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Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Seen in patients with recent history of binge drinking with little/no nutritional intake Anion gap metabolic acidosis associated with acute cessation of ETOH consumption after chronic abuse Characterized by high serum ketone levels and an elevated AG Consider other causes of elevated AG, as well as co-ingestants Concomitant metabolic alkalosis can occur from dehydration (volume depletion) and emesis Ethanol metabolism depletes NAD stores[1] Results in inhibition of Krebs cycle, depletion of glycogen stores, and ketone formation High NADH:NAD also results in increased lactate production Acetoacetate is metabolized to acetone so elevated osmolal gap may also be seen Differential Diagnosis Starvation Ketosis Binge drinking ending in nausea, vomiting, and decreased intake Positive serum ketones Wide anion gap metabolic acidosis without alternate explanation Urine ketones may be falsely negative or low Lab measured ketone is acetoacetate May miss beta-hydroxybutyrate Consider associated diseases (ie pancreatitis, rhabdomyolysis, hepatitis, infections) Oral nutrition if able to tolerate Consider bicarb if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy Discharge home after treatment if able to tolerate POs and acidosis resolved Consider admission for those with severe volume depletion and/or acidosis Hypoglycemia is poor prognostic feature, indicating depleted glycogen stores See Also Continue reading >>

Ketosis

Ketosis

Ketosis (Acetonemia, Ketonemia) is a common multifactorial disease resulting in downer cow syndrome in adult cattle worldwide[1]. Causes which predisposed to ketosis include: Ketosis is a common disease of dairy cows in early lactation caused by a negative energy balance that results in high concentrations of circulating nonesterified fatty acids (NEFAs) (acetone, acetoacetate, and β-hydroxybutyrate (BHB)). This disease is usually associated with fatty liver. Clinical signs Clinically affected cattle shows signs of anorexia, reduced milk yield and may present as downer cows. Neurological signs of restlessness and ataxia may sometimes be noted. A sweet breath may be observed by an observant farmer or veterinarian. Diagnosis is based on presenting clinical signs supported by laboratory tests such as urinalysis and milk detection of ketones. During the first month of lactation, ratios of glycerophosphocholine:phosphocholine less than 2.5 in the milk indicate a high risk for developing ketosis[2]. Blood tests showing elevated NEFAs can assist diagnosis in more valuable cattle[3]. Bolus IV administration of 500 mL of 50% dextrose solution is a common therapy[4]. Glucocorticoids including dexamethasone or isoflupredone acetate at 5–20 mg/dose, IM, generally results in a more sustained response. Oral propylene glycol (250–400 g) may be effective as ketosis therapy[5]. Continue reading >>

Ketosis

Ketosis

Not to be confused with Ketoacidosis. Ketosis is a metabolic state in which some of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis in which blood glucose provides energy. Ketosis is a result of metabolizing fat to provide energy. Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose.[1][2] It is almost always generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted (or from metabolising medium-chain triglycerides[3]). The main ketone bodies used for energy are acetoacetate and β-hydroxybutyrate,[4] and the levels of ketone bodies are regulated mainly by insulin and glucagon.[5] Most cells in the body can use both glucose and ketone bodies for fuel, and during ketosis, free fatty acids and glucose synthesis (gluconeogenesis) fuel the remainder. Longer-term ketosis may result from fasting or staying on a low-carbohydrate diet (ketogenic diet), and deliberately induced ketosis serves as a medical intervention for various conditions, such as intractable epilepsy, and the various types of diabetes.[6] In glycolysis, higher levels of insulin promote storage of body fat and block release of fat from adipose tissues, while in ketosis, fat reserves are readily released and consumed.[5][7] For this reason, ketosis is sometimes referred to as the body's "fat burning" mode.[8] Ketosis and ketoacidosis are similar, but ketoacidosis is an acute life-threatening state requiring prompt medical intervention while ketosis can be physiological. However, there are situations (such as treatment-resistant Continue reading >>

Ketogenic Complete Foods

Ketogenic Complete Foods

What is ketosis? Ketosis is a natural metabolic state wherein your body runs on ketones rather than glucose for energy. It requires you maintain 0 or very few (typically under 50g per day absolute maximum) carbohydrates and only adequate levels of protein (your body can convert protein to glucose through gluconeogenesis, so overdoing protein will prevent a deep level of ketosis). High levels of fat are required to make up the calories and provide ketones. Ketosis is also the same state your body enters when fasting or starving, which you can imagine there is an immense amount of research on. However the body is perfectly equipped for a regular ketogenic diet. The Inuit are an example of a culture who have been on a ketogenic diet for thousands of years. It's also been used to treat epilepsy with significant success. The induction phase of the Atkins diet is also ketogenic. There's a somewhat uncomfortable period of adaptation, but once adapted ketosis seems to have multiple benefits and the drawbacks seem easily mitigated with complete foods. Ketosis is also sometimes confused with ketoacidosis, which is a dangerous diabetic condition. This is a misunderstanding; ketosis is not ketoacidosis. Risks A primary risk for a ketogenic diet is that avoiding carbohydrates makes it difficult to receive all the required nutrients, this is obviously not a problem for complete foods. The other main risk seems to be that it's easy to overdo protein if you are eating a lot of meat, which may be bad for your kidneys. This is also very easily controlled with complete foods. That said, please do your own research beyond this page before making a major change to your diet, and as with the rest of the wiki do not consider anything written here to constitute medical advice. Drawbacks (mitig Continue reading >>

Adverse Reactions To Ketogenic Diets: Caution Advised

Adverse Reactions To Ketogenic Diets: Caution Advised

As the ketogenic diet gains popularity, it’s important to have a balanced discussion regarding the merits of this diet. Let me emphasize right out of the gate that this is not a diet without merits (excuse the double negative); in fact, it has significant therapeutic potential for some clinical pathologies. However, it is also a diet with inherent risk, as evidenced by the extensive list of adverse reactions reported in the scientific literature—and this has not yet been a thorough enough part of the public discussion on ketogenic diets. The AIP Lecture Series is a 6-week video-based, self-directed online course that will teach you the scientific foundation for the diet and lifestyle tenets of the Autoimmune Protocol. This is the first of a series of articles discussing various facets of a ketogenic diet with an inclination toward balancing the discussion of the pros and cons of this high-fat, low-carb, low/moderate-protein diet. My interest in this topic stems from concerns I have over its general applicability and safety, simultaneous with its growing popularity. I feel a moral and social obligation to share what I understand of these diets, from my perspective as a medical researcher. The dangers of a ketogenic diet was, in fact, the topic of my keynote presentation at Paleo F(x) this year (links to video will be provided once available). This series of articles will share the extensive research that I did in preparation for this presentation, including all of the topics covered during my talk as well as several topics that I didn’t have time to discuss (also see the free PDF Literature Review at the bottom of this post). For every anecdotal story of someone who has regained their health with a ketogenic diet, there’s a counterpoint story of someone who derai Continue reading >>

Ketogenesis

Ketogenesis

Ketogenesis pathway. The three ketone bodies (acetoacetate, acetone, and beta-hydroxy-butyrate) are marked within an orange box Ketogenesis is the biochemical process by which organisms produce a group of substances collectively known as ketone bodies by the breakdown of fatty acids and ketogenic amino acids.[1][2] This process supplies energy to certain organs (particularly the brain) under circumstances such as fasting, but insufficient ketogenesis can cause hypoglycemia and excessive production of ketone bodies leads to a dangerous state known as ketoacidosis.[3] Production[edit] Ketone bodies are produced mainly in the mitochondria of liver cells, and synthesis can occur in response to an unavailability of blood glucose, such as during fasting.[3] Other cells are capable of carrying out ketogenesis, but they are not as effective at doing so.[4] Ketogenesis occurs constantly in a healthy individual.[5] Ketogenesis takes place in the setting of low glucose levels in the blood, after exhaustion of other cellular carbohydrate stores, such as glycogen.[citation needed] It can also take place when there is insufficient insulin (e.g. in type 1 (but not 2) diabetes), particularly during periods of "ketogenic stress" such as intercurrent illness.[3] The production of ketone bodies is then initiated to make available energy that is stored as fatty acids. Fatty acids are enzymatically broken down in β-oxidation to form acetyl-CoA. Under normal conditions, acetyl-CoA is further oxidized by the citric acid cycle (TCA/Krebs cycle) and then by the mitochondrial electron transport chain to release energy. However, if the amounts of acetyl-CoA generated in fatty-acid β-oxidation challenge the processing capacity of the TCA cycle; i.e. if activity in TCA cycle is low due to low amo Continue reading >>

Ketosis

Ketosis

From Wikipedia, the free encyclopedia The English used in this article or section may not be easy for everybody to understand. You can help Wikipedia by reading Wikipedia:How to write Simple English pages, then simplifying the article. (February 2012) Ketosis occurs when ketone bodies are released into the bloodstream due to low glycogen levels in the liver. Ketone bodies are created by the breakdown of fatty acid. Ketosis can be understood as the use of body fat as a source of energy. The body goes through ketosis when there is not enough carbohydrate to refill glycogen in the liver. An example of this kind of diet is the Atkins diet, where followers start by eating fewer than 20g of carbohydrates per day. It takes 48 hours for the brain to switch from glucose to ketone bodies. Ketosis helps the body prevent using protein, from muscles, for gluconeogenesis to make glucose. Ketosis In essence, a ketogenic diet mimics starvation, allowing the body to go into a metabolic state called ketosis (key-tow-sis). Normally, human bodies are sugar-driven machines: ingested carbohydrates are broken down into glucose, which is mainly transported and used as energy or stored as glycogen in liver and muscle tissue. When deprived of dietary carbohydrates (usually below 50g/day), the liver becomes the sole provider of glucose to feed your hungry organs – especially the brain, a particularly greedy entity accounting for ~20% of total energy expenditure. The brain cannot DIRECTLY use fat for energy. Once liver glycogen is depleted, without a backup energy source, humanity would’ve long disappeared in the eons of evolution. The backup is ketone bodies that the liver derives primarily from fatty acids in your diet or body fat. These ketones – ?-hydroxybutyrate (BHB), acetoacetate and Continue reading >>

Low-carbohydrate Diets

Low-carbohydrate Diets

Many promoters of dietary schemes would have us believe that a special substance or combination of foods will automatically result in weight reduction. That's simply not true. To lose weight, you must eat less, or exercise more, or do both. There are about 3,500 calories in a pound of body weight. To lose one pound a week, you must consume about 500 fewer calories per day than you metabolize. Most fad diets, if followed closely, will result in weight loss—as a result of caloric restriction. But they are usually too monotonous and are sometimes too dangerous for long-term use. Moreover, dieters who fail to adopt better exercise and eating habits will regain the lost weight—and possibly more. My advice to people who are considering a low-carbohydrate diet is not to try it on their own by reading a book but to seek supervision from a physician who can monitor what they do. The most drastic way to reduce caloric intake is to stop eating completely. After a few days, body fats and proteins are metabolized to produce energy. The fats are broken down into fatty acids that can be used as fuel. In the absence of adequate carbohydrate, the fatty acids may be incompletely metabolized, yielding ketone bodies and thus ketosis. Prolonged fasting is unsafe, because it causes the body to begin to digest proteins from its muscles, heart, and other internal organs. Low-carbohydrate diets also produce ketosis, but if properly designed, they enable the body's nutritional needs to be met by dietary protein, dietary fat, stored body fat, and stored glycogen, so that body muscles are spared [1]. As this "nutritional ketosis" begins, there is a diuretic (water loss) effect, leading the dieter to think that significant weight reduction is taking place. However, most of the early l Continue reading >>

Ketogenic Diet Beginners Guide

Ketogenic Diet Beginners Guide

Brief Overview A ketogenic diet is a way of eating that promotes a state of ketosis in the body. Generally speaking a ketogenic diet will have the following macronutrient ratios: High Fat – 60%-80% of total calories come from fat. Moderate Protein – 15%-35% of total calories come from protein. Low Carbohydrate – 5% or less of total calories come from carbohydrates. Everyone’s macronutrient breakdown will be different and depends on a variety of factors. Reference our Keto Macro Calculator to figure out what yours are! Eating in accordance with these macronutrient ratio’s will deplete your body of glucose and force it to start producing ketones. Your body will then use these ketones for energy. What is Ketosis From Wikipedia: Ketosis is a metabolic state in which some of the body’s energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis in which blood glucose (sugar) provides most of the energy. With the abundance of high carbohydrate foods available in modern times, virtually all human beings that don’t make a concerted effort to restrict carbs are always in a state of glycolysis. There are a number of reasons why ketosis is beneficial when compared to glycolysis, which we will get into later. What are Ketones? Ketones are the fuel source your body is running on when it’s in a state of ketosis. They are produced in the liver when glycogen is depleted and are characterized as a slower burning fuel source when compared to glucose. Insulin and Keto This is where the magic happens. Eating a high carb diet means you’re always producing insulin to transport the glucose around your body. The fat can just sit around and watch because insulin is doing all the work. The fat is eventually stored, which leads to weight gain. In a Continue reading >>

Ketogenic Diet - A Connection Between Mitochondria And Diet

Ketogenic Diet - A Connection Between Mitochondria And Diet

This article is written by Dr Gabriela Segura, Consultant Cardiologist, and published here with her permission. Mitochondria are an essential part of good cardiac function. Numbers in square brackets refer to references at the bottom of the article. Contents 1 Introduction 2 Mitochondrial Dysfunction 3 Ketosis – Closer Look 4 References 5 External links Ketosis is an often misunderstood subject. Its presence is thought to be equal to starvation or a warning sign of something going wrong in your metabolism. But nothing could be farther from the truth, except if you are an ill-treated type 1 diabetic person.[1] Ketones – contrary to popular belief and myth – are a much needed and essential healing energy source in our cells that come from the normal metabolism of fat. The entire body uses ketones in a more safe and effective way than the energy source coming from carbohydrates – sugar AKA glucose. Our bodies will produce ketones if we eat a diet devoid of carbs or a low carb diet (less than 60 grams of carbs per day).[2] By eating a very low carb diet or no carbs at all (like a caveman) we become keto-adapted. In fact, what is known today as the ketogenic diet was the number one treatment for epilepsy until Big Pharma arrived with its dangerous cocktails of anti-epileptic drugs. It took several decades before we heard again about this diet, thanks in part to a parent who demanded it for his 20-month-old boy with severe seizures. The boy’s father had to find out about the ketogenic diet in a library as it was never mentioned as an option by his neurologist. After only 4 days on the diet, his seizures stopped and never returned.[3] The Charlie Foundation was born after the kid’s name and his successful recovery, but nowadays the ketogenic diet is available to th Continue reading >>

Ketosis

Ketosis

(pathology) A metabolic state in which the body produces ketones to be used as fuel by some organs so that glycogen can be reserved for organs that depend on it. This condition occurs during times of fasting, starvation, or while on a ketogenic weight-loss diet. Continue reading >>

Low-carbohydrate Diet

Low-carbohydrate Diet

Not to be confused with slow carb diet. This article is about low carbohydrate diets as a lifestyle choice or for weight loss. For low-carbohydrate dietary therapy for epilepsy, see Ketogenic diet. Low-carbohydrate diets or low-carb diets are dietary programs that restrict carbohydrate consumption. Foods high in easily digestible carbohydrates (e.g., sugar, bread, pasta) are limited or replaced with foods containing a higher percentage of fats and moderate protein (e.g., meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds) and other foods low in carbohydrates (e.g., most salad vegetables such as spinach, kale, chard and collards), although other vegetables and fruits (especially berries) are often allowed. The amount of carbohydrate allowed varies with different low-carbohydrate diets.[1] Such diets are sometimes 'ketogenic' (i.e., they restrict carbohydrate intake sufficiently to cause ketosis). The induction phase of the Atkins diet[2][3][4] is ketogenic. The term "low-carbohydrate diet" is generally applied to diets that restrict carbohydrates to less than 20% of caloric intake, but can also refer to diets that simply restrict or limit carbohydrates to less than recommended proportions (generally less than 45% of total energy coming from carbohydrates).[5][6] Definition and classification[edit] Low-carbohydrate diets are not well-defined.[7] The American Academy of Family Physicians defines low-carbohydrate diets as diets that restrict carbohydrate intake to 20 to 60 grams per day, typically less than 20% of caloric intake.[8] A 2016 review of low-carbohydrate diets classified diets with 50g of carbohydrate per day (less than 10% of total calories) as "very low" and diets with 40% of calories from carbohydrates as "mild" low-carbohydrate diets.[9] Used for Continue reading >>

Ketogenic Diet

Ketogenic Diet

This article is about a dietary therapy for epilepsy. For information on ketogenic diets as a lifestyle choice or for weight loss, see Low-carbohydrate diet and No-carbohydrate diet. The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain-function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Almost half of children, and young people, with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] The most common adverse effect is constipation, affecting about 30% of patients—this was due to fluid restriction, which was once a feature of the diet, but this led to increased risk of kidney stones, and is no longer considered beneficial.[2][3] The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was develope Continue reading >>

Ketogenic Diet

Ketogenic Diet

The ketogenic diet is a high-fat, medium protein, low carbohydrate diet primarily used for children with treatment-resistant epilepsy. It induces ketosis, a metabolic state in which the body derives most of its energy from ketones rather than glucose. Types of ketogenic diets[edit] Evidence for a ketogenic diet[edit] In an animal model, a ketogenic diet was shown to increase mitochondrial biogenesis.[1] A similar result was found in a study of fasting mice.[2] Neurotransmitters regulate nerve impulses is the brain by either inhibiting impulse firing or exciting the neuron to fire. A primary inhibitory neurotransmitters is GABA and a primary excitatory neurotransmitters is glutamate. In patients with epilepsy, if the normal balance of inhibition and excitation is disrupted, a seizure can occur. It us unknown why ketogenic diets are protective against epilepsy. In animal models, the ketone bodies acetoacetate and acetone have anticonvulsant properities through a novel pathway.[3] Ketone bodies are also a more efficient fuel than glucose. The Charlie Foundation supports the use of ketogenic diets with children with severe epilepsy.[4] Neurodegenerative diseases[edit] There is evidence from uncontrolled clinical trials and animal models that ketogenic diets may be protective in neurodegenerative disorders including Alzheimer's and Parkinson's.[5] Mice fed a ketogenic diet had increased activity of dopaminergic neurons.[6] In a rat model of Parkinson's, a ketogenic diet was protective against neurotoxicity by up-regulating glutathione.[7] A study found dietary ketosis enhanced memory in patients with mild cognitive impairment.[8] Chronic fatigue syndrome[edit] No studies have been done on the effects of ketogenic diets in Chronic fatigue syndrome. Some CFS clinicians recomme Continue reading >>

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