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Nutritional Ketoacidosis

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 >>

Why Dka & Nutritional Ketosis Are Not The Same

Why Dka & Nutritional Ketosis Are Not The Same

There’s a very common misconception and general misunderstanding around ketones. Specifically, the misunderstandings lie in the areas of: ketones that are produced in low-carb diets of generally less than 50 grams of carbs per day, which is low enough to put a person in a state of “nutritional ketosis” ketones that are produced when a diabetic is in a state of “diabetic ketoacidosis” (DKA) and lastly, there are “starvation ketones” and “illness-induced ketones” The fact is they are very different. DKA is a dangerous state of ketosis that can easily land a diabetic in the hospital and is life-threatening. Meanwhile, “nutritional ketosis” is the result of a nutritional approach that both non-diabetics and diabetics can safely achieve through low-carb nutrition. Diabetic Ketoacidosis vs. Nutritional Ketosis Ryan Attar (soon to be Ryan Attar, ND) helps explain the science and actual human physiology behind these different types of ketone production. Ryan is currently studying to become a Doctor of Naturopathic Medicine in Connecticut and also pursuing a Masters Degree in Human Nutrition. He has interned under the supervision of the very well-known diabetes doc, Dr. Bernstein. Ryan explains: Diabetic Ketoacidosis: “Diabetic Ketoacidosis (DKA), is a very dangerous state where an individual with uncontrolled diabetes is effectively starving due to lack of insulin. Insulin brings glucose into our cells and without it the body switches to ketones. Our brain can function off either glucose or fat and ketones. Ketones are a breakdown of fat and amino acids that can travel through the blood to various tissues to be utilized for fuel.” “In normal individuals, or those with well controlled diabetes, insulin acts to cancel the feedback loop and slow and sto Continue reading >>

Ketosis & Measuring Ketones

Ketosis & Measuring Ketones

Generally, ketone concentrations are lower in the morning and higher in the evening. Whatever time you pick to measure ketone levels, make sure to keep it consistent. Also, do not measure your ketone levels right after exercise. Ketone levels tend to be lower while your glucose levels higher so you won't get representative numbers. Keep in mind there are daily fluctuations caused by changes in hormone levels. Don't get discouraged! Another aspect that affects the level of ketones is the amount of fat in your diet. Some of you may show higher concentration of ketones after a high-fat meal. Coconut oil contains MCTs that will help you boost ketones. To easily increase your fat intake on a ketogenic diet, try fat bombs - snacks with at least 80% fat content. Ketone levels tend to be higher after extensive aerobic exercise as your body depletes glycogen stores. Exercise may help you get into ketosis faster. ketogenic "fruity" breath is not pleasant for most people. To avoid this, drink a lot of water, mint tea and make sure you eat foods rich in electrolytes. Avoid too many chewing gums and mints, as it may put you out of ketosis; there may be hidden carbs affecting your blood sugar. Increase your electrolyte intake, especially potassium. You are likely going to lose some sodium and potassium when switching to the keto diet. Finally, if you find it hard to lose weight on a ketogenic diet, there may be plenty other reasons than the level of ketone bodies: Not Losing Weight on Low-Carb Ketogenic Diet? Don’t Give Up and Read Further. Continue reading >>

Nutritional Ketosis Vs Ketoacidosis

Nutritional Ketosis Vs 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. Read more science on Nutritional Ketosis VS Ketoacidosis at The poor, misunderstood calorie Blog Continue reading >>

Nutritional Ketosis, Part I – The State Of Being A Superman

Nutritional Ketosis, Part I – The State Of Being A Superman

If you regularly follow articles on health and nutrition, you have undoubtedly heard about ketosis. In the last several years, the interest around ketogenic diets has been rising constantly, with more and more studies done and data available to critically assess their effectiveness. When people hear the word “diet”, the first objective they associate it with is losing weight. But ketogenic diets are more than just methods of weight-control. They have profound therapeutic effects on certain medical conditions and, generally, represent an evolutionary advantage that has allowed our species to survive and thrive. Unfortunately, with typical dietary choices of today – driven largely by clever marketing messages and hidden agendas of large food corporations trying to convince you that eating their stuff is the best thing you can do and you should really ignore any potential health implications – ketosis has become a forgotten skill. Which, in the era of overwhelming proliferation of metabolic disorders and other debilitating diseases, puts those who do not consider following at least some form of a ketogenic diet at higher risk. This article is an attempt to change the current state of affairs. Ketosis is a vitally important metabolic state – and knowing when and how to use it is something that you definitely want to do if you care about your physical and cognitive performance. So, let’s take a closer look at what ketosis is and why you might be interested in it. Your body constantly requires energy. Every single little process in every cell needs fuel– even when you seem to be doing absolutely nothing. You need energy not only to move your body by contracting your muscles, but also for cell division, maintaining heartbeat, digestion and, most importantly – b 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 >>

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

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 and anion gap but not Fasting Blood Glucose (FBG) compared to the STZ only-treated group. Figures Citation: Murunga AN, Miruka DO, Driver C, Nkomo FS, Cobongela SZZ, Owira PMO (2016) Grapefruit Derived Flavonoid Naringin Improves Ketoacidosis and Lipid Peroxidation in Type 1 Diabetes Rat Model. PLoS ONE 11(4): e0153241. Editor: Bridget Wagner, Broad Institute of Harvard and MIT, UNITED STATES Received: January 5, 2016; Accepted: March 27, 2016; Published: April 13, 2016 Copyright: © 2016 Murunga et al. This is an open access article distributed under the terms of the Creative Commons Attributi Continue reading >>

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 >>

Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?

Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?

In this article we will cover what a Ketogenic diet is and if you can manage your diabetes while on this diet. Ketogenic diet for diabetics is a highly controversial topic, but we will break down everything here for you! As a Certified Diabetes Educator (CDE), I have to tell you from the start I will have a biased view here. Sorry, but I feel that I need to be completely honest right up front! I will however, present all the evidence that is available currently on the subject. As a CDE, I have been taught to follow the American Diabetes Association Dietary Guidelines for Americans which is low in carbohydrates, high in fiber, with fresh vegetables, fruits and whole grains. The Ketogenic Diet this article will be discussing is much lower in carbohydrates, in order to promote the state of nutritional ketosis, or the fat burning state for weight loss. What is a Ketogenic Diet? The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up? Your body uses the carbohydrates you eat for energy, so if we restrict how many carbohydrates we eat, the body has to get its fuel source from fat. A byproduct of this fat burning state are ketones which are produced; this is called nutritional ketosis. You can determine if you are in this fat burning state by purchasing urine ketone testing strips from your local pharmacy. The Ketogenic Diet with Diabetes Some precautions must be made clear; this diet is not appropriate for people with any Continue reading >>

Ketosis Definition: Ketosis Is Not Ketoacidosis

Ketosis Definition: Ketosis Is Not Ketoacidosis

Ketosis Definition | Nutritional Ketosis Definition | Ketogenic Effect | Ketogenic Diet Ketone Levels There has been a lot of confusion around regarding nutrition and ketosis. Ketosis should not be mistaken with ketoacidosis, which is a serious metabolic disorder. In ketoacidosis, excess ketone production makes the blood acidic. Ketosis, on the other hand, is the healthy metabolic condition where the liver breaks down fat to produce ketones for energy. Ketosis Definition The human body is just like a machine that requires some form of energy to run. Glucose, coming from carbohydrate intake, is the primary source of energy for the body. Usually, cells draw glucose from the blood and break it down to produce energy. In fact, the liver stores the excess glucose as glycogen. When the body is in short supply of carbs, it uses fats and proteins to produce energy instead. Now, the liver cannot break down the fat completely. Instead, it will produce ketone bodies.These ketones are then utilized for energy. When the body produces more ketones than it needs, the blood ketone level increases and puts the body into the state of ketosis. Once in this state, the body uses fat as energy. A low-carb, high-fat, moderate-protein diet like keto diet can put a person into ketosis. The liver produces ketones all of the time, not just when the glycogen stores deplete. Generally, the excess of ketones are exhaled through breath, or, the kidneys excrete them through urine. During ketosis only, ketones become the prime energy source. Essentially, the fat that you are consuming is being transferred directly into energy once you have achieved a state of ketosis. What Do You Mean By Nutritional Ketosis? Let’s get a bit more technical: When the blood ketone level rises more than the general level 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 >>

What Is “nutritional Ketosis”?

What Is “nutritional Ketosis”?

IN A NUTSHELL: Nutritional ketosis is a state of health in which your body is efficiently burning fat as its primary fuel source instead of glucose. When undergoing a ketogenic diet you are essentially converting yourself from a “sugar burner” to a “fat burner”. This is accomplished by reducing your consumption of carbohydrates, increasing your intake of fat, and consuming only an adequate amount of protein to meet your body’s needs. The term nutritional ketosis is claimed to have been coined by Dr. Stephen Phinney & Jeff Volek, two of the leading experts and researchers in the field of low carbohydrate dieting (Check out this informative video to hear a talk from Dr. Phinney). Ketosis is achieved by following a “ketogenic diet” which is high in fat, very low in carbohydrates, and adequate in protein (Please Note: It is “adequate” in protein, NOT “high” in protein. More on this later). By consuming more lipids you are enhancing your body’s fat burning function by up-regulating the enzymes and other “metabolic machinery” needed to burn fat more efficiently, therefore making it easier for your body to tap into stored adipose tissue as an energy source (i.e. you turn yourself into a fat-burning machine!). But don’t we NEED carbohydrates? While it’s true that our red blood cells and a small percentage of brain cells and kidney cells are exclusively glucose dependent, the body can actually GENERATE carbohydrates in a process called gluconeogenesis in which certain non-carbohydrate substrates like proteins (amino acids) and certain constituents of fatty acids (glycerol) can be converted into glucose. The quantities of glucose produced by the body are sufficient to meet the needs of these particular cells and also help to balance the body’s bl Continue reading >>

Low-carb Diets & Ketoacidosis

Low-carb Diets & Ketoacidosis

Drastically switching up your diet always carries the risk of side effects -- which is why it's important to talk to a doctor first -- but low-carb diets shouldn't cause ketoacidosis. This life-threatening condition, which develops when the blood becomes acidic, is generally only a risk for people with undiagnosed or poorly controlled type-1 diabetes. Low-carb diets actually put you in ketosis, a very mild form of ketoacidosis that does not carry the same life-threatening risk. Video of the Day Low-Carb Diets and Your Metabolism Reducing your carb intake can whittle your waist, and more restrictive low-carb diets speed up weight loss by affecting how your body generates energy. Normally, your body turns to carbs as the primary source of energy for your cells, and several tissues -- like your liver and muscles -- store carbs in the form of glycogen for almost-immediate energy. However, on a low-carb diet you're not getting enough carbs to replenish those glycogen stores, so your body turns to fat. It burns fatty acids -- the fat molecules that help make up your fat tissue -- to create ketone bodies, an alternate source of fuel. Because you're creating more ketone bodies for energy, you're burning more fat -- and losing weight. Low-Carb Diets Cause Dietary Ketosis Diets low enough in carbs to switch your primary fuel source over to ketone bodies are called ketogenic diets, and those that restrict your carb intake to 20 to 25 grams daily are typically low-carb enough to put you into ketosis. In addition to burning fat, ketogenic diets help you lose weight by controlling your appetite. One study, published in the American Journal of Clinical Nutrition in 2008, found that men following a ketogenic diet ate less and reported feeling less hungry than dieters following a modera Continue reading >>

Defining Keto, And Ketosis Vs. Ketoacidosis

Defining Keto, And Ketosis Vs. Ketoacidosis

Ketosis Is Often Misunderstood And Confused With Ketoacidosis …A good number of less-informed doctors and medical professionals confuse ketoacidosis, a diabetic complication, with the dietary ketosis that is associated with ketogenic diets and fasting states in the body…which leads them to advise you that ketosis is dangerous. The truth is, ketosis and ketoacidosis are completely different, and nutritional ketosis is totally safe. Now, clearly, if you’ve had previous health problems involving your liver, kidneys, gallbladder, or pancreas, then you should seek advice from your doctor before making any changes to your diet, to insure your safety. Differentiating Nutritional Ketosis & Ketoacidosis First, let’s cover some semantics. Your body can produce, from fat and some amino acids, three ketone bodies (“ketone” refers to the chemical structure where oxygen is double-bonded to carbon sandwiched between at least two other carbons), which are: acetone, acetoacetone, and beta-hydroxybutyrate (B-OHB). And why does your body produce ketones? …Basically, it’s a key evolutionary advantage. Your brain can only function with glucose and ketones. And, since you can only store about 24 hours worth of glucose, you would die of hypoglycemia if you were ever forced to fast for longer than 24 hours. Quite fortunately, however, your liver can turn fat and certain amino acids (the building blocks of proteins) into ketones to feed our brains (among other uses). So the ability of our bodies to produce ketones is required for even basic survival. Next, what is diabetic ketoacidosis? …A diabetic person will effectively go into a state of starvation when they don’t receive enough insulin (typically a Type I diabetic, but sometimes in insulin-dependent Type II diabetics). T Continue reading >>

I’ll See Your Ketoacidosis And Raise You A Renal Failure

I’ll See Your Ketoacidosis And Raise You A Renal Failure

A while back I posted on a paper that appeared in The Lancet about an obese woman who came to the emergency room with gastroenteritis and was misdiagnosed as being in diabetic ketoacidosis (a life-threatening disorder). She was misdiagnosed because the pinheads covering the ER couldn’t get past the fact that she had been on a low-carb diet. At the time I posted on this travesty I noted that this Lancet paper would from here on out be waved in the face of anyone who was following or advocated a low-carb diet as proof that such a diet is dangerous and can cause diabetic ketoacidosis (DKA). Well, now we’ve got an answer. Next time someone tells you that it has been proven that low-carb diets are dangerous and can cause ketoacidosis, you can resort to poker terminology and reply that you’ll see their ketoacidosis and raise them a renal failure. A few days ago I got wind of a paper published a few years ago that can be used as a counterpoint to the above mentioned idiotic paper in The Lancet that has given low-carbers such a bad time. This paper, published in the journal Renal Failure in 1998, is, like the other paper, a case report. The short version is as follows: An obese young man arrived comatose in the emergency room. In an effort to lose weight he had been consuming a high-carbohydrate canned beverage as his sole source of nutrition for the two weeks prior. His blood sugar–at about 20 times normal–was extremely elevated and led to a diagnosis of diabetic ketoacidosis. The physicians on staff treated the patient appropriately, and he, over the next 20 hours or so, regained consciousness as his blood sugar levels and other lab parameters began to normalize. During a lab analysis 22 hours after admission the doctors found the patient to be breaking down and rel Continue reading >>

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