Have you heard all the buzz about the keto diet and want to know more? Did a friend tell you they’re “in ketosis” and you got interested? Here’s everything you need to know about ketogenic diets and being in ketosis for fat loss, brain function, satiety, and performance. Editor’s Note: This article is being updated … Continue reading The Keto Diet: Next Big Thing or Dangerous Fad?

Additional evidence, although independent of mitohormesis, further supports the induction of NFE2L2 activity by nutritional ketosis. Succinate is a byproduct of ketolysis and is oxidized to fumarate by succinate dehydrogenase. Therefore, the increased presence of ketones and increased rate of ketolysis during nutritional ketosis are likely to increase fumarate, which can succinylate cysteine residues of proteins [363]. In particular, fumarate can succinylate Keap1, thereby allowing NFE2L2 to enter the nucleus to induce transcription [364, 365]. In the retinas of rats injected with BHB, the nuclear content of NFE2L2 and the total homogenate content of SOD2 and GCL increased in conjunction with increased fumarate concentration [366]. BHB injection also decreased retinal ROS production and degeneration following induction of ischemia, and this protection was dependent on NFE2L2 [366]. These effects were observed at blood concentrations of BHB between 1 and 2 mM, which is consistent with nutritional ketosis.
Most people who have metabolic syndrome have insulin resistance. The body makes insulin to move glucose (sugar) into cells for use as energy. Obesity, commonly found in people with metabolic syndrome, makes it more difficult for cells in the body to respond to insulin. If the body can’t make enough insulin to override the resistance, the blood sugar level increases, causing type 2 diabetes. Metabolic syndrome may be a start of the development of type 2 diabetes.

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Metabolic syndrome is the commonly observed clustering of obesity, high blood pressure, abnormal blood lipids, and insulin resistance. Some healthy debate exists regarding its definition and existence, but it is clinically apparent that the components of metabolic syndrome occur together more often than expected by chance. Investigations into monogenic diseases that model features of the common metabolic syndrome have uncovered responsible genes. Genome-wide association studies of the components of the metabolic syndrome have been enormously successful. Research will continue to uncover how metabolic pathways interact to form the metabolic syndrome and its subsequent risk for atherosclerosis and diabetes.

Ketone esters (BHB-BD) increases activation of protein synthesis 31. Following exercise, complex signalling pathways within the muscle are activated to trigger the synthesis of muscle protein. A key regulator of muscle protein synthesis is a ‘kinase’ enzyme called mTOR. When athletes mixed ketone ester with a protein and carbohydrate recovery drink , muscle samples revealed that mTOR was much more strongly activated with ketone drinks compared with carbohydrate control drinks. This could help to promote gain of muscle mass occurring as a result of exercise.   

Alcoholic ketoacidosis (AKA) presents infrequently, but can occur with acute alcohol intoxication, most often following a binge in alcoholics with acute or chronic liver or pancreatic disorders. Alcoholic ketoacidosis occurs more frequently following methanol or ethylene glycol intoxication than following intoxication with uncontaminated ethanol.[11]
Some people may ask: Why not just have liposuction of the abdomen and remove the large amount of abdominal fat that is a big part of the problem? Data thus far shows no benefit in liposuction on insulin sensitivity, blood pressure, or cholesterol. As the saying goes, "If it's too good to be true, it probably is." Diet and exercise are still the preferred primary treatment of metabolic syndrome.
Saturated fat: A type of fat found in abundance in butter, whole milk, ice cream, full-fat cheese, fatty meats, poultry skin, and palm and coconut oils. Saturated fat raises levels of heart-threatening LDL cholesterol in your bloodstream. It can also interfere with your body’s ability to absorb blood sugar easily. Limiting saturated fat can help control your risk for heart disease.
317. Jornayvaz F. R., Jurczak M. J., Lee H. Y., et al. A high-fat, ketogenic diet causes hepatic insulin resistance in mice, despite increasing energy expenditure and preventing weight gain. American Journal of Physiology-Endocrinology and Metabolism. 2010;299(5):E808–E815. doi: 10.1152/ajpendo.00361.2010. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Choose foods that are less likely to cause an additional sudden rise in blood sugar. These foods can be identified by determining their glycemic index value (see Resources). Look for foods with a low glycemic index value, such as beans and legumes, and avoid high glycemic foods, such as white potatoes. Don't assume a food has a low glycemic number, even if it appear healthy; many healthy foods can cause a rise in blood sugar, particularly in susceptible individuals.

Because the population of the U.S. is aging, and because metabolic syndrome is more likely the older you are, the American Heart Association (AHA) has estimated that metabolic syndrome soon will become the main risk factor for cardiovascular disease, ahead of cigarette smoking. Experts also think that increasing rates of obesity are related to the increasing rates of metabolic syndrome.
The situation for Type II diabetics is different because some insulin production remains and some cells of the body can still respond to insulin. It is worth noting that insulin sensitivity can be different between the different tissues of the body such as liver, adipose tissue and muscle. A small amount of insulin release can help to prevent development of DKA unless the body is totally insulin resistant. Insulin resistance is a term used to indicate that for a given amount of insulin, the cells of the body are less responsive and take up less glucose. This means that blood glucose levels remain higher for longer when insulin resistant Type II diabetics eat a carbohydrate rich meal. Over time, the pancreas secretes more insulin to compensate for reduced insulin sensitivity, which can damage the insulin producing (beta) cells. Furthermore, having high blood glucose can lead to a number of side effects:
Additional indications of exogenous BHB upregulating antioxidant defense have been observed, although without consideration of HDAC inhibition. In rats, injection of BHB has increased activities of SOD and catalase and prevented the increase in lipid peroxidation and decreases in SOD, catalase, and GSH induced by paraquat injection, all of which were observed in kidney homogenate [104]. Furthermore, BHB also prevented the paraquat-induced decrease in nuclear NFE2L2, indicating involvement of antioxidant signaling [104]. Similarly, BHB treatment has increased FOXO3a, SOD2, and catalase content in cardiomyocytes [105], indicating that BHB may also influence antioxidant defense in the heart. In this study, BHB also prevented the decrease of FOXO3a, SOD2, and catalase content that resulted from H2O2 treatment [105]. Despite the amount of research that has been done on the antiseizure mechanisms of ketogenic diets, the influence of BHB on HDAC inhibition and related antioxidant defense appears to have not yet been investigated in brain tissue. However, BHB appears to inhibit HDAC2 in microvascular and neuronal brain cells [106], and BHB-induced HDAC inhibition is thought to have a role in the antiseizure effects of ketogenic diets [107].
High blood sugar levels coupled with high blood ketones, on the other hand, will mean that you have a pathologically low level of insulin – something non-diabetics do not suffer from. This can lead to ketoacidosis – a potentially life-threatening condition. If this happens, you’ll need to inject more insulin; if you’re at all unsure of what to do, contact a medical professional. Coveting really high blood ketones for weight control is not worth the risk for type 1 diabetics.
Just wanted to share that I made this recipe yesterday. I don’t have a lot of success with loaves so I used my bun top pans and the recipe gave me 12 rolls and a small loaf which I cut into 6 slices for a couple of french toast breakfast treats for me! I used a 1/4 cup measure for the rolls (not packed) and pressed the dough into the round shape. I thought I’d only get 6 actual burger buns but they were big enough to carefully slice in half so I got 12! I baked the rolls for 30 min and the loaf for 60. This will be my go to from now on! Thank you!

Maria, I made this bread today – weighed my ingredients carefully and followed instructions. My only adaptation was adding a little liquid Stevia, cinnamon, and raisins right before putting into the bread pan. It raised nicely but fell a little while cooling and is pretty heavy, although tastes great. Any help on what I did wrong? (I’m not sure my water was boiling enough – it was just starting to bubble, not full rolling boil, when I added it. Would that make the difference?)


It just needed a bit more structure, so for trial number three I split the difference, using half coconut flour and half almond flour. There’s a reason they say the third time’s a charm. This was the perfect blend. The bread was moist but firm enough to hold its shape, and it didn’t taste like coconut. After that, I began experimenting: hazelnut flour worked great, and cheese and scallions added great flavor.

AGAIN I tried the protein bread, this time I even bought Jay Robb whey protein even though I have a huge container of whey protein, I thought I needed to try to do exactly what you were doing ;). And AGAIN my bread flopped. I whipped the egg whites very STIFF but as soon as I add the protein it breaks them down and it turns to a thick liquid. I bake it anyway and it comes out probably half the size of yours and there are spots through out that look dense like it’s not done. I love the bread and I need a bread substitute to feel satisfied. I’ll keep trying. sighhhhh.

In order to obtain the most comparable measures, it is useful to measure blood ketones at the same time each day. Measuring immediately on waking means that there are fewer potential variables that could alter the measurement, such as exercise, or different food intake. However, it can also be useful to check ketone levels around 60-90 minutes after an intervention such after eating a fat rich meal or consuming exogenous ketones.      
Hi John, You could possible try a hand mixer in a bowl instead of the food processor, but I haven’t tried it, so can’t vouch for the results. Most likely the bread would not be as tall because the mixer would completely deflate the first half of the egg whites when you add them to the batter. The second half should be folded so that part will be find. If you try with a bowl and hand mixer, let me know how that goes.
Hi Maria, I love your bread recipes but can’t get over the one thing, the gritty texture you get in one every couple bites due to the psyllium husk, I have tried different brands and all have it. I haven’t tried Jay Robs yet. But have you tried ground up chia seeds instead by any chance? I read somewhere to just add twice the amount of water. Thanks

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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Today was my second attempt at making “Amazing Bread”. Maybe I needed to bake it longer, but both times, it turned out gooey. The texture was not like bread at all, but more like a dumpling. I was able to slice it and I am hoping that toasting it will make it edible since I do not want to throw it out. I weighed every ingredient by the gram and used psyllium husk POWDER.

In some cases epilepsy cannot be treated successfully using anticonvulsant medications. In some cases where drugs have failed, the ketogenic diet has been widely documented to deliver transformative seizure control, reducing frequency by anywhere between 40-90%43. Whilst the exact mechanisms underlying the beneficial effect of the ketogenic diet are unclear, the hypothesised mechanisms include:
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.
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.
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!
Hi Maria! Just wanted to say I love this recipe and I found a way to make similar single servings quickly that look like english muffins! I just use a greased ramekin and combine 2 tbsp almond flour, 2 tsp psyllium husk (or 1 tsp powder), pinch of salt and baking powder. Then stir in 2 tbsp + 2 tsp egg whites, 2 tbsp water, 1 tsp olive oil and 1/8 tsp apple cider vinegar. Microwave for 1 min then flip out onto a plate and microwave for another 30 sec. Toast and top with whatever you’d like! 🙂
A study on hippocampal mitochondrial function in rats more directly supports the induction of mitohormesis by a ketogenic diet. After the first day of the diet (Bio-Serv F3666), H2O2 production by isolated mitochondria was increased [96]. After the third day, mitochondrial levels of oxidized glutathione (GSSG) and hippocampal levels of 4-hydroxy-2-nonenal (4-HNE) were also increased, further indicating an increase in oxidative stress. However, at completion of the first week, upregulation of antioxidant signaling occurred, indicated by increased nuclear content and transcriptional activity of nuclear factor erythroid-derived 2-like 2 (NFE2L2), which persisted through the remainder of the study. By the third week, mitochondrial H2O2 production decreased to below baseline [96]. In the liver, content of reduced acetyl CoA, which is indicative of mitochondrial redox status, decreased after three days of the ketogenic diet, but increased relative to the control diet after three weeks, indicating an initial increase in oxidative stress followed by a decrease [96]. This was in conjunction with changes in NFE2L2 nuclear content and transcriptional activity similar to those observed in the hippocampus. As with the previously described C. elegans experiments, the time course of these observations is a strong indication of mitohormesis, and the similarity in results between the liver and hippocampus suggests that a ketogenic diet can induce mitohormesis in a variety of tissues.
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Well, everyone, I am sensitive to psyllium so I experimented and it kind of worked! I made a half recipe using chia seed I ground in my Vitamix into 5 buns. They didn’t really rise but the flavor was quite good. Might add garlic and onion powder next time. I was able to slice the skinny bun and have a burger on it. Yum! Hadn’t had a burger on a bun for ages! Worth a try! I did weigh everything and was very precise so inaccurate quantities would not be an issue. Maria, any ideas on how to make this mixture rise some? I’m sure I’m not the only one with psyllium issues. Can’t have flax much either and I think if I have the chia too often that will give me tummy trouble also. One more question Maria. Is there a reason for no salt in the egg white protein bread? I don’t really like the flavor or texture but thought salt and seasonings would help. Thank you, Maria! You have made my meals so much more enjoyable! So grateful!
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If you divide the dough in 3 you’ll cook the bread for 90 seconds on high, but if you cook it all together you’ll want to do 150 seconds (2 1/2 minutes). Either way, it’ll come out looking pale and spongy (and not very appetizing at all tbh!). But worry not, just wait for it to cool down until just lightly warm (it continues to cook guys!), and then you’ll definitely want to give it a toast to get some texture on.

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I had the same problem. Everything blended beautifully, rose in oven, then fell. Toothpick came out clean after 45 min of baking. I let it cool and then cut into it this morning and it has raw spots throughout the loaf. I am so disappointed because I killed a dozen eggs to make it and really don’t want to do it again. I wonder if the oven needs to be warmer and the cooking time needs to be increased?
One of the foods that people tell us they miss most after going keto is bread. (And cookies or cakes, but you get the idea.) We get it, bread is undeniably comfort food. Growing up, it wasn’t unheard of to eat toast for breakfast, a sandwich for lunch, and maybe even a slice of buttered bread along with dinner. Not only is that ton of carbs, but it’s also a lot of empty calories when we could have been eating real-food alternatives, like this bread made from nutrient-dense ingredients!
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