First, you DO NOT need a silica mat. I made these in a huge oven-safe frying pan sprayed liberally with cooking spray and it worked great. After the five minutes cooking time, I took the pan out of the oven and just let it sit. Everything firmed up nicely, I lifted one edge of the “noodle” and the whole thing peeled out beautifully. I rolled it up and sliced into fettucine and it worked AWESOME. I also added a pinch of Kosher salt, a pinch of black pepper, and a half pinch of garlic powder to the batter. ABSOLUTELY PERFECT. These are NOODLES folks, not slimy oddly-textured whatever-the-hecks, but real noodles. The texture is just right. These are what I’ve been looking for forever. God bless you for this!!!!!. We’re having pot roast for dinner, and while my girls have noodles with their sauce, SO WILL I!!!!!!
While there have not been large studies that show the relationship between the ketogenic diet and cancer, we will be publishing a case study about that topic. The author failed to comment that pediatric patients with epilepsy are on the diet for usually about 2 years with no harmful effects. Before the false studies about heart disease and fat, the low carb diet was a respected way to lose weight. Studies into our metabolism show we can use both fat and carbohydrate as fuel. So stepping away from our high carb diet- I am sorry to say that we eat more carbs since the 70s with most of it processed and we now use high fructose corn syrup to sweeten products and we have a wide spread childhood obesity problem. If cholesterol is a concern try plant sterols and stenals to block cholesterol from the receptors in the body. So much more can be said about a keto diet than this article states
You can find all my recipes on the main landing page of my website. There’s a search bar at the top and you can type anything you’re looking for, if I’ve made a recipe for it you’ll see it. Also there’s a tab at the top of the page that says recipe index and a ton of categories for you to find what you’re looking for. If you want to never miss a new recipe, I post twice weekly, you can subscribe to my website by adding you email address in the middle of the landing page, that says, Never Miss a Recipe. Hope that helps!
Walnut flour can be used for all low-carbohydrate baking needs and it can be swapped out for other grains in your diet. You can make pancakes, breads, muffins, cakes, you name it! Walnut flour is delicious, so give it a try. There are many brands, but we’ve linked you to one of the best-sellers or top choices on Amazon above. The brand listed is fine ground in California, USA.
I am post menopause and I did lose about 40 lbs. Then I stalled and stalled. I was too hot all the time and was having sleep issues. I added more carbs and was better. I attempted keto/ low carb again in January. Two weeks in I had the same symptoms. It is not uncommon. It works well for some but not for me and a few of the other women at my gym. I liked what I was eating and I stuck to it through the stall but no. With the guidance of my trainer I have modified it, lost weight and feel great. Sleep helps!
Hi Stacey, I can’t give medical advice and definitely recommend following your doctor’s recommendations. You can ask him/her if low carb would be better suited for you. Also, you may want to double check with him/her if the kidney concern was related to high protein, because that is a common misconception about keto – it is not a high protein diet/lifestyle.
Thanks! I actually checked the link you put in the article to the original recipe. And in that article, she says that the noodles don’t necessarily re-heat very well, they seem to get over cooked. Have you found that you can have leftovers of these noodles without ruining them? Just thinking maybe I’d make a smaller lasagne, less likely to even have any left over, then. And only need one batch.
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
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]
Most recently, Wilson et al. (27) investigated the effect of a 10-week KD on strength, body composition, blood lipids and hormonal response in resistance trained males, while following a periodized resistance training program. The investigation included a 2-week dietary adaptation period, and a control group, which followed a more traditional macronutrient ratio consisting of 55% CHO, 25% fat and 20% protein (WD). The 10-week dietary intervention was followed by a 1-week CHO re-introduction for the KD group. Average caloric consumption across the 11-week intervention was similar between groups. Blood lipids remained constant and were not significantly different between groups. The KD group did, however, elicit a significant increase in blood triglycerides during week 11, with the re-introduction of CHO. Total testosterone was significantly increased in the KD group, compared to WD, however, free testosterone was not significantly different between groups. While both groups saw increases in lean body mass, the KD group realized gains significantly greater than the WD group. Similarly, the KD group experienced significantly greater decreases in fat mass during the 10-week CHO restriction period. There were no significant differences in measures of strength or power between groups. From this, the authors concluded that the KD favorably impacted body composition, with no negative impact on blood lipids or muscular strength and power.
Hwu believes risks of cardiovascular disease and diabetes — which are both associated with high blood pressure, glucose and cholesterol — may be reduced by following the ketogenic diet, based on research. A recent study from Johns Hopkins found a ketogenic diet was not only safe, but effective for adults who had certain severe forms of epilepsy, supporting previous research.
During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative bromides (discovered 1857) and phenobarbital (1912), the ketogenic diet was widely used and studied. This changed in 1938 when H. Houston Merritt, Jr. and Tracy Putnam discovered phenytoin (Dilantin), and the focus of research shifted to discovering new drugs. With the introduction of sodium valproate in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time restricted to difficult cases such as Lennox–Gastaut syndrome, declined further.[10]
Hi Barb, That can definitely be it. Losing when you are close to goal can be more difficult. It could also be that your body’s healthy weight is a little higher than what you’d like – which doesn’t mean you can’t lose, but makes it more difficult. If just eating Keto foods isn’t working, double check the macros for your weight and see if the amount you’re eating needs to be adjusted. You’ll find more help and support in our support group here.
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 who 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 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 children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
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.
A: The amount of weight you lose is entirely dependent on you. Obviously adding exercise to your regimen will speed up your weight loss. Cutting out things that are common “stall” causes is also a good thing. Artificial sweeteners, dairy, wheat products and by-products (wheat gluten, wheat flours, and anything with an identifiable wheat product in it).
Carbohydrates are used to make glycogen, which is required for muscle function. The difference between this and common meal plans is the amount of carb intake is limited to enough for the glycogen production of a normal person. Not every carbohydrate is created equal. Sugar alcohols don’t affect most people’s blood sugar levels. Nor does most fiber. A keto eater is interested in net carbs, figured by total carbohydrate minus fiber minus sugar alcohols.
One of the staples of low-carb diets is protein. Lean meats like fish, chicken, beef, and pork are all wonderful protein sources that are sure to satisfy your cravings. Eggs can be incorporated into meals at any time of day and contain six grams of protein, which makes them perfect as a pre-workout snack, too. Vegans can replace meat with plant-derived protein products like tofu and tempeh. When you assemble your meals, keep in mind that protein should take up roughly one-fourth of your plate.
This is something I always do the wrong way. I always melt it and use a full 1/4 cup of melted coconut oil because I don’t know how to properly measure solid coconut oil. The brand I use is very hard when solid and comes in a tub so I have to scrape it with a spoon to get shavings. 1/4 cup of coconut oil shavings is not the same as 1/4 cup of solid coconut oil in a block – 1/4 cup shavings would have less oil because of the air in between.
Interested in trying a fad diet? There are plenty to choose from, and low-carb pasta can be incorporated into most. The Atkins, ketogenic, and paleo diets — to name just a few — all prescribe a low-carb lifestyle to support health and fitness. On these diets, instead of consuming carbs for energy, you will eat protein, healthy fats, fruits, and veggies. Each of the aforementioned programs allows for a small portion of carbs each day, so you can chow down on low-carb pasta without falling off plan.
Made them tonight. I thought I messed them up since they looked eggy but really they turned out great. I can’t do gluten so I tried the xanthum and I also added some garlic powder to the mix for taste.i think I cooked for 7 minutes total.we actually sliced them into little squares and threw them into homemade chicken noodle soup. It tasted close to dumpling style noodles. Not slick/chewy but very good. My 14 year old T1 loved them and wants me to make more. Overall it absolutely loved these. Will be making again in the very near future. Thanks for such a great and simple recipe!
Melissa, First of all, welcome to the keto family! Unfortunately, we don’t use Carbquick so we can’t give advice on that. Regarding psyllium husk powder and oat fiber, they are typically used in very small amounts in conjunction with another keto-friendly flour because they can create very dense and/or rubbery baked goods when used alone. We hope this helps!

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]
This article originally appeared in Personal Training Quarterly (PTQ)—a quarterly publication for NSCA Members designed specifically for the personal trainer. Discover easy-to-read, research-based articles that take your training knowledge further with Nutrition, Programming, and Personal Business Development columns in each quarterly, electronic issue. Read more articles from PTQ »
If you’re willing to use sugar alcohols, those solve the problem of missing bulk. I use a mix of 4oz xylitol, 3oz erythritol, & 1/2 tsp concentrated stevia powder (NOW brand) and it replaces 1:1 for sugar. Then for brown sugar, you take that and mix it with molasses or black strap molasses (I think 1TBSP per cup) plus maple or rum or butter extract to taste. Just mix with a fork until it’s well mixed and it will come pretty close. Hope that helps.

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This recipe is FABULOUS! I just made it and used a muffin pan. I got 12 smaller muffins out of the batch. I baked them until they were dark golden and pulled away from the pan. After sitting on a cooling rack they got wonderfully hardened to a nice little crunch then the inside is so moist and tender. I’m a crunchy texture person so this is perfect for me!

Over the long-term the KD poses possible risks as well, although the evidence remains unclear on this topic. Consumption of a high fat diet, particularly saturated fat, is associated with increased cardiovascular risk (23) and consumption of saturated fat has been shown to acutely induce insulin resistance and raise blood triglyceride levels (12). Nevertheless, many KD studies have documented improvements in markers of cardiovascular risk, including improvements in vascular function (24) reduction in inflammatory markers (10), and other markers of cardiovascular health (13,20). Methodological issues, such as clear definitions of dietary interventions, may play a significant role in obscuring the underlying principles, however, it is clear that more targeted research is warranted.
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?
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.
I remember years ago loving the Monterey Chicken at Chili’s Restaurant Grill & Bar. Then, they took it off the menu, and it has been just a distant memory ever since. Since starting Keto, I have thought about making a keto friendly version. In fact, I did post a very lazy crockpot version of the recipe that is keto friendly/low carb, which is delicious, but I missed the skillet version like Chili’s Restaurant.
The purpose of this study was to evaluate the effects of a low-carbohydrate, ketogenic diet (LCKD) in overweight and obese patients with type 2 diabetes over 16 weeks. Specifically, we wanted to learn the diet's effects on glycemia and diabetes medication use in outpatients who prepared (or bought) their own meals. In a previous article, we reported the results observed in 7 individuals [10]; this report includes data from those 7 individuals along with data from additional participants enrolled subsequently.
Hi Patti, It’s up to you if you want to go by weight or by volume. I include both for convenience. Some people don’t want to weigh all their food, though weighing is definitely more accurate. The volumes listed are based on how a food is normally served, so for iceberg lettuce it would be chopped, not minced. It sounds like you’re weighing anyway, so in this case just use the weights instead (they are shown in grams in parentheses next to the volumes). Hope this helps! 

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.
If you’ve decided to move forward in trying the keto diet, you will want to stick to the parameters of the eating plan. Roughly 60 to 80 percent of your calories will come from fats. That means you’ll eat meats, fats, and oils, and a very limited amount of nonstarchy vegetables, she says. (This is different from a traditional low-carb diet, as even fewer carbs are allowed on the keto diet.)
Thanks so much for sharing your results. You look so good, and you have inspired me to try a more structured version of the Keto Diet. I lost some weight recently on HCG 2.0, which puts you into ketosis (keto flu and all!). I have tried to maintain my weight loss with a version of the Keto Diet, but I know that I am probably still eating too many carbs and not enough fat. I am 47, and I contine to have issues with keeping the weight off despite a healthy diet and exercise. I am sure it is hormone-related.
Fiber and fatty acids combine in ground flaxseed with ALA and other proteins. Flaxseed promotes healthy cholesterol levels, and its fiber will help to keep your digestive tract running smoothly. The ALA and other proteins promote heart health by increasing the muscle energy of the heart. Smooth hair, clear skin and healthy nails are some other side benefits of flaxseed.
Just found your website! What an incredible help it is for me. I just converted to a low carb diet a couple of weeks ago, and must admit began struggling with some of the foods we love as a family and didn’t want to give up. Plus the information about almond flour increasing inflammation was eye opening. I have both rheumatoid and osteo – arthrits and recently it has really acted up. Now I know why. I will use coconut four more now! Thank you.
These low carb egg noodles have the texture of homemade egg noodles. Although they aren’t gluten free they have 0 carbs for a generous serving. They are easy to make with just three ingredients! Use them any way you’d use regular pasta; in soups, casseroles, and with any low carb pasta sauce. They are especially good with the easy Alfredo Sauce recipe right here on Lowcarb-ology.
If you are trying to get the kids to eat healthier and not rely on sugary cereals you might find this keto one will win them over. It has a great texture from the nuts and seeds and has a sweet warming flavor from the cinnamon and sweetener. This cereal is great with your choice of milk or can be made a bit more filling by adding in some fresh berries.

Hi Megan, My batter is pretty sticky, too, which is fine. You can add a little more almond milk if it’s very thick. Other than that, if they are dry they were probably in the oven too long. Try reducing the baking time a bit next time. The last step of dipping in butter for the cinnamon coating should also help with dryness. I hope you’ll try them again!
Dr. Perlmutter is the leading integrative medicine neurologist in North America today. His ability to fully integrate conventional medicine diagnosis and treatment with the latest innovations in nutritional and environmental medicine is phenomenal. As a teacher and clinician, he has fundamentally changed how physicians and patients think about neurological degeneration and, happily, regeneration.
If you’re following a low-carb diet, it’s tempting to limit breakfast cereal to a sprinkling on your Greek yogurt -- and with good reason. Because grains are carbohydrate-rich, there are few truly low-carb cereal options, and many boast upwards of 40 grams per serving. As of October 2015, the FDA hasn’t defined what “low-carb” means in terms of grams or percentage of calories. However, with a little detective work, you can find hot or cold cereals with 20 grams of carbohydrates or fewer per serving, which can fit into some lower-carb diets.
Yancy WS Jr, Westman EC, McDuffie JR, Grambow SC, Jeffreys AS, Bolton J, Chalecki A, Oddone EZ, “A randomized trial of a low-carbohydrate diet vs orlistat plus a lowfat diet for weight loss,” Arch Intern Med. 2010 Jan 25;170(2):136-45. http://www.ncbi.nlm.nih.gov/pubmed/20101008?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2.
I am very new to this diet, but I must say I am so impressed. No snack cravings were the first surprise! I am already gluten intolerant so was bummed out to learn of all the flours that are way too high carbs especially rice flours! But already I have tried many recipes even found one made with almond flour taste just like the cheddar biscuits at red lobster! Heading out, I saw you mentioned oat fiber.. what can you use this in?
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 who 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 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 children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
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:
Several recent studies indicate that a low-carbohydrate diet is effective at improving glycemia. A few studies have shown that in non-diabetic individuals, low-carbohydrate diets were more effective than higher carbohydrate diets at improving fasting serum glucose [13,14] and insulin [6,14-16], and at improving insulin sensitivity as measured by the homeostasis model [6]. One of these studies also included diabetic patients and noted a comparative improvement in hemoglobin A1c after 6 months (low fat diet: 0.0 ± 1.0%; low carbohydrate diet: -0.6 ± 1.2%, p = 0.06) [6] and 12 months (low fat diet: -0.1 ± 1.6%; low carbohydrate diet: -0.7 ± 1.0%, p = 0.019) duration [5]. In a 5-week crossover feeding study, 8 men with type 2 diabetes had greater improvement in fasting glucose, 24-hour glucose area-under-the-curve (AUC), 24-hour insulin AUC, and glycohemoglobin while on the low-carbohydrate diet than when on a eucaloric low-fat diet [7]. In a 14-day inpatient feeding study, 10 participants with type 2 diabetes experienced improvements in hemoglobin A1c and insulin sensitivity as measured by the euglycemic hyperinsulinemic clamp method [8]. Hemoglobin A1c also improved in an outpatient study of 16 participants who followed a 20% carbohydrate diet for 24 weeks [9].
I have great respect for Harvard Medical School. I notice that they support their readers posting comments and I am most appreciative of the article and all the many thoughtful comments by the readers. The readers seem to have the most expertise here and I hope that the doctor who wrote the article will think long and hard about the comments by readers. After 35 years of clinical practice in mental health, I notice that all issues of emotion involve medical issues, nutrition, and the gut bacteria. I would say that these issues and all of the executive brain functions seem to improve with ketogenic principles. For those that apply it in a flexible and smart manner, it appears to improve every area of their lives. I strongly encourage the author of the article to take one class via The Institute for Functional Medicine. If he is open to more learning he can take more classes and get certified. I’m sure a fine doctor, he will be an even better doctor and personally healthier, if he gets more training. Are we all open to new learning(especially us healthcare providers)?
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[54]
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]
Measuring blood ketones is the most reliable method. There is a home blood test you can use, but the strips can be very expensive. An alternative is to measure ketones in the urine with a dipstick test, which is much more accessible and inexpensive. However, this method is much less reliable and as time goes on and the body adapts to ketosis, it becomes even less reliable.

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.[54]

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