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.
Since the ingredients are eggs and cream cheese, and the recipe for scrambled eggs or an omelette is eggs and cream or milk, which is almost the same, the taste is going to be eggy. Adding gluten,which has no taste, is not going to change the flavor. I thought it might change the texture, but it didn’t do that either. How it’s mixed, baked, or simmered isn’t going to change the flavor either.
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking.
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
Hi Brenda, I’m a fan! I love what you do! Pictures look great! I’m 61 Keto for 14 months and 60 lbs off! 10 more to go. I eat at TDEE to loose it works for me. I’m 5’8” 1900 calories 20 total carbs 50 protein and 182 fat. Copious amounts of fat! I speed walk. I live too far a gym to go. Rural MS! Blessings on your journey. Thank you for all you do!
This is REALLY good. My OH also thought that this was ‘proper’ bread LOL! Why do people think that anything not made with wheat is not ‘proper’? I guess they don’t have a gluten intolerance. This really is the best low carb GF bread I’ve tasted in a LONG while. It will become a staple in this household that’s for sure. Will definitely still use the 90 second rolls as well for convenience!
Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D., “A Randomized Trial of a Low-Carbohydrate Diet for Obesity — NEJM,” N Engl J Med 2003; 348:2082- 2090. http://www.nejm.org/doi/full/10.1056/NEJMoa022207.
Normal dietary fat contains mostly long-chain triglycerides (LCTs). Medium-chain triglycerides (MCTs) are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[18] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhea, and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[18] 

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!
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.
I was on the ketogenic diet for 6 months to support my husband, who is on it permanently for epilepsy. The diet totally messed with my hormones, which my doctor and my husband’s nutritionist sadly confirmed was a possibility. I am continuing to eat low-carb, but the ketogenic thing unfortunately seemed to work against me as a 49-year old pre-menopausal woman.

Where does nutrition info come from? Nutrition facts are provided as a courtesy, sourced from the USDA Food Database. You can find individual ingredient carb counts we use in the Low Carb & Keto Food List. Carb count excludes sugar alcohols. Net carb count excludes both fiber and sugar alcohols, because these do not affect blood sugar in most people. We try to be accurate, but feel free to make your own calculations.
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.
So rather than giving one-size-fits-all dietary advice or weaponizing the word “balanced” it might be better if the medical community suggested that there are Individual differences that need to be considered. This might also help those lay folk who have had success with one dietary lifestyle or another also realize that what’s valid for them may not be good advice for others.
Normal dietary fat contains mostly long-chain triglycerides (LCTs). Medium-chain triglycerides (MCTs) are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[18] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhea, and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[18]
I’ve done the micro version for slices and it was quite good. Today trying the loaf recipe – but with the micro version and this one my mix never comes out like a batter – more like a moist dough. Any ideas what I may be doing wrong please? I have to say though that you are wonderful giving me a non carb bread – my husband loves bread and needs to lose weight. Many thanks!

At 60 minutes, the bread showed as done with a toothpick. Removed it from the oven and it sank down the center. I waited 15 minutes. Cut a piece off and it was wet, like not done in the center. I baked it 15 more min and it stayed the same. Is it supposed to be wet/moist like, maybe it’s oily from the coconut oil? If it’s supposed to be completely dry but moist, not wet, then something went wrong.
I began my low carb diet (around 50 net per day) almost 3 months ago. I have only lost 2 lbs. I need to lose at least 30. I am 62 years old and in good health. Everything I have read leads me to believe that I am doing everything correctly. I even make my own Keto bagels! What do you think could be the issue? I tried going down to less than 20 carbs but I just cannot do it. Thanks for any help you can provide.
This is the best keto bread recipe out there, in my opinion. I make it every week. The psyllium husk is brilliant and really makes this like more traditional bread. I add a TBL of swerve to help counter any egg taste too. Comes out great every time. Sometimes I add cheddar cheese and that’s delicious too! I love this bread. Thank you for sharing the recipe! It’s a winner!
So today I was sitting here getting some work done and occasionally looking out the window. The roses on the trellis are pretty actively in bloom and the trees are loaded with bright green leaves. The colors are bright against a glowery gray sky, though and it looks chilly. It’s not in the least – I think the high today is going to be 81F – BUT it LOOKS that way.
Similar to the recommendations I make in Grain Brain, a ketogenic diet should derive a majority of its calories from fat. However, the optimal macronutrient ratio will vary from person to person. Some will thrive on roughly 80% of calories from healthy fats and 20% from carbohydrates and protein. Others may do better in the range of 60 – 75% of calories from fat and slightly more protein. I encourage you to experiment to find what works best for you. To meet this goal, you must consume plentiful amounts of healthy plant and animal fats. Some good examples of healthy fats include:
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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.
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!)
I liked this product a lot it fit in perfectly with my low carb diet. It is quite tasty and I enjoyed it with my morning coffee. My only camplaint is how Amazon packed it for shipping. They have become quite careless with their packing to protect items that can smash. The outer box of this product often will be damaged but the cereal in separate bags is usually fine.
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]
Similar to the recommendations I make in Grain Brain, a ketogenic diet should derive a majority of its calories from fat. However, the optimal macronutrient ratio will vary from person to person. Some will thrive on roughly 80% of calories from healthy fats and 20% from carbohydrates and protein. Others may do better in the range of 60 – 75% of calories from fat and slightly more protein. I encourage you to experiment to find what works best for you. To meet this goal, you must consume plentiful amounts of healthy plant and animal fats. Some good examples of healthy fats include:
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!
Soba noodles: In many Japanese dishes, fiber-rich soba noodles are the star player. While they’re similar in texture to traditional long noodles, their nutty flavor makes them a great fit for savory and slightly sweeter dishes. At 24g of carbs per cup, they’re a higher-carb option than veggies, but still lower in carbs than a cup of regular spaghetti which has around 43g of carbs.
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]
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.
Ground psyllium husk powder is 100% pulverized psyllium husk shells and is used to give a bread-like texture to what you’re baking. Due to its high fiber content it’s often sold as a laxative which can be good to know if you have a sensitive digestive system. When adding it to a liquid it turns into a gel-like substance. It works a bit like gluten in traditional baking, and makes it possible to handle the dough when rolling or shaping it.
Hi Beth, I do use the one that is linked from the recipe card and it doesn’t turn purple for me. But, I have heard some people say they did end up with purple bread – just not sure if they used the same brand or not. Either way it’s a visual thing and still totally fine to eat. Sorry to hear about the mix-up with the orange flavor, hope it was still edible for you and you’ll try again with the plain kind!
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! 

Hi, I’m still a bit skeptical, I have seen some of my friends do the keto diet, and have had good results. Though I am still not sure about the idea of the fats being eaten. They say they eat meat with the fat and must do so, is this correct? Also isn’t this not good for the body especially for the kidneys? Second, can a diabetic do this diet? There are many questions running through my head.

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]
41 pounds is wonderful! How much more do you feel you need to lose? I honestly think you’re not eating enough with just 700-900 calories and then you’re body is craving and hunger when you are actually home. I would suggest trying to be more at 1000 -1100 on each day consistently and give it at least a month. I’ve not quite figured out the plateau area yet for myself and since writing this post my weight hasn’t budged and it’s been 3 weeks so I am working on changing some things and will update if I have success with it. Also I forgot to mention Intermittent Fasting? Have you tried that? Dr.Eric Berg on youtube has a lot of info on that if you’re interested. Good luck!

The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron's cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a "gate" which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.[7]
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.
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.
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.
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
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.

Almond flour is a great low carb pasta alternative. It contains 1.6 grams of carbohydrates and 1.6 grams of dietary fiber, resulting in zero net carbs[*]. White, bleached, enriched flour contains over 76 grams of total carbohydrates with only 2 grams of fiber[*]. Almonds are also an excellent source of healthy fats, vitamin E, manganese and magnesium[*].
My 1st attempt & it was delish w/unsweetened organic coconut milk.Had no hazelnuts & only half the amount of almonds so I substituted extra pecans. Used unground flax & also added additional 2 tbs ground flax for more fiber. Added 1 tbs vanilla. Used a combo of sweeteners: Eryth, Xylitol & Stevia. Next time will grind ingredients separately to get a more chunky result.
If you're a fan of health food already, you'll appreciate that a good portion of low-carb pastas are made using gluten-free ingredients. Gluten is a substance found in wheat and similar grains that some individuals do not tolerate well. In fact, those who suffer from celiac disease are completely allergic to it. If you find that your body doesn't agree with foods like bread and cereal, there's a good chance you'll feel better after switching to a gluten-free diet. There are lots of low-carb pasta varieties available that have a noodle-like texture thanks to beans, not wheat.

ADA dieters can use it to cut the amount of carbohydrates from grains in their diet and to allow for other carbohydrate containing foods in the diet based on their recommended amounts. Walnut flour also contains healthy fats, fiber to help slow down the break down of other carbohydrates eaten with a meal and it’s got a great nut-buttery taste. The oils in the walnuts give it added flavor.


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.
1. These cookies are lightly sweetened. If you want them sweeter add more Sukrin Gold (2 tbsp) or add a little stevia glycerite (1/4 tsp) and taste. 2. All ovens are different and baking temps and/or times may need to be adjusted. If you have a wall oven, you might want to cook at 325 degrees F. The cookies might have to go a little longer if you do. 3. Be careful not to pack the almond flour and oat fiber. Packing ingredients leads to using more and can result in dry baked goods. 4. For a flatter, softer cookie use 4 oz of sliced almonds instead of 5 ounces and bake for slightly less time. Also use a room temperature egg instead of a cold egg. 5. Ingredient substitutions may affect texture, moisture content, and cooking time.
Hi Maya! I’ve been trying to lose weight on a low fat diet, to no avail, so I’m trying Keto. I came across your recipe while looking for almond flour bread recipes. (Love the occasional turkey breast half-sammie for lunch or the occasional toasted slice for breakfast). Yours appears to be a very carefully thought-out recipe which I’m anxious to try. I really like how you explained things so thoroughly, gave tips. There’s nothing like learning with the benefit of others’ tried and tested experience. I’m not rating this recipe since I haven’t tried it yet, but based on your effort alone, it gets five stars! Many thanks, Alice

One downside to a ketogenic diet for weight loss is the difficulty maintaining it. “Studies show that weight loss results from being on a low-carb diet for more than 12 months tend to be the same as being on a normal, healthy diet,” says Mattinson. While you may be eating more satiating fats (like peanut butter, regular butter, or avocado), you’re also way more limited in what’s allowed on the diet, which can make everyday situations, like eating dinner with family or going out with friends, far more difficult. Because people often find it tough to sustain, it’s easy to rely on it as a short-term diet rather than a long-term lifestyle.
While there are many almond-flour pastas advertised as low carb, be sure to triple-check the label. Many brands contain more carbohydrates than you’d believe. Al Dente Carba Nada contains over 24 grams of total carbohydrates, or 17 grams net carbs[*]. Fiber Gourmet, also advertised as low carb, contains over 40 grams of total carbohydrates per serving and 3 grams of sugar[*].
Measuring blood ketones is the most reliable method. There is a home blood test you can use, but the strips can be very expensive. An alternative is to measure ketones in the urine with a dipstick test, which is much more accessible and inexpensive. However, this method is much less reliable and as time goes on and the body adapts to ketosis, it becomes even less reliable.
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.

These are amazing! I only had almond meal instead of almond flour and didn’t have a donut pan so I used a muffin pan. I was surprised at how light and fluffy they were, and the taste! Oh my!! I was so wrapped I made another batch today but just left them plain with no coating and they were divine. I also froze some yesterday and thawed one and they freeze excellent. Thank you Maya!

Important Disclaimer: The information contained on Bodyketosis is intended for informational and educational purposes only. Any statements made on this website have not been evaluated by the FDA and any information or products discussed are not intended to diagnose, cure, treat or prevent any disease or illness. Please consult a healthcare practitioner before making changes to your diet or taking supplements that may interfere with medications.


My daughter loves cereal, but I rarely let her have it because it jacks her blood sugar like crazy, and is rarely filling enough. This is low carb enough that if she likes it, I can fill her up with other stuff, too, while letting her have the cereal she so badly wants. I was just admonished by the nutritionist at her endocrine clinic for letting her often have a nutritionally vacant breakfast (toaster waffles; we get so busy in the morning! I need to be better at pre-prep).

Sunflower seed meal and pumpkin seed meal are ideal options for those who are allergic to any of the nut flours we mentioned above. These seed flours are high in vitamins and minerals such as vitamin E, copper, thiamine, selenium, and phosphorus, and relatively low in net carbs (less than five net carbs in every 1-ounce serving), making them a healthy keto-friendly option.
Please note that I am not a medical or nutritional professional. I am simply recounting and sharing my own experiences on this blog. Nothing I express here should be taken as medical advice and you should consult with your doctor before starting any diet or exercise program. I provide nutritional information for my recipes simply as a courtesy to my readers. It is calculated using MacGourmet software and I remove erythritol from the final carb count and net carb count, as it does not affect my own blood glucose levels. I do my best to be as accurate as possible but you should independently calculate nutritional information on your own before relying on them. I expressly disclaim any and all liability of any kind with respect to any act or omission wholly or in part in reliance on anything contained in this website.
Participants were recruited from the Durham Veterans Affairs Medical Center (VAMC) outpatient clinics. Inclusion criteria were age 35–75 years; body mass index (BMI) >25 kg/m2; and fasting serum glucose >125 mg/dL or hemoglobin A1c >6.5% without medications, or treatment with oral hypoglycemic agents (OHA) and/or insulin. Exclusion criteria were evidence of renal insufficiency, liver disease, or unstable cardiovascular disease by history, physical examination, and laboratory tests. All participants provided written informed consent approved by the institutional review board. No monetary incentives were provided. 
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