| Summary: | Summary Objective Alternate day fasting (ADF) is a popular weight loss regimen. Whether carbohydrate restriction can enhance the weight loss achieved with ADF remains unclear. Accordingly, this study examined the effect of ADF combined with a low‐carbohydrate diet on body weight and metabolic disease risk factors. Methods Adults with obesity (n = 31) participated in ADF (600 kcal “fast day” alternated with an ad libitum “feast day”) with a low‐carbohydrate background diet (30% carbohydrates, 35% protein, and 35% fat). The 6‐month trial consisted of a 3‐month weight loss period followed by a 3‐month weight maintenance period. Results Body weight decreased (−5.5 ± 0.5%; P < .001) during the weight loss period (month 0‐3) but remained stable (P = .57) during the weight maintenance period (month 4‐6). Net weight loss by month 6 was −6.3 ± 1.0%. Fat mass was reduced (P < .01) by month 6, while lean mass and visceral fat mass remained unchanged. Total cholesterol and low‐density lipoprotein (LDL) cholesterol levels decreased (P < .05) by −6 ± 2% and − 8 ± 3%, respectively, by month 6. Systolic blood pressure was also reduced (P = .03) by −7 ± 3 mm Hg. Fasting insulin decreased (P = .03) by −24 ± 8% by month 6 relative to baseline. High‐density lipoprotein (HDL) cholesterol, triglycerides, diastolic blood pressure, heart rate, fasting glucose, homeostatic model assessment of insulin resistance (HOMA‐IR), and haemoglobin A1C (HbA1c) remained unchanged. Conclusions These findings suggest that ADF combined with a low‐carbohydrate diet is effective for weight loss, weight maintenance, and improving certain metabolic disease risk factors such as LDL cholesterol, blood pressure, and fasting insulin. While these preliminary findings are promising, they still require confirmation by a randomized control trial.
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