Development of metabolic syndrome depends on distribution as well as amount of fat. Excess fat in the abdomen (called apple shape), particularly when it results in a high waist-to-hip ratio (reflecting a relatively low muscle-to-fat mass ratio), increases risk. The syndrome is less common among people who have excess subcutaneous fat around the hips (called pear shape) and a low waist-to-hip ratio (reflecting a higher muscle-to-fat mass ratio).


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!!
Anyone with metabolic syndrome should make every attempt to reduce their body weight to within 20% of their "ideal" body weight (calculated for age and height), and to incorporate aerobic exercise (at least 20 minutes) into their daily lifestyle. With vigorous efforts to reduce weight and increase exercise, metabolic syndrome can be reversed, and the risk for cardiovascular complications can be substantially improved.
In the United States, metabolic syndrome has a high prevalence in African Americans, particularly African American women, and this has been attributed to the higher prevalence of obesity, hypertension, and diabetes in this population. [40] However, the highest age-adjusted prevalence of metabolic syndrome in the United States is found in Mexican Americans, approximately 31.9% of whom had the condition (compared with 27% of the general population) in a 1988-1994 survey. [41]
In a separate post, I explained the difference between nutritional ketosis (NK) and diabetic ketoacidosis (DKA). If this distinction is not clear, I’d suggest giving this separate post a quick skim for a refresher.  DKA is a pathologic (i.e., harmful) state that results from the complete or near absence of insulin.  This occurs in the setting of type 1 diabetes or very end-stage type 2 diabetes, and often as the result of a physiologic insult (e.g., an infection) where the patient is not receiving sufficient insulin to bring glucose into his cells.  A person with a normal pancreas, regardless of how long he fasts (including the fellow I reference above who fasted for 382 days!) or how much he restricts carbohydrates, can not enter DKA because even a trace amount of insulin will keep B-OHB levels below about 7 or 8 mM, well below the threshold to develop the pathologic acid-base abnormalities associated with DKA. Let me reiterate, it is physiologically impossible to induce DKA in anyone that does not have T1D or very, very, very late-stage T2D with pancreatic “burnout.”
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I have made this recipe twice in less than a week. The first batch I stuffed them with egg and spinach and the second batch I stuffed with pepperoni and mozzarella. The possibilities are endless. The second batch was a little crumbly, so I added warm water until they formed and held properly. I shaped them into small empanadas. Thank you for these, they are delicious!
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I also had the problem of gumminess. I watched your video and did as you did…I didn’t make any replacements or anything. I didn’t use Jay Robb psyllium. Mine came from a bulk bin somewhere (and I ground it into powder myself), did that make a difference? the loaf was purple but i don’t care about color, i just want it to taste good and not vinegar-y and not gummy!! thanks so much for any suggestions!
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???
I have been looking for a good keto bread recipe. I have tried a few others with a “meh”. This one is a WOW! Prior to going Keto, I loved to cook and bake, it is my main hobby. But after going Keto, I have had to learn a whole new way of cooking. I followed the recipe to a T knowing how to work my way around the kitchen and the only difference is the fact that mine turned out purple. It is clearly the psyllium. Thank you so much for a wonderful and easy recipe for a great bread!

Finally, an important consideration is the effect of the ketogenic diet on blood lipids. This is because the levels of various lipids in the blood have been shown to predict the likelihood of cardiovascular disease. Lipids and cholesterol are carried through the blood in biochemical assemblies called ‘lipoproteins,’ because they do not dissolve in water. There are two broad classes of lipoproteins in the blood: high density lipoprotein (HDL) and low density lipoprotein (LDL). HDL is thought of as more ‘healthy’ (H = ‘Healthy’) because it responsible for moving cholesterol and lipids from the peripheral tissues into the liver for metabolism. LDL is demonised as bad cholesterol (L = ‘Lethal’), levels are elevated after a fatty meal and elevated LDL is associated with cholesterol build up in the arteries. 
I actually went on a ketogenic diet last year to see if it would help my migraines. I have a history of chronic migraines which would usually last 3 days, sometimes longer. Triptans help a lot but I don’t like having to take them. I stayed in ketosis for about 8 months and experienced a significant reduction in migraines, from feeling some type of headache (mild o r severe) almost everyday to 1 or 2x per month while in ketosis. Although I’m very healthy otherwise, I do think my migraines may have something to do with blood sugar fluctuations (despite previously eating a whole foods diet and no refined carbs), and keto totally stabilized this. I eventually came off of Keto because I’m not really a meat lover. When I came off, but remained low carb, my migraines stayed under control for the most part. When I increase carbs, they do return.

Blood pressure goals are generally set lower than 130/80. Some blood pressure medications offer more benefits than simply lowering blood pressure. For example, a class of blood pressure drugs called ACE inhibitors has been found to also reduce the levels of insulin resistance and actually deter the development of type 2 diabetes. This is an important consideration when discussing the choice blood pressure drugs in the metabolic syndrome.
208. Steinberg G. R., Watt M. J., McGee S. L., et al. Reduced glycogen availability is associated with increased AMPKα2 activity, nuclear AMPKα2 protein abundance, and GLUT4 mRNA expression in contracting human skeletal muscle. Applied Physiology, Nutrition, and Metabolism. 2006;31(3):302–312. doi: 10.1139/h06-003. [PubMed] [CrossRef] [Google Scholar]

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The discovery of many appetite-related hormones provided molecular basis for appetite control, decreasing the relevance of the metabolites hypothesis (Karatsoreos et al., 2013). Recently, Sumithran et al. demonstrated that there is a long-term persistence of changes in some peripheral hormones involved in food control (Sumithran et al., 2011). In this study, they found a significant difference in mean levels of many food intake-related hormones 1 year after the cessation of weight loss via the hypocaloric diet. There was a long lasting decrease of anorexigenic compounds: leptin, PYY, cholecystokinin, insulin, and pancreatic peptide and an increase of the orexigenic molecule ghrelin. Moreover, they found that hunger remained elevated 1 year after diet cessation. In a successive study the same group investigated hunger-related hormones after 8 weeks of KD, demonstrating that during ketosis the increase of ghrelin (a strong stimulator of appetite) was suppressed (Sumithran et al., 2013). These results are consistent with those of Ratliff et al (Ratliff et al., 2009), who found no significant change in fasting plasma ghrelin after 12 weeks of VLCD.


If you need to lose weight, find an eating plan you can stick with. “Whatever results in lasting weight loss for you is the best approach for you,” Wright says. “If you make over-restrictive changes you can't maintain, as soon as you tire of that diet, you will fall back to what you did previously, gain weight, and raise your risk of type 2 diabetes.”

People who have metabolic syndrome or are at risk for it may need to take medicine as treatment. This is especially true if diet and other lifestyle changes have not made a difference. Your doctor may prescribe medicine to help lower blood pressure, improve insulin metabolism, lower LDL cholesterol and raise HDL cholesterol, increase weight loss, or some combination of these.

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Ultimately, cancer is highly complex, whereas some tumors may be highly responsive to carbohydrate restriction, others may become adapted to utilise fats or ketones. Cancer, and the treatments currently in use cause unpleasant systemic effects such as muscle wasting and compromise of the immune system, therefore any interventions should be undertaken under the guidance of a doctor. There are limited treatment options available for some types of cancer, many drugs have toxic side effects and many types of cancer have a poor prognosis. In these cases, considering metabolism as an adjunct to conventional treatments is interesting, and offers the potential of another avenue of attack on cancer.  
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In a subsequent series of experiments, glucose metabolism in C. elegans was inhibited by knockdown of the insulin receptor, insulin-like growth factor 1 (IGF-1) receptor, and insulin receptor substrate 1 (IRS-1) [73]. Consistent with the previous study [72], inhibition of glucose metabolism increased mitochondrial respiration concomitant with ROS-dependent increases in lifespan, stress resistance, and antioxidant enzyme activity. However, in this case, detection of ROS was mitochondria-specific, and repeated measures allowed for changes in antioxidant enzyme activities to be evaluated more closely in relation to the timing of changes in mtROS. Compared to controls, inhibition of glucose metabolism resulted in higher mitochondrial O2 consumption at 12 h, higher mtROS production at 24 h, and higher activities of SOD and catalase at 48 h, suggesting a dependence of antioxidant activity on mtROS and a dependence of mtROS on mitochondrial respiration. The most striking result is the lower mtROS at 120 h, indicating that the initial increase in mtROS and subsequent increase in antioxidant enzyme activity ultimately lowered net mtROS production to a level lower than controls, which is the proposed explanation for the more than twofold increase in lifespan. As with the previous study, this demonstration of mitohormesis is further supported by the changes in ROS production, antioxidant enzyme activity, and lifespan having been prevented with antioxidant treatment.

^ Jump up to: a b Gatta-Cherifi, Blandine; Cota, Daniela (2015). "Endocannabinoids and Metabolic Disorders". Endocannabinoids. Handbook of Experimental Pharmacology. 231. pp. 367–91. doi:10.1007/978-3-319-20825-1_13. ISBN 978-3-319-20824-4. PMID 26408168. The endocannabinoid system (ECS) is known to exert regulatory control on essentially every aspect related to the search for, and the intake, metabolism and storage of calories, and consequently it represents a potential pharmacotherapeutic target for obesity, diabetes and eating disorders. ... recent research in animals and humans has provided new knowledge on the mechanisms of actions of the ECS in the regulation of eating behavior, energy balance, and metabolism. In this review, we discuss these recent advances and how they may allow targeting the ECS in a more specific and selective manner for the future development of therapies against obesity, metabolic syndrome, and eating disorders.


I actually clicked on the story just to see if they included anything about it’s use in managing chronic migraine. I have chronic migraine, basically intractable. Nothing has helped. I’ve tried medications, meditations, and everything in between including a bunch of dietary changes. Keto is my next consideration. I’m happy to hear it helped you! Thanks for sharing
Sorry, I realized I should have clarified which kind of freshly milled flours. Specifically, wheat, rye and spelt. I have been using freshly milled flour for over a year now and my family loves it. I have recently bought 3 of your books and I am learning all kinds of wonderful new things, but I am having a hard time letting go of freshly milled flour completely. Your thoughts on the subject would be much appreciated!
Hey Maya!! This is the 2nd recipe I’ve tried off your website and again I love it!! Turned out really well. I can have sandwiches again or a quick piece Of toast when I’m in a hurry to get out the door. I was skeptical about the xanthan gum since I tried a recipe using psyllium husk powder. I did not like it. I can’t taste the xanthan gum so I have no problem using it going forward. Thanks again for the recipe!!!

My bread came out a teeny bit “eggy”…which wasn’t bad, I still enjoyed it. Maybe some egg yolk made it in the batter??? Anyway, the slight egginess made me think of French toast. So with the last few pieces, that’s what I made. I mixed an egg, heavy cream, and a little vanilla to coat the bread…used browned butter to sub for syrup…then topped off with Swerve confectioners sugar. It was delicious!
Hi Melissa, Are you beating the whole eggs? It needs to be egg whites only. Whole eggs will never form peaks. Adding a little cream of tartar helps, as well as making sure you start with a very clean bowl (preferably not plastic if you’re having issues). Having the egg whites at room temperature can be a little easier, too, though I usually don’t need to. Hope this answers your question!

I made this bread today and love it! The only problem I have is that the bread is very moist on the inside. The crust is perfect. I baked it at 350 for 70 mins and the bottom of the bread was a little moist as well as the inside. I measured all of my ingredients as your instructions say. Please help. This is the best bread I’ve made in the 2 years we have been eating wheat free.


I read through aaaaallllll the comments for research before I made this bread, one thing I noticed when making your protein buns was – when I used 2 teaspoons of baking powder they deflated when exiting the oven. When I reduced the BP to 1.5 teaspoons, they turned out fine. I made two batches with 2 tsp of BP – they turned out like raisins, and 2 batches with 1.5 tsp of BP and they turned out fine. No one posting mentioned adjusting the baking powder – perhaps that would help in this recipe since deflating is a problem, maybe there is too much chemical loft for the non-gluten structure to handle?
Divya, I’m happy to hear the flavor was great, but sorry to hear the bread was flat! I’ll try to help you troubleshoot…first I would check to make sure that your baking powder is fresh. Also, did you use the full cup of egg whites? Did you use a 9 by 5-inch loaf pan? Did you cook it at 350F and is your oven properly calibrated? Did you bake it for the amount of time the recipe calls for?
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