Coconut flour is a low carbohydrate alternative to regular flour. A quarter cup serving contains 16 grams of carbohydrates, 10 grams of fiber, 4 grams of fat and 4 grams of protein for a total of 120 calories.  While it’s a bit higher in carbs compared to other low carb substitutes for flour, it makes up for it in texture. Its light appearance and consistency make it more absorbent than any other flours.
I actually went on a ketogenic diet last year to see if it would help my migraines. I have a history of chronic migraines which would usually last 3 days, sometimes longer. Triptans help a lot but I don’t like having to take them. I stayed in ketosis for about 8 months and experienced a significant reduction in migraines, from feeling some type of headache (mild o r severe) almost everyday to 1 or 2x per month while in ketosis. Although I’m very healthy otherwise, I do think my migraines may have something to do with blood sugar fluctuations (despite previously eating a whole foods diet and no refined carbs), and keto totally stabilized this. I eventually came off of Keto because I’m not really a meat lover. When I came off, but remained low carb, my migraines stayed under control for the most part. When I increase carbs, they do return.

The central aim of the ketogenic diet is to push the body into a state of ketosis, where metabolism shifts from burning carbohydrates as the primary energy source to fat, or “ketone bodies.” These ketones are a special type of fat that serve as cellular “superfuel.” In order to achieve ketosis, one must consume a diet high in healthy fats and dramatically lower in sugar and carbohydrates. This allows blood sugar to drop to the point that glucose is significantly less available to the body to burn as a source of fuel. In the absence of glucose, the body shifts its focus to ketones for energy production. Ketosis not only burns fat—which supports weight loss and BMI reduction if in a calorie deficit—it also transitions the body’s energy source to what clearly turns out to be a better fuel. In fact, energy derived from burning fat is associated with a remarkable reduction in the amount of damaging free radicals in the body, in comparison to burning sugar.
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.
Besides having the benefits mentioned above, if you really want to make sure you are in ketosis I would suggest buying a glucometer which is a blood test. A simple prick on your finger using ketone strips to measure. Anywhere from 0.5 and up means you are most likely keto adapted. It’s definitely not cheap but it is the most accurate measurement. There are other methods as well, like using urine ketone strips but not as accurate I don’t feel. There is also a breath ketone meter if you hate the blood pricking idea.
A Cochrane systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures.[2] Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types of diets or ways of introducing them to make them more tolerable.[2] In the largest trial of the ketogenic diet with a non-diet control[16], nearly 38% of the children and young people had half or fewer seizures with the diet compared 6% with the group not assigned to the diet. Two large trials of the Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.[2]
Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[19] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[31] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[18] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[51] Other formula products include KetoVolve[52] and Ketonia.[53] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[53]
This cereal, made by Nutritious Living, comes in four flavors – original, strawberry, vanilla-almond, and maple pecan – and has just six grams of net carbs per serving. These cereals also have 12 grams of protein and six grams of fiber to keep you feeling full until lunchtime. Despite the sweet-sounding flavors, Hi-Lo cereals have just one gram of sugar per serving. The cereal is made with soy grits, wheat gluten, soy protein, corn bran, rice flour, and corn meal.
Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D., “A Randomized Trial of a Low-Carbohydrate Diet for Obesity — NEJM,” N Engl J Med 2003; 348:2082- 2090. http://www.nejm.org/doi/full/10.1056/NEJMoa022207.
Hi Kathy, Almond flour doesn’t rise very much, but if they didn’t at all, it might be that you need newer baking powder. Falling apart is also likely due to the baking time I had in the original recipe, and I’ve updated it for a better result. Check the post for new tips! Cookies sound like an interesting idea, too, though I think the batter might be too liquid to form them.
I am a recent convert to using freeze-dried fruit and if you try this amazing crunchy granola you will see why. The fruit has a much more intense flavor than fresh berries and helps to add that fruity note to the nuts and coconut flakes. It also makes this cereal more child-friendly because the fruit turns the milk pink! This granola can also be formed into bars to give you a boost of energy through the day.
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!
The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[43] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[19] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]
Carbohydrates are a good source of quick energy to fuel your body's natural functions and keep you going during busy days. They have gotten a bad reputation in the fitness and weight-loss worlds, though, because many typical carbs that people take in are starchy, sugary, salty and contain no useful nutrition. Choose the right kind of low-carb cereal and you can enjoy a quick and convenient breakfast or snack entirely guilt-free.
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.

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.
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.
Thanks for your quick reply. Yes, BP is fresh. My batter wasn’t runny either. In fact I was going to add some more liquid but decided to leave as it was. The only other thing it could have been is that I live at 5100′ elevation and it was cold and snowing the day I made them. I am going to make them again and see what happens. I am not giving up! 🙂
Thank you, thank you. I appreciate ALL the work that has gone into this information. I am starting TODAY and so grateful for this coming out in time to really help me. and I am excited to see anything else you will have in the future. I am sure you will be credited for helping so many of us get healthier. My doctor agreed I could go on a Keto diet for 3 months, so I am hoping for some help with my diabetes. He states I don’t need it since I seem to have it under control…but, I feel strongly in at least trying it and see if I can improve my A1c. THANKS AGAIN!
I just made these and followed the advice of another comment. I added a scoop of vanilla whey protein and a scoop of sour cream. I did not have a donut pan so used my regular sized muffin tins. I buttered the tins very generously. I filled half full and it made 10. I shortened the baking time to 13 minutes which was perfect. I made a glaze of heavy whipping cream and powdered swerve for half and the cinnamon sugar combination for the other half. They are fabulous!
Fat is an important energy source; however, it plays a secondary role as an energy substrate, particularly during exercise that exceeds moderate intensity. For example, one of the fundamental concepts of bioenergetics illustrates this point through the axiom “fat burns in a carbohydrate flame;” clearly emphasizing the important role of CHO in energy metabolism. In the absence of adequate CHO availability, as might occur during starvation, near the end of a long endurance event or CHO-restricting diet, the body must turn to an alternate source to maintain energy for all tissues. Under normal dietary conditions there is a steady supply of glucose which the body readily uses as a primary fuel.
Y. Wady Aude, MD; Arthur S. Agatston, MD; Francisco Lopez-Jimenez, MD, MSc; Eric H. Lieberman, MD; Marie Almon, MS, RD; Melinda Hansen, ARNP; Gerardo Rojas, MD; Gervasio A. Lamas, MD; Charles H. Hennekens, MD, DrPH, “The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat,” Arch Intern Med. 2004;164(19):2141-2146. http://archinte.jamanetwork.com/article.aspx?articleid=217514. 

Hi Cyn, The numbers are general guidelines but will vary depending on many factors, such as activity level, insulin resistance, weight and more. There is no single magic number, just conventional recommendations that are a good starting point. I will have a macro calculator coming soon that will help determine what is best for each person, but even then it’s an approximation. The only way to know for sure is to test. If keto is your goal, it’s usually best to start lower and then see if you can stay in ketosis when increasing.

The carb content of cereals can be counterintuitive, with some sweeter-tasting varieties having fewer grams than healthy-looking kinds. For instance, a 3/4-cup serving of Honey Nut or Chocolate Cheerios has 22 grams of carbs, while a 1-cup serving of whole wheat mini-biscuits or bran flakes with raisins has 40 to 45 grams, depending on the brand. Most granolas are high-carb as well, with 35-plus grams per serving. The carbs in similar cereals may vary between brands, too, so inspect the nutrition facts label on every box before you buy.

Thank you! I think though many doctors and nutritionists are not keto friendly at all. They still believe in moderation and that grains are important, my own hubby’s doctor, same thing. That way of eating has failed for so many of us, even my husband. I think the keto diet is especially helpful if you’re in pre-menopausal, but that’s just my 2 cents. I’d say do more research. I’v found Dr.Jockers on youtube and Dr.Eric berg to have sound advice.

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.


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.
Some people on a keto or low carb diet choose to count total carbs instead of net carbs. This makes it more difficult to fit in more leafy greens and low carb vegetables (which are filled with fiber), so you should only try that if you don’t get results with a net carb method. And, start with reducing sugar alcohols and low carb treats before deciding to do a “total carbs” method.

Louise holds a Bachelors and Masters in Natural Sciences from Cambridge University (UK). She attended Columbia University for her JD and practiced law at Debevoise & Plimpton before co-founding Louise's Foods, Paleo Living Magazine, Nourishing Brands, & CoBionic. Louise has considerable research experience but enjoys creating products and articles that help move people just a little bit closer toward a healthy life they love. You can find her on Facebook or LinkedIn.
If no food processor is at hand, you can also do it by hand (it just takes a little more time and arm muscle!). Add all the dry ingredients to a large bowl and whisk until thoroughly combined. Pour in vinegar and whisk until thoroughly distributed. Pour in egg while whisking vigorously and keep whisking until the dough becomes too stiff to whisk. Using your hands, knead the dough until thoroughly incorporated, adding a teaspoon of water at a time as needed (we use 2). 

Carbs in fruits and veggies do count, but you don’t add up the carbs and sugar. Sugar is already included in the carbs – it’s just listed separately on labels because some people want to see a breakdown of how much of the carbs are sugars (versus other, complex carbs). If it says 2g carbs and 2g sugar, it means there is 2g total carbs and all of them are sugar (in this case).
I have several health challenges and the latest was the need to be on a gluten free diet. At first I thought it wouldn’t be too bad as I had seen many products in the store to help me. Then…I started tasting them. Can I say cardboard might have more flavor and texture?!? Oh my, what an adventure…lol! Then I found you and your amazing recipes! It is very apparent the time, dedication and love you put into making each recipe taste perfect.
While low-carb simply describes a vague behavior pattern that is subject to each person, ketosis is an objective and measurable fat-burning state of the human body. It is when the body’s metabolism switches gears to burn fat for energy instead of sugar. It is this metabolic state in which people experience the full benefits of a ketogenic lifestyle.

Quite by coincidence I started Keto around the same time as you. I’m 48 and had been struggling with hormones. I’ve lost 10 pounds, not bragging as I had far more to lose than you. I have 2 questions. First, I’m struggling with getting all of my fat in. Never thought I’d tire of avocados. Do you have any good fat bomb recipes? I’ve tried many online and they just don’t taste good at all. Hoping with all your experience you may have some ideas. Most websites have the same recipes as others.

First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[48]


Hello, I found your recipes after reading A Year of No Sugar by Eva Schaub and needing some delicious sugar free recipes. I recently decided to try keto and am almost done a 2 week challenge (more low carb than true keto but have kept the carbs below 70g, except 1 day). My questions are is alcohol allowed in your view? I’m not a huge drinker but I do like a glass of wine with dinner. What about “cheat” days. I’m not planning to go back to eating all the processed foods but denying them completely seems pretty counter intuitive and I’m hoping for ideas. Last question, what about fruit? How can any food plan completely rule out fruit? That also seems unhealthy and I’m wondering if you think ekto should be used as a temporary weight loss plan, with low carb being the longer term plan? Thank you! And you look amazing in the photos.
I have made this twice, both in the microwave. I have a tall coffee mug and it seems to work fine. I used Golden Monk Fruit Sweetener once and Swerve confectioners once and both were good. First time I microwaved for a full minute – a little dry but still delicious. Second time for 55 seconds and still a tad dry, but again, still delicious. Next time, I’ll shoot for 50 seconds!
Thanks to the use of turmeric in this amazing keto porridge, the cereal has a lovely golden color and can be a great filling cereal to have to get your body off to a good start in the morning. This sugar-free recipe also uses bee pollen which has proven anti-inflammatory properties and can actually help if you suffer from hay fever, especially if you can source a supply of local pollen.

When you eat foods high in carbohydrates and fat, your body naturally produces glucose. Carbohydrates are the easiest thing for the body to process, and therefore it will use them first – resulting in the excess fats to be stored immediately. In turn, this causes weight gain and health problems that are associated with high fat, high carbohydrate diets (NOT keto).

The biggest difference is in the fat!! Your fat should be around 70-75% of your daily food intake! When I first heard that, I was like, “Are you kidding, No Way, I will surely gain weight!” I was truly wrong and misguided. I think we’ve all been too accustomed to hearing for years and years that fat makes you fat! That is the farthest thing from the truth. Let’s not blame the butter for what the bread did. Sugar and Carbs are the culprit to gaining weight among other health related issues.

Made from dried and defatted coconut flesh, coconut flour has a high fiber content, with 8 grams of carbs and 5 grams of fiber in two tablespoons. To use the flour, replace up to 20 percent of the regular flour in a recipe with coconut flour and add an equal amount of liquid. For example, if a bread recipe calls for five cups of all-purpose flour, use 4 cups of the all purpose flour and one cup of coconut flour plus one cup of water. You can also use the flour alone for breading. 

And, very unlike generic, boxed spaghetti, shirataki noodles come pre-packaged in liquid, portioned out in a plastic bag that gets refrigerated. The noodles are watery and emanate a faint, fishy odor (though they're 100 percent vegan), which comes from the plant they are made from. Shirataki noodle manufacturers recommend rinsing, draining and drying the noodles before using them in dishes -- this'll help reduce the smell. Nevertheless, the pasta alternative is a smart choice for those looking for something gluten-free, low-carb or lighter in calories.

I needed a break from breakfast chia pudding, and I found this lovely recipe. I’ve been craving sugary cereals since I started Keto. I made this the night before and had it the next morning. This was everything I wanted and more, and also super simple to make. Mine weren’t as crunchy as I’d hoped (were still soft and cookie-like next day), but were still amazing! Probably because I stored them in the fridge overnight. Either way, delicious and nutritious and took me back to Cinnamon Toast Crunch, so 10/10!!
Proponents of the ketogenic diet say the problem with a high-carbohydrate diet is that it induces high insulin levels and keeps the body burning sugar and carbs instead of fat. In contrast, on a low-carb diet, the body learns to burn fat preferentially. When this happens, acids known as ketones are released from fat into the body, while insulin levels go down. Ketosis can occur after several days on a low-carb diet.

I too have been following you for a long time, trying your recipes and loving most of them. I am 4 days into the keto diet. I have not looked at the scale yet, but I kinda feel like my clothes fit a bit better. I am not in ketosis though…I was glad to hear that it took you a bit longer to get there so I don’t feel like I am doing it wrong. I am 62 and 5 foot 2 and I just can’t seem to keep my protein low enough. Too much meat I am guessing. I am trying to stay at 1330 calories, 105 grams of fat, 20 carbs, and 76 protein. I am very interested in learning what you eat in your typical meals for the day. I use the free version of My fitness pal.


Conversely, eating a dinner high in fiber, with lots of vegetables and whole grains will keep your blood sugar much steadier, based on how long it takes to break down the food into blood sugar. It takes your digestive system a long time to get a piece of whole-grain bread from the place where it looks like toast to the place where it looks like molecules of blood sugar.
I bought this as an alternative to the Medi-Fast Oatmeals. This one has similar caloric, protein, fat, and carb content, with lots of vitamins, without the price tag you get with MediFast. I liked the taste of it and will buy it again as a result. The nutritional content is better than any of the Quaker Oats products involving Oatmeal, and for someone who is constantly battling obesity, having a thick bowl of oatmeal is a welcome addition to my diet.
As with cold cereals, your best bet for a low-carb breakfast cereal comes in the form of whole grains. Oatmeal is an excellent choice because it is high in fiber and contains a substance called beta-glucan, which slows down the digestive process. That means you will stay full throughout the morning. Bran cereals can also be eaten hot, and whole grains such as quinoa or grits can be flavored to be either savory or sweet. Quinoa goes especially well with walnuts and raisins, dates or dried figs. It is is also scrumptious when flavored with a little bit of coriander and served with a poached egg on top. Grits are also a natural partner for eggs, but they are also delicious with pecans and fresh blueberries. Drizzle a bit of honey, agave or real maple syrup on top for sweetness. This will increase the carb count a bit, but the nutritional benefits of starting your day with a hearty, hot breakfast are more than worth the few extra carbs.
Where does nutrition info come from? Nutrition facts are provided as a courtesy, sourced from the USDA Food Database. You can find individual ingredient carb counts we use in the Low Carb & Keto Food List. Carb count excludes sugar alcohols. Net carb count excludes both fiber and sugar alcohols, because these do not affect blood sugar in most people. We try to be accurate, but feel free to make your own calculations.
Adequate food records were available for analysis in a proportion of participants at each of the 4 timepoints (Table ​(Table2).2). Participants completed food records at a mean of 2.5 and a median of 3 timepoints. In general, comparing baseline to subsequent timepoints, mean carbohydrate intake decreased substantially and energy intake decreased moderately while protein and fat intake remained fairly constant.
I had pasta last night, and I feel guilty that I cheated. This recipe is that good. I followed your directions exactly, including simmering the noodles in some sauce for a few minutes. What size pan did you use? It was hard for me to estimate and I ended up throwing away some egg mixture. Putting pan sizes in all your wonderful recipes would be helpful. Keep up the good work. You are my low-carb, go-to guru.
I was doing LCHF (under 20 carbs most days) , Type II diabetic on a little insulin, After less than 3 mos I brought my A1C from 10.9 down to 7.1…….off to a great start. Now…..I am not only diabetic, I recently had open heart surgery (quadruple bypass),meaning “cardiac diet”. Do you know of any diabetic/cardiac people that are doing Keto? Curious about high fat for cardiac. (FYI: My Doctors are following me closely so know what I’m doing.)
Gluconeogenesis is the endogenous production of glucose in the body, especially in the liver primarily from lactic acid, glycerol, and the amino acids alanine and glutamine. When glucose availability drops further, the endogenous production of glucose is not able to keep up with the needs of the body and ketogenesis begins in order to provide an alternate source of energy in the form of ketone bodies. Ketone bodies replace glucose as a primary source of energy. During ketogenesis due to low blood glucose feedback, stimulus for insulin secretion is also low, which sharply reduces the stimulus for fat and glucose storage. Other hormonal changes may contribute to the increased breakdown of fats that result in fatty acids. Fatty acids are metabolized to acetoacetate which is later converted to beta-hydroxybutyrate and acetone. These are the basic ketone bodies that accumulate in the body as a ketogenic diet is sustained. This metabolic state is referred to as "nutritional ketosis." As long as the body is deprived of carbohydrates, metabolism remains in the ketotic state. The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small concentrations without any alterations in blood pH. It greatly differs from ketoacidosis, a life-threatening condition where ketone bodies are produced in extremely larger concentrations, altering blood ph to acidotic a state.
Hi Pete, We used American cheese because that’s what is on a Big Mac and we were making Big Mac Bites. Also, it’s a misconception that American cheese is not real cheese, it all depends on what you buy. The individually wrapped cheese sliced labeled “cheese product” aren’t real cheese but you can purchase American cheese from the deli counter which is real cheese. If you want to double-check just ask to see the label before purchasing. Boar’s Head makes a great REAL American cheese.
But I just made some biscuits from an old cooking book, which had Almonds grounded (so I just used my almond flour) & I switched sugar for some xylitol & then thought I’d use the Coconut flour in place of ordinary Plain Flour! I did it cup for cup, so it was 2/3 cup……remembered about needing more liquid, so I added an egg (receipt already had 150g butter, which I put in 160g) They taste nice, but I think maybe I should have reduced the coconut flour, after reading your points, or added another egg, or more butter, what would you do? They also have an almond on top. thanks, Pam
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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