Do lower-carbohydrate diets increase total energy expenditure? An updated and reanalyzed meta-analysis of 29 controlled-feeding studies
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BACKGROUND: The effect of macronutrient composition on total energy expenditure (TEE) remains controversial, with divergent findings among studies. One source of heterogeneity may be study duration, as physiological adaptation to lower carbohydrate intake may require 2 to 3 wk. OBJECTIVE: We tested the hypothesis that the effects of carbohydrate [expressed as % of energy intake (EI)] on TEE vary with time. METHODS: The sample included trials from a previous meta-analysis and new trials identified in a PubMed search through 9 March 2020 comparing lower- and higher-carbohydrate diets, controlled for EI or body weight. Three reviewers independently extracted data and reconciled discrepancies. Effects on TEE were pooled using inverse-variance-weighted meta-analysis, with between-study heterogeneity assessed using the I2 statistic. Meta-regression was used to quantify the influence of study duration, dichotomized at 2.5 wk. RESULTS: The 29 trials ranged in duration from 1 to 140 d (median: 4 d) and included 617 participants. Difference in carbohydrate between intervention arms ranged from 8% to 77% EI (median: 30%). Compared with reported findings in the prior analysis (I2 = 32.2%), we found greater heterogeneity (I2 = 90.9% in the reanalysis, 81.6% in the updated analysis). Study duration modified the diet effect on TEE (P < 0.001). Among 23 shorter trials, TEE was reduced on lower-carbohydrate diets (-50.0 kcal/d; 95% CI: -77.4, -22.6 kcal/d) with substantial heterogeneity (I2 = 69.8). Among 6 longer trials, TEE was increased on low-carbohydrate diets (135.4 kcal/d; 95% CI: 72.0, 198.7 kcal/d) with low heterogeneity (I2 = 26.4). Expressed per 10% decrease in carbohydrate as %EI, the TEE effects in shorter and longer trials were -14.5 kcal/d and 50.4 kcal/d, respectively. Findings were materially unchanged in sensitivity analyses. CONCLUSIONS: Lower-carbohydrate diets transiently reduce TEE, with a larger increase after ∼2.5 wk. These findings highlight the importance of longer trials to understand chronic macronutrient effects and suggest a mechanism whereby lower-carbohydrate diets may facilitate weight loss.
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Low- compared with high-carbohydrate diets also increase total energy expenditure after 2-3 wk.
“Low- compared with high-carbohydrate diets also increase total energy expenditure after 2–3 wk (100).”
From The carbohydrate-insulin model: A physiological perspective on the obesity pandemic (2021) · cites this paper as [100]
In a recent meta-analysis, low- compared with high-carbohydrate diets slightly reduced energy expenditure in trials <2.5 weeks, but low-carbohydrate diets increased energy expenditure in longer trials.
“In a recent meta-analysis, low- compared with high-carbohydrate diets slightly reduced energy expenditure in trials < 2.5 wk, but low-carbohydrate diets increased energy expenditure in longer trials (100).”
From The carbohydrate-insulin model: A physiological perspective on the obesity pandemic (2021) · cites this paper as [100]
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Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions
(2019) · doi:10.1002/9781119536604 · Cited by 14,828 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799 · see citing works
The combination of estimates from different experiments
Cochran, W. G. (1954) · Biometrics · doi:10.2307/3001666 · Cited by 5,380 · see citing works
Ludwig (2002) · doi:10.1001/jama.287.18.2414 · Cited by 1,775 · see citing works
Self-citationA comparison of heterogeneity variance estimators in simulated random‐effects meta‐analyses
Langan, D., Higgins, J. P. T., Jackson, D., Bowden, J., Veroniki, A. A., Kontopantelis, E., Viechtbauer, W., & Simmonds, M. (2019) · Research Synthesis Methods · doi:10.1002/jrsm.1316 · Cited by 1,074 · see citing works
Metan: fixed- and random-effects meta-analysis
Harris, R. J., Deeks, J. J., Altman, D. G., Bradburn, M. J., Harbord, R. M., & Sterne, J. A. C. (2008) · The Stata Journal: Promoting communications on statistics and Stata · doi:10.1177/1536867x0800800102 · Cited by 1,027 · see citing works
Choosing effect measures and computing estimates of effect
Higgins, J. P., Li, T., & Deeks, J. J. (2019) · Cochrane Handbook for Systematic Reviews of Interventions · doi:10.1002/9781119536604.ch6 · Cited by 977 · cited 1× · see citing works
“Standard errors of the effect size were calculated when data were available from individual participant data or from SDs of each diet along with the estimated correlation between diets in crossover studies (38).”
MethodHarbord, R. M., & Higgins, J. P. T. (2008) · The Stata Journal: Promoting communications on statistics and Stata · doi:10.1177/1536867x0800800403 · Cited by 897 · see citing works
Obesity Pathogenesis: An Endocrine Society Scientific Statement
Schwartz, M. W., Seeley, R. J., Zeltser, L. M., Drewnowski, A., Ravussin, E., Redman, L. M., & Leibel, R. L. (2017) · Endocrine Reviews · doi:10.1210/er.2017-00111 · Cited by 727 · cited 1× · see citing works
“According to some thinking, on a calorie-per-calorie basis, all sources of metabolizable energy are alike in their effects on body energy stores and weight for practical purposes (1).”
BackgroundThe Carbohydrate-Insulin Model of Obesity
Ludwig, D. S., & Ebbeling, C. B. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.2933 · Cited by 452 · see citing works
Self-citationRosqvist, F., Iggman, D., Kullberg, J., Cedernaes, J., Johansson, H.-E., Larsson, A., Johansson, L., Ahlström, H., Arner, P., Dahlman, I., et al. (2014) · Diabetes · doi:10.2337/db13-1622 · Cited by 429 · see citing works
Analyzing effect sizes: Random-effects models.
Raudenbush, S. W. (2009) · Cited by 418 · see citing works
Obesity energetics: body weight regulation and the effects of diet composition
Hall, K. D., & Guo, J. (2017) · Gastroenterology · doi:10.1053/j.gastro.2017.01.052 · Cited by 367 · see citing works
Fat and carbohydrate overfeeding in humans: different effects on energy storage
Horton, T., Drougas, H., Brachey, A., Reed, G., Peters, J., & Hill, J. (1995) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/62.1.19 · Cited by 339 · see citing works
The physiological psychology of hunger: a physiological perspective
Friedman, M. I., & Stricker, E. M. (1976) · Psychological Review · doi:10.1037/0033-295x.83.6.409 · Cited by 334 · see citing works
Hall, K. D., Chen, K. Y., Guo, J., Lam, Y. Y., Leibel, R. L., Mayer, L. E., Reitman, M. L., Rosenbaum, M., Smith, S. R., Walsh, B. T., et al. (2016) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.133561 · Cited by 330 · see citing works
Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals
Pawlak, D. B., Kushner, J. A., & Ludwig, D. S. (2004) · The Lancet · doi:10.1016/s0140-6736(04)16937-7 · Cited by 325 · see citing works
Self-citationTrends in Intake of Energy and Macronutrients—United States, 1971-2000
(2004) · JAMA · doi:10.1001/jama.291.10.1193 · Cited by 321 · see citing works
Effects of a Low–Glycemic Load vs Low-Fat Diet in Obese Young Adults: A Randomized Trial
Ebbeling, C. B., Leidig, M. M., Feldman, H. A., Lovesky, M. M., & Ludwig, D. S. (2007) · JAMA · doi:10.1001/jama.297.19.2092 · Cited by 284 · see citing works
Self-citationKetogenic diets, mitochondria, and neurological diseases
Gano, L. B., Patel, M., & Rho, J. M. (2014) · Journal of Lipid Research · doi:10.1194/jlr.r048975 · Cited by 279 · see citing works
Ebbeling, C. B., Feldman, H. A., Klein, G. L., Wong, J. M. W., Bielak, L., Steltz, S. K., Luoto, P. K., Wolfe, R. R., Wong, W. W., & Ludwig, D. S. (2018) · BMJ · doi:10.1136/bmj.k4583 · Cited by 274 · see citing works
Self-citationDiet-induced ketosis increases monocarboxylate transporter (MCT1) levels in rat brain
Leino, R. L., Gerhart, D. Z., Duelli, R., Enerson, B. E., & Drewes, L. R. (2001) · Neurochemistry International · doi:10.1016/s0197-0186(00)00102-9 · Cited by 233 · see citing works
Acute oxidative stress and systemic Nrf2 activation by the ketogenic diet
Milder, J. B., Liang, L., & Patel, M. (2010) · Neurobiology of Disease · doi:10.1016/j.nbd.2010.05.030 · Cited by 214 · see citing works
Miller, V. J., Villamena, F. A., & Volek, J. S. (2018) · Journal of Nutrition and Metabolism · doi:10.1155/2018/5157645 · Cited by 200 · see citing works
Phinney, S. D., Bistrian, B. R., Wolfe, R. R., & Blackburn, G. L. (1983) · Metabolism · doi:10.1016/0026-0495(83)90105-1 · Cited by 173 · see citing works
Increasing Adiposity: Consequence or Cause of Overeating?
Ludwig, D. S., & Friedman, M. I. (2014) · JAMA · doi:10.1001/jama.2014.4133 · Cited by 151 · see citing works
Self-citationCapacity for Moderate Exercise in Obese Subjects after Adaptation to a Hypocaloric, Ketogenic Diet
Phinney, S. D., Horton, E. S., Sims, E. A. H., Hanson, J. S., Danforth, E., & LaGrange, B. M. (1980) · Journal of Clinical Investigation · doi:10.1172/jci109945 · Cited by 149 · see citing works
Ketogenic diets and physical performance
Phinney, S. D. (2004) · Nutrition & Metabolism · doi:10.1186/1743-7075-1-2 · Cited by 122 · see citing works
Fat adaptation in well-trained athletes: effects on cell metabolism
Yeo, W. K., Carey, A. L., Burke, L., Spriet, L. L., & Hawley, J. A. (2011) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/h10-089 · Cited by 118 · see citing works
6Ketosis of starvation: A revisit and new perspectives
Owen, O. E., Caprio, S., Reichard, G. A., Mozzoli, M. A., Boden, G., & Owen, R. S. (1983) · Clinics in Endocrinology and Metabolism · doi:10.1016/s0300-595x(83)80046-2 · Cited by 116 · see citing works
Timeline of changes in appetite during weight loss with a ketogenic diet
Nymo, S., Coutinho, S. R., Jørgensen, J. O. L., Rehfeld, J. F., Truby, H., Kulseng, B. E., & Martins, C. (2017) · International Journal of Obesity · doi:10.1038/ijo.2017.96 · Cited by 108 · see citing works
Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet
Bostock, E. C. S., Kirkby, K. C., Taylor, B. V., & Hawrelak, J. A. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.00020 · Cited by 102 · see citing works
The science of obesity: what do we really know about what makes us fat? An essay by Gary Taubes
Taubes, G. (2013) · BMJ · doi:10.1136/bmj.f1050 · Cited by 93 · see citing works
Mechanisms Preserving Insulin Action during High Dietary Fat Intake
Lundsgaard, A., Holm, J. B., Sjøberg, K. A., Bojsen-Møller, K. N., Myrmel, L. S., Fjære, E., Jensen, B. A. H., Nicolaisen, T. S., Hingst, J. R., Hansen, S. L., et al. (2018) · Cell Metabolism · doi:10.1016/j.cmet.2018.08.022 · Cited by 85 · see citing works
Energy expenditure in humans: effects of dietary fat and carbohydrate
Abbott, W. G. H., Howard, B. V., Ruotolo, G., & Ravussin, É. (1990) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1990.258.2.e347 · Cited by 84 · see citing works
Čiapaitė, J., van den Broek, N. M. A., Brinke, H. T., Nicolay, K., Jeneson, J. A. L., Houten, S. M., & Prompers, J. J. (2011) · Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids · doi:10.1016/j.bbalip.2011.05.005 · Cited by 77 · see citing works
Shepard, T. Y., Weil, K. M., Sharp, T. A., Grunwald, G. K., Bell, M. L., Hill, J. O., & Eckel, R. H. (2001) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/73.4.703 · Cited by 76 · see citing works
A comparative study of different means of assessing long-term energy expenditure in humans
ROSENBAUM, M. S., Ravussin, É., Matthews, D. E., Gilker, C. D., Ferraro, R. T., Heymsfield, S. B., Hirsch, J., & Leibel, R. L. (1996) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1996.270.3.r496 · Cited by 74 · see citing works
Chaput, J.-P., Tremblay, A., Rimm, E. B., Bouchard, C., & Ludwig, D. S. (2008) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.2.303 · Cited by 73 · see citing works
Self-citationImpaired Metabolic Flexibility to High-Fat Overfeeding Predicts Future Weight Gain in Healthy Adults
Begaye, B., Vinales, K. L., Hollstein, T., Ando, T., Walter, M., Bogardus, C., Krakoff, J., & Piaggi, P. (2020) · Diabetes · doi:10.2337/db19-0719 · Cited by 73 · see citing works
Carbohydrate balance predicts weight and fat gain in adults
Eckel, R. H., Hernandez, T. L., Bell, M. L., Weil, K. M., Shepard, T. Y., Grunwald, G. K., Sharp, T. A., Francis, C. C., & Hill, J. O. (2006) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.4.803 · Cited by 72 · see citing works
Protein sparing during treatment of obesity: ketogenic versus nonketogenic very low calorie diet
Vazquez, J. A., & Adibi, S. A. (1992) · Metabolism · doi:10.1016/0026-0495(92)90076-m · Cited by 67 · see citing works
Ruskin, D. N., & Masino, S. A. (2012) · Frontiers in Neuroscience · doi:10.3389/fnins.2012.00033 · Cited by 67 · see citing works
Dirlewanger, M., Vetta, V. D., Guenat, E., Battilana, P., Seematter, G., Schneiter, P., Jéquier, E., & Tappy, L. (2000) · International Journal of Obesity · doi:10.1038/sj.ijo.0801395 · Cited by 61 · see citing works
Hall, K. D., Guo, J., Chen, K. Y., Leibel, R. L., Reitman, M. L., ROSENBAUM, M. S., Smith, S. R., & Ravussin, É. (2018) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqy390 · Cited by 56 · see citing works
The impact of keto-adaptation on exercise performance and the role of metabolic-regulating cytokines
Sherrier, M. C., & Li, H. (2019) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqz145 · Cited by 56 · see citing works
Very-low-carbohydrate diets and preservation of muscle mass
Manninen, A. H. (2006) · Nutrition & Metabolism · doi:10.1186/1743-7075-3-9 · Cited by 56 · see citing works
Energy-intake restriction and diet-composition effects on energy expenditure in men
Rumpler, W. V., Seale, J., Miles, C., & Bodwell, C. E. (1991) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/53.2.430 · Cited by 52 · see citing works
<p>Impact Of Ketogenic Diet On Athletes: Current Insights</p>
McSwiney, F. T., Doyle, L., Plews, D. J., & Zinn, C. (2019) · Open Access Journal of Sports Medicine · doi:10.2147/oajsm.s180409 · Cited by 50 · see citing works
Substrate utilization in man: Effects of dietary fat and carbohydrate
de Venne, W. P. H. G. V., Westerterp, K. R., & ten Hoor, F. (1994) · Metabolism · doi:10.1016/0026-0495(94)90237-2 · Cited by 48 · see citing works
Shaw, D. M., Mérien, F., Braakhuis, A. J., Maunder, E., & Dulson, D. K. (2019) · Sports Medicine · doi:10.1007/s40279-019-01246-y · Cited by 48 · see citing works
Watanabe, M., Singhal, G., Fisher, F. M., Beck, T. C., Morgan, D. A., Socciarelli, F., Mather, M. L., Risi, R., Bourke, J., Rahmouni, K., et al. (2019) · Endocrine · doi:10.1007/s12020-019-02124-3 · Cited by 44 · see citing works
Hron, B. M., Ebbeling, C. B., Feldman, H. A., & Ludwig, D. S. (2015) · Obesity · doi:10.1002/oby.21213 · Cited by 42 · see citing works
Self-citationWinzell, M. S., Magnusson, C., & Åhrén, B. (2006) · Metabolism · doi:10.1016/j.metabol.2006.09.008 · Cited by 38 · see citing works
Ergogenic Properties of Ketogenic Diets in Normal-Weight Individuals: A Systematic Review
Kang, J., Ratamess, N. A., Faigenbaum, A. D., & Bush, J. A. (2020) · Journal of the American College of Nutrition · doi:10.1080/07315724.2020.1725686 · Cited by 38 · see citing works
Ultra-Processed Food and Obesity: The Pitfalls of Extrapolation from Short Studies
Ludwig, D. S., Astrup, A. V., Bazzano, L., Ebbeling, C. B., Heymsfield, S. B., King, J. C., & Willett, W. C. (2019) · Cell Metabolism · doi:10.1016/j.cmet.2019.06.004 · Cited by 36 · see citing works
Self-citationShimy, K. J., Feldman, H. A., Klein, G. L., Bielak, L., Ebbeling, C. B., & Ludwig, D. S. (2020) · Journal of the Endocrine Society · doi:10.1210/jendso/bvaa062 · Cited by 35 · see citing works
Self-citationFat, Carbohydrate, Salt, and Weight Loss
Bortz, W. M., WROLDSON, A., MORRIS, P., & Issekutz, B., Jr. (1967) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/20.10.1104 · Cited by 27 · see citing works
Fukazawa, A., Koike, A., Karasawa, T., Tsutsui, M., Kondo, S., & Terada, S. (2020) · Nutrients · doi:10.3390/nu12051269 · Cited by 26 · see citing works
Bush, N. C., Resuehr, H., Goree, L. L., Locher, J. L., Bray, M. S., Soleymani, T., & Gower, B. A. (2018) · Journal of Nutrition · doi:10.1093/jn/nxx040 · Cited by 20 · see citing works
Hawley, J. A. (2011) · Nestlé Nutrition Institute Workshop series · doi:10.1159/000329283 · Cited by 16 · see citing works
Effects of Dietary Fat and Carbohydrate Exchange on Human Energy Metabolism
de Venne, W. P. H. G. V., & Westerterp, K. R. (1996) · Appetite · doi:10.1006/appe.1996.0022 · Cited by 15 · see citing works
Diets High In Fish And Sugar-sweetened Beverages Affect Energy Expenditure And Energy Balance.
Mitchell, C. M., Piaggi, P., Krakoff, J. A., & Votruba, S. B. (2020) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000687324.83241.eb · Cited by 1 · see citing works
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- [53]Dickinson S, Ludwig D, Ebbeling C, Allison D, Henschel B. Do lower-carbohydrate diets increase total energy expenditure? An updated and reanalyzed meta-analysis of 29 controlled feeding studies. Open Science Framework. 2020; [Internet]. [Accessed 2020 Nov 24]. Available from: https://osf.io/2hyqr/. PMC7948201 33274750
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Self-citationPaoli, A., Cenci, L., Pompei, P., Sahin, N., Bianco, A., Neri, M., Caprio, M., & Moro, T. (2021) · Nutrients · doi:10.3390/nu13020374 · Cited by 133 · see citing works
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Cipryan, L., Dostal, T., Litschmannová, M., Hofmann, P., Maffetone, P. B., & Laursen, P. B. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.785694 · Cited by 16 · see citing works
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Impact of the ketogenic diet on body fat, muscle mass, and exercise performance: a review
Chung, N. (2023) · Physical Activity and Nutrition · doi:10.20463/pan.2023.0031 · Cited by 15 · see citing works
Holsen, L. M., Hoge, W. S., Lennerz, B. S., Cerit, H., Hye, T., Moondra, P., Goldstein, J. M., Ebbeling, C. B., & Ludwig, D. S. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab090 · Cited by 15 · see citing works
Self-citationSoto-Mota, A., Pereira, M. A., Ebbeling, C. B., Aronica, L., & Ludwig, D. S. (2023) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2022.12.014 · Cited by 14 · see citing works
Self-citationLundanes, J., Storliløkken, G. E., Solem, M. S., Dankel, S. N., Tangvik, R. J., Ødegård, R. A., Holst, J. J., Rehfeld, J. F., Martins, C., & Nymo, S. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.11.018 · Cited by 11 · see citing works
Rushing, K. A., Bolyard, M. L., Kelty, T. J., Wieschhaus, N., Pavela, G., Rector, R. S., & Plaisance, E. P. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1165224 · Cited by 11 · see citing works
Santos, H. O., & Penha-Silva, N. (2025) · Nutrition · doi:10.1016/j.nut.2024.112617 · Cited by 11 · see citing works
Kahleová, H., Znayenko‐Miller, T., Motoa, G., Eng, E. M., Prevost, A., Uribarri, J., Holubkov, R., & Barnard, N. D. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1426642 · Cited by 10 · see citing works
Soto-Mota, A., Jansen, L. T., Norwitz, N. G., Pereira, M. A., Ebbeling, C. B., & Ludwig, D. S. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.12.017 · Cited by 10 · see citing works
Self-citationNorgren, J., Sindi, S., Sandebring-Matton, A., Ngandu, T., Kivipelto, M., & Kåreholt, I. (2023) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2023.100096 · Cited by 9 · see citing works
Overestimated Impact of Lower-Carbohydrate Diets on Total Energy Expenditure
Guyenet, S. J., & Hall, K. D. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab213 · Cited by 9 · see citing works
A high-carbohydrate diet lowers the rate of adipose tissue mitochondrial respiration
Bikman, B. T., Shimy, K., Apovian, C. M., Yu, S., Saito, E. R., Walton, C. M., Ebbeling, C. B., & Ludwig, D. S. (2022) · European Journal of Clinical Nutrition · doi:10.1038/s41430-022-01097-3 · Cited by 9 · see citing works
Self-citationThe roles of different macronutrients in regulation of appetite, energy intake and adiposity
Speakman, J. R. (2021) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2021.100297 · Cited by 9 · see citing works
García-Gorrita, C., Onofre, N. S., Merino-Torres, J. F., & Soriano, J. M. (2025) · Nutrients · doi:10.3390/nu17162699 · Cited by 8 · see citing works
Jackson, M. I. (2022) · Metabolites · doi:10.3390/metabo12070591 · Cited by 8 · see citing works
Ho, D. K. N., Liao, Y. C., Mayasari, N. R., Chien, M., Chung, M. C., Bai, C., Huang, Y., Chen, Y., Tseng, S., Chang, C., et al. (2024) · Obesity Reviews · doi:10.1111/obr.13760 · Cited by 8 · see citing works
Physiological responses to carbohydrate overfeeding
Walhin, J., Gonzalez, J. T., & Betts, J. A. (2021) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000755 · Cited by 7 · see citing works
Implication of lipid turnover for the control of energy balance
Bernard, S., & Spalding, K. L. (2023) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2022.0202 · Cited by 6 · see citing works
Zambrano-Villacres, R., Campuzano-Donoso, M., Reytor-González, C., Rossetti, G., Cobellis, L., Cobellis, F., Pilone, V., Simancas‐Racines, D., & Schiavo, L. (2026) · Nutrients · doi:10.3390/nu18111751 · Cited by 7 · see citing works
Martins, C., Bryan, D. R., Sweatt, S. K., Garvey, W. T., Fontaine, K. R., Dutton, G. R., & Gower, B. A. (2025) · Obesity · doi:10.1002/oby.24201 · Cited by 6 · see citing works
Dietary carbohydrates and weight loss maintenance
van Baak, M. A. (2021) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000758 · Cited by 5 · see citing works
Optimizing Lymphedema Outcomes through Lifestyle
Keith, L., & Erkstam, R. (2023) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2301016 · Cited by 4 · see citing works
Hägele, F. A., Dörner, R., Koop, J., Lübken, M., Seidel, U., Rimbach, G. H., Müller, M. J., & Bosy‐Westphal, A. (2023) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2023.03.025 · Cited by 4 · see citing works
Chronic positive mass balance is the actual etiology of obesity: A living review
Manninen, A. H. (2023) · Global Translational Medicine · doi:10.36922/gtm.222 · Cited by 4 · see citing works
Storz, M. A., & Ronco, Á. L. (2025) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2025.107557 · Cited by 3 · see citing works
Chueh, T.-L., Wang, Z., Ngu, Y. J., Lin, P.-L., Owaga, E., & Hsieh, R. (2024) · Nutrients · doi:10.3390/nu16142331 · Cited by 6 · see citing works
Shahinfar, H., Payandeh, N., Ebaditabar, M., Babaei, N., Davarzani, S., Djafarian, K., & Shab‐Bidar, S. (2021) · Nutrition and Health · doi:10.1177/02601060211063070 · Cited by 3 · see citing works
Niu, X., Zhang, Y., Lai, Z., Huang, X., Gao, J., Lu, F., Chang, Q., & Yuan, Y. (2022) · Aesthetic Surgery Journal · doi:10.1093/asj/sjac105 · Cited by 3 · see citing works
The energy balance theory: an unsatisfactory model of body composition fluctuationsPreprint
Arencibia‐Albite, F., & Manninen, A. H. (2020) · medRxiv · doi:10.1101/2020.10.27.20220202 · Cited by 3 · see citing works
Istfan, N. W. (2025) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00487.2024 · Cited by 2 · see citing works
Organ cross-talk and the aetiology of obesity – an impasse
Speakman, J. R. (2022) · Journal of Holistic Integrative Pharmacy · doi:10.1016/s2707-3688(23)00060-2 · Cited by 2 · see citing works
Banton, S., Pezzali, J. G., Richards, T. L., Hillyer, L. M., David, W. L., Pisco, J. M., Templeman, J. R., & Shoveller, A. K. K. (2025) · Translational Animal Science · doi:10.1093/tas/txaf018 · Cited by 2 · see citing works
The fatal threat of carryover effects to the validity of crossover dietary trials
Ludwig, D. S., Willett, W. C., & Putt, M. E. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.10.025 · Cited by 2 · see citing works
Self-citationA case study of overfeeding 3 different diets
Feltham, S., & Westman, E. C. (2021) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000668 · Cited by 2 · see citing works
Dietary Carbohydrate, Energy Expenditure, and Weight Loss: Is Eating Less and Burning More Possible?
Magkos, F., & Astrup, A. V. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa423 · Cited by 2 · see citing works
Booth, D., & Gibson, E. L. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab382 · Cited by 2 · see citing works
Reply to A Drewnowski et al, O Devinsky, D A Booth and E L Gibson, and D J Millward
Ludwig, D. S., Aronne, L. J., Astrup, A. V., de Cabo, R., Cantley, L. C., Friedman, M. I., Heymsfield, S. B., Johnson, J. D., King, J. C., Krauss, R. M., et al. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab385 · Cited by 2 · see citing works
Self-citationReply to C M Sciarrillo et al.
Soto-Mota, A., Jansen, L. T., Norwitz, N. G., Pereira, M. A., Ebbeling, C. B., & Ludwig, D. S. (2024) · Journal of Nutrition · doi:10.1016/j.tjnut.2024.01.026 · Cited by 2 · see citing works
Self-citationWong, J. M., Ludwig, D. S., Allison, D. B., Baidwan, N. K., Bielak, L., Chiu, C.-Y., Dickinson, S., Golzarri‐Arroyo, L., Heymsfield, S. B., Holmes, L., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107490 · Cited by 1 · see citing works
Self-citationLow-carbohydrate diet for people with type 2 diabetes mellitus
Burgos, M. A., Ivaldi, D., Oltra, G. V., Liquitay, C. M. E., & Garegnani, L. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015954 · Cited by 1 · see citing works
Torres, S. Y. L., Gower, B. A., Garvey, W. T., & Martins, C. (2025) · Obesity · doi:10.1002/oby.70020 · Cited by 1 · see citing works
García-Gorrita, C., Onofre, N. S., Merino-Torres, J. F., & Soriano, J. M. (2025) · Nutrients · doi:10.3390/nu17223559 · Cited by 1 · see citing works
He, Y., Dai, Z.-H., Yu, A. P., Wong, S. H., & Poon, E. T. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70379 · Cited by 1 · see citing works
Rethinking COVID-19 and Beyond: Prevention, Remedies, and Recovery
Maffetone, P. B., & Laursen, P. B. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.748498 · Cited by 1 · see citing works
Change to a Higher Carbohydrate Diet and Energy Expenditure among Postmenopausal Women
Prentice, R. L., Neuhouser, M. L., Tinker, L. F., & Howard, B. V. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab095 · Cited by 1 · see citing works
Editorial: Is reducing dietary carbohydrate the way to go?
Magkos, F., & Mittendorfer, B. (2021) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000753 · Cited by 1 · see citing works
Ludwig, D. S., & Ebbeling, C. B. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab098
Self-citationAngelidi, A. M., Bartell, E., Huang, Y., Zeleznik, O. A., Estanyol-Torres, N., Mi, M. Y., Bhupathiraju, S. N., Ra, K., Wittenbecher, C., Lasky-Su, J. A., et al. (2026) · Nature Communications · doi:10.1038/s41467-026-68353-z
Self-citationZEMB, P. A., & Joulia, F. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6068352
Rice, S. M., Buchanan, L., Calkins, M. W., Cucuzzella, M. T., Cywes, R., Devine, P. L., Kalamian, M., Kalayjian, T., Reynolds, D. B., & Westman, E. C. (2026) · Journal of Metabolic Health · doi:10.4102/jmh.v9i1.152
- Authors
- Ludwig, D. S., Dickinson, S. L., Henschel, B., Ebbeling, C. B., & Allison, D. B.
- Affiliations
- Boston Children's Hospital (US)
- Indiana University Bloomington (US)
- Corresponding author
- Ludwig, David S
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 151
- Issue
- 3
- Pages
- 482-490
- ISSN
- 0022-3166 (ISSN-L)
- PMC
- PMC7948201
- OpenAlex
- W3110348447
- Cited by
- 71
- References
- 68
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 10 · 2023: 13 · 2022: 12 · 2021: 20 · 2020: 3
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Nutrition (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Funders
- New Balance Foundation
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Keywords
- low-carbohydrate diet, total energy expenditure, macronutrient composition, carbohydrate intake, study duration, physiological adaptation, energy balance, controlled feeding study, meta-analysis heterogeneity, weight maintenance, weight loss maintenance, weight gain prevention
- MeSH terms
- Diet, Carbohydrate Loading, Duration of Therapy, Body Weight, Energy Intake, Clinical Trials as Topic, Dietary Carbohydrates, Energy Metabolism, Humans, Obesity, Diet, Carbohydrate-Restricted
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