I bought a package and boiled the whole thing. I split it up to make two different meals with. The first one was simple jarred sauce and parmesan and the second was the noodles, sauteed zucchini and tomato, ricotta cheese, and parmesan. Both were DELICIOUS. With the tomato sauce dish, I really couldn't even tell the noodles were any different. Maybe they're slightly more fragile, but it's no worse than whole wheat ... full review
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.
Hi Maria, Did you use all the same ingredients and amounts? If you did they should be sweet, but I do think they need the coating for the best flavor and sweetness on the outside. That being said, everyone’s sweet tooth is different so you can add more sweetener next time if you want to. I usually don’t recommend canola oil – use butter, coconut oil, or avocado oil instead to grease. Heavy cream should be fine to sub for almond milk, but you might need a tad more since it’s thicker.
However, replacing high carb flours like all-purpose flour, wheat flour, corn flour, and rice flour with low-carb flour is not as simple as just using one for the other. Due to the difference in composition between high-carb and low-carb flours, you will need to use different amounts of low-carb flour together with other essential ingredients that you don’t typically find in traditional baking recipes like psyllium husk, xanthan gum, and protein powder.
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]
I thought that eating this amount of protein would leave me a withered and emaciated little boy, but this is a belief I held for years of being beating over the head with jugs of protein powder and bro-science. It turns out, you (or, at least I) don’t need as much protein as once thought. However, eating very FEW grams of protein is not smart either. 
If you are like me you were brought up eating sugary cereals like frosted flakes and if the truth were told I do miss them! However now that we are eating keto they just don’t figure anymore, so this low carb recipe has been great to find. You are using coconut flakes and sweetening them, so you still have the sweet taste and crunchy texture that we all remember!

Protein: When people first reduce carbohydrates in their diets, it doesn't seem as though the amount of protein they eat is as important to ketosis as it often becomes later on. For example, people on the Atkins diet often eat fairly large amounts of protein in the early stages and remain in ketosis. However, over time, some (perhaps most) people need to be more careful about the amount of protein they eat as (anecdotally) the bodies of many people seem to "get better" at converting protein into glucose (gluconeogenesis). At that point, each individual needs to experiment to see if too much protein is throwing them out of ketosis and adjust as necessary.
Not in the mood for cake? Brownies definitely come second on that list of delicious treats that we want once we turn to a ketogenic diet. You can easily make keto brownies that you can fully enjoy without having to fight against the craving to have more. Besides using almond flour and other mixtures of flours, you can make them out of avocado as well.

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.
^ 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]
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]
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.
There are many recipes here that use coconut flour OR almond flour. Some I even have instructions to use both (from the post above, you can see they are not easily interchangeable). Is he tolerant of almond flour? I have many recipes which use that. Some recipes that use a small quantity of almond flour/meal, you can actually use some seed flours such as sunflower or pumpkin. I managed to make Fat Head pizza once using ground sunflower seeds when I ran out of almond flour. 

The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]
Nutritional ketosis has been proposed as a mechanism through which hunger may be suppressed. A recent meta-analysis investigated the impact of diet on appetite and shed some light on this possible phenomenon (11). The meta-analysis included 12 studies which investigated the effect of either a very low energy diet (VLED: defined as <800 calories per day) or ketogenic low-carbohydrate diet (KLCD: defined as CHO consumption of <10% of energy or <50 g/day, but ad libitum consumption of total energy, protein and fat). Interventions ranged from 4 – 12 weeks and weight loss was from 5.0 to 12.5 kg. In all studies nutritional ketosis was confirmed in VLED and KLCD via circulating levels of β-hydroxybutyrate. Interestingly, both groups reported decreases in appetite. The results of this meta-analysis are noteworthy in two regards. The VLED groups were clearly and significantly hypocaloric, suggesting a state in which hunger should be increased, not decreased. Similarly, the KLCD groups experienced simultaneous reductions in weight and appetite, while eating an ad libitum diet. The results of this meta-analysis provide support for the theory that nutritional ketosis may exert an appetite suppressing effect.
So I made this recipe and the taste is amazing! However, mine is still in more of a powder form and never got any crispness to it. So we really can’t eat it. Any suggestions on what I can do to make it right? The only difference I had was I used stevia instead of 1/3 cup of a sweetener. I even tried cooking it another 10 minutes thinking my oven just needed more time to crisp it. Thank you for your help! I have loved all the recipes I’ve tried from your site.
I made these donuts super skeptically but holy crap am I impressed. They taste like the little mini donuts you get from the carnival. I baked them until I thought they were dark brown enough but I ate a donut as soon as the timer went off and it crumbled quite a bit. Luckily I had the oven on and could just pop them back in. I would recommend these to everyone!!!
Haven’t ever really eaten turnips? It’s time to give them a second look. They’re inexpensive and their natural sweetness makes them seem like a real treat. Leave the skins on the turnips before roasting to make this already super-easy recipe even quicker. Try them alongside your favorite burger or sandwich recipe for a fry that’s a vegetable in disguise.
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.
Almond Meal is made slightly different than almond flour. Instead of blanching the almonds to remove the skins, the skins on the almonds are kept on. It’s a little bit coarser than almond flour and still bakes the same. For baked goods, I like to use a super fine ground almond flour but I will equally use almond meal as it seems to perform just as well in most recipes, at a reduced cost.
I’ve tried a ”ton” of low carbs foods...so trust me when I tell you how good this stuff is. If your low carb or keto...Sola products are sanity in a bag with a taste authenticity comparitative to their high carb counterparts. You won’t be disappointed so go ahead and order extra. I like to put it in my yogurt, cottage cheese, protein shakes, sugar free pudding, etc. It’s the jam with almond milk by itself too.

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!
If you enjoy flaked cereal, grab a box of Special K Protein from your grocer’s shelves. A ¾-cup serving has 19 grams of carbohydrate, and it’s sweetened with both sugar and sucralose. Natural food stores may carry Julian Bakery Paleo Coconut Flakes, which has no added sweeteners and contains only three ingredients – coconut meat, coconut water and palm starch – and 14 grams of carbs per 1-ounce serving. Hi-Lo cereal, original flavor, which can be ordered online, contains only 13 carb grams per ½ cup and gets its sweetness from evaporated cane juice.
I have been reading all the above comments about the gluten verse other ingredients. As a pastry chef, the information that has been missing here is that not only is gluten a protein, it is also the “elastic” that holds the pasta together. 80% of the proteins in flour are called glutenin and gladin. When combined with liquid, they form the elastic substance called gluten.
The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]
If you prefer hot to cold cereal, Sensato makes a High Fiber Hot Cereal that comes in five flavors: plain, apple cinnamon, butter pecan, “strawberrilicious,” and vanilla almond. The cereal is sweetened with artificial sweetener, so there are no calories from sugar. Each serving has about 12 grams of carbs, ten of which are fiber. The cereal is a mix of wheat bran, flax seed meal, and soy protein isolate.

While the ketogenic diet may sound “new,” it actually parallels the way many of our ancestors ate, before the advent of agriculture allowed for the domestication of staple crops like wheat and corn. Before the widespread emergence of these crops into the modern diet, which are high in carbohydrates and sugar (particularly in their most processed forms), our ancestors ate a wide variety of wild plants and animals and much less carbohydrate or sugar. This diet, naturally lower in carbohydrate, forced our ancestors’ bodies to burn fat for fuel as opposed to carbohydrates — the core goal of the ketogenic diet.
Hi Sandy, You might be able to deep fry them (haven’t tried), but you’d still have to bake them first. The batter is too thin to just straight deep fry, it wouldn’t hold together. You can make them into a different shape if you don’t have a donut pan; some people have used muffin tins. Otherwise the cheap but great donut pan I use is linked in the post above if you want to get one.
We can help. We’ve put together a list of the top 10 healthiest and lowest carbohydrate options for diabetes. Whether you are on an American Diabetes Association (ADA) Diet or a Ketogenic diet, you can enjoy them with diabetes guilt free. If you are on a ketogenic diet, we hope that you are being followed by your doctor and nutritionist for needed lab work.

The only problem with using almond flour is that it is easy to overdo it. A cup of almond flour, for example,  consists of about 90 almonds — an amount that someone would rarely eat in one sitting. Although there are many health benefits that you can get from almonds, consuming high quantities of them will flood your body with inflammatory fats and phytates, which can worsen pre-existing health issues.
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?
Maya, I think what you are doing is brilliant. I am a 70-year old professional woman, educator and coach. I’ve grown our family vegetables every summer since I can remember. However, health conscious 20 or 30 years ago is a far different scenario today. Until I started having digestive issues about 5 years ago, I figured I was in the “above average” category of healthy eating.

Regular flour is made from wheat and grains, both of which have high amounts of carbohydrates. To make a similar flour with fewer carbohydrates, different sources — sources considered low-carb — are used. These sources typically include nuts such as almonds and walnuts, seeds such as flax seed, and legumes such as peanuts and soy. Wheat also can be used as low-carb flour, but only if the wheat section containing the protein is used and nothing else.
With all of the new low-carb food products hitting the marking lately, you may be wondering if it is really worth it to make your own keto-friendly baked goods. Unfortunately, many “keto-friendly” products have been found to contain more net carbs and a bigger impact on insulin secretion than indicated by the packaging. For this reason, one ready-made “keto cookie” can kick you out of ketosis, even if the label says “only with four net carbs.”

3. Dreamfields Low-Carb Pasta: Now this pasta really comes down to the individual. The company says they’ve created this whole-wheat pasta in a way that won’t impact your blood sugar significantly, “Its blend of fiber and plant proteins helps create a pasta that offers many healthy benefits while still having the same great taste of traditional pasta.” You see, the low-carb spaghetti box says there are 41 grams of carbs and 5 grams of fiber, which leaves you with a whopping 36 grams of carbs–not low at all–but again, the company says these carbs shouldn’t impact you like normal carbs. But many people have found they still have to take insulin for all of those 36 grams of carbs, but that the carbs do raise their blood sugar slower than a normal serving of 36 grams of carbs. Others say they don’t see a spike in their blood sugar and the pasta is indeed low-impact. You will have to experiment and decide for yourself!
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).
In regard to serum measurements, the mean fasting glucose decreased by 17% from 9.08 ± 4.09 mmol/L at baseline to 7.57 ± 2.63 mmol/L at week 16 (p = 0.04) (Table ​(Table4).4). Serum sodium and chloride levels increased significantly, but only by 1% and 3%, respectively. Uric acid level decreased by 10% (p = 0.01). Serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001). Increases occurred in both high-density lipoprotein (HDL) cholesterol (8%) and low-density lipoprotein (LDL) cholesterol (10%) but these changes were of borderline statistical significance (p = 0.08 and p = 0.1, respectively). The following blood tests did not change significantly: total cholesterol, potassium, bicarbonate, urea nitrogen, creatinine, calcium, thyroid-stimulating hormone, and hemoglobin.
I don’t make pancakes often and never waffles, but I have definitely used it for the crepes A LOT. The key to the crepes is that the liquid is super thin–like cake mix, not like brownie mix. The xantham gum is really not a huge amount for the full recipe. It is under 1 TBSP per cup of other dry ingredients. Let me know if you like it better with the wheat gluten. Thanks for writing!
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.

Not in the mood for cake? Brownies definitely come second on that list of delicious treats that we want once we turn to a ketogenic diet. You can easily make keto brownies that you can fully enjoy without having to fight against the craving to have more. Besides using almond flour and other mixtures of flours, you can make them out of avocado as well. 

Once you start eating this very low amount of carbs, you’re body will become keto adapted. You are starving it from the carbs therefore it needs to find a source of fuel. When you’re in ketosis, your body will no longer have the carbs it once used to fuel your body. It will have to resort to using your own body fat for fuel. This is amazing because you’ll lose body fat if that was your goal and many other benefits you’ll see below.
There are several different types of flour made from seeds. Flaxseed meal is an excellent source of omega-3 fatty acids and can be used in muffins, pancakes and other baked goods as an oil or butter substitute. A 1/4-cup serving has 8 grams of carbohydrates. Although more difficult to find, sunflower seed flour is very low in carbohydrates with less than 6 grams per 1/4 cup.

Having tempting, unhealthy foods in your home is one of the biggest reasons for failure when starting any diet. To maximize your chances of success with the keto diet, you need to remove as many triggers as you can. This crucial step will help prevent moments of weakness from ruining all your hard work.If you aren’t living alone, make sure to discuss with your family or housemates before throwing anything out. If some items are simply not yours to throw out, try to compromise and agree on a special location so you can keep them out of sight.
There are many recipes here that use coconut flour OR almond flour. Some I even have instructions to use both (from the post above, you can see they are not easily interchangeable). Is he tolerant of almond flour? I have many recipes which use that. Some recipes that use a small quantity of almond flour/meal, you can actually use some seed flours such as sunflower or pumpkin. I managed to make Fat Head pizza once using ground sunflower seeds when I ran out of almond flour.
Hi Liz, Low carb bread doesn’t rise as well as one made with wheat flour, but it shouldn’t be quite that short. Some factors that might contribute include the age of your baking powder and how well the batter is mixed – the mixing process helps create air bubbles. Also, did you use baking soda or baking powder? They are not the same. Baking soda needs something to interact with, in this recipe I use baking powder. More baking powder *might* help, but is risky because using too much can cause it to fall even more flat.

Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D., “A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity,” N Engl J Med 2003; 348:2074-2081. http://www.nejm.org/doi/full/10.1056/NEJMoa022637.
Ok, this is about the smallest amount of vital wheat gluten that you can get but it will last forever if you keep it tightly sealed in the freezer. You can even give my low carb yeast bread a whirl as long as you have the gluten around. Also – these low carb egg noodles would be almost impossible to make without a silicone baking mat to put over the baking sheet. Parchment didn’t work very well because the batter didn’t spread right.

Almond flour is available in supermarkets and grocery stores, but you can find it for the lowest price when you buy it in bulk online. Make sure you purchase the finest blanched almond flour that has no darker specks of skin. The finer the grind of the almond flour, the finer the consistency of your baked goods and the easier it will be for your food to rise.


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!)

From the study itself: “Mortality increased when carbohydrates were exchanged for animal-derived fat or protein and mortality decreased when the substitutions were plant-based … Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.”
You’re transitioning. Your body is equipped to process a high intake of carbs and a lower intake of fat. Your body needs to create enzymes to be able to do this. In the transitional period, the brain may run low on energy which can lead to grogginess, nausea, and headaches. If you’re having a large problem with this, you can choose to reduce carb intake gradually. 

H. Guldbrand, B. Dizdar, B. Bunjaku, T. Lindström, M. Bachrach-Lindström, M. Fredrikson, C. J. Östgren, F. H. Nystrom, “In Type 2 Diabetes, Randomisation to Advice to Follow a Low-carbohydrate Diet Transiently Improves Glycaemic Control Compared with Advice to Follow a Low-fat Diet Producing a Similar Weight Loss,” Diabetologia (2012) 55: 2118. http://link.springer.com/article/10.1007/s00125-012-2567-4.
I've been on the search for low carb crackers for dips and chicken salad for years...I was excited to find these but a little surprised by the expensive price tag. I figured I'd give them a shot anyway. I really like these crackers - they remind me of Mary's Gone Crackers but less crispy. I wouldn't choose to eat them alone - they definitely need a dip or chicken salad to go with them or else they're pretty bland, besides the seed taste. The only problem was that over half of the bag was broken which made it impossible for me to dip them into anything chunky. For $10 per box, they should have them in a tray or something to eliminate this mistake. Unfortunately, I won't buy them again unless the price drops by at least half.

Thanks for this inputs. 20 years ago I gain 17 pounds a year for 5 years. I was healthy but my dr told me start diet, any diet just come back in a month I want to see you start loosing… I started Atkins and lost 7 pound in a month. She was checking my progress every six months and checking my condition. I lost 64 pounds in 3 years. Now I started eating out of control. I am eating healthy but too much… I gain 40 pound back after 20 years. Now I will start again my Atkins to take off 30 pounds…
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.
Instead of getting that store-bought can of frosting that’s filled with sugar, food coloring, and trans fats, make your own! Cream cheese and butter come together perfectly to create a rich and creamy frosting that makes all of your cakes taste better. If you want an example of a great cream cheese frosting (with added fruit compote), check out our Low Carb Spice Cakes with Cream Cheese Frosting.
This was amazing!!! So I had to try a chocolate/peanut flour (Reese puff) variation for my husband and, Nailed it! I followed yor recipe but subbed the almond flour with peanut flour and also added a couple of tbsp natural peanut butter and 1tbsp unsweetened cocoa. Then baked it for 20 minutes. Once out of the oven I then sprinkled it with a combo of 3tbsp of Swerve and 1tbsp of unsweetened cocoa powder. Oh my!!! Thank you for making breakfast fun again! You’re awesome 🙂
Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.  Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.
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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