Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose).[19] Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.[56]
There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.[7]
To minimize the risk of hypoglycemia, Yancy and his team decrease medication as soon as a patient starts the diet. While drugs like metformin and liraglutide (Victoza) are less of a concern, there are others that pose a substantial hypoglycemia threat. In addition to insulin, the sulfonylurea drugs glipizide and glyburide require a watchful eye, as they work by stimulating the pancreas to make more insulin, increasing the risk of dangerous lows in the face of insufficient carbohydrate intake. “People on this diet need to be prepared to check their blood glucose any time they feel like it could be getting too low,” says Urbanski. “I would say a minimum of twice a day, but ideally three to four times a day, at least in the beginning in order to see the effect of the diet on their blood glucose readings.”
When you eat less than 50 grams of carbs a day, your body eventually runs out of fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you’ll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis. It's important to note that the ketogenic diet is a short term diet that's focussed on weight loss rather than the pursuit of health benefits. 
Hi, I'm Amanda. I’ve been cooking primal keto and lactopaleo recipes for over a decade, and have developed recipes for top nutrition coaches and ketogenic meal subscription boxes. I'm the author of Keto Life (a guide) and the best-selling Wicked Good Ketogenic Diet Cookbook (a cookbook). Ever heard the phrase,"never trust a skinny chef"? Well, consider me super trustworthy. I will probably never be "skinny," and that’s OK because I’m not here to teach you how to lose weight, my goal is to provide you with awesome recipes. I absolutely adore the ketogenic lifestyle, and it has helped me overcome a number of health issues. I hope my recipes help you do the same, while eatin’ good!
Look, the good doctor is right – he only forgot to stress “portion control” which is why many fanatical dieters are so kee-jerk reactive to any discussion – odds are you over ate like a hog before your keto diet, and are weak and insecure in your diet plans. Eat EVERYTHING in small amounts, and you will live long and prosper. The only thing to avoid are processed foods. Cook your meals from scratch using quality ingredients.
When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]
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