This is fantastic! I don’t feel like I’m on a “diet” at all. There’s plenty of food, plenty of protein- (I’m an omnivore- a clean one tho), the juices and snacks are tasty. It’s even surprisingly easy to swallow a spoonful of MCT oil (medium chain triglycerides), it tastes like buttery coconut cream! If that seems strange, one could simply mix it in with the salad or shake it up in the juices. No problem.
Fillenworth suggests Brami beans as a great snack for keto dieters, especially since most legumes tend to be too high in carbohydrates. With only 60 calories, 2 grams of fiber, and a whopping 7 grams of protein per 25 beans, these Brami beans are an excellent way to boost protein intake (especially if you need a break from meat). (Related: Is a Vegetarian Keto Diet Healthy?)
In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[53]

A low carb diet plan is a way of eating that is high in fat, moderate in protein and low in carbohydrates. There are different variations of low carb, and the keto diet is a special type of low carb with added characteristics. The number of carbohydrates will vary depending on your insulin tolerance and activity level, but on average, these are the common numbers of carbs:
We understand that you may not have time to track all your macros, which is why we include the macros with each keto recipe.  However, try grabbing a handful of almonds for a keto snack and realizing even a big handful is over a "serving size" and greater than 200 calories.  If you are using the keto diet for weight loss, this may not fit into your macros of 1200-1500 calories per day.
After about two to seven days of following this eating routine, you go into something called ketosis, or the state your body enters when it doesn't have enough carbs for your cells to use for energy. Then it starts making ketones, or organic compounds that your bod then uses in place of those missing carbs—and oh, it also burns fat for more energy, says Beth Warren, R.D., founder of Beth Warren Nutrition and author of Living A Real Life With Real Food.
Early studies reported high success rates: in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (what is known as a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).[18]
Still, it can be hard to get enough fat when you first start this diet. Butter, nuts, coconut and olive oils, and fatty cuts of meat are all on the menu. However, don't go overboard with polyunsaturated fats like soybean, corn, or sunflower oil. Keto dieters who increase their intake of those fats often end up with gastrointestinal distress that causes them to jump ship.
For example; if you get into ketosis and release your stored fat in your fat cells, there is a chance you could end up with a fatty liver since all these fat flowing out has to come out through the liver.  The way to prevent this is to consume larger quantities of vegetables or salad as a way of keeping your liver flushed of fat. A recent study, in fact, found that the ketogenic diet reduced fat on the liver, inflammation, and fibrosis.6 
Meal prepping is the secret to eating on a tight budget. It allows you to buy the items that are on sale, in bulk, and prepare them for quick access throughout the week. The meal prep detailed here took us about 2 hours of “active time” and another 3 hours of “passive time”. The passive time was mostly waiting for the chicken to cook/cool. The items we prepped for this meal plan are:

Probably, and there are a few reasons why, Keatley says. For starters, people usually reduce their daily caloric intake to about 1,500 calories a day because healthy fats and lean proteins make you feel fuller sooner—and for a longer period of time. And then there’s the fact that it takes more energy to process and burn fat and protein than carbs, so you're burning slightly more calories than you did before. Over time, this can lead to weight loss.
Vicky started Tasteaholics in 2015 with her boyfriend, Rami, hoping to document all their low carb cooking adventures. She lives in NYC and her favorite food is steak and lava cake. She enjoys photography, travel, cooking, working out, cats & Harry Potter. She loves sharing her knowledge, cooking tips and creative dishes with all of Tasteaholics’ readers.
That's because my intro to this seemingly new plan was when I worked in a hospital, where ketogenic diets were specifically used as a medical nutrition therapy for pediatric patients with seizure disorders, for whom medication was no longer effective. In other words: It was used as an absolute last resort for families who felt otherwise hopeless in the face of a neurological disease, and under strict medical supervision.
Like those other guys, the keto diet follows strict guidelines on what you can and can’t eat, suggesting you limit your daily carb intake to 20 to 30 net grams while upping your fat like crazy. If all goes well, your body will stop getting all its energy from glucose and insulin produced by grains, sugars, and starches and instead start cranking out ketones to break down and burn up stored fat. Sound good? Of course, it does.

A lot of conflicting information has been circulated about the consumption of fat. People are sometimes concerned that adding fat to their diets will cause them to gain weight. This is not necessarily the case. Fat is a neutral food when it comes to insulin. It is also satisfying. Fat makes you feel full longer to help with intermittent fasting (IF).
What else happens when we break down muscle glycogen? We lose water weight! Our muscles store about 3 grams of water for every gram of glycogen, meaning we can lose quite a bit of weight right away when we tap into glycogen stores for fuel. That's why someone who loses weight in "just one week!" from a low-carb plan is likely losing water weight, not necessarily real weight that stays off over time.
Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions.[18] Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.[3]

No deep fryers or air fryers needed for these wings! Forget those greasy chicken wings you’d order at a restaurant and opt-in for these homemade guiltless garlic parmesan wings. You won’t find rancid vegetable oil, gluten or a deep frier here — just avocado oil, healthy pecorino romano and free-range, organic chicken for a twist on an otherwise unhealthy classic.
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. There is some evidence of synergistic benefits when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[3]
Meat is fair game when you’re following the keto diet, which is why Griffin is a fan of putting together a plate of charcuterie when you’re in the mood for a snack. This doesn’t need to be one of those fancy displays you’d find at a restaurant — you can keep it simple and arrange whatever cured meats you have on hand. (Psst: This one makes a great party appetizer, too!)
Typically packed in oil with heads removed, these are easily forked and eaten for a perfect low-carb snack. If you’re wondering what they taste like? They taste like a mild tuna, actually. They often come in flavors such as jalapeno and tomato sauces for some added delight. Don’t knock it till you try it, and they’re fairly inexpensive, so they’re worth a shot.
The problem is that, with a bit more time, the pancreas eventually stops compensating, becomes exhausted, and makes less and less insulin—allowing the sugar in your blood to go higher and higher. So, the first stage of insulin resistance is normal or low blood sugars due to excessive compensation of insulin. Then this is followed by higher and higher blood sugars as you lose the ability to compensate for the sugar with insulin. This is called diabetes.
The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.[7]

Try Googling “TDEE Calculator”. Once you plug in your stats, the site will calculate your total daily energy expenditure. This is a useful guide in determining how many calories to eat. From there, if you are trying to lose weight, just reduce your caloric intake, increase your expenditure (through exercising more), or use a combination of the two.
Reaction to eggs could be due to the following: Read Healthy Traditions website regarding chickens being fed soy – soy will be in the eggs. If you can’t get truly organic soy corn free eggs, you may order through them. It is said all soy, even organic is contaminated GE, plus it is said by reliable sources that organic soy, if consumed, should only be fermented. Non organic soy and corn are GE and heavily sprayed with diluted white phosphorus and flamydahyde (sp?) embalming fluid i.e. glousphate (sp) in Roundup Ready among other toxic chemical witch’s brews that farmers use requiring wearing hazmat suits.

The beauty of salmon is that you can cook it with marginal interference. A simple sauce of butter, lemon juice, chopped garlic, and some salt and pepper will go a long way to enhancing the natural flavor of the salmon. Drizzle the sauce over 4-6 oz portions of fish, bake at 450F for 5 minutes per 1/2″ thickness of fish. In another bowl, toss the asparagus with olive oil, salt, and pepper, spread it out evenly on a cookie sheet, and roast in the oven at 450 for 20 minutes. Easy dinner (with leftovers if you plan ahead) that’s full of nutrition, protein, and healthy fat, while keeping your carbs low. Get the recipe and instructions


The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
You may also want to buy some Ketostix Reagent Strips so that you can check to see if you are in ketosis for the first few weeks. However, after the first 3-4 weeks on the plan, the goal is to become "keto-adapted". Once adapted, the body should be burning the ketones for fuel. The stick shouldn't register as deep purple if you are using the ketones as a fuel source. And they now have blood ketone meters available to track blood ketones at home. This is a much more accurate way to track your individual ketone levels. See my ketosis page for more information.

When you eat a ketogenic diet, you switch your body’s fuel source to fat rather than the body’s usual source, glucose (1). From this fuel source switch, the hunger hormone, Ghrelin, is reduced which causes your appetite to decrease (1). Because of the reduction in appetite, it is easier to adopt an intermittent fasting approach or an approach that lessons unwanted eating behavior outside your desired hours (AKA curbs the late night munchies). Therefore, I recommend eating 4 bigger meals rather than 6 small meals on a Ketogenic Meal Plan.
Stomach growling? Reach for a handful of macadamia nuts, which have the highest amount of fat and lowest amount of carbs in the nut family, according to previous research in the journal Nutrients. Nutrition aside, they’re snacking all-stars because they’re easy to bring with you and don’t need to be refrigerated. Keep a stash wherever you spend your day — in the car, at your desk, or in the pantry at home.

Lunch: pat dry chicken and cut into cubes. Lightly (!) salt and pepper. Heat a skillet over medium heat, once hot add coconut oil and fry chicken cubes until brown from all sides. Remove chicken, and add crushed garlic, curry paste and fish sauce to pan. Stir until fragrant and remaining oil in pan and curry paste are well combined. Then add coconut milk and whisk until well combined. Simmer and reduce sauce until desired consistency (1-3 minutes). Pour sauce over chicken and sprinkle with sesame seeds. Serve with baby spinach.
Saturated fat is not harmful in the context of a low carb diet. This study from Johns Hopkins Medical School confirms this. The ketogenic diet plan is healthier because the higher saturated fat intake increases your HDL cholesterol, and at the same time, a lower carb intake decreases your triglycerides levels. These two factors are the major markers for heart disease, and the closer your triglyceride/HDL ratio is to 1, the healthier your heart. In reality, the cause of heart disease is a chronically high carbohydrate consumption, not a high saturated fat and cholesterol intake. I think the best way to learn this is to get a full blood test before you start a ketogenic diet plan, then do the diet faithfully for 3 months. Then have your blood work checked again. You'll see the difference and discover how much better you feel. 
*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease. Information on this site is provided for informational purposes only, it is not meant to substitute medical advice provided by your physician or any other medical professional. You should not use the information contained on this site for diagnosing or treating a health problem, disease, or prescribing any medication. Please read product label before use. Best results are only achieved when combined with diet and exercise program. Results not typical for any or all claims.

Hunger is one way to know if you’re in fat burning, because the longer you do keto, the less hungry you’ll be.39,40 If you’re getting severe hunger with weakness and brain fog, you’re not quite into keto. Back off a bit. Don’t be doing 20-hour fasts. You need more fuel to give your body the energy it needs, and that includes energy to manufacture the enzymes to burn fat instead of glucose. Take it slow, add more fat to your first meal, and eat nutrient-dense foods. If you need more nutrients, try adding some nutritional yeast and electrolytes, and major amounts of potassium. These will help you fix insulin resistance and help you get into fat burning. Bone broth is great for a snack. It’s just nutrients without calories, period.


Each meal you have to judge how much fat you need. If you’re really battling a high appetite/high craving day or week, you might want to add more fat, especially at breakfast to trim your appetite throughout the day and enable you to go longer without cravings and hunger. Ketosis in general suppresses your appetite, so your hunger will be greatly reduced. You're going to be able to go many hours without eating. So let the hunger dictate how much fat you eat. If you're not hungry, cut down on the fat and go a little bit lighter. You might need a little bit more fat sometimes, but don't go crazy, because that's going to slow you down.
A systematic review in 2018 looked at sixteen studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein (LDL), high total cholesterol, and weight loss.[23]
Be flexible. We don’t know your personal goal, your budget, your cooking skills, what your favorite foods are or what foods you don’t like to eat so we cannot personalize the meal plan just for you. This plan is just to give you ideas of what to cook for breakfasts, lunches and dinners. So please feel free to adjust and personalize it to make it work for you.
Try Googling “TDEE Calculator”. Once you plug in your stats, the site will calculate your total daily energy expenditure. This is a useful guide in determining how many calories to eat. From there, if you are trying to lose weight, just reduce your caloric intake, increase your expenditure (through exercising more), or use a combination of the two.

This recipe is from our e-book, 20 Low-Carb Instant Pot Pressure Cooker Recipes. In the e-book we call it “Better Than Crack Chicken”, which it really is! We switched up the seasoning a little (omitted the Ranch mix and added our own keto-friendly seasonings), and this takes it over the top in terms of deliciousness. Our e-book is now on sale on Amazon for just $4.99!
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those that have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram (EEG) shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[45]
That’s why you’ll find snacks of all flavors — salty, sweet, and savory — in this keto snack recipe roundup. There are grab-and-go options, as well as keto snacks requiring some preparation and cooking. We’re willing to bet that they’re in fact so tasty, you’ll forget you’re on a diet. All the while, these keto snacks will keep you going strong in ketosis — that uber fat-burning state you’re aiming for as your body shifts from burning carbs to fats for fuel.
Some keto cookies or a keto brownie can certainly be delicious, but if you’re looking for a dessert that’s a little more interesting, then you have to try this chocolate chia pudding! I love chia seeds for a number of reasons. They’re high in antioxidants, vitamins such as calcium, potassium and magnesium, Omega-3 ALA, dietary fiber and even protein. So, while this dish feels like a dessert, you’re receiving plenty of necessary nutrients. Enjoy guilty-free!
Your game plan: Keep a bunch of easy snacks in the back of your mind so you’re prepared when hunger hits. Simplicity is key here, because when you’re hungry you won’t have the time or patience to run to the store and fix something up. That’s why we’ve focused this list of 10 keto-friendly snacks on ingredients you likely already have in your kitchen.
Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[55]
Julie Hand is a certified holistic health and nutrition counselor (Institute for Integrative Nutrition), personal fitness trainer (National Personal Training Institute), and yoga teacher (Kripalu Center for Yoga & Health). Though she can’t resist trying every science-backed health tip, she also has a penchant for crystals and astrology (don’t judge). You can find her walking the beach (coffee in hand, of course) and practicing the ukulele on weekends.

You've likely heard horror stories of what competitors feel like when they cut carbs low, or when the average bro talks about going keto. However, the odds are that those people were not actually in nutritional ketosis, or more importantly, following a well-formulated ketogenic diet. Yes, you may experience some fogginess and discomfort, but it doesn't have to be intense if you handle it right.


Leftovers will be another thing we will take into consideration. Not only is it easier on you, but why put yourself through the hassle to cook the same food more than once? Breakfast is something I normally do leftover style, where I don’t have to worry about it in the morning and I certainly don’t have to stress about it. Grab some food out the fridge, pre-made for me, and head out the door. It doesn’t get much easier than that, does it?


Chocolate and avocados are a strangely fantastic combination. Adding avocado to dessert-type recipes gives them a smooth, silky texture without a pronounced flavor. That’s certainly the case with this pudding, which is crazy easy to make. Just add cocoa powder, avocado, stevia, vanilla extract and salt to a bowl and mix. Easy? Yes. Tasty? Also yes.
It is very interesting to read about the keto/low card diet.I love to change my lifestyle as I an TYPE 2 Diabetic.I subscribed for a free printable low carb meal .The initial email stated that that I will receive an email for instructions to access the members area .Your free download will be there.However it is very deceiving ,I never got the 2nd email with instructions which is frustrating and not good .Hopefully this is not a way to get us to pay to get the printable version.
Your game plan: Keep a bunch of easy snacks in the back of your mind so you’re prepared when hunger hits. Simplicity is key here, because when you’re hungry you won’t have the time or patience to run to the store and fix something up. That’s why we’ve focused this list of 10 keto-friendly snacks on ingredients you likely already have in your kitchen.
All the bad hype you have been hearing about high-fat diets is not exactly true. If you personally read the studies involving high-fat diets, you’ll discover that 99% of it is a combination of high-fat and high-carbohydrate diets. When you combine high carbohydrates with fat or even protein, insulin will spike dramatically. So that deep-fried donut or deep-fried fatty fries are really fried carbohydrates.
Some ingredients you will already have in your cupboards like seasonings and condiments.  We list these out at the beginning of the meal plan.  We assume that you'll have them in stock.  If you're worried you won't have them all, you can check the meal plan for the daily ingredients as well!  There are also some rare ingredients that we suggest you purchase at the beginning of you ketogenic diet journey.  You'll begin to use these low carb ingredients in more and more of your keto diet recipes.  You can get bargains on items such as almond flour if you purchase ahead online instead of waiting to purchase at the grocery store.  In addition, you won't have to wander the health stores for hours in search of these items to find out they don't stock them, or that they are ridiculously over-priced.
While healthy fats are a keto mainstay, they're not the only thing you need: "It's important to make sure you're getting plenty of vitamins, minerals, and phytonutrients when observing the keto diet," Sugiuchi explains. Seaweed snacks, she says, are a salty and crunchy way to score some extra nutrients and can satisfy any crunchy/salty/carby cravings.

I have the same calories limit and macro. I easily stay within the limit but I completely stopped eating any type of bread, pasta, rice, potatoes and starchy food. I started using butter or coconut oil to cook and put mayo EVERYWHERE. It’s my new favourite topping for lettuce even XD. Then I eat plenty of eggs/meat/fatty fish and cheese. Olives are great as a snack. I cut out completely milk and use whipping cream instead. If you get into this completely counter intuitive way of thinking of food it’s super easy to get enough fat within the calorie limit.


*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease. Information on this site is provided for informational purposes only, it is not meant to substitute medical advice provided by your physician or any other medical professional. You should not use the information contained on this site for diagnosing or treating a health problem, disease, or prescribing any medication. Please read product label before use. Best results are only achieved when combined with diet and exercise program. Results not typical for any or all claims.
What else happens when we break down muscle glycogen? We lose water weight! Our muscles store about 3 grams of water for every gram of glycogen, meaning we can lose quite a bit of weight right away when we tap into glycogen stores for fuel. That's why someone who loses weight in "just one week!" from a low-carb plan is likely losing water weight, not necessarily real weight that stays off over time.

Josh Axe, a doctor of natural medicine and clinical nutritionist, estimates that about 25% of people who try a ketogenic diet experience these symptoms, with fatigue being the most common. “That happens because your body runs out of sugar to burn for energy, and it has to start using fat,” he says. “That transition alone is enough to make your body feel tired for a few days.”
Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[55]
Thank you Mira for your quick reply. I didn’t make it that same day but I just made a batch now and they are excellent! I really enjoyed them. I made the recipe times 10 for 12 large muffin slots in the muffin tin. I’m thinking of shaping a larger round of batter on a parchment lined pan next time and after baking, carefully cutting in half to make 2 rounds to make a pizza crust. Thank you so much!!!
Some ingredients you will already have in your cupboards like seasonings and condiments.  We list these out at the beginning of the meal plan.  We assume that you'll have them in stock.  If you're worried you won't have them all, you can check the meal plan for the daily ingredients as well!  There are also some rare ingredients that we suggest you purchase at the beginning of you ketogenic diet journey.  You'll begin to use these low carb ingredients in more and more of your keto diet recipes.  You can get bargains on items such as almond flour if you purchase ahead online instead of waiting to purchase at the grocery store.  In addition, you won't have to wander the health stores for hours in search of these items to find out they don't stock them, or that they are ridiculously over-priced.
For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer (two weeks) but the long-term seizure reduction rates are unaffected.[43] Parents are encouraged to persist with the diet for at least three months before any final consideration is made regarding efficacy.[9]
Early studies reported high success rates: in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (what is known as a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).[18]
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