The coordinated effects of AMPK, SIRT1, and SIRT3 are primarily mediated through PGC-1α, which is activated through phosphorylation by AMPK [242, 265] and deacetylation by SIRT1 [77, 242, 266–269]. SIRT3 also increases PGC-1α activity [270], possibly through cAMP response element binding protein (CREB) [271, 272], but the exact mechanism has not been elucidated. In addition to phosphorylating PGC-1α, activated AMPK also increases PGC-1α expression [260, 273–276]. Activation of β2-adrenergic receptors [277–280] and the adiponectin AdipoR1 receptor [281] also increase PGC-1α expression, independently of AMPK activation [278, 281]. PGC-1α activity is increased by oxidative stress [76, 77, 282–284], possibly through activation of AMPK [259, 260] or p38 mitogen-activated protein kinase (MAPK) [283, 284], or inhibition of glycogen synthase kinase 3β, which inhibits PGC-1α through phosphorylation [77, 283]. In contrast, insulin decreases PGC-1α activity through phosphorylation by PKB [285]. Once activated, PGC-1α interacts with the PPAR family of nuclear receptors [286] and the FOXO family of transcription factors [287] to influence expression of a variety of bioenergetic and antioxidant proteins. PGC-1α most notably increases transcription of proteins involved in mitochondrial biogenesis and respiration [76, 242, 265, 267, 269, 274, 279, 282, 285, 288–293] but also increases transcription of antioxidant proteins including SOD1 [76], SOD2 [76, 282, 289, 292–294], catalase [282], GPx [76, 294], thioredoxins [282, 283, 292], TRXR [282, 292], Prx3 [282, 292], and Prx5 [282, 292], as well as the mitochondrial uncoupling proteins UCP2 [76, 265, 282, 288, 294], UCP3 [76, 265, 294], and ANT [76, 295].
Yes, you read that right. Meat. Bagel. It's basically ground pork cooked into the shape of a bagel (or a donut, however you'd like to think of it). After it's cooked, cut it in half and fill it with lettuce, tomato, avocado, and onions for one hell of a breakfast sandwich. They also freeze up nicely. Meat lovers, you've got Ditch The Wheat to thank for this creation.

I was well aware of the dearth of mainstream knowledge of NK, and particularly the conflation of NK with diabetic ketoacidosis (DKA), a pathologic state that results from the complete or near absence of insulin, which is what prompted my writing and desire to share my journey. And I was once in the wanker category of folks who spoke with “authority” about ketosis, despite knowing somewhere between zero and nothing on the topic. I remember exactly where I was sitting in a clinic at Johns Hopkins in 2002 during my residency explaining to (admonishing, really) a patient who was on the Atkins diet how harmful it was because of DKA. Not only that, the ketogenic diet could be seen as the antithesis of a “healthy” diet by conventional standards. I could see how this was a difficult proposition for many to acknowledge.
Whey protein isolate. This one is pretty much a must if you’re baking the bread in a pan (say as opposed to muffins), as it will ensure your bread doesn’t collapse post-bake. Having said that, you can sub it with more almond flour and bake it in a muffin pan (smaller baked goods have don’t require as much structure). Not exactly the same, but works well.
Hello, I’m sure you must roll your eyes at getting yet another post about glitches when making this bread. Unlike the first loaf I made I had four loaves turn out gummy. it still makes reasonable toast but I’d like to avoid this the next time I make the bread. I used your recommended almond flour, and I really ground the psyllium. However in narrowing things down there are two factors that may have contributed to the problem: 1) I mixed up two loaves at a time and I wonder if the dough was too heavy for my mixer and did not combine sufficiently. 2) I may have let a very small amount of yolk fall into the whites. Would either of these caused the gummy texture? Thanks for this amazing website. We purchased all your books and find them a wealth of information. Liz
The key with diabetes is always consistency. A steady intake of the right amount of carbohydrates helps in keeping things under better control and prevents blood sugar spikes. Although many people believe that low-carb is best, that is not true during pregnancy. You need the carbohydrates for the growth of the fetus and to keep your energy level up. Talk to your doctor and nutritionist about what is best for you.
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Hi John, You could possible try a hand mixer in a bowl instead of the food processor, but I haven’t tried it, so can’t vouch for the results. Most likely the bread would not be as tall because the mixer would completely deflate the first half of the egg whites when you add them to the batter. The second half should be folded so that part will be find. If you try with a bowl and hand mixer, let me know how that goes.
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. 
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?
Thanks for this article. I just started a Keto diet so found it appropriate to my current lifestyle. Though I don’t believe your bottom line is strong enough since you simply stating that the diet is “hard to follow” and food is “notoriously unhealthy” without evidence going deeper into why those “notoriously unhealthy” foods are worse than keeping carbohydrate-heavy food that are addictive and give the body a quick sugar high for energy. I believe “hard to follow” is your opinion only, since acceptable Keto foods are found at all restaurants easily and also all grocery stores. All the foods you mention: “rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water” are all Keto-friendly. Many people have been on a Keto-diet for years. A healthy lifestyle is a healthy mindset change and making right choices – it’s not going to be easy.

Impaired mitochondrial function often results in excessive production of reactive oxygen species (ROS) and is involved in the etiology of many chronic diseases, including cardiovascular disease, diabetes, neurodegenerative disorders, and cancer. Moderate levels of mitochondrial ROS, however, can protect against chronic disease by inducing upregulation of mitochondrial capacity and endogenous antioxidant defense. This phenomenon, referred to as mitohormesis, is induced through increased reliance on mitochondrial respiration, which can occur through diet or exercise. Nutritional ketosis is a safe and physiological metabolic state induced through a ketogenic diet low in carbohydrate and moderate in protein. Such a diet increases reliance on mitochondrial respiration and may, therefore, induce mitohormesis. Furthermore, the ketone β-hydroxybutyrate (BHB), which is elevated during nutritional ketosis to levels no greater than those resulting from fasting, acts as a signaling molecule in addition to its traditionally known role as an energy substrate. BHB signaling induces adaptations similar to mitohormesis, thereby expanding the potential benefit of nutritional ketosis beyond carbohydrate restriction. This review describes the evidence supporting enhancement of mitochondrial function and endogenous antioxidant defense in response to nutritional ketosis, as well as the potential mechanisms leading to these adaptations.
Well good luck Tiffany, I hope it works for you. I totally understand and feel your pain :). I have been trying to do the Protein Bread FOREVER! And nothing, I mean nothing, buying Jay Rob brand, buying a new stand mixer, everything I could think of and nothing ever worked and still doesn’t. I can make the buns and they are acceptable, but I would so love to make the loaf. Anyway, I’m wondering, since I live in Florida, does the atmophere, weather have anything to do with it? It is very humid here. Maybe that’s something that needs to be addressed??

I have a question I hope you can set me straight. I was putting the almond flour in my dry measuring cup and it didn’t seem right. I checked around the internet and found someone who said always weigh almond flour. So, I did. 8oz. = 1 cup so 8oz almond flour. It looks like enough but so much more than one dry measure cup. I got as far as doing the food processor part and realized I needed more eggs. So, I’m kinda in holding until I go to the store so, I thought I’d ask.. have I made a terrible mistake and wasted a lot of supplies or am I cool?

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How, exactly, does our body take pyruvate (from glucose) or acetyl CoA (from fat) and generate so much ATP?  The answer lies in the beauty of the Krebs Cycle, which feeds into a process called the electron transport chain (or ETC), I alluded to above.  Since the adage ‘you can’t get something for nothing’ is as true in biochemistry as it appears to be in life, to get all that ATP (i.e., stored energy in the form of the phosphate bond), we need to give up something.  What the ETC does give up, as its name suggests, is electrons.  Through a series of redox reactions the ETC trades the stored energy held by electrons going from higher to lower energy states in exchange for the chemical energy stored in the bonds of the third phosphate group on an ATP molecule.
Thanks for starting a new recipe since the comments were getting out of hand on the sub rolls post 🙂 Can you say what size loaf pan you used for this. I have tried the recipe twice in a loaf pan of 2 very different sizes, and they turned out radically different. I think there is a sweet spot which you obviously found with yours. I’d like to find it for mine, too. Thanks for the great bread recipe. It’s one of the only recipes I know by heart because it is so elegantly simple.
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Finally, choose a healthy fat to include with your breakfast. These choices might include coconut oil, avocado oil, grass-fed butter, ghee, or bacon fat. You will probably be cooking your protein source and vegetable in your chosen fat source, but you might also use it in a sauce. When adding flavor to any recipe (not just breakfast recipes) the sauce can make or break the dish. Here are a few sauces you might choose to include:
Many questions about the role of such an important intermediate of lipid metabolism remains unanswered, e.g., the role of BHB in food control. For example, whether or not BHB could act as a satiety signal in the brain, considering its role in energy supply to CNS. We have to consider that the effects of KBs on hunger reduction can only be seen after many days following fasting or KD initiation (Paoli et al., 2010); this is consistent with the abovementioned threshold of brain utilization of KB as an energy source, i.e., 4 mmol/L (Veech, 2004), which is close to the Km for the monocarboxylate transporter (Leino et al., 2001). During the first days of fasting or KD there is a rise of BHB and adiponectin concentrations (Halberg et al., 2005). One of the putative causes of hunger in starved humans may be due—together with other causes—to adiponectin. When adiponectin binds to its receptor AdipoR1, AMP-activated protein kinase (AMPK) is phosphorylated in the ARC of the hypothalamus (Valassi et al., 2008). The increase of AMPK activity in the hypothalamus may increase food intake and hepatic glucose output in mice while the decrease seems to reduce food intake (Zhang et al., 2009). KDs can also act similarly to a caloric restriction on AMPK (Newman and Verdin, 2014). Interestingly, AMPK seems to have opposing actions on the liver, muscle tissues and the brain: in liver and muscle AMPK activation increases FA oxidation by decreasing malonyl-CoA concentrations (Malonyl-CoA is the first intermediate in the lipogenic pathway and is also an inhibitor of carnitine palmitoyltransferase-1 (CPT-1). CPT-1 activity can be limiting for FA oxidation), through the inactivation of the acetyl-CoA carboxylase 1 (ACC1). AMPK can also increase the activity of malonyl-CoA decarboxylase (MCD), which enhances the decrease of malonyl-CoA levels.

As with PGC-1α, nutritional ketosis may activate FOXO3a by increasing activity of AMPK and sirtuins or by decreasing insulin. Expression of FOXO3a is increased by fasting, caloric restriction, and BHB [103, 105], all of which are or can be components of a ketogenic diet. Furthermore, BHB treatment has extended lifespan in C. elegans in a manner dependent on FOXO3a [95], and a ketogenic diet (% energy: 89 fat, <1 carbohydrate, and 10 protein) has increased median lifespan and decreased tumors and age-associated losses of physical and cognitive performance, all in conjunction with increased hepatic content of FOXO3a [36].
Polycystic ovarian syndrome. Thought to be related to insulin resistance, this disorder involves the release of extra male hormones by the ovaries, which can lead to abnormal menstrual bleeding, excessive hair growth, acne, and fertility problems. It is also associated with an increased risk for obesity, hypertension, and — in the long-term — diabetes, heart disease, and cancer.
Many neurological conditions share a common feature of impaired brain energy metabolism. It isn’t always clear if this impairment is the cause or the effect of the disease, but nonetheless, interventions that even partially restore or improve brain energy metabolism could help to prevent, slow or even reverse some conditions of the brain. Because ketones can: 1) get into the brain; 2) undergo metabolism by a distinct pathway that bypasses glucose metabolism, providing ketones by either following a ketogenic diet or by taking exogenous ketones could impact the natural course of some neurological conditions. 
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The root cause of most cases of metabolic syndrome can be traced back to poor eating habits and a sedentary lifestyle. In some cases, a diagnosis of metabolic syndrome has also been assigned to those already diagnosed with hypertension or with poorly controlled diabetes. There also seems to be an association with non-alcoholic fatty liver disease, polycystic ovarian disease, and some cancers. A few cases are thought to be linked to genetic factors.

Scheme of orexigenic and anorexigenic effects of ketosis. The picture is highly schematic. For more details please see the text. AMPK, AMP-activated protein kinase; CCK, cholecystokinin; GABA, gamma-aminobutyric acid; BHB, β-hydroxybutyric acid; FFA, free fatty acids; ROS, reactive oxygen species; NPY, neuropeptide Y; AgRP, agouti gene-related protein.
What is the link between ketones and diabetes? Ketone is a chemical produced by the body when fats are broken down for energy. Ketone testing is important for people with diabetes, because high levels can lead to diabetic ketoacidosis (DKA), when acid levels become too high in the blood and the person loses consciousness. Find out when and why to do ketone testing. Read now
Bread is one of the foods that people miss most on keto – at least I know I did – and a loaf of almond flour bread is a great alternative. But, for a lot of folks, it’s quite a task to make, because you have to separate eggs, and whisk the whites to stiff peaks and so on. So, for those folks on the go, or those without ovens and those simply without the time or inclination to cook, this 90-second keto bread made in the microwave is the perfect solution. It’s literally as simple as mixing a few ingredients in a mug and popping it in the microwave. And in less than two minutes you have a keto friendly bread, almost as easy as putting bread in the toaster.
A reduced availability of dietary carbohydrates leads to an increased liver production of KBs. The liver cannot utilize KBs because it lacks the mitochondrial enzyme succinyl-CoA: 3-ketoacid (oxoacid) CoA transferase (SCOT) necessary for activation of acetoacetate to acetoacetyl CoA. KBs are utilized by tissues, in particularly by brain. KBs enter the citric acid cycle after being converted to acetyl CoA by hydroxybutyrate dehydrogenase (HBD), succinyl-CoA: 3–CoA transferase (SCOT), and methylacetoacetyl CoA thiolase (MAT). Modified from Owen (2005), Paoli et al. (2014).

An increase in fat burning ability could improve endurance capacity: as body fat represents a larger store of energy (150,000 kCal) compared to carbohydrate (2000 kCal), a greater ability to burn fat during exercise could prolong endurance performance. Whilst the theory appears sound, there is only one study showing an IMPROVEMENT in performance with a low carbohydrate diet18, with many showing no clear benefit of a low carbohydrate diet 19 ,20.    

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?
Ketones may also have effects in neurons beyond their use as an energy source. Preliminary work shows ketones can affect neurotransmitter release, reduce inflammation in the brain and reduce damage caused by oxidative stress8. Whilst the strength of the clinical evidence supporting the use of ketosis varies according to the condition, future work should look to explore the efficacy and underlying mechanisms further. Ketosis (by diet or by exogenous ketones) could offer an intervention that has good efficacy, but without the side effects profile of many drugs currently in use. It should be noted that the use of ketogenic diet or exogenous ketones in the conditions discussed below is still classified as ‘experimental’ in the most part and so individuals should not their alter medication or diet without full medical supervision.  
The 2 major issues that will lead to a flat loaf is not whipping the egg whites and gently folding them in OR using almond meal instead of a finely ground almond flour. If you've tried everything and they don't seem to be working for you, the next best option will be to make a larger recipe. Try making 1.5x this recipe (it's easy to do using the servings slide bar) and you'll have a much larger loaf.