Original Article

European Journal of Clinical Nutrition (2013) 67, 759–764; doi:10.1038/ejcn.2013.90; published online 1 May 2013

Lipids and cardiovascular/metabolic health

Ketosis and appetite-mediating nutrients and hormones after weight loss

P Sumithran1, L A Prendergast1,2, E Delbridge1, K Purcell1, A Shulkes3, A Kriketos1 and J Proietto1

  1. 1Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
  2. 2Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
  3. 3Department of Surgery (Austin Health), University of Melbourne, Melbourne, Victoria, Australia

Correspondence: Professor J Proietto, Department of Medicine, University of Melbourne, Level 2, Boronia Building, Heidelberg Repatriation Hospital, 300 Waterdale Rd, Heidelberg, Victoria 3081, Australia. E-mail: j.proietto@unimelb.edu.au

Received 1 October 2012; Revised 27 March 2013; Accepted 3 April 2013
Advance online publication 1 May 2013





Diet-induced weight loss is accompanied by compensatory changes, which increase appetite and encourage weight regain. There is some evidence that ketogenic diets suppress appetite. The objective is to examine the effect of ketosis on a number of circulating factors involved in appetite regulation, following diet-induced weight loss.



Of 50 non-diabetic overweight or obese subjects who began the study, 39 completed an 8-week ketogenic very-low-energy diet (VLED), followed by 2 weeks of reintroduction of foods. Following weight loss, circulating concentrations of glucose, insulin, non-esterified fatty acids (NEFA), β-hydroxybutyrate (BHB), leptin, gastrointestinal hormones and subjective ratings of appetite were compared when subjects were ketotic, and after refeeding.



During the ketogenic VLED, subjects lost 13% of initial weight and fasting BHB increased from (mean±s.e.m.) 0.07±0.00 to 0.48±0.07mmol/l (P<0.001). BHB fell to 0.19±0.03mmol/l after 2 weeks of refeeding (P<0.001 compared with week 8). When participants were ketotic, the weight loss induced increase in ghrelin was suppressed. Glucose and NEFA were higher, and amylin, leptin and subjective ratings of appetite were lower at week 8 than after refeeding.



The circulating concentrations of several hormones and nutrients which influence appetite were altered after weight loss induced by a ketogenic diet, compared with after refeeding. The increase in circulating ghrelin and subjective appetite which accompany dietary weight reduction were mitigated when weight-reduced participants were ketotic.


appetite; ketosis; very-low-energy diet; weight loss

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