Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[19] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[31] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[18] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[51] Other formula products include KetoVolve[52] and Ketonia.[53] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[53]
In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[55]
Reduced hunger. Many people experience a marked reduction in hunger on a keto diet. This may be caused by an increased ability of the body to be fueled by its fat stores. Many people feel great when they eat just once or twice a day, and may automatically end up doing a form of intermittent fasting. This saves time and money, while also speeding up weight loss.

By cutting carbs, you’ll also cut sugar and simple, refined carbohydrates, which means a steadier supply of energy. (No more sugar highs and crashes!) Once their bodies are used to the diet, “The first thing people report is, ‘Oh my gosh, I have this steady energy and I don’t have the need to snack at 3 p.m. because my energy is waning,’” Nisevich Bede says. Research published in January 2015 in the journal Obesity Review showed that the keto diet may lead to fewer hunger pangs and a lower desire to eat. (3)

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In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[55]
The possible benefits of the diet are impressive, but there are a few potential downsides to note. One is it’s tough to stick to. In fact, in a review of 11 studies involving adults on the keto diet, which was published in January 2015 in the Journal of Clinical Neurology, researchers calculated a 45 percent compliance rate among participants following the approach with the aim of controlling epilepsy. (13) “The diet is pretty hard to follow because it’s a complete shift from what you’re used to,” Nisevich Bede says. Slashing your intake of carbs can also make you feel hungrier than usual — a feeling that can last until you’re three weeks in.

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