Age \< 18 years

Pregnancy

Breastfeeding

Moderate or severe kidney failure

Cardiovascular diseases: heart failure (NYHA III-IV), unstable angina, acute coronary syndrome or stroke within the past 12 months, paroxysmal atrial fibrillation, any type of atrioventricular block, left bundle branch block

Liver diseases: Child-Pugh C, elevated transaminases with AST or ALT ≥ 5 times the upper limit of normal, INR ≥ 1.5, total bilirubin ≥ 2 mg/dL

Diabetes: type 1 diabetes mellitus, type 2 diabetes mellitus with insufficient pancreatic endocrine reserve (C-peptide \< 0.8 ng/mL), type 2 diabetes mellitus on multiple daily insulin injections

Last attempt of VLCKD outside the research protocol within the past 12 months

Eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder

Psychiatric comorbidities, alcohol or substance dependence

Frail elderly patients

Adherence and Tolerability of Four Very Low-Calorie Ketogenic Diet Approaches in Adults With Obesity or Complicated Overweight

What this study is about