Once or twice per week you can have a treat. Remember you will have 600-1000 calories to work with in the main meal. This should make it pretty easy to enjoy some of your favorite foods or go out to a restaurant with friends/family. Just make sure to not go over the calorie budget for the day. If you do end up going over the calorie budget for the day then you can compensate by slightly reducing calories the following days.
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]
“This seems like a fairly intense means of exercise – so perhaps not for those unfamiliar with exercise. Having guidance in the gym, and working out with others can be very motivating – this is an important concept to understand. If new to exercise you can certainly find this environment with more options for beginners,” says Anthony Dugarte MD about Kinobody’s intensity.
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