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]

Insulin triggers include carbohydrates, sugars, excessive protein. Also, every time you eat, you trigger insulin – unless you eat fat only. Combining certain foods, in fact, really spikes insulin, such as combining protein with sugars—so meat with bread, meats with sugary condiments like ketchup, barbeque sauce, sweet chili sauce and chicken fingers—these are deadly for the blood sugar and really spike insulin like birthday cake. Also, certain compounds in fast food really spike insulin, especially MSG, which is added to all kinds of fast foods, not just Asian food.

Janie, We haven’t made this recipe in the oven, but yes, we think it would work well! Here’s how we would do it: 1) crisp the bacon on the stovetop; 2) for step 2 in the recipe above, add all ingredients to a 9 by 13-inch casserole dish, cover it with foil, and bake it at 350F until the chicken is fully cooked, about 30 to 45 minutes (the chicken should not be pink in the center, and it should shred easily with a fork); 3) remove and shred the chicken; 4) stir the shredded chicken into the creamy sauce along with the cheddar cheese; 5) top with bacon and scallion and serve. If you give it a try, please let us know how it goes!

Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance: