Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.
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Approach weight loss first by considering your lifestyle. Eat more veggies, fruit, seafood, and whole grains; prioritize good-for-you unsaturated fats; and think inclusive versus exclusive. There's no need to replace meals with powders when you can instead make shifts toward healthier eating habits that promote physical, mental, and psychological well-being for life.