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). 

184. Davies S. P., Helps N. R., Cohen P. T., Hardie D. G. 5′-AMP inhibits dephosphorylation, as well as promoting phosphorylation, of the AMP-activated protein kinase. Studies using bacterially expressed human protein phosphatase-2C alpha and native bovine protein phosphatase-2AC. FEBS Letters. 1995;377(3):421–425. doi: 10.1016/0014-5793(95)01368-7. [PubMed] [CrossRef] [Google Scholar]


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 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.
Bailey, We’re so happy to hear you enjoyed this recipe! Regarding having bread fall, did you cook it for the full amount of time the recipe calls for, and did you cover the top with foil for the last 15 minutes? If so, there might be an issue with your oven’s calibration (you can get an inexpensive oven thermometer to check this). Another tip is to let your eggs come to room temperature first. Another factor is the altitude at which you’re baking; if you’re at high altitude, you might need to slightly adjust the oven temperature and bake time. The other thing to remember is that there will usually be a little bit of fall to most keto breads (in fact, every keto bread we’ve ever made) because keto flours lack gluten and are naturally quite dense; however, you can see in the photos, we still got a good rise on this loaf. I hope these tips help!
The FOXO family of transcription factors is highly conserved and promotes longevity and resistance to cellular stress. Although there are a variety of FOXO isoforms with varying tissue distribution [318–320], FOXO3a has been the most thoroughly studied in relation to energy sensing, mitochondrial function, and antioxidant defense. Similar to PGC-1α, FOXO3a is activated through phosphorylation by AMPK [321–323] and deacetylation by SIRT1 [324, 325] and SIRT3 [326–329], and its transcriptional activity is at least partly dependent on AMPK [322] and SIRT1 [325]. In a variety of organisms, tissues, and cell types, FOXO3a increases mitochondrial biogenesis and expression of TFAM [329], but is more known for increasing expression of antioxidant and repair proteins, including SOD2 [287, 330, 331], catalase [287, 330, 332, 333], glutathione S-transferase (GST) [322], thioredoxins [287, 323], Prx3 [287, 334], Prx5 [287], and metallothioneins I and II [322], as well as UCP2 [287, 322] and the DNA repair enzyme growth arrest and DNA damage-inducible 45 (GADD45) [322, 324, 335, 336]. FOXO3a is also activated by oxidative stress [324, 331, 333], possibly in a SIRT1-dependent manner [324], and likely mediated through c-Jun N-terminal protein kinase (JNK), which allows FOXOs to translocate to the nucleus by promoting dissociation of 14-3-3 [337, 338]. Furthermore, FOXO3a and SIRT3 interact in mitochondria to induce mitochondrial gene expression in an AMPK-dependent manner [339]. FOXO3a also induces expression of LKB1 [340] and NAMPT [341], indicating a feed-forward cycle of activation with AMPK and sirtuins. Like PGC-1α, FOXO3a transcriptional activity is inhibited by insulin through PKB [331].

According to the National Institutes of Health, a mother’s high normal blood sugar levels can put their baby at risk for birth problems. If the mother’s blood sugar levels were high, it is more likely that the baby will have high insulin levels as well at birth. Therefore it is important that during your pregnancy, you are following under the directions of your physician any guidelines which will help you balance your blood sugar levels.
Swigging ACV may not sound appealing, but it could help keep blood sugar in balance if taken before you eat. Some research has found that consuming apple cider vinegar before meals reduced blood glucose levels of patients with prediabetes by nearly half. The theory is that acetic acid, a component of the vinegar, slows down the conversion of carbohydrates into sugar in the bloodstream. Pro tip: Mix a tablespoon or two into a glass of water—taking it straight will burn!
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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.            
Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.  The Merck Manual was first published in 1899 as a service to the community.  The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America.  Learn more about our commitment to Global Medical Knowledge.

KBs can cross the BBB but not in a homogenous manner. For example, past experiments have demonstrated that BHB utilization is different in various brain areas (Hawkins and Biebuyck, 1979). Areas without BBB, hypothalamic regions and the lower cortical layers have a higher BHB metabolism compared to the lower one of the basal ganglia (Hawkins and Biebuyck, 1979). Also the metabolic meaning of the three KBs is different: while the main KB produced in the liver is AcAc, the primary circulating ketone is BHB. The third one, acetone, is produced by spontaneous decarboxylation of AcAc, and it is the cause of the classic “fruity breath.” Acetone does not have any metabolic functions, but it can be used as a clinical diagnostic marker. BHB acid is not, strictly speaking, a KB because the ketone moiety has been reduced to a hydroxyl group. Under normal conditions the production of free AcAc is negligible and this compound, transported via the blood stream, is easily metabolized by various tissues including skeletal muscles and the heart. In conditions of overproduction, AcAc accumulates above normal levels and a part is converted to the other two KBs. The presence of KBs in the blood and their elimination via urine causes ketonemia and ketonuria. Apart from being the fundamental energy supply for CNS, glucose is necessary for the replenishment of the quota of oxaloacetate, since this intermediate of the tricarboxylic acid cycle (TCA) is labile at body temperature and cannot be accumulated in the mitochondrial matrix. Hence it is necessary to refurnish the TCA with oxaloacetate via the anaplerotic cycle that derives it from glucose through ATP dependent carboxylation of pyruvic acid by pyruvate carboxylase (Jitrapakdee et al., 2006). This pathway is the only way to create oxaloacetate in mammals. Once produced by the liver, KBs are used by tissues as a source of energy (Fukao et al., 2004; Veech, 2004; McCue, 2010): initially BHB is converted back to AcAc that is subsequently transformed into Acetoacetyl-CoA that undergoes a reaction producing two molecules of Acetyl-CoA to be used in the Krebs cycle (Figure ​(Figure22).
But that doesn't mean it could never, ever happen—in fact, it actually did happen to one women on a "no-carbohydrate" diet, according to a 2006 case report in the New England Journal of Medicine. According to the case report, the woman was on a strict low-carb regimen for four years (she ate fewer than 20 grams of carbs a day—20 grams per day is the minimum on the keto diet, but most people eat 50 grams per day), but her ketoacidosis cleared up after she was put on a diet with normal carbohydrate intake.
There is also exciting early research suggesting that ketosis may be beneficial for many other conditions, such as reducing the frequency and severity of migraine headaches, reversing PCOS, perhaps enhancing conventional brain cancer therapies, possibly slowing down the progression of Alzheimer’s disease, along with potentially helping people live longer, healthier lives.
Preparing a keto breakfast is no different than preparing any other meal. Simply focus on your macros, then fill in those macros with nutrient-dense foods. For example, if you know you’re sticking to 70% fats, 25% protein, and 5% carbs, you know you need a protein source, a low carb vegetable, and a fat source, either for sauteing or by preparing a sauce.
Hi Kristi, I’m glad you liked the taste! Sorry it didn’t rise for you. It’s hard to say what happened without being in the kitchen with you. Were the peaks in the egg whites not firm enough, or did they fall too much when folding with the rest of the batter? That is the main culprit I can think of, as the egg whites are a big part of what creates the volume in this bread.

Although resting skeletal muscle is less metabolically active than the heart, kidneys, brain, or liver, it rivals even the brain in being the body's most metabolically demanding tissue when considered relative to total tissue mass [369]. Physical activity can greatly increase this demand, making exercise a practical and powerful way to induce bioenergetic adaptations.


Our bodies need sugar to make energy for the cells. Without it, we cannot do basic functions. When we eat foods with glucose, insulin pairs with it to allow it to enter into the cell wall. If the insulin is not there, then the glucose molecule can’t get through the wall and cannot be used. The extra glucose hangs out in the bloodstream which is literally high blood sugar.
As you may recall, about 60% of the energy we expend, say 1,800 kcal/day for someone consuming 3,000 kcal/day in weight balance, is purely devoted to keeping us alive by generating enough ATP (“energy currency”) to do 2 things: allow ion gradients to function and allow muscular relaxation.  So, obviously, we can’t tolerate – literally even for one minute – insufficient ATP production.  In fact, one of the most potent toxins known to man (cyanide) exerts its effect on this process by inhibiting the electron transport chain which generates the bulk of the ATP our body produces.  Even the most transient interruption of this process is fatal.
A ketogenic diet also has been shown to improve blood sugar control for patients with type 2 diabetes, at least in the short term. There is even more controversy when we consider the effect on cholesterol levels. A few studies show some patients have increase in cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing its effects over time on diabetes and high cholesterol.
Normally, the body breaks down carbohydrates, fat, and (sometimes) proteins to provide energy. When carbohydrate is consumed in the diet, some is used immediately to maintain blood glucose levels, and the rest is stored. The hormone that signals to cells to store carbohydrate is insulin. The liver stores carbohydrate as glycogen, this is broken down and released between meals to keep blood glucose levels constant. Muscles also store glycogen, when broken down this provides fuel for exercise. Most cells in the body can switch readily between using carbohydrates and fat as fuel. Fuel used depends on substrate availability, on the energy demands of the cell and other neural and hormonal signals. 
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In Alzheimer’s disease (AD), the function of the brain is compromised by the buildup of debris (plaques and tangles) inside the neurons. This mainly occurs in the areas of the brain associated with memory, intelligence, judgement, behaviour and language and impairs the ability to complete normal day to day tasks and to interact socially. Whilst the symptoms of AD usually only begin to appear with age, evidence suggests that damage to the brain begins to accumulate years earlier. This includes the buildup of plaques and tangles and a decreased ability to metabolise glucose (brain insulin insensitivity)50. If an individual has Type 2 Diabetes (systemic insulin insensitivity), the risk of AD is tenfold higher51.
Inducing ketosis requires severely limiting your carbohydrate consumption, this way you cut off supply of glucose to your cells. In addition to severely restricting carbs, you also need to limit your protein consumption, since protein can be converted into glucose in small amounts. This is the exact reason that most low-carb diets (such as Atkins or the Paleo diet) do not result in ketosis, because they allow a high intake of protein that keeps supplying the body with enough energy that it doesn’t need to burn fat.
Recurrent migraines are highly prevalent and sometimes debilitating. They manifest as throbbing, one-sided headaches and can also involve visual disturbances (aura). Many of the processes involved in migraine are shared with those implicated in epilepsy, especially an abnormally high glutamate (excitatory) activity. In fact, medical professionals sometimes prescribe anti seizure medications that block glutamate activity to migraine patients. The ketogenic diet has been associated with improved migraine control both anecdotally and in a small number of case studies 74 ,75 ,76 ,77. Researchers are currently undertaking further investigations to confirm if the ketogenic diet or exogenous ketones are viable and effective treatment options for migraine patients.  
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While several national and international organizations use certain criteria to define metabolic syndrome, others, including the American Diabetes Association (ADA), question the value of the specific diagnosis of metabolic syndrome. They point out that the criteria, taken together, are no more useful at predicting the risk of cardiovascular disease or diabetes than the individual criteria considered separately. The science needs to be clearer, suggests the ADA, before metabolic syndrome be considered a definable syndrome.
Even without the gluten of a traditional tortilla, this keto bread recipe creates a soft and pliable alternative perfect for all your favorite taco fillings. Almond and coconut flours keep carbs to a minimum, while xanthan gum holds everything together. Each tortilla tallies up to 2 net carbs, and takes only five minutes to cook. No Bulletproof substitutions needed — just avoid eating xanthan gum too often.
The key sign of metabolic syndrome is central obesity, also known as visceral, male-pattern or apple-shaped adiposity. It is characterized by adipose tissue accumulation predominantly around the waist and trunk.[5] Other signs of metabolic syndrome include high blood pressure, decreased fasting serum HDL cholesterol, elevated fasting serum triglyceride level, impaired fasting glucose, insulin resistance, or prediabetes. Associated conditions include hyperuricemia; fatty liver (especially in concurrent obesity) progressing to nonalcoholic fatty liver disease; polycystic ovarian syndrome in women and erectile dysfunction in men; and acanthosis nigricans.
Maria – I’ve tried making this loaf twice and each time it’s still gummy! I use the same Nuts.com almond flour and Jay Robb psyllium husk powder, and weigh everything. The first time, I baked 60m and let cool completely. The loaf shrunk down and was gummy all in the center, like it was undercooked. This time, I baked 115m (after slicing at 75m and finding it gummy), and it shrunk down immediately after removing from the oven and is still gummy! Any advice? I want large, fluffy, non-gummy slices like you!
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While exercise is a great way to bring down your blood glucose immediately, remember that physical activity should be a part of your lifestyle, not just a tool for producing one good test result. Getting your recommended periodic A1C tests will help you and your doctor determine if your blood glucose control is on target. And when you use your meter to test at home and at work, be sure to look for patterns in the results. This can help you and your diabetes care team tell whether you need to adjust your diet, medications, or both. The most important thing you can do to manage diabetes well is to control your blood glucose, and exercise is a key step toward reaching that goal.
Within the healthcare system people with type 2 diabetes are still often given advice on blood sugar-raising foods. It is not uncommon to receive nice, colored folders, like the Swedish one above. In this folder it’s stated that foods that raise blood sugar slowly are good for you. Examples of such foods are said to be fruit, rice, pasta, potatoes and bread!
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Therefore the combustion enthalpy (∆H) of each fuel is an important factor in the energy it can provide to the cell. When expressed as the energy per 2 carbons in the molecule, ketones (BHB) have a higher combustion enthalpy (∆H) than pyruvate, lactate and glucose (see table). This means that the amount of energy that could possibly be transferred to ATP is higher than for those other substrates:
I was so excited about making this bread. I recently cut all grains out of my life and I’m also in the process of going gluten free because i have a lot of digestive issues. I followed the recipe precisely. Checked the temp before taking it out of oven. It looked amazing nice and golden brown. I cut into it and i couldn’t wait for that first bite. I was so disappointed it has an odd flavor I just couldnt stomach and it was very salty to me. I tried a few tiny bites with different condiments and couldn’t eat it. After reading some comments, I see it is supposed to be unsalted butter. I used salted, but why did it seem to have a bitter sour taste to it?
In ketogenesis, two acetyl-CoA molecules instead condense to form acetoacetyl-CoA via thiolase. Acetoacetyl-CoA momentarily combines with another acetyl-CoA via HMG-CoA synthase to form hydroxy-β-methylglutaryl-CoA. Hydroxy-β-methylglutaryl-CoA form the ketone body acetoacetate via HMG-CoA lyase. Acetoacetate can then reversibly convert to another ketone body—D-β-hydroxybutyrate—via D-β-hydroxybutyrate dehydrogenase. Alternatively, acetoacetate can spontaneously degrade to a third ketone body (acetone) and carbon dioxide, although the process generates much greater concentrations of acetoacetate and D-β-hydroxybutyrate. When blood glucose levels are low, ketone bodies can be exported from the liver to supply crucial energy to the brain.[28]
For the eggs, beat the 4 eggs in a medium sized bowl until whites and yolks are combined.  Heat a medium skillet (I used the same skillet as the pancakes) over medium-low heat.  Add the butter and then the beaten eggs. Let the eggs cook until the edges begin to set.  push the eggs with a rubber spatula scraping the bottom of the pan.  scrape occasionally to get large folds of soft scrambled eggs.  When the eggs are just set and still a little runny, remove from the heat.  

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! 🙂


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.
While it is believed that carbohydrate intake after exercise is the most effective way of replacing depleted glycogen stores,[72][73] studies have shown that, after a period of 2–4 weeks of adaptation, physical endurance (as opposed to physical intensity) is unaffected by ketosis, as long as the diet contains high amounts of fat, relative to carbohydrates.[74] Some clinicians refer to this period of keto-adaptation as the "Schwatka imperative" after Frederick Schwatka, the explorer who first identified the transition period from glucose-adaptation to keto-adaptation.[75]
“Individuals vary in their blood ketone levels (i.e., beta-hydroxybutyrate – aka BOHB) over the course of a day and from day to day. This can be due to variations in dietary carbohydrate and protein from meal to meal and from day to day…Additional factors that increase blood BOHB are endurance exercise and also after consuming fats containing medium chain triglycerides (MCT) such as butter, coconut oil, or purified MCT oil. In contrast, there is often a steep drop in BOHB after high intensity exercise, the mechanism for which has yet to be proven. This post-sprint drop in BOHB tends to be temporary (lasting for an hour or two), which means that it’s cause is very different from the days-long drop in blood BOHB that one sees after a large carb meal.”
Fortunately, since peaking in 2001-2002, the overall prevalence of metabolic syndrome in the United States has fallen, primarily due to decreases in the prevalences of hypertriglyceridemia and hypertension—and in spite of increases in the prevalences of hyperglycemia and obesity/waist circumference. [27]  Data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) showed that the age-adjusted prevalence of metabolic syndrome had fallen to approximately 24% in men and 22% in women. [28]
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.      
According to the National Institutes of Health, a mother’s high normal blood sugar levels can put their baby at risk for birth problems. If the mother’s blood sugar levels were high, it is more likely that the baby will have high insulin levels as well at birth. Therefore it is important that during your pregnancy, you are following under the directions of your physician any guidelines which will help you balance your blood sugar levels.
Rick, Yes, I would try baking it longer if it’s coming out gummy. If it’s starting to brown too much outside, but the inside doesn’t seem to be fully cooked, you could cover it with foil to prevent over-browning. Another trick I sometimes use is to leave the bread in the oven to cool once it’s done baking (sometimes covering the loaf with foil to prevent over-browning). I hope these tips help!
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