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Nutritional Ketoacidosis

Ketosis

Ketosis

There is a lot of confusion about the term ketosis among medical professionals as well as laypeople. It is important to understand when and why nutritional ketosis occurs, and why it should not be confused with the metabolic disorder we call ketoacidosis. Ketosis is a metabolic state where the liver produces small organic molecules called ketone bodies. Most cells in the body can use ketone bodies as a source of energy. When there is a limited supply of external energy sources, such as during prolonged fasting or carbohydrate restriction, ketone bodies can provide energy for most organs. In this situation, ketosis can be regarded as a reasonable, adaptive physiologic response that is essential for life, enabling us to survive periods of famine. Nutritional ketosis should not be confused with ketoacidosis, a metabolic condition where the blood becomes acidic as a result of the accumulation of ketone bodies. Ketoacidosis can have serious consequences and may need urgent medical treatment. The most common forms are diabetic ketoacidosis and alcoholic ketoacidosis. What Is Ketosis? The human body can be regarded as a biologic machine. Machines need energy to operate. Some use gasoline, others use electricity, and some use other power resources. Glucose is the primary fuel for most cells and organs in the body. To obtain energy, cells must take up glucose from the blood. Once glucose enters the cells, a series of metabolic reactions break it down into carbon dioxide and water, releasing energy in the process. The body has an ability to store excess glucose in the form of glycogen. In this way, energy can be stored for later use. Glycogen consists of long chains of glucose molecules and is primarily found in the liver and skeletal muscle. Liver glycogen stores are used to mai Continue reading >>

#14: Nutritional Ketosis Is Not Diabetic Ketoacidosis

#14: Nutritional Ketosis Is Not Diabetic Ketoacidosis

For some, there is confusion between the terms nutritional ketosis that results from following a ketogenic diet and diabetic ketoacidosis (DKA) that sometimes occurs in persons with diabetes, more so in type 1 diabetes (T1D) than in type 2 diabetes (T2D). The purpose of this blog post is to make the distinction between these conditions and to reassure those with diabetes who choose to manage their blood glucose with appropriate insulin doses and a well-formulated ketogenic diet that this combination will not result in DKA. The characteristics of a well-formulated ketogenic diet was described in blog post #13 and my ketogenic diet was described in blog post #9. In a person with T1D, a low insulin level results from autoimmune destruction of the pancreatic beta-cells that are the sole source of insulin production. If you understand the major functions of insulin, you can understand what goes wrong in persons with T1D. Insulin is an anabolic hormone that directs both the utilization and storage of nutrients (glucose, amino acids, and fatty acids). For example, insulin stimulates the synthesis of glycogen from glucose. Glycogen is a large branching chain of glucose molecules that allows glucose to be stored for later use primarily in muscle and liver. Insulin stimulates the synthesis of triglycerides from both glucose and fatty acids for storage primarily in fat cells (adipocytes). Insulin also stimulates the synthesis of proteins from amino acids to build most of the enzymes, structural, transport, and contractile protein molecules (e.g. muscle) needed for body functions. In addition to promoting the storage of glucose and fat, insulin also instructs cells to use glucose as a fuel preferentially over fat to help clear it from the bloodstream. In persons with T1D, insulin p Continue reading >>

Ketosis Vs. Ketoacidosis: What You Should Know

Ketosis Vs. Ketoacidosis: What You Should Know

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>

Ketosis: Fear, Uncertainty And Doubt

Ketosis: Fear, Uncertainty And Doubt

Perhaps nothing is more damaging to the new low-carber than the intentional spread of fear, uncertainty and doubt regarding the state of ketosis compared to the dangerous state of ketoacidosis. The former is a natural and healthy state of existence, the latter is a condition that threatens the life of type 1 diabetics and type 2 diabetics whose disease has progressed to the point where their pancreatic beta cells can no longer produce insulin (ketoacidosis is also a risk for alcoholics). So if you’re not an alcoholic, a type 1 diabetic or a late-stage type 2 diabetic, fear of ketosis is misdirected. You should regard with suspicion anyone who confuses the two and warns you against a low-carb diet because they cannot tell the difference. The confusion between ketosis and ketoacidosis is a sign of a grave misunderstanding of basic biology (if not a complete lack of critical faculty). So too is the assumption that ketosis is the “early stage” of ketoacidosis or that “ketosis leads to ketoacidosis” in a person whose pancreas is still able to produce insulin. If you don’t trust me (and why should you), you should consider listening to some people who know a lot more about this than either you or I ever will: Nutritional ketosis is by definition a benign metabolic state… by contrast, ‘diabetic ketoacidosis’ is an unstable and dangerous condition that occurs when there is inadequate pancreatic insulin response to regulate serum B-OHB. This occurs only in type-1 diabetics or in late stage type-2 diabetics with advanced pancreatic burnout. (Dr. Phinney & Dr. Volek, The Art and Science of Low Carbohydrate Living, p.4) Later in the book (p.80), Phinney and Volek explain further: [Type-1 diabetics] need insulin injections not just to control blood glucose levels, Continue reading >>

Beyond Weight Loss: A Review Of The Therapeutic Uses Of Very-low-carbohydrate (ketogenic) Diets

Beyond Weight Loss: A Review Of The Therapeutic Uses Of Very-low-carbohydrate (ketogenic) Diets

Very-low-carbohydrate diets or ketogenic diets have been in use since the 1920s as a therapy for epilepsy and can, in some cases, completely remove the need for medication. From the 1960s onwards they have become widely known as one of the most common methods for obesity treatment. Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors. The possibility that modifying food intake can be useful for reducing or eliminating pharmaceutical methods of treatment, which are often lifelong with significant side effects, calls for serious investigation. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possible mechanisms for the therapeutic actions of the ketogenic diet on different diseases. The present review also questions whether there are still some preconceived ideas about ketogenic diets, which may be presenting unnecessary barriers to their use as therapeutic tools in the physician’s hand. During recent years, an increasing amount of evidence has accumulated in the literature, suggesting that very-low-carbohydrate ketogenic diets (VLCKD) could have a therapeutic role in numerous diseases. The use of VLCKD in treating epilepsy has been well established for many decades and these diets have become even more widely known, as they became popular in the 1970s for weight loss—especially as the ‘Atkins Diet’.1 More recently, the therapeutic use of ketogenic diets in other diseases has been studied with positive results—it is an important direction for research because, clearly, Continue reading >>

What Everybody Ought To Know About Ketosis

What Everybody Ought To Know About Ketosis

Recently I wanted to explore the world of Ketosis. I thought I knew a little bit about ketosis, but after doing some research I soon realised how wrong I was. 3 months later, after reading numerous books, listening to countless podcasts and experimenting with various diets I know have a sound understanding of ketosis. This resource is built as a reference guide for those looking to explore the fascinating world of ketosis. It is a resource that I wish I had 3 months ago. As you will soon see, a lot of the content below is not mine, instead I have linked to referenced to experts who have a greater understanding of this topic than I ever will. I hope this helps and if there is something that I have missed please leave a comment below so that I can update this. Also, as this is a rather long document, I have split it into various sections. You can click the headline below to be sent straight to the section that interests you. For those that are really time poor I have created a useful ketosis cheat sheet guide. This guide covers all the essential information you should know about ketosis. It can be downloaded HERE. Alternatively, if you're looking for a natural and sustainable way to improve health and lose weight head to this page - What is Ketosis? What Are The Benefits from being in Ketosis? Isn’t Ketosis Dangerous? Ketoacidosis vs Ketosis What Is The Difference Between a Low Carb Diet and a Ketogenic Diet? Types of Ketosis: The Difference Between Nutritional, Therapeutic & MCT Ketogenic Diets Is The Ketogenic Diet Safe? Long Term Effects Thyroid and Ketosis - What You May Want To Know What is a Typical Diet/Macro Breakdown for a Ketogenic Diet? Do I Need to Eat Carbs? What do I Eat On a Ketogenic Diet? What Do I Avoid Eating on a Ketogenic Diet? Protein Consumption a Continue reading >>

The Ketogenic Diet And Type 1 Diabetes

The Ketogenic Diet And Type 1 Diabetes

What is type 1 diabetes? How is it different than type 2? Type 2 diabetes is a condition where the body becomes resistant to insulin, forcing the pancreas to produce ever more insulin, and leading to a downward spiral of metabolic illness. It’s also called “Adult Onset Diabetes”, because the vast majority of people who develop it do so in adulthood, after years of eating a high-carb diet. Type 1 diabetes, also known as “Juvenile Diabetes”, is a disorder where the body’s immune system attacks the cells of the pancreas responsible for producing insulin. Only the pancreas can produce insulin, and insulin is the hormone primarily responsible for shuttling molecules out of the blood and into cells for energy or storage. That means, if the pancreas isn’t producing insulin, a person will starve to death from the inside. Their cells, literally, cannot get any food. They can eat and eat and eat, but there’s no mechanism to transport that food energy into the cells. That’s why they need regular insulin shots. On a regular-carb diet, those insulin shots might be several times per day. On a high-carb diet, those shots will be even more frequent. Type 1 diabetics must keep injecting themselves with insulin in order to deal with all the glucose in their blood stream. They have to keep insulin levels high, if they eat high carbs, because they have a high level of glucose to deal with. Being ketogenic means insulin levels don’t have to be high, because there isn’t a high level of glucose that needs to be shuttled around. And, because there isn’t a big requirement for insulin, the type 1 diabetic can reduce the amount of insulin needed on a daily basis (many reduce this requirement by 80%). The important thing to remember is that someone suffering from type 1 dia Continue reading >>

Ketogenic Diet: 25 Proven Benefits And How To Know If It’s Right For You

Ketogenic Diet: 25 Proven Benefits And How To Know If It’s Right For You

The ketogenic diet has been touted for its many health benefits such as weight loss, cognitive function, neurodegenerative diseases, and cancer. In this post, we cover: Different ways to get into ketosis Physiology and pathways that are changed when you are in ketosis, which explains how the ketogenic diet derives its benefits Genetic factors that may affect the safety and effectiveness of ketosis 17 Health conditions that may be helped by the ketogenic diet Negative effects of ketosis and how to mitigate them Ketogenic Diets Improve Cognitive Function and Brain Health Ketogenic Diet as a Cancer Treatment Ketogenic diets are defined by a low carbohydrate (typically under 50 grams/day) and high fat intake, leading to an elevation of free fatty acids and ketone bodies in the blood (R). The first ketogenic diets in the medical literature are noted in publications in the 1920s, although wider popularity and increased research was not seen in medical literature until the 1960s (R). Variations of the diets have remained popular for the past 20-30 years, with proponents claiming that the diets boost weight loss and energy while offering protection from certain metabolic diseases (R). A ketogenic diet and fasting affect the body similarly. Both deplete the body’s glucose reserves, so the body starts turning fatty acids into ketones (R). When the body doesn’t have enough carbohydrates from food, it burns fat by producing ketones or ketone bodies (R, R). In non-diabetics, ketosis can be achieved in 3 ways, i.e. Fasting or severe caloric restriction (R) Prolonged physical exercise in fasted state, depending on intensity and duration (R, R2) Nutritional ketosis, i.e. by consuming a very low carbohydrate diet Supplementation, such as by supplementing with medium chain triglyceri Continue reading >>

The Diet That Reverses Diabetes. Nutritional Ketosis For Diabetes

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 ability to burn fat instead of glucose as fuel, many people would have starved to death. Ketosis refers to the fuel source your body survives on. The standard western supermarket diet is high in carbohydrates and as your body absorbs these carbohydrates they are converted into glucose (sugar), these glucose molecules are then transported into cells by insulin to fuel each cell in your body. When we reduce our carbohydrate intake to a minimum (usually 5 to 10% of daily caloric intake) there is no longer enough glucose to fuel the body, so the body very cleverly goes looking for a second fuel s Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

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Ketosis: What Is Ketosis?

Ketosis: What Is Ketosis?

Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>

* What Are Ketones And Nutritional Ketosis?

* What Are Ketones And Nutritional Ketosis?

There is a lot of confusion about the term ketosis among medical professionals as well as laypeople. It is important to understand when and why nutritional ketosis occurs, and why it should not be confused with the metabolic disorder we call ketoacidosis. Ketosis is a metabolic state where the liver produces small organic molecules called ketone bodies. Most cells in the body can use ketone bodies as their source of energy. When there is limited supply of external energy sources, such as during prolonged fasting or carbohydrate restriction, ketone bodies can provide energy for most organs. Ketosis can be regarded as a normal, adaptive physiologic response that is essential for life, enabling us to survive periods of famine. Nutritional ketosis should not be confused with ketoacidosis, a metabolic condition where the blood becomes acidic as a result of the accumulation of ketone bodies. Ketoacidosis can have serious consequences and may need urgent medical treatment. The most common forms are diabetic ketoacidosis and alcoholic ketoacidosis. A ketogenic diet requires carbohydrate and protein restriction, with 50 to 80 percent of calories coming from fats; this forces your body to shift toward using ketones as its primary fuel source, instead of glucose. In the past the only way to achieve this was to restrict the carbohydrate foods that your body uses for fuel. This would force your body to go from using glucose as it's primary source of fuel to using ketones as the primary source for energy. When your body is in nutritional ketosis, your body is using fat as its source of energy. Today we can also achieve this state in our bodies with Keto//OS supplementation. * How do I know if I am in a Nutritional Ketosis state? There are significant differences between Keto//OS and Continue reading >>

Sglt2 Inhibitors

Sglt2 Inhibitors

SGLT2 inhibitors are not indicated for treatment of adults with type 1 diabetes mellitus, a metabolic disorder that also is characterized by hyperglycemia. In type 1 diabetics, however, the pancreas produces little to no insulin. Sodium glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antihyperglycemics designed to work against SGLT2, a low-affinity, high-capacity transporter protein found in the kidney’s proximal tubules. The mechanism for SGLT2 inhibitors involves preventing the excretion of urinary glucose by reabsorbing glucose. SGLT2 inhibitors discourage this reuptake of glucose in the kidney. SGLT2 inhibitors are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus, a metabolic disorder commonly characterized by hyperglycemia (high blood sugar) and inadequate levels of insulin or insulin resistance. Some SGLT2 inhibitors have been linked to side effects ranging from UTIs to kidney problems, amputations, bladder cancer and diabetic ketoacidosis (dka). Using SGLT2 inhibitors for the Treatment of Type 2 Diabetes Generally, SGLT2 inhibitors are taken orally once per day, usually before breakfast. Your doctor will prescribe the strength of the pill and tell you exactly how and when to take it. The dose may be changed if your doctor decides doing so would be more beneficial for you. While taking an SGLT2 inhibitor, your doctor may advise you to check your blood sugar levels in accordance with a particular schedule. Be aware that SGLT2 inhibitors will be likely to cause your urine to test positive for glucose. Your doctor may also order tests to check your blood sugar levels and hemoglobin A1C while taking SGLT2 inhibitors. Your doctor may periodically order these same tests, and possibly other Continue reading >>

Metabolic Effects Of The Very-low-carbohydrate Diets: Misunderstood

Metabolic Effects Of The Very-low-carbohydrate Diets: Misunderstood "villains" Of Human Metabolism

Go to: The Ketone Bodies are an Important Fuel The hormonal changes associated with a low carbohydrate diet include a reduction in the circulating levels of insulin along with increased levels of glucagon. This activates phosphoenolpyruvate carboxykinase, fructose 1,6-biphosphatase, and glucose 6-phosphatase and also inhibits pyruvate kinase, 6-phosphofructo-1-kinase, and glucokinase. These changes indeed favor gluconeogenesis. However, the body limits glucose utilization to reduce the need for gluconeogenesis. In the liver in the well-fed state, acetyl CoA formed during the β-oxidation of fatty acids is oxidized to CO2 and H2O in the citric acid cycle. However, when the rate of mobilization of fatty acids from adipose tissue is accelerated, as, for example, during very low carbohydrate intake, the liver converts acetyl CoA into ketone bodies: Acetoacetate and 3-hydroxybutyrate. The liver cannot utilize ketone bodies because it lacks the mitochondrial enzyme succinyl CoA:3-ketoacid CoA transferase required for activation of acetoacetate to acetoacetyl CoA [3]. Therefore, ketone bodies flow from the liver to extra-hepatic tissues (e.g., brain) for use as a fuel; this spares glucose metabolism via a mechanism similar to the sparing of glucose by oxidation of fatty acids as an alternative fuel. Indeed, the use of ketone bodies replaces most of the glucose required by the brain. Not all amino acid carbon will yield glucose; on average, 1.6 g of amino acids is required to synthesize 1 g of glucose [4]. Thus, to keep the brain supplied with glucose at rate of 110 to 120 g/day, the breakdown of 160 to 200 g of protein (close to 1 kg of muscle tissue) would be required. This is clearly undesirable, and the body limits glucose utilization to reduce the need for gluconeogenesis Continue reading >>

Difference Between Ketosis And Diabetic Ketoacidosis

Difference Between Ketosis And Diabetic Ketoacidosis

There is a distinct difference between Diabetic Ketoacidosis, Nutritional Ketosis, and Exogenous Ketones. Diabetic ketoacidosis is a dangerous state that occurs in the absence of insulin. What happens is your blood sugar levels rise, but it’s insulin that needs to pull the sugar out of the blood into the cells. This absence of insulin results in the blood not being able to deplete itself of the sugar, and the sugar will not be absorbed into the cells. So your body thinks it’s starved of energy in the absence of blood sugars and begins producing abnormal amounts of ketones. There is nothing to manage the production of ketones and blood sugar, ending up with very high levels of both, which can be quite dangerous. Diabetic ketoacidosis can’t happen if there is enough insulin present in the body. Nutritional ketosis is the process of your body breaking down fat as a source of fuel and creating ketones. This only happens when following a low carbohydrate – high fat diet. Exogenous ketones, such as KETO//OS, are ketone bodies that you can take and absorb into your body without being in a state of nutritional ketosis. Taking exogenous ketones will elevate your level of ketones for 3 – 6 hours. There are many benefits to taking exogenous ketones as well. So is a ketone supplement, such as KETO//OS, safe to take for diabetics? If you are a controlled diabetic, and you’ve been approved by your healthcare provider to take exogenous ketones. Then yes, it’s quite safe. And, there could be a great benefit due to the beneficial impact of insulin sensitivity that is associated with ketones and bhb (beta hydroxybutyrate). It’s important to remember to manage your blood ketone levels as much as you manage your blood sugar levels. Continue reading >>

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