It is also not possible to characterize online forum users with respect to variables such a weight, age or race, which may influence the side effect profile. Other factors may introduce measurement bias, as follows. Posts are essentially anonymous and participation is dependent on the motivations of the user, their access to the relevant technology, and in this instance their ability to express themselves in the English language. The experiences of online forum users may not be representative of the larger pool of individuals on KD and they may differ in their likelihood to report negative outcomes. There is also no objective measure of adherence to the dietary precepts of KD or of the establishment of ketosis that are commonly reported in user forums.
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