It’s a fairly common scene for new keto dieters. Aubrey Marcus recently referenced a highly-disturbing stat that 25% of physicians still equate consuming dietary cholesterol with increased blood cholesterol, an association that has been unequivocally refuted by recent science. But before you accept AHA-sanctioned diet advice, determine if there’s actually a problem.
It is important to understand that the statement that carbohydrates are “nonessential” is not only factually inaccurate, it results in adopting a low-carbohydrate diet or ketogenic diet that increases your risk for a wide variety of chronic health conditions that may ultimately shorten lifespan, decrease your quality of life, and accelerate your risk for chronic disease.
Fat (and the ketones produced from fat) are a readily available source of fuel. Once someone is fat adapted and in ketosis, they will find they can easily go hours (even days) without food and not have drastic energy level swings. And if someone is looking for a non caffeine, non-sugar 'pick me up' while in a ketogenic state, then supplemental ketone salts are the perfect answer.
Diabetes is said to be a ‘progressive, chronic’ disease – incurable, in other words. Recently, case reports and clinical studies have accumulated claiming diabetes reversal with a low-carb or ketogenic diet. Many will debate if ‘reversal’ is the right term since adding in sugar and flour will bring their diabetes back. Nevertheless, there remains no doubt that people with diabetes benefit from these kinds of diets [1]. For diabetics, both type 1’s and type 2’s, a well-formulated low-carb or ketogenic diet should be the first line of lifestyle treatment.
In a survey of both children and adults, researchers found that a very low carbohydrate diet promotes “exceptional glycemic control” in those with type 1 diabetes mellitus. When it comes to type 2 diabetes, the Journal of American Medical Association recently published a review examining the effective use of the ketogenic diet in those with type 2 diabetes.
The keto diet restricts carbs so much that anyone who is on blood sugar lower medication or who has type 1 or type 2 diabetes must consult his or her doctor before making such a severe dietary change. As the body adapts to low-carb dieting, medication dosages and treatment plans will have to be revised, and blood sugar levels must be carefully monitored.
Certain Cancers Keto may be used in combination with chemotherapy and radiation, some studies have suggested, including one published in November 2018 in the journal Oncology. (12) But ultimately more studies are needed to determine if keto can play a role in cancer therapy, and patients should not use it as a stand-alone treatment or without a doctor’s consent.

Nutritionists frequently advise clients to reach for more healthy fats and protein to stay full throughout the day. With this in mind, it makes perfect sense that a ketogenic diet would be about as good as it gets for staying satiated. One study from the American Journal of Clinical Nutrition found this type of low-carb approach was more effective for weight loss and managing hunger than a similar high-protein diet with a greater percentage of carbohydrates. One 2013 study even suggested the eating plan may suppress hunger hormones more effectively than other weight-loss programs.

Keto diets, like most low carb diets, work through the elimination of glucose. Because most folks live on a high carb diet, our bodies normally run on glucose (or sugar) for energy. We cannot make glucose and only have about 24 hours’ worth stored in our muscle tissue and liver. Once glucose is no longer available from food sources, we begin to burn stored fat instead, or fat from our food.
The kidneys play an important role in metabolizing protein, and it’s possible that eating too much of the nutrient can have a negative impact on kidney function. While ketogenic diets are supposed to be much higher in fat than they are in protein, many keto eaters make the mistake of loading up on lots of meat, Mancinelli says. The result? You could end up eating way more protein than you actually need.
Balance your fat. Saturated fat has received a terrible rap in the literature, but that doesn’t mean it’s the only fat you should consume. Look to the fatty acid ratios of ruminants like beef and lamb—or your own adipose tissue—for guidance. They have about equal amounts of saturated and monounsaturated fat with a small amount of PUFA. Mix up the butter and cream with olive oil and avocado oil.
Probably, and there are a few reasons why the keto diet usually equals weight-loss gold, says Keatley. For starters, people usually reduce their daily caloric intake to about 1,500 calories a day because healthy fats and lean proteins make you feel fuller sooner—and for a longer period of time. And then there’s the fact that it takes more energy to process and burn fat and protein than carbs, so you're burning slightly more calories than you did before. Over time, this can lead to weight loss.
That first drop might be mostly water weight. But research suggests that the keto diet is good for fat loss, too. An Italian study of nearly 20,000 obese adults found that participants who ate keto lost around 12 pounds in 25 days. However, there aren’t many studies looking at whether the pounds will stay off long-term, researchers note. Most people find it tough to stick with such a strict eating plan, and if you veer off your diet, the pounds can easily pile back on.
That’s why many health experts are concerned about people on the keto diet, especially those who try it without the guidance of a doctor or nutritionist. Doctors say that high-fat diets like this one may raise cholesterol levels, and some studies suggest that they increase the risk of diabetes. Some have even called it a “cardiologist’s nightmare.”
In some ways, it’s similar to the Atkins diet, which similarly boosts the body’s fat-burning abilities through eating only low-carb foods, along with getting rid of foods high in carbs and sugar. Removing glucose from carbohydrate foods will cause the body to burn fat for energy instead. The major differences between the classic keto and the Atkins diet is the former emphasizes healthier keto fats, less overall protein and no processed meat (such as bacon) while having more research to back up its efficacy.
Thank you for your objective review of the Keto Diet. I am not overweight but decided to try the Keto lifestyle because I have a lot of inflammation issues, including asthma and osteoarthritis. I had also been experiencing uncomfortable intestinal issues. I have been following the Keto lifestyle for 4 1/2 weeks, and I feel so much better- especially my stomach! I am eating a ton of leafy greens, broccoli and cauliflower. I am also enjoying Brussel sprouts, whole avacados and zucchini. I think the reason this is working well for me is because my body chemistry loves all the vegetables, good fats and protein. I also think that taking away sugar has had a big impact on how I feel. I’m just not eating grains and sugar. lots more veggies, berries, and consciously incorporating healthy fat. My stomach is flat again, and I have no more bloating or constipation. I have only lost 5 pounds, but I think my system is clean and operating better than it has in years. My point is that every person’s body chemistry is different. The Keto lifestyle seems to be what My body needed to feel my best. I did experience “the Keto flu” about a week into it, but it was short lived. I think that to be successful it is really important to eat a wide variety of veggies and good fats every day.

"The keto diet is a high-fat, moderate-protein, and very low-carb way of eating that leads to ketosis, which is a metabolic process that shifts the body to utilize a different power source," says Pamela M. Nisevich Bede, MS, RD, a registered dietitian at Abbott who specializes in sports nutrition, weight loss, and diet trends. It's similar to the Atkins diet, but is even lower in protein and higher in fat. In short: "Your body turns fat into fuel instead of running on easy-to-access carbs, which are its energy fuel source," says Nisevich Bede.


Another possible nutrient deficiency: potassium, a mineral important for both electrolyte balance and blood pressure control, notes MedlinePlus. “Inadequate intake of potassium is likely when consumption of fruits and starchy vegetables are decreased,” says Asche. She recommends adding lower-carb sources of potassium to the diet, including avocado and spinach — as well as lower-carb sources of fiber, such as chia seeds and flaxseed (be sure to enjoy ground for the best health benefits).
The keto diet cuts your daily carbohydrates to less than 20 grams; for people with diagnosed diabetes, this may help them manage the condition. A one-year study found that putting people with type 2 diabetes into ketosis dramatically improved their blood sugar control. Also, reports study author Steve Phinney, MD, PhD, chief medical officer of Virta Health, a type 2 diabetes reversal treatment, “Patients were able to lose on average 12 percent of their body weight, about 31 pounds.” Doctors want you to know these 13 things about the keto diet.
At the core of the classic keto diet is severely restricting intake of all or most foods with sugar and starch (carbohydrates). These foods are broken down into sugar (insulin and glucose) in our blood once we eat them, and if these levels become too high, extra calories are much more easily stored as body fat and results in unwanted weight gain. However, when glucose levels are cut off due to low-carb intake, the body starts to burn fat instead and produces ketones that can be measured in the blood (using urine strips, for example). 

Ketogenesis has existed as long as humans have. If you eat a very low amount of carbohydrates, you starve your brain of glucose, its main fuel source. Your body still needs fuel to function, so it taps into your reserve of ketones, which are compounds the liver creates from fat when blood insulin is low. This process is known as ketosis: It’s like when a hybrid car runs out of gas and reverts to pure electricity.
There are numerous benefits that come with being on keto: from weight loss and increased energy levels to therapeutic medical applications. Most anyone can safely benefit from eating a low-carb, high-fat diet. Below, you’ll find a short list of the benefits you can receive from a ketogenic diet. For a more comprehensive list, you can also read our in-depth article here >
The keto diet works by eliminating carbohydrates from the your daily intake and keeping the body’s carbohydrate stores almost empty, therefore preventing too much insulin from being released following food consumption and creating normal blood sugar levels. This can help reverse “insulin resistance,” which is the underlying problem contributing to diabetes symptoms. In studies, low-carb diets have shown benefits for improving blood pressure, postprandial glycemia and insulin secretion. (7)
Constipation is a common side effect of low-carb eating plans, including the ketogenic diet. Severely curbing your carb intake means saying goodbye to high-fiber foods like whole grains, beans, and a large proportion of fruits and vegetables, says Ginger Hultin, MS, RDN, Seattle-based nutritionist and spokesperson for the Academy of Nutrition and Dietetics.
I am confused by this statement, as there are many wonderful “white” substitutions that taste great, and don’t make me feel like i am missing out. One of the things I thought I was just going to die if I couldn’t ever have it again, was waffles with peanut butter & maple syrup. Guess what….there is a sub for that! I am T2D, and my doctor, who specializes in diabetes, told me to stop eating sugar, carbs and she said that in a perfect world, I would stop eating fruit, as it contains sugar. That’s when I found Keto, on my own. I’ve been on it for a little over a month or so, and have lost 12lbs, but more importantly, BS levels that were averaging in the 200’s are now lower than the 90’s, consistently… The highest number I’ve tested was 97, after I ate dinner & had a satisfying bowl of Keto ice cream. I’ve been diagnosed Diabetic for approx 4yrs, but am certain I was diabetic for probably 3 yrs prior to that. I’m not over weight, and did not have the hope of “losing weight and getting off meds”. This has been my answer, and I truly think that if we did live in a perfect world, more things like this would be taught to those of us who need better choices than medications. There are so many other things in the world that are suppressed due to greed of Big Pharma & Government. Let’s start helping our fellow man be healthy & heal….
Carbs are still the primary fuel for the body during high-intensity exercise. A ketogenic diet may be better suited to athletes performing endurance sports (like marathon running or cycling). Athletes engaged in more intense cardio (like sprinting, hockey, football) may perform better with a higher percentage of carbohydrates. These athletes may experience a decrease in high-intensity output while following a ketogenic diet, but ultimately, a lowered carbohydrate intake as isn’t “dangerous” for athletes.

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He also told me that I was in horrible shape, that I would need a lot of medication, and that because I was T2, insulin would do nothing for me. I still remember walking out of the building after. I felt like shooting myself. My brother had just gone blind from retinopathy 2 months earlier. There was no hope for me. High numbers were inevitable. Complications were inevitable.
I started the ketogenic diet because I am a diabetic and refuse to take the medications that Drs advise because I’ve had bad reactions to them. I have lost about 20 pounds and the blood glucose is better controlled. I am also sleeping well most of the time. I did have the diarrhea but that has worked itself out. The one problem I am having is low blood pressure. I awoke dizzy one night and decided to check it and it was 73/48. I add himalayan sea salt to the water as recommended but sometimes still have a problem. A friend recommended using cream of tartar but what I have read said that it lowers blood pressure. Would I have to worry about low blood pressure if I added this to my water???

Ketoacidosis most commonly arises with people with diabetes. Diabetic ketoacidosis occurs in response to a severe lack of proper insulin activity whereas alcoholic ketoacidosis is a harmful metabolic condition arising when someone consumes alcohol but no food, explains Michael J. Gonzalez-Campoy, MD, PhD, medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology, in Eagan, Minnesota. Either way, this is a dangerous situation.
Far from being a new “fad diet”, the keto diet— a very low carb, high fat diet — has been used by doctors since the 1920’s to treat patients with serious illnesses. In recent years the keto diet has steadily been gaining more attention, due to how it promotes weight loss by forcing the body to burn fat for energy. More than ever before, a wider audience is now considering trying the keto diet, including those interested in benefits beyond weight loss. Examples include a reduced risk for diabetes, increased energy and protection against age-related neurological diseases. (1)
The low-carb diet induces ''nutritional ketosis," Dr. Saslow tells EndocrineWeb, which is not the same as ketoacidosis. Ketones are a chemical your body produces when you burn stored fat; if you are on a low-carb diet you may be ''in ketosis.'' Ketoacidosis is different; it is a life-threatening condition in which levels of ketones and blood sugar are dangerously high, which may occur in people who have poorly controlled diabetes.
Keto flu is a real thing. Cutting your carbs to the bone and going into a state of ketosis (where your body burns fat for energy) can bring on a cluster of uncomfortable symptoms, such as headaches, fatigue, muscle aches, nausea, and diarrhea. The side effects are the result of your body transitioning to using fat as its primary source of energy instead of carbs, explains Kristen Mancinelli, MS, RDN, author of The Ketogenic Diet. Once it adapts to the new fuel source (usually within a week or two), you’ll start to feel better.

3. Lower levels of physical performance; when you have just started taking a keto diet, you will likely notice limitations in your physical performance. However, this is just your body adapting to the diet. As you continue with the diet and your body gets used to it, this side effect will go away and your strength and persistence will get back to normal again.
Cancer cells express an abnormal metabolism characterized by increased glucose consumption owing to genetic mutations and mitochondrial dysfunction. Previous studies indicate that unlike healthy tissues, cancer cells are unable to effectively use ketone bodies for energy. Furthermore, ketones inhibit the proliferation and viability of cultured tumor cells.
As far as the the Ketogenic Diet goes, it is a very personal decision between you and hopefully your physician. I would just recommend working closely with your physician for all the recommended lab tests to make sure you remain healthy while on the diet. That’s really the goal of any “diet” anyway, right? To get healthy? This is why we normally always recommend moderation with everything…moderation in the foods you eat along with moderate amounts of exercise equals a healthy lifestyle that will prevent diabetes or help you control your diabetes if you already have it.

Obviously, if you could keep the weight off, it may help in preventing diabetes. There are many risk factors for diabetes, but the Diabetes Prevention Program in 2002 followed 1,079 people with prediabetes. This groundbreaking study showed that 58% were able to prevent the progression of developing diabetes through diet and exercise. Want to know what the great news is? They didn’t have to eat 20 carbohydrates per day to achieve this!


Mild ketosis is a natural phenomenon that occurs in humans during fasting and lactation (19,20). Postexercise ketosis is a well-known phenomenon in mammals. Although most of the changes in the physiological parameters induced following exercise revert back to their normal values rapidly, the level of circulating ketone bodies increases for a few hours after muscular activity ceases (21). It has been found that in trained individuals, a low blood ketone level protects against the development of hypoglycemia during prolonged intermittent exercise (22). In addition, ketosis has a significant influence on suppressing hunger. Thus, a ketogenic diet is a good regulator of the body’s calorie intake and mimics the effect of starvation in the body.
Hi, I think Keto is a great starting point. I am almost 60 years old and finally feel good, no fogginess or sluggishness. For the first time I have no hippy handles and my tummy is flatter – no bloating or puffiness and I feel more energetic. I have only been doing Keto for about 4 weeks. I am so happy with the results!! I will continue for another 8 weeks or so then I will add more foods back in BUT moderation is key. I will slowly up my healthy carbs and find what is good for me. Happy days everyone!!! =)
The ketogenic diet is a powerful new tool to hit the mainstream recently. This style of eating has substantial data behind it showing that it can boost fat-burning, reduce inflammation, boost cognitive performance, and more. What has not been covered quite enough are common keto side effects and how you can avoid them to make the best of this powerful eating style.
Keto Diet is NOT strictly 20 grams of carbs per day. Not only are you biased but you are not being truthful. 20 grams per day is just the recommended guideline for maintaining ketosis. Many people can consume 40, 50 even 60 and 70 grams of carbs per day and stay in ketosis. It depends on the person. Age, size lifestyle and exercise all factor into how many carbs can be allowed and maintain ketosis. It is ok to not recommend a diet but when you leave out important aspects you do both your readers and yourself an injustice. Don’t base your article on one or two 3 page leaflets you read on ketosis written 20 years ago.
I know it is hard when you have been taught something, and believed it, and taught it to others…only to be shown that what you have been taught is not the end all be all that you were led to believe. It sucks. But, you can choose to ignore the truth, and continue to follow the incorrect path. Or, you can look at the facts, and realize that what you have been taught is not the truth…and you can take a new path, which will lead many to wonderful new lives.
84 obese diabetes patients were randomized to either follow a ketogenic diet (<20 g Carbs/day) or a reduced-calorie, low-glycemic diet (55% calories from carbs, 500 kcal deficit). The ketogenic group had greater improvements in HbA1c, body weight, and HDL cholesterol compared to the low-glycemic group. Diabetes medications were reduced or eliminated in 95.2% of the ketogenic group and 62% of the low-glycemic group.
I have multiple autoimmune diseases. I fought 4 doctors, all of whom told me that adults can’t get type 1. I finally went to the Jefferson Diabetes Center. Yup! Type 1 diabetes. I’m slender, do marathons, bp 100/60, triglyceride/HDL ratio 1.08. And I STILL fought 4 doctors because of the ADA misinformation. All it takes is a simple blood test to look at antibodies. That’s all it takes, but the test is almost never run.
Plus, "some research has found that athletes on a keto diet become less efficient in their exercise," Brown says. Because of this, the researchers involved in the study recommended that instead of going for a keto diet, athletes who want to take advantage of their body's ability to use fat as fuel alternate between training in a carb-depleted state (for example, doing a fasted workout in the morning after not eating carbs the night before) and eating carbs as normal. (Related: 8 Things You Need to Know About Exercising on The Keto Diet)

They focus on what to eat instead of what not to eat, according to Dr. J. Michael Gonzalez-Campoy, medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology, who worked on healthy eating guidelines with the American Association of Clinical Endocrinologists, the American College of Endocrinology, and The Obesity Society.

In order for this process of fat breakdown to ‘work’, the protein content must be kept low enough to prevent gluconeogenesis. So, just because you are eating a low carbohydrate diet, does not mean you are in ketosis. It is important to note here, that this nutritional ketosis is different from ketoacidosis, which is the setting of low blood pH level that occurs in people with diabetes and can be very dangerous.

As far as the the Ketogenic Diet goes, it is a very personal decision between you and hopefully your physician. I would just recommend working closely with your physician for all the recommended lab tests to make sure you remain healthy while on the diet. That’s really the goal of any “diet” anyway, right? To get healthy? This is why we normally always recommend moderation with everything…moderation in the foods you eat along with moderate amounts of exercise equals a healthy lifestyle that will prevent diabetes or help you control your diabetes if you already have it.
The biggest issue is that some people consider keto to be a free pass to skip the green stuff. Either that, or they assume “vegetable=carb” and avoid them. Without plants, it’s tough to eat enough fiber, especially the fermentable, prebiotic kind that sustains our gut bacteria. We don’t need bowel-rending quantities of fiber. We shouldn’t take pride in the ability to fill the toilet bowl with perfect coils of crucifer corpses. These are unnecessary at best and downright harmful at worst.
Fat (and the ketones produced from fat) are a readily available source of fuel. Once someone is fat adapted and in ketosis, they will find they can easily go hours (even days) without food and not have drastic energy level swings. And if someone is looking for a non caffeine, non-sugar 'pick me up' while in a ketogenic state, then supplemental ketone salts are the perfect answer.

This means that instead of generating tons of ketones from the very beginning, most people experience hypoglycemia for a period of time. With hypoglycemia comes a disruption in cortisol signaling which is what accounts for the HPA axis dysfunction. Finally, HPA axis dysfunction leads to an increase in secretion of minerals from the body in the urine.
The truth is though, her reaction is part of the problem. “I can’t believe your numbers improved so drastically without taking the medication.” THAT is the main problem with our medical community. They have been taught, and most have bought into the lie, that everything is better with medication. Medication is the go to. That is why we have so many health issues in this country. Let’s eat a crappy diet because our government/medical community recommends it…and then when that diet leads to medical complications…let’s throw drugs/medication at it. Many, if not the majority, of the medical issues we have could be done away with if we actually ate as we should. But no…we want cake.

I’ve said many times before that keto dieters tend to eat less produce, either because they don’t like it and see keto as a free pass for near-carnivory, they worry about the carbs in produce throwing them out of ketosis, or they somehow think plants are restricted on keto. These are mistakes. Common ones. You can eat plenty of produce on keto. You should eat plenty of produce on keto. Mushrooms of all kinds. Leafy greens. Cruciferous veggies like broccoli, cauliflower, bok choy. Low-carb fruits like berries. Anything fibrous.


“When you start the keto diet, you lose sodium and other electrolytes in the urine due to reductions in insulin,” says Yawitz. “This is a major contributor to symptoms of keto flu.” So it’s important to replenish sodium through the diet, especially if you exercise or sweat a lot. “This can help ward off more serious side effects that are seen with long-term sodium deficiencies,” says Yawitz. These include lethargy and confusion — and in extreme cases, seizures, coma, and death, according to the Mayo Clinic.
The ketogenic diet may seem like the Jekyll to the Hyde-like low-fat craze of the 1990s. The bulk of current research finds that the middle ground between the two extremes is more beneficial for overall health. Make it easy for yourself: Eat at least two servings a week of fatty fish (salmon, sardines, mackerel) and cook with a variety of quality fats (olive oil, canola oil, avocado oil) throughout the week.
However, the complete opposite occurred, practitioners began to lose excess body fat, feel healthier, and in some cases, issues of diabetes even began to subside. Nutritionists began to study the effect of a fat-based diet and its impact on human health, years later; the modified ketogenic diet emerged from the research and had been used with success in modern society.

I suggest you or other readers who are not familiar with Dr Wahl's work and research into autoimmune disease and brain biology get a copy of 'The Wahl's Protocol'. Medicine and nutrition are ever-changing sciences and sadly we can't rely on our standard medical practioners (or registered dieticians) to share important research we should all be able to access.

Heart disease. The connection between the ketogenic diet and cardiovascular disease risk factors is complicated. Many studies have found that the keto diet can lead to significant reductions in total cholesterol, increases in HDL cholesterol levels, decreases in triglycerides levels, and reductions in LDL cholesterol levels, as well as potential improvements in blood pressure levels.


“Tremendous Results”….guess that’s why the diabetes nationwide gets worse every year, because of the stellar advice your kind is giving out. I’ve been on the virta clinic for two months and already went off insulin, Janumet and Jardiance, which I’ve been on for 10 years, with blood sugars between 80 and 150. The advice you give makes people get sick slower. The ketogenic approach deals with the real issue, carbohydrate intolerance. If you are lactose intolerant you stop ingesting lactose. Type two diabetes is simply carbohydrate intolerance. Stop eating the carbs and the symptoms go away. I think you meet to cite some of the other research out there I’ve read in other books and the work the Virta Clinic has done. In my opinion you’ve cherry picked data to suit your preconceived beliefs.
The longer you’re in ketosis, the more fat you burn. Unfortunately, you may also start to lose muscle tissue, too. While protein is considered the powerhouse muscle builder, your muscles need carbs for adequate formation and maintenance. Without those carbs, your body may start breaking down muscle. “Since your body starts to eat away at muscles as it enters ketosis, your heart, being a muscle, may also be damaged in the process,” Derocha says.

In the study, the researchers fed mice a ketogenic diet for several days and expected to find a favorable outcome — perhaps weight loss or another indication of improved health. Instead, they found that the liver began resisting insulin almost immediately and the mice were unable to regulate their blood sugar levels after only three days on the diet. (Insulin resistance, meaning that cells in the body don't respond to insulin, is a key characteristic of type 2 diabetes.)
Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [± SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m2. Hemoglobin A1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly.
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