Cinnamon toast crunch is the best cereal by a long shot and I can guarantee this by asking anyone and everyone if it was a part of their childhood, and even adulthood. It is, without fail, the cereal I see the most people purchase when I am at the grocery store. We knew that if we were going to attempt a low carb cereal we would need to pick one that everyone could undoubtedly agree upon as the best, so we decided on Cinnamon Toast Crunch.
Rami co-founded Tasteaholics with Vicky at the start of 2015 to master the art of creating extremely delicious food while researching the truth behind nutrition, dieting and overall health. You can usually find him marketing, coding or coming up with the next crazy idea because he can't sit still for too long. His top read is The 4-Hour Workweek and he loves listening to Infected Mushroom in his spare time.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]

Must say, however, that the shape of choice (for most pasta-like results) are the cavatelli. Both because the ridges help the sauce to stick better, and for the resulting texture and mouthfeel. Though you’ll need to procure a (9 bucks!) cavatelli & gnocchi board. Cavatelli are very similar to gnocchi in shape (which you can make too!), though slightly thinner and with more of a bite. 

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.


When first switching your body to ketosis, there’s a period popularly nicknamed ‘keto flu’. This is the period in which your body is constantly craving carbohydrates because it’s just beginning to learn how to focus on fats. The ‘fast’ induction method involves eating nothing but fats for three to four days, and drinking lots of beef or chicken broth, the high-sodium kinds, to ease the headache and other flu-like symptoms.
Instead of making your own cereal, you can always have a low-carb alternative. Try out chia seed pudding, flax granola sprinkled into coconut or almond milk, salted caramel pork rind cereal, or just mix together toasted nuts that are crushed and crispy. It’s quite easy to find a crunchy alternative to cereal (or just a low-carb replacement in general) so keep on the lookout and experiment for yourself to see which you like best.
Today we tackle low carb flour alternatives. There are a few wheat-based flour products on the market that have somehow magically been de-carbified. You are free to use these if you wish, but I steer clear of them. I stay away from most things with wheat as it is, but I did try these out a few times and I can’t say that they live up to the promise. They don’t taste very good, they don’t rise well or hold together well, and you have to ask yourself: what sort of processing do they go through to reduce the carb count so much?
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.
Finally! A granola that I don’t HAVE to put any kind of a sweetener in! I’ve been keto for almost 2 years and have really missed a good bowl of granola/cereal for breakfast. Your recipe is perfect. I made it ahead of time and keep it in an airtight container. It’s so nice to be able to grab the container, pour some in a bowl and enjoy, and for me, I find that the nuts give a good flavor without the sweetener. I’m always looking for recipes that I don’t HAVE to use a sweetener in because almost all of the ones used in LCHF recipes cause war in my bowels, sigh. This recipe is perfect. THANK YOU so much for getting online for the rest of us. 🙂
To replace 1 egg, mix 1 tbsp ground flax meal with 3 tbsp of water and allow it to swell. This can be used to replace the eggs but it will not give to properties that eggs do. Eggs help bind the ingredients, eggs help the baking become light, fluffy and rise. Eggs help emulsify the mixture. This formula is used in many vegan recipes or those who are allergic to eggs. If a recipe is heavily based on eggs, this substitution will not work.
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).
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. 

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.


Instead of adding sugar to your coffee, you can put a few drops of stevia in there to sweeten it up. Stevia is a great sweetener and won’t increase your blood sugar levels – so it’s a perfect way to sweeten your morning coffee. If you find stevia to have a bitter aftertaste, erythritol and monk fruit extract are two other keto-friendly sweeteners worth trying.
I’m afraid I don’t. I have never used peanut flour and would hate to guess a conversion for you. And as you may know, almond flour and coconut flour are completely different beasts so are used completely differently to one another. If you are about to throw it away anyway, maybe try experimenting with it, you have nothing to lose (other than some eggs and butter perhaps).
"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.
Hello there. Thanks for sharing this recipe. I am sooo excited to try it. In fact, I have just ordered some almond flour. I have a question regarding eggs. The recipe calls for four. Can I use two instead, and substitute with flax eggs for the other two? I have a lot of flax in my cupboard and I am looking for creative ways to use it up. Also, it is nice to be able to utilise ingredients already in my cupboard. I am trying to get out of the habit of buying new ingredients for everything new recipe I want to try. Anyway, looking forward to your response. Thank you.

1. Aragon AA, Schoenfeld BJ, Wildman R, Kleiner S, VanDusseldorp T, Taylor L, Earnest CP, Arciero PJ, Wilborn C, Kalman DS, Stout JR, Willoughby DS, Campbell B, Arent SM, Bannock L, Smith-Ryan AE, and Antonio J. International Society of Sports Nutritionists Position Stand: Diets and body composition. Journal of the International Society of Sports Nutrition 14:16, 2017.

In addition, no statement on this website has been evaluated by the Food and Drug Administration, and any product mentioned or described on this website is not intended to diagnose, treat, cure, or prevent any disease. If you purchase anything through a link on this website, you should assume that we have an affiliate relationship with the company providing the product or service that you purchase, and that we will be paid in some way. We recommend that you do your own independent research before purchasing anything.

A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]
Most people don’t know this but when mitochondria make energy, they also produce oxidative stress. Think of how an engine burns gas to make energy and waste products, it is somewhat similar. While small amounts of oxidative stress can be beneficial to the body, too much can contribute to chronic inflammation. Chronic inflammation is at the root of almost every chronic disease people face today.
On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off. This is great if you’re trying to lose weight, but there are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you alert and focused.
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.

If you are a coconut lover you will really love this hot cereal in the morning. This is one of the best breakfast cereals you can have, especially on a colder day, as it gets you filled up and heated up at the same time. It has a rich coconut flavor which is complemented by the vanilla and is sweet enough to satisfy a sweet tooth, and with only two grams of carbs in each serving, it is definitely low.
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).
From baseline to week 16, the mean body weight decreased significantly from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg, BMI decreased from 42.2 ± 5.8 kg/m2 to 39.4 ± 6.0 kg/m2, and waist circumference from 130.0 ± 10.5 cm to 123.3 ± 11.3 cm (Table ​(Table3).3). The percent change in body weight was -6.6%. The mean percent body fat decreased from 40.4 ± 5.8% to 37.0 ± 6.0%. Systolic and diastolic blood pressures did not change significantly over the 16 weeks. The mean heart rate decreased from 81.2 ± 12.9 beats per minute to 74.6 ± 14.0 beats per minute (p = 0.01).
Thanks for posting about the psyllium Sarah,, I tried psyllium flakes 10g and they turned out great. Not even very fragile. It just gets thick so the batter doesn’t self-level, I had to do my best, and the thick spots required 1 extra minute in the oven. Used immediately in a skillet lasagne- just ground beef, jar of pasta sauce, mozz cheese and cream cheese. Definitely wouldn’t have been much of a lasagne without the “pasta”! So these noodles are my hero 🙂
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!

This is such a great addition to breakfast. With that said I tweaked it a bit by adding a bit more butter and vanilla. After cooling I pressed it into a spring-form pan to use for a cheese cake, end result was great. Guests couldn’t believe their desert was carb free gluten free. I think the possibilities for this recipe is endless, nuts, chocolate shavings or chunks my husband added cranraisins. Thank you so much for posting.


After the 1st time I started making these i started making it as a cake using a small casserole dish cutting into 8 pieces, without the sugar/cinnamon topping. I tried monk fruit sugar and love it (new at Costco in Seattle) I also used 2% milk (all I had on-hand). I’ve made several batches and theres been some on the counter for 2 weeks now. My husband and I love having a treat we can grab on the go.
Hi! My donuts are in the oven right now, but they are spreading too much & not rising. Almost running off the donut pan. I only filled them 3/4 full as you show in the video. I doubled the recipe using the above calculator. I know I followed it exactly. Any idea of what I did wrong? The batter tasted yummy and so did the finished product, the donuts just weren’t as pretty as yours.
Hi Krystal, I haven’t tried a sweet version of this bread. Honey wouldn’t be low carb, so just keep that in mind. Adding a sweetener should work, but other ingredients would need to be adjusted. You may need a little more of the wet ingredients if using a granulated sweetener, or a little more almond flour if using a liquid sweetener. If you try adding something, let me know how it turned out for you!
Check the nutrition labels on all your products to see if they’re high in carbs. There are hidden carbs in the unlikeliest of places (like ketchup and canned soups). Try to avoid buying products with dozens of incomprehensible ingredients. Less is usually healthier.Always check the serving sizes against the carb counts. Manufacturers can sometimes recommend inconceivably small serving sizes to seemingly reduce calorie and carb numbers.
A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]
Low Carb FoodsLow Carb MixesLow Carb BarsLow Carb BreadsLow Carb BrowniesLow Carb Cakes - PiesLow Carb CandyLow Carb CerealLow Carb ChocolateLow Carb CondimentsLow Carb CookiesLow Carb EntreesLow Carb MuffinsLow Carb PastaLow Carb PastriesLow Carb SnacksDiet FoodsHealthy MixesHealthy BarsHealthy BreadsHealthy BrowniesHealthy Cakes - PiesHealthy CandyHealthy CerealHealthy ChocolateHealthy CondimentsHealthy CookiesHealthy EntreesHealthy Frozen FoodHealthy MuffinsHealthy PastaHealthy PastriesHealthy Peanut ButterHealthy Snack FoodsSupplements
I made 2 mugs of this recipe tonight. I made my husbands with 2 squares of Ghirardelli 100% cacao. I made mine with 1 heaping Tbl. of unsweetened baking cocoa and 3 TBL of sweetener (instead of 2Tbl) the remaining ingredients were added as the recipe called for. Hands down, the cake made with the baking coca had a better texture and flavor. We will definitely make it again whenever we need a chocolate fix. Thanks for sharing.
It took me a long time to find you but your website has been a huge blessing. My husband is a diabetic and I didn’t know what to do to handle this. He also loves desserts which was a real challenge. I could find lots of paleo sites but they all use honey or maple syrup which is still sugar and not good for a diabetic. So here you are and everything you do is perfect for us. I think you are a genius. And you have sooooo enhanced my life. Thank you so much for being here and sharing. Please don’t ever go away!
It’s a habit to enjoy a brie cheese for desert instead of a piece of chocolate cake but each are favored deserts in France. I’m personally more satisfied after a 350 calorie sized wedge of brie than the same number of calories of cake.. which will give me sugar crash and .. really I’d like two slices of cake(I’ve got a sweet tooth that once I get going it wants to keep being fed)
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!!
Hello, I can’t have any actual sugars in my diet. So when your label at the end says 1 sugar etc is that for the “fake” sweeteners in each recipe? Or real sugars? I can have ones like Splenda, truvia, etc. It’s only so specific for me because it’s to keep all sugar away and control my seizures. These desserts sound amazing and seem to fit my diet till the sugar part on the label.
Shirataki noodles are available in many shapes -- spaghetti, fettucini, macaroni -- and can be purchased plain. Products like Miracle Noodle and NoOodle Noodles sell this type, which tends to be extra-slippery, nutritionally void (they are mostly made up of water) and close to calorie-free. Other brands, like House Foods and Nasoya's Pasta Zero blend the yam flour with tofu or chickpeas, which adds just a few calories and grams of carbohydrates and fiber.
Next, the noodles are tasteless, so they make a great vessel for your pasta sauces. These are 6g net carbs per serving, but the servings are huge! We generally aren’t big fans of the concept of eating less of something to make it seem lower in carbs. But, we have found that when cooked, even half of the recommended serving is pretty sizable for these noodles.
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.)
Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.
I’ve been doing keto on and off for a year. Before that, I explored eliminating “inflammatory” or “reactive” foods based on another eating program. I have Celiac and autoimmune issues and I think one of the reasons people stall with Keto is because they are eating too many typically “inflammatory” foods–foods that your body has a harder time digesting and as a result create systemic inflammation which, in turn, cause weight loss plateaus. For those trying to fight through a Keto Plateau, I would suggest eliminating ALL dairy (try subbing ghee for butter), artificial sweeteners (including stevia and erythritol) and all nuts for 5 days. I know it sounds close to impossible but all three of these Keto staples are some of the biggest culprits of inflammation in the body. I found this suggestion on another Keto website and tried it and dropped 6 lbs in 5 days. Another typically inflammatory food is Eggs. If you can’t eliminate all of these foods at once, try eliminating one at a time for a minimum of 5 days and see if there is any movement on the scale. For those who have stalled, chances are at least one of your Keto staples is holding you up. Good luck!
Net carbs is simply total carbs minus fiber and non-digestible sugar alcohols, like erythritol. (This doesn’t apply to high glycemic sugar alcohols, like maltitol.) We don’t have to count fiber and certain sugar alcohols in net carbs, because they either don’t get broken down by our bodies, are not absorbed, or are absorbed but not metabolized. (Read more about sugar alcohols here.)
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!

New to low carb eating, My first attempt actually turned out really well. Baked 70mins. came out a little under, no color change from psyllium, lots of little air pockets ,but still firm and a little dense. Held up well to firm butter and refrigerated almond butter. Cant wait to have toast or a sandwich. Thanks for doing all the hard trial & error work and keep the recipes coming.


Made this today for my husband. It is delicious. I used coconut oil (the hard kind) and added 1 tsp of cinnamon. Only problem is that it did not crisp up. It’s more “bendy” than crispy. Not dry enough. Definitely baked it long enough. Should I use less coconut oil next time. Any ideas. Thanks. I will definitely make again because the taste is awesome.
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.
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.
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).
All cold cereals are going to have some carbs in them. The key is to avoid simple carbohydrates, such as those found in processed grains like corn flakes or any old-school cereal made with refined white flour and a ton of sugar. The health organization Diabetes UK recommends choosing a cereal based on whole wheat, oats or bran. In addition to eating whole grain cereals, you also need to avoid excess added sugar such as high fructose corn syrup. The Center for Young Women's Health suggests that you choose a cereal that contains fewer than 8 grams of sugar per serving. Dried fruit counts as added sugar, so pay attention to the ingredient list. You can always purchase unsweetened cereal and add fresh fruit as a sweetener, because the vitamins, minerals and antioxidant benefits of fresh fruit outweigh the natural sugars.

Hi Vivian – I am 60 yo and researching Keto and would love more information from you since we are same age. What is TDEE? What fat sources do you use and how much daily? What are some meals you make regularly and what does a day of food look like? What is the easiest/best way to count carbs getting started? If you and Brenda are ok with you giving me your email I would love to learn more from you! I just need some help getting started. Brenda – thank you for all your information and recipes!
Hi I’m new to Keto. I have been reading about it, and understanding what to eat and what not to eat. My problem is I’m not sure if I’m doing it correctly. I’m constantly hungry whereas information reads that I will never be hungry. I use fats as required along with topping up with vegetables in my meals yet this does not fill me up. I haven’t experienced the Keto flu and I’ve even put on weight! I have been doing this for about 3 weeks now. Any ideas where I am going wrong.
According to the Institute of Medicine, women should get 21 to 25 grams of fiber a day and men 30 to 38 grams a day, so it behooves you to know where the big numbers are. And, it turns out, lots of those big numbers are in foods that are naturals for the most important meal of the day—breakfast. Use the morning meal to jump-start your fiber intake and you'll find the recommended amount becoming a realistic goal.
The only issue with keto, is really that I’m afraid that it might be hard to up my calories to a maintenance weight now that I’ve gotten a taste preference for the rich assortment of foods with no carbs in them. I’m satisfied with less calories than I will need after my excess fat is burned off… but , maybe I bet my body will send more hunger signs once there isn’t anymore body fat in the cupboard to use instead of what goes down my throat.
You can make “quick breads”–or non-yeast breads with it. It does not have enough gluten to make dough rise well. If you see a bread that calls for almond flour or coconut flour (to a certain extent–coconut flour usually requires more eggs), you can often substitute this mix for a lower fat, lower calorie, more diverse-tasting flour. If you are after yeast products, I recommend my Low Carb Sprouted Flour Mix. (Bread and yeast product recipes for that mix are coming soon!)
The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.[7]
Purnell JQ, Hokanson JE, Marcovina SM, Steffes MW, Cleary PA, Brunzell JD. Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes Control and Complications Trial. JAMA. 1998;280:140–146. doi: 10.1001/jama.280.2.140. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
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