Like many variables in diet, health, and disease, it behooves us to look beyond the bumper sticker explanation. I want to highlight a couple of posts I wrote, to attempt to provide a little more nuance and understanding to the subject: “Ketosis — advantaged or misunderstood state?” Parts I and II. Part I follows below. I’m hoping to write more on the topic in the not-too-distant future since there’s been a number of intriguing papers published recently (certainly since 2012). But I also wanted to bring these back into focus in light of the information I’m seeing more of on the interwebz. (You can also visit the Ketosis section of the site to view more articles on the subject.)
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When lifestyle changes aren't enough, a child take prescription medicines to treat individual risk factors. So, kids with high blood pressure might be put on antihypertension drugs. Others with high LDL cholesterol might be prescribed statins or other lipid-lowering drugs. Children with high blood sugar, who are on the brink of developing diabetes, may get medicine to decrease insulin resistance.
When preparing keto bread recipes, look out for low-carb ingredients that could contribute to brain fog and inflammation. Skip recipes that require conventional dairy or yeast, and avoid eating common keto bread ingredients like psyllium husk, xanthan gum, and nuts or nut butters too often — these can contain mold or irritate your gut. Grass-fed butter, ghee, and coconut flour are the few exceptions that will still produce a stellar loaf.
The BBB, largely formed by the brain capillary endothelial cells, provides a protective barrier between the systemic blood and the extracellular environment of the CNS. Passage of FAs from the blood to the brain may occur either by diffusion or by proteins that facilitate their transport. Studies indicate that FATP-1 and FATP-4 are the predominant FA transport proteins expressed in the BBB based on human and mouse expression studies (Mitchell et al., 2011).
I have been looking for a good keto bread recipe. I have tried a few others with a “meh”. This one is a WOW! Prior to going Keto, I loved to cook and bake, it is my main hobby. But after going Keto, I have had to learn a whole new way of cooking. I followed the recipe to a T knowing how to work my way around the kitchen and the only difference is the fact that mine turned out purple. It is clearly the psyllium. Thank you so much for a wonderful and easy recipe for a great bread!
It is interesting to note that the KB are capable of producing more energy than glucose due to the changes in mitochondrial ATP production induced by KB (Kashiwaya et al., 1994; Sato et al., 1995; Veech, 2004). During fasting or KD glycaemia, though reduced, remains within physiological levels (Seyfried and Mukherjee, 2005; Paoli et al., 2011). This euglycemic response to extreme conditions comes from two main sources: glucogenic amino acids and glycerol liberated via lysis from triglycerides (Vazquez and Kazi, 1994; Veldhorst et al., 2009). Glucogenic amino acids (neoglucogenesis from amino acids) are more important during the earlier phases of KD, while the glycerol becomes fundamental as the days go by. Thus, the glucose derived from glycerol (released from triglyceride hydrolysis) rises from 16% during a KD to 60% after a few days of complete fasting (Vazquez and Kazi, 1994). According to Bortz (1972) 38% of the new glucose formed from protein and glycerol is derived from glycerol in the lean while 79% in the obese (Bortz et al., 1972). It is important to note that during physiological ketosis (fast or very low calorie ketogenic diets) ketonemia reaches maximum levels of 7–8 mmol/L with no change in blood pH, while in uncontrolled diabetic ketoacidosis blood concentration of KBs can exceed 20 mmol/L with a consequent lowering of blood pH (Robinson and Williamson, 1980; Cahill, 2006) (Table ​(Table11).

A stack of pancakes might sound like the opposite of a keto-friendly breakfast, but where there's a will, there's a way. These ones from A Big Man's World are made with the perfect combination of almond flour, coconut flour, and eggs for a result so fluffy, you'll hardly be able to tell they're low in carbs. The blueberries add a touch of sweetness (but they contain sugar, so be careful about the portions).
First of all, thanks for the recipe. I tried it yesterday with coconut flour and egg whites, and I failed miserably. It rose 5 or 6 times in volume and then collapsed like the world economy. Also, it was very moist on the inside. I’ll try the almond flour version with half the baking powder and full eggs this time, but I’m having trouble wrapping my head around measurements. If 1 and 1/2 cup of almond flour is 5oz, how can 1/2 cup of coconut flour be 2.5oz (equalling 7.5oz for 1 and 1/2 cup)? If anything, almond flour is more dense, not less.
The metabolic syndrome quintuples the risk of type 2 diabetes mellitus. Type 2 diabetes is considered a complication of metabolic syndrome. In people with impaired glucose tolerance or impaired fasting glucose, presence of metabolic syndrome doubles the risk of developing type 2 diabetes.[28] It is likely that prediabetes and metabolic syndrome denote the same disorder, defining it by the different sets of biological markers.
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Broyles, S., Katzmarzyk, P. T., Srinivasan, S. R., Chen, W., Bouchard, C., Freedman, D. S., & Berenson, G. S. (2010, May). The pediatric obesity epidemic continues unabated in Bogalusa, Louisiana. Pediatrics, 125(5). Retrieved from http://pediatrics.aappublications.org/content/125/5/900?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token
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You've probably heard of the keto diet, the trendy weight loss plan that advocates for cutting down carbs and upping your fat intake. (That means no to pastries and pasta, and yes to meat, eggs, and heart-healthy oils.) If your morning routine of the past involved bagels, toast, or oatmeal, trying to come up with keto breakfast ideas can feel like a rude awakening. With so many carb-heavy a.m. foods, it's arguably the hardest meal to find ketogenic diet-approved substitutes for — especially when you're staring right in the face of a donut on your morning coffee run.

Pizza for breakfast? You betchya! This recipe by All Day I Dream About Food slashes carbs by subbing in cauliflower for the standard wheat flour crust, and racks up plenty of fats and protein with toppings like cheese, sausage, eggs, and avocado. It’s as gooey and crispy as your favorite pizza pie, but costs you a slim 5.43 grams of net carbs a serving. Perfect for relaxing weekend mornings or keto-friendly brunch.
This poses a real evolutionary dilemma.  We need an enormous amount of energy just to not die, but the single most important organ in our body (also quite energy hungry in its own right) can’t access the most abundant source of energy in our body (i.e., fat) and is, instead, almost solely dependent on the one macronutrient we can’t store beyond a trivial amount (i.e., glucose). Obviously our species wouldn’t be here today if this were the end of the story. But, to understand how we survived requires one more trip down biochemistry memory lane.  In the figure below (also included and described in the video) I gloss over a pretty important detail.
My loaves always had air pockets and a gummy texture. I made a loaf yesterday and when I was putting it in the oven, the power went out. The dough sat on the counter for 3 – 4 hours until the power came back on and I was able to bake it. The finished loaf cooled in the oven all night (I took it out of the loaf pan) and when I cut into it this morning, the texture was perfect – no gooey middle, no air pocket! Perhaps the secret is to let the dough rest before baking??

In type 2 diabetes the body has an increasingly harder time to handle all the sugar in the blood. Large amounts of the blood sugar-lowering hormone insulin are produced, but it’s still not enough, as insulin sensitivity decreases. At the time of being diagnosed with type 2 diabetes, people usually have ten times more insulin in their bodies than normal. As a side effect, this insulin stores fat and causes weight gain, something that has often been in progress for many years before the disease was diagnosed.

BMI (body mass index), an alternate measure of obesity that is used by many healthcare practitioners; it is calculated by taking: (Weight in pounds X 705) / (height in inches squared); for example: (150 pounds X 705) / (67 inches X 67 inches) = a BMI of 23.5. An adult with a BMI greater than 30 is considered obese. This calculation does not, however, describe where the excess weight is on the body.

Hey there… I’m new to keto, so I’m hoping my questions don’t come across as really stupid. Your bread looks great, and if I can get bread again, then that’s simply awesome. The pictures remind me of banana bread. Is there a way of adding this flavor without going insanely overboard on the carbs? And without that artificial banana taste? Also, would this recipe work as muffins? Thanks, Kelly
[Guideline] Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol. 2009 Jan 20. 53(3):298-304. [Medline].
Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.
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Thank you for the recipe. I was going to give up gluten free bread making but your recipe made my day! I used ghee instead of butter as I was too lazy to melt butter. It rose prettily in the oven. Such a nice loaf of bread. Definitely not eggy and it even has the fluffiness of bread. I would like to double the recipe and make it in a 1 lb loaf pan. Do you think that’s feasible? Many thanks,
Is there any way you can post at the beginning of a recipe: NOT for weight loss. I have tried a few recipes before reading the comments below, made it, then saw it was a no no for weight loss. Thanks! I made your pita bread too and it rocks. I am waiting for this amazing bread to come out of the over right now. I am worried about eating now though. Too many carbs for weight loss?

Carbohydrates ultimately break down into glucose. Many people believe that carbs are bad for people with diabetes. This is not true. Carbs are fuel for the body, so they have to be eaten. You just need to be smart about which ones you eat and how much you eat of them. Picking foods that are high in carbs but have no other nutrition is not smart. Examples of these foods are:
Ketone esters (BHB-BD) decreases muscle protein breakdown30. Exercise triggers the breakdown of some muscle proteins in order to top up metabolic processes inside the cell. This results in a rise in ‘branched chain amino acid’ levels inside the muscle after exercise. Taking a ketone ester drink before exercise decreased the exercise-induced rise in muscle branched chain amino acid levels. This could help to protect muscle during exercise. 
A well-formulated ketogenic diet, besides limiting carbohydrates, also limits protein intake moderately to less than 1g/lb body weight, unless individuals are performing heavy exercise involving weight training when the protein intake can be increased to 1.5g/lb body weight. This is to prevent the endogenous production of glucose in the body via gluconeogenesis. However, it does not restrict fat or overall daily calories. People on a ketogenic diet initially experience rapid weight loss up to 10 lbs in 2 weeks or less. This diet has a diuretic effect, and some early weight loss is due to water weight loss followed by a fat loss. Interestingly with this diet plan, lean body muscle is largely spared. As a nutritional ketosis state sustains, hunger pangs subside, and an overall reduction in caloric intake helps to further weight loss.
It looks and smells beautiful when baking. The bottom of my loaves is heavy and dense. The top rises and makes an air pocket. As a result, it’s just not really pleasant to eat with it being so dense and solid even though it tastes good. The few good pieces at the very ends were yummy. I really don’t know what to do. Almond flour is expensive to be going through it like this. 🙁

Dr. Campos, it is unfortunate that you retain the medical community’s negative stance on the ketogenic diet, probably picked up in medical school when you studied ketoacidosis, in the midst of an obesity and type II diabetes epidemic that is growing every year, especially among populations who will never see the Harvard Health Letter. The medical community has failed in reversing this trend, especially among children, and the public is picking up the tab, in the form of higher health insurance premiums to treat chronic metabolic diseases which doctors cannot cure. The ketogenic diet does not bid its adherents to eat unhealthy processed meats, and the green leafy vegetables that it emphasizes are important in a number of nutritional deficiencies. People lose weight on the ketogenic diet, they lose their craving for sugar, they feel more satiety, they may become less depressed, their insulin receptors sensitivity is improved, and these are all the good outcomes you fail to mention. There is a growing body of research which demonstrates the neuroprotective effects of the ketogenic diet to slow cancer progression, as well as diseases like Parkinson’s and Alzheimer’s, for which there are no effective medical treatments. Please respect your patients by providing them with evidence-based medical outcomes, not opinions.
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Attempt #4 or 5, I lost count 🙂 I measured everything by weight (ounces and grams as you listed) not by cups or tsps, etc. Put in oven at 375 since I don’t have convection and the previous attempts didn’t rise. This one rose beautifully! Nice beautiful color! Cooked 80 minutes. Let cool completely in my 8×4 metal loaf pan. Several hours later, I decided to take out of pan and cut a slice. It caved a little in on the sides, it looks similar to your 12 oz water picture, but it is wet. I’m not sure you’d call it gummy but definitely too much moisture again. And, I thought I finally had one! Back to the testing…I’ve gone thru 1/2 my Honeyville 5 lb bag and haven’t had one successful loaf yet 🙁
Oatmeal is the ultimate morning meal in the winter months—and anytime your soul needs something warm. Ruled.me’s breakfast porridge makes that experience possible on a keto diet. Instead of your usual oats, it’s made with flaxseed meal and coconut flour, and sweetened with erythritol, to keep sugar and carb counts low. (The texture feels something like cream of wheat.)

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Further indicating that ketones influence mtROS production through alteration of electron transport, treatment of rat hippocampal slices with BHB + ACA (1 mM each) prevented the increase in mtROS and mitigated the decrease in ATP production that otherwise result from inhibition of mtETC complex I with rotenone [111]. In mitochondria isolated from the brains of mice injected with BHB, although inhibition of complex I with rotenone and 1-methyl-4-phenylpyridinium increased rather than decreased mtROS production, the BHB treatment prevented the decrease in O2 consumption caused by inhibition of complex I, and this occurred independently of uncoupling [112]. Consistent with the results from hippocampal brain slices, the BHB treatment also mitigated the decrease in ATP production caused by complex I inhibition [112]. These effects were prevented by inhibition of complex II with 3-nitropropionic acid or malonate, indicating that BHB primarily influences mitochondrial respiration at complex II [112], which is consistent with ketolysis increasing formation of succinate and FADH2. However, in mutated cells prone to complex I disassembly and an associated severe decrease in complex I activity, treatment with BHB + ACA (5 mM each) increased both the assembly and activity of complex I [113], indicating that ketones somehow promote repair of complex I damage and may therefore influence mitochondrial respiration at more than one site.

A giant, late-night dinner is your blood sugar’s worst enemy. That’s because our bodies become more insulin resistant as the day goes on—so a meal that you eat in the evening will cause a greater spike in blood sugar than a meal you eat in the morning. Because of this, many nutrition experts advise front-loading your meals, or eating bigger meals earlier in the day and having a smaller dinner at least three hours before bed.
Russel Wilder first used the ketogenic diet to treat epilepsy in 1921. He also coined the term "ketogenic diet." For almost a decade, the ketogenic diet enjoyed a place in the medical world as a therapeutic diet for pediatric epilepsy and was widely used until its popularity ceased with the introduction of antiepileptic agents. The resurgence of the ketogenic diet as a rapid weight loss formula is a relatively new concept the has shown to be quite effective, at least in the short run.

This was a great read. I aim to restrict carbs always because I believe most are why the American population is obese. I would very much like to hear more about carb restriction excluding the discussion on processed meats and processed high salt content foods because I consume neither. I also don’t consume dairy or eggs. So can you provide some substance.
First I tried using coconut flour only. The batter was very thick and pasty and the resulting bread was very firm and dry, like a really dry biscuit. It did, however, keep its shape well and toasted up evenly golden-brown in a skillet with oil. I thought about trying again with more liquid, but that wouldn’t solve its fatal flaw: the strong, overwhelming coconut flavor. Even chicken and sun-dried tomato pesto could barely cover it up.

I actually clicked on the story just to see if they included anything about it’s use in managing chronic migraine. I have chronic migraine, basically intractable. Nothing has helped. I’ve tried medications, meditations, and everything in between including a bunch of dietary changes. Keto is my next consideration. I’m happy to hear it helped you! Thanks for sharing
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Admittedly, I started my journey on this path in 2009, with a deep dive into ketosis in the Spring of 2011, but it seemed so obscure! (For a timeline of what I did, I think I covered it somewhere in this talk…yes I’m too lazy to actually confirm this by skimming through it.) All told I spent approximately 3 years in the strictest state of nutritional ketosis (NK) with one very memorable deviation when I had 6 or 7 full-sized and upsettingly decadent desserts circa September 2013. I believe the diet helped me transition from metabolic syndrome to metabolic health and I certainly thought it could benefit other people. This nutritional state could gain some steam, I thought.
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Despite continuous advances in the medical world, obesity continues to remain a major worldwide health hazard with adult mortality as high as 2.8 million per year. The majority of chronic diseases like diabetes, hypertension, and heart disease are largely related to obesity which is usually a product of unhealthy lifestyle and poor dietary habits. Appropriately tailored diet regimens for weight reduction can help manage the obesity epidemic to some extent. One diet regimen that has proven to be very effective for rapid weight loss is a very-low-carbohydrate and high-fat ketogenic diet.[1][2][3]
This was a great read. I aim to restrict carbs always because I believe most are why the American population is obese. I would very much like to hear more about carb restriction excluding the discussion on processed meats and processed high salt content foods because I consume neither. I also don’t consume dairy or eggs. So can you provide some substance.
The trick here is not only to avoid all obvious sourced of carbohydrate (sweets, bread, spaghetti, rice, potatoes), but also to be careful with your protein intake. If you eat large amounts of meat, eggs and the like, the excess protein will converted into glucose in the body. Large amounts of protein can also raise your insulin levels somewhat. This compromises optimal ketosis.
Hi Eva, That’s awesome that you are helping your son this way. I haven’t tried this with other tools, but you could probably use either the blender or the food processor. The key is to pulse in step 5, not just constantly blend, so that the whites don’t fully break down. Other than that, it should be pretty similar. As for the yolks, if you don’t want to make creme brulee, I usually just put a couple extras into an omelet (or breakfast casserole, or any other dish requiring cooked eggs) mixed with whole eggs.

194. Ruth M. R., Port A. M., Shah M., et al. Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects. Metabolism. 2013;62(12):1779–1787. doi: 10.1016/j.metabol.2013.07.006. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
The difference between ketosis and ketoacidosis is the level of ketones in the blood. Ketosis is a physiological adaptation to a low carbohydrate environment like fasting or a ketogenic diet. There are situations (such as treatment-resistant epilepsy) where ketosis can be beneficial to health. Ketoacidosis is an acute life-threatening state requiring prompt medical intervention; its most common form is diabetic ketoacidosis where both glucose and ketone levels are significantly elevated.
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Additional evidence, although disparate and primarily based on neuronal mitochondrial function related to epileptic seizures, further supports the potential for nutritional ketosis to induce mitohormesis [9]. Much of this is based on signal transduction, antioxidant defense, and oxidative capacity, all of which will be discussed in proceeding sections.
Before we begin, a disclaimer in order: If you want to actually understand this topic, you must invest the time and mental energy to do so.  You really have to get into the details.  Obviously, I love the details and probably read 5 or 6 scientific papers every week on this topic (and others).  I don’t expect the casual reader to want to do this, and I view it as my role to synthesize this information and present it to you. But this is not a bumper-sticker issue.  I know it’s trendy to make blanket statements – ketosis is “unnatural,” for example, or ketosis is “superior” – but such statements mean nothing if you don’t understand the biochemistry and evolution of our species.  So, let’s agree to let the unsubstantiated statements and bumper stickers reside in the world of political debates and opinion-based discussions.  For this reason, I’ve deliberately broken this post down and only included this content (i.e., background) for Part I.
We have solid evidence showing that a ketogenic diet reduces seizures in children, sometimes as effectively as medication. Because of these neuroprotective effects, questions have been raised about the possible benefits for other brain disorders such as Parkinson’s, Alzheimer’s, multiple sclerosis, sleep disorders, autism, and even brain cancer. However, there are no human studies to support recommending ketosis to treat these conditions.

Thanks for this article. I just started a Keto diet so found it appropriate to my current lifestyle. Though I don’t believe your bottom line is strong enough since you simply stating that the diet is “hard to follow” and food is “notoriously unhealthy” without evidence going deeper into why those “notoriously unhealthy” foods are worse than keeping carbohydrate-heavy food that are addictive and give the body a quick sugar high for energy. I believe “hard to follow” is your opinion only, since acceptable Keto foods are found at all restaurants easily and also all grocery stores. All the foods you mention: “rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water” are all Keto-friendly. Many people have been on a Keto-diet for years. A healthy lifestyle is a healthy mindset change and making right choices – it’s not going to be easy.
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Add yeast and maple syrup (to feed the yeast, see notes) to a large bowl. Heat up water to 105-110°F, and if you don't have a thermometer it should only feel lightly warm to touch. Pour water over yeast mixture, cover bowl with a kitchen towel and allow to rest for 7 minutes. The mixture should be bubbly, if it isn't start again (too cold water won't activate the yeast and too hot will kill it). 
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