Excess abdominal fat leads to excess free fatty acids in the portal vein, increasing fat accumulation in the liver. Fat also accumulates in muscle cells. Insulin resistance develops, with hyperinsulinemia. Glucose metabolism is impaired, and dyslipidemias and hypertension develop. Serum uric acid levels are typically elevated (increasing risk of gout), and a prothrombotic state (with increased levels of fibrinogen and plasminogen activator inhibitor I) and an inflammatory state develop.
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]
Have breakfast within an hour or two of waking up and then eat a snack or meal every three to six hours after that, says Rebecca Denison, RD, doctor of integrative medicine and diabetes educator at Greater Baltimore Medical Center’s Geckle Diabetes and Nutrition Center. This will add up to three to six total meals and snacks daily. It takes about four to six hours for your body to digest a meal. “You want to eat just a teeny bit before you actually need it so that your body doesn’t have to figure out how to keep your blood sugar stable,” Denison explains.
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Even without the gluten of a traditional tortilla, this keto bread recipe creates a soft and pliable alternative perfect for all your favorite taco fillings. Almond and coconut flours keep carbs to a minimum, while xanthan gum holds everything together. Each tortilla tallies up to 2 net carbs, and takes only five minutes to cook. No Bulletproof substitutions needed — just avoid eating xanthan gum too often.
It is known that different dietary components exert some effects on gut microbiome composition, mainly in relation to obesity and inflammatory states. In general, a Mediterranean diet has a positive effect while a high-protein diet seems to have detrimental effects due to putrefaction phenomena (Lopez-Legarrea et al., 2014; Flint et al., 2015). Few data are available at this time about the effects of KD on gut microbiota. For example, a study by Crawford et al. (2009) investigated the regulation of myocardial ketone body metabolism by the gut microbiota and demonstrated that, during fasting, the presence of gut microbiota improved the supply of ketone bodies to the heart where KBs were oxidized. In the absence of a microbiota, low levels of KB was associated with a related increase in glucose utilization, but heart weight was still significantly reduced. The myocardial-mass reduction was completely reversed in germ-free mice feeded with a ketogenic diet. Regarding food control we can hypothesize that the particular metabolic state of ketosis could provide some benefit to weight and food control via synergic actions between butyrate production by gut bacteria and circulating high blood ketones (Sanz et al., 2015).
Brandi, Oh no, I’m sorry to hear about such a severe allergy! We carefully tested and re-tested this recipe and this is the best version we came up with. In order to come up with a recipe that doesn’t use coconut flour, we’d have to play around with not only alternative flours, but also adjust the amount of liquid (because coconut flour absorbs more liquid than most other flours), and additionally, potentially alter the bake temperature and bake time as well. I have a recipe for Paleo Sandwich Bread on my other blog that doesn’t use coconut flour that you might be interested in: https://www.anediblemosaic.com/best-paleo-sandwich-bread/. I hope this is helpful!
I found your recipes and was eager to try them! This morning I made the almond and coconut flour bread, blueberry muffin and the pancakes for family breakfast. They were all delicious!! I was amazed at how moist they were. However, even thought the bread was light, it did not achieve the height shown with the recipe. I need advice on how to achieve a higher loaf. My family was delighted at the healthier version of our Sunday morning breakfast. Thank you, Maya, for the time and effort spent in perfecting and sharing your recipes.
A ketogenic diet could be an interesting alternative to treat certain conditions, and may accelerate weight loss. But it is hard to follow and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. We also do not know much about its long-term effects, probably because it’s so hard to stick with that people can’t eat this way for a long time. It is also important to remember that “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.

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^ Yiu H. Hui (February 1985). Principles and issues in nutrition. Wadsworth Health Sciences Division. p. 91. Retrieved 2014-05-19. Eskimos actually consume more carbohydrates than most nutritionists have assumed. Because Eskimos frequently eat their meat raw and frozen, they take in more glycogen than a person purchasing meat with a lower glycogen content in a grocery store. The Eskimo practice of preserving a whole seal or bird carcass under an intact whole skin with a thick layer of blubber also permits some proteins to ferment into carbohydrates.


So how does this work? A quick run-through: The first tip was to eat low carb. This is because a low-carb diet lowers your levels of the fat-storing hormone insulin, allowing your fat deposits to shrink and release their stored energy. This tends to cause you to want to consume less calories than you expend – without hunger – and lose weight. Several of the tips mentioned above are about fine-tuning your diet to better this effect.
Thank you Mira for your quick reply. I didn’t make it that same day but I just made a batch now and they are excellent! I really enjoyed them. I made the recipe times 10 for 12 large muffin slots in the muffin tin. I’m thinking of shaping a larger round of batter on a parchment lined pan next time and after baking, carefully cutting in half to make 2 rounds to make a pizza crust. Thank you so much!!!
A recent systemic review and meta-analysis of randomized controlled trials comparing the long-term effects (greater than 1 year) of dietary interventions on weight loss showed no sound evidence for recommending low-fat diets. In fact, low-carbohydrate diets led to significantly greater weight loss compared to low-fat interventions. It was observed that a carbohydrate-restricted diet is better than a low-fat diet for retaining an individual’s BMR. In other words, the quality of calories consumed may affect the number of calories burned. BMR dropped by more than 400 kcal/day on a low-fat diet when compared to a very low-carb diet.
^ Jump up to: a b Sinclair, H. M. (1953). "The Diet of Canadian Indians and Eskimos" (PDF). Proceedings of the Nutrition Society. 12 (1): 69–82. doi:10.1079/PNS19530016. ISSN 0029-6651. It is, however, worth noting that according to the customary convention (Woodyatt, 1921 ; Shaffer, 1921) this diet is not ketogenic since the ratio of ketogenic(FA) to ketolytic (G) aliments is 1.09. Indeed, the content of fat would have to exactly double (324 g daily) to make the diet ketogenic (FA/G>1–5).

The previous definitions of the metabolic syndrome by the International Diabetes Federation[40] and the revised National Cholesterol Education Program are very similar and they identify individuals with a given set of symptoms as having metabolic syndrome. There are two differences, however: the IDF definition states that if body mass index (BMI) is greater than 30 kg/m2, central obesity can be assumed, and waist circumference does not need to be measured. However, this potentially excludes any subject without increased waist circumference if BMI is less than 30. Conversely, the NCEP definition indicates that metabolic syndrome can be diagnosed based on other criteria. Also, the IDF uses geography-specific cut points for waist circumference, while NCEP uses only one set of cut points for waist circumference regardless of geography. These two definitions are much more similar than the original NCEP and WHO definitions.
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]
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Add yeast and maple syrup (to feed the yeast, see notes) to a large bowl. Heat up water to 105-110°F, and if you don't have a thermometer it should only feel lightly warm to touch. Pour water over yeast mixture, cover bowl with a kitchen towel and allow to rest for 7 minutes. The mixture should be bubbly, if it isn't start again (too cold water won't activate the yeast and too hot will kill it). 
Although convincing, the bulk of evidence in relation to the inhibitory effects of ketosis on appetite is still anecdotal. Preliminary scientific reports seem to support this phenomenon, and the evidence shows that KD is more effective, at least in the short/medium-term, on fat loss (Paoli, 2014). It was demonstrated that diet-induced weight loss leads to changes in energy expenditure and in appetite-regulating hormones that facilitate weight regain and the return to initial energy homeostasis (Sumithran et al., 2011). This response to alteration of energy balance nullifies the success of many dietary approaches. It is well-known that the long-term success of a nutritional approach is defined by the amount of weight regain and is the main problem regarding the so-called weight cycling or “yo-yo” effect (Jeffery, 1996). A recent study by our group has demonstrated that a brief ketogenic period, if followed by a longer period of correct Mediterranean diet could avoid this yo-yo effect (Paoli et al., 2013). During the ketogenic period subjects reported less hunger, confirming previous studies (Nickols-Richardson et al., 2005; Johnston et al., 2006; Johnstone et al., 2008) on hunger-suppression effect of ketogenic diet. Despite these clinical findings, the mechanisms of action of ketosis on appetite reduction are still not completely understood. Clinical results are suggestive of both direct and indirect (via modifications of hunger-related hormones concentration) actions of KBs on appetite (Sumithran et al., 2013).
Some investigators feel that mitochondrial dysfunction and compromised brain glucose metabolism may play a role in the development of autism. As autism is sometimes accompanied by seizures such as those seen in epilepsy (which could be improved by the ketogenic diet), the diet has been trialled in a small number of case studies. These cases have shown that the ketogenic diet can lead to improvements in the childhood autism rating scale score 78 ,79, however dietary adherence may prove even more of a challenge with these children, decreasing the viability of the ketogenic diet as an intervention.   
Maya, this is a beautiful looking bread. I’m going to try it, but before I do, I’d like to know if you have ever tried doubling the recipe. It seems that it would work–based on the fact that my almond flour bread that I have made for years uses 3 1/4 cups flour, and turns out pretty well. (I’m pretty content with my recipe, but admit that yours looks better due to the whiteness and it appears to have more air bubbles, indicating it’s probably lighter.) If I don’t hear from you, I’ll probably go ahead and double it, and use a 9×5 pan–wish me luck.
Comments are welcomed and encouraged. The purpose of comments on our site is to expand knowledge, engage in thoughtful discussion, and learn more from readers.Criticism and skepticism can be far more useful than praise and unflinching belief.There’s an art and science to critical thinking and how to conduct yourself. There’s a multitude of fallacious appeals we could spell out, but a good rule of thumb is not to attack the person, attack the ideas. Don’t look for the flaws in the person, look for the flaws in the hypothesis. Let’s keep the brawling to movies depicting minor league hockey teams and political “news” shows.Thank you for adding to the discussion.
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.
I can’t find an 8×4 pan in the local stores, so while I wait for one to be shipped I went ahead and made these into hamburger bun shape. I don’t have a kitchen scale so I just measured everything super precise and got great results. I only have NOW brand psyllium husk powder so yes, they are an odd shade of purple but they taste great so I don’t care. What I really wanted was a vessel for butter and it made for a great snack before bed- which I know I’m not supposed to have but I was too curious to wait until morning! 🙂 Thanks for the update on this recipe, it made all the difference!
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 made this bread and as everybody knows it is wonderful. I have one problem though, my son loved it but the next day he told me he was gasy and a bit painful. I know that fiber causes some gas but I was wondering if you know from your experience with so many people, if this will go away after a while or does it mean that he shouldn’t eat any psyllium husk anymore…

For the eggs, beat the 4 eggs in a medium sized bowl until whites and yolks are combined.  Heat a medium skillet (I used the same skillet as the pancakes) over medium-low heat.  Add the butter and then the beaten eggs. Let the eggs cook until the edges begin to set.  push the eggs with a rubber spatula scraping the bottom of the pan.  scrape occasionally to get large folds of soft scrambled eggs.  When the eggs are just set and still a little runny, remove from the heat.  
Independent of nutritional ketosis, increased dietary fat intake increases expression of UCP2 and UCP3 in muscle [142], and fatty acids facilitate uncoupling through UCP2 [143, 144], UCP3 [94, 143, 144], and ANT [145]. Given the high fat intake that is characteristic of a ketogenic diet, it is logical to expect nutritional ketosis to increase mitochondrial uncoupling.
Blood tests often report the level of total cholesterol (HDL + LDL) as well as the levels of each type independently. It is possible that the relative abundance (ratio) of HDL: LDL is more important to predict the occurrence of cardiovascular disease that the total cholesterol level109. Whilst the ketogenic diet can cause an increase in total cholesterol, the ratio of healthy HDL : less healthy LDL generally increases (i.e more HDL)110 whilst following a ketogenic diet. In contrast, whilst total cholesterol tends to be lower whilst following a low fat diet, the ratio of HDL:LDL tends to be lower (i.e more LDL)21. 
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.
Ceejoy – Please don’t give into fear mongering. There is nothing wrong with the microwave. It is 100% safe to use. If you still want to not use one, that’s your choice but please don’t spread incorrect information and try and get people to be fearful of something that is safe. If you have any legit studies to prove this (recent ones) please share those.
In sheep, ketosis, evidenced by hyperketonemia with beta-hydroxybutyrate in blood over 0.7 mmol/L, occurs in pregnancy toxemia.[78][79] This may develop in late pregnancy in ewes bearing multiple fetuses,[78][79] and is associated with the considerable glucose demands of the conceptuses.[80][81] In ruminants, because most glucose in the digestive tract is metabolized by rumen organisms, glucose must be supplied by gluconeogenesis,[82] for which propionate (produced by rumen bacteria and absorbed across the rumen wall) is normally the principal substrate in sheep, with other gluconeogenic substrates increasing in importance when glucose demand is high or propionate is limited.[83][84] Pregnancy toxemia is most likely to occur in late pregnancy because most fetal growth (and hence most glucose demand) occurs in the final weeks of gestation; it may be triggered by insufficient feed energy intake (anorexia due to weather conditions, stress or other causes),[79] necessitating reliance on hydrolysis of stored triglyceride, with the glycerol moiety being used in gluconeogenesis and the fatty acid moieties being subject to oxidation, producing ketone bodies.[78] Among ewes with pregnancy toxemia, beta-hydroxybutyrate in blood tends to be higher in those that die than in survivors.[85] Prompt recovery may occur with natural parturition, Caesarean section or induced abortion. Prevention (through appropriate feeding and other management) is more effective than treatment of advanced stages of ovine ketosis.[86]
As described throughout the previous sections, there are many instances of codependencies and feed-forward loops in bioenergetic and antioxidant signal transduction, which supports the well-known potential for metabolic stimuli, such as diet or exercise, to have a profound physiological influence. Given the central role of mitochondria in oxidative phosphorylation and ROS production, the overlap between bioenergetic and antioxidant signaling is not surprising and is possibly an outcome of evolution favoring efficiency. PGC-1α is at the center of this overlapping and complex network of codependencies. The likely role of PGC-1α as a coactivator of FOXO3a indicates a possible dependence of FOXO3a transcriptional activity on PGC-1α [287], indicating FOXO3a as a central mediator as well. Furthermore, FOXO3a induces transcription of PGC-1α [287, 322, 367], and formation and antioxidant transcriptional activity of the PGC-1α-FOXO3a complex are partly dependent on interaction with SIRT1 [325]. In muscle, expression of many of the bioenergetic and antioxidant proteins previously discussed is dependent on PGC-1α [265]. Upstream, activation of PGC-1α is dependent on AMPK [242] and SIRT1 [242, 269] and partly dependent on SIRT3 [270]. Furthermore, activation of SIRT1 is dependent on AMPK [242], which may also be the case for SIRT3. AMPK and PGC-1α are therefore two key factors, with critical supporting roles of the sirtuins, in the signal transduction linking bioenergetics to antioxidant defense. Further supporting the relevance of this linkage to nutritional ketosis, expression of AMPK, SIRT1, FOXO3a, and NFE2L2 is required for extension of lifespan in C. elegans by exogenous BHB [95], and expression of AMPK, p38 MAPK, and NFE2L2 is required for the extension of lifespan, also in C. elegans, by mitohormesis induced through inhibition of glucose metabolism [73]. The induction of AMPK [259, 260], SIRT3 [263, 329], p38 MAPK [310–313], PGC-1α [76, 77, 260, 282, 283], FOXO3a [324, 331, 333], and NFE2L2 [358–360] activity by oxidative stress also makes this signaling highly relevant to mitohormesis [263, 282, 360], especially given that activation of these proteins has been shown to decrease mitochondrial or cellular ROS [76, 263, 282, 289, 323, 332, 334, 356, 359, 367]. Furthermore, mitochondrial biogenesis [346] and the activities of AMPK [259, 260], SIRT3 [329], p38 MAPK [311, 312], PGC-1α [76, 77, 260, 283], FOXO3a [324], and NFE2L2 [368] are increased by H2O2, more specifically associating this signaling with mitohormesis. Given that AMPK and sirtuins are upstream of the majority of this signaling and that AMPK and sirtuin activities are stimulated by both bioenergetic and oxidative stressors, these stressors are likely the primary signals through which nutritional ketosis may induce the mitochondrial and antioxidant adaptations characteristic of mitohormesis (Figure 2).
The use of lifestyle interventions to treat and prevent chronic disease is attractive because of their potential to lower medical costs and produce more robust and holistic improvements in health. Ketogenic diets have been studied sporadically for more than 100 years, but over the last 15 years, a growing number of researchers have contributed to what is now a critical mass of discoveries that link the process of keto-adaptation to a broad range of health benefits [10–33]. Early clinical research focused on the use of “extreme” versions of ketogenic diets to treat seizures, but recent research indicates that benefits related to the management of epilepsy, weight loss, metabolic syndrome, and type 2 diabetes can be achieved with an approach that is less restrictive in carbohydrate and protein, and therefore more satisfying, sustainable, and feasible for the general population. A “well-formulated” ketogenic diet is generally characterized by a total carbohydrate intake of less than 50 g/d and a moderate protein intake of approximately 1.5 g/d per kg of reference weight [34]. This typically increases circulating β-hydroxybutyrate (BHB) and acetoacetate (ACA) from concentrations that are typically less than 0.3 mM into the range of nutritional ketosis, which for BHB, we define as 0.5–3 mM [35]. This range is below the typical 5–10 mM range for BHB that occurs during prolonged fasting, and well below concentrations characteristic of ketoacidosis [34, 35]. From the perspective of meeting energy demands, the reduced carbohydrate and moderate protein intakes necessarily make ketogenic diets high in fat. Despite this contradiction with mainstream dietary guidelines, ketogenic diets may be beneficial for many health conditions, particularly the previously mentioned conditions related to mitochondrial impairment, which includes obesity [10, 11], diabetes [12–14], cardiovascular disease [15–17], cancer [15, 18–26], neurodegenerative diseases [19, 20, 27–30], and even aging [31–33, 36, 37].
If you are diagnosed with metabolic syndrome, the goal of treatment will be to reduce your risk of developing further health complications. Your doctor will recommend lifestyle changes that may include losing between 7 and 10 percent of your current weight and getting at least 30 minutes of moderate to intense exercise five to seven days a week. They may also suggest that you quit smoking.
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143. Echtay K. S., Winkler E., Frischmuth K., Klingenberg M. Uncoupling proteins 2 and 3 are highly active H+ transporters and highly nucleotide sensitive when activated by coenzyme Q (ubiquinone) Proceedings of the National Academy of Sciences. 2001;98(4):1416–1421. doi: 10.1073/pnas.98.4.1416. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Triglycerides are a common form of fat that we digest. Triglycerides are the main ingredient in animal fats and vegetable oils. Elevated levels of triglycerides are a risk factor for heart disease, heart attack, stroke, fatty liver disease, and pancreatitis. Elevated levels of triglycerides are also associated with diseases like diabetes, kidney disease, and medications (for example, diuretics, birth control pills, and beta blockers). Dietary changes, and medication if necessary can help lower triglyceride blood levels.
Emerging data suggest an important correlation between metabolic syndrome and risk of stroke. [58] Each of the components of metabolic syndrome has been associated with elevated stroke risk, and evidence demonstrates a relationship between the collective metabolic syndrome and risk of ischemic stroke. [59] Metabolic syndrome may also be linked to neuropathy beyond hyperglycemic mechanisms through inflammatory mediators. [60]
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.

Physical inactivity is a predictor of CVD events and related mortality. Many components of metabolic syndrome are associated with a sedentary lifestyle, including increased adipose tissue (predominantly central); reduced HDL cholesterol; and a trend toward increased triglycerides, blood pressure, and glucose in the genetically susceptible. Compared with individuals who watched television or videos or used their computers for less than one hour daily, those who carried out these behaviors for greater than four hours daily have a twofold increased risk of metabolic syndrome.[27]


While it is believed that carbohydrate intake after exercise is the most effective way of replacing depleted glycogen stores,[72][73] studies have shown that, after a period of 2–4 weeks of adaptation, physical endurance (as opposed to physical intensity) is unaffected by ketosis, as long as the diet contains high amounts of fat, relative to carbohydrates.[74] Some clinicians refer to this period of keto-adaptation as the "Schwatka imperative" after Frederick Schwatka, the explorer who first identified the transition period from glucose-adaptation to keto-adaptation.[75]
A giant, late-night dinner is your blood sugar’s worst enemy. That’s because our bodies become more insulin resistant as the day goes on—so a meal that you eat in the evening will cause a greater spike in blood sugar than a meal you eat in the morning. Because of this, many nutrition experts advise front-loading your meals, or eating bigger meals earlier in the day and having a smaller dinner at least three hours before bed.
In recent times there has been an exponential increase in the rates of obesity and diabetes. Popular opinion has blamed (in turn) overconsumption of fat, overconsumption of carbs and sugar and overconsumption of calories. Whilst the overall calorie balance is a crucial factor that cannot be overlooked, it is also the case that different macronutrients in the diet (especially carbs and fat) have different effects on the body when consumed.  
This paleo keto bread recipe makes a delicious option for coconut lovers. For a low-fuss loaf, blend coconut flour with ingredients like eggs, coconut oil, and salt — then bake away for a sturdy bread with only 1.3 net carbs per serving. Make this recipe totally nut-free (and more Bulletproof) by swapping almond milk with full-fat canned coconut milk.
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