This high-fat, adequate-protein, low-carb fad diet sends the body into a state of ketosis, in which the body uses stored fat for energy. Research published in Clinical Cardiology suggests the ketogenic, or “keto,” diet can be an effective weight loss method, but to be successful, you must follow the plan consistently with no cheat days — otherwise, you’re just eating a high-fat diet that may be high in unhealthy fats for no reason. (1) (A pro tip? If you're planning on doing the diet, consider perusing this complete keto food list and reading up on the healthiest fats for keto diet followers.)
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.

Although some studies have indicated that a ketogenic diet is associated with dyslipidemia (cholesterol and triglyceride perturbations), many of these results were obtained from studies on rodents and did not always agree with what the data show in human studies. A recent review summarized the controversy, highlighting the discrepancies in the literature. In part, the discordance is likely due to the exact composition of the diet, specific study design, as well as the metabolic differences between rodents and humans.

Using the Bulletproof Diet, including Brain Octane Oil every day for long periods of time, and eating carbohydrates some of the time but not always, avoiding inflammatory foods, and using Bulletproof Intermittent Fasting, I was able to recently test with perfect insulin sensitivity — I scored a one on a scale of 1 to 120 (see my numbers below). I also had above average glucose tolerance. That’s metabolic flexibility by the numbers!
Your New Year's resolution diet should be based on a well-balanced eating plan that fits your lifestyle, rather than a weird fad replete with food restrictions. That's according to U.S. News & World Report's best diet rankings for 2018. The two diets that tied for the top spot -- the Mediterranean Diet and the DASH Diet -- fit that bill because they feature real food and reasonable, flexible guidelines, experts said.
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
Why was the DASH diet been ranked as the best diet, the healthiest diet, and the best diet for diabetes, 8 years in a row? The expert panel of physicians assembled by US New & World Reports chose DASH because it is proven to improve health, has a balance of healthy food groups, and it actually works. And now the Mediterranean diet has jumped out in front. So delicious and heart healthy. DASH has been proven to lower blood pressure and cholesterol, and is associated with lower risk of several types of cancer, heart disease, stroke, heart failure, kidney stones, reduced risk of developing diabetes, can slow the progression of kidney disease, and now is associated with reduced risk of depression.
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,[34] 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.[35] 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.[9] 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.[36]
2- Eat more vegetables, fruits, grains, and legumes. The base of the Mediterranean diet pyramid should make up the base of every meal. When you can, opt for vegetarian entrees like this Cauliflower and Chickpea Stew;  Spicy Spinach and Lentil Soup; or Spanakopita (Greek Spinach Pie). Rely more on satisfying, flavor-packed salads to make up a good portion of your plate. Some ideas: Kindey Bean Salad; Mediterranean Chickpea Salad; Greek Salad; Bean and Lentil Salad.
U.S. News & World Report ranked the keto diet at the very bottom of their list of the best and worst diets of 2018. A panel of 25 nationally recognized experts, including Registered Dietitians, Professors, and Clinicians, looked at 40 diets and evaluated their nutritional completeness, ability to produce short-term and long-term weight loss, how easy it is to follow, its safety and potential for preventing and managing diabetes and heart disease.  While keto ranked the worst, the DASH diet and Mediterranean diet ranked the best. Keep reading for more info on these diets.

This book has helped me tremendously! My doctor recommended the Dash Diet for my high blood pressure. I have to say, it was not easy to break my addiction to sugar. Phase one (2 weeks) is painful. I failed a few times before finally breaking through and sticking with it. I had SO much success on phase one, I was afraid to move on and reintroduce fruit and whole grains to my diet so I remained on it for another 2 weeks. In one month of following the diet closely I lost almost 20 pounds. My blood pressure dropped so dramatically that my medication had to be significantly decreased. I did not do the exercise as recommended in the book due to very low energy levels, but imagine that if I had, I would have lost more weight. I highly recommend this book to anyone who has high blood pressure or cholesterol and wants to lose weight.
Incidentally , there’s a very informative article on the bbc website about one of the last remaining hunter/gather societies left in the world, living in Tanzania. They have amazing gut health and no t2d. Would you like to guess at the type of diet they follow? This would be the caveman diet that the writer mentions, and yes these people might not live as long as us but the cause of death is never a lack of motivation to stay on a keto diet.
If it all feels a little bit 90s, that’ll be because this was basically the diet that kept Rachel from Friends looking, well, like Rachel from Friends. Think of it as the 20th-century version of no carbs before Marbs. Thankfully though, the old premise of each as much as you want, as long as you don’t go near a carb, has had a makeover. The New Atkins diet reintroduces carbs in phases.

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.
With any healthy diet in moderation, weight loss is an achievable goal, as long as you reduce caloric intake, eat a balanced selection of nutritious foods, and get ample exercise. The Mediterranean diet is comprised of a diverse set of delicious ingredients, making it an easy diet to stick to. As it's full of fiber and good fats, the Mediterranean diet supports satiety, which can help you reduce caloric intake, supporting weight loss and management.
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!

Benefits The main ingredient in hummus, chickpeas pack an impressive amount of fiber (more than half of a woman’s 25 g daily quota), as well as iron, zinc, folate, and magnesium, according to a paper published in November 2014 in the journal Applied Physiology, Nutrition, and Metabolism. (15,16) The stats above are for a whole cup, but you only need ½ cup per day to reap the benefits.
The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy.[25][26] It is approved by national clinical guidelines in Scotland,[26] England and Wales[25] and reimbursed by nearly all US insurance companies.[27] Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet.[9][28] About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.[9] A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.[5][29]
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.’
HCG, or Human Chorionic Gonadotropin, is a hormone produced during pregnancy by the placenta after implantation, and doctors sometimes prescribe it for fertility issues. But this hormone has also gained popularity as a weight-loss supplement — and using it as such can be dangerous. In fact, the U.S. Food and Drug Administration (FDA) warns against purchasing over-the-counter hCG, as these supplement products are illegal. (34)

At the conclusion of the intervention, both groups had improved in all metrics but “these changes were more significant in subjects who were on the LCKD as compared with those on the LCD.” [10]. As a result, the researchers supported the study outlined above and concluded that their “…study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects.” [10]
But DASH—which stands for Dietary Approaches to Stop Hypertension—is far from a fad diet. Created by the National Heart, Lung, and Blood Institute (NHLBI), the DASH Diet is designed to improve health in people with high blood pressure, a.k.a. hypertension. (In the U.S., one out of every three adults has high blood pressure, according to the Centers of Disease Control and Prevention.) U.S. News & World Report has named the DASH Diet the best overall diet for the past eight years.

There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[53]

Cyrus Khambatta earned a PhD in Nutritional Biochemistry from UC Berkeley after being diagnosed with type 1 diabetes in his senior year of college at Stanford University in 2002. He is an internationally recognized nutrition and fitness coach for people living with type 1, type 1.5, prediabetes and type 2 diabetes, and has helped hundreds of people around the world achieve exceptional insulin sensitivity by adopting low-fat, plant-based whole foods nutrition.


A ketogenic diet is high in fat and low in carbohydrates. It’s called “ketogenic” because people on this diet shift from using glucose (a type of sugar) as their main fuel source to ketone bodies, which are derived from fat. In other words, people on the ketogenic diet can use their bodies’ fat stores as fuel—and this is why many studies show that this diet is superior for sustainable weight loss.
Researchers at Florida State University studied watermelon for its ability to regulate blood pressure due to it being “one of the richest natural sources of L-citrulline”, an amino acid that the body converts into L-arginine, which improves circulation. They discovered that watermelon, due to its high L-citrulline, may prevent pre-hypertension from becoming full blown hypertension.
You can eat what you love. It’s evident that with such a variety of whole, fresh foods available to you as options, it’s easy to build meals based on the diet. And, you don’t have to eliminate your favorites, either. They may just require some tweaks. For instance, rather than a sausage and pepperoni pizza, you’d choose one piled high with veggies and topped with some cheese. You can also fit in a lot of food into one meal. Filling up on fresh foods like fruits and vegetables will allow you to build volume into meals for fewer calories.
If you like eating meat and want to lose weight, you might be tempted to try this recent extreme diet fad that proponents have made some pretty outrageous claims about. One: that eating nothing but meat can cure you of autoimmune diseases. The problem is that there’s no good research to support that notion, or any other health claim, for that matter. Indeed, omitting foods known to be good for you — fruits and veggies among them — can lead to a bunch of unwanted side effects, including constipation and potentially dangerous nutrient deficiencies. Still, since you’re cutting out so many food groups, there’s a decent chance you’ll lose weight, experts say. Regardless of any possible benefits you might see, this restrictive approach is definitely one you’ll want to ask your doc about before you even consider diving in.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
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Be choosy about carbs. You can decide which ones you eat, and how much. Look for those that are low on the glycemic index (for instance, asparagus is lower on the glycemic index than a potato) or lower in carbs per serving than others. Whole grains are better choices than processed items, because processing removes key nutrients such as fiber, iron, and B vitamins. They may be added back, such as in “enriched” bread.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
Eat More Produce. Eating lots of low-calorie, high-volume fruits and vegetables crowds out other foods that are higher in fat and calories. Move the meat off the center of your plate and pile on the vegetables. Or try starting lunch or dinner with a vegetable salad or bowl of broth-based soup, suggests Barbara Rolls, PhD, author of The Volumetrics Eating Plan. The U.S. government's 2005 Dietary Guidelines suggest that adults get 7-13 cups of produce daily. Ward says that's not really so difficult: "Stock your kitchen with plenty of fruits and vegetables and at every meal and snack, include a few servings," she says. "Your diet will be enriched with vitamins, minerals, phytonutrients, fiber, and if you fill up on super-nutritious produce, you won't be reaching for the cookie jar."
“Having your groceries delivered cuts back on the impulse buys, wasting money, and over portioning. Plus, you can pre-load your weekly list so it's effortless,” Moreno explains. Moreno also recommends keeping healthy snacks on your “auto-ship” list on Amazon. This way, you never run out! Moreno swears by these delectable protein brownies. “Stash one in every purse!”
When you eat foods high in carbohydrates and fat, your body naturally produces glucose. Carbohydrates are the easiest thing for the body to process, and therefore it will use them first – resulting in the excess fats to be stored immediately. In turn, this causes weight gain and health problems that are associated with high fat, high carbohydrate diets (NOT keto).

“Instead of using a heavy salad dressing, try a drizzle of thick balsamic glaze along with a squeeze of fresh lemon or lime juice” Taub-Dix says. “By cutting the fat in your diet, you can not only save calories, but you can also leave room for healthier fats like avocado or nuts, which are toppings you can actually chew and enjoy with greater satisfaction.”


I would love to join a study! Could you recommend where to go to find one? I have done 30 or less total carbs a day for almost 2 years and feel great. I have NEVER EVEN ONCE gone over 40 total so I do follow it and I do not cheat on high carb foods, although I do occasionally over-eat on low carb foods resulting in a bit over 30 maybe 1 -2 times a month. I do feel that time will provide more support and think that the medical community should educate on this as another alternative. It isn’t for everyone because it is a bit more problematic if a person does fall of the straight and narrow too often but it can be done!
Here are a few of the most common side effects that I come across when people first start keto. Frequently the issues relate to dehydration or lack of micronutrients (vitamins) in the body. Make sure that you’re drinking enough water (close to a gallon a day) and eating foods with good sources of micronutrients. To read more on micronutrients, click here >
The Dietary Approaches to Stop Hypertension, or DASH, diet has been consistently ranked by US News & World Report as a top diet for heart health and weight loss, and it’s no surprise why. Unlike fad diets that call for extreme calorie or food-group restrictions without scientific evidence that supports their efficacy, the DASH diet involves making manageable dietary changes that are flexible and rooted in proven nutritional advice.
Participants completed take-home food records (4 consecutive days, including a weekend) collected at baseline and at weeks 2, 8, and 16 during the study. Participants were given handouts with examples of how to complete the records. A registered dietician analyzed the food records using a nutrition software program (Food Processor SQL, ESHA Research, Inc., Salem, OR).
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.

“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.
“Tremendous Results”….guess that’s why the diabetes nationwide gets worse every year, because of the stellar advice your kind is giving out. I’ve been on the virta clinic for two months and already went off insulin, Janumet and Jardiance, which I’ve been on for 10 years, with blood sugars between 80 and 150. The advice you give makes people get sick slower. The ketogenic approach deals with the real issue, carbohydrate intolerance. If you are lactose intolerant you stop ingesting lactose. Type two diabetes is simply carbohydrate intolerance. Stop eating the carbs and the symptoms go away. I think you meet to cite some of the other research out there I’ve read in other books and the work the Virta Clinic has done. In my opinion you’ve cherry picked data to suit your preconceived beliefs.

Dr. Reynolds reviewed numerous research studies on ketogenic diets,6 and he has found that most studies show that the drop in blood sugar is typically short-term—only lasting during the initial three months or so—but does not last.  "So it is very hard to encourage ketogenic diets when we have no evidence that they work over longer periods of time," he tells EndocrineWeb.

One study from 2005 followed 22 people with Type 1 Diabetes for 12 months. The difference here however is they consumed 70-90 grams of carbohydrates per day versus the restrictive less than 20 grams per day on the Ketogenic Diet. Remember my motto? Moderation is the key! The results were positive; less hypoglycemia, insulin requirements were reduced and their A1c dropped from 7.5% to 6.4%.


When foods are processed, their potassium levels actually decrease. So, choosing whole or minimally processed foods can improve blood pressure regulation from both a sodium and a potassium perspective. In addition, you’ll usually decrease your intake of saturated fat, added sugars, and overall calories—all of which can help you lose weight, and keep it off for good. 

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:


“Regardless of how solid they are, your diet and exercise plans won’t work if you aren’t sticking to them. You’ve made a commitment to yourself, so come through with it,” Roussell says. As you plan your meals or snacks, Roussell suggests putting an X over it on your menu map. If you skip a meal or eat something that isn't in your plan, circle that meal. At the end of each week, count the number of meals you ate according to your meal plan and divide that number by the total number of meals, snacks, and post-workout smoothies you had planned, then multiply it by 100.
The Mediterranean diet is most famous for its benefit to heart health, decreasing the risk of heart disease by, in part, lowering levels of “bad” LDL cholesterol, and reducing mortality from cardiovascular conditions. It’s also been credited with a lower likelihood of certain cancers, like breast cancer, as well as conditions like Parkinson’s disease and Alzheimer’s disease. (1)
Calorie Restriction. Most of the research on type 2 diabetes supports the use of calorie restriction for improving many of the metabolic issues that contribute to the condition. [19] [20] Both the keto diet and low-calorie diets have been shown to help reduce insulin resistance, and many researchers postulate that being in a calorie deficit is the key variable behind these positive effects.[19] [20] For most of us, the keto diet is the better option to experience the benefits of calorie restriction because it allows you to cut your calories naturally without eliciting strong hunger pangs and cravings.
Pros: Compared to eating a traditional diet, switching to a low-carb diet can significantly reduce body fat, studies show. Cap your carb intake at 20% of daily calories and the weight-loss results are even stronger—plus, you can reduce your risk for heart disease and stroke. Some research suggests low-carb diets are even better than low-fat diets: One study in Annals of Internal Medicine found that people who limited their carbs lost eight more pounds than those who cut back on fat. If you cut back on carbs enough, your body learns to burn fat as fuel instead. Studies are mixed on how low-carb diets affect performance, but some evidence suggests that endurance performance can actually improve among people whose bodies adapt to fat-burning fairly easily.
2. A strong, healthy heart. Eating Mediterranean decreases practically every heart-disease risk factor -- high blood pressure, cholesterol, and triglyceride levels. When 605 patients who'd had a first heart attack followed the diet for four years, they had a 50 to 70 percent lower risk of having a second heart attack, angina, or a stroke or pulmonary embolism. "There's no single aspect of the diet that keeps your heart healthy," says Dr. Stampfer; it's the synergy of all the diet's elements. Antioxidants in fruits, vegetables, and beans help prevent the atherosclerosis that can make plaque build up in arteries. Omega-3 fatty acids in fish lower blood pressure, arrhythmia risk, and triglyceride levels. Olive oil lessens LDL ("bad") cholesterol. And wine and other spirits in moderation may lower heart-disease risk.

In terms of weight loss, you may be interested in trying the ketogenic diet because you’ve heard that it can make a big impact right away. And that’s true. “Ketogenic diets will cause you to lose weight within the first week,” says Mattinson. She explains that your body will first use up all of its glycogen stores (the storage form of carbohydrate). With depleted glycogen, you’ll drop water weight. While it can be motivating to see the number on the scale go down (often dramatically), do keep in mind that most of this is water loss initially.
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