In a small bowl combine the almond flour, cheese, and Italian seasoning together.
In a large bowl combine the beef, onion, green pepper, eggs, Worcestershire sauce, garlic, pepper, salt, and almond flour mixture. Mix until well combined.
Line a sheet pan with foil. place the meat on the sheet pan and form the mixture into a loaf shape.
Top the loaf with the ketchup mixture.
Bake for 45-55 minutes until it reaches an internal temperature of 160ºF.