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.
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. There are several possible explanations for this gap between evidence and clinical practice. One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.
I believe that nature teaches us in wonderful ways about what works. Take the four seasons for example. I’ve adapted a ketogenic way of eating that is a cyclic method. I workout a lot, and a focus of mine is increasing muscle mass and strength. While I wouldn’t be able to maintain and/or increase those two factors with the amount of intense workouts I have, I don’t follow a strict ketogenic “diet”. I go about 3 weeks of being in keto, and then for a couple of days, I eat whatever I want. That means, I can eat cake, cookies, pies, whatever I want, for those two days. I even get to enjoy birthday cake ;). Then after that, I go back to keto. It’s work WONDERS. It’s EXTREMELY maintainable, I’m still loosing weight and achieving my goals. I’ve also been getting better at listening to my body and understanding how certain foods affect my body—which is something we’re not taught. It’s really amazing how we have such intelligent systems that are ALWAYS communicating with us. We just have to understand how to listen to them. Truly. The problem with a lot of our society, is that we are stuck in the high-end of the cyclic, or the feasting mode, and we think it’s normal! Hence the many ailments and medical conditions that keep increasing. The point is, there are many variations of following a ketogenic way of eating, and it DOES require a life-style change. Just like any other recommendation from a dietician or educator.
“Think outside of the box when you’re preparing what to eat. I wake up every day excited to eat breakfast because I love the foods I've bought and prepared and can't wait to savor them,” Moreno says. Instead of boring oatmeal in the morning, which Moreno calls, “Oliver Twist food,” jazz it up. “Try oatmeal with vanilla protein powder, walnuts toasted in ghee, and cinnamon, that’s much more exciting.”
Choose Liquid Calories Wisely. Sweetened drinks pile on the calories, but don't reduce hunger like solid foods do. Satisfy your thirst with water, sparkling water with citrus, skim or low-fat milk, or small portions of 100% fruit juice. Try a glass of nutritious and low-calorie vegetable juice to hold you over if you get hungry between meals. Be careful of alcohol calories, which add up quickly. If you tend to drink a glass or two of wine or a cocktail on most days, limiting alcohol to the weekends can be a huge calorie saver.
Great article! Sustainability is key and Keto diet is extremely restrictive compared to others. Many of the comments I see don’t understand the importance of many years of research before stating something has a “significant difference” than the recommendations that are already in place. Also, understanding the pro/carb/fat balance in each meal instead of focusing on just carbohydrates. We have practiced the same modified Mediterranean diet at my practice where someone can enjoy life, eat complex carbohydrates and years later they are still successful and hundreds of pounds have been lost for good 🙂 Thank you for the reminder (and the comparison of Adkins supported research).
Need more tips to follow the DASH diet? You'll find a free guide that is full of meal plans, DASH diet food lists and recipes at the National Institutes of Health website. You'll also find a 7-day DASH Diet Eating Plan that guides you through a full week's worth of meals. If you want more help, there are other DASH diet guides online and DASH diet books that are available for purchase.
Dairy products such as cream and cheeses. They work well in cooking as they satisfy. The problem is if you’re munching a lot of cheese in front of the TV in the evening… without being hungry. Be careful with that. Or lots of cream with dessert, when you’re actually already full and just keep eating because it tastes good. Or another common culprit: loads of heavy cream in the coffee, many times per day.
In January 2017, at 63 years of age, I was diagnosed with type 2 diabetes. I had probably been living with it unknowingly for years. In 2009 my doctor recommended the South Beach diet because I was showing blood-sugar levels that were considered pre-diabetic. I stayed on it for a while but then, as with all other diets I’ve tried in my life, I failed and put all the weight back on, plus some. When I was officially diagnosed last year with type 2 diabetes I was a whopping 284 pounds (129 kg). I was always fatigued, could barely walk a block without getting tired and my health was failing.
There’s also some evidence that it might help with type 2 diabetes. “An emerging body of research is finding that a keto plan may have some real benefits thanks to its ability to improve the body’s ability to use insulin and also help control appetite, which can result in easier weight loss,” says Karen Ansel, R.D.N., co-author of Healthy in a Hurry.
Obviously, it’s still possible to lose weight on any diet – just eat fewer calories than you burn, right? The problem with this simplistic advice is that it ignores the elephant in the room: Hunger. Most people don’t like to “just eat less”, i.e. being hungry forever. That’s dieting for masochists. Sooner or later, a normal person will give up and eat, hence the prevalence of “yo-yo dieting”.
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. There is some evidence of synergistic benefits when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.
“Acknowledge that health is an onion; it's layered and complex, and isn't just about nutrition,” Moreno says. “Map out your health and wellness path by creating lists of issues vs. goals in your life within the realms of nutrition, movement, sleep, stress, spiritual, social, and medical issues. You’ll learn to see yourself as an amalgam of health traits and not just a roster of foods you ate in the last week.”
Reynolds, AN. "Comment on 'An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals with Type 2 Diabetes: A Randomized Controlled Trial." Journal of Medical Internet Research. 2018; 20(5):e180, May 2018. Available at: http://www.jmir.org/2018/5/e180/ Accessed May 4, 2018.
The Keto diet emphasizes weight loss through fat-burning. The goal is to quickly lose weight and ultimately feel fuller with fewer cravings, while boosting your mood, mental focus and energy. According to Keto proponents, by slashing the carbs you consume and instead filling up on fats, you safely enter a state of ketosis. That’s when the body breaks down both dietary and stored body fat into substances called ketones. Your fat-burning system now relies mainly on fat – instead of sugar – for energy. While similar in some ways to familiar low-carb diets, the Keto diet’s extreme carb restrictions – about 20 net carbs a day or less, depending on the version – and the deliberate shift into ketosis are what set this increasingly popular diet apart.
These carbohydrate recommendations are not PER DAY, they are per meal. This is the major difference between Ketogenic diets and a consistent, low carbohydrate diet CDEs advocate for. 30-45 carbs per meal is considered a low carb diet. Eating this in the form of a Mediterranean diet is what I recommend and what my article outlined. In a perfect world, we try to have people steer clear of anything artificial or processed when possible. Just eat fresh foods, like our grandparents did, who never had these types of health problems.
It sounds as if you may have been following a very strict keto protocol. I’m not, and have not followed a ketogenic diet, but am interested in it. I’ve been reading up on it a bit on the blog called Mark’s Daily Apple.* I’ve been following it for several years now, even before Mark tried keto. Based on some of his blog post, both keto related and otherwise, it seems that women do better with slightly more carbs than men. He’s written several blog post specifically for women, including one called 7 Keto Tips for Women, which you may want to read. https://www.marksdailyapple.com/7-keto-tips-for-women/ Then there is this one Where I Part Ways with the Popular Keto Movement https://www.marksdailyapple.com/where-i-part-ways-with-the-popular-keto-movement/ Perhaps the problem wasn’t the keto diet in and of itself, but that you went too low carb for you. It’s worth considering. I’ve also found this site to be pretty interesting https://peterattiamd.com/ Here’s a link to his section on keto https://peterattiamd.com/category/ketosis/ He followed a ketogenic diet for a number of years, though as of 2016 was no longer ketogenic, but definitely eating lower carb than most. (That is under Articles, on the drop down menu, click on Personal.)
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.
"Even though it's called the Mediterranean diet, it's not really a diet," said Atlanta registered dietitian Rahaf Al Bochi, a spokeswoman for the Academy of Nutrition and Dietetics. "It doesn't tell you what to eat and not eat. It's a lifestyle that encourages consuming all food groups but gives more weight to those which have the most health benefits."
My principal hope in this article is to provide journalists with a resource to do what basic journalism demands, namely to ensure that stories are scientifically balanced and accurate. At the end of this post I provide contacts for some of the credentialed experts who helped me compile this research. Reporters, please seek out these or other low-carb diet experts so you can provide accurate, up-to-date information for your readers.
Results of meta-analysis of 12 large studies conducted between 1966 and 2008, covering more than 1.5 million subjects, were published in the British Journal of Nutrition in 2009. The authors concluded that the Mediterranean diet is associated with significant health benefits, including lower mortality overall, and reduced risk of chronic diseases like heart disease, cancer, Alzheimer’s and Parkinson’s.
Either there are very few participants in the studies, they don’t have an even number of males vs. females, or they don’t last but a few months. One study only looked at 28 people; only 21 completed the study and 20 of these participants were men. On top of this, they were only followed for 16 weeks. Okay, so we see that 20 men can limit their carbohydrates severely for 4 months and lose weight which automatically makes their A1c come down. Great! So, the real question is, how long can these 20 men stay on this diet for the rest of their lives? How long would you like to go without eating any fresh fruit? I’m craving some now, so I’m taking a break to go grab a snack now!
There is research that supports the ketogenic diet for diabetes management, while other research seems to recommend opposing dietary treatments like a plant-based diet. Research from 2017 confirms that people with diabetes who followed a plant-based diet experienced significant improvements in blood sugars and A1c, cardiovascular disease risk factors, gut bacteria that is responsible for insulin sensitivity, and inflammatory markers like c-reactive protein.
He has been on keto diet for at least 3 years now. I think that he is some proof that yes, it does work. And it may be that some people do need keto. However, I don’t believe that everyone needs keto diet to get reversal. I have had reversal with regular ADA diet in my clinic. Not just a few! Many have reversed. However, I just want for keto dieters to find a clinical trial. We do need more information. We must understand what happens in the long term on keto diet. I personally did Atkins years ago, which was 20 grams. I had a very hard time to stay on it. I lost 20 pounds, and then I did gain it back. I just could not live without some more carbohydrates than this allowed. I don’t know about being on 60 to 70 carbs, and staying in ketosis. It seemed I was out of it at 22 carbs. Anyway, this was not for me. Maybe it is for you. No one is saying that one should never go on a keto diet, but we are wary of it. We need more science behind it. Therefore, I am just going to put this out here now. I will paste it down the page so that others may see it. They are taking participants. If you fit the criteria, please help us to get more than people’s opinion about this diet. Then we can be more positive about it, and recommend it if the science is there. Here is the link to the clinical trial. Thanks for your comments:
The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients. Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective. Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug. There is some evidence that adolescents and adults may also benefit from the diet.
When Steve contacted TheDiabetesCouncil, he wanted to know where to find information on meal plans for the Ketogenic Diet. There are many resources online where you can search for meal plans for the Ketogenic Diet. There are also many books you can purchase at your local bookstore. The Atkins Diet is the most well- known Ketogenic Diet in its Induction Phase which is the first 2 weeks in this diet.
As for individuals with type 2 diabetes, Dr. Galati says, "a very low carbohydrate diet could be tolerated, albeit with extreme caution. Transitioning to a ketogenic diet will require several lifestyle changes as well as careful monitoring of both your food intake and glucose levels and adjustments to your medications. Also, you should increase your water consumption."
I’m not Edward, but I’ve been on a keto diet for 3 weeks. I don’t find it difficult at all. I’ve attended 2 birthday parties, and it’s easy to say “No thank you” when I’m offered cake because my health is my top priority. Drinking a lot of water to support the kidneys is an absolute must. Also, supplementing sodium, potassium and magnesium keeps electrolytes in balance. A Naturopathic doctor is a great source of information on true lifestyle modifications.
“However, saturated fat has long been lauded as a heart-harming macronutrient; the American Heart Association recommends no more than 13 grams of saturated fat per day. In fact, Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center For Women’s Health at NYU Langone Medical Center, said saturated fats can increase bad cholesterol.” -Christina Stiehl, PopSugar reporter17
First, I want to thank you for all of your dedication and work in providing this site. The difficulty of maintaining a healthy weight is a big problem for so many people. My personal question & issue in staying on Keto is my craving for fresh fruit. This a.m I had a large fresh peach along with my “Bullet Proof” coffee. Have I now sabotaged today’s Keto eating?
There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.
Diabetes is one of the most common chronic diseases in the world. In 2014, diabetes affected about 387 million people worldwide and resulted in $612 billion dollars of health-related costs.  Unfortunately, as a conventional western lifestyle of poor nutrition and exercise habits becomes more popular, diabetes is expected to affect about 592 million people worldwide.  In the United States alone, diabetes increased from 5.58 diagnosed cases in 1980 to 22.3 million diagnose cases in 2013. 
“There are many diet plans on the market today that promote good health,” says Emily Kyle, RDN, who is in private practice in Rochester, New York. “The key is finding one that does not cause you stress or agony.” Ask yourself questions such as: Would the diet guidelines make you happy? Anxious? Stressed? Are you able to follow them long term? “Factors such as enjoyment, flexibility, and longevity should be strongly considered,” adds Kyle.
The more doctors test it, the more they find that eating Mediterranean is the absolute best way to lose weight. Based on the cooking and eating styles of Italy, France, Greece, Spain, and other Mediterranean countries, the plan features olive oil, fruits and vegetables, nuts, legumes, fish and poultry, whole grains and, yes, wine! It's high in heart-healthy fats and, unlike other diets, doesn't forbid any food group. "It's hard to stay on extreme diets," says Harvard nutrition expert Walter Willett, MD, PhD, whose book Eat, Drink, and Be Healthy popularized the approach in the United States. "This diet has lots of variety and wonderful flavors so people stick with it."
In her book, Susan highlights one of the major problems with dinner time today: quality time. Does everyone else remember when dinner time was family time? When we would all sit down together, share our day, talk, laugh, and leave when the meal was done? Susan and I shared our childhood dinning experiences when we discussed her call for embracing the the Mediterranean lifestyle — incorporating exercise, relaxation, and family meals back into our daily routines. This book is looking for someone who is looking to make a lifestyle choice. The way that you eat, sitting down with your families at the dinner table. No more meals on the go, no more meals with the TV. I wanted to bring back the importance of food in our households,” noted Susan.
Grains and beans are high in lectins, and it’s no surprise that the top allergen foods also have a high lectin content. The lectins in nightshade vegetables can be troublesome for some people, while others handle them just fine. Cooking and peeling removes some of the lectin content in vegetables (but not grains, they’re pretty heat stable), but some super-sensitive people have to avoid them completely.
Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures and kidney stones. The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone. About 1 in 20 children on the ketogenic diet will develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone. The stones are treatable and do not justify discontinuation of the diet. Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in a sevenfold decrease in the incidence of kidney stones. However, this empiric usage has not been tested in a prospective controlled trial. Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome, which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication. On the other hand, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria and other rare genetic disorders of fat metabolism. A person with a disorder of fatty acid oxidation is unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their body would consume its own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.
Based on long-overlooked DASH research and developed into a weight loss plan by the foremost DASH dietitian and leading nutrition expert, Marla Heller, MS, RD, this effective and easy weight loss program includes menu plans, recipes, shopping lists, and more. Readers will enjoy a diet 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. The result: improved metabolism, lower body fat, improved strength and cardiovascular fitness, without counting calories. And, of course the DASH diet can lower cholesterol and blood pressure without medication!
Unsurprisingly, the results showed that nothing had happened to the weight of the women receiving calcium or the placebo. However, the group which took the multivitamin lost more weight – about 3 kg more – and improved their health markers. Among other things, their basal metabolic rate (the rate at which the body burns calories when at rest) increased.
Swanson, a professor of neurology who has researched the impacts of ketogenic diets on inflammation in the brain, got curious about the ketogenic diet when trying to treat the inflammation that persists for days after a person suffers a stroke. When he tried inducing a ketogenic state in mice with stroke injuries, he said, “I was overwhelmed by the effect.” Blocking glucose metabolism worked to suppress inflammatory genes, which in turn helped stroke healing.
You still have to cap alcohol. The hallmark of a Mediterranean diet is that drinking red wine socially is thought to be one reason why the diet is so healthy. But women should still stick to one glass, and men two glasses. If you have a history of breast cancer in the family, know that any alcohol consumption raises that risk. (31) In that case, talk to your doctor to find out what’s right for you.
What the diet advocate says: ‘It essentially means scaling your carbohydrate intake up and down in accordance with your activity levels,’ explains performance nutritionist Liam Holmes (phnutrition.co.uk). He uses the principles of nutrient timing to get elite athletes and CrossFit enthusiasts to their leanest before competitions. ‘The body works harder when it doesn’t have carbs as fuel, so it learns to become a more efficient burner of the fuel once it is there.’
For me, I chose to become a CDE because I had worked as a Registered Nurse first on a medical unit, then in a Medical ICU. These are the units where most of the people with diabetes are, so I had seen every horrific complication that diabetes can cause. When I had a chance to become a Diabetes Educator…to actually help PREVENT some of those horrible complications…I jumped at the chance!
The DASH diet is an acronym for Dietary Approaches to Stop Hypertension. As you can probably guess, this eating plan was originally developed to help people lower their blood pressure. But it can do a whole lot more than that: The DASH diet has been shown to reduce bad cholesterol and improve insulin sensitivity. Studies have also suggested that following a DASH diet plan can reduce the risk of serious health issues such as stroke, kidney stones, and diabetes. It's no wonder why so many doctors recommend the DASH diet to their patients and why the plan has been ranked as the "best overall diet" by US News & World Reports for eight years in a row.
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those that have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram (EEG) shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.
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.
The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and 30s, it was largely abandoned in favour of new anticonvulsant drugs. Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs. For this group, and for children in particular, the diet has once again found a role in epilepsy management.
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.
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.
Being in optimal ketosis for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet. If this doesn’t result in noticeable weight loss, you can be certain that too many carbs are NOT part of your weight issue and not the obstacle to your weight loss. There are, in fact, other causes of obesity and being overweight. The next three tips in this series might help you.
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.