The graph below, also from the Cahill and Veech paper, shows the blood chemistry of a person starving for 40 days.  Within about 3 days, a starving person’s level of glucose stops falling.  Within about 10 days they reach a steady-state equilibrium with B-OHB levels exceeding glucose levels and offsetting most of the brain’s need for glucose. In fact, the late George Cahill did an experiment many years ago (probably would never get IRB approval to do such an experiment today) to demonstrate how ketones can offset glucose in the brain. Subjects with very high levels of B-OHB (about 5-7 mM) were injected with insulin until glucose levels reached 1 mM (about 19 mg/dL)!  A normal person would fall into a coma at glucose levels below about 40 mg/dL and die by the time blood glucose reached 1 mM.  These subjects were completely asymptomatic and 100% neurologically functional.

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.
In order to best investigate the efficiency of different fuels, one needs a closed system, where the substrate conditions can be changed and the oxygen consumption and work done can be accurately measured. Isolated (ex-vivo) animal hearts are the best model to study these variables, as it is easy to manipulate the fuel provided (i.e glucose, ketones), to measure the oxygen use and also the amount of work (how much fluid is pumped). 
As with other sources of oxidative stress, mtROS can damage enzymes and cell membranes and subsequently facilitate the pathogenesis of chronic disease [41]. Oxidative damage to mitochondrial DNA (mtDNA) is of particular concern because of its proximity to the electron transport chain (mtETC). Furthermore, compared to nuclear DNA, mtDNA is more prone to oxidative damage and is not repaired as effectively [42–45], although this has been debated based on more recent evidence [46–50]. Unrepaired mtDNA damage leads to mitochondrial dysfunction, which is implicated in the pathogenesis of a variety of chronic diseases [51] and associated with shorter lifespan [52]. Therefore, while moderate levels of mtROS have important roles in signaling and health, protection against excessive levels is also important.
Garlic: Potent, but effective. Garlic is known as one of the oldest medicines in the world…and with good reason. An animal study that administered high doses of raw garlic to rats for 4 weeks found that it had a profound effect of reducing blood glucose levels, as well as cholesterol and triglycerides compared to rats who did not receive raw garlic (2). They also tested rats with boiled garlic, and saw no changes in blood glucose, so the benefit comes from raw garlic.
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So rather than giving one-size-fits-all dietary advice or weaponizing the word “balanced” it might be better if the medical community suggested that there are Individual differences that need to be considered. This might also help those lay folk who have had success with one dietary lifestyle or another also realize that what’s valid for them may not be good advice for others.

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.

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.
91. Speijer D. Oxygen radicals shaping evolution: why fatty acid catabolism leads to peroxisomes while neurons do without it: FADH(2)/NADH flux ratios determining mitochondrial radical formation were crucial for the eukaryotic invention of peroxisomes and catabolic tissue differentiation. Bioessays. 2011;33(2):88–94. doi: 10.1002/bies.201000097. [PubMed] [CrossRef] [Google Scholar]
One of the hardest things to do when I travel is to find something to take for lunch OTHER than salads–that gets old fast! This will be a HUGE help so that I can add “bread” back into my lunch menus! Thank you VERY much! So fast, so easy, and VERY usable for those of us stuck in hotel rooms with limited options for eating in. It really does have the texture of whole-grain type of bread!! You’re a life saver! 😀
This was my first time baking anything EVER and it turned out perfectly! I do find that the bread does taste a tad “eggy” but it’s soft and a perfect replacement for sandwich bread. I can finally have grilled cheese sandwiches again!! Next time around, I’ll double the recipe because the bread was smaller than expected. Thanks for this amazing recipe!
Patterns can be great because they help you figure out what is causing undesirable blood sugar values. A good way to track of it is to keep a journal of all of the food you eat, activities you do and your blood sugar levels for 1 week. During this week, check your sugar before and after you eat, as well as in between meals. Also document any insulin that you give yourself.
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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!).

Appetite regulation: One of the first things people notice when they’re in ketosis is that they’re no longer hungry all the time. In fact, research has shown that being in ketosis suppresses appetite. One study looked at people who lost weight by following a ketogenic diet for eight weeks and then reintroduced small amounts of carbs. The researchers reported that the levels of ghrelin (the “hunger hormone”) were suppressed in those who remained in ketosis, whereas those who were no longer in ketosis had higher ghrelin levels.

The effects of a ketogenic diet on cholesterol and triglycerides is complex. It is dependant on the exact composition of the diet, the genetic and physical characteristics of the individuals studied and other hormonal and environmental factors. Therefore, blood lipid changes whilst on the ketogenic diet can vary between individuals. This means that it is advisable to track your personal levels by having a blood test before starting the ketogenic diet and to follow this with regular testing to monitor any changes.  
Usually, there are no immediate physical symptoms. Medical problems associated with the metabolic syndrome develop over time. If you are unsure if you have metabolic syndrome, see your healthcare provider. He or she will be able to make the diagnosis by obtaining the necessary tests, including blood pressure, lipid profile (triglycerides and HDL), and blood glucose.
L-glutamine, an amino acid needed in large amounts by your body, has been shown to help build lean muscle by suppressing insulin levels and stabilizing blood sugar. One study found that supplementing with L-Glutamine for six weeks improved body composition in patients with type 2 diabetes. L-glutamine has also been shown to help heal a leaky gut, which is important for digestive health and immunity. In addition to supplements, you can find L-glutamine in foods such as bone broth, grass-fed beef, cottage cheese, spirulina, asparagus, broccoli rabe, salmon, and turkey.
Info: You can buy the products I’ve linked to in the post above from Thrive Market. Thrive Market is an US based online store that sells all the products you need for low carb cooking at wholesale prices! If you become a member, you can get 25-50% off the best healthy and organic premium products for just $60/year. Click here to join and receive an extra 25% off your first order!
An increase in fat burning ability could decrease the efficiency of exercise: one adaptation to a high fat diet is an increase in a process called mitochondrial uncoupling. This means that some of the stored energy from metabolic substrates is not used to generate ATP but is ‘dissipated’ leading to a decrease in efficiency of energy production 26 ,19.  
You need to take your medicine, but sometimes, meds for the other things that ail you can raise your blood sugar. We’ve got a list of them here. If you take one or more of these, talk to your doctor about alternative meds that could control your other conditions without affecting your blood sugar. Remember that everyone is different. Just because you take a medication on the list doesn’t mean that it raises your blood sugar—or, if it does, that it raises it enough to worry about. If your doctor says it’s safe to do so, you can stop taking a suspect med for a few days, carefully monitor your blood sugar, and see if it improves. If you want to be a proper scientist, you should then re-start the med to see if the sugar goes up again. And don’t try this at home! Do it only under your doc’s guidance.
Embarrassing admission: I remember exactly where I was sitting in a clinic at Johns Hopkins in 2002 explaining to (admonishing, really) a patient who was on the Atkins diet how harmful it was because of DKA.  I am so embarrassed by my complete stupidity and utter failure to pick up a single scientific article to fact check this dogma I was spewing to this poor patient. If you’re reading this, sir, please forgive me. You deserved a smarter doctor.
It’s a habit to enjoy a brie cheese for desert instead of a piece of chocolate cake but each are favored deserts in France. I’m personally more satisfied after a 350 calorie sized wedge of brie than the same number of calories of cake.. which will give me sugar crash and .. really I’d like two slices of cake(I’ve got a sweet tooth that once I get going it wants to keep being fed)
293. Geng T., Li P., Okutsu M., et al. PGC-1α plays a functional role in exercise-induced mitochondrial biogenesis and angiogenesis but not fiber-type transformation in mouse skeletal muscle. American Journal of Physiology-Cell Physiology. 2010;298(3):C572–C579. doi: 10.1152/ajpcell.00481.2009. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
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I made your bread yesterday. You are right–it IS the best tasting keto bread yet! And I’ve made dozens of recipes through the years! I enlarged it–made a recipe and a half, and used a 9×5 glass pan. I confess, I did make a mess of it at one point. I used carton egg whites, and they didn’t do as well as fresh egg whites do. I ended up with a lot of foam on top and liquid on the bottom. I tried adding the dough to it, but had trouble smoothing out the many lumps. Soooo, I used my hand mixer to mix the whole mess. I put it in the pan and decided to just throw it out, thinking it could never turn into a good loaf of bread. But I went ahead and put it in the oven, and it turned out great! The rise was higher than any other almond flour bread I’ve ever made. So it’s obviously a very “forgivable” recipe. Many thanks!!
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Metabolic syndrome promotes coronary heart disease through several mechanisms. It increases the thrombogenicity of circulating blood, in part by raising plasminogen activator type 1 and adipokine levels, and it causes endothelial dysfunction. [14] Metabolic syndrome may also increase cardiovascular risks by increasing arterial stiffness. [15] Additional mechanisms include oxidative stress, [16] which has been associated with numerous components of metabolic syndrome. [17]
Garlic: Potent, but effective. Garlic is known as one of the oldest medicines in the world…and with good reason. An animal study that administered high doses of raw garlic to rats for 4 weeks found that it had a profound effect of reducing blood glucose levels, as well as cholesterol and triglycerides compared to rats who did not receive raw garlic (2). They also tested rats with boiled garlic, and saw no changes in blood glucose, so the benefit comes from raw garlic.

Maria, thank you for this recipe! Made this yesterday, and was shocked that it really did come together so quickly! I weighed the ingredients out as you recommended, and that worked out really well which I prefer since so many measuring implements can vary from one to the next. I made the almond flour and egg white version, but may eventually try it with the coconut flour. Even my non-paleo, grain-eating husband liked this bread and agreed to put it in his sandwich bread rotation–so that excites me too! My bread did have a slight purplish hue to it (used the Vitacost brand psyllium husk powder), so I just ordered some of the Jay Robb brand psyllium powder so that my husband won’t have an excuse to not eat this when he goes to make a sandwich with it. Thanks again!


Target organ damage occurs through multiple mechanisms in metabolic syndrome. The individual diseases leading to metabolic syndrome produce adverse clinical consequences. For example, hypertension in metabolic syndrome causes left ventricular hypertrophy, progressive peripheral arterial disease, and renal dysfunction. [12] However, the cumulative risk for metabolic syndrome appears to cause microvascular dysfunction, which further amplifies insulin resistance and promotes hypertension. [13]
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 there, how many slices you get really depends on the kind of loaf pan you use. I find I get around 20 slices for a bread made in the regular loaf pan (though with this recipe they will be rectangular rather than square) and 12-14 slices using a small loaf pan as described in the post. That’s why I decided to state a portion size – 12 per bread. 1 portion = 0.6 net carbs
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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.
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.
Hi Maria, glad you like the bread! Good question about the olive oil – on the one hand using the same amount as butter would mean you stick with the same wet/dry ratio, on the other had olive oil doesn’t firm up at room temperature, but butter and coconut oil do. Therefore, I’d try using a bit less olive oil than butter, maybe 40g instead of 60g. You could also get hold of refined coconut oil, which does not have the coconut taste, for example this one.
My first try at this recipe –lower half was gummy. Crust tasted amazing to I’m eating the ends as toast. I’m too frugal to throw away 3 cups of almond flour, so I cubed up the rest of the loaf, put it in to bake at 350 for 30 minutes or so. Cubes are great on salad -taste like toasted almond/sesame. Now I’m making savory bread pudding with about 2 cups of the cubes (6 eggs, 3/4c almond milk, 1/4c cream, cooked bacon bits, shallots, basil and chives). Baking in muffin tins. Will be taking them for lunches.

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Forget Atkins and Paleo — the new low-carb diet du jour is called keto, as in ketogenic. Although there are many similarities between these diets, a keto diet is all about restricting carbohydrates and increasing healthy fats. The goal is to force your body’s metabolism into ketosis, which means it burns fat instead of glucose — because without carbs, glucose isn’t readily available.
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