Survey of Very-Low-Calorie Weight Reduction Diets

The US Public Health Service stated that "because of the potential hazards of starvation diets and the need for continuous medical supervision..., such diets should never be self-administered."¹Total fasting produces a number of detrimental side effects, including severe ketosis, hyperuricemia, negative nitrogen balance, hyponatremia, hypokalemia, hypoglycemia, neutropenia, alopecia, and increased renal loss of phosphate and magnesium.²,³Even in trials of intermittent fasting under close medical supervision, patients experienced hyperuricemia, sodium depletion, ketosis, and hyperketonemia. Duncan et al⁴reported atrial fibrillation in three patients with cardiovascular disease who exercised while following an intermittent fasting protocol. Fasting as a weight reduction regimen became popular following the publication ofFasting: The Ultimate Diet, by Allan Cott⁵in 1975 (Table). Cott stated that "fasting brings a welcome physiological rest for the digestive tract and the central nervous system. It normalizes metabolism." In addition, the total fasting approach was recommended