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Even when established in the 70’s the diet was only ever recommended to be followed two weeks at a time. Strict menu of foods results in choices that aren't all that appealing and tasty to most people though the high protein component of the diet aids in a feeling of fullness and satisfaction. Funnily enough nearly every meal for a week recommends coffee or tea, perhaps because the caffeine content contributes to a temporary increase in metabolism. The Scarsdale diet also recommended drinking at least 4 glasses of water per day which is easily the minimum any person would be recommended to drink. The doctor who invented the diet recommends that dieters walk 3km each day, so obviously exercise comes into play.
The original Scarsdale approach isn't followed much these days but there are variants of the diet that are more suited to modern nutritional beliefs.

However a primary reason why the diet may be difficult for many people is, just like many other diets, it concentrates predominately on food restrictions with little regard for food enjoyment.
It is no secret that water is beneficial to flushing the system of toxins and aiding in weight loss in general. However, it is unlikely that a person would be able to effectively do this much physical activity given the low calorie intake. Initially when the Scarsdale diet was created the risks of a high protein diet were not yet known, but since then a high protein diet is generally not recommended namely due to the pressure it puts on the kidneys and the risk it poses in developing osteoporosis. The diet consists predominately of fresh fruit, vegetables and lean meat with only 3 meals per day - no food or snacks in between.
The calorie intake is one reason many critics slam the diet, because it is so low and perhaps not enough to function optimally let alone carry out various forms of exercise.

Tarnower then suggested that it be followed by his keep trim programme, which although not quite as strict as the Scarsdale component (containing more calories), still banned many foods. Particularly with respect to fruits and vegetables, certain parts of the menu allow you to eat as much of a particular food as you would like.

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