Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]
Nine healthy young males participated in this study, which appears in the journal Nutrients. The researchers asked them to follow a 7-day high fat, low-carbohydrate diet that was similar to the keto diet, consisting of 70 percent fat, 10 percent carbohydrates, and 20 percent protein. They also had to consume a 75-gram glucose drink before and after the diet.
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]
I find I’m most motivated to lose weight when the experience resembles a modern game filled with achievements and challenges, and no other app delivers that experience so well as My Diet Coach. The opening screen reveals two avatars—one that represents your current weight and one that represents your future self—and your quest is to make the two match up. It’s enough to make losing pounds feels like gaining levels in an RPG, or getting good gear to show for weeks or a months of effort.

Onakpoya, I., Posadzki, P., & Ernst, E. (2014, February 17). The efficacy of glucomannan supplementation in overweight and obesity: A systematic review and meta-analysis of randomized clinical trials. [Abstract]. Journal of the American College of Nutrition, 33(1), 70–78. Retrieved from