I teach ADA. I saw 49 people in 8 months. All except 1 lost weight and had A1C reduction. 16 reversed their condition. All this on ADA diet. ADA works, you just have to follow it. Keto will work also, I just do not believe that it is healthy in the long term. We need more study results, and evidence that it works before we recommend that everyone should go on a keto diet. I would recommend that any of you who are on keto diet, and who are adamant that it works, and that ADA does not, should look for clinical trials and become subjects. We will need to know scientifically that it works, not just by word of mouth. And we will need to see medical evidence that it helps. If there is science behind it, I am sure that ADA will get behind it. Their are medical programs where you can be followed on a keto diet. Look for those.

Rami co-founded Tasteaholics with Vicky at the start of 2015 to master the art of creating extremely delicious food while researching the truth behind nutrition, dieting and overall health. You can usually find him marketing, coding or coming up with the next crazy idea because he can’t sit still for too long. His favorite book is The 4-Hour Workweek and artist is Infected Mushroom.


U.S. News’s panel of experts noted that the Mediterranean Diet earned this year’s top spot because research suggests it can help improve longevity and ward off chronic disease. The Mediterranean Diet was also ranked No. 1 in several other categories: Easiest Diet to Follow, Best Diet for Healthy Living, and Best Diet for Diabetes. It also tied with the Ornish Diet for Best Diet for Heart Health.

If you've been trying to eat healthy for a long time, you know how quickly you get sick of chicken breasts and broccoli. Break out of your diet rut with the Middle Eastern diet. It's based on the same principles as the Mediterranean diet but with more of an emphasis on plant-based foods and a different flavor profile. With all the tasty and healthy spices, you'll never get bored of making dinner and you'll get all the same heart-healthy benefits as its geographical cousin's diet.

The aim is far broader than suggested by the article here: It’s not just about what you put in your mouth – it’s also about timing and exercise. There are three ways to be in ketosis – which simply means that “fat burning” and not being dependent on sugars. Fasting puts a man into ketosis in 3 days and a woman by 2 days. Endurance exercise gets you there in a couple of hours. Eating a high fat diet will do it too. The goal however is hidden by the detail – it is to acquire a “Flexible Metabolism”. The aim is to switch on the full fat burning capacity and keep it running – which takes from between 4 to 12 weeks physical adaptation (for the muscles to fully be able to use ketones). The heart runs approximately 27% more efficiently on ketones than on glucose! The brain works better too – Alzheimer’s being referred to by researchers as “diabetes 3”. Once you have a Flexible Metabolism you can consume carbs during or after exercise without dropping out of ketosis – though this depends on your own bio-individuality. I can eat quite a lot of carbs – without losing ketosis – my partner cannot.
Take the word DIET out of this book because it has to be a lifestyle change. Either you want to lose weight, or this will be just another part of yo-yoing. Either you want to get your blood pressure down, or you'll accept you doctor's order to start a second antihypertensive. I just came off 6 months of veganism, so the beef eating especially revolted me at first, but this is healthy eating at it's finest. Low-carb, lots of veggies and eventually fruits - even alcohol (either as a grain - beer, ...more
Add mint to your usual oven-roasted chicken, and it becomes a whole new meal with a Mediterranean diet twist. Plus, it has perks: Mint has been known to alleviate digestion issues. Olives add flavor for very few calories (five olives only have 26 calories), while figs add a natural sweetness. This chicken dish by Russell Bry, concept chef of Yalla Mediterranean in California, just might become your new go-to.
If the diet is a quick fix rather than one that promotes lasting lifestyle changes, this could pose a problem. In particular, extreme diets that promise big weight loss up front aren’t always sustainable — and you may end up overeating or even binge eating if you feel deprived. “Consider if the diet’s habits are ones you can continue throughout your lifetime, not just 21 or 30 days,” says Angie Asche, RD, a sports dietitian in Lincoln, Nebraska.
Popularized by the documentary Forks Over Knives, the Ornish diet is a low-fat, plant-based diet plan based on whole grains, vegetables, fruits, and legumes. It's based on a lacto-ovo style of vegetarianism, allowing only egg whites and nonfat dairy products. It's packed with vitamins, fiber, and lots of filling plants to keep you satiated. Some studies have shown it can reverse heart disease and have beneficial effects on other chronic health conditions. (BTW, there is a difference between a vegan diet and a plant-based diet.)
Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance:

The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals and calcium-rich foods. In particular, the B vitamins, calcium and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a multivitamin with minerals and calcium with vitamin D.[3] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises:[27]
One study, published in the journal Nutrition & Metabolism, found a group of 28 people with type 2 diabetes overall lost about 6 percent of their body weight and lowered their blood glucose levels when they followed a keto diet for 16 weeks. The authors recommended individuals on this diet who have diabetes be under close medical supervision, and noted more research is needed on the diet’s long-term effects because the study was small and short term.
The MIND diet, or Mediterranean-DASH Intervention for Neurodegenerative Delay, is a sort of hybrid between the DASH diet and the Mediterranean diet. It features foods meant to slow the progression or development of Alzheimer’s disease, the most common form of dementia and an incurable neurodegenerative condition that more than 5 million Americans are living with, according to the Alzheimer’s Association. (12) Some research backs up this notion, including a study published in September 2016 in Alzheimer’s Dementia that found a link between following the MIND Diet and a reduced risk of the disease. (13)
Many CDEs actually have diabetes…it’s what draws them to choose this career…to help others with diabetes, to share their knowledge. Most already wear an insulin pump and continuous glucose sensors (CGMs) also. When I first became certified on each new pump and CGM, I would wear them (and check my BG 4-6 times per day) for 2-3 weeks, not only to learn the technology really well, but to gain a sense of how my patients must feel having to wear them 24 hours per day. Since, I’ve started a 6 month old baby on a insulin pump and CGM all the way up to a 89 year old…there are no boundaries for people with diabetes!
Also, if you listen to Dr Bernstein talk about his childhood (he is well into his 80’s), the “original” recommended diet was only ketogenic in the sense that it was high-carb and caused keto-acidosis, which he describes as almost killing him as a teenager. He still considers the ADA recommendations as ketogenic for this reason (you only have to listen to him a short time to hear him railing against the ADA).
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.
On the flip side, hypos can be an issue, especially early on…and if you treat them too aggressively, they could knock you out of ketosis. I remember my first 3 weeks on keto, my CGM trend line hugged a blood sugar of around 80.  It was glorious, but I had to reduce insulin substantially through trial and error and felt like I was low every five seconds.
“During physiological ketosis ketonemia reaches maximum levels of 7/8 mmol/L with no change in pH while in uncontrolled diabetic ketoacidosis it can exceed 20 mmol/L with a concomitant lowering of blood pH. Blood levels of ketone bodies in healthy people do not exceed 8 mmol/L precisely because the central nervous system (CNS) efficiently uses these molecules for energy in place of glucose,” researchers summarize.
Mike, that’s exactly right! With T2, we no longer have the option of eating carbs, sugar and all the good stuff. Why can’t dieticians and the ADA recognize that and quit trying to shove all those carbs down our throats? I don’t get it… I seriously don’t. And I think the author of this article would do an about face is she actually had diabetes. It’s amazing the amount of people who claim to be experts that seriously don’t get it!! It I had Celiac Disease, I couldn’t eat gluten… at all. Why is the same not recognized for diabetics? Our meters show us when we are eating too many carbs. Its VERY clear as the number goes very high. What do the professionals not get about that? It’s been the most amazing thing about this whole process for me and I just can’t believe how biased people are against a very low carb diet for managing diabetes. You think that because people can’t maintain that kind of diet for long term makes it OK to go ahead and be against it? Did it ever occur to any of the professionals that by recommending a low carb diet it might actually encourage people to maintain it? Instead, you are giving them excuses and reasons to eat way too many carbs!! Last August 2016 I was diagnosed with T2, with an A1C of 12.7. My last blood test showed an A1C of 6.2 (July 2017) and I had reduced some of the meds I was originally on. I am still working on lowering my numbers. The whole process has been a slow progression to keto and I had to stumble on the whole thing myself through my own research. I tried vegan at first and quickly realized that I was eating too many carbs. Then I went low carb but knew I could do better. When I tried the Keto diet, my numbers went much lower. You get over the sweet addictions. You get over the bread addictions and you find suitable substitutions. You do what you have to do. But by not recommending an ultra low carb diet simply because you don’t think people can do it is ridiculous! It is basically telling people that they can’t possibly manage their own lives… they can’t possibly make their own, good choices. And then, because you are the authority, you are giving them reasons to not even try. You defeat them before they even begin. It just amazes me!
Sodium reduction is part of the DASH equation, but it’s not the only focus. Eating by DASH  recommendations also increases your intake of potassium, calcium, magnesium and fiber—all nutrients that play a role in cardiovascular health, as well as the prevention of other chronic diseases. It’s thought to be the combination of increasing your intake of these nutrients and decreasing your intake of added sugar, salt, sodium and unhealthy fats that leads to lower blood pressure and a laundry list of other long-term health benefits.
At the first visit, participants were instructed how to follow the LCKD as individuals or in small groups, with an initial goal of ≤20 g carbohydrate per day. Participants were taught the specific types and amounts of foods they could eat, as well as foods to avoid. Initially, participants were allowed unlimited amounts of meats, poultry, fish, shellfish, and eggs; 2 cups of salad vegetables per day; 1 cup of low-carbohydrate vegetables per day; 4 ounces of hard cheese; and limited amounts of cream, avocado, olives, and lemon juice. Fats and oils were not restricted except that intake of trans fats was to be minimized. Participants were provided a 3-page handout and a handbook [11] detailing these recommendations. Participants prepared or bought all of their own meals and snacks following these guidelines.
“As soon as you start consuming a normal amount of carbohydrates again, you immediately go out of ketoacidosis or the fat burning state”. I am sure you know the difference between nutritional ketosis and ketoacidosis yes? One is the natural fat burning state, and the other is toxic. Right now i am in ketosis but not ketoacidosis. One has a natural balance of Ph level, the other not. Once you make that statement, i have a sick feeling i am not getting the right information here.

Recent studies have also shown that garlic supports blood-sugar metabolism, and helps control lipid levels in the blood. What’s more? Eating garlic can help boost your immune system, help ward off heart disease, fight inflammation, increase memory retention, and lower blood pressure, so consider adding some to your next meal. At the very least, it is preferable over salt, which can lead to water weight gain and bloating.


Don’t think that “Mediterranean diet” means gorging on pasta and pizza, though. People in Mediterranean countries traditionally eat small portions of grains – for example, a side dish of 1/2 to 1 cup of pasta, instead of the full platter of pasta Americans are used to. Fill the rest of your plate with vegetables to fill you up without many calories.

If you've never given farro a try, this pretty bowl of goodness will have you stopping by the grocery store on your way home tonight. Farro has basically zero fat, is a great source of fiber, and an even better source of bone-boosting calcium. It's a little denser than brown rice and is a bit more substantial than quinoa. This bowl takes only 35 minutes to make—perfect for meal-prep days. Obsessed? Try these healthy recipes featuring high-fiber foods.)
I have T2D and IBS and my blood sugar readings were degrading. I was going to have to take a second daily dose of Metformin and the first one already played havoc with the IBS. I started a low-carb diet because my T1D husband had been inspired by a podcast by Sam Harris with scientist Gary Taubes, author Why We Get Fat, Good Calories, Bad Calories and the Case Against Sugar, and started dumping the majority of his carbs a month previous. He had cut his insulin use literally in half and lost 15 pounds. He was feeling better and visibly had more energy. I was resistant to the diet and even the idea of it. I have been on Atkins and Sugar Busters and while I did fine on Sugar Busters back in the day, Atkins was too fat-based and that was the opposite of how I had been raised to think about dieting. I knew that the Diabetic diet given to me by the Diabetic Educator had never been enough and I get carby binge cravings even though it offers plenty of carbs and calories. I also knew that it’s a cycle for me-eat more carbs, want more carbs, and never really feel satisfied. On top of that, when my stomach hurts I seek carbs, and it hurts quite often. I did Weight Watchers and the Diabetic diets because they let me “cheat” and have my carbs while dieting. To be fair, just the act of tracking my food improved my outcome on either. But I got mad at WW when they upped the points for carbs on their system and made it so I couldn’t eat cake for lunch if I wanted to. Not that I made a practice of it, but it was principle of the thing. Long story short, I was pretty doubtful that I would be very successful on Atkins or Keto. To humor my husband I began a low-carb diet that started out as Atkins 20 or Keto and has morphed to more of an Atkins 30-40 for my personal comfort while using Keto, Atkins, and Paleo recipes and ultimately cutting all gluten. That means 30-40 net carbs per day, rather than per meal and a lot of natural non-processed foods. The first week was quite terrible. But even through the Keto Flu I recognized that my IBS symptoms felt better. I started to suspect that if I felt that bad just from quitting carbs that maybe there was more to the idea of sugar addiction than I wanted to believe. I’m six weeks in now and I’m losing a steady pound a week plus my sugars have dropped radically. A pound a week might not sound like much but it’s more than I’ve lost in 10 years. I have PCOS and insulin resistance so I’ve had a fasting blood sugar that ranged from 109-113 since my early twenties. It was flying high around 160-170 before the diet, now I’m reading between 119-139. Even more than that, my IBS symptoms stabilized. I’ve been tracking all my food using the free Atkins meal tracker so I started trying to narrow the foods that caused flare ups. I’m lactose intolerant but I knew that and used lactose free products or Lactaid for the cream based dishes. I had my gall bladder removed and so have always put down my symptoms to an inability to process dairy and fats. Big surprise to find that a higher fat, higher dairy diet was making my symptoms disappear. Gluten is the only common factor so far. Celiac? Just a food sensitivity? I don’t know, but that will be the next investigation. It is an investigation that I would never have thought to start on the Diabetic diet. Like the author, I’m very fond of cake and carbs. Luckily there are low-carb, no-gluten recipes for muffins and cakes. They aren’t exactly the same and some are definitely better than others, but they are out there. Plus, there is nothing wrong with having true birthday cake once a year if that is really what you need and if you don’t have a reason to avoid it, like binge symptoms or IBS flare ups. My husband let himself have a piece of cheesecake the other day and felt physically awful for two day after, plus he had to use a lot of insulin to counter the spike. It’s a pretty good deterrent. Just a side note but I had other symptoms of inflammation as well. My ankles were swelling to golf ball size and painful, it was difficult for me to stand and walk comfortably when this happened. While they haven’t stopped completely, the discomfort has gone way down as has the swelling and frequency. What’s my point? I’m not a salesman for a particular diet. Everyone is different and some people might respond very well to Keto and/or Atkins while others may not need anything that extreme. I’m not knocking the Diabetic diet. My dad lost 150 pounds 38 years ago on a very low calorie/low carb Diabetic diet that gradually increased and he has kept the weight off all this time and kept his blood sugar steady with medication, but has not had to go to insulin even at age 84. Also, he was a smoker, a diabetic, had hemochromatosis and was over 300 pounds with an apple body shape. He has had some fall out from this-he didn’t stop the smoking until a heart attack 20 years ago and that didn’t help. But he has made it to 84 and when he walked into his doctor’s office 40 years ago I’m guessing the doctor wouldn’t have put any money on that survival rate. Unfortunately, it looks like I need the lower carb version and will continue to need it to manage my symptoms. I didn’t want it, that’s for sure. But Diabetics are locked in a death struggle with Diabetes and it won’t give up just because we are tired or want our sugar. So for me, it has to be Very Low Carb for Life. Others may find they need this too and discouraging them from trying it is not doing them any favors. Hopefully I will continue to find this sustainable. I just need to keep reminding myself that I am more fond of my feet and my vision than my birthday cake.
Ketoacidosis (KA) is a life-threatening condition in which your body doesn’t make enough insulin. This causes you to have dangerously high levels of ketones (substances occurring when the body uses fat stores for energy) and blood sugar. The combination of both makes your blood incredibly acidic, and this can, in turn, change the normal functioning of your internal organs such as your liver and kidneys. Patients suffering from ketoacidosis must get treatment immediately or they could slip into a coma and even die.
In addition to its 4 grams of belly-filling fiber, a cup of hearty oatmeal delivers as much protein as an egg. In other words, the popular breakfast food is an excellent weight loss tool. In fact, according to a study in the Annals of Nutrition and Metabolism, scientists found that having oatmeal for breakfast resulted in greater fullness, lower hunger ratings, and fewer calories eaten at the next meal compared with a serving of ready-to-eat sugared corn flakes, even though the calorie counts of the two breakfasts were identical. For an added fiber boost, sprinkle some berries and chia seeds on top of your oatmeal, but be sure to stay away from fattening syrup and sugar.
Nuts, the second food to watch, contain a fair amount of carbohydrate, and it’s very easy to unwittingly scarf down large quantities. Cashew nuts are among the worst carb-wise – you’ll find that they contain around 20% carbohydrate by weight. For someone following a strict keto diet with a 20 grams of carbs per day allowance, this means that consuming 100 grams (which happens in a flash!) will have filled their daily quota. Peanuts tend to be around 10-15% carbohydrate – not putting them in the clear either.

But people who started following the keto diet noticed weight loss for a few reasons: When you eat carbs, your body retains fluid in order to store carbs for energy (you know, in case it needs it). But when you’re not having much in the carb department, you lose this water weight, says Warren. Also, it's easy to go overboard on carbohydrates—but if you're loading up on fat, it may help curb cravings since it keeps you satisfied.
Hi, I’m still a bit skeptical, I have seen some of my friends do the keto diet, and have had good results. Though I am still not sure about the idea of the fats being eaten. They say they eat meat with the fat and must do so, is this correct? Also isn’t this not good for the body especially for the kidneys? Second, can a diabetic do this diet? There are many questions running through my head.
“I’m no longer on insulin, and I have cut down my medications due to keto. I never had to deal with trying to find a spot to inject or having to deal with bruises on my belly,” she says. “I know this may sound silly, but I have a picture of my old insulin syringes in my wallet. I look at it to remind me of what I had to do before keto. It grounds me, and when I have days of self-doubt, I remind myself how far I’ve come.”

A review published in December 2015 in the journal Diabetes Therapy suggested ultra-low-carb diets were effective at managing blood sugar, decreasing weight, and managing cardiovascular risk in individuals with type 2 diabetes in the short term, but the benefits were not sustainable over the long term. When compared with higher-carb diets over a period of longer than about 12 weeks, the health results were similar.
Nonetheless, Fung told Live Science that she thinks the study clearly demonstrates the potential for a ketogenic diet to have a detrimental effect in humans. And, until researchers better understand the risks of those detrimental effects, she suggested that people consider other ways of accomplishing their health goals, such as trying a less-restrictive diet.
What the diet guru says: According to David Zinczenko, author of The 8-hour Diet, eating all your meals within a set window is the key to burning fat. ‘By carving out an eight-hour window in which to eat to your heart's content, you'll burn your body's fat stores effortlessly. The science is actually simple: for several years, researchers have been producing remarkable weight loss results in people using "intermittent fasting". In this case, fasting is about eating whatever you want, but staying within a sensible eight-hour window. This gives your body the chance to burn away your fat stores for the energy it needs.’
What is your opinion on the conflicting opinions about whether or not wine is healthy or harmful? It seems there is a daily article touting research that proclaims wine is health alternating with another article about research that indicates that even moderate intake of wine is associated with cancer or dementia. I’m trying to understand all of this conflicting data with the reality/evidence of Mediterranean cultures that include daily intake of wine. Is it the amount drunk that is key?
The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals and calcium-rich foods. In particular, the B vitamins, calcium and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a multivitamin with minerals and calcium with vitamin D.[3] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises:[27]
The DASH diet has sometimes even been described as an Americanized version of the famous Mediterranean diet, according to the official DASH diet website. But as healthy as the DASH diet is, it's certainly not restrictive. It includes an eating plan rich in fruits, vegetables, low-fat and nonfat dairy, lean meats, fish, poultry, nuts, beans, seeds, heart-healthy fats, and limited amounts of whole grains. These delicious and nutritious foods join forces together to help your overall health improve. An added perk? You can also shed some unwanted pounds on the DASH diet — especially if you follow the DASH Diet Weight-Loss Solution plan.
On May 24, 2018, I had a 90-day follow-up appointment with my doctor. When he came to the exam room with my chart he immediately started to fist pump me with praise of congratulations, he was ecstatic. I am now at 233 pounds (106 kg)! I have lost 51 pounds (23 kg) and my girlfriend has lost 25 pounds (11 kg). I went from a 42-inch (107 cm) waist to a 38-inch (96 cm) waist. But, here’s the best part, my A1c came down to 5.7 and all my health markers have improved. He called me his poster child for being on the path to curing my Type 2 diabetes.
The researchers agree that the diet itself isn’t inherently dangerous. But, cautions Weiss, “If you have any medical condition, if you take any medicine at all – there are lots of things that change how medicines work in our bodies, and nutrition is definitely one of them. If you’re making a real change in your nutrition, you really should talk to your doctor.”

The "all meat all the time" low-carb approach or strict veganism can be great options for people who thrive on clear diet rules (and those two are actually the most popular diets out there) but these extremes are not for everyone. If you prefer more of a moderate approach, the Flexitarian diet is the clear winner. The "flexible vegetarian" mindset allows you a healthy balance of plant-based foods, responsibly sourced meats, and quality fats. The best part? It's not super restrictive, so you have plenty of nutritious food options. (Start here: How to Adopt a Flexitarian Diet)
The DASH Diet Weight Loss Solution was chosen as one of top new diet plans of 2013 by The Today Show, while The DASH Diet Action Plan was named one of the top life-changing health books, by Huffington Post readers. See more recent news stories about the DASH diet. Meet the author and learn more about the weight loss plan by watching our Dr. Oz episode, the PBS show, or join one of our free support groups for weight loss or for the mostly vegetarian plan, or our new group for the Med-DASH plan on Facebook!

The risks are more long term, such as risk of nutritional deficiency (vitamin c, a, k and b vitamins) and also increased risk of bowel and possibly breast cancer cancer due to limited fibre intake. Ketosis generally isn’t recommended and it’s not exactly a state that would the body would usually be in, but it can be done safely for set periods of time.’
You'll find lots of free Mediterranean diet resources on the Oldways website, including an easy-to-understand food pyramid; a printable grocery list; gender- and age-specific tips on making the Mediterranean switch; a quick-read "starter" brochure; a recipe newsletter; and even a glossary defining Mediterranean staples, from bruschetta to tapenade.
You'll find lots of free Mediterranean diet resources on the Oldways website, including an easy-to-understand food pyramid; a printable grocery list; gender- and age-specific tips on making the Mediterranean switch; a quick-read "starter" brochure; a recipe newsletter; and even a glossary defining Mediterranean staples, from bruschetta to tapenade.
I think the larger question is why we are seeing such a sudden rash of anti-keto stories. So many of them quote no experts sources and do not provide citations for their claims. Skeptics with little acquaintance with the diet are quoted exclusively instead. From a journalistic perspective, this lack of balance of viewpoints and the failure to back up claims with evidence falls below basic reporting standards. Offenders on this list include even the Harvard School of Public Health, which recently published more than one  unsourced, one-sided article on the keto diet (This is in addition to the Lancet Public Health article cited above, by Harvard researchers, which suggests that a low-carb diet kills you). These stories could reflect lazy reporting or they could very well be scare tactics to steer people away from the keto diet.  Why would reporters or scientists at Harvard be doing such a thing? That’s material for another post. Stay tuned.
People claiming huge benefits of these supplements – despite the lack of solid scientific support – may sometimes have a financial reason to believe in the supplements. Some of these products are sold under a multi-level marketing arrangement, where sales people are paid based on commission. For example, the company Prüvit sells drinkable ketones, called KETO//OS with a multi-level marketing structure.
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