Adherence
Adherence to low-carbohydrate (LCD) and very low-carbohydrate ketogenic diets (VLCKD) is significantly lower than adherence to vegan or vegetarian diets, with attrition rates often exceeding 40-60% in long-term trials, leading to a convergence of metabolic outcomes between diet groups over time.
If you are trying a low-carb or keto diet for diabetes or weight loss, expect that sticking to it is the hardest part. Many people drop out or stop strictly following the diet within a year, causing their results to look like those of people on other diets. To succeed, focus on sustainability over perfection. If strict keto (<50g carbs) feels too restrictive or socially isolating, a moderate low-carb approach (<130g carbs) might be easier to maintain long-term, even if the initial weight loss is slower. The key is not the specific number of grams, but your ability to keep the diet going.
A meta-analysis evaluated the 15 studies of ketogenic diets for epilepsy in adults. The studies had a combined dropout rate of 45%, with fewer patients completing the trials of the CKD (38%) and better completion rates with the MAD (56%). ... When ketogenic diets are used to control epilepsy, adherence appears to be inversely related to the degree of dietary restriction. ... In meta-analyses, there is a significant A1c reduction in people adhering to LCD compared to a high carb (fat restricted) diet ... However, the A1c reduction appears to be due to the studies with carbohydrate restriction to less than 26% of energy, so this may not be generalizable. ... VLCKDs have shown superior weight loss to other eating plans in some studies ... but this advantage is no longer seen at 12 months. ... Iqbal’s randomized two year study ... adherence was low based on these metrics. Additionally, the VLCKD group had a 60% attrition rate and participants in both groups appeared to consume similar diets with moderate restriction in carbohydrates at the study’s conclusion.
Why this rating
Based on multiple RCTs and meta-analyses cited in the review, showing consistent patterns of high attrition and outcome convergence.
Source
Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review
Nitya Kumar et al. · Dove Medical Press (Taylor and Francis Group) · 2022
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