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Ketoacidosis occurs mainly in people with type 1 diabetes if they do not take insulin. In diabetic ketoacidosis (DKA), blood sugar and ketones rise to dangerous levels, which disrupts the blood’s delicate acid-base balance. People in ketoacidosis feel extremely ill and experience profound dehydration, vomiting, abdominal pain, and weakness. DKA requires hospitalization so that IV fluids and insulin can be given to gradually and safely lower blood sugar.
I was well aware of the dearth of mainstream knowledge of NK, and particularly the conflation of NK with diabetic ketoacidosis (DKA), a pathologic state that results from the complete or near absence of insulin, which is what prompted my writing and desire to share my journey. And I was once in the wanker category of folks who spoke with “authority” about ketosis, despite knowing somewhere between zero and nothing on the topic. I remember exactly where I was sitting in a clinic at Johns Hopkins in 2002 during my residency explaining to (admonishing, really) a patient who was on the Atkins diet how harmful it was because of DKA. Not only that, the ketogenic diet could be seen as the antithesis of a “healthy” diet by conventional standards. I could see how this was a difficult proposition for many to acknowledge.

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 published a guideline to harmonize the definition of the metabolic syndrome.[39] This definition recognizes that the risk associated with a particular waist measurement will differ in different populations. Whether it is better at this time to set the level at which risk starts to increase or at which there is already substantially increased risk will be up to local decision-making groups. However, for international comparisons and to facilitate the etiology, it is critical that a commonly agreed-upon set of criteria be used worldwide, with agreed-upon cut points for different ethnic groups and sexes. There are many people in the world of mixed ethnicity, and in those cases, pragmatic decisions will have to be made. Therefore, an international criterion of overweight (BMI≥25) may be more appropriate than ethnic specific criteria of abdominal obesity for an anthropometric component of this syndrome which results from an excess lipid storage in adipose tissue, skeletal muscle and liver.
I don’t think I have ever posted anything on any other blog before in my life, but this time it’s just plain necessary. 🙂 Basically, I just wanted to let you know that you are a GENIUS, this is by far the best grain free bread I have ever tasted!! I made it with almond flour and egg whites only, and even my boyfriend (who’s the type of guy who generally dislikes anything remotely healthy) had to admit that it’s pretty good — and that it doesn’t remind him of scrambled eggs. 🙂 So thank you, thank you, thank you!

Our keto bread recipe has a beautiful golden crust. It has great structure with a lovely rise and perfect bread-like crumb. It slices well for sandwiches or toasting, but you don’t have to toast or grill it to make it taste good. Sliced with a smear of salted butter is keto perfection. And it actually tastes like bread, not eggs or almonds or coconut. Additionally, this bread will keep well wrapped in the fridge for up to a week!
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).

In addition, metabolic syndrome has been implicated in the pathophysiology of several other diseases, including obstructive sleep apnea. Breast cancer has also been linked to metabolic syndrome, possibly through dysregulation of the plasminogen activator inhibitor-1 (PAI-1) cycle. [64] Additional studies have linked metabolic syndrome with cancers of the colon, gallbladder, kidney, and, possibly, prostate gland. [65] Evidence is emerging of an association with psoriasis. [66, 67]
I made this after watching your video – which made all the difference since I realized I could use a electric mixer. I also measured carefully by weighing the egg whites……and it came out PERFECTLY. I’ve been hungry for a piece of toast with my egg in the morning, smothered in your ccnut oil/mac nut spread and cinnamon. Well, I didn’t wait until morning. Couldn’t resist two pieces toasted with my afternoon tea just now. Thanks so much, Maria.
A sustainable exercise program, for example 30 minutes five days a week is reasonable to start, providing there is no medical contraindication. (If you have any special concerns in this regard, check with your doctor first.) There is a beneficial effect of exercise on blood pressure, cholesterol levels, and insulin sensitivity, regardless of whether weight loss is achieved or not. Thus, exercise in itself is a helpful tool in treating metabolic syndrome.
Weigh your ingredients. This will forever be a staple recommendation for any sort of gluten free baking here at gnom-gnom. As aside from leading to less dirty dishes, it will ensure consistent results time and time again. Remember that gluten free (and particularly keto) baking is notoriously finicky, and measuring by cups is anything but accurate. And if you don’t own a baking scale, measure with cups by dropping the ingredients onto them rather than scooping them out (which often leads to overpacking).
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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.
A ketogenic diet could be an interesting alternative to treat certain conditions, and may accelerate weight loss. But it is hard to follow and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. We also do not know much about its long-term effects, probably because it’s so hard to stick with that people can’t eat this way for a long time. It is also important to remember that “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.
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. 
I have made your sub bread a few times with not good results. Tasted ok but it was gummy in the middle. Tonight I made the bread and it looked beautiful in the oven but when I took it out it deflated and was completely hollow in the middle. lol. This time I weighed everything to the T. I used Honeyville almond flour, liquid egg whites, and psyllium powder. Think I will skip trying the bread and try the sub bread again one more time. Probably made the sub bread 4x and all times came out gummy….grrrr. Hate to give up because the taste was good. Any suggestions??
Type 2 diabetes is by far the most common form (around 90% of all cases) and the one which is increasing the most. It primarily affects overweight people in middle age or later. It’s not uncommon for the affected person to also have a high blood pressure and an abnormal lipid profile. Gestational diabetes is a temporary special case of type 2 diabetes.
Note that urine measurements may not reflect blood concentrations. Urine concentrations are lower with greater hydration, and after adaptation to a ketogenic diet the amount lost in the urine may drop while the metabolism remains ketotic. Most urine strips only measure acetoacetate, while when ketosis is more severe the predominant ketone body is β-hydroxybutyrate.[36] Unlike glucose, ketones are excreted into urine at any blood level. Ketoacidosis is a metabolic derangement that cannot occur in a healthy individual who can produce insulin, and should not be confused with physiologic ketosis.
A combination of baking soda, lemon juice, and baking powder eliminates the need for yeast in this bubbly keto bread recipe. With tons of Italian seasonings, olive oil, and flaky salt sprinkled on top, you’ll want to include this loaf with every meal. Each generous slice is 3 net carbs — and to stay more Bulletproof, simply avoid eating garlic and xanthan gum too often.

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A good low carb breakfast can set the tone for the rest of the day, so we make sure it’s delicious and satisfying! Whether it’s a quick Bulletproof coffee to get your day started or a full blown bacon, egg and cheese, pancake Sunday breakfast, everybody loves the first meal of the day. Our full collection of keto breakfast recipes should inspire you to mix breakfast up a bit and try to include new things in your morning routine.
The most common reason that any bread falls is that it needed to bake for longer. That being said, I’ll be perfectly honest – sometimes this keto bread recipe falls anyway, even despite doing everything else right. Fortunately this isn’t a huge deal because it still tastes delicious – IF you baked it for long enough and the center is cooked through.
Love how quick and easy these are to whip up and they’re really satisfying to eat. Made them tonight to use as hamburger buns; sliced them in half and grilled them and they worked great. I think the coconut gives them some sweetness that reminds me of cornbread (I used a coconut/almond milk blend for the liquid). I think we’ll be making a lot of these!
Missing bread on your keto diet? No need. Here you’ll find the most popular keto bread recipes, rated by thousands of people. Take a bite of the famous keto bread, oopsies, seed crackers and mouth watering classics like BLT sandwich, garlic bread, naan and biscuits. Not only are these bread recipes far healthier than regular bread, they’re also ready in a flash!
The clinical relevance of nutritional ketosis to mitochondrial function is further indicated by promotion of ketogenic diets for treatment of mitochondrial disorders [19, 20, 26, 30, 247, 403]. The most prominent example is the study of mitochondrial adaptations as a mechanism for the well-known antiseizure effect of ketogenic diets [19, 29, 33, 162, 247, 403–405]. As previously discussed, the dramatic shift in energy metabolism and subsequent increase in circulating ketones induced by a ketogenic diet can enhance mitochondrial function and endogenous antioxidant defense. The primary mechanism behind these adaptations appears to be the increased demand for fat oxidation resulting from carbohydrate restriction. However, ketones themselves have important metabolic and signaling effects that enhance mitochondrial function and endogenous antioxidant defense, implying that a well-formulated ketogenic diet should have greater benefit than a nonketogenic low-carbohydrate diet. Regardless of the mechanism(s), the potential outcomes imply protection against chronic disease through improved mitochondrial function and, in turn, decreased potential for oxidative stress and subsequent pathology. However, further research is needed to better understand how nutritional ketosis influences mitochondrial function across different tissues and how these influences relate to human disease. Future research should also focus on further differentiation of the effects of carbohydrate restriction from the direct effects of ketones.
I can’t find an 8×4 pan in the local stores, so while I wait for one to be shipped I went ahead and made these into hamburger bun shape. I don’t have a kitchen scale so I just measured everything super precise and got great results. I only have NOW brand psyllium husk powder so yes, they are an odd shade of purple but they taste great so I don’t care. What I really wanted was a vessel for butter and it made for a great snack before bed- which I know I’m not supposed to have but I was too curious to wait until morning! 🙂 Thanks for the update on this recipe, it made all the difference!
I was recently diagnosed with diabetes which I had had uncontrolled for an estimated seven years. I have done a lot of research and while there is a lot of diabetes information available, little was helpful for whatever reasons – too simplistic in nature, didn’t answer hard hitting questions, or didn’t apply forward thinking scenarios. This article is one of the best I have read because it is both clear and concise and givens you all of your essential important information in a single place – something everyone needs. Even after all of my research, I still learned a couple new things reading this article. Excellent reference.

Hi Jen, It sounds like it needed to bake for longer – this is why it sunk and was still moist. The timing varies by ovens and even different pans. I hope you’ll try it again and just keep it in there for longer. You can cover the top if it starts to brown too much. For the one you made, depending on how moist it was in the middle, you may be able to salvage it somewhat by pan frying the slices.
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I was recently diagnosed with diabetes which I had had uncontrolled for an estimated seven years. I have done a lot of research and while there is a lot of diabetes information available, little was helpful for whatever reasons – too simplistic in nature, didn’t answer hard hitting questions, or didn’t apply forward thinking scenarios. This article is one of the best I have read because it is both clear and concise and givens you all of your essential important information in a single place – something everyone needs. Even after all of my research, I still learned a couple new things reading this article. Excellent reference.
Brain glucose and KB uptake was investigated in rats subjected to mild experimental ketonemia induced by 2 weeks on the KD or by 48 h fasting. To test this, researchers developed a carbon-11 labeled AcAc (11)C-AcAc for PET use. They found in rats that after 10 days of KD (11)C-AcAc brain uptake increased up to 8-fold, an increase comparable to those measured after 48 h of fasting (Pifferi et al., 2008).
For a given quantity of fuel, the maximum amount of work that can be obtained from that fuel in a closed system is called ‘the Gibbs free energy’ (G). This takes into account the inherent ‘heat’ (combustion enthalpy (H)) and a property called entropy (a measure of tendency towards ‘disorder’ (S). The change in Gibbs free energy (∆G) is related to the change in combustion enthalpy (∆H), change in entropy (∆S) and the temperature (T):
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.
The metabolic theory states that the root cause of cancer is a defect in mitochondrial energy production or ‘an irreversible injuring in respiration’91. Once the cells ability to produce energy is compromised, this is hypothesised to lead to the subsequent accumulation of changes that make the cell cancerous92. A key change is decreased mitochondrial glucose metabolism in cancer cells. Cancer cells ferment glucose to lactate (which happens outside of the mitochondria) at a much higher rate than normal cells93, in a change called ‘The Warburg Effect.’ This implicates damage to the mitochondria and failure in energy production as a central process of cancer progression. 
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Going from a standard-American diet to a well-formulated low-carb or ketogenic diet is a health upgrade. However, it usually comes with unpleasant but temporary symptoms of carbohydrate withdrawal, also known as the keto flu. This is easily addressed by using Nutrita to properly follow a ketogenic diet or simply by familiarizing yourself with basic electrolyte management.

“Whole fruit is nothing but good for people who have prediabetes,” Wright says. Just don't consume produce in the form of juice or smoothies. “Though a smoothie does give one a concentrated source of nutrients, they are often packed with calories that don’t satisfy our hunger as there is little fiber in them,” Denison says. So rather than drinking your fruit, eat it, spacing it out over your day.


Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. [4] It is a risk factor for coronary heart disease, as well as diabetes, fatty liver, and several cancers. The clinical manifestations of this syndrome may include hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein cholesterol (HDL-C), and abdominal obesity. (See Prognosis, Workup, Treatment, and Medication.)
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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.
The longest studies/follow-ups for ketogenic diets are about 10 years long and have shown it to be safe [3, 4, 5, 6]. Studies that carefully keep people in metabolic wards to strictly monitor food intake and biomarkers are always short because they are very costly and laborious. Moreover, most participants are not able or willing to participate for a long time in a study that supervises food intake around the clock. For these reasons, these kinds of studies are always of short duration, a few weeks maximum.
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This keto bread recipe delivers sweet heat with no corn whatsoever — instead, it uses a blend of coconut flour and sweetener to capture the same taste and texture for about 3 net carbs per serving. Add fresh cranberries and jalapeño slices for a fun twist that pairs well with holiday meals. To keep this recipe more Bulletproof, use grass-fed butter, swap almond milk with full-fat canned coconut milk, and skip the peppers if you have a nightshade sensitivity.
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