Dr. Campos, it is unfortunate that you retain the medical community’s negative stance on the ketogenic diet, probably picked up in medical school when you studied ketoacidosis, in the midst of an obesity and type II diabetes epidemic that is growing every year, especially among populations who will never see the Harvard Health Letter. The medical community has failed in reversing this trend, especially among children, and the public is picking up the tab, in the form of higher health insurance premiums to treat chronic metabolic diseases which doctors cannot cure. The ketogenic diet does not bid its adherents to eat unhealthy processed meats, and the green leafy vegetables that it emphasizes are important in a number of nutritional deficiencies. People lose weight on the ketogenic diet, they lose their craving for sugar, they feel more satiety, they may become less depressed, their insulin receptors sensitivity is improved, and these are all the good outcomes you fail to mention. There is a growing body of research which demonstrates the neuroprotective effects of the ketogenic diet to slow cancer progression, as well as diseases like Parkinson’s and Alzheimer’s, for which there are no effective medical treatments. Please respect your patients by providing them with evidence-based medical outcomes, not opinions.

Insulin resistance also may increase your risk for metabolic syndrome. Insulin resistance is a condition in which the body can’t use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it’s used for energy. Insulin resistance can lead to high blood sugar levels, and it’s closely linked to overweight and obesity. Genetics (ethnicity and family history) and older age are other factors that may play a role in causing metabolic syndrome.

Hi Howard, You’re right that this bread doesn’t rise much – the volume comes mostly from whipping the egg whites. If the whites fell too much, the bread might not be tall enough. But even if they didn’t, it might still be shorter than some other tall bread loaves. Feel free to multiply the recipe by 1.5 if you prefer a taller loaf. I’m glad you liked the flavor and texture!
The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with "insulin resistance." Insulin resistance means that the body does not use insulin efficiently to lower glucose and triglyceride levels. Insulin resistance is a combination of genetic and lifestyle factors. Lifestyle factors include diet, activity and perhaps interrupted sleep patterns (such as sleep apnea).
Lower HbA1c: HbA1c is an abbreviation for ‘glycosylated hemoglobin.’ Hemoglobin is a protein inside red blood cells, this means it is always exposed to the substances that circulate in the blood (i.e glucose). When glucose levels are high, glucose can bind to hemoglobin (i.e it becomes glycoyslated). As red blood cells survive inside the body for 100-120 days, the amount of glyosylated hemoglobin is a good indicator of long term glucose control. The healthy limit for HbA1C is below 5.7% (Source: WebMD). 
Acetone is a molecule that results from the breakdown of acetoacetate. Acetone is commonly referred to as a ‘waste product’ as it is less readily used as energy compared to BHB (although some studies have shown that acetone can be oxidised as a fuel4. That said, some evidence suggests that it is responsible for the antiseizure effects of ketogenic diets so in may not be completely inert. At low levels acetone in the breath corresponds well to levels of ketones in the blood 12,13, however this is not the case as blood BHB levels increase 13 and if the increase is rapid, such as with exogenous ketone consumption11. 
The key sign of metabolic syndrome is central obesity, also known as visceral, male-pattern or apple-shaped adiposity. It is characterized by adipose tissue accumulation predominantly around the waist and trunk.[5] Other signs of metabolic syndrome include high blood pressure, decreased fasting serum HDL cholesterol, elevated fasting serum triglyceride level, impaired fasting glucose, insulin resistance, or prediabetes. Associated conditions include hyperuricemia; fatty liver (especially in concurrent obesity) progressing to nonalcoholic fatty liver disease; polycystic ovarian syndrome in women and erectile dysfunction in men; and acanthosis nigricans.
In addition to the seaweed and glycogen carbohydrates mentioned above, the Inuit can access many plant sources. The stomach contents of caribou contain a large quantity of partially digested lichens and plants, which the Inuit once considered a delicacy. They also harvested reindeer moss and other lichens directly. The extended daylight of the arctic summer led to a profusion of plant life, and they harvested plant parts including berries, roots and stems, as well as mushrooms. They preserved some gathered plant life to eat during winter, often by dipping it in seal fat.[71]
There is debate regarding whether obesity or insulin resistance is the cause of the metabolic syndrome or if they are consequences of a more far-reaching metabolic derangement. A number of markers of systemic inflammation, including C-reactive protein, are often increased, as are fibrinogen, interleukin 6, tumor necrosis factor-alpha (TNF-α), and others. Some have pointed to a variety of causes, including increased uric acid levels caused by dietary fructose.[18][19][20]
^ Brunner EJ, Hemingway H, Walker BR, Page M, Clarke P, Juneja M, Shipley MJ, Kumari M, Andrew R, Seckl JR, Papadopoulos A, Checkley S, Rumley A, Lowe GD, Stansfeld SA, Marmot MG (November 2002). "Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: nested case-control study". Circulation. 106 (21): 2659–65. doi:10.1161/01.cir.0000038364.26310.bd. PMID 12438290.
We can say that no species, including humans, could have survived for millions of years without the ability to withstand brief periods of hunger or starvation (Amen-Ra, 2006). These periods of fasting are themselves ketogenic (McCue, 2010) during which the concentrations of insulin and glucose decrease while that of glucagon increases in the attempt to maintain normal blood glucose levels. When the body passes from a condition of food abundance to one of deprivation (or else via VLCKD simulated deprivation), there is, with a slight delay, an increase in the concentration of free FAs as well as KB in the blood. Thus, from this point of view KD could be compared to caloric restriction for fasting. These manipulations of nutrients, both in quantity and quality, seem to not only act on blood glucose/KB level but also to promote changes in metabolic pathways and cellular signaling. How this kind of metabolic condition (ketosis) can affect satiety and hunger mechanisms is still a matter of debate.

There are many long-term benefits of being in ketosis. The benefit that is most important for many people is fat loss. Following the ketogenic diet even helps you to reduce the otherwise hard to lose belly fat. The primary reason why it is easy to lose excess fat on a ketogenic diet is the normalization of appetite. You don’t feel the need to overeat, day in and day out. Most people find it easy to lose weight on a ketogenic diet, even morbidly obese people that have tried failed on multiple other diets.
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This is the best keto bread I have ever made! By far! My bread was a little flat, but I think my baking powder needs to be replaced. I did make two substitutions with this recipe. I replaced egg whites with whole eggs, and ghee with coconut oil. Everything else, I already had on hand. I will definitely make this again and play with it a little. Really delicious bread.
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.
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This bread looks amazingly awesome and I will be trying it soon, but with a gluten free psyllium husk brand. I just wanted to point out that J Robb’s Psyllium Husk package declares the presence of WHEAT. Read the label listed on his website. Using his Psyllium Husk would make the bread NOT gluten free. It also states that it has a multitude of other allergens and possibly all of them are in a package at the same time. Just a heads up.

I want to say thank you. I don’t always have time to bake, and this is a life saver, of sorts. My brother is diabetic, and his doctor recommended a low-carb diet; I’m diabetic also, and gluten intolerant. This bread has the most wonderful taste and texture, and is so quick and easy, I’ve already committed the recipe to memory. Even my SO, who is neither gluten free nor diabetic, likes the taste and texture. I did cut down the salt, because like some others, I found the 1/4 teaspoon to be too salty. Other than that, raves and kudos!! We are thrilled, and planning all the different ways we’re going to use this bread. Many thanks!!
Agree with post regarding salt omitted salt, grilled it first time. It definitely reminds me of corn muffins texture. This morning make recipe added 1 T. of swerve brown sugar and dash or cinnamon,nutmeg and chopped walnuts OMG. It was great topped with cream cheese frosting(cream cheese,butter ,vanilla and swerve confection .Thanks can’t wait to try pumpkin spice next time I’m craving carrot cake thanks so much!
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.
For a given quantity of fuel, the maximum amount of work that can be obtained from that fuel in a closed system is called ‘the Gibbs free energy’ (G). This takes into account the inherent ‘heat’ (combustion enthalpy (H)) and a property called entropy (a measure of tendency towards ‘disorder’ (S). The change in Gibbs free energy (∆G) is related to the change in combustion enthalpy (∆H), change in entropy (∆S) and the temperature (T):
AMPK is activated through phosphorylation of the Thr172 residue of the AMPK α catalytic subunit [174–176], and this phosphorylation is largely regulated by molecules related to bioenergetic homeostasis including AMP, ADP, catecholamines, adiponectin, glycogen, and insulin. In general, AMPK is activated by energy deficit and induces signaling that upregulates energy production. AMP and ADP are direct byproducts of energy depletion while adiponectin and catecholamines serve as endocrine signals to increase energy production, often in response to energy depletion. In contrast, indications of energy surplus, such as glycogen and insulin, inhibit activation of AMPK. Nutritional ketosis increases the aforementioned factors that activate AMPK and decreases those that inhibit AMPK, suggesting that nutritional ketosis is similar to caloric restriction in inducing a signal of energy depletion.
Unfortunately I did not care for this recipe. I’ve been cooking snow I was 8yrs old and cook everything from scratch but I always make a recipe and follow it to a T the first time..based on that..this was like eating scrambled eggs..the taste was very very eggy! Texture was like scrambled eggs too on the inside.. Also very very salty!! I’m wondering if taking out the yolk and eliminating half the salt could make this better. I’m bummed because I really wanted to like it. 
Ana, We like using a combination of almond flour and coconut flour for this bread to achieve the best flavor and texture. We haven’t tried this bread using only coconut flour, but it may work. Coconut flour absorbs liquid differently, so you’ll want to use about 1/4 the amount of coconut flour as almond flour (since the recipe calls for 2 cups almond flour, that would be 1/2 cup coconut flour in addition to the 3/4 cup coconut flour that the recipe already calls for). However, the flavor and texture of this bread will likely be different with that substitution. Please let us know how it goes if you give it a try!
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