J Nutr 2009, 8:23–31.CrossRef Competing interest We declare that no conflict of interest. We have no financial or other interest in the product or distributor of the product. Author’s contribution Paola Brancaccio, participated the design of the study, performed the

statistical analysis, the interpretation of data and drafted the manuscript, Francesco Mario Limongelli, have given final approval of the version, Iride Paolillo, participated to the acquisition Gemcitabine supplier of data and carried out urinalysis, bioimpedance analysis and muscle ultrasound, Antonio D’Aponte, participated to the acquisition of data and carried out the Wingate test, Vincenzo Donnarumma, carried out all the laboratory analysis, Luca Rastrelli, performed the water analysis, participated the interpretation of data, drafted the manuscript and given final approval of the version. All authors read and approved the final manuscript.”
“Background Many procedures used for body weight reduction by athletes in sports that include weight categories lead to a series of negative side effects which directly influence physiological efficiency during sports performance. The practice of rapidly losing a significant amount of weight, through low calorie diets, deliberate dehydration, saunas etc., just before competition, is widespread BMS-907351 mouse [1–3]. These traditional methods are often

unsafe and typically impair health, physiological function, water balance, electrolytes, see more glycogen and lean body mass [1, 4–6] and are sometimes illegal as with the use of diuretics [3].

However for athletes competing in sports divided into weight categories a safe method of weight loss that does not impair performance can be a legitimate and important tool. For example, bodybuilders regularly need to reduce fat and/or weight before competition preferably without affecting muscle strength or muscle size [7] and a VLCKD (very low carbohydrate ketogenic diet) is commonly used to achieve this. VLCKD is a diet in which the daily carbohydrate intake is below 30 g and this restriction limits glucose availability to tissues, stimulating ketogenesis in the liver. The physiological function of ketosis is to supply the heart and central nervous system (CNS) with a high energy metabolic substrate during reduced glucose availability – by this mechanism ketones allowed our ancestors to survive and remain efficient even when deprived of food [8, 9]. On this basis the ketosis induced by a VLCKD may be defined as “physiological ketosis” to distinguish it from the severe pathological ketosis (or ketoacidosis) commonly seen in uncontrolled diabetes [10–12]. The use of low carbohydrate ketogenic diets for weight loss, despite their efficacy, has been an area of controversy. In the last few years though an increasing amount of evidence has accumulated concerning the positive effects on short term weight loss, metabolic profile with regards to insulin sensitivity, glycemic control and serum lipid values [12–16].