Maya, Thank You so much for this recipe. I made it as written with your suggestion of 2-3 Tbsp of psyllium husks and I am in heaven! Thank you so much! Being keto has been an amazing thing for me and my health but was truly starting to miss certain foods. This was so good and my family loved it too! Definitely a keeper for me. Thank you again! A quick question- if I halved the coconut oil, would that throw the texture off too much?
So imagine my delight, as an adult, every time I get to pour a bowl of keto friendly cereal comprised completely of paleo granola clusters that I feel good about! I’m willing to bet that your inner child is going to be just as excited about this homemade sugar-free granola when you try it, too. Paleo cereal can now be a part of your morning routine and I highly recommend a sprinkle of it on keto oatmeal too!

It's not the easiest plan to follow, but the theory of ketosis as a possible prevention against disease is gaining attention from cancer specialists. Tumor immunologist Dr. Patrick Hwu, one of the leading cancer specialists in the U.S., has followed the keto diet for four years, although he prefers to call it the fat-burning metabolism diet, or fat-burning diet. More research is needed to prove its benefits, but Hwu, the head of cancer medicine at MD Anderson in Houston, believes in it after seeing improvements in his own health.
I was worried. I read my ingredients and follow the instructions to the letter. I made the little bow ties. I put them in the freezer for 15 minutes and I fried them in garlic and olive oil. They were so good. I think they would definitely stand up to any sauce that you added to them (after they were fried) I can’t wait to try them as fried ravioli. I’m also going to stuff a few with ricotta and sauerkraut, fry them, dress them with sour cream, and call them a pierogi.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[18] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[48] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[18]

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.


When starting a low carb keto diet, it’s best to stick to breakfast basics like eggs, omelettes, quiche, breakfast meats, or even leftovers. Eating cleanly helps re-adjust the taste buds and provides the body with the nutrition it may have missed while eating the standard American diet (SAD). But anyone can get tired of bacon and eggs, so it’s nice to have other options.
Use our premium meal planner tool (free trial) to access tons of weekly meal plans, complete with shopping lists. You can adapt the plans to your liking, skipping any meal, choosing how many people you’re cooking for, and the shopping lists adapt. You can even start a new plan from scratch (of from pre-existing ones), tailor them completely and save them.
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).

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.
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.
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!
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.
Rod, With a ketogenic lifestyle, the point is to stay within your macros, so if you’re not gluten-intolerant and the flour fits into your macros, you should be fine. Have you calculated what your macros should be? We have a post talking about which macro calculators we like best, if you’re interested: https://theketoqueens.com/macro-calculator-review/ Additionally, a doctor can help you figure out the macros that will work best for your health and fitness goals. Best of luck and welcome to the keto family!
The ketogenic diet, or keto, relies on using your fat as fuel, instead of glucose from carbohydrates or protein. Simply put, the daily ketogenic diet consists of 75 percent fat, 20 percent of protein, and a teeny allotment of carbohydrates, about 5 percent. This balance of macronutrients is intended to put your body in a state of ketosis, which suppresses the release of insulin and blood glucose levels. The benefits of ketosis to your health are improvements in biomarkers like blood glucose, reduction of blood pressure and decreased appetite due to fullness linked to consumption of fats.
My point here is that the warnings about the ketogenic principles are well taken and well documented. My concern is implications that this is a fad. I don’t use the word diet with my patients and I’m concerned that the principles behind the label and the real results that these readers have commented on might get minimized. I have found it best to encourage patients to read authors like: Stephen Phinney, Jeff Volek, Patricia Daly, and Charles Gant and the be partners with their doctors and check blood work as they move along. I am not for or against the article. If ketogenic principles offer people enduring, satisfying, and cohesive change then why not read about its potential and flexilbity?
The information you share, including that which might otherwise be Protected Health Information, to this site is by design open to the public and is not a private, secure service. You should think carefully before disclosing any personal information in any public forum. What you have written may be seen, disclosed to, or collected by third parties and may be used by others in ways we are unable to control or predict, including to contact you or otherwise be used for unauthorized or unlawful purposes. As with any public forum on any site, this information may also appear in third-party search engines like Google, MSN, Yahoo, etc. Your use of this site is governed by Harvard University and its affiliates Terms of Use located at www.health.harvard.edu/privacy-policy and may be amended from time to time.
The improvement in glycemic control occurred while medications for diabetes were discontinued or reduced in most participants (Table ​(Table5).5). During the study, hypertension and hyperlipidemia medication doses were not increased from baseline nor were new agents added, except in 3 individuals. No serious adverse effects related to the diet occurred. One participant had a hypoglycemic episode requiring assistance from emergency services after he skipped a meal but the episode was aborted without need for transportation to the emergency room or hospitalization.
Also, I wanted to let you know what a fabulous addition your recipes were to our Christmas. I made the orange spritz cookies which were well received by those with diabetes, my gluten free friends, and everyone! I made them Christmas Eve. Christmas morning, I made your apple coffee cake and it was fab along with eggs, sausage and fruit. Thank you so much!
Participants completed take-home food records (4 consecutive days, including a weekend) collected at baseline and at weeks 2, 8, and 16 during the study. Participants were given handouts with examples of how to complete the records. A registered dietician analyzed the food records using a nutrition software program (Food Processor SQL, ESHA Research, Inc., Salem, OR).
Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.
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.
"Avoid inflammatory oils like safflower, sunflower, corn, or soybean oils and opt for whole food cereal or granolas with limited ingredients, which tend to be made from nuts, seeds and occasionally whole oats or puffed rice," says Kelly LeVeque, RD, a celebrity nutritionist who works with Jennifer Garner and Jessica Alba, and author of Body Love. One of her faves: This grain-free granola from Thrive Market, which has a blissfully short ingredient list but tons of flavor.
2. Adzuki Bean Pasta from ExploreAsian, Gluten-Free: This one has a different flavor than it’s black bean counterpart, and has twice as many carbs. But at 11 grams of carbs per serving, that’s still a lot fewer carbs than traditional pasta. You could even mix this pasta into the pot of boiling water with the black bean pasta to change things up and reduce the carbs in your bowl at the same time. (This company has some higher carb bean pasta variations, too!)
I think these are unbelievable! This is actually the first time I've written a review on Amazon, but I feel like I have to with these. I am trying to do a low carb/low cal diet to lose about 30 pounds, and have a huge weakness for pasta. I have tried Shirataki noodles, spaghetti squash, skipping the pasta altogether and just making veggies with sauce, and this is BY FAR the best way to quench my craving for pasta.
Erythitol gives me painful tummy cramps; Swerve or Pyure and generic brands all cause this. 1 tsp liquid stevia or liquid Splenda is equivalent to 1 C erythitol, so 1/4-1/2 tsp is enough for this recipe. However adding a liquid sweetener offsets the solid to liquid ratio. I usually add sifted egg protein powder in the amount of the powered sweetener. A glaze can be made with coconut milk, liquid sweetener, and thickened with xanthan gum. A lemon extract or raspberry extract are perfect for flavoring the glaze.

These tasted amazing. But my donuts did not keep its shape. I used the exact ingredients. My batter turned out very wet for a baking recipe. Maybe add a bit more almond flour to get a thicker consistency? My donuts stuck to the pan pretty bad so I’ll have to grease the pan even more. I’m planning to try this recipe again next week and hoping it turns out well because I wanna add blueberries! This is the best low carb doughnut recipe I’ve found!
Cutting back on protein is one of the largest challenges to the diet. Because high levels of protein in the diet can turn into glucose in a process called gluconeogenesis, the keto theory says too much protein in the diet can mean too much glucose, whisking you out of ketosis. That’s why bacon, which has a ton of fat but not a lot of protein is a preferred food over chicken breast, which is high in protein with very little fat.

So, recently when I was craving Monterey Chicken and didn’t have time to wait for the chicken to cook in the crockpot, I made a low carb skillet version that turned out just like the one I remembered. It was extremely flavorful and delicious! All in all, it took about 25 minutes from start to finish since I had already cooked the bacon earlier in the day and my homemade low carb sugar-free BBQ sauce was already in the fridge.
One of the common problems with eating a ketogenic diet is that your system can become a bit less regular than normal, so one of the best ways to sort it is to up the fiber. This cereal is loaded with fiber and can be really helpful to reset your system. It also has a hint of chocolate, making it kid-friendly too. Just serve this with your choice of milk for a healthy and filling breakfast.
Do you have a great low-carb recipe that you want to share? We can cook it, photograph it and publish it here on the site, with your name on it. Or maybe you have a traditional recipe you want us to make a low-carb version of. Please send us an e-mail at [email protected] with your suggestions on how to make our recipes better. Alternatively, leave a comment below.
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.

Despite “cereal” being often associated with “carbs,” these days there are plenty of low carb cereals available. Remember that milk has naturally occurring sugars, which are carbs, so be sparing in how much milk you put on your cereal if you want to cut even more carbs. You can also opt for hot cereals – plain oatmeal is actually one of the best whole grain, low carb choices out there – if you do not like plain cereal and milk. The five brands above provide particularly good options in their low carb counts along with high fiber and protein. Head to your nearest supermarket today to find some great low carb cereals!


The remaining calories in the keto diet come from protein — about 1 gram (g) per kilogram of body weight, so a 140-pound woman would need about 64 g of protein total. As for carbs: “Every body is different, but most people maintain ketosis with between 20 and 50 g of net carbs per day,” says Mattinson. Total carbohydrates minus fiber equals net carbs, she explains.
Taken together, these results demonstrate a positive effect of LCD/KD on body composition. While KD may not be superior to other dietary strategies aimed at weight reduction, the evidence does suggest that it may be equally effective. Nevertheless, the International Society of Sports Nutritionists, in their Position Stand on the effects of diets on body composition, suggest the KD holds little benefit over higher CHO diets, with one notable exception; KD may enhance appetite control (1).
If you are facing a really busy day and don’t have time to cook eggs and bacon, you could rustle up this filling and delicious grain and gluten-free cereal to get the whole family off to a healthy start. It takes a few minutes to cook, then you can enjoy this warming bowlful either on its own or with some fresh berries for added fruitiness. Perfect for a busy family!
Now, how to actually use these nut meals and flours? It is not so simple as taking a conventional recipe and swapping almond flour in for wheat flour. Almond flour lacks gluten, a protein found in wheat that helps baked goods rise and hold their shape. It also has much higher fat and moisture contents than wheat. All of these factors need to be considered when making an almond flour recipe.
Ketogenic and low-carb diets aren’t as new as most people think. The ketogenic diet was developed in the early 1900’s to help control pediatric seizure cases who were not responding to medical treatment. Low-carb diets gained a lot of attention due to the Atkins nutrition plan which emerged in the 1970’s and remains a fairly popular program today. When it comes to keto vs low-carb, they are actually pretty different and can have drastically different effects on the human body.
The information you share, including that which might otherwise be Protected Health Information, to this site is by design open to the public and is not a private, secure service. You should think carefully before disclosing any personal information in any public forum. What you have written may be seen, disclosed to, or collected by third parties and may be used by others in ways we are unable to control or predict, including to contact you or otherwise be used for unauthorized or unlawful purposes. As with any public forum on any site, this information may also appear in third-party search engines like Google, MSN, Yahoo, etc. Your use of this site is governed by Harvard University and its affiliates Terms of Use located at www.health.harvard.edu/privacy-policy and may be amended from time to time.
Hi Kathy, I would persevere with coconut flour. Many people say it doesn’t work like regular flour, and while that may be true, I have learned to work with it. I ensure I use enough eggs, enough sweetener and flavours or enough salt and spices to overpower the subtle coconut flour taste. I have a whole new category in my recipe finder just for coconut flour recipes. Wy not give may flourless berry sponge a try to begin with, I love it and my kids make it all the time, even as cupcakes too.
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!
The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[5]
^ Ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg, saccharin and vanilla flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1).[17] The eggnog may also be cooked to make a custard, or frozen to make ice cream.[37]
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. 

Weight loss is a common target for disease management, as well as health promotion. The prevalence of obesity remains high among U.S. adults (36.5%) (5), as well as children and adolescents (17%) (6). Importantly, obesity is a significant contributor to increased morbidity and mortality, as well as being a primary driver of increasing medical expenses (4). Despite much effort and cost, there has been little success on this front and obesity remains a public health crisis.
I recently started using Carbquik and overall, I'm pleased with it. I'm on a low-carb diet, and my dining options have really opened up! So far, I've made cheese biscuits, pizza dough, and pancakes. The pizza dough isn't great, but if you use the right kind of pizza pan and roll it thin enough, it's certainly acceptable and it beats not being able to have pizza at all.
I love you guys! I never miss an email- something good in every one (usually recipes). I printed out the sweetener list and put it on the fridge. This is wonderful today, will print asap. We started low carb in April. In 2 months I lost 40 pda and my hub lost 28! When I went in for my 3 month A1C my count had dropped from 7.2 to 5.8!! My Dr was as thrilled as I was! I still have 160 pds to go but this is the easiest diet I have been on. Weekends are hardest though. We want to eat out the time- you have any suggestions??
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!
I’m trying your recipe for the first time. It is very similar to a bun recipe that I make with psyllium husks so I am incorporating the method from that into this recipe. I made a few slight changes… I added garlic powder ground Rosemary and oregano, one quarter cup ground flaxseed, one tablespoon apple cider vinegar. I only used 3 eggs, and increased the Water by 2 tablespoons. By adding apple cider vinegar and the baking soda, they create a very light effervescent foam as they interactwhen I add the warm water, which acts naturally to the raise the bread, thereby allowing me to decrease the eggs. I added the extra water due to the extra dry ingredients. I’m very confident that this will work out very well. It always works with my buns so I’m eager to test this out. Thank you again for the base recipe.

I made this bread several times now using ground flaxseed in place of the psyllium powder and it came out perfect every time. I decided to try it as a sweet bread and added 1/2 cup raisins, 1 Tbsp. cinnamon, 1/4 cup erythritol and 2 Tbsp. Splenda. After it was done I iced it with 1/2 cup powdered sugar mixed with enough milk (about 1 Tbsp. to keep it thick but a little runny. Now I have a healthy, delicious, loaf of cinnamon raisin bread. Thanks for the great recipe!


Wow!! I was so happy to see last night that I had all of the ingredients except the flax seeds, so I threw all these ingredients together and am enjoying them this morning on my homemade Gree yogurt…delish!! This is really giving me my cereal satisfaction. I did substitute some ground flax for the flax seeds and it seems to have worked beautifully. Other than that I followed the recipe exactly and couldn’t be happier with the results! Thank you thank you for posting this!
There are three instances where there’s research to back up a ketogenic diet, including to help control type 2 diabetes, as part of epilepsy treatment, or for weight loss, says Mattinson. “In terms of diabetes, there is some promising research showing that the ketogenic diet may improve glycemic control. It may cause a reduction in A1C — a key test for diabetes that measures a person’s average blood sugar control over two to three months — something that may help you reduce medication use,” she says.

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!
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.

I saw your recipe on Highfalutin today and since it is snowing I gave it a try to add to our chicken noodle soup. The recipe is super!!! Now we can have noodles without all of the carbs. The soup and noodles turned out so good. I used parchment paper and a cookie sheet that decided it needed a new wonky shape when heated( mixture was really thick on on side) but I was able to salvage all of the mix after repeatedly reheating the thicker portions until they were set. No sogginess in the noodles and they held up well in the soup. Kudo’s to your creativity! Now to try them in other things as mentioned in the comments that I didn’t read before making the recipe, whoops!!

"Avoid inflammatory oils like safflower, sunflower, corn, or soybean oils and opt for whole food cereal or granolas with limited ingredients, which tend to be made from nuts, seeds and occasionally whole oats or puffed rice," says Kelly LeVeque, RD, a celebrity nutritionist who works with Jennifer Garner and Jessica Alba, and author of Body Love. One of her faves: This grain-free granola from Thrive Market, which has a blissfully short ingredient list but tons of flavor.
I know I know, you’re reading the directions and you’re annoyed that you have to cut each and every ¾ inch square out and transfer it to a pan because WHO HAS TIME FOR THAT. But I am here to tell you that YOU HAVE TIME FOR IT because the end result is cereal that fancy-person-you made yourself, which is going to make you feel very elite and accomplished because WHO DOES THAT?
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.
While these sources have lower carbs, they typically have higher fat contents. For example, most nuts are calorically dense with fat, though most of it is good fats such as monounsaturated and polyunsaturated varieties. If someone is trying to reduce his fat intake as well as his carbohydrate intake, then it may be a good idea to look into low-carb flour varieties that also are low-fat, such as soy flour.

50 NET carbs is quite high because you are probably eating more like 70-100 total carbs. If you can cut down to 30 NET carbs you may see results. You really need to make sure you’ve upped your fat so you won’t be hungry. After writing this post I’m now actually counting TOTAL carbs instead of NET and sticking to just 30 total carbs a day which is what has helped the scale move. Also be sure to get other measurements for yourself besides the scale. You could be losing inches and fat like I did for the 6 week pics.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[18] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[48] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[18]
These are great additions to the low carb pantry. No need to give up wonderful baked goods and live low carb. I use them all the time. I have also tried many of Carolyn’s recipes that use nut flours and coconut flour. They are awesome! You can easily take them to parties where people are expecting flour-baked goods and fool them. Thank you Carolyn for your many contributions to the low carb lifestyle!

Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]
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