Instagram user @healthyhappydays_ was happy with her results, though. "I found it easy to stick to as it's only three days," she told us. "You know you're going to see results if you [are] 100% committed to it... If you're feeling bloated, especially after a big weekend or event, it's a good diet to do to get back to shape in a short space of time. That's the reason why I did it after being indulgent over [the holidays]." Because she typically sticks to a vegetarian or vegan diet, she substituted out two veggie sausages instead of the hot dogs and the meat.
Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions. Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.
The ketone bodies are possibly anticonvulsant; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.