Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
When your carb intake is that low, your body can't burn glucose (a.k.a the sugar from carbs) for energy like it normally would. So instead, it burns fat for energy, a process that then releases ketones as a byproduct, says Eric Klett, M.D. an endocrinologist and associate professor of medicine and nutrition at the University of North Carolina at Chapel Hill. (This process explains why people on the keto diet see such crazy weight-loss results.)
In low carb and keto baking, we’re concerned with two things: 1) keeping carbs low, and 2) still achieving a baked good that has great flavor and texture (because if we can’t gag it down there’s just no point, right? Lol). Low carb bread recipes are usually gluten free and grain free (although we’ve seen a couple that use oat fiber), but then the challenge is to get creative to get the right combination of ingredients to yield something that rises properly and tastes good.

You’ve got a few options here. Erythritol (Lakanto is awesome here), Xylitol (non-corn though to avoid tummy troubles!) and allulose are my top choices (no aftertaste at all!). Pyure is also a good one for muffins and quick breads, particularly if you’re trying to limit your sugar alcohol consumption (it’s added stevia makes it twice as sweet as sugar… i.e. you add half!).


At the University of Leicester, scientists have showing that the level of sugar in your blood can affect blood vessels which in turn can have potentially dangerous effects on your heart and blood pressure. Glucose has an important role to play in the normal functions of the cardiovascular system.  Untreated high sugar levels can lead to life threatening illnesses.
The goal of metabolic syndrome treatment is to reduce the risk of heart disease and diabetes by controlling the associated problematic health conditions (high blood pressure, high cholesterol, diabetes, insulin resistance). “A study in which 53 percent of people had metabolic syndrome at the start found that over three years, intensive lifestyle changes—mainly diet and exercise—resulted in the lowest risk of developing diabetes and the lowest risk of developing metabolic syndrome in those who didn’t have it,” Ndumele says. Recommended changes include:

The prevalence of metabolic syndrome increases with age, with about 40% of people older than 60 years meeting the criteria. [26] However, metabolic syndrome can no longer be considered a disease of only adult populations. Alarmingly, metabolic syndrome and diabetes mellitus are increasingly prevalent in the pediatric population, again in parallel with a rise in obesity. [50]
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As a matter of fact, in animal models intracerebroventricular injections of long-chain FA reduced hypothalamic expression of NPY. NPY is an important orexogenic neuropeptide that is a downstream target of leptin and insulin in the hypothalamus. In some forms of hyperphagic obesity, characterized by elevated plasma leptin and insulin levels, the lack of action of insulin on NPY expression could explain the pathological condition. Central administration of oleic acid, fatty-acid synthase, or CPT-1 inhibitors prevents the rise in hypothalamic NPY mRNA induced by fasting (Obici et al., 2003). But glucose level is also involved in KD's food control mechanisms. According to glucostatic theory (Mayer, 1955) data indicates that ketosis did not influence FA glucose but instead stimulated the elevation of post-prandial glucose (Sumithran and Proietto, 2013) in non-diabetic subjects, while in diabetics there was a reduction of fasting glucose (Westman et al., 2008). It is important to note that carbohydrate availability may increase cellular levels of long-chain FA-CoA through an increase of malonyl-CoA, which inhibits oxidation of FAs.

Other mechanisms that have been suggested include: changes in ATP production making neurons more resilient in the face of metabolic demands, altered brain pH affecting neuronal activity, direct inhibitory effects of ketone bodies or fatty acids on ion channels, alterations in amino acid metabolism, and changes in synthesis of the inhibitory neurotransmitter GABA. (10)
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.
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
I would like to point out that the metric conversion of 3/4 cup to 90g coconut flour as stated in your recipe is incorrect. Should be 84g per package labeling (Bob’s Red Mill). Unfortunately I made my first batch with 90g of coconut flour, and it was definitely not “pourable”. More like scoopable. I will try again with correct amount but thought I would point so you can update the recipe. Thank you!

If your blood sugar gets too high, then you may have Ketoacidosis. What happens is that the body does not have enough insulin to use the glucose cells, so it starts to break down fat and muscle for fuel. This causes ketones to enter the bloodstream and causes a pretty bad chemical imbalance. Ketones can also be found in your urine, which is an easy way to test. Signs of Diabetic Ketoacidosis are:
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.

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).
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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!
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Keeping a log of your blood sugars is a great way to be knowledgeable about your body and how it is reacting to foods and events. To start, check before and after every meal, along with one in-between meal check. It is important that you keep a log of these blood sugars, along with all of the foods that you are eating, activities you are performing and any insulin or medications that you are taking. Do this for a week, and see if you can identify any patterns. Take this log to your doctor and talk to them about your findings.
I made the bread on Sunday and we loved it. When I made up the dough, I started out with less water because it’s really humid here and it was a wet, drizzly day. I had to use a different psyllium husk because I can’t get Jay Robb here (I’ll have to order some). It was Walmart’s equate brand (I was desperate to try the recipe right away), so my bread was purple, but nobody minded. I had to grind almonds myself and ended up adding an extra tablespoon of psyllium to get my dough to the same texture as Maria’s in the video, but it baked up perfectly. It was delicious, but I did notice an odd smell. Is that the psyllium, maybe? I’m on a strict diet to get my blood sugar back down to normal, so this bread is such a treat. Thanks so much for sharing this with us.
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:

Maya, I can’t tell you how excited I am to find this recipe! I have three young cats who are on a raw diet. In my previous life I was a home economics major and was taught not to waste anything. So from making their raw food I have the byproducts of egg whites and chicken bones and skin. It all gets frozen for future use. I use the bones and skin to make my own bone broth but I have egg whites out the ying yang! They are frozen in jars with the measurement of the contents on the lid. Now I’m going to thaw some and make bread! Have you tried making french toast with this?
The oral glucose tolerance test (OGTT), or glucose tolerance test is a blood test used (not routinely however) to diagnose diabetes, and gestational diabetes. Information in regard to reliability of the oral glucose tolerance test is important, as some conditions (common cold), or food (caffeine), or lifestyle habits (smoking) may alter the results of the oral glucose tolerance test.
If you are someone who has struggled with the roller coaster of blood sugar management, I have some good news! Research shows that there are common herbs and spices, likely ones that you already have in your kitchen, that have some potential positive effects on improving blood sugar. Today, I’m breaking down some of the superstar herbs and spices that data has indicated may help with blood sugar management.
I LOVE this bread. I’ve made it a ton of times and it never disappoints. In fact, my friend and I like this bread more than any regular grain based bread we’ve ever had. I do have one small problem and was wondering if anyone can tell me what I am doing wrong. No matter how many times I’ve made this bread, the loaf always comes out lop-sided; meaning, it rises on one side more than the other and I cannot for the life of me figure out why. I would love to include a picture to illustrate what I mean, but there is no option to do this. All I can say is one side of the bread rises out above the bread tin more than the other side. I use a smaller loaf tin lined with parchment paper and follow all of the baking instructions to the tee. Any ideas???
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.

To think of it another way, if you start with stored energy – glucose or fat, for example, which if burned in calorimeter will give off varying amounts of heat – and you’re willing to convert their carbon, hydrogen, and oxygen molecules into another form with less energy – water and carbon dioxide which, if burned, produce very little heat – it’s a fair trade!  The ETC is simply the vehicle that allows our body to make the switch.
Type II diabetics can reduce their risk of developing these complications by keeping blood glucose levels within a healthy range (4.5 - 6.5 mM). This can be achieved using insulin injections, but using insulin is not without side effects (i.e hypoglycemia requiring assistance and weight gain)101. Therefore dietary carbohydrate restriction is likely to be a good lifestyle change to help with diabetes management,. Companies such as Virta Health are popularising this approach to diabetes management and pioneering the use of technology to improve compliance. The benefits of carbohydrate restriction include:
Pancakes. They’re a breakfast classic. You see them on just about every breakfast menu you’ve ever looked at and for good reason. But sadly they are not low carb, even in the slightest. So what if I told you that you can have your pancakes on a low carb diet and eat them without feeling guilty? With these Keto Silver Dollar Pancakes you can do just that.
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NOTE:  Make sure to weigh your ingredients to ensure it rises properly and doesn’t get hallow and gummy.  Also, if you do weigh and grind your psyllium and still have a problem, try grinding the psyllium again.  We have a batch of psyllium that we ground and didn’t work.  Stay really wet.  So we ground it again and it works great!  Also, if your loaf looks nice and big but then deflates after removed from the oven, try reducing the baking powder to 3 teaspoons.

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].

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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]
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!

Hey there… I’m new to keto, so I’m hoping my questions don’t come across as really stupid. Your bread looks great, and if I can get bread again, then that’s simply awesome. The pictures remind me of banana bread. Is there a way of adding this flavor without going insanely overboard on the carbs? And without that artificial banana taste? Also, would this recipe work as muffins? Thanks, Kelly
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.

In addition to eating small meals at night, it's best to limit dishes piled high with pasta, rice, sugar, and other carbs. “When you focus on whole-food carbs spread throughout the day, the less pressure there's going to be on your pancreas to constantly chug out insulin,” Wright says. You want your blood sugar to roll like hills over the course of the day rather than spike like mountain peaks and plummet to valleys, she adds.
Hi Diane, the bread should not be moist in the middle now should it fall apart. I don’t think substituting the butter for coconut oil could have been the reason for the problem – they have similar consistencies and can normally be subbed for one another without problem. The only thing I can think of is that you may need to bake it for longer. Ovens do vary and maybe it was the case that it was just not done. I hope this helps 🙂
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Loaded with protein-packed ground beef, sharp cheddar, veggies, and everyone's favorite taco add-ons (salsa and sour cream, anyone?), this skillet from Peace, Love, and Low Carb is like eating nachos for breakfast — minus the chips. The best part: It can be meal prepped ahead of time for a week's worth of breakfasts. (Just leave the toppings off and add them after you've heated up a serving in the morning.) Who says tacos only belong on Tuesdays?
The ketogenic is known to improve the metabolic syndrome risk factors [8]. Type 2 diabetes is like a subset of metabolic syndrome. Metabolic syndrome can be seen as the umbrella term harboring the conditions necessary for setting you up for outright type 2 diabetes, and a low-carb or ketogenic diet may even prevent the development of the condition.
Metabolic syndrome is a cluster of metabolic risk factors that come together in a single individual. These metabolic factors include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for blood clotting. Affected individuals are most often overweight or obese. An association between certain metabolic disorders and cardiovascular disease has been known since the 1940s.
Research shows that Western diet habits are a factor in development of metabolic syndrome, with high consumption of food that is not biochemically suited to humans.[21] Weight gain is associated with metabolic syndrome. Rather than total adiposity, the core clinical component of the syndrome is visceral and/or ectopic fat (i.e., fat in organs not designed for fat storage) whereas the principal metabolic abnormality is insulin resistance.[22] The continuous provision of energy via dietary carbohydrate, lipid, and protein fuels, unmatched by physical activity/energy demand creates a backlog of the products of mitochondrial oxidation, a process associated with progressive mitochondrial dysfunction and insulin resistance.
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).

The brain is a particularly greedy organ when it comes to energy requirement. To put this comment in perspective consider the following: though our brain represents only about 2% of our body mass, it accounts for about 20% of our energy expenditure.  (In children, by the way, this may be closer to 40-50% of basal metabolic demand.) So, beyond the ATP issue, above, there is a substrate issue with the brain as neurons derive most of their energy from glucose.  While there is emerging evidence that neurons can also oxidize fatty acids directly in small amounts and may even prefer lactate (over glucose), these two substrates do not approach the levels of consumption by neurons that glucose does.  So, for the purpose of this discussion, let’s just focus on the need of the body to provide glucose to the brain.
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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