Side effects and complications while fasting and calorie restriction dieting.


Liver and gallbladder disease before and after very-low-calorie diets.
Am J Clin Nutr. 1992 Jul;56(1 Suppl):235S-239S.
Andersen T.
Department of Medical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Hepatobiliary characteristics of untreated obese patients and those of patients reducing weight through very-low-calorie diets (VLCDs) are reviewed. In untreated obesity, hepatobiliary abnormalities are prevalent. Fatty change is common and may be related to insulin resistance. Moreover, portal inflammation and fibrosis are prevalent findings, also in the absence of alcohol abuse. The liver plays a key role in the hyperinsulinism and hyperlipidemia, and hepatic drug metabolism is influenced by enhanced glucuronidation and sulphatation. Predisposition to gallstone formation can be ascribed to increased biliary cholesterol secretion in concert with changed nucleating factors and altered gallbladder motility. Weight loss by VLCD reduces fatty change but may induce slight portal inflammation and fibrosis. Insulin resistance and pharmacokinetic abnormalities regress. During VLCD the risk of gallstone formation is markedly increased. The deleterious effects described of a rapid weight loss should draw some attention to the liver and biliary tract during VLCD treatment.

Nonphysician supervision of a very-low-calorie diet. Results in over 200 cases.
Int J Obes. 1981;5(3):237-41.
Atkinson RL, Kaiser DL.
Nonphysician nutritional therapists treated 234 obese patients with a 12-week behavioral modification, nutrition education program followed by up to 12 weeks on a very-low-calorie diet (VLCD). Mean weight decreased from 104.5 kg to 85.8 kg after 12 weeks on VLCD. Mean maximal weight loss for all patients was 17.2 kg. Blood pressure decreased from 133/86 to a low of 111/70 during VLCD. In 91 hypertensive patients, blood pressure fell from 145/95 to 128/81 after 12 weeks of VLCD. No serious side effects of VLCD were noted, although two patients developed mild cases of gout and one patient was taken off the fast when premature ventricular contractions were noted on ECG. Cost analysis reveals that physician care is almost three times as expensive as care by non-physician nutritional therapists. We conclude that the treatment of obesity should be performed by nutritional therapists under physician supervision using a comprehensive program of behavioral modification and VLCD.

Obesity and risk of gallstone development on a 1200 kcal/d (5025 Kj/d) regular food diet
Heshka S, Spitz A, Nuñez C, Fittante AM, Heymsfield SB, Pi-Sunyer FX.
Int J Obes Relat Metab Disord. 1996 May;20(5):450-4.

Gallstone formation and weight loss.
Weinsier RL, Ullmann DO.
Obes Res. 1993 Jan;1(1):51-6. Review.

Gallstone formation during weight-reduction dieting.
Liddle RA, Goldstein RB, Saxton J.
Arch Intern Med. 1989 Aug;149(8):1750-3.