Since then, it’s safe to say I dove down the rabbit hole. The more I learned, the more I grew tired of reading so much misinformation on the topic. While there are more thoughtful people and articles on the subject of ketosis these days (e.g., here’s a thoughtful video on ketosis and ketogenic diets from one of my most important ketosis mentors, Steve Phinney, a co-founder of Virta Health1Disclosure: I’m an investor in, and advisor to, Virta Health.), there are still pieces like the one Vox published this month, that doesn’t exactly do the topic justice.
Most of these benefits occur due to the decrease in dietary carbohydrate intake; it is largely unknown what role ketones themselves play in the efficacy of the diet. Because of this, it is unclear how exogenous ketones could be used to help treat diabetes. One effect that is consistently reported is that ketone ester and ketone salt drinks and infusions lower blood glucose and lipid levels 11,106 ,107. It is also possible that exogenous ketones have a positive effect on insulin sensitivity; ketone ester supplementation increased insulin sensitivity in rodents by 73%108. It is possible that exogenous ketones could be used alongside diet and lifestyle changes to help control blood in diabetes, but further research must be done before this can be realised. 
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For those, like myself, wanting a low-carb real bread I would recommend a proper low-carb yeast bread recipe with vital wheat gluten (the vast majority of people have zero gluten sensitivity, so the gluten-free fad is at best a waste and at worst a scam). Such breads have approx 1.5-2 grams more net carbs per 40g slice (5-6 grams total net carbs) than this recipe and I think it’s worth it.
The presence of abnormally high levels of KETONES in the blood. These are produced when fats are used as fuel in the absence of carbohydrate or available protein as in DIABETES or starvation. Ketosis is dangerous because high levels make the blood abnormally acid and there is loss of water, sodium and potassium and a major biochemical upset with nausea, vomiting, abdominal pain, confusion, and, if the condition is not rapidly treated, coma and death. Mild ketosis also occurs in cases of excessive morning sickness in pregnancy.
The low carbohydrate content of the ketogenic diet prevents blood sugar spikes and stabilizes insulin levels. Chronically high insulin levels and the disrupted incretin signaling (gut derived molecules) lead to insulin resistance over time (pre-diabetes). This means that our cells are not willing to take up vast amounts of glucose anymore and more and more insulin is needed for glucose uptake – a vicious cycle.
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I had the same effect but I used the same pan. The issue I had was the egg whites. I beat them with a mixer for 2 minutes with the cream of tartar and still couldn’t get them whipped. I’d say they were half whipped. I gave up and put them in the loan pan anyway. The bread looked the same and tasted great but it was somewhat spongy. I’m wondering if the egg whites really wouldn’t whip because I didn’t realize they had to be room temp. The bread is great but it won’t hold up for sandwiches. Any tips on egg whipping? I felt egg defeated today!
I absolutely LOVE this bread. I make a fresh loaf every 1-2 weeks as needed. It took 3 tries to get it right. I had tried it with pre-ground NOW foods powdered psyllium husk powder and got a gooey, purple version [that still tasted great and toasted fine], and then I must have used a tiny bit too much liquid in another version because it was too dense, but now I precisely weigh everything and grind up my own psyllium husks in my coffee grinder as fine as I can get it and it comes out perfect every time. This is going to sound dramatic, but this bread has changed my life. lol… it’s a go-to for a quick meal if I have nothing else prepared because I can always find something delicious and keto-friendly to either slather on top, or make toast for my eggs, French toast [I can’t REMEMBER the last time I had French toast before I started making this bread!], or a quick little sandwich on the go. Maria – I’ve read almost all of your books and use so many of your recipes and tell everyone that will listen about you. I’ve sent your books to numerous family members, too. Thank you so much for everything you do. I started eating ‘The Maria Way’ last September and have lost that ‘inner carb demon’ that made me hungry all the time. That alone is priceless to me. I feel like I’ve finally been set free! Food has no hold over me anymore, now it’s about all the delicious and healthy food I CAN have and LOVE.
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.

Blood pressure goals are generally set lower than 130/80. Some blood pressure medications offer more benefits than simply lowering blood pressure. For example, a class of blood pressure drugs called ACE inhibitors has been found to also reduce the levels of insulin resistance and actually deter the development of type 2 diabetes. This is an important consideration when discussing the choice blood pressure drugs in the metabolic syndrome.
Given the prevalence of this category of illness, and the insidious nature of the conditions, an intervention with minimal side effects (vs. drugs) such as ketosis could be used as a first line intervention before attempting treatment with medication in some cases. However, there is still some way to go before research can conclusively address this possibility, individuals considering the diet should do so with full medical supervision.

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.

Insulin resistance. Insulin is a hormone that helps your body use glucose -- a simple sugar made from the food you eat -- as energy. In people with insulin resistance, the insulin doesn't work as well, so your body keeps making more and more of it to cope with the rising level of glucose. Eventually, this can lead to diabetes. Insulin resistance is closely connected to having excess weight in the belly.

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.
Glucose. Usually a fasting glucose test is performed but, in some cases, a healthcare practitioner may also order a post prandial glucose (after a meal) or a GTT (glucose tolerance test – several glucose tests that are taken before and at timed intervals after a glucose challenge). The goal of glucose testing is to determine whether a person has diabetes or a decreased ability to process glucose (impaired glucose tolerance), which can eventually result in diabetes.
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.
Yes, beating the egg whites until semi-stiff could trap even more air and result in fluffier bread. If you try it, can you let us know how it went? I’d be super interested to hear. As for the rise, it really depends on your tin. If it’s a large (regular) bread tin, your bread would probably not rise above. If you use a half-sized (ca 500g) tin, it should.
The hypothalamus is the brain's main center responsible for hunger/satiety (H/S) control. In the theory that Mayer proposed more than 60 years ago, he assigned a central role to glucose levels in the H/S control: the so-called “glucostatic theory” (Mayer, 1955). Mayer suggested that depletion of carbohydrate availability leads to hunger, and the hypothalamic centers with receptors sensitive to glucose levels might be involved in the short-term regulation of energy intake (Mayer, 1955). The “feeding center” in the lateral hypothalamic area (LHA), according to the glucostatic theory, reacts to the between-meal fall of blood glucose and stimulates food intake. The LHA contains glucose-inhibited neurons that are stimulated by hypoglycemia, a process crucial to mediating the hyperphagia normally induced by hypoglycemia. The subsequent post-prandial hyperglycemia activates the “satiety center” in the ventromedial hypothalamus (VMH), which contains glucose-excited neurons and inhibits both “feeding center” and food intake.
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^ Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC (October 2009). "Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity" (PDF). Circulation. 120 (16): 1640–45. doi:10.1161/CIRCULATIONAHA.109.192644. PMID 19805654.
In addition to BHB inducing upregulation of antioxidant defense, ketones have direct antioxidant capacity. BHB scavenges •OH, as does ACA, although to a lesser extent [108]. The applicability of this antioxidant capacity has been investigated in vitro and in vivo in the context of hypoglycemia. In cultured hippocampal neurons, treatment with BHB or ACA decreased ROS during hypoglycemia induced through inhibition of glycolysis, and in hypoglycemic rats, infusion of BHB decreased hippocampal lipid peroxidation [108].
^ Vancampfort D, Correll CU, Wampers M, Sienaert P, Mitchell AJ, De Herdt A, Probst M, Scheewe TW, De Hert M (July 2014). "Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables". Psychological Medicine. 44 (10): 2017–28. doi:10.1017/S0033291713002778. PMID 24262678.

I just tried this for the first time and it didn’t turn out :(, it is very gummy and dense. I used Now Healthy Foods Psyllium Husk Powder, I measure out 10 TBSP and then weighed it, it went way over 90 grams on my scale so I kept using less and less until I got to what I thought was 90 grams. This powder is very fine. I looked for Jay Robb psyllium husk powder but the only thing on his website is psyllium seed husks? No powder? I see on your “store” you’re promoting “Frontier” psyllium husk powder, should we use that instead?
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First of all, almond flour bread will never have EXACTLY the same texture as wheat bread because it lacks the gluten. It will be slightly softer. But. Baking with almond flour is never an exact science. If your almond flour is coarser, just add an extra couple of tbsp next time and the bread will be firmer. Or try reducing the amount of water so it dries out more. I would not recommend changing the amount of egg (unless you used extra large eggs). Hope this helps!
The distribution of adipose tissue appears to affect its role in metabolic syndrome. Fat that is visceral or intra-abdominal correlates with inflammation, whereas subcutaneous fat does not. There are a number of potential explanations for this, including experimental observations that omental fat is more resistant to insulin and may result in a higher concentration of toxic free fatty acids in the portal circulation. [21]
As the rate of oxidative phosphorylation approaches the capacity of the mtETC, Δp will increase and facilitate mtROS production [53]. Higher oxidative capacity should therefore decrease the potential for mtROS production and subsequent oxidative damage. Furthermore, greater oxidative capacity may compensate for the resulting decrease in efficiency of ATP production associated with increased mitochondrial uncoupling. Since oxidative phosphorylation occurs exclusively in mitochondria, mitochondrial density is a key determinant of oxidative capacity [154].
The only reason to continue to give this bad advice is the lingering fear of natural fat. If you’re going to avoid fat you need to eat more carbohydrates in order to get satiated. But in recent years the old theory about fat being dangerous has been proven incorrect and is today on its way out. Low-fat products are simply unnecessary. So this reason doesn’t hold up either.
Insulin resistance. Insulin is a hormone that helps your body use glucose -- a simple sugar made from the food you eat -- as energy. In people with insulin resistance, the insulin doesn't work as well, so your body keeps making more and more of it to cope with the rising level of glucose. Eventually, this can lead to diabetes. Insulin resistance is closely connected to having excess weight in the belly.

The advice on carbohydrate-rich foods, for example, may make a person with type 2 diabetes require initiation of treatment with insulin injections. One single year’s insulin-consumption may easily cost $2000 or more. Multiply this number by the 422 million diagnosed people diabetes worldwide and you will see the enormous economical interests in this.
If you are diagnosed with metabolic syndrome, the goal of treatment will be to reduce your risk of developing further health complications. Your doctor will recommend lifestyle changes that may include losing between 7 and 10 percent of your current weight and getting at least 30 minutes of moderate to intense exercise five to seven days a week. They may also suggest that you quit smoking.
Cancer is a broad term that refers to the presence of abnormal cells in the body that have the potential to grow and spread to other sites in the body. Cancer develops over time as cells acquire defects that affect their function, growth, proliferation and metabolism. Recently a list of ‘Hallmarks of Cancer’ was proposed by some of the leading investigators, Hannahan and Weinburg90 . These hallmarks include:
Because carbohydrates break down into glucose, they have the greatest impact on your blood glucose level. To help control your blood sugar, you may need to learn to calculate the amount of carbohydrates you are eating so that you can adjust the dose of insulin accordingly. It's important to keep track of the amount of carbohydrates in each meal or snack.
4.) Fill the dough into a loaf tin lined with baking paper. If you don’t use a silicone loaf pan line ALL SIDES with parchment paper so the bread will release easily. Smooth the top, but don’t press down too much – keep as much air in the dough as possible. Bake at 180 Celsius / 350 Fahrenheit for about 45 minutes or until a knife inserted comes out clean!
In controlled studies on exercise-trained humans and animals, ketogenic diets have been shown to increase fat oxidation [8, 167] and expression or activity of carnitine palmitoyltransferase [167, 168] and β-HAD [168, 172], demonstrating that nutritional ketosis induces adaptation beyond exercise. Similarly, in a study comparing the independent and combined effects of exercise and a ketogenic diet on rats, the combination resulted in greater β-HAD and citrate synthase activities in skeletal muscle and higher maximal O2 consumption than either intervention alone, further indicating the potential for exercise to magnify adaptations induced by nutritional ketosis [156].
Ketones are a special type of fat that can stimulate the pathways that enhance the growth of new neural networks in the brain. A ketogenic diet is one that is high in fats, and this diet has been a tool of researchers for years, used notably in a 2005 study on Parkinson’s patients finding an improvement in symptoms after just 28 days. The improvements were on par with those made possible via medication and brain surgery. Other research has shown the ketogenic diet to be remarkably effective in treating some forms of epilepsy, and even brain tumors.
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Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.
My blood sugar is in the pre-diabetic range. D-ribose raises my blood sugar quite a bit. Test and see what it does for you before committing to taking it. Start testing your blood sugar 1/2 hour after taking the D-ribose and every 1/2 hour for about 2 hours to fully test the effects. If you take it in a liquid on an empty stomach, it can get into your bloodstream pretty fast.
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Maria, I made your bread using NOW psyllium, it tastes more like a loaf of real bread than anything I’ve tried. It’s lots better than the pricey Low Carb Bread Company loaves that I have been buying on Netrition. I had previously tried a similar recipe that had coconut flour, and even though I added quite a bit of onion powder, the coconut flavor was still distinguishable, and I’m not a fan.
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In skeletal muscle, oxidative capacity and mitochondrial content are related to fiber type. Compared to type II fibers, type I fibers have larger mitochondria [370] with greater oxidative enzyme content [371]. While fiber type is plastic, particularly in response to endurance exercise, transformation from oxidative, slow-twitch fibers (type I) to glycolytic, fast-twitch fibers (type II) is unlikely to occur [372, 373]. Type II fibers, however, can shift in humans from highly glycolytic (type IIx) to more oxidative (type IIa) [373]. Compared to type IIx fibers, type IIa fibers have greater citrate synthase activity, indicating greater mitochondrial content [374]. The relevance of oxidative capacity and fiber type to oxidative stress has been demonstrated by greater mitochondrial respiration with less H2O2 production in permeabilized fibers from rat muscle consisting primarily of type I or IIa fibers versus type IIb fibers [375]. Although muscle fiber-type transformation has been well characterized in response to exercise, this appears to not be the case for ketogenic diets. However, in rats, β-hydroxyacyl-CoA dehydrogenase (β-HAD) has been shown to increase most prominently in glycolytic, type IIb fibers following 4 weeks of a ketogenic diet (% energy: 70 fat, 6 carbohydrate, and 24 protein) [165], suggesting transition of these fibers towards type IIa fibers and, in turn, indicating potential for nutritional ketosis to promote a more oxidative muscle fiber composition.
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I have a loaf cooling on the counter right now. I couldn’t wait to take a piece of it so I hacked a piece off after 5 minutes and tasted it. I don’t get it, it’s the closest thing to real bread but does’t have any wheat in it! How can the crust taste so good?! I’m on a low carb diet so I have suffered through all sorts of weird tasting bread. This one is chewy, with nooks and crannies for sauces and butter. Mine came out purple, but I think it’s a lovely color. I used the bulk psyllium husk powder at my local health food store.


Insulin resistance also may increase your risk for metabolic syndrome. Insulin resistance is a condition in which the body can’t use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it’s used for energy. Insulin resistance can lead to high blood sugar levels, and it’s closely linked to overweight and obesity. Genetics (ethnicity and family history) and older age are other factors that may play a role in causing metabolic syndrome.

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Eating mindfully. A child who learns to see food as fuel and not emotional compensation can start to make better choices at mealtime — for example, selecting complex carbs instead of simple carbs (whole-grain instead of white bread, brown rice instead of white); getting more fiber with beans, fruits, and vegetables; choosing "healthy" fats like olive oil and nuts; and avoiding too many empty calories from soda and sweets.
Ketosis could benefit patients with PD, as ketones provide an alternative energy source to the brain and also have antiinflammatory effects. Several research groups have shown that the ketogenic diet can have manifold beneficial effects in animal models of PD: alleviating motor symptoms, reducing inflammation, decreasing neuronal loss 61 ,62. Also, an in vitro model of PD (neurons in culture treated with a drug called MPTP) was used to demonstrate that addition of 4 mM of BHB was protective against neurodegeneration52. An early study of the ketogenic diet in PD patients reported very promising results: patients improved their clinical PD ‘score,’ as classified by factors including tremor, balance and mood 63. Whilst there are promising results, further clinical studies are required to demonstrate if the ketogenic diet or exogenous ketones (either alone or in combination) are a tolerable and efficacious intervention for PD.            
All I can say is WOW! I am a week in on this Keto way of eating and came across this simple recipe. Gotta admit, I didn’t think I would like it…I LOVE IT! So easy to make…took me 20 minutes total! It was light, moist and delicious. I used one small loaf pan, doubled the ingredients and made the regular one and the cheese mix in. Can’t wait to share the rest with my co-workers…we are doing this together. Will be back to check for other recipes. Thank you!
Hey Maya!! This is the 2nd recipe I’ve tried off your website and again I love it!! Turned out really well. I can have sandwiches again or a quick piece Of toast when I’m in a hurry to get out the door. I was skeptical about the xanthan gum since I tried a recipe using psyllium husk powder. I did not like it. I can’t taste the xanthan gum so I have no problem using it going forward. Thanks again for the recipe!!!

Whilst the diet is broadly acknowledged to be safe strategy where medications have failed, side effects such as kidney stones, hyperlipidemia and can occur47. Furthermore, maintaining dietary adherence in young school age children can be very challenging for caregivers. Exogenous ketones may be an alternative or a adjunct to the ketogenic diet in epilepsy. Early work suggests that exogenous ketones could have antiseizure effects. Injection of the ketones acetoacetate and acetone have been found to have anticonvulsant properties in animal models48, and an acetoacetate diester was found to protect against seizures in rats exposed to high levels of oxygen49. Further studies are required to understand specifically how ketone bodies affect seizure control, however for children who experience daily seizures a combination of the ketogenic diet and exogenous ketones could be helpful to manage their condition.    
Wow… I made this for the first time yesterday and feel like I don’t need bread anymore this is a real game changer. It turned out a little dry the first time, but then I adjusted the time (80 seconds) and it made all the difference! I also added a little bit of swerve and it tasted like regular bread to me!! Toasted it and topped with Philadelphia 😀
The effects of a ketogenic diet on cholesterol and triglycerides is complex. It is dependant on the exact composition of the diet, the genetic and physical characteristics of the individuals studied and other hormonal and environmental factors. Therefore, blood lipid changes whilst on the ketogenic diet can vary between individuals. This means that it is advisable to track your personal levels by having a blood test before starting the ketogenic diet and to follow this with regular testing to monitor any changes.  

Theresa, Thanks so much for your comment! We aren’t sure what you mean though; our recipe above calls for 2 cups (224g) of almond flour, which is the same measurement you mentioned from the brand you use (112g per 1 cup X 2 cups = 224g). It may be helpful to reach out to a particular almond flour manufacturer if you have a product-specific question. We hope this helps and happy keto baking!
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