Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20. 120 (16):1640-5.

Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.  Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.


About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether.[18] Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions.[46] This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure-free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.[9]
Your glycogen stores can still be refilled while on a ketogenic diet. A keto diet is an excellent way to build muscle, but protein intake is crucial here. It’s suggested that if you are looking to gain mass, you should be taking in about 1.0 – 1.2g protein per lean pound of body mass. Putting muscle on may be slower on a ketogenic diet, but that’s because your total body fat is not increasing as much.5Note that in the beginning of a ketogenic diet, both endurance athletes and obese individuals see a physical performance for the first week of transition.
A ketogenic diet also has been shown to improve blood sugar control for patients with type 2 diabetes, at least in the short term. There is even more controversy when we consider the effect on cholesterol levels. A few studies show some patients have increase in cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing its effects over time on diabetes and high cholesterol.
The metabolic syndrome can be induced by overfeeding with sugar or fructose, particularly concomitantly with high-fat diet.[36] The resulting oversupply of omega-6 fatty acids, particularly arachidonic acid (AA), is an important factor in the pathogenesis of metabolic syndrome.[medical citation needed] Arachidonic acid (with its precursor – linoleic acid) serve as a substrate to the production of inflammatory mediators known as eicosanoids, whereas the arachidonic acid-containing compound diacylglycerol (DAG) is a precursor to the endocannabinoid 2-arachidonoylglycerol (2-AG) while fatty acid amide hydrolase (FAAH) mediates the metabolism of anandamide into arachidonic acid.[37][35] Anandamide can also be produced from N-acylphosphatidylethanolamine via several pathways.[35] Anandamide and 2-AG can also be hydrolized into arachidonic acid, potentially leading to increased eicosanoid synthesis.[35]
Conklin's fasting therapy was adopted by neurologists in mainstream practice. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. In 1921, prominent endocrinologist Henry Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin's success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite only having studied the patients for a short time. Further studies in the 1920s indicated that seizures generally returned after the fast. Charles P. Howland, the parent of one of Conklin's successful patients and a wealthy New York corporate lawyer, gave his brother John Elias Howland a gift of $5,000 to study "the ketosis of starvation". As professor of paediatrics at Johns Hopkins Hospital, John E. Howland used the money to fund research undertaken by neurologist Stanley Cobb and his assistant William G. Lennox.[10]
How many calories should I eat a day? A calorie is an amount of energy that a particular food provides. Consuming more calories than needed will result in weight gain, consuming too few will result in weight loss. How many calories a person should eat each day depends on a variety of factors, such as age, size, sex, activity levels, and general health. Read now
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
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Snack on portion-controlled fruit, seeds and nuts. One study found that snacking on 42g of almonds per day (instead of munching on something high-carb with equal calories) helped to reduce belly fat and improved cholesterol levels. “The high levels of fibre are proven to combat excess calorie consumption later in the day,” says registered dietitian Lucy Jones.

Plus, a 2015 study from the Annals of Internal Medicine showed that for those who have a hard time following a strict diet, simplifying the weight loss approach by just increasing fiber intake can still lead to weight loss. Women should aim for at least 25 grams of fiber per day (based on a 2,000-calorie) diet, according to the most recent U.S. Dietary Guidelines. Not sure where to start? Check out our step-by-step guide to increasing your fiber intake.
Although you'll be cutting way back on carbohydrates and sugar, some fruits are still okay to eat on the keto diet (though you'll still want to be mindful about quantity in order to remain in ketosis). The fruits that make the cut contain far fewer carbs than their off-limits cousins such as apples, pears, bananas, pineapples, papayas, grapes, and fruit juices in general.

Continue to adhere to medical advice for overall health . It’s important to work with your doctor to assess your overall risk of metabolic syndrome and related heart problems, says Ndumele. Get key markers (such as blood pressure, cholesterol, and blood sugar) checked as recommended by your doctor. If you’ve been prescribed medication for high blood pressure, high cholesterol or insulin resistance, be sure to take it as directed.
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]
Inner knee, medial thigh or submandibular region [Figure 14] with a less dense fat are better managed with a standard wet technique rather than the UAL. Improved results with less fatigue in treating fibrous areas such as gynecomastia, posterior trunk, upper abdomen, posterior hip rolls and trochanteric regions [Figure 15] support the use of UAL as an adjunct to SAL rather than as an alternative.
Many Plastic surgeons are still apprehensive about the physiology of large-volume liposuction and patients being exposed to prolonged procedures, anaesthesia, fluid shifts, and infusion of high doses of epinephrine and Lignocaine. The super-wet and tumescent techniques used under regional anaesthesia permits local anaesthesia of the skin and subcutaneous tissues by direct infiltration. Large volumes of a lactated Ringer's solution with epinephrine and the limited use of dilute anaesthetic solutions produce tumescence and firmness of targeted areas. Dilution of lignocaine and epinephrine diminishes and delays their peak plasma concentrations reducing potential toxicity.

In the mid-1990s, Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC's Dateline programme and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.[1]
Insulin is a hormone that allows glucose to move into tissue cells, where is it is used for energy production. Insulin then prompts the liver to either store the remaining excess blood glucose as glycogen (for short-term energy storage) and/or to use it to produce fatty acids (which then become triglycerides). In people with insulin resistance, additional insulin must be released by the pancreas to overcome the tissue cells' resistance and allow glucose to enter the cells. This resistance and response to resistance can lead to increased insulin and glucose concentrations in the blood. Over time, increased glucose levels can harm blood vessels and organs such as the kidneys. Increased insulin levels can increase sodium retention by the kidneys, resulting in increases in blood pressure (which can lead to hypertension).
The primary problem in metabolic syndrome is insulin resistance. In the body's attempt to compensate for insulin resistance, extra insulin is produced, leading to elevated insulin levels. The elevated insulin levels can lead, directly or indirectly, to the characteristic metabolic abnormalities seen in these patients. Frequently, the insulin resistance will progress to overt type 2 diabetes, which further increases the risk of cardiovascular complications.
Cannulae used today are extremely small, typically less than 6 mm, some are very small with an inside diameter of less than 0.6 mm. Blunt-tipped cannulae are standard as they decrease injury to blood vessels and reduce bleeding. The use of multiple side ports allows for efficient evacuation of fat. Manual systems consisting of syringes and canula tips have also been developed as some surgeons prefer the use of quiet and disposable instruments, they are more popular in small local aspirations of isolated fat bulges. They also became popular as a back-up system. Over time, aspiration units developed by manufacturers in consultation with surgeons have gradually become more powerful as well as quieter and allow for an efficient, pleasant surgical environment.
The Modified Atkins diet and modified ketogenic diet (sometimes called 'modified ketogenic therapy') use a high proportion of fats and a strict control of carbohydrates. These are often considered more flexible than the classical or MCT ketogenic diets, as more protein can be eaten, and approximate portion sizes may be used in place of weighed recipes.
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Visceral fat develops in the abdomen below the muscle layer. Tumescent liposuction works on the subcutaneous fat, or the fat directly under skin. This procedure does not go below the muscle where visceral fat is located. Tumescent liposuction (as with all liposuction procedures) is good for only the fat that is above the muscle and easily reachable. The safety of this procedure is that it doesn't go below the muscle to areas where large blood vessels and organs are located. For now, the only way to reduce this area is diet and exercise!

While many people think that cardiovascular workouts are the best possible way to burn belly fat, combining your workout styles is actually a better way to quickly lose belly fat. When you do weight training in between cardio exercising, that high-intensity exercise can cause your metabolism to shoot up, burning more fat more quickly. Alternating workout styles and physical demands on your body can keep your metabolism “on its toes”, operating at a high level, even burning fat when you’re not working out!


The keto diet was originally designed not for weight loss, but for epilepsy. In the 1920s, doctors realized that keeping their patients on low-carb diets forced their bodies to use fat as the first-line source of fuel, instead of the usual glucose. When only fat is available for the body to burn, the body converts the fats into fatty acids, and then into compounds called ketones, which can be taken up and used to fuel the body's cells.
Lipodystrophic disorders in general are associated with metabolic syndrome. Both genetic (e.g., Berardinelli-Seip congenital lipodystrophy, Dunnigan familial partial lipodystrophy) and acquired (e.g., HIV-related lipodystrophy in patients treated with highly active antiretroviral therapy) forms of lipodystrophy may give rise to severe insulin resistance and many of metabolic syndrome's components.[27]
Animal proteins (meat, fish, etc.) have very little, if any, carbs. You can consume them in moderate amounts as needed to control hunger. Overall, choose fattier cuts of meat rather than leaner ones. For example, chicken thighs and legs are preferable to chicken breasts because they contain much more fat. We’ve got quick keto diet chicken recipes to help.

There is enough information on the internet on what and how to eat if you want to burn belly fat, but one that makes sense is the slower and smaller principle. By eating smaller meal portions, and consuming them slowly, you will allow your body time to process what it’s taking in before releasing those enzymes that tell the body it’s “full”. Also, smaller portions allow you to eat more meals per day, which keeps your metabolism and digestive system active and engaged for longer, which is great for burning belly fat!
The objective of liposuction is to remove small pockets of fat to improve the silhouette, but it’s not a substitute for substantial weight loss. A good candidate for liposuction is someone who is already at or near their ideal healthy weight but has some “problem areas” that don’t respond to diet and exercise. For best results, candidates should have good muscle tone and firm skin. They should be willing to continue a healthy lifestyle after the procedure.
Choose whole grains such as brown rice and whole-wheat bread instead of white rice and white bread. Whole-grain foods are rich in nutrients compared with more processed foods. Whole grains are higher in fiber, so the body absorbs them more slowly. They do not cause a rapid spike in insulin, which can trigger hunger and cravings. The 2015-2020 Dietary Guidelines from the USDA recommend that at least half of your grains be whole-grains.
It’s scary but true that most of the disorders associated with metabolic syndrome are symptomless. However, one very common visible sign of metabolic syndrome is a large waist circumference: at least 40 inches for men and 35 inches for women. If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. (26)
In the first week, many people report headaches, mental fogginess, dizziness, and aggravation. Most of the time, this is the result of your electrolytes being flushed out, as ketosis has a diuretic effect. Make sure you drink plenty of water and keep your sodium intake up.6One of the fathers of keto, Dr. Phinney, shows that electrolyte levels (especially sodium) can become unbalanced with low carb intake.
Keto diets are high in healthy fats and protein also tend to be very filling, which can help reduce overeating of empty calories, sweets and junk foods. (4) For most people eating a healthy low-carb diet, it’s easy to consume an appropriate amount of calories, but not too many, since things like sugary drinks, cookies, bread, cereals, ice cream or other desserts and snack bars are off-limits.
Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.  Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.
The diet may not work for everyone but is suitable for many different seizure types and epilepsy syndromes, including myoclonic astatic epilepsy, Dravet syndrome, infantile spasms (West syndrome), and those with tuberous sclerosis. If you or your child has feeding problems, or has a condition where a high fat diet would cause problems, the diet may not be suitable.
The metabolic syndrome is the name of a cluster of risk factors that, when they appear together, dramatically raise your risk of heart disease, heart failure, stroke and diabetes, as well as other non-cardiovascular conditions. Like smoking, it’s one of the strongest predictors of heart disease. “Nearly one in three Americans have metabolic syndrome. Many people don’t recognize that they have the condition and underestimate the risks it presents,” says Chiadi E. Ndumele, M.D., M.H.S. , cardiologist at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. “Understanding that you have metabolic syndrome in the first place can help motivate you to make the needed changes.” 
Doctors disagree on the issues of scarring with not suturing versus resolution of the swelling allowed by leaving the wounds open to drain fluid. Since the incisions are small, and the amount of fluid that must drain out is large, some surgeons opt to leave the incisions open, while others suture them only partially, leaving space for the fluid to drain out.[15]
Another analysis of popular diets published in the Annals of Internal Medicine in April 2015 found the Atkins diet to result in more weight loss than simply educating people on portion control, but also noted that most of the studies of this low-carb diet involved registered dieticians helping participants make food choices, rather than the self-directed process by which most people pick up the diets. That's true of many diet studies, the researchers noted, so study results likely look rosier than weight loss in the real world. 
Something that makes the keto diet different from other low-carb diets is that it does not “protein-load.” Protein is not as big a part of the keto diet as fat is. Reason being: In small amounts, the body can change protein to glucose, which means if you eat too much of it, especially while in the beginning stages, it will slow down your body’s transition into ketosis.
Leafy greens like collard greens, watercress, kale, and arugula may not be on your everyday list, but they all contain a compound called sulforaphane. This nutrient has been shown to act directly on the genes that determine “adipocyte differentiation”—basically, turning a stem cell into a fat cell. A healthier intake of the compound means a healthier body weight for you. And just a scant teaspoon of vinaigrette will help your body absorb the fat-soluble nutrients.
.. it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. What is unhealthy about red meat. We should know that acrilamides, pyrroles in burnt meat (and veges) from BBQ and over-heated cooking inflames the colon. According to Clark H R, PhD ND an inflamed part allows easy entry for the cancer nucleus and cancer complex, to start and fuel a malignancy at that location.

Dr. Ayoub performs liposuction on patients who are close to their ideal weight, so you should not substitute this procedure for weight loss. Instead, you will be a few pounds lighter, but have a body that is shaped the way you want it. Patients find that their clothes fit better and small bulges that once bothered them are completely gone.*While you will initially be swollen after your liposuction surgery, as your swelling subsides, your results will be more noticeable.
Eating the right kinds of fats is crucial if you want to cut down on your belly fat. Some fats will only contribute more to visceral fat, such as saturated fats. Lead author Lucinda Summers from the Oxford Centre for Diabetes says in her research report, if you add polyunsaturated fats, like those found in nuts and certain types of fish, you can benefit from their anti-inflammatory potential and actually help to reduce your visceral fat levels.

Power-assisted liposuction (PAL). This type of liposuction uses a cannula that moves in a rapid back-and-forth motion. This vibration allows the surgeon to pull out tough fat more easily and faster. PAL may sometimes cause less pain and swelling and can allow the surgeon to remove fat with more precision. Your surgeon may select this technique if large volumes of fat need to be removed or if you've had a previous liposuction procedure.


One of the most common reasons people call our office is to get information about liposuction prices. The average cost of liposuction is a difficult question to answer because there are many factors that can affect the price of liposuction. For example, stomach liposuction cost will be very different then the cost of total body liposuction and traditional liposuction costs will be different then laser liposuction cost. This blog helps to answer some of the questions about liposuction costs for women and men, but really the best way to find out how much liposuction will cost for you would be to come in for a complimentary consultation.

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]

Normal dietary fat contains mostly long-chain triglycerides (LCTs). Medium-chain triglycerides (MCTs) are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[18] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhea, and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[18]
A diet that’s low in fat and carbohydrates can improve artery function, according to a 2012 study by Johns Hopkins researchers. After six months, those on the low-carb diet had lost more weight, and at a faster pace. But in both groups, when weight was lost—and especially when belly fat shrank—the arteries were able to expand better, allowing blood to travel more freely. The study shows that you don’t have to cut out all dietary fat to shrink belly fat. For heart health, simply losing weight and exercising seems to be key.
The Modified Atkins diet and modified ketogenic diet (sometimes called 'modified ketogenic therapy') use a high proportion of fats and a strict control of carbohydrates. These are often considered more flexible than the classical or MCT ketogenic diets, as more protein can be eaten, and approximate portion sizes may be used in place of weighed recipes.
Even small changes to your diet can make a difference when you're trying to lose weight, so don't feel like you have to follow a strict regimen or cut out entire food groups. If you like to bake, try low-calorie substitutions in your recipes. Cooking at home more often can help you lose weight, especially if you look for ways to reduce fat and calories in your meals. As you make changes like these, you may even find that you enjoy healthy eating.
There is an enhanced fat removal with minimal blood loss, improved skin retraction and safer large-volume procedures with the UAL. Reports of cutaneous burns, [Figure 13] hypo and hyperaesthesia and seroma formation brought considerable debate concerning the long-term effects and clinical use of UAL. Subsequent evidence of large trials with long term follow-ups have led it to be well-established and accepted technique.[26,27] It is especially indicated in areas of dense, fibrotic fat.
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]
Any guess at what disorder affects 40 percent of people over the age of 60? It’s called metabolic syndrome, which unfortunately does not simply mean that your metabolism is slow or out of whack. Metabolic syndrome is a metabolic disorder that involves not one, but a combination of three or more of the following health issues: abdominal obesity, high blood sugar, high triglyceride levels, high blood pressure or low HDL (“good”) cholesterol.

For many of Dr. Ayoub’s patients in Omaha, liposuction is the first surgical procedure they have ever undergone. So, it’s understandable that they would be nervous about having liposuction performed, despite their desire to lose their stubborn fatty deposits. When you work with us, though, you need not worry. Your safety and comfort are our top priorities, and we will do everything possible to make your liposuction procedure a pleasant experience.
Spinal anaesthesia is preferred as bulk of fat to be sucked out is situated in lower half of the torso and the duration of surgery is about three hours. It reduces the drugs administered to the patient as general anaesthesia is avoided. A 27 gauge needle avoids the often troublesome post spinal anaesthesia headaches. Fentanyl is additionally added to the high spinal because it has a bupivacaine sparing effect on spinal anaesthesia. This covers the subcostal areas as well and further reduces the need of lignocaine in the infiltrating solution.
It seems strange that a diet that calls for more fat can raise “good” cholesterol and lower “bad” cholesterol, but ketogenic diets are linked to just that. It may be because the lower levels of insulin that result from these diets can stop your body from making more cholesterol. That means you’re less likely to have high blood pressure, hardened arteries, heart failure, and other heart conditions. It's unclear, however; how long these effects last.

To banish stubborn belly fat, you have to ramp up your workouts. In a study published in the journal Medicine and Science in Sports and Exercise, people who completed a high-intensity workout regimen lost more belly fat than those who followed a low-intensity plan. (In fact, the low-intensity exercises experienced no significant changes at all.) "You need to exercise at full intensity because the end goal is to burn more calories, and high intensity exercise does just that," says Natalie Jill, a San Diego, Calif.-based certified personal trainer. High intensity workouts mean you're going all out for as long as you can. If this sounds intimidating, think of it this way: you'll burn more calories in less time.
Many risks associated with liposuction can be minimized by taking precautions before and after surgery. For example, if you are a smoker, your surgeon will ask you to quit smoking before and after surgery to ensure that your incisions heal properly. In addition, avoiding aspirin and other nonsteroidal anti-inflammatory drugs can help minimize the risk of bleeding during and after surgery.

The end result of the “ketone diet” is staying fueled off of circulating high ketones (which are also sometimes called ketone bodies) — which is what’s responsible for altering your metabolism in a way that some people like to say turns you into a “fat-burning machine.” Both in terms of how it feels physically and mentally, along with the impact it has on the body, being in ketosis is very different than a “glycolytic state,” where blood glucose (sugar) serves as the body’s energy source.

Central obesity is a key feature of the syndrome, being both a sign and a cause, in that the increasing adiposity often reflected in high waist circumference may both result from and contribute to insulin resistance. However, despite the importance of obesity, patients who are of normal weight may also be insulin-resistant and have the syndrome.[27]

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