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Metabolic syndrome is a common condition that goes by many names (dysmetabolic syndrome, syndrome X, insulin resistance syndrome, obesity syndrome, and Reaven syndrome). Most people identified as having this syndrome have been educated about the importance of watching for signs of diabetes, having their blood pressure monitored and lipid levels checked, and exercising – but there has been little to tie all of these factors together except pursuit of a "healthier lifestyle."

I have tried four times to make the bread recipe with no success, but on my next try I will make sure the egg whites are truly room temp. I have not seen that come up in any discussion but it’s the only thing I can think of at this point. I am an experienced baker, not a novice. I added 1/8 tsp each garlic powder and onion powder and added 1/2 tsp stevia powder. These make the flavor a little more complex and definitely solves the complaint of vinegar or fiber taste. The taste is very good. However unlike some other disappointed bakers on this site, I did not throw away the failed attempts. I took the wet heavy bread from one failed try and tore it into small bits to dry for bread pudding with whiskey sauce. That is DELICIOUS, the next failed batch was sliced very thin and cut in half vertically for “toast points.”. I dried the pieces on a cookie sheet in a 300 degree oven until dry and somewhat brown and crispy. They taste EXACTLY like bagel chips we used to buy. My next batch became seasoned bagel crisps. I still want bread, but these are GREAT! Please don’t throw away failed attempts! There are other uses! I also fried some of my dried cubes in garlic oil for croutons, which were also delicious. I’m still trying, because I think if you can do it, surely I can do it.
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The notion that metabolic syndrome, or its surrogate markers hyperinsulinemia and insulin resistance, antedate and contribute to the pathogenesis of coronary heart disease, diabetes, and at least some cases of hypertension was proposed many years ago.21,35 Coronary heart disease in the setting of metabolic syndrome can to a great extent be attributed to dyslipidemia (increased dense LDL cholesterol, diminished HDL cholesterol, and hypertriglyceridemia)231 as well as to elevations in blood pressure and blood glucose and the presence of a procoagulant, proinflammatory state.22,228 In addition, some studies suggest that hyperinsulinemia and insulin resistance, as well as hyperglycemia, may be independent risk factors.51 Whether elevated FFA levels or a dysregulation of intracellular fatty acid metabolism contribute to atherosclerosis by directly altering the function of endothelium (see the section entitled “Vascular Endothelial Cells and Atherogenesis”) or other cells in the vascular wall remains to be determined. Relevant to this discussion, low levels of adiponectin are associated with an increased risk for coronary heart disease in humans,155 whereas, as noted earlier, overexpression of adiponectin or its globular subunit diminishes the severity of atherosclerosis in ApoE–/– mice.232,233

I tried this recipe today and I’m blown away. I haven’t started Keto yet but I am soon. I’ve been trying recipes out, and I truly didn’t expect this to come out right the first time because I’ve never whipped egg whites or folded them into anything. I’m a terrible baker. It was so easy! Even my toddler and husband loves this! I didn’t use the sweetener and love the way it tastes!
Cheryl, We use beef gelatin in this recipe to act as a binder and add a bit more chewiness to help simulate regular bread. (If you’re interested, we talk more about using beef gelatin in keto baking in this post: We haven’t experimented with this recipe to omit the beef gelatin, but you might be able to get a similar result using a bit more psyllium husk powder, flaxseed meal, ground chia seeds, xanthan gum, or guar gum. If you decide to play around with the recipe, please let us know how it goes!
So, if I’m deprived of a dietary source of glucose, I depend solely on my liver to release glycogen (a process known as hepatic glucose output, or HGO).  How long can HGO supply my brain with sufficient glucose? It depends on a few things that impact both the “source” and the “sink” of glucose.  Other competing sinks for glucose (e.g., activity level, thermogenic needs) and sources (e.g., glycerol and gluconeogenic amino acid availability) can make a difference for a while. But, in a state of starvation we’ve only got about one to three days before we’re in trouble.  If our brain doesn’t get a hold of something else, besides glucose, we will die quite unceremoniously.
Based on the reciprocal activation described above, nutritional ketosis is likely to activate SIRT1 and SIRT3 indirectly through activation of AMPK. However, more direct activation of sirtuins by nutritional ketosis is possible. Since reduction of NAD+ to NADH occurs outside of mitochondria only during glycolysis, which is less active during nutritional ketosis, more cytosolic NAD+ remains oxidized, further facilitating activation of SIRT1 [247]. In addition to the decrease in glucose availability during nutritional ketosis, glycolysis may be further inhibited through activation of pyruvate dehydrogenase kinase and subsequent inhibition of pyruvate dehydrogenase (PDH), which occurs in response to dietary carbohydrate restriction [248–251] or infusion of BHB, ACA, or fatty acids [252]. Consistent with the relevance of these factors to nutritional ketosis, a ketogenic diet (% energy: 89 fat, <1 carbohydrate, and 10 protein) has decreased expression of PDH in mouse liver [36]. More importantly, there is direct evidence of nutritional ketosis promoting an increase in NAD+ concentration. Treatment with BHB + ACA (1 mM each) has increased NADH oxidation in rat neocortical mitochondria [109], and a ketogenic diet (Bio-Serv F3666) has increased NAD+ concentration in rat hippocampus [253]. There is also evidence of nutritional ketosis regulating sirtuin expression. A low-carbohydrate (20% of energy) diet combined with ketone esters (6% w/v) has increased SIRT1 protein content in brown adipose of mice [149], and a ketogenic diet (% energy: 90 fat, 0 carbohydrate, and 10 protein) has increased SIRT3 expression in mouse liver [37].
This bread does have quite a few ingredients, but you’ll find that most are staple paleo and keto pantry ingredients. In the list below you’ll find details on several ingredients and possible subs. But if possible, please do try and make this recipe without any subs. As out of the 18 permutations we tried, this one really was terrific and the absolute best.

Ketosis occurs either as a result of increased fat oxidation, whilst fasting or following a strict ketosis diet plan (ENDOGENOUS ketosis), or after consuming a ketone supplement (EXOGENOUS ketosis). When in a state of ketosis the body can use ketones to provide a fuel for cellular respiration instead of its usual substrates: carbohydrate, fat or protein. 
I have been making Maria’s bread in my convection oven for a while and I had to lower the temp considerably to make sure it didn’t burn on the outside (even with a shorter baking time). I have a “portable” convection oven and I had always assumed that convection was the way to go for baking. Then I read some more about it and saw that convection is best for meats, etc. but not for baking, and I tried using the ‘normal” baking setting. My bread was MUCH better baked on normal. I used the temperature in the recipe and the timing and it came out perfect. No monkeying around with settings or duration.
Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.
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I love how simple this recipe is and how quickly they bake!  My oven is broken and only goes to 350, so I had to adjust the bake time and think I slightly overbooked them as they were a bit dry.  I followed some of the comments’ recommendations and used half egg whites and half whole eggs (I made 4) and did not find them eggy.  They were light and fluffy, but a bit bland.  I added rosemary to 2 and garlic powder, cheddar cheese and parsley to 2.  I just eyeballed the additions and found them bland.  Next time I will add more herbs/cheese.  I did butter them and found they soaked up the butter – again maybe because they were dry?  I will definitely make these again.  Thanks again for a great quick and easy recipe!

Oh Maria! Your bread recipe is fabulous! I have been playing around with it a little because the psyllium was a little too much for my gut! Went to 8 TBS of psyllium and added 2 TBS of Jay Robb Protein Isolate powder and a little sweetener (trying to make a yeasty flavor) I also turned it into buns which are easier for my household. I must say they turned out great! I even added caraway seeds to one batch for a rye flavor! I cannot thank you enough for making it so much easier to eat right when you have BREAD, ROLLS and DESSERTS that are fabulous!
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.
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.
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).
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Everyone loves a bagel, lox and eggs for breakfast. While lox and eggs are keto-approved, bagels can cost you 48 grams of carbs or more depending on the seasonings or flavor. These keto bagels by Keto Connecthave only 3 grams of net carbs a serving and don’t skimp on flavor, thanks to everything bagel seasoning. This blogger uses cream cheese, almond flour and cheese to provide good protein and fat, with 10 grams and 15 grams respectively.
Maria – Love this recipe – took me 4 times before I got it how I wanted it and I add sesame seeds. Then I slice really really thin – about 1/2 cm then dry all the slices in the oven ready for toasting. However, right now I can only find baking powder with vanilla. Can I sub baking soda which together with the vinegar should work but how much? Can you help please?
The sirtuin isoforms SIRT1 [232, 233] and SIRT3 [234–236] are nicotinamide adenine dinucleotide- (NAD+) dependent deacetylases associated with longevity. Many reactions are regulated by the redox state of NAD+ and its phosphorylated form, NADP+. Among these reactions, a prominent role of reduced NADP+ (i.e., NADPH) is to support reductive biosynthesis and antioxidant defense, requiring the NADP+/NADPH ratio to be kept low [237]. In contrast, the NAD+/NADH ratio is kept high to support energy metabolism [237], thereby linking sirtuin function to bioenergetic status [238]. Although sirtuins are inhibited by high concentrations of NADH, their activity is influenced more by absolute NAD+ concentration than the NAD+/NADH ratio [238].
Last point of background: Everything I’ve just presented is based on data from starving subjects.  If one restricts carbohydrate intake, typically to less than about 20-50 gm/day (dependent on timing and carbohydrate composition), and maintains modest but not high protein intake (because protein is gluconeogenic – i.e., protein in excess will be converted to glycogen by the liver), one can induce a state referred to as “nutritional ketosis” with similar physiology to what I’ve just presented without resorting to starvation.  Why you’d do this is something I will discuss later.
Some Inuit consume as much as 15–20% of their calories from carbohydrates, largely from the glycogen found in raw meats.[43][44][47][45][50] Furthermore, the blubber, organs, muscle and skin of the diving marine mammals that the Inuit eat have significant glycogen stores that are able to delay postmortem degradation, particularly in cold weather.[51][52][53][54][55][56]

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!