, minerals, trace elements, fatty acids, protein and electrolyte balance. Carbohydrates may be entirely absent, or substituted for a portion of the protein; this choice has important metabolic effects. Medically supervised VLCDs have specific therapeutic applications for rapid weight loss, such as in 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.

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

Unmonitored VLCDs with insufficient or unbalanced nutrients can cause sudden death by cardiac arrest either by starvation or during refeeding.

Contents

Very-low-calorie diets (VLCDs) are diets of 800 kilocalories (3,300 kJ) or less energy intake per day, whereas low-calorie diets are between 1000-1200 kcal per day.

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. The US dietary guidelines recommend that VLCDs can be used for weight loss in obese individuals only in limited circumstances and only under supervision by experienced personnel in a medical care setting where the individual can be medically monitored and high-intensity lifestyle intervention can be provided. For the general public, VLCDs are not recommended due to low evidence. As there are considerable risks of starvation with an inadequately composed or supervised VLCD, people attempting these diets must be monitored closely by a physician to prevent complications.

VLCDs appear to be more effective than behavioral weight loss programs or other diets, achieving approximately 4 kilograms (8.8 lb) more weight loss at 1 year and greater sustained weight loss after several years. When used in routine care, there is evidence that VLCDs achieve average weight loss at 1 year around 10 kilograms (22 lb) or about 4% more weight loss over the short term. VLCDs can achieve higher short-term weight loss compared to other more modest or gradual calorie restricted diets, and the maintained long-term weight loss is similar or greater. VLCDs were shown to reduce lean body mass. Combining VLCD with other obesity therapies yield more effective results in weight loss. Low-calorie and very-low-calorie diets may produce 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 is regained quickly afterward.

VLCDs are efficient and recommended for liver fat reduction and weight loss before bariatric surgery.

A 2001 review found that VLCD has no serious harmful effect when done under medical supervision, for periods of 8–16 weeks with an average weight loss of 1.5-2.5 kg/week. However, VLCD may increase the risk of developing gallstones if the fat content of VLCD is not sufficient, but data is lacking to know the precise amount of fat that is necessary to avoid gallstones formation. Indeed, dietary fat stimulates gall bladder contraction, thus, if following a fat-free VLCD, the bladder does not empty. Another potential side effect is constipation (depending on the fiber content of the diet).

VLCD were not found to increase food cravings, and on the contrary, appear to reduce food cravings more than low-calorie diets.

Previous formulations (medical or commercial) of carbohydrate-free very low calorie diets provided 200–800 kcal/day and maintained protein intake, but eliminated any carbohydrate intake and sometimes fat intake as well. These diets subject the body to starvation and produce an average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). However, the total lack of carbohydrates avoids protein sparing and thus produce a loss of lean muscle mass, as well as other adverse side effects such as increased risks of gout, and electrolyte imbalances, and are thus disadvised. 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 VLCD formulas, the total diet replacements better preserve lean body mass, reduce known side effects and improvenutritional status[clarify].

Unmonitored VLCDs with insufficient macronutrient and mineral intake have the potential to cause an electrolyte imbalance and sudden death via ventricular tachycardia either by starvation or upon refeeding.

The earliest data on VLCDs come from the aftermath of World War II, when several scientific experiments were undertaken to examine what conditions could lead to starvation and how to rehabilitate safely to eating, such as the Minnesota Starvation Experiment, in an effort to reduce the casualties caused by famine following the war.

VLCD is used for clinical purposes since at least the 1980s.

In 1978, 58 people died in the United States after following very-low-calorie liquid protein diets. Following this event, the FDA requires since 1984 that protein VLCDs providing fewer than 400 calories a day carry a warning that they can cause serious illness and need to be followed under medical supervision. However, newer regulations require this warning only on protein products that aim to provide more than half of a person's calories and are promoted for weight loss or as a food supplement. This enabled protein VLCD drinks such as Slim-Fast that provide fewer than 400 calories to avoid warnings by recommending that users "also eat one sensible meal each day".

In 1991, the Federal Trade Commission charged three liquid VLCD companies, Optifast, Medifast and Ultrafast, with deceptive advertising. The case was settled after the companies agreed to stop using what the FTC alleged to be deceptive claims about the long-term results and the safety of these diets.

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  5. Joshi, S; Mohan, V (November 2018). "Pros & cons of some popular extreme weight-loss diets". The Indian Journal of Medical Research. 148 (5): 642–647. doi:10.4103/ijmr.IJMR_1793_18. PMC6366252. PMID 30666989.
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  9. Holderbaum, M; Casagrande, DS; Sussenbach, S; Buss, C (February 2018). "Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review". Surgery for Obesity and Related Diseases (Systematic review). 14 (2): 237–244. doi:10.1016/j.soard.2017.09.531. PMID 29239795.
  10. Thom, G; Lean, M (May 2017). "Is There an Optimal Diet for Weight Management and Metabolic Health?"(PDF). Gastroenterology (Review). 152 (7): 1739–1751. doi:10.1053/j.gastro.2017.01.056. PMID 28214525.
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  15. Isner JM, Sours HE, Paris AL, Ferrans VJ, Roberts WC (December 1979). "Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval". Circulation. 60 (6): 1401–12. doi:10.1161/01.cir.60.6.1401. PMID 498466.
  16. Sours HE, Frattali VP, Brand CD, Feldman RA, Forbes AL, Swanson RC, Paris AL (April 1981). "Sudden death associated with very low calorie weight reduction regimens". The American Journal of Clinical Nutrition. 34 (4): 453–61. doi:10.1093/ajcn/34.4.453. PMID 7223697.
  17. Strychar I (January 2006). "Diet in the management of weight loss". CMAJ. 174 (1): 56–63. doi:10.1503/cmaj.045037. PMC1319349. PMID 16389240.
  18. Parretti HM, Jebb SA, Johns DJ, Lewis AL, Christian-Brown AM, Aveyard P (March 2016). "Clinical effectiveness of very-low-energy diets in the management of weight loss: a systematic review and meta-analysis of randomized controlled trials"(PDF). Obesity Reviews. 17 (3): 225–34. doi:10.1111/obr.12366. PMID 26775902. S2CID 8327496.
  19. Astbury NM, Aveyard P, Nickless A, Hood K, Corfield K, Lowe R, Jebb SA (September 2018). "Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial". BMJ. 362: k3760. doi:10.1136/bmj.k3760. PMC6156558. PMID 30257983.
  20. Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, Lee CJ, Bleich SN, Clark JM (April 2015). "Efficacy of commercial weight-loss programs: an updated systematic review". Annals of Internal Medicine. 162 (7): 501–12. doi:10.7326/m14-2238. PMC4446719. PMID 25844997.
  21. Clifton, PM; Keogh, JB (25 April 2018). "Effects of Different Weight Loss Approaches on CVD Risk". Current Atherosclerosis Reports. 20 (6): 27. doi:10.1007/s11883-018-0728-8. PMID 29696385. S2CID 13964240.
  22. Anderson JW, Konz EC, Frederich RC, Wood CL; Konz; Frederich; Wood (1 November 2001). "Long-term weight-loss maintenance: A meta-analysis of US studies". Am. J. Clin. Nutr. (Meta-analysis). 74 (5): 579–84. doi:10.1093/ajcn/74.5.579. PMID 11684524.CS1 maint: multiple names: authors list (link)
  23. Astrup A, Quaade F (1989). "VLCD compliance and lean body mass". International Journal of Obesity. 13 Suppl 2: 27–31. PMID 2559044.
  24. Alhamdan, BA; Garcia-Alvarez, A; Alzahrnai, AH; Karanxha, J; Stretchberry, DR; Contrera, KJ; Utria, AF; Cheskin, LJ (September 2016). "Alternate-day versus daily energy restriction diets: which is more effective for weight loss? A systematic review and meta-analysis". Obesity Science & Practice. 2 (3): 293–302. doi:10.1002/osp4.52. PMC5043510. PMID 27708846.
  25. Koutroumanidou, E; Pagonopoulou, O (March 2014). "Combination of very low energy diets and pharmacotherapy in the treatment of obesity: meta-analysis of published data". Diabetes/Metabolism Research and Reviews (Meta-analysis). 30 (3): 165–74. doi:10.1002/dmrr.2475. PMID 24115299. S2CID 25559307.
  26. Mustajoki, P; Pekkarinen, T (February 2001). "Very low energy diets in the treatment of obesity". Obesity Reviews (Review). 2 (1): 61–72. doi:10.1046/j.1467-789x.2001.00026.x. PMID 12119638. S2CID 2088405.
  27. Andersen T (July 1992). "Liver and gallbladder disease before and after very-low-calorie diets". The American Journal of Clinical Nutrition. 56 (1 Suppl): 235S–239S. doi:10.1093/ajcn/56.1.235S. PMID 1615889.
  28. Astrup A, Vrist E, Quaade F (February 1990). "Dietary fibre added to very low calorie diet reduces hunger and alleviates constipation". International Journal of Obesity. 14 (2): 105–12. PMID 2160441.
  29. Kahathuduwa, CN; Binks, M; Martin, CK; Dawson, JA (October 2017). "Extended calorie restriction suppresses overall and specific food cravings: a systematic review and a meta-analysis". Obesity Reviews (Systematic review and meta-analysis). 18 (10): 1122–1135. doi:10.1111/obr.12566. PMC6226249. PMID 28557246.
  30. Howard, A. N. (1975). "Dietary Treatment of Obesity". Obesity: Its Pathogenesis And Management. Springer Netherlands. pp. 123–153. doi:10.1007/978-94-011-7155-7_5. ISBN 978-94-011-7155-7.: 130–133
  31. Johnstone, A (May 2015). "Fasting for weight loss: an effective strategy or latest dieting trend?". International Journal of Obesity (Review). 39 (5): 727–33. doi:10.1038/ijo.2014.214. PMID 25540982. S2CID 24033290.
  32. Zoumbaris, Sharon K.; Bijlefeld, Marjolijn (25 November 2014). Encyclopedia of diet fads : understanding science and society (Encyclopaedia) (2nd ed.). Greenwood. ISBN 9781610697606.
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Very-low-calorie diet
Very low calorie diet Language Watch Edit A very low calorie diet VLCD also known as semistarvation diet 1 and crash diet 2 3 4 5 6 7 is a type of diet with very or extremely low daily food energy consumption Often described as a fad diet it is defined as a diet of 800 kilocalories 3 300 kJ per day or less 8 9 Modern medically supervised VLCDs use total meal replacements with regulated formulations in Europe and Canada which contain the recommended daily requirements for vitamins minerals trace elements fatty acids protein and electrolyte balance Carbohydrates may be entirely absent or substituted for a portion of the protein this choice has important metabolic effects 10 11 Medically supervised VLCDs have specific therapeutic applications for rapid weight loss such as in 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 8 12 13 14 Very low calorie diets mostly consist of liquid drinks although very low calorie meals also exist Unmonitored VLCDs with insufficient or unbalanced nutrients can cause sudden death by cardiac arrest either by starvation or during refeeding 15 16 Contents 1 Definition 2 Health effects 3 History and society 4 See also 5 References 6 External linksDefinition EditVery low calorie diets VLCDs are diets of 800 kilocalories 3 300 kJ or less energy intake per day whereas low calorie diets are between 1000 1200 kcal per day 8 Health effects EditThe 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 12 The US dietary guidelines recommend that VLCDs can be used for weight loss in obese individuals only in limited circumstances and only under supervision by experienced personnel in a medical care setting where the individual can be medically monitored and high intensity lifestyle intervention can be provided 14 For the general public VLCDs are not recommended due to low evidence 13 As there are considerable risks of starvation with an inadequately composed or supervised VLCD people attempting these diets must be monitored closely by a physician to prevent complications 14 17 VLCDs appear to be more effective than behavioral weight loss programs or other diets achieving approximately 4 kilograms 8 8 lb more weight loss at 1 year and greater sustained weight loss after several years 10 18 When used in routine care there is evidence that VLCDs achieve average weight loss at 1 year around 10 kilograms 22 lb 19 or about 4 more weight loss over the short term 20 VLCDs can achieve higher short term weight loss compared to other more modest or gradual calorie restricted diets and the maintained long term weight loss is similar or greater 10 21 22 VLCDs were shown to reduce lean body mass 23 24 Combining VLCD with other obesity therapies yield more effective results in weight loss 25 Low calorie and very low calorie diets may produce 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 is regained quickly afterward 10 VLCDs are efficient and recommended for liver fat reduction and weight loss before bariatric surgery 8 9 A 2001 review found that VLCD has no serious harmful effect when done under medical supervision for periods of 8 16 weeks with an average weight loss of 1 5 2 5 kg week 26 However VLCD may increase the risk of developing gallstones if the fat content of VLCD is not sufficient but data is lacking to know the precise amount of fat that is necessary to avoid gallstones formation 26 27 Indeed dietary fat stimulates gall bladder contraction thus if following a fat free VLCD the bladder does not empty 26 Another potential side effect is constipation depending on the fiber content of the diet 23 28 VLCD were not found to increase food cravings and on the contrary appear to reduce food cravings more than low calorie diets 29 Previous formulations medical or commercial of carbohydrate free very low calorie diets provided 200 800 kcal day and maintained protein intake but eliminated any carbohydrate intake and sometimes fat intake as well 17 30 These diets subject the body to starvation and produce an average weekly weight loss of 1 5 2 5 kilograms 3 3 5 5 lb 17 However the total lack of carbohydrates avoids protein sparing and thus produce a loss of lean muscle mass as well as other adverse side effects such as increased risks of gout and electrolyte imbalances and are thus disadvised 17 30 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 VLCD formulas the total diet replacements better preserve lean body mass reduce known side effects and improve nutritional status clarify 10 Unmonitored VLCDs with insufficient macronutrient and mineral intake have the potential to cause an electrolyte imbalance and sudden death via ventricular tachycardia either by starvation or upon refeeding 15 16 History and society EditThe earliest data on VLCDs come from the aftermath of World War II when several scientific experiments were undertaken to examine what conditions could lead to starvation and how to rehabilitate safely to eating such as the Minnesota Starvation Experiment in an effort to reduce the casualties caused by famine following the war 31 VLCD is used for clinical purposes since at least the 1980s 26 In 1978 58 people died in the United States after following very low calorie liquid protein diets 32 Following this event the FDA requires since 1984 that protein VLCDs providing fewer than 400 calories a day carry a warning that they can cause serious illness and need to be followed under medical supervision 32 However newer regulations require this warning only on protein products that aim to provide more than half of a person s calories and are promoted for weight loss or as a food supplement 32 This enabled protein VLCD drinks such as Slim Fast that provide fewer than 400 calories to avoid warnings by recommending that users also eat one sensible meal each day 32 In 1991 the Federal Trade Commission charged three liquid VLCD companies Optifast Medifast and Ultrafast with deceptive advertising The case was settled after the companies agreed to stop using what the FTC alleged to be deceptive claims about the long term results and the safety of these diets 32 See also EditDieting Ketogenic diet Ketosis List of diets Management of obesity Negative calorie food Protein sparing modified fast a type of very low calorie diet aiming to spare proteins and thus preserve muscle tissues 30 References Edit Ahmed W Flynn MA Alpert MA April 2001 Cardiovascular complications of weight reduction diets The American Journal of the Medical Sciences Review 321 4 280 4 doi 10 1097 00000441 200104000 00007 PMID 11307868 How to diet nhs uk NHS 27 April 2018 Take the test Is an 800 calorie diet right for me BBC Food Bonet Anna 28 November 2018 Are crash diets ever a good idea for weight loss Netdoctor A crash diet is typically a very low calorie diet where you eat a very restrictively for a short period of time explains Registered Dietician Helen Bond Joshi S Mohan V November 2018 Pros amp cons of some popular extreme weight loss diets The Indian Journal of Medical Research 148 5 642 647 doi 10 4103 ijmr IJMR 1793 18 PMC 6366252 PMID 30666989 Crash dieting Desperate measures The Independent 15 September 2009 Crash diets can cause transient deterioration in heart function ScienceDaily 2018 02 02 a b c d Thorell A MacCormick AD Awad S Reynolds N Roulin D Demartines N Vignaud M Alvarez A Singh PM Lobo DN September 2016 Guidelines for Perioperative Care in Bariatric Surgery Enhanced Recovery After Surgery ERAS Society Recommendations World Journal of Surgery Professional society guidelines 40 9 2065 83 doi 10 1007 s00268 016 3492 3 PMID 26943657 a b Holderbaum M Casagrande DS Sussenbach S Buss C February 2018 Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery a systematic review Surgery for Obesity and Related Diseases Systematic review 14 2 237 244 doi 10 1016 j soard 2017 09 531 PMID 29239795 a b c d e Thom G Lean M May 2017 Is There an Optimal Diet for Weight Management and Metabolic Health PDF Gastroenterology Review 152 7 1739 1751 doi 10 1053 j gastro 2017 01 056 PMID 28214525 Howard AN 1981 The historical development efficacy and safety of very low calorie diets International Journal of Obesity 5 3 195 208 PMID 7024153 a b Obesity identification assessment and management of overweight and obesity in children young people and adults nice org uk NICE November 2014 Retrieved 30 September 2019 a b US Department of Health and Human Services 2017 2015 2020 Dietary Guidelines for Americans health gov health gov Skyhorse Publishing Inc Retrieved 30 September 2019 a b c Jensen MD Ryan DH Apovian CM Ard JD Comuzzie AG Donato KA Hu FB Hubbard VS Jakicic JM Kushner RF Loria CM Millen BE Nonas CA Pi Sunyer FX Stevens J Stevens VJ Wadden TA Wolfe BM Yanovski SZ Jordan HS Kendall KA Lux LJ Mentor Marcel R Morgan LC Trisolini MG Wnek J Anderson JL Halperin JL Albert NM Bozkurt B Brindis RG Curtis LH DeMets D Hochman JS Kovacs RJ Ohman EM Pressler SJ Sellke FW Shen WK Smith SC Jr Tomaselli GF American College of Cardiology American Heart Association Task Force on Practice Guidelines Obesity Society 24 June 2014 2013 AHA ACC TOS guideline for the management of overweight and obesity in adults a report of the American College of Cardiology American Heart Association Task Force on Practice Guidelines and The Obesity Society Circulation 129 25 Suppl 2 S102 38 doi 10 1161 01 cir 0000437739 71477 ee PMC 5819889 PMID 24222017 a b Isner JM Sours HE Paris AL Ferrans VJ Roberts WC December 1979 Sudden unexpected death in avid dieters using the liquid protein modified fast diet Observations in 17 patients and the role of the prolonged QT interval Circulation 60 6 1401 12 doi 10 1161 01 cir 60 6 1401 PMID 498466 a b Sours HE Frattali VP Brand CD Feldman RA Forbes AL Swanson RC Paris AL April 1981 Sudden death associated with very low calorie weight reduction regimens The American Journal of Clinical Nutrition 34 4 453 61 doi 10 1093 ajcn 34 4 453 PMID 7223697 a b c d Strychar I January 2006 Diet in the management of weight loss CMAJ 174 1 56 63 doi 10 1503 cmaj 045037 PMC 1319349 PMID 16389240 Parretti HM Jebb SA Johns DJ Lewis AL Christian Brown AM Aveyard P March 2016 Clinical effectiveness of very low energy diets in the management of weight loss a systematic review and meta analysis of randomized controlled trials PDF Obesity Reviews 17 3 225 34 doi 10 1111 obr 12366 PMID 26775902 S2CID 8327496 Astbury NM Aveyard P Nickless A Hood K Corfield K Lowe R Jebb SA September 2018 Doctor Referral of Overweight People to Low Energy total diet replacement Treatment DROPLET pragmatic randomised controlled trial BMJ 362 k3760 doi 10 1136 bmj k3760 PMC 6156558 PMID 30257983 Gudzune KA Doshi RS Mehta AK Chaudhry ZW Jacobs DK Vakil RM Lee CJ Bleich SN Clark JM April 2015 Efficacy of commercial weight loss programs an updated systematic review Annals of Internal Medicine 162 7 501 12 doi 10 7326 m14 2238 PMC 4446719 PMID 25844997 Clifton PM Keogh JB 25 April 2018 Effects of Different Weight Loss Approaches on CVD Risk Current Atherosclerosis Reports 20 6 27 doi 10 1007 s11883 018 0728 8 PMID 29696385 S2CID 13964240 Anderson JW Konz EC Frederich RC Wood CL Konz Frederich Wood 1 November 2001 Long term weight loss maintenance A meta analysis of US studies Am J Clin Nutr Meta analysis 74 5 579 84 doi 10 1093 ajcn 74 5 579 PMID 11684524 CS1 maint multiple names authors list link a b Astrup A Quaade F 1989 VLCD compliance and lean body mass International Journal of Obesity 13 Suppl 2 27 31 PMID 2559044 Alhamdan BA Garcia Alvarez A Alzahrnai AH Karanxha J Stretchberry DR Contrera KJ Utria AF Cheskin LJ September 2016 Alternate day versus daily energy restriction diets which is more effective for weight loss A systematic review and meta analysis Obesity Science amp Practice 2 3 293 302 doi 10 1002 osp4 52 PMC 5043510 PMID 27708846 Koutroumanidou E Pagonopoulou O March 2014 Combination of very low energy diets and pharmacotherapy in the treatment of obesity meta analysis of published data Diabetes Metabolism Research and Reviews Meta analysis 30 3 165 74 doi 10 1002 dmrr 2475 PMID 24115299 S2CID 25559307 a b c d Mustajoki P Pekkarinen T February 2001 Very low energy diets in the treatment of obesity Obesity Reviews Review 2 1 61 72 doi 10 1046 j 1467 789x 2001 00026 x PMID 12119638 S2CID 2088405 Andersen T July 1992 Liver and gallbladder disease before and after very low calorie diets The American Journal of Clinical Nutrition 56 1 Suppl 235S 239S doi 10 1093 ajcn 56 1 235S PMID 1615889 Astrup A Vrist E Quaade F February 1990 Dietary fibre added to very low calorie diet reduces hunger and alleviates constipation International Journal of Obesity 14 2 105 12 PMID 2160441 Kahathuduwa CN Binks M Martin CK Dawson JA October 2017 Extended calorie restriction suppresses overall and specific food cravings a systematic review and a meta analysis Obesity Reviews Systematic review and meta analysis 18 10 1122 1135 doi 10 1111 obr 12566 PMC 6226249 PMID 28557246 a b c Howard A N 1975 Dietary Treatment of Obesity Obesity Its Pathogenesis And Management Springer Netherlands pp 123 153 doi 10 1007 978 94 011 7155 7 5 ISBN 978 94 011 7155 7 130 133 Johnstone A May 2015 Fasting for weight loss an effective strategy or latest dieting trend International Journal of Obesity Review 39 5 727 33 doi 10 1038 ijo 2014 214 PMID 25540982 S2CID 24033290 a b c d e Zoumbaris Sharon K Bijlefeld Marjolijn 25 November 2014 Encyclopedia of diet fads understanding science and society Encyclopaedia 2nd ed Greenwood ISBN 9781610697606 External links EditDiet amp VLCD summary of studiesPortals Access related topics Food portal Retrieved from https en wikipedia org w index php title Very low calorie diet amp oldid 1047673247, wikipedia, wiki, book,

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