There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[54]

Take action: Aim to do aerobic (cardio) exercise, such as running or biking, for at least 150 minutes a week. The intensity should vary from moderate to vigorous so that you increase your cardiac capacity without overtaxing your body. Two times a week, also do a 20-minute session of resistance training, such as weight lifting. (These sessions can be done on the same days as the aerobic workouts or on alternate days.) Both types of exercise make your heart pump more blood, which strengthens it. Hate to exercise? Walking counts as cardio. Just be sure to wear a pedometer or an activity-tracking device (Gulati likes those from Fitbit), and shoot for 10,000 steps a day, or about five miles. “This amount ensures that you’re getting the minimal daily cardio-exercise recommendations,” says Gulati. To add resistance benefits, carry five-pound arm weights on your walks and include steep hills in your route.

A Cochrane systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures.[2] Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types of diets or ways of introducing them to make them more tolerable.[2] In the largest trial of the ketogenic diet with a non-diet control[16], nearly 38% of the children and young people had half or fewer seizures with the diet compared 6% with the group not assigned to the diet. Two large trials of the Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.[2]
These types of back-and-forth weight fluctuations can contribute to disordered eating, Kizer says, or can worsen an already unhealthy relationship with food. “I think this diet appeals to people who have issues with portion control and with binge eating,” she says. "And in many cases, what they really need is a lifestyle coach or a professional counselor to help them get to the bottom of those issues."

Just this week, a 25,000-person study presented at the European Society of Cardiology Congress in Munich suggested that people on the lowest-carb diets had the highest risk of dying from cancer, cardiovascular conditions, and all other causes. Another study, published this month in the Lancet, also found that people who followed diets that were low in carbs and high in animal proteins had a higher risk of early death compared to those who consumed carbs in moderation. (The opposite was true, however, for low-carb dieters who opted for plant-based proteins over meat and dairy.)


More good news: Snacks are totally allowed (and I'm not just talking about carrot sticks). There are plenty of packaged options out there designed for keto fans. FATBAR is one of them. These snack bars have 200 calories, 16 grams of fat, and four grams of net carbs. They're also plant-based and are made with almond or cashew butter, cocoa butter, coconut, pea protein, sunflower seeds, and chia seeds.
If you're losing weight but not as fast as you'd like, don't get discouraged. Dropping pounds takes time, just like gaining them did. Experts suggest setting a realistic weight loss goal of about one to two pounds a week. If you set your expectations too high, you may give up when you don’t lose weight fast enough. Remember, you start seeing health benefits when you've lost just 5%-10% of your body weight.
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