Metabolic syndrome is defined as the presence of a cluster of risk factors that are associated with a significantly higher risk for cardiovascular disease in the general population. The definitions for metabolic syndrome from different expert groups are somewhat different but generally include measures of adiposity, dyslipidemia, hypertension, and abnormal fasting blood glucose levels. Insulin resistance is the dominant but not the only condition underlying the pathogenesis of metabolic syndrome. The different components of the metabolic syndrome are independent risk factors for the development and progression of chronic kidney disease (CKD); hence, patients with metabolic syndrome are significantly more likely to have CKD. Conversely, metabolic syndrome is highly prevalent in patients with ESRD, including among those undergoing maintenance dialysis.

Ketogenesis is the pathway that forms ketone bodies from fatty acids. Starvation (specifically low levels of blood insulin and glucose) triggers ketogenesis in the liver cells’ mitochondria. Two molecules of acetyl-CoA from the breakdown of fatty acids are condensed via acetyl-CoA transferase to form acetoacetyl-CoA; a third is added to form 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) in a reaction catalysed by HMG-CoA synthase. HMG-CoA lyase then splits this to re-generate acetyl-CoA and form one molecule of AcAc. Beta-hydroxybutyrate (BHB) is formed from reduction of AcAc by BHB-dehydrogenase enzyme, and acetone results from spontaneous, non-enzymatic decarboxylation of AcAc. Acetone is a volatile molecule which is primarily excreted in the breath, although some evidence suggests that a small amount can be metabolised and oxidised4.
Oh Maria! Your bread recipe is fabulous! I have been playing around with it a little because the psyllium was a little too much for my gut! Went to 8 TBS of psyllium and added 2 TBS of Jay Robb Protein Isolate powder and a little sweetener (trying to make a yeasty flavor) I also turned it into buns which are easier for my household. I must say they turned out great! I even added caraway seeds to one batch for a rye flavor! I cannot thank you enough for making it so much easier to eat right when you have BREAD, ROLLS and DESSERTS that are fabulous!
Theoretically, supplying ketones during this period of compromised glucose metabolism could prevent the energy deficit and reduce the likelihood of long-term brain damage. This could be because ketones can act as an alternative, highly energy efficient substrate7. Additionally, the antioxidant, antiinflammatory33 and anti-apoptosis properties of ketones (i.e ketones prevent the opening of the mitochondrial permeability transition pore, which causes cell death66) could protect against neuronal loss and damage. 

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“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.”
Recent studies indicate that mood disorders such as depression and anxiety can be linked to a range of physical changes in the brain, such as inflammation or change in gene expression71. Early results from animal studies have shown that ketosis could improve mood disorders, although the mechanism is still unclear. Rats fed exogenous ketones for several weeks showed reduced anxiety behaviours72. Similarly, endogenous and exogenous BHB alleviated depressive behaviour in mice subjected to stress73. This was found to be linked to altered epigenetic markers (modifications to DNA that affect the degree of gene expression) and an increased amount of brain derived neurotrophic factor (BDNF) in the brain. At this time, there are no trials investigating the effects of ketosis in human patients with mood disorders. 
Acetyl-CoA can be metabolized through the TCA in any cell, but it can also undergo a different process in liver cells: ketogenesis, which produces ketone bodies.[27] Ketone bodies are also produced in mitochondria, and usually occur in response to low blood glucose levels.[28] When glucose levels are low, oxaloacetate is diverted away from the TCA cycle and is instead used to produce glucose de novo (gluconeogenesis). But when oxaloacetate is unavailable to condense with acetyl-CoA, acetyl-CoA cannot enter the cycle, and so the body has evolved an alternative way to harvest energy from it.

BMI (body mass index), an alternate measure of obesity that is used by many healthcare practitioners; it is calculated by taking: (Weight in pounds X 705) / (height in inches squared); for example: (150 pounds X 705) / (67 inches X 67 inches) = a BMI of 23.5. An adult with a BMI greater than 30 is considered obese. This calculation does not, however, describe where the excess weight is on the body.


Humans have always relied on ketones for energy when glucose sources were scarce (i.e. no fruits available during winter). It is a normal state of metabolism. In fact, most babies are born in a state of ketosis. However, with abundant sources of carbohydrate, people rarely access ketosis and it becomes a dormant metabolic pathway.Our ancestors likely had frequent periods of time when high carbohydrate food wasn’t immediately available. For this reason, our bodies are amazing at adapting to burning of ketones for fuel.

I’m so glad you love it, Tanya! Yes, $17 sounds like a lot for xanthan gum. I use this one here. Swerve is sweeter than erythritol, so you’d need less of it – I have a conversion chart here. You’re absolutely right about the xanthan gum and texture – it will make the bread more chewy. It will still be more of a “light and fluffy” bread, but definitely less muffin-like with the xanthan gum. I haven’t tried add-ins yet – let me know how it goes if you try!
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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When preparing keto bread recipes, look out for low-carb ingredients that could contribute to brain fog and inflammation. Skip recipes that require conventional dairy or yeast, and avoid eating common keto bread ingredients like psyllium husk, xanthan gum, and nuts or nut butters too often — these can contain mold or irritate your gut. Grass-fed butter, ghee, and coconut flour are the few exceptions that will still produce a stellar loaf.
Increasing dietary fiber, especially insoluble fiber from cereal and grains, is associated with a reduced risk of diabetes and has been shown to reduce fasting blood glucose and modestly lower HbA1c in people with type 2 diabetes (Martin, J Nutr 2008; Post,J Am Board Fam Med 2012). In people with type 1 diabetes, 50 grams of dietary fiber per day has been shown to significantly improve blood sugar control and reduce hypoglycemic events (Giacco, Diabetes Care 2000). The American Dietetic Association states that "diets providing 30 to 50 g fiber per day from whole food sources consistently produce lower serum glucose levels compared to a low-fiber diet. Fiber supplements providing doses of 10 to 29 g/day may have some benefit in terms of glycemic control." (Slavin, J Am Diet Assoc 2008). Although ConsumerLab.com has not tested fiber products, we have produced a webinar about that provides more information.
Hi Al, I’m glad you liked the taste and am honored you chose my site for your first ever comment! 🙂 I haven’t tried this recipe in a bread machine. Most likely the biggest issue with your bread being flat is that you didn’t fold the egg whites in – breaking them down would definitely make the bread flat. I haven’t tried adding yolks as most people want their bread less egg-y, not more. I’d have some concerns about the bread being too “wet” by adding them though, even if you like an eggy taste. A better option might be to brush the top with yolks for color.

The best part about this bread is that it makes it so much easier to eat a low carb diet. Yes, there are some savage beasts (joking) that don’t miss bread at all and are happy to just eat bacon seven times a day, but if you’re anything like me, bread was a staple of your diet growing up and you still have a look of yearning in your eyes when they drop that bread basket in the middle of the table at family dinner. I feel your pain. This low carb bread recipe is your shoulder to cry on.

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