The media keeps simplifying this diet as “soups and shakes”, so I can see why some people may be outraged. But it’s much more than that. Let's explore why
These "soups and shakes" are actually more broadly known as meal replacements (MR). MR are used to help those living with obesity meet a target of 800 calories per day. Otherwise termed: very low calorie diet (VLCD).
What is a Very Low Calorie Diet (VLCD)?
A VLCD is a strategic short-term dietary approach employing nutrient-dense meal replacements to induce ketosis, a state where the body shifts from utilizing glycogen (stored sugar) to ketones, sourced from fatty acids. In simpler terms, it means your body taps into its fat reserves for energy, resulting in rapid weight loss.
However, it's worth noting that the ketogenic diet, often criticized by healthcare professionals for the general population, is not a one-size-fits-all solution. Here's why:
Low in Carbs and Fiber: The keto diet restricts carbs and eliminates fiber-rich cereals, which can impact overall health, including bowel function and disease risk.
Potential Nutrient Deficiencies: It may lead to deficiencies in selenium, specific B vitamins, and magnesium.
High in Unhealthy Fats: The diet can be rich in trans and saturated fats, associated with increased inflammation in the body.
Social Limitations: It's a restrictive diet that may affect social interactions and personal enjoyment, potentially leading to social exclusion.
Despite its limitations, ketosis has shown clinical promise, especially in helping obese individuals achieve a 5-10% weight loss. This can yield significant health benefits, including:
Improved heart health, marked by enhanced blood cholesterol, blood lipids, blood pressure, and reduced inflammation.
Positive effects on mental health.
Alleviation of sleep apnea and breathing issues.
Enhanced mobility and pain management.
Improved fertility, including benefits for men.
Reduced risk of certain cancers.
Moreover, recent clinical trials have explored the role of short-term VLCDs in treating obesity and type 2 diabetes (T2DM), effectively inducing ketosis. These trials, spanning approximately 8-20 weeks and involving total meal replacements (TMR), have resulted in substantial weight loss and T2DM remission among obese patients. Notably, over 30% of patients remained in remission two years after treatment—a significant achievement in managing these conditions.
Why TMR?
MRs are fortified with vitamins and minerals to prevent deficiency (which can occur on other low calorie diets). Plus they contain plenty of protein. This protects muscle mass; preserving immune function and metabolism. So they are much safer to follow, compared to fad diets.
Patients may get up to 5 MRs (bars, porridge, curries, pancakes etc) a day. Which means if spaced out, patients can eat at regular intervals throughout the day. Unlike some other fad diets 👀
MRs take the maths out of dieting. This prevents calorie counting (snooze), food weighing (who actually has the time?) and removes some thought processes around food (which can make dieting mentally draining).
Why a multidisciplinary approach?
The dietitian screens patient prior to commencing a programme with VLCD or not, to ensure they are eligible. Screening includes:
disordered behaviours (eating, drugs, alcohol)
medical history (gallstones, kidney disease, cancer, stroke)
medication history (steroids, SSRI etc)
supports behaviour change during TMR and any side effects
provides dietary advice for slow reintroduction and maintenance.
The doctor will examine medical history, examine blood results, adjust medications and support the wider team. The psychologist will support behaviour change in the patient, facilitates education around body image and disordered eating, works with the patient to develop coping strategies and supports the wider team with complex caseload.
Summary
This is a promising option for those living in a larger body and those living with T2DM. Weight loss is the by product of this diet, with main benefits on the slides. This diet should only be carried out under the clinical supervision of doctors, psychologists and specialist dietitians.