Optimally, the management approach results in weight loss based on a healthy diet and regular physical activity, which includes a combination of aerobic activity and resistance training, reinforced with behavioral therapy. Metformin, an insulin sensitizer, or a thiazolidinedione (eg, rosiglitazone, pioglitazone) may be useful. Weight loss of ≈ 7% may be sufficient to reverse the syndrome, but if not, each feature of the syndrome should be managed to achieve recommended targets; available drug treatment is very effective.
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

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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!

If for any reason you get a fail…a spongy loaf , or one with a buble don’t throw it away. Cut off the top bubble and cut into squares or triangles then taost for great pita like chips…cube the bottom sprinkle on some spices and toast or rebake for croutons…I have had my successes and failures wih this loaf but the ingredients are too expensive to waste…another idea would be to toast the bottom after you slice the top off and then add butter, garlic and cheese for a good garlic bread.


In the absence of acetyl CoA (several ways this can happen, including substrate shortage, as I’m describing here) we evolved a cool trick.  Our liver can make – out of fat or protein, though we much prefer to use fat so we can spare our protein and prevent severe muscle wasting – something called beta-hydroxybutyrate, one of the 3 ketone bodies I described above.
Glucose-sensitive neurons have been identified in a number of CNS regions including the metabolic control centers of the hypothalamus. Medeiros et. al. have used patch-clamp electrophysiology to examine whether neurons in a specific specialized region known as the subfornical organ (SFO), an area where the blood-brain barrier is not present, are also glucose sensitive or not. These experiments demonstrated that SFO neurons are glucose-responsive and that SFO is an important sensor and integrative center of circulating signals of energy status (Medeiros et al., 2012).
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.
Hello from Jakarta, Indonesia! I just tried your recipe coz i was making an eggs bennedict & needed something for “bread”. Your recipe was BY FAR the easiest to make & quite tasty! Initially i was worried about the “eggy” taste, but didn’t happen. I think i will be making this often… i will pre-measure the 30gr of almond flour & cut up 10gr of butter pieces for easier assembly in the mornings. Cheers!
Nice and firm. Baked it on the recommended temp, added 6 or 7 minutes. Pressed the middle and it was great. I let it cool. What was nice about it was obviously it’s low carb bread…hurray for that, but it cut well. Got 18 slices easily about 1/2 inch thick without breakage. Most importantly, it wasn’t greasy, or almond tasting overload, just delicious.
In some cases epilepsy cannot be treated successfully using anticonvulsant medications. In some cases where drugs have failed, the ketogenic diet has been widely documented to deliver transformative seizure control, reducing frequency by anywhere between 40-90%43. Whilst the exact mechanisms underlying the beneficial effect of the ketogenic diet are unclear, the hypothesised mechanisms include:
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170. Garbow J. R., Doherty J. M., Schugar R. C., et al. Hepatic steatosis, inflammation, and ER stress in mice maintained long term on a very low-carbohydrate ketogenic diet. American Journal of Physiology-Gastrointestinal and Liver Physiology. 2011;300(6):G956–G967. doi: 10.1152/ajpgi.00539.2010. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
The metabolic syndrome can be induced by overfeeding with sugar or fructose, particularly concomitantly with high-fat diet.[36] The resulting oversupply of omega-6 fatty acids, particularly arachidonic acid (AA), is an important factor in the pathogenesis of metabolic syndrome.[medical citation needed] Arachidonic acid (with its precursor – linoleic acid) serve as a substrate to the production of inflammatory mediators known as eicosanoids, whereas the arachidonic acid-containing compound diacylglycerol (DAG) is a precursor to the endocannabinoid 2-arachidonoylglycerol (2-AG) while fatty acid amide hydrolase (FAAH) mediates the metabolism of anandamide into arachidonic acid.[37][35] Anandamide can also be produced from N-acylphosphatidylethanolamine via several pathways.[35] Anandamide and 2-AG can also be hydrolized into arachidonic acid, potentially leading to increased eicosanoid synthesis.[35]
Another product of elevated levels of free FA is polyunsaturated FA (PUFA). The potential ability of PUFA to block seizure activity in the brain is speculated to be associated with KD. Some mechanisms are thought to be a direct inhibition of voltage-gated sodium and calcium channels, modulation of a lipid-sensitive potassium channel, the activity of the sodium pump to limit neuronal excitability, or the induction of expression and activity of proteins in the mitochondria, thereby inducing a neuroprotective effect by partially inhibiting the production of reactive oxygen species (ROS) (Bough and Rho, 2007; Paoli et al., 2014).
Thank you for the recipe. I was going to give up gluten free bread making but your recipe made my day! I used ghee instead of butter as I was too lazy to melt butter. It rose prettily in the oven. Such a nice loaf of bread. Definitely not eggy and it even has the fluffiness of bread. I would like to double the recipe and make it in a 1 lb loaf pan. Do you think that’s feasible? Many thanks,
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.
^ Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F (October 2005). "Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement". Circulation. 112 (17): 2735–52. doi:10.1161/CIRCULATIONAHA.105.169404. PMID 16157765.

We have solid evidence showing that a ketogenic diet reduces seizures in children, sometimes as effectively as medication. Because of these neuroprotective effects, questions have been raised about the possible benefits for other brain disorders such as Parkinson’s, Alzheimer’s, multiple sclerosis, sleep disorders, autism, and even brain cancer. However, there are no human studies to support recommending ketosis to treat these conditions.
Metabolic syndrome is thought to be caused by adipose tissue dysfunction and insulin resistance. Dysfunctional adipose tissue also plays an important role in the pathogenesis of obesity-related insulin resistance. [18] Both adipose cell enlargement and infiltration of macrophages into adipose tissue result in the release of proinflammatory cytokines and promote insulin resistance. [19]
.. it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. What is unhealthy about red meat. We should know that acrilamides, pyrroles in burnt meat (and veges) from BBQ and over-heated cooking inflames the colon. According to Clark H R, PhD ND an inflamed part allows easy entry for the cancer nucleus and cancer complex, to start and fuel a malignancy at that location.
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.

As will be discussed in the following sections, many of the signaling proteins involved in regulating antioxidant defense also regulate oxidative phosphorylation and fat oxidation. There is abundant evidence (Table 1) showing ketogenic and low-carbohydrate diets to increase expression, content, or activity of many targets of these signaling proteins, further indicating increased oxidative capacity. It is particularly striking that ketogenic or low-carbohydrate diets upregulate expression of proteins associated with each of the five mtETC complexes.

4. Tapia P. C. Sublethal mitochondrial stress with an attendant stoichiometric augmentation of reactive oxygen species may precipitate many of the beneficial alterations in cellular physiology produced by caloric restriction, intermittent fasting, exercise and dietary phytonutrients: “Mitohormesis” for health and vitality. Medical Hypotheses. 2006;66(4):832–843. doi: 10.1016/j.mehy.2005.09.009. [PubMed] [CrossRef] [Google Scholar]
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If someone has already had a heart attack, their LDL ("bad") cholesterol should be reduced below 70mg/dl. A person who has diabetes has a heart attack risk equivalent to that of someone who has already one and so should be treated in the same way. If you have metabolic syndrome, a detailed discussion about lipid therapy is needed between you and your doctor, as each individual is unique.

Metabolic syndrome has been shown to be associated with an increased risk of cataract in several observational studies (Table 19.2). Paunksnis et al. reported an association between metabolic syndrome and cataract among middle-aged European men and women.16 In the Blue Mountains Eye Study (BMES), metabolic syndrome was associated with an increased risk of all subtypes of cataract including cortical, nuclear, and posterior subcapsular cataract (PSC) among elderly Australians.17 In a population of Malay adults in Singapore, a significant association between metabolic syndrome and cataract was also found.13 A dose–response relationship was also observed between an increasing number of metabolic syndrome components and cataract. Among the subtypes, cortical cataract showed a positive association with metabolic syndrome.13 Lindblad et al. examined a large, population-based cohort of Swedish women who participated in the Swedish Mammography Cohort and found that a combination of three components of metabolic syndrome, including raised waist circumference, diabetes, and hypertension, increased the risk of cataract extraction by 68% compared to those without any of these components.15 In addition, metabolic syndrome increased the risk of cataract extraction by approximately three-fold among women aged less than 65 years. Galeone et al. found that metabolic syndrome was associated with a two-fold increased risk of cataract extraction in a clinic-based study in Italy.14 Further, a significant linear trend in risk was also reported with an increasing number of metabolic syndrome components.


In skeletal muscle, impaired mitochondrial function contributes to age-associated atrophy, impaired contraction, and insulin resistance [2]. While exercise provides a direct stimulus for mitochondrial adaptation in muscle, with great potential to prevent or treat the aforementioned conditions, the global effects of exercise on bioenergetic homeostasis may lead to mitochondrial adaptations in other tissues as well. Based on this, exercise has the potential to influence any condition for which impairments in global energy metabolism or local mitochondrial function are a contributing factor, which is arguably the case for a majority of chronic diseases. Exercise is therefore an excellent adjunct to nutritional ketosis because it facilitates β-oxidation and ketogenesis by increasing energy demand and depleting glycogen storage, which is likely to augment the signaling induced by nutritional ketosis.
Metabolic syndrome (MetS) is the commonly observed clustering of obesity, hypertension, dyslipidemia, and insulin resistance. The components of MetS occur together more often than expected by chance and display significant heritability. Investigations into monogenic diseases that model features of the common MetS have uncovered responsible genes. Genome-wide association studies (GWAS) of the components of the MetS have been enormously successful. Meta-analysis of public GWAS data and risk-score analysis are revealing the role of common single-nucleotide polymorphism genotypes in MetS pathophysiology. A pleotropic polygenic architecture underlies MetS, making it a fascinating complex trait. Research will continue to uncover how metabolic pathways interact to form the MetS and its subsequent risk for atherosclerosis and diabetes.
Hi Amber, Yes, the baking powder and egg whites do help it rise a bit, just not as much as regular bread. It’s hard to say what went wrong, if anything. Everyone’s palate is a little different, so it’s possible you just didn’t like it, or maybe something didn’t go as it should have. It could be that the batter and whites weren’t folded together quite enough?
Patients with metabolic syndrome can have several disorders of coagulation that make it easier for blood clots to form within blood vessels. These blood clots are often a precipitating factor in developing heart attacks. Patients with metabolic syndrome should generally be placed on daily aspirin therapy to help prevent such clotting events. You should speak to a doctor, of course, before starting any new medication regimen.

Practically speaking, because it takes several days to raise blood ketone levels by following the ketogenic diet it has been virtually impossible to study the effects of ketosis on brain injury in humans. It is also complicated by the difficulty in quantifying the extent of the damage without repeated imaging and there is a lack of reliable biomarkers for concussion. Furthermore, concussions can’t be ‘administered’ to humans experimentally, making it impossible to study in a controlled setting. Therefore much of the proof of concept research looking a ketosis for concussion has been done in animals. Nevertheless, the results are promising: rats who were given a ketogenic diet or ketone precursors before67 and after68 a controlled concussive injury have were found to have improved brain energy metabolism, and improved cognitive and motor function post injury. Also, giving exogenous ketones as an injection post-injury protected the brain against glutamate induced excitotoxicity69 and alleviated the decrease in brain ATP that occurs due to the depression of glucose metabolism70. Therefore, as scientists’ ability to quantify concussion in humans improves, ketosis could be an interesting intervention to attempt to reduce the harmful after-effects.  
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sdLDL. This is a measurement of the number of small dense low-density lipoprotein molecules a person has. LDL varies in size, and the smaller denser molecules, which tend to form when elevated triglycerides and VLDL are present in the blood, are thought to be more aggressive in causing atherosclerosis. This test is now commercially available, but is not performed by many laboratories and is not ordered frequently. Its ultimate clinical utility has yet to be determined. It may be evaluated in a LDL particle testing.
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:

I have just tried this recipe and I am so pleased with the result ! I am not a confident baker but the recipe is quite easy to follow. I now have bread that I can use for sandwiches and looking forward in particular to toast for breakfast tomorrow. You have made me so happy as I was beginning to think that I would not be able to find an edible low carb/gluten free /dairy free bread. Not eggy at all and a lovely soft texture. I made it with the coconut oil as a dairy free alternative and the taste of the coconut is quite pronounced. I was interested to see that someone else used olive oil . Do you know what amount of olive oil would be appropriate ? Thank you again, I will be trying out your other recipes now that I have found your website.


There is also exciting early research suggesting that ketosis may be beneficial for many other conditions, such as reducing the frequency and severity of migraine headaches, reversing PCOS, perhaps enhancing conventional brain cancer therapies, possibly slowing down the progression of Alzheimer’s disease, along with potentially helping people live longer, healthier lives.

Eat 15 g less carbohydrates at your next meal. While skipping meals is not a healthy option for individuals with high blood sugar, decreasing the number of carbohydrates consumed at the next meal can help force your body to use the excess sugar. Check your blood sugar an hour after the meal and if your sugar level has decreased but is still high, decrease the next meal by 30 g of carbohydrates.

I was so excited about making this bread. I recently cut all grains out of my life and I’m also in the process of going gluten free because i have a lot of digestive issues. I followed the recipe precisely. Checked the temp before taking it out of oven. It looked amazing nice and golden brown. I cut into it and i couldn’t wait for that first bite. I was so disappointed it has an odd flavor I just couldnt stomach and it was very salty to me. I tried a few tiny bites with different condiments and couldn’t eat it. After reading some comments, I see it is supposed to be unsalted butter. I used salted, but why did it seem to have a bitter sour taste to it?
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BHB, in addition to being an important energy substrate, is also a signaling molecule [100–102]. Although not induced through mtROS, BHB inhibits class I and II histone deacetylases (HDACs) in a dose-dependent manner, resulting in greater histone acetylation regardless of whether BHB is elevated through fasting, caloric restriction, or infusion [103]. This inhibition is associated with increased expression of forkhead box O (FOXO) 3a and metallothionein II and increased protein content of FOXO3a, SOD2, and catalase [103]. Consistent with these changes, the kidneys of mice with elevated blood BHB concentrations (∼1.2 mM) were protected from paraquat-induced (50 mg/kg) oxidative damage to proteins and lipids, which was indicated by lower levels of protein carbonyls, 4-HNE, and lipid peroxides [103]. Upregulation of antioxidant defense by BHB-induced HDAC inhibition also appears to be the mechanism through which exogenous BHB extends lifespan in C. elegans [95]. The dependence of this response on FOXO3a, NFE2L2, and several bioenergetic signaling proteins that influence the activities of these two transcription factors [95] is indicative of the overlap between bioenergetics and antioxidant defense that is characteristic of mitohormesis.


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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