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Nutritional Ketoacidosis

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[severe Ketoacidosis In Breastfeeding Woman With Low Energy And Carbohydrate Intake].

Abstract Ketoacidosis is a life threatening condition usually caused by diabetes mellitus or alcohol. In this case report we present a lactating woman who developed a severe ketoacidosis a few weeks post partum. Her nutritional status was inadequate due to illness and a diet low on carbohydrates. Five case reports regarding ketoacidosis in lactating women have previously been described in the literature. This case report highlights the importance of nutrition during periods of breast feeding. Continue reading >>

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  1. Yai

    To start with, I apologise for my ignorance, however Forum members have been so helpful, I wish to ask another question please:
    I have read many threads saying how successful people have been in lowering their blood glucose and losing weight by drastically cutting their intake of carbohydrates. I believe that fewer than 30g of carbohydrates a day is classed as a ketogenic diet. As a type 2 diabetic of many years, I am worried to try lowering my carbohydrates so much in case I make myself ill. Can anyone offer any comfort please, or have I got my proverbials in a twist?

  2. BrianTheElder

    Yai said: ↑
    To start with, I apologise for my ignorance, however Forum members have been so helpful, I wish to ask another question please:
    I have read many threads saying how successful people have been in lowering their blood glucose and losing weight by drastically cutting their intake of carbohydrates. I believe that fewer than 30g of carbohydrates a day is classed as a ketogenic diet. As a type 2 diabetic of many years, I am worried to try lowering my carbohydrates so much in case I make myself ill. Can anyone offer any comfort please, or have I got my proverbials in a twist? Hi
    @Yai Ketosis is the state in which your body burns ketones instead of glucose for fuel.
    Normally carbs supply glucose and insulin is produced by your body when it detects glucose so that the glucose can cross cell membranes and enter the system. Unfortunately, excessive carbs can lead to excess insulin and your body becomes insulin resistant, which is the start of T2D. One of the functions of insulin is to store fat, so this is a direct side effect.
    An alternative, which was common in the diet in pre-modern times, was to eat more meat and fat (especially) rather than carbs. Without carbs your body produces ketones as fuel as a direct replacement for glucose, ie ketosis replaces glycolysis.
    Ketosis is a natural state and not to be confused with ketoacidosis, which is a serious condition in T1D when the ketones are an order of magnitude higher.
    Generally to achieve ketosis, you should eat less than 20g of carbs/day. You should also eat moderate protein, about 0.8g/kg of body weight. The rest of your diet is fat and you can eat what you like as fat is filling and you will reach satiety before you exceed any calorie limit.

  3. Resurgam

    As you are diabetic lowering your carbs should make you better - but it isn't a one size fits all level of carbs - I used to lose weight easily on 80 gm of carb a day and had to go up higher to stop it - on 20 gm a day I was in a state of collapse and could not walk up stairs, but crawled up on all fours.
    When diagnosed diabetic I went to low carbing to control it, but did not try to get down to what for me are low levels, just went back to normal for me eating - and that seems to have fixed things, though I will be adding in more exercise as the weather improves.

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The Diet That Reverses Diabetes. Nutritional Ketosis For Diabetes

The most important way to manage diabetes is through proper nutrition; however, if you want to reverse this disease and reduce or even eliminate diabetes medications, then it could be advisable to avoid the American Diabetes Association dietary guidelines, and turn away from commonly prescribed diets that have made diabetes much, much worse. A growing body of scientific data is pointing towards a diet that has the potential to reverse Type 2 Diabetes, and even reduce drug dependence for Type 1 Diabetes: The Ketogenic Diet. More than just a diet, using fat to fuel the body instead of carbohydrates has scientifically proven to improve biomarkers of age, optimise weight loss and reverse many chronic diseases, including some cancers. Not only does the ketogenic diet offer a potential cure for diabesity (diabetes + obesity), the positive side-effects of this lifestyle choice are numerous. Big claims? Indeed, however, new long-term research into this way of eating is shattering old-school paradigms on nutrition and is changing the way we view and approach our modern diet. The ketogenic diet has been around since the beginning of time and is an important part of our evolution, without the Continue reading >>

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  1. Ash Simmonds

    This topic is actually much simpler than it's made out to be, that being it is merely a question of quantity of ketone production, and is only an issue in an individual who is unable to produce insulin.
    Unfortunately this is often glossed over even in medical texts, so it's not uncommon for even doctors and nurses to misunderstand the simple yet crucial difference, not to mention nutritionists.
    In the end it's all a matter of volume. Kind of like the difference between a sip, a gulp, and drowning.
    A moderate carbohydrate diet will often result in occasional trace amounts of ketone levels in the blood, typically after a fast (first thing in the morning) or after a decent exercise session. A very low carbohydrate diet is ketogenic by nature due to both low levels of carbohydrates in circulation/storage and ingestion of high levels of fat, and will result in moderate levels of ketone bodies circulating, usually around quarter-to-half the concentration of blood glucose, but occasionally reaching or even exceeding parity.
    Proper starvation - as in complete caloric avoidance for a week or two - can result in ketone bodies up to double or even triple circulating glucose levels, but even then the body has plenty of feedback loops to maintain ketone levels that are still well within safe parameters, you'll do organ damage from other stressors before ketones become a problem. There is of course something called alcoholic ketoacidosis, but this requires extensive periods of time where near 100% of your calories are derived from ethanol.
    Point being, this has nothing to do with nutritional ketosis. If you are capable of producing insulin then there is no danger of acidosis, which is actually ridiculously elevated ketones AND glucose levels.
    Serum ketone body levels typically look like this:
    Normal diet: 0-0.1 mmol/L
    Normal diet overnight fasted: 0.1-0.5 mmol/L
    Ketogenic Diet: 0.6-3.0 mmol/L
    1-4 weeks starvation: 6-10 mmol/L
    Diabetic insulin deficiency: >20 mmol/L

  2. Ketoacidosis

    http://caloriesproper.com/?p=4192
    Quote
    Ketoacidosis
    Nutritional ketosis is a normal, physiological response to carbohydrate and energy restriction. A ketogenic diet is an effective weight loss strategy for many. Ketoacidosis, on the other hand, is a pathological condition caused by insulin deficiency. The common theme is low insulin; however, in ketoacidosis, blood glucose levels are very high. Ketone levels are elevated in both states, although are 10-20x higher in ketoacidosis (~0.5-2 vs. > 20 mM). Nutritional ketosis and ketoacidosis should not be confused with one another, and a ketogenic diet doesn't cause ketoacidosis.
    ...
    In people on a ketogenic diet, blood glucose levels are not increased. This is an important aspect differentiating nutritional ketosis from ketoacidosis.
    ...
    Ketogenic dieting is safe, and can be beneficial. Ketoacidosis is pathological, and can be fatal.

  3. Ash Simmonds

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/
    Quote
    Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood "Villains" of Human Metabolism
    ...
    Diabetic Ketoacidosis vs. Dietary Ketosis
    Diabetic patients know that the detection in their urine of the ketone bodies is a danger signal that their diabetes is poorly controlled. Indeed, in severely uncontrolled diabetes, if the ketone bodies are produced in massive supranormal quantities, they are associated with ketoacidosis.
    ...
    However, during very low carbohydrate intake, the regulated and controlled production of ketone bodies causes a harmless physiological state known as dietary ketosis.

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Grapefruit benefits | How to use grapefruit to prevent diabetes Whether we have a history of diabetes or have already been diagnosed, it is essential that before starting any treatment on our own, we consult a specialist. Grapefruit has a known diuretic power . Therefore it is widely used in diets for weight loss purposes. Currently, the benefits of this fruit have been demonstrated to prevent diabetes , and even to reduce the adverse effects of a certain medication against cancer, the so-called oncological medication. A very healthy fruit to prevent diabetes. Grapefruit gives us a good number of nutrients and vitamins, in addition to preventing diabetes. Around 90% of its content is water, so we can achieve a good satiating effect. By having fewer calories than other citrus fruits, grapefruit has a healthy impact on other insulin levels . Insulin is directly related to the accumulation of body fat. In addition to the percentage of water, grapefruit stands out for its content of vitamin C and folic acid, antioxidants and minerals such as potassium and magnesium. We will also find in it a good number of beneficial acids for our body. This is the case of citric acid, tartaric, oxalic

Grapefruit Derived Flavonoid Naringin Improves Ketoacidosis And Lipid Peroxidation In Type 1 Diabetes Rat Model

Abstract Hypoglycemic effects of grapefruit juice are well known but the effects of naringin, its main flavonoid on glucose intolerance and metabolic complications in type 1 diabetes are not known. Sprague-Dawley rats divided into 5 groups (n = 7) were orally treated daily with 3.0 ml/kg body weight (BW)/day of distilled water (group 1) or 50 mg/kg BW of naringin (groups 2 and 4, respectively). Groups 3, 4 and 5 were given a single intra-peritoneal injection of 60 mg/kg BW of streptozotocin to induce diabetes. Group 3 was further treated with subcutaneous insulin (4.0 IU/kg BW) twice daily, respectively. Stretozotocin (STZ) only-treated groups exhibited hyperglycemia, polydipsia, polyuria, weight loss, glucose intolerance, low fasting plasma insulin and reduced hepatic glycogen content compared to the control group. Furthermore they had significantly elevated Malondialdehyde (MDA), acetoacetate, β-hydroxybutyrate, anion gap and significantly reduced blood pH and plasma bicarbonate compared to the control group. Naringin treatment significantly improved Fasting Plasma Insulin (FPI), hepatic glycogen content, malondialdehyde, β-hydroxybutyrate, acetoacetate, bicarbonate, blood pH a Continue reading >>

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  1. uktay001

    Hi everyone i just found this interesting article about the difference between diabetic ketoacidosis with nutritional ketosis.
    Hope this helps someone or gives them an understanding how different they are.
    Is ketosis dangerous?

    You may have heard from your doctor that ketosis is a life-threatening condition. If so, your doctor is confusing diabetic ketoacidosis (DKA) with nutritional ketosis, or keto-adaptation. First, some semantics. Our body can produce, from fat and some amino acids, three ketone bodies (a “ketone” refers the chemical structure where oxygen is double-bonded to carbon sandwiched between at least 2 other carbons). These ketone bodies we produce are: acetone, acetoacetone, and beta-hydroxybutyrate (B-OHB). [For anyone who is interested, they are the 3 most right structures on the figure, below.]
    Why do we make ketones? For starters, it’s a vital evolutionary advantage. Our brain can only function with glucose and ketones. Since we can’t store more than about 24 hours worth of glucose, we would all die of hypoglycemia if ever forced to fast for more than 24 hours. Fortunately, our liver can take fat and select amino acids (the building blocks of proteins) and turn them into ketones, first and foremost to feed our brains. Hence, our body’s ability to produce ketones is required for basic survival.
    What is diabetic ketoacidosis? When a diabetic (usually a Type I diabetic, but sometimes this occurs in very late-stage, insulin-dependent, Type II diabetics) fails to receive enough insulin, they go into an effective state of starvation. While they may have all the glucose in the world in their bloodstream, without insulin, they can’t get any into their cells. Hence, they are effectively going into starvation. The body does what it would do in anyone – it starts to make ketones out of fat and proteins. Here’s the problem: the diabetic patient in this case can’t produce any insulin, so there is no feedback loop and they continue to produce more and more ketones without stopping. By the time ketone levels (specifically, beta-hydroxybutyrate) approach 15 to 25 mM, the resulting pH imbalance leads to profound metabolic derangement and the patient is critically ill.
    But this state of metabolic derangement is not actually possible in a person who can produce insulin, even in small amounts. The reason is that a feedback loop prevents the ketone level from getting high enough to cause the change in pH that leads to the cascade of bad problems. A person who is said to be “keto-adapted,” or in a state of nutritional ketosis, generally has beta-hydroxybutyrate levels between about 0.5 and 3.0 mM. This is far less than the levels required to cause harm through acid-base abnormalities.
    Keto-adaption is a state, achieved through significant reduction of carbohydrate intake (typically to less than 50 grams per day), where the body changes from relying on glycogen as its main source of energy to relying on fat. Specifically, the brain shifts from being primarily dependent on glucose, to being primarily dependent on beta-hydroxybutyrate. This has nothing to do with what a diabetic patient is experiencing in DKA, but does illustrate how poorly informed and quick to react the medical community is. DKA and nutritional ketosis (or keto-adaptation) have as much in common as a house fire and a fireplace.





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    Back again after a break took up running and kept at the same weight now going for 1 more stone.​

  2. uktay001

    Metabolism and ketosis
    The primary goal of our metabolic system is to provide fuels in the amounts needed at the times needed to keep us alive and functioning. As long as we’ve got plenty of food, the metabolic systems busies itself with allocating it to the right places and storing what’s left over. In a society such as ours, there is usually too much food so the metabolic system has to deal with it in amounts and configurations that it wasn’t really designed to handle, leading to all kinds of problems. But that’s a story for another day.
    If you read any medical school biochemistry textbook, you’ll find a section devoted to what happens metabolically during starvation. If you read these sections with a knowing eye, you’ll realize that everything discussed as happening during starvation happens during carbohydrate restriction as well. There have been a few papers published recently showing the same thing: the metabolism of carb restriction = the metabolism of starvation. I would maintain, however, based on my study of the Paleolithic diet, that starvation and carb restriction are simply the polar ends of a continuum, and that carb restriction was the norm for most of our existence as upright walking beings on this planet, making the metabolism of what biochemistry textbook authors call starvation the ‘normal’ metabolism.
    So, bearing in mind that carb restriction and starvation are opposite ends of the same stick and that what applies to one applies to the other, let’s look at how it all works. I’ll explain it from a starvation perspective, but all the mechanisms work the same for a carb-restricted diet.
    During starvation the primary goal of the metabolic system is to provide enough glucose to the brain and other tissues (the red blood cells, certain kidney cells, and others) that absolutely require glucose to function. Which makes sense if you think about it. You’re a Paleolithic man or woman, you’re starving, you’ve got to find food, you need a brain, red blood cells, etc. to do it. You’ve got to be alert, quick on your feet, and not focused on how hungry you are.
    If you’re not eating or if you’re on a low-carbohydrate diet, where does this glucose come from?
    If you’re starving, glucose comes mainly from one place, and that is from the body’s protein reservoir: muscle. A little can come from stored fat, but not from the fatty acids themselves. Although glucose can be converted to fat, the reaction can’t go the other way. Fat is stored as a triglyceride, which is three fatty acids hooked on to a glycerol molecule. The glycerol molecule is a three-carbon structure that, when freed from the attached fatty acids, can combine with another glycerol molecule to make glucose. Thus a starving person can get a little glucose from the fat that is released from the fat cells, but not nearly enough. The lion’s share has to come from muscle that breaks down into amino acids, several of which can be converted by the liver into glucose. (There are a few other minor sources of glucose conversion: the Cori cycle, for example, but these are not major sources, so we’ll leave them for another, more technical, discussion.)
    But the breakdown of muscle creates another problem, namely, that (in Paleolithic times and before) survival was dependent upon our being able to hunt down other animals and/or forage for plant foods. It makes it tough to do this if a lot of muscle is being converted into glucose and your muscle mass is dwindling.
    The metabolic system is then presented with two problems: 1) getting glucose for the glucose-dependent tissues; and 2) maintaining as much muscle mass as possible to allow hunting and foraging to continue.
    Early on, the metabolic system doesn’t know that the starvation is going to go on for a day or for a week or two weeks. At first it plunders the muscle to get its sugar. And remember from a past post that a normal blood sugar represents only about a teaspoon of sugar dissolved in the entire blood volume, so keeping the blood sugar normal for a day or so doesn’t require a whole lot of muscular sacrifice. If we figure that an average person requires about 200 grams of sugar per day to meet all the needs of the glucose-dependent tissues, we’re looking at maybe a third of a pound of muscle per day, which isn’t all that big a deal over the first day. But we wouldn’t want it to continue at that rate. If we could reduce that amount and allow our muscle mass to last as long as possible, it would be a big help.
    The metabolic system could solve its problem by a coming up with a way to reduce the glucose-dependent tissues’ need for glucose so that the protein could be spared as long as possible.
    Ketones to the rescue.
    The liver requires energy to convert the protein to glucose. The energy comes from fat. As the liver breaks down the fat to release its energy to power gluconeogenesis, the conversion of protein to sugar, it produces ketones as a byproduct. And what a byproduct they are. Ketones are basically water soluble (meaning they dissolve in blood) fats that are a source of energy for many tissues including the muscles, brain and heart. In fact, ketones act as a stand in for sugar in the brain. Although ketones can’t totally replace all the sugar required by the brain, they can replace a pretty good chunk of it. By reducing the body’s need for sugar, less protein is required, allowing the muscle mass (the protein reservoir) to last a lot longer before it is depleted. And ketones are the preferred fuel for the heart, making that organ operate at about 28 percent greater efficiency.
    Fat is the perfect fuel. Part of it provides energy to the liver so that the liver can convert protein to glucose. The unusable part of the fat then converts to ketones, which reduce the need for glucose and spare the muscle in the process.
    If, instead of starving, you’re following a low-carb diet, it gets even better. The protein you eat is converted to glucose instead of the protein in your muscles. If you keep the carbs low enough so that the liver still has to make some sugar, then you will be in fat-burning mode while maintaining your muscle mass, the best of all worlds. How low is low enough? Well, when the ketosis process is humming along nicely and the brain and other tissues have converted to ketones for fuel, the requirement for glucose drops to about 120-130 gm per day. If you keep your carbs below that at, say, 60 grams per day, you’re liver will have to produce at least 60-70 grams of glucose to make up the deficit, so you will generate ketones that entire time.
    So, on a low-carb diet you can feast and starve all at the same time. Is it any wonder it’s so effective for weight loss?
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    The Question isn't CAN YOU? It's WILL YOU?
    Back again after a break took up running and kept at the same weight now going for 1 more stone.​

  3. mels72

    Wow thanks for those... It is useful to understand the mechanics and useful to be able to answer all the do gooders who tut at me and claim i am not doing my body any good oh and it is a lazy way of losing weight.... Lolz. Little do they know..
    Mels

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