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]
Keto low carb: less than 20 grams of carbs per day. This level will be ketogenic for most people — if protein intake remains moderate. In our keto recipes, less than 4 per cent of its total energy is coming from carbs, and the rest will come from protein and fat. In keto recipes we also keep the protein level moderate, as excess protein can be converted to glucose in your body. See note* below.
Protein can turn into carbohydrates via a metabolic process called gluconeogenesis (making new carbs) and will do in people at varying degrees. Protein turning into carbohydrates means you’re not in ketosis. However, this is generally an overblown statement that only happens at the extreme cases when you are drinking a lot of liquid protein shakes. 
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.
Russel Wilder first used the ketogenic diet to treat epilepsy in 1921. He also coined the term "ketogenic diet." For almost a decade, the ketogenic diet enjoyed a place in the medical world as a therapeutic diet for pediatric epilepsy and was widely used until its popularity ceased with the introduction of antiepileptic agents. The resurgence of the ketogenic diet as a rapid weight loss formula is a relatively new concept the has shown to be quite effective, at least in the short run.

In addition, on the day the diet was initiated, diabetes medications were reduced – generally, insulin doses were halved, and sulfonylurea doses were halved or discontinued. Due to the possible diuretic effects of the diet soon after initiation, diuretic medications were discontinued if of low dosage (up to 25 mg of hydrochlorothiazide or 20 mg of furosemide) or halved if of higher dosage. Participants were also instructed to take a standard multivitamin and drink 6–8 glasses of water daily, and were encouraged to exercise aerobically for 30 minutes at least three times per week. 

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.
Hi Jan, Sorry they didn’t work for you. It’s hard to say what happened without being in the kitchen with you. Did you use exactly the same ingredients and amounts? Also, if they were not cooked, then they probably needed to be in the oven for longer. If they were clumpy, it’s also possible that the almond flour wasn’t fine blanched (it needs to be) or the batter wasn’t mixed well enough. Hope this helps.
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!
2. Raygan, F., Bahmani, F., Kouchaki, E., Aghadavod, E., Sharifi, S., Akbari, E., . . . Asemi, Z. (2016). Comparative effects of carbohydrate versus fat restriction on metabolic profiles, biomarkers of inflammation and oxidative stress in overweight patients with Type 2 diabetic and coronary heart disease: A randomized clinical trial. PMID: 28607566 

Some health experts recommend people get between 45 and 65 percent of their daily calories from carbs, with more active people erring on the higher side and less active people eating fewer carbs. For example, an active woman between the ages of 19 and 25, who is aiming to maintain weight, should consume about 2,600 calories that include 293-423 grams of carbs a day. They should then get 15 to 25 percent of calories from fat and protein.
Almond flour, a misnomer, is more accurately almond meal. It consists of ground almonds that have a flour-like consistency. Almonds are naturally low in carbs -- 1 cup of almond meal contains a mere 2 grams -- in addition to being high in calcium and protein. Almond meal crumbles more easily than gluten-based flour so it can be used to replace no more than one-quarter of the flour in a recipe that calls for grain flour. When baking with 100 percent almond meal, additional eggs or egg replacers are required.
The ketogenic diet is not a benign, holistic, or natural treatment for epilepsy; as with any serious medical therapy, complications may result.[28] These are generally less severe and less frequent than with anticonvulsant medication or surgery.[28] Common but easily treatable short-term side effects include constipation, low-grade acidosis, and hypoglycaemia if an initial fast is undertaken. Raised levels of lipids in the blood affect up to 60% of children[38] and cholesterol levels may increase by around 30%.[28] This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and if persistent, by lowering the ketogenic ratio.[38] Supplements are necessary to counter the dietary deficiency of many micronutrients.[18]
Most people are used to how white flour works, but when they try to bake or cook with low-carb flour, they most likely will notice some differences. Depending on the source of the flour — and how many carbs, fat and protein calories it has — the flour may well react differently. For example, flour with high protein may clump easier; the flour also may brown or burn quicker than regular flour. This means cooks and bakers may have to experiment with the flour to learn how it works.
It can sometimes be difficult to find a cereal that actually fills you up till lunch, so a keto-compliant granola can be the answer. This one is deliciously crunchy and has a warming flavor from the cinnamon and tastes great with your favorite nut milk. Nuts can be a great source of goodness and energy, so this can also be eaten as a snack when you need a little something to keep you going.
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.
I doubled the recipe. Accidentally added 3tsps baking powder. Also added 1/4 cup ground flax, 1/4 cup sesame seeds, 1/2 cup slivered almonds. I then mixed it for 3 minutes in my stand mixer. I baked the bread for 60 min and then added 10 and then another 10more. I used a thermometer and let it get to 200 degrees internal temperature.. That’s what I use for regular bread and seems accurate for your recipe. I’ll try to send a picture. It looks like bakery bread and tastes delicious. My family who are Leary of myGF and grain Free experiments love this bread!!!!
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 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.


After increasing water intake and replacing electrolytes, it should relieve most all symptoms of Keto Flu. For an average person that is starting a ketogenic diet, eating 20-30g of net carbs a day, the entire adaptation process will take about 4-5 days. My advice is to cut your carbs to fewer than 15g to ensure that you are well on your way into ketosis within one week. If you are experiencing any more keto flu symptoms, double check your electrolyte intake and adjust.
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!
Quite by coincidence I started Keto around the same time as you. I’m 48 and had been struggling with hormones. I’ve lost 10 pounds, not bragging as I had far more to lose than you. I have 2 questions. First, I’m struggling with getting all of my fat in. Never thought I’d tire of avocados. Do you have any good fat bomb recipes? I’ve tried many online and they just don’t taste good at all. Hoping with all your experience you may have some ideas. Most websites have the same recipes as others.
Thanks so much for sharing your results. You look so good, and you have inspired me to try a more structured version of the Keto Diet. I lost some weight recently on HCG 2.0, which puts you into ketosis (keto flu and all!). I have tried to maintain my weight loss with a version of the Keto Diet, but I know that I am probably still eating too many carbs and not enough fat. I am 47, and I contine to have issues with keeping the weight off despite a healthy diet and exercise. I am sure it is hormone-related. 

Try to replace all soda and juice consumption with something that has no sugar or only trace amounts of sugar. Switch out fruit juices for low-carb smoothies and tea. Tea comes in a variety of flavors that can help you get through the day if you get tired of water. There are a variety of different smoothies you can make for a meal replacement or as a quick snack as well.

.. it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. What is unhealthy about red meat. We should know that acrilamides, pyrroles in burnt meat (and veges) from BBQ and over-heated cooking inflames the colon. According to Clark H R, PhD ND an inflamed part allows easy entry for the cancer nucleus and cancer complex, to start and fuel a malignancy at that location.
Thanks so much for sharing your results. You look so good, and you have inspired me to try a more structured version of the Keto Diet. I lost some weight recently on HCG 2.0, which puts you into ketosis (keto flu and all!). I have tried to maintain my weight loss with a version of the Keto Diet, but I know that I am probably still eating too many carbs and not enough fat. I am 47, and I contine to have issues with keeping the weight off despite a healthy diet and exercise. I am sure it is hormone-related.
Almond flour works well as a wheat flour substitute. Because it is so dense and crumbly, you'll need an extra egg to give baked goods rise and structure. Lower the oven temperature by 25 degrees Fahrenheit and allow food to cool completely before serving. A 1/4-cup serving of almond flour has 6 grams of carbohydrates and 3 grams of fiber. At only 5 grams of carbohydrates per 1/4 cup, hazelnut flour is another low-carbohydrate option. It is a good source of vitamin E and healthy fats. Replace up to 30 percent of wheat with hazelnut flour in baked goods such as pie crust and cookies.
I’ve been using Hodgson Mill soy flour for years, and I’m absolutely heart-broken they stopped making it. I wish I knew why! It was low in carbs and the flavor & consistency differences between the Hodgson Mill and regular flour were negligible. I’ve tried Bob’s soy flour, and it’s not even in the same ballpark with a salty, metallic taste. And the consistency is a super fine, chunky powder that clumps.
JoAnna, We have 3 ways we typically thicken soups: 1) with a bit of cream cheese, 2) with heavy cream, or 3) with beef gelatin. Depending on which you use, it will change the flavor of the soup slightly, but cream cheese or heavy cream might be a really delicious flavor pairing with mushrooms! Xanthan gum will also work if you have it on hand (start with a little and work your way up), but we don’t use it (unfortunately it causes tummy troubles for a lot of people, us included!).
I have a question. Firstly, thank you for the recipe. I really enjoyed the mug cake. But, I am a bit confused about carb content. The nutritional information for the cake says 1 mug cake has 4 net carbs. But 2 tablespoon of erythritol has 24 carbs, plus the carbs from almond flour, egg etc. Then how is it 4 net carbs? Sorry for bothering you but I am on a 20 carb Keto diet and I really need to know if I overdid it on the carbs. Thank you!
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 

As with cold cereals, your best bet for a low-carb breakfast cereal comes in the form of whole grains. Oatmeal is an excellent choice because it is high in fiber and contains a substance called beta-glucan, which slows down the digestive process. That means you will stay full throughout the morning. Bran cereals can also be eaten hot, and whole grains such as quinoa or grits can be flavored to be either savory or sweet. Quinoa goes especially well with walnuts and raisins, dates or dried figs. It is is also scrumptious when flavored with a little bit of coriander and served with a poached egg on top. Grits are also a natural partner for eggs, but they are also delicious with pecans and fresh blueberries. Drizzle a bit of honey, agave or real maple syrup on top for sweetness. This will increase the carb count a bit, but the nutritional benefits of starting your day with a hearty, hot breakfast are more than worth the few extra carbs.

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.
And, very unlike generic, boxed spaghetti, shirataki noodles come pre-packaged in liquid, portioned out in a plastic bag that gets refrigerated. The noodles are watery and emanate a faint, fishy odor (though they're 100 percent vegan), which comes from the plant they are made from. Shirataki noodle manufacturers recommend rinsing, draining and drying the noodles before using them in dishes -- this'll help reduce the smell. Nevertheless, the pasta alternative is a smart choice for those looking for something gluten-free, low-carb or lighter in calories.
I’m afraid there won’t be a straight substitution ratio because they behave a little differently. Not as different as coconut flour vs almond flour, but flaxseed nonetheless will have a different protein/fat/water ratio so will act in cakes and baking in a unique way. Saying that I love experimenting. I would begin by using a lower amount of the flaxseed to whichever recipe you decide to try, then mix and see what the result is. It may be that you need some extra liquid, an extra egg or a little more flaxseed. Sorry, that’s probably not the easy answer, but in the long run, if you get to really know how these new flours world – bam – you’re away!
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
The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture, and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more food energy than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein, and carbohydrate is then evenly divided across the meals.[37]
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?
If you are trying to get the kids to eat healthier and not rely on sugary cereals you might find this keto one will win them over. It has a great texture from the nuts and seeds and has a sweet warming flavor from the cinnamon and sweetener. This cereal is great with your choice of milk or can be made a bit more filling by adding in some fresh berries.
Maintaining a healthy weight has never been easy for me. I’ve struggled with sugar addiction and weight gain since I was a teen. You can read about my whole journey here and see Before pics as well. But since I’ve been low carb over the last 4 years I’ve been able to easily maintain my weight. Now with keto, I’m hoping to change my body even more. I may not lose “pounds” but just seeing these results shows the scale number is just one measurement and to me the body fat number is more important.

Disclaimer: Nothing contained on this Site is intended to provide health care advice. Should you have any health care-related questions, please call or see your physician or other health care provider. Consult your physician or health care provider before beginning the Atkins Diet as you would any other weight loss or weight maintenance program. The weight loss phases of the Atkins Diet should not be used by persons on dialysis. Individual results may vary.

Proponents of the ketogenic diet say the problem with a high-carbohydrate diet is that it induces high insulin levels and keeps the body burning sugar and carbs instead of fat. In contrast, on a low-carb diet, the body learns to burn fat preferentially. When this happens, acids known as ketones are released from fat into the body, while insulin levels go down. Ketosis can occur after several days on a low-carb diet.

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.
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?
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).
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.
Because people with type 2 diabetes are at an increased risk for cardiovascular disease, there’s a specific concern that the saturated fat in the diet may drive up LDL, or “bad,” cholesterol levels, and further increase the odds of heart problems. If you have type 2 diabetes, talk to your doctor before attempting a ketogenic diet. They may recommend a different weight-loss diet for you, like a reduced-calorie diet, to manage diabetes. Those with epilepsy should also consult their doctor before using this as part of their treatment plan.
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
Personally, we like to use individual flours and combinations of flours instead of pre-made mixes like Carbquick. For example Carbquicks ingredients are: CarbaloseTM flour (enzyme enriched wheat, vital wheat gluten, wheat fiber, high-protein patent wheat flour, soy fiber, canola oil, salt, emulsifiers, enzymes, ascorbic acid, calcium propionate), palm and palm-kernel oil, buttermilk powder, baking powder, egg white powder, lecithin, salt, natural flavors.
Carbs in fruits and veggies do count, but you don’t add up the carbs and sugar. Sugar is already included in the carbs – it’s just listed separately on labels because some people want to see a breakdown of how much of the carbs are sugars (versus other, complex carbs). If it says 2g carbs and 2g sugar, it means there is 2g total carbs and all of them are sugar (in this case).
I received these today. They came packed with cold packs that were not cold at all. The tracking info shows that they were delivered at 3pm and I arrived home at 5pm. It was if they were not refrigerated at all. Tried the original crust tonight anyway. Very tasty. The crusts are small and one crust is pretty much a meal for one person but worth the money especially if you ever made cauliflower crust from scratch.

The primary outcome was the change from baseline to week 16 in hemoglobin A1c. Changes in all variables were analyzed by the paired t-test or Wilcoxon signed-ranks test, as appropriate. Linear regression analysis was used to examine predictors of change in hemoglobin A1c. A p value of 0.05 or less was considered statistically significant. Statistical analysis was performed using SAS version 8.02 (SAS Institute, Cary, NC).

I am a recent convert to using freeze-dried fruit and if you try this amazing crunchy granola you will see why. The fruit has a much more intense flavor than fresh berries and helps to add that fruity note to the nuts and coconut flakes. It also makes this cereal more child-friendly because the fruit turns the milk pink! This granola can also be formed into bars to give you a boost of energy through the day.


A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]
Hi Carleen, I wouldn’t recommend unblanched almond flour. It might be ok but the texture will be much worse than using finely ground blanched. I haven’t tried the recipe with flax but I expect that it will work better with psyllium, which provides that chewy bread texture and flax doesn’t do that. If you don’t want to use coconut oil, I’d recommend butter or ghee over vegetable oils. The almond flour biscuits should work fine as toppings.

Katie, Almond flour is probably the easiest keto-friendly flour for a new cook to work with. It’s very versatile and can be used in recipes for cookies, muffins, breads, scones, cakes, etc. (Of course the ratio of almond flour to other ingredients changes based on what you’re making.) But with that being said, because almond flour doesn’t have gluten, it can be difficult to simulate the soft crumb of regular baked goods unless you combine almond flour with another keto-friendly flour and/or a binding agent. This is why a lot of our recipes call for more than one type of flour. I hope this helps! If you’re looking for a certain recipe in particular please let us know and we’ll try to point you in the right direction!
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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