After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]
Rest assured, not everyone experiences this side effect of the ketogenic diet and, if you do, it will abate on its own; furthermore, there are some simple preventative steps you can take to lower your likelihood of “catching” this flu. As you adopt a ketogenic diet, make sure you replace electrolytes, eat enough fat to meet your total caloric needs, drink plenty of water, and exercise as you are able. It’s very important, however, to ensure that you aren’t relying on sugary sports drinks to replace electrolytes, as all that added sugar will prevent your metabolism from entering ketosis. Ultimately, electrolytes play a crucial role in our health and many Americans do not consume them at adequate levels, so it is very important to monitor your intake of these nutrients regardless of whether or not you are an adherent of the ketogenic diet.
The KD stands in stark contrast to current macronutrient recommendations for both health promotion, as well as enhancement of athletic performance (7,21). The KD is characterized by a macronutrient distribution ratio consisting of approximately 70 – 80% fat, 10 – 20% protein and <5% carbohydrate (CHO), with daily CHO intake limited to ≤50 grams. Two of the most prominent and vocal researchers of the KD, Jeff Volek, PhD and Stephen Phinney, MD, PhD, in their book The Art and Science of Low Carbohydrate Performance, recommend protein consumption of 0.6 – 1.0 grams per lb of lean body mass, a figure which almost perfectly matches the commonly recommended protein intake for athletes (i.e., 1.2 – 2.0 g/kg bodyweight) (21,26). With CHO intake radically restricted and protein within the commonly recommended range, fat becomes the primary macronutrient target for manipulation.

Hi Cathy, are you adapting these recipes yourself or are they already developed using coconut flour? From experience, it takes a lot of attempts to get it right (but fun too, it brings out the scientist in me). Coconut flour requires a high number of eggs for volume, thickening, protein, binding, and structure. I would be worried if there was too much avocado in there as that is just adding a soft ingredient that gives no structure. The sweet potato would add volume but unless there is enough eggs and coconut flour in the recipe, again it won’t add to the solidity of the final recipe. Psyllium I add purely to get a better crumb texture. It swells and thickens and helps bind all the other ingredients together nicely. Scones – they won’t have risen because of the lack of gluten (yay), but I quite like heavy scones as a personal choice. I started baking using recipes that had already been developed using these low-carb flours, and start by adjusting the flavours only not the ratios of the bulk ingredients. You will soon get the hang of them. Start with my flourless berry sponge, I use these ratios all-the-time! Yum.
I tried to make the egg noodles and it was a total failure. Followed the directions without any substitutions.’ Not sure what happened. The texture was off. It was nearly impossible to remove from the pan and I used the latex mat and sprayed as well. It was mushy and seemed undercooked. I was disappointed because I had made the sauce and was ready to eat. It looked like the mixture was set and cooked, Perhaps my oven is off.
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
Melanie, curious to know what the quality of the foods you are eating? Organic? Grass fed Beef/butter? What oils are the using for fats? And do you think you are getting enough dark leafy greens, which give you the nutrient density needed to detox well? toxins stored in fat cells can cause issues with weight lose. looking into these topics and some light tweaks may help you with your goals! Best of luck!
Thank you so much for all of this great info! My husband started a Keto plan two weeks ago so I have been researching going Keto for a few weeks now. I figured I’d use him as a guinea pig to test buying food, preparing and cooking meals to see how easy or hard it would be to hit his macros for the day. I decided to start it this week (today is my fourth day) so now I am doubling up on the recipes so there’s enough for the both of us. I am still constantly looking for more recipes and trying to get more comfortable with changing up food so we are not eating the same things everyday. I can’t wait to try the meatloaf since it’s one of my favorite dishes! Thank you again for all the work you put in to sharing this info with others!
Hits the spot! I love traditional cereal and this definitely satisfied my tastebuds!! I will say I did realize how important it is to not over pulse, and to create a thin layer when placing in the oven. For the first few minutes I had a thick, maybe 3/4 inch layer, and I ended up thinning it out after reading reviews. I think in total I baked mine for 25-28 minutes. It was a little soft after coming out of the oven, but like you said it hardens after it cools. I added cinnamon, and wish I added more (I love a strong cinnamon flavor).
Hi Joellen, It doesn’t rise as much as a wheat bread but does a little. The almond flour being frozen might have made it worse, I’m not sure – I don’t store mine there since I go through it a lot. I’m glad you like the texture. If you want a taller loaf, you can multiply the recipe by 1.5 or even double it, but would need to increase the cook time and probably cover it to prevent browning the top too much before the middle is done.
In contrast with standard pastas, the nutritional profile of low-carb pastas varies widely from brand to brand. There are options made using black beans, edamame, chickpeas, and other beans. Legume-based noodles may have a slightly higher carb count, but they contain a good amount of fiber and protein to keep you full and energized. Shirataki noodles are made using the root of the Asian konjac plant and are virtually calorie-free. They don't, however, offer as much of a nutritional kick as other options.

I have spent weeks reading and learning about the Keto diet plan, downloading random recipes that my husband might even try, and have been overwhelmed with all the information. I was pleased to find your system and how organized everything seems to be. The only question I have is will I be able to “temporarily suspend” my subscription if I find there are more recipes than I have time to prepare. I want to only do about 3 per week and repeat them as leftovers, since I have very little time after working a 12-hour shift, to do much cooking. Once I “catch up,” I would reinstate my subscription. Is that an option? Looking forward to trying out your program.
But traditional cereals contain simple carbohydrates, which are the enemy of low carb dieters. Before you despair, know that there are plenty of low carb cereals you can find in your grocery store; they are made with soy and whole grains, which provide a lot of fiber, and are low in sugar. Here are five of the best low carb cereal brands to look for next time you go shopping.
Like any other fad diet, you can lose weight and see some positive results in the short term, but what effect does a low-carbohydrate ketogenic diet have on your long-term health? Recent research published by The Lancet studied the eating patterns of more than 15,400 adults in the U.S. and another 432,000 people around the world. Researchers found that restricted carbohydrate levels replaced or supplemented by animal-based protein and fat sources could lead to a higher risk of premature death.
My 1st attempt & it was delish w/unsweetened organic coconut milk.Had no hazelnuts & only half the amount of almonds so I substituted extra pecans. Used unground flax & also added additional 2 tbs ground flax for more fiber. Added 1 tbs vanilla. Used a combo of sweeteners: Eryth, Xylitol & Stevia. Next time will grind ingredients separately to get a more chunky result.
While there are many almond-flour pastas advertised as low carb, be sure to triple-check the label. Many brands contain more carbohydrates than you’d believe. Al Dente Carba Nada contains over 24 grams of total carbohydrates, or 17 grams net carbs[*]. Fiber Gourmet, also advertised as low carb, contains over 40 grams of total carbohydrates per serving and 3 grams of sugar[*].
There are several different types of flour made from seeds. Flaxseed meal is an excellent source of omega-3 fatty acids and can be used in muffins, pancakes and other baked goods as an oil or butter substitute. A 1/4-cup serving has 8 grams of carbohydrates. Although more difficult to find, sunflower seed flour is very low in carbohydrates with less than 6 grams per 1/4 cup.
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.

The low glycaemic index treatment (LGIT)[49] is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[5] Although it is also a high-fat diet (with approximately 60% calories from fat),[5] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[18] However, the types of carbohydrates consumed are restricted to those that have a glycaemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]
Because pasta. One of the things most peeps understandably miss the most when going keto, or grain free for that matter (🙋🏿!!). Because let’s face it, not much beats a bowl of pasta. And while this low carb version is a little different (think fried pasta/gnocchi), fairly certain you’ll be surprised by the al dente-like results and wonderful pairing with traditional Italian sauces.
For those who prefer to weigh ingredients rather than volume measure everything, here are my weights: using Honeyville almond flour, 2 cups is 6.5 ounces; and NOW brand psyllium husk you need 1 ounce. (I have the husks so I ground some to a fine powder in my coffee/spice grinder and measured 1/4 cup of the powder, which weighed 1 ounce or 31 grams. In future, I will just weigh 31 grams of husks into the grinder and know I have the right amount.) A quarter cup of coconut oil, like other fats, weighs 2 ounces.
Yes, some ideas on meal plans and very easy recipes would be very helpful. I’m 67, very overweight, diabetes, high blood pressure. My big love are all the carbs. This way of life seems impossible to me, all that fat just doesn’t sound appealing. I can’t see how to eat that much fat a day. Years ago, I did try Dr. Atkins diet but I had a very hard time with the very limited carbs. But now, I need to something drastic but haven’t a clue how to start.
Eat this for breakfast or for added energy before a work out.  Made in America in small batches, the fermentation process opens up the nutrients to be readily absorbed and introduces gut prebiotics to keep your gastrointestinal system running smoothly. Try this fermented option for thirty days. The makers state that you will experience improved digestion and increased energy levels.

We can help. We’ve put together a list of the top 10 healthiest and lowest carbohydrate options for diabetes. Whether you are on an American Diabetes Association (ADA) Diet or a Ketogenic diet, you can enjoy them with diabetes guilt free. If you are on a ketogenic diet, we hope that you are being followed by your doctor and nutritionist for needed lab work.
I guess the closest would be almond flour/ground almonds but there is not a direct substitution because wheat flour behave totally differently because it has gluten. Great question to ask and I am so glad you are starting low carb. Begin by baking an established low carb recipe first. All the hard recipe development has been done for you. Enjoy, and welcome.
I think that what Beverly is talking about when she says English battered fish is one where it isn’t crunch, exactly. The fish is dipped in a flour and egg based thick batter and deep-fried, leaving a lovely chewy coating on the outside. So delish! The closest thing I can think of in US terms are those batter dipped hot-dogs on a stick people used to eat. Anyway, I suspect we’d be moving more in the direction of some substitute using beaten egg whites, perhaps? Maybe modifying something more in the line of keto pancake batter?
In addition, on the day the diet was initiated, diabetes medications were reduced – generally, insulin doses were halved, and sulfonylurea doses were halved or discontinued. Due to the possible diuretic effects of the diet soon after initiation, diuretic medications were discontinued if of low dosage (up to 25 mg of hydrochlorothiazide or 20 mg of furosemide) or halved if of higher dosage. Participants were also instructed to take a standard multivitamin and drink 6–8 glasses of water daily, and were encouraged to exercise aerobically for 30 minutes at least three times per week.

Hi Tanisha, Sunflower seed flour should work in the same quantity (you can buy it here). I haven’t tried it for this recipe, but it does often work as a good almond flour replacement. The only thing to keep in mind is that the bread may come out green in color – sunflower seed flour tends to do this when baked – but it doesn’t affect the taste. Let me know how it goes if you try it!
Urine ketone data were missing in a median of 4 participants (range 0–8) at any given visit. The proportion of participants with a urine ketone reading greater than trace was 1 of 17 participants at baseline, 5 of 17 participants at week 2, and similar frequencies at subsequent visits until week 14 when 2 of 18 participants had readings greater than trace and week 16 when 2 of 21 participants had readings greater than trace. During the study, only 27 of 151 urine ketone measurements were greater than trace, with one participant accounting for all 7 occurrences of the highest urine ketone reading (large160).
If you are low carb and nut-free, coconut flour may be one of your best options for low carb and keto baking. Still, it’s not an easy flour to work with, especially if you are new to this low carb diet thing. So before you start, I suggest you read my primer on How to Bake with Coconut Flour. You can’t just sub in coconut flour for regular flour or for other low carb flours. It’s very dense and it requires an inordinate amount of eggs to bake properly, so direct substitutions will result in utter failure!

I greased the inside of the mould with melted butter first making sure I didn’t miss the cone or donut hole. I baked in a foster oven until there were 5 mins left. 3.25° for 30mins. When 5 mins were left I turned off the oven and let them sit in the remaining heat for 5 mins. Took them out and set them to cool for a while. Once they were cool I turned them over on to wax paper and they came out no problem nothing stuck even the donut hole.
While CHO is almost universally regarded as necessary for both health and athletic performance, many studies have called into question the absolute necessity of dietary CHO. As early as 1930 there was evidence demonstrating the efficacy of long-term CHO restriction (14). In an audacious attempt to demonstrate proof-of-concept, arctic explorers Dr. Viljalmur Stefansson and K. Anderson, agreed to participate in a study that involved one year of eating a diet that consisted solely of “meat.” The diet, which consisted of beef, pork, lamb, and chicken, also included significant portions of animal fat, as well as organ meat. This dietary regimen yielded a macronutrient distribution of approximately 81% fat, 18% protein and 1% CHO, over the course of 375 days. The subjects experienced a modest reduction in weight, which occurred during the first week; there were no restrictions on food portions, subjects ate to satisfy appetite. Interestingly, the researchers noted no vitamin deficiencies, no significant change in mental alertness or physical impairment, or any other deficit attributed to eating a high fat, all-meat diet.

Participants were recruited from the Durham Veterans Affairs Medical Center (VAMC) outpatient clinics. Inclusion criteria were age 35–75 years; body mass index (BMI) >25 kg/m2; and fasting serum glucose >125 mg/dL or hemoglobin A1c >6.5% without medications, or treatment with oral hypoglycemic agents (OHA) and/or insulin. Exclusion criteria were evidence of renal insufficiency, liver disease, or unstable cardiovascular disease by history, physical examination, and laboratory tests. All participants provided written informed consent approved by the institutional review board. No monetary incentives were provided.
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