During the ketosis phase of the nutritional intervention, the IWQOL-Lite scores did not change for the sexual life, social anxiety, and work area domains (Table S1). A significant improvement was observed in the physical function and self-esteem scores during this phase. When comparing the visit of reduced ketosis and endpoint with baseline, a significant improvement was found in all domains, except for social anxiety, which did not change throughout the nutritional intervention.
The first modern study of fasting as a treatment for epilepsy was in France in 1911.[12] Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[13]
If you want to try a ketogenic diet, be aware that you'll have to adjust it for your individual metabolism and experiment with the right balance of carbs and calories. While some low-carbohydrate dieters find they are able to break stalls in their weight loss, others find that it is more difficult for them to stay in this state. You may want to consult a registered dietitian to build keto-friendly menus for you that will meet your nutritional needs. Be sure to keep your health care provider informed when you start a new diet, especially if you have ongoing health conditions.
When you’re on keto, you’re less hungry. Ketones help control hormones that influence appetite.[2] They suppress ghrelin, your “hunger hormone,” and at the same time they boost cholecystokinin (CCK) — the hormone that keeps you feeling full.[3] You won’t want to snack as regularly, making it easier to go longer without food. Your body will then reach into its fat stores for energy. The result? More weight loss. Learn more here about how the keto diet suppresses appetite.
Protein is generally considered the most satiating macronutrient, but it’s mostly used for cell repair, maintenance and growth. Thus protein intake is mostly important in order to fill your body’s protein needs. Protein is not very effective as a fuel (i.e. as calories). Excess protein has to first be converted to glucose in the liver, in order to be used as fuel. Eating protein in excess of your body’s needs is not necessarily a good thing, and it can reduce the effect of a strict low-carb diet. Learn more
But it has its share of critics as well. The keto diet is sometimes referred to as “the bacon and butter diet” because it calls for 75% of daily calories to come from fat. Keto followers are gobbling up bacon, steak, sausage, and chicken (skin and all). They’re adding butter to their morning coffee. They’re drowning their salads with ranch dressing.

Protein is generally considered the most satiating macronutrient, but it’s mostly used for cell repair, maintenance and growth. Thus protein intake is mostly important in order to fill your body’s protein needs. Protein is not very effective as a fuel (i.e. as calories). Excess protein has to first be converted to glucose in the liver, in order to be used as fuel. Eating protein in excess of your body’s needs is not necessarily a good thing, and it can reduce the effect of a strict low-carb diet. Learn more

I have been researching the Ketogenic Diet and Peleo Keto Diet since May. This is probably the most through article that I have seen on it and I thank you. Wish I had seen it 3 months ago. Now I can get back on track. I am still chuckling over the one comment above about seeing why you lose weight, as you can’t eat anything…it does appear so at first. Just have to be committed to being careful and monitoring the good fats, low carbs, lean non-processed protein,NO sugars and which vegetables that aren’t too starchy to be included. It is overwhelming at first, but able to be done if in the right mindframe. Evelyn, Chicago, IL


At the first visit, participants were instructed how to follow the LCKD as individuals or in small groups, with an initial goal of ≤20 g carbohydrate per day. Participants were taught the specific types and amounts of foods they could eat, as well as foods to avoid. Initially, participants were allowed unlimited amounts of meats, poultry, fish, shellfish, and eggs; 2 cups of salad vegetables per day; 1 cup of low-carbohydrate vegetables per day; 4 ounces of hard cheese; and limited amounts of cream, avocado, olives, and lemon juice. Fats and oils were not restricted except that intake of trans fats was to be minimized. Participants were provided a 3-page handout and a handbook [11] detailing these recommendations. Participants prepared or bought all of their own meals and snacks following these guidelines.
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 was inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]

A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]
In general, you want to eat the minimum amount of protein to preserve lean body mass and not overtax your kidneys. If you eat too much protein, the excess converts to glucose through a process called gluconeogenesis. You don’t want that to occur in ketosis. Instead, eat anti-inflammatory protein—at the minimum amount to preserve or build lean body mass. My favorite sources are wild-caught fish, grass-fed and -finished beef and wild meats (elk, bison, etc.), pasture-raised poultry, nuts, and seeds. Make sure fish has more selenium (which helps protect the brain) than mercury, to mitigate heavy metal toxicity. Good sources that have a safe selenium/mercury ratio include: tuna, opah, wahoo, spearfish, swordfish. 

The purpose of this study was to evaluate the effects of a low-carbohydrate, ketogenic diet (LCKD) in overweight and obese patients with type 2 diabetes over 16 weeks. Specifically, we wanted to learn the diet's effects on glycemia and diabetes medication use in outpatients who prepared (or bought) their own meals. In a previous article, we reported the results observed in 7 individuals [10]; this report includes data from those 7 individuals along with data from additional participants enrolled subsequently.
1st Tippy Tale is now live!📚My 31-Day Keto Diet Transformation! (Link in bio) Truth: The last few months of 2017 was rough for me. With so many life changes happening, I found myself at the corner of mental and physical exhaustion. Bottling so much inside, I let my stress take the best of me. I started to neglect my health in ways I haven’t done in years. I desperately needed positive change. I desperately needed myself back... . . I talk about the horrible side effects that happened to me during those 3 months of neglect and my 31-day Keto diet journey to reset my lifestyle. You can watch my YouTube video (link in bio) or read my blog post on my website (tippytales.com) for details on the Keto diet, how I went about doing it, my honest opinion, my results, my current status 2 months post my reset and if I am making it a lifestyle.🤔☺️ . . Putting yourself out there and showing a before and after picture is scary for a lot of people. I am no different to this thought but I needed to share this. Why? Quite frankly because I am proud and I know how hard I worked to get myself back. Although my aesthetics did change, I know the bigger change is within. I can full heartedly say I love my body and the woman I’ve become from this fight to get myself back. If this inspires one person to believe in themselves a little more today than yesterday then these series of awkward poses served its purpose.😜 . . We are all human and some times we have setbacks in life. I believe setbacks are there for a reason..to test us. To test how bad we truly and deeply want it. Besides, what’s a good story without a killer comeback?! Not a good one in my humble opinion.😉 #TippyTales 📚
Cyclical ketogenic diet (CKD): If you find it difficult to stick to a very low-carb diet every day, especially for months on end, you might want to consider a carb-cycling diet instead. Carb cycling increases carbohydrate intake (and sometimes calories in general) only at the right time and in the right amounts, usually about 1–2 times per week (such as on weekends).
Rami co-founded Tasteaholics with Vicky at the start of 2015 to master the art of creating extremely delicious food while researching the truth behind nutrition, dieting and overall health. You can usually find him marketing, coding or coming up with the next crazy idea because he can’t sit still for too long. His favorite book is The 4-Hour Workweek and artist is Infected Mushroom.
Unfortunately, there’s no long-term data on ketogenic diets versus other diets. In a 2015 Italian study, those on a ketosis diet lost 26 pounds in three months. About half of the participants stayed on the diet for a year but lost little additional weight in the next nine months. People in a 2014 Spanish study who followed a very-low-calorie ketogenic diet lost an average of 44 pounds in a year—but a third of them dropped out, possibly because it was too hard to maintain.
Rami co-founded Tasteaholics with Vicky at the start of 2015 to master the art of creating extremely delicious food while researching the truth behind nutrition, dieting and overall health. You can usually find him marketing, coding or coming up with the next crazy idea because he can’t sit still for too long. His favorite book is The 4-Hour Workweek and artist is Infected Mushroom.
Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.

If you want to try a ketogenic diet, be aware that you'll have to adjust it for your individual metabolism and experiment with the right balance of carbs and calories. While some low-carbohydrate dieters find they are able to break stalls in their weight loss, others find that it is more difficult for them to stay in this state. You may want to consult a registered dietitian to build keto-friendly menus for you that will meet your nutritional needs. Be sure to keep your health care provider informed when you start a new diet, especially if you have ongoing health conditions.
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
“I have been recommending low-carb and ketogenic diets to my family practice and consultation patients since early 2017. Diet Doctor is an incredibly valuable resource for my patients; counseling low-carb would be much more difficult without all the great information available. My orthopaedic pre-habilitation, diabetes, mood disorder, Alzheimer’s, PCOS, cancer, and obese patients all benefit from low-carb. Low-carb has brought back the joy in family medicine!”
“I have been a UK family doctor since 1990, and discovered the low-carb and keto ways of life in 2014. Until then, I had never seen a way of eating that resulted in normal weight and improvements in other health problems like diabetes, epilepsy, arthritis, and asthma. When I discovered Diet Doctor I was very impressed, and loved the recipes. I now run low-carb courses for the public and health care professionals.”
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]
When your body goes into ketosis, it will start to produce by-products called ketones. This includes acetone—yes, the same chemical found in nail polish remover, which your body actually naturally makes on its own, according to a 2015 review of research. Because acetone is a smaller molecule, it tends to make its way into your lungs. You’ll eventually exhale them out, resulting in “keto breath.” Your mouth might also have a metallic taste, but it won’t last forever as you adjust to the diet. Just be diligent about brushing your teeth!
The ketogenic diet is used to treat drug-resistant childhood epilepsy. It has become a fad diet for people attempting to lose weight.[39] Dieters trying this often do not achieve true ketosis as this requires extreme carbohydrate restriction, and maintaining a ketogenic diet is difficult.[39][11] Some diet advocates make misleading claims that the ketogenic diet can treat or prevent cancer.[14]
I have pancreatitis, well controlled, which is the way I want to keep it. The biggest difficulty I have with keto is this: I eat a small portion of steel cut oats in the morning. When I don’t, within two days , I start having bleeding, dark in colour. My endrocrinolagest feels that I need the roughage in the steel cut oats to replete the bowel lining. I have great difficulty loosing weight, always have, even though I eat very clean, no junk food, never eat out, don’t like pop, don’t crave sugar, cook all food fresh. Any comment? Willing to try anything you can suggest.
45. Kahathuduwa C.N., Davis T., O’Boyle M., Boyd L.A., Chin S.H., Paniukov D., Binks M. Effects of 3-week total meal replacement vs. typical food-based diet on human brain functional magnetic resonance imaging food-cue reactivity and functional connectivity in people with obesity. Appetite. 2018;120:431–441. doi: 10.1016/j.appet.2017.09.025. [PubMed] [CrossRef] [Google Scholar]
–As with most of our recipes, you can alter them to fit your tastes. Don’t like cheddar? Use mozzarella, or feta, or even brie! Feel free to use turkey bacon, salami or perhaps even mushrooms for a vegetarian spin. These Bacon Egg & Cheese Cups are so versatile!And, since we know people are going to ask – yes, you can make 1 giant Bacon, Egg & Cheese Cup in the form of a pie! Just lay that bacon along the bottom of your pan, prebake it a bit in the oven and assemble one giant cup! Use a pie pan, cheesecake pan or small casserole dish (note: depending on your bakeware, you may need to double the ingredients)!Tasteaholics
Can’t you take ketone supplements? No. While it is possible to elevate ketones by taking them, “without the low-carb stimulus, there is no net increase in ketone production, no decrease in insulin, and no net increase in fat oxidation,” says Volek. Don’t trust trainers or “body hackers” who say you can induce ketosis quickly without changing your diet.

“I have been recommending low-carb and ketogenic diets to my family practice and consultation patients since early 2017. Diet Doctor is an incredibly valuable resource for my patients; counseling low-carb would be much more difficult without all the great information available. My orthopaedic pre-habilitation, diabetes, mood disorder, Alzheimer’s, PCOS, cancer, and obese patients all benefit from low-carb. Low-carb has brought back the joy in family medicine!”
Our bodies are incredibly adaptive to what you put into it – when you overload it with fats and take away carbohydrates, it will begin to burn ketones as the primary energy source. Optimal ketone levels offer many health, weight loss, physical and mental performance benefits.1There are scientifically-backed studies that show the advantage of a low-carb, ketogenic diet over a low-fat diet. One meta-analysis of low-carbohydrate diets showed a large advantage in weight loss. The New England Journal of Medicine study resulted in almost double the weight loss in a long-term study on ketone inducing diets.
Looking for that hearty crunch that’s packed full of flavor? Look no more. Instead of cracking open a box of Ritz or Cheez-Its, go ahead and make your own! You can make crackers from anything including flaxseed meal (featured in The RULED Book), chia seeds, or even almond flour to make your own homemade crunchy snacks with a delicious flavor of your own.
Essential fatty acids (the omegas) provide core functions to the human body, but they are often times out of balance when on a standard diet. On keto, with a little bit of preparation, your omega fatty acids are easily manageable. If you want to know more about essential fatty acids, omegas, and how they interact with our body on a ketogenic diet, you can read more here >

(60/60) 17.5 inches ? and I lost 23 pounds!!! . Today is a BIG, BIG deal for me. I'm celebrating #60daysketo and I've lost and gained so many things! . What I've lost on #keto : ?23 pounds ?2.25 inches on arms ?3 inches on waist ? 5.5 inches on pooch ?3.5 inches on hips ?1.75 inches on each thigh ?1.5 inches on each calf . YOU GUYS, I lost 23#, and more than 17.5 inches in only 60 days in #ketosis !!! . Because of having surgery only a couple of weeks into my 60 day goal, I wasn't even able to work out much, and so I'm just now getting back into the swing of #powerlifting again, so almost ALL of this is by diet alone. . I didn't count calories, I only counted my carb and stayed below 40 net carbs every day. . So what comes next? . Well first, new swimsuits. Mine are falling off, and I can see baby abs coming through, so HELLO TWO PIECE! . I am also sticking with keto a bit longer, because @matthewlindow is still on it to lose weight for the military (I'll post his progress pics soon) but after that I'm going to be doing #modifiedketo where I consume about 25 g of carbs 30 minutes before my workout for a couple of months, and the guage if I'm still losing fat and gaining muscle. . My body is an experiment right now, but worst case scenario I'll be unhappy with adding in more carbs and will go back to keto . . . . . . . . . . . . . . #gains #muscle #fitness #fitspo #weightloss #fitnessfriday#cardio #obesetobeast #fitfam #fattofit#noexcuses #flexfriday #flex#weightlossjourney #bodyrecomposition#fitnessmotivation #thickfit #girlswholift#goals #legendary #health #diet#countingcalories #weightlossmotivation#foodisfuel
L-glutamine is an amino acid with many functions in your body including acting as a powerful antioxidant[*][*]. Research shows that L-glutamine can help stabilize blood glucose levels[*] and has been recommended to help reduce sugar cravings. Supplementing with L-glutamine (about ½-1 teaspoon powdered form or 500 mg dose) may help in reducing carb/sugar cravings and aid in your ketogenic weight-loss journey.
An important strength of this study was the use of 3 different techniques for determining body composition in different settings, i.e., obesity and no ketosis, marked reduction in body weight with high ketosis, and finally, substantial reduction in body weight without ketosis. The tight control of adherence by daily measurement of B-OHB is another relevant strength of this work. A potential limitation of our study could be the sample size; however, because each subject underwent 4 evaluations, enabling each individual subject’s own results to be compared, this adds statistical power to the study and a real difference between the experimental points.

The following measurements were made every other week: anthropometric and vital sign measurements; urine testing for ketones; and assessment for hypoglycemic episodes and other symptomatic side effects. Weight was measured on a standardized digital scale while the participant was wearing light clothes and shoes were removed. Skinfold thickness was measured at 4 sites – the average of 2 measurements at each site was entered into an equation to calculate percent body fat [12]. Waist circumference was measured at the midpoint between the inferior rib and the iliac crest using an inelastic tape; 2 measurements were averaged in the analysis. Blood pressure and heart rate were measured after the participant had been seated quietly without talking for 3 minutes. Certified laboratory technicians assessed urine ketones from a fresh specimen using the following semi-quantitative scale: none, trace (up to 0.9 mmol/L [5 mg/dL]), small (0.9–6.9 mmol/L [5–40 mg/dL]), moderate (6.9–13.8 mmol/L [40–80 mg/dL]), large80 (13.8–27.5 mmol/L [80–160 mg/dL]), large160 (>27.5 mmol/L [160 mg/dL]). Hypoglycemic episodes and symptomatic side effects were assessed by direct questioning of the participant and by self-administered questionnaires.


“I recommend a high-fat, low-protein, ultra-low to no-carbohydrate diet with intermittent fasting to my fertility patients. Immunologic dysfunction can contribute to recurrent pregnancy loss and infertility. One of the easiest ways to improve immunologic function is to reduce inflammation throughout the body. The keto diet does this. I use Diet Doctor myself and recommend it to patients as a valuable resource.”

After reading the FAQ (which is really great, btw), one of the things I'm wondering about is whether the low calorie approach works well in conjunction with Keto. I like the general idea, but with my weight, I'm thinking I would like to try to keep my overall calorie intake low, in addition to cutting carbs, refined sugars, etc. out of my diet. It doesn't seem to be expressly forbidden, but it doesn't seem to be what many people do, based on what i've read so far. Basically, I think in addition to this approach to nutrition, I'd also like to keep my calorie deficient high. I think both would go a long way towards helping me be healthier.


If any of your numbers are significantly different from what is listed, there may be deeper underlying health issues to be addressed. These are things that can be great to work on with a functional medicine or nutrition practitioner to find the root of your issues. You can get a comprehensive idea of your cholesterol and inflammation levels with our Complete Thyroid Report.
Participants completed take-home food records (4 consecutive days, including a weekend) collected at baseline and at weeks 2, 8, and 16 during the study. Participants were given handouts with examples of how to complete the records. A registered dietician analyzed the food records using a nutrition software program (Food Processor SQL, ESHA Research, Inc., Salem, OR).
–As with most of our recipes, you can alter them to fit your tastes. Don’t like cheddar? Use mozzarella, or feta, or even brie! Feel free to use turkey bacon, salami or perhaps even mushrooms for a vegetarian spin. These Bacon Egg & Cheese Cups are so versatile!And, since we know people are going to ask – yes, you can make 1 giant Bacon, Egg & Cheese Cup in the form of a pie! Just lay that bacon along the bottom of your pan, prebake it a bit in the oven and assemble one giant cup! Use a pie pan, cheesecake pan or small casserole dish (note: depending on your bakeware, you may need to double the ingredients)!Tasteaholics
“I follow and recommend a low-carb or keto lifestyle, with and without intermittent fasting, to all of my patients whether or not they have lifestyle-related chronic conditions. I do this because of the health benefits to anyone who follows them, but also because of the science behind them and the impressive clinical results I have seen in my patients. I have recommended the Diet Doctor website for the past 5-6 years as a first-stop to find completely trustworthy information, delicious recipes, great visuals and excellent videos.”
Hi Sam, it won’t work. You will be incredibly hungry and you won’t have any energy. The idea of the keto diet is to get your body used to use fat to burn energy not carbs. Since you won’t be eating carbs energy has to come from “something” and it can’t be protein. I can’t recall what happens when you have too much protein when doing Keto but it was something scary. In general, I do not recommend the Keto diet without some sort of supervision by your doctor or nutritionist that can watch your process and progress.
While in ketosis, your body effectively uses fat for fuel. In general, the daily intake of net carbs required to enter ketosis could vary from 20 to 100 grams per day. Most people, who have experienced ketosis, claim to have reached that state at about 20-50 grams of net carbs per day. I'd suggest you start at 20-30 grams and see how you can adjust it for your needs.
You're using it for a particular, short-term period.The meal substitute diet can function so quick and so well that you might decide to keep on following it for a longer while. You've acquired the flavor and habit of consuming the yummy meal substitute products that you think you'll stick to the program for a vague period. However, you need to understand that enduring high-calorie deficit in your system may not be good on an extended basis. Take advantage of the diet only as a boost to significant weight reduction or to be a procedure for a huge occasion arriving soon or under strict doctors monitoring.
Just because you're getting headaches doesn't mean your diet is the culprit. Berkeley University Health Services reports that headaches may also be a sign of muscle tightening in your neck triggered by fatigue, depression or emotional stress. However, if you're experiencing chronic headaches, you're not losing more than 2 pounds weekly and you're drinking plenty of water, it may be time to talk with your doctor. Although headaches can occur while dieting, chronic headaches that don't subside may be a sign of a more serious medical condition.
Eat fats with all your meals. Fats are the cornerstone of the ketogenic diet, and will encourage your body to burn fatty ketones for fuel. Typically, calories from fat should comprise 80 – 90% of your meals.[10] (However, you cannot eat unlimited fats on a ketogenic diet; the calories can still add up and cause weight gain.[11]) Examples of fatty foods include:
If you talk to keto aficionados, you’ll find many save leftovers from dinner for the next day’s lunch. Cook once, eat twice—your keto diet menu for lunch is solved. If you don’t like leftovers or if you’re craving something different for lunch, the mid-day meal can be as simple as a scoop of chicken salad. Or, hit the salad bar at a local grocery store and top a bowl of greens with some good-fat goodies. You can also try one of these simple keto lunches:
Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD; Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD; Helena C. Kraemer, PhD; Abby C. King, PhD, “Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women,” JAMA. 2007;297(9):969-977. http://jama.jamanetwork.com/art icle.aspx?articleid=205916.
At the first visit, participants were instructed how to follow the LCKD as individuals or in small groups, with an initial goal of ≤20 g carbohydrate per day. Participants were taught the specific types and amounts of foods they could eat, as well as foods to avoid. Initially, participants were allowed unlimited amounts of meats, poultry, fish, shellfish, and eggs; 2 cups of salad vegetables per day; 1 cup of low-carbohydrate vegetables per day; 4 ounces of hard cheese; and limited amounts of cream, avocado, olives, and lemon juice. Fats and oils were not restricted except that intake of trans fats was to be minimized. Participants were provided a 3-page handout and a handbook [11] detailing these recommendations. Participants prepared or bought all of their own meals and snacks following these guidelines.
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