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Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [± SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m2. Hemoglobin A1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly.
Once you start eating this very low amount of carbs, you’re body will become keto adapted. You are starving it from the carbs therefore it needs to find a source of fuel. When you’re in ketosis, your body will no longer have the carbs it once used to fuel your body. It will have to resort to using your own body fat for fuel. This is amazing because you’ll lose body fat if that was your goal and many other benefits you’ll see below.
If you are wondering what the heck a daikon radish is, don’t worry, I was in the same boat this time last year. My first experience with daikon radish was in my CSA box. I actually got a purple daikon radish and had absolutely no idea what to do with it. So I pulled out all my cookbooks and found a recipe in my Inspiralize Everything cookbook (affiliate link).
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[18] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[48] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[18]
Moreover, two recent meta-analyses sought to investigate the effect of LCD on weight loss and cardiovascular disease risk. Sackner-Bernstein et al. (19) compared LCD to LF, among overweight and obese men and women. The authors found a significantly greater effect of weight loss in the LCD vs. the LF diets (-8.2 kg vs. -5.9 kg). The impact of diet on cardiovascular risk factors was split, with LCD resulting in significantly greater improvements in HDL cholesterol and triglycerides, while the LF resulted in significantly greater improvements in LDL and total cholesterol. From this the authors concluded that LCD were a viable alternative to LF diets and recommended “dietary recommendations for weight loss should be revisited to consider this additional evidence of the benefits of [low] CHO diets.” A significant limitation of this meta-analysis, however, was the authors’ definition of low-carbohydrate as a daily CHO consumption less than 120 grams. This value, while well below the standard recommendation of daily CHO consumption, still far exceeds the strict recommendation of KD (≤50 g/day), therefore the results of this meta-analysis must be approached with caution.
Made them tonight. I thought I messed them up since they looked eggy but really they turned out great. I can’t do gluten so I tried the xanthum and I also added some garlic powder to the mix for taste.i think I cooked for 7 minutes total.we actually sliced them into little squares and threw them into homemade chicken noodle soup. It tasted close to dumpling style noodles. Not slick/chewy but very good. My 14 year old T1 loved them and wants me to make more. Overall it absolutely loved these. Will be making again in the very near future. Thanks for such a great and simple recipe!
Also, I wanted to let you know what a fabulous addition your recipes were to our Christmas. I made the orange spritz cookies which were well received by those with diabetes, my gluten free friends, and everyone! I made them Christmas Eve. Christmas morning, I made your apple coffee cake and it was fab along with eggs, sausage and fruit. Thank you so much!
Dr. Perlmutter is the leading integrative medicine neurologist in North America today. His ability to fully integrate conventional medicine diagnosis and treatment with the latest innovations in nutritional and environmental medicine is phenomenal. As a teacher and clinician, he has fundamentally changed how physicians and patients think about neurological degeneration and, happily, regeneration.

Hi, Just wanted to thank you for this recipe. Although I cook a lot, I never had such a great idea. I cooked the noodles in the microwave in a square glass container because I didn’t want to wait. I cut in halves and used them as lasagna’s pasta. Its was absolutely delicious. Is as good or even better than the real thing. Thanks again for sharing. From now on my life is different!
Love your blog and recipes, thank you! Congratulations on doing keto – I’ve been sugar, dairy, grain and pretty much all carb free for over a year keeping my carbs to under 30 grams per day. My question is about coffee…did you give it up? I was drinking way too much coffee with heavy cream so I finally gave that up for Califia almond/coconut creamer sugar free of course! Did you give up coffee during the keto trial?
Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more
Hi Joellen, It doesn’t rise as much as a wheat bread but does a little. The almond flour being frozen might have made it worse, I’m not sure – I don’t store mine there since I go through it a lot. I’m glad you like the texture. If you want a taller loaf, you can multiply the recipe by 1.5 or even double it, but would need to increase the cook time and probably cover it to prevent browning the top too much before the middle is done.
Hi Maya! I’ve been trying to lose weight on a low fat diet, to no avail, so I’m trying Keto. I came across your recipe while looking for almond flour bread recipes. (Love the occasional turkey breast half-sammie for lunch or the occasional toasted slice for breakfast). Yours appears to be a very carefully thought-out recipe which I’m anxious to try. I really like how you explained things so thoroughly, gave tips. There’s nothing like learning with the benefit of others’ tried and tested experience. I’m not rating this recipe since I haven’t tried it yet, but based on your effort alone, it gets five stars! Many thanks, Alice
Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance:

Must say, however, that the shape of choice (for most pasta-like results) are the cavatelli. Both because the ridges help the sauce to stick better, and for the resulting texture and mouthfeel. Though you’ll need to procure a (9 bucks!) cavatelli & gnocchi board. Cavatelli are very similar to gnocchi in shape (which you can make too!), though slightly thinner and with more of a bite. 
Made them tonight. I thought I messed them up since they looked eggy but really they turned out great. I can’t do gluten so I tried the xanthum and I also added some garlic powder to the mix for taste.i think I cooked for 7 minutes total.we actually sliced them into little squares and threw them into homemade chicken noodle soup. It tasted close to dumpling style noodles. Not slick/chewy but very good. My 14 year old T1 loved them and wants me to make more. Overall it absolutely loved these. Will be making again in the very near future. Thanks for such a great and simple recipe!
The trick to working with coconut flour is accepting the fact that it requires a lot of eggs to give it structure and a decent consistency. It can be a little shocking to see half a dozen to a dozen eggs in a recipe, but as you try it out, you will see that it works. The end results are rarely too eggy or rubbery. You will also be surprised to see how little coconut flour is used in most recipes. It’s incredibly dense, but expands remarkably with the added eggs and liquid, so you typically only need about a third of the amount you would need with conventional flour or nut flours.
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.
In relation to overall caloric intake, carbohydrates comprise around 55% of the typical American diet, ranging from 200 to 350 g/day. The vast potential of refined carbohydrates to cause harmful effects were relatively neglected until recently. A greater intake of sugar-laden food is associated with a 44% increased prevalence of metabolic syndrome and obesity and a 26% increase in the risk of developing diabetes mellitus. In a 2012 study of all cardiometabolic deaths (heart disease, stroke, and type 2 diabetes) in the United States, an estimated 45.4% were associated with suboptimal intakes of 10 dietary factors. The largest estimated mortality was associated with high sodium intake (9.5%), followed by low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%), low intake of omega-3 fats (7.8%), low intake of vegetables 7.6%), low intake of fruits (7.5%), and high intake of artificially sweetened beverages (7.4%). The lowest estimated mortality was associated with low polyunsaturated fats (2.3%) and unprocessed red meats (0.4%). In addition to this direct harm, excess consumption of low-quality carbohydrates may displace and leave no room in the diet for healthier foods like nuts, unprocessed grains,  fruits, and vegetables.
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.
Net carbs is simply total carbs minus fiber and non-digestible sugar alcohols, like erythritol. (This doesn’t apply to high glycemic sugar alcohols, like maltitol.) We don’t have to count fiber and certain sugar alcohols in net carbs, because they either don’t get broken down by our bodies, are not absorbed, or are absorbed but not metabolized. (Read more about sugar alcohols here.)
These tasty mini burgers are perfect for parties because they can feed your low carb AND carb-loving guests and no one will even miss that bread. Make them for tailgating parties, game day parties, summer picnics, or just a fun weeknight dinner for the family. Once you dip those little burger bites in that special sauce you’re going to be going back for seconds!
WY conceived, designed, and coordinated the study; participated in data collection; performed statistical analysis; and drafted the manuscript. MF assisted with study design, performed data collection, and helped to draft the manuscript. AC analyzed the food records. MV assisted with study/intervention design and safety monitoring. EW participated in the conception and design of the study, and assisted with the statistical analysis. All authors read and approved the final manuscript.

I made these yesterday using straight from the fridge eggs and cream cheese, parchment paper sprayed with cooking spray (I folded up the sides of the paper to prevent leakage), and a mini-chopper. Even with these imperfect tools my noodles were perfect. I was able to just tilt the pan until the batter was covering the entire area, which made them fairly thin and a few on one side were over-done but still were fine in my faux chicken faux noodle soup. They cut easily and slid right off the paper. My kids had nothing bad to say either! I will make them thicker next time for eating in a sauce as they are fairly soft but did hold up in the soup and even by lunch today were still great. Thank you!

It was worth the try since so many of the recipes on this site are wonderful — but I’ll make a little real pasta for an occasional cheat day, or I’ll just add lots of sauteed mushrooms to the bolognese sauce and just have a bowl of sauce. If I try this again I’ll shape the dough into small gnocchi and serve with a butter- or cream-based sauce. That might work because I won’t be thinking “pasta.”


A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]
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.

Participants returned every other week for 16 weeks for further diet counseling and medication adjustment. When a participant neared half the weight loss goal or experienced cravings, he or she was advised to increase carbohydrate intake by approximately 5 g per day each week as long as weight loss continued. Participants could choose 5 g carbohydrate portions from one of the following foods each week: salad vegetables, low-carbohydrate vegetables, hard or soft cheese, nuts, or low-carbohydrate snacks. Diabetes medication adjustment was based on twice daily glucometer readings and hypoglycemic episodes, while diuretic and other anti-hypertensive medication adjustments were based on orthostatic symptoms, blood pressure, and lower extremity edema.
Yancy WS Jr, Westman EC, McDuffie JR, Grambow SC, Jeffreys AS, Bolton J, Chalecki A, Oddone EZ, “A randomized trial of a low-carbohydrate diet vs orlistat plus a lowfat diet for weight loss,” Arch Intern Med. 2010 Jan 25;170(2):136-45. http://www.ncbi.nlm.nih.gov/pubmed/20101008?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2.
If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin.
Yes, some ideas on meal plans and very easy recipes would be very helpful. I’m 67, very overweight, diabetes, high blood pressure. My big love are all the carbs. This way of life seems impossible to me, all that fat just doesn’t sound appealing. I can’t see how to eat that much fat a day. Years ago, I did try Dr. Atkins diet but I had a very hard time with the very limited carbs. But now, I need to something drastic but haven’t a clue how to start.
Shirataki Noodles: There are people who like this pasta, but I don’t know many of them. You probably should try it yourself just in case you’re one of those few who likes them. With essentially zero calories, carbs, fat, or protein (in other words: void of nutrition whatsoever), these “noodles” are made with yam flour (konnyaku) and water. There are a variety of brands and you can find them just about everywhere these days. In your grocery store, you’ll probably find them within the produce section. Even stranger is that they are packaged in a bag full of water. What’s the downside to a pasta that has basically zero carbs? They smell gross. They taste gross. The texture is gross. Ick. You’re encouraged to rinse them thoroughly in an effort to rid them of their funky taste and smell, but I found that no amount of rinsing was good enough. If you’re someone who does like these noodles, please let us know how you managed to make them edible!
Maya, I think what you are doing is brilliant. I am a 70-year old professional woman, educator and coach. I’ve grown our family vegetables every summer since I can remember. However, health conscious 20 or 30 years ago is a far different scenario today. Until I started having digestive issues about 5 years ago, I figured I was in the “above average” category of healthy eating.

Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer.[59][60] A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.[61]

In regard to serum measurements, the mean fasting glucose decreased by 17% from 9.08 ± 4.09 mmol/L at baseline to 7.57 ± 2.63 mmol/L at week 16 (p = 0.04) (Table ​(Table4).4). Serum sodium and chloride levels increased significantly, but only by 1% and 3%, respectively. Uric acid level decreased by 10% (p = 0.01). Serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001). Increases occurred in both high-density lipoprotein (HDL) cholesterol (8%) and low-density lipoprotein (LDL) cholesterol (10%) but these changes were of borderline statistical significance (p = 0.08 and p = 0.1, respectively). The following blood tests did not change significantly: total cholesterol, potassium, bicarbonate, urea nitrogen, creatinine, calcium, thyroid-stimulating hormone, and hemoglobin.


It's worth noting that many low-carb diets vary in their intake requirements. For instance, the Atkins diet recommends eating less than 100 grams of carbs a day, while the Mayo Clinic points out that any diet is considered low in carbs if it falls under the Dietary Guidelines for Americans' recommendation to consume 900 to 1300 calories of carbohydrates per day (or 45% to 65% of your total calories, based on a 2000 calorie diet).
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking.
Hi Maya! I’ve been trying to lose weight on a low fat diet, to no avail, so I’m trying Keto. I came across your recipe while looking for almond flour bread recipes. (Love the occasional turkey breast half-sammie for lunch or the occasional toasted slice for breakfast). Yours appears to be a very carefully thought-out recipe which I’m anxious to try. I really like how you explained things so thoroughly, gave tips. There’s nothing like learning with the benefit of others’ tried and tested experience. I’m not rating this recipe since I haven’t tried it yet, but based on your effort alone, it gets five stars! Many thanks, Alice
In summary, the LCKD had positive effects on body weight, waist measurement, serum triglycerides, and glycemic control in a cohort of 21 participants with type 2 diabetes. Most impressive is that improvement in hemoglobin A1c was observed despite a small sample size and short duration of follow-up, and this improvement in glycemic control occurred while diabetes medications were reduced substantially in many participants. Future research must further examine the optimal medication adjustments, particularly for diabetes and diuretic agents, in order to avoid possible complications of hypoglycemia and dehydration. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
I have been on a low carb keto diet for more than a year. As T2DM my A1C dropped from 9% to 5.4% & I discontinued meds. All my lipids improved even with ample healthy saturated fat. More than a year now so I wonder why this would be a short term improvement when its obvious that I will not go back to a high A1C and taking 3 diabetes medications including sulphonylureas. It is clear from this article that you lack the necessary experience that would be gained from wholeheartedly trying the diet or monitoring patients doing it properly like me. I would be probably be facing my first amputation if I believed the negativity in your article. So for people with diabetes who may be dissuaded by your article. Ignore it and take back your health by restricting carbs (<25 g a day) or as low as you reasonably can below 130g while being satisfied that you are getting adequate nutrition.
With just 4g of carbs, this pasta, made from hearts of palm, is a plant-based pasta substitute you may not have heard about before. Palmini is low in calories, high in fiber, gluten free, and looks more like traditional pasta than some other alternatives. It can be purchased canned or in pouches. While you can eat it straight from the package, it also cooks up well—keeping its pasta-like consistency.
Hi Patti, It’s up to you if you want to go by weight or by volume. I include both for convenience. Some people don’t want to weigh all their food, though weighing is definitely more accurate. The volumes listed are based on how a food is normally served, so for iceberg lettuce it would be chopped, not minced. It sounds like you’re weighing anyway, so in this case just use the weights instead (they are shown in grams in parentheses next to the volumes). Hope this helps!

Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [± SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m2. Hemoglobin A1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly.
I have been on a low carb keto diet for more than a year. As T2DM my A1C dropped from 9% to 5.4% & I discontinued meds. All my lipids improved even with ample healthy saturated fat. More than a year now so I wonder why this would be a short term improvement when its obvious that I will not go back to a high A1C and taking 3 diabetes medications including sulphonylureas. It is clear from this article that you lack the necessary experience that would be gained from wholeheartedly trying the diet or monitoring patients doing it properly like me. I would be probably be facing my first amputation if I believed the negativity in your article. So for people with diabetes who may be dissuaded by your article. Ignore it and take back your health by restricting carbs (<25 g a day) or as low as you reasonably can below 130g while being satisfied that you are getting adequate nutrition.

This paleo low carb bread recipe with almond flour came about somewhat by accident during my Sunday meal planning. Lately I’ve been making the flattened version of my 4-ingredient almond flour biscuits to use for sandwiches each week, but since I’ve been wanting to create an almond flour bread recipe, last weekend I decided to attempt that instead.
I really appreciate this article. I have done low Carb for the most part for over 15 years and was able to keep my weight down. Now that I have gone through menopause is just keeps getting harder. I try doing keto but tend to fall off the wagon a lot and go back to low Carb or Weight Watchers. Simple ideas would be great. I think some keto bloggers make it seem that you have to create difficult recipes. Thanks for all you do.
I’ve done the micro version for slices and it was quite good. Today trying the loaf recipe – but with the micro version and this one my mix never comes out like a batter – more like a moist dough. Any ideas what I may be doing wrong please? I have to say though that you are wonderful giving me a non carb bread – my husband loves bread and needs to lose weight. Many thanks!
While everyone needs to eat carbohydrates, some people need more carbs than others. People who are very active need to eat more carbs than people who are sedentary. Those with diabetes also usually need to limit the amount of carbohydrates they consume during each meal to help keep their blood sugar levels in check. Finally, people on low-carb diets such as the Atkins or South Beach diets may limit their carbohydrate intakes in an attempt to boost weight loss.
It’s a habit to enjoy a brie cheese for desert instead of a piece of chocolate cake but each are favored deserts in France. I’m personally more satisfied after a 350 calorie sized wedge of brie than the same number of calories of cake.. which will give me sugar crash and .. really I’d like two slices of cake(I’ve got a sweet tooth that once I get going it wants to keep being fed)
These are amazing! I only had almond meal instead of almond flour and didn’t have a donut pan so I used a muffin pan. I was surprised at how light and fluffy they were, and the taste! Oh my!! I was so wrapped I made another batch today but just left them plain with no coating and they were divine. I also froze some yesterday and thawed one and they freeze excellent. Thank you Maya!
Cereal is a tough one to give up when starting a low carb, grain-free or paleo diet. It’s easy to make, it’s tasty and it fills you up. For a little bit, anyway, before the subsequent blood sugar crash. But it turns out that you don’t have to give it up at all, as long as you are willing to make your own. And many of these low carb cereal recipes are almost as easy to make as grabbing the box from your cupboard and pouring cereal into your bowl. From granola to squares to hot cereals for a cold winter morning, we’ve got you covered.
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