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Starvation Ketosis

Renal Fellow Network: Starvation Ketosis: A Rare Cause Of Metabolic Acidosis

Renal Fellow Network: Starvation Ketosis: A Rare Cause Of Metabolic Acidosis

Starvation Ketosis: A Rare Cause of Metabolic Acidosis Asa child growing up in India, I have seen several family members performingritual fasting. Fasting is aubiquitous religio-cultural practice that is found, in varying forms, acrossthe world. The month-long Ramadan and Buddhist Lent fasts are examples ofreligious observances practiced by followers of Islam, and Buddhism,respectively. These fasts are characterized by a documented impact on metabolic health , which can be minimized by well-known management strategies .The practice of fastingis a major part of Hinduism and can range from light restriction toextreme abstention. Mahatma Gandhi was a fervent supporter of fasting byreligious convictionand as a way of freeingoneself of theconstraints of the body. He used fasting as a means of exerting politicalpressure and engaged in several hungerstrikesto protest withnon-violence. Inthe western countries, starvation ketosis or ketoacidosis has been reported inindividuals with strict dieting (e.g. carb-restricted, ketogenic diets or Atkins diet), extreme exercise, andrarely with malnutrition. Few cases of starvation-induced ketoacidosis during pregnancy and lactation , and during the perioperative period have also been reported in literature. Isaw a young non-verbal woman with quadriplegia who was admitted from a nursinghome with a two-day history of worsening abdominal pain and leakage around herpercutaneous endoscopic gastrostomy(PEG) tube site. Her medical history was significant for severe developmentaldelay and chronic constipation. She was afebrile and the rest of the vitalswere stable. Her PEG tube feeds had been stopped one day prior to the hospitaladmission due to abdominal pain. Additionally, she received small doses of ivmorphine for pain control. Due to no oral Continue reading >>

Metabolism And Ketosis

Metabolism And Ketosis

Dr. Eades, If the body tends to resort to gluconeogenesis for glucose during a short-term carbohydrate deficit, are those who inconsistently reduce carb intake only messing things up by not effecting full blown ketosis? If the body will still prefer glucose as main energy source unless forced otherwise for at least a few days, is it absolutely necessary to completely transform metabolism for minimal muscle loss? Also, if alcohol is broken down into ketones and acetaldehyde, technically couldn’t you continue to drink during your diet or would the resulting gluconeogenesis inhibition from alcohol lead to blood glucose problems on top of the ketotic metabolism? Would your liver ever just be overwhelmed by all that action? I’m still in high school so hypothetical, of course haha… Sorry, lots of questions but I’m always so curious. Thank you so much for taking the time to inform the public. You’re my hero! P.S. Random question…what’s the difference between beta and gamma hydroxybutyric acids? It’s crazy how simple orientation can be the difference between a ketone and date rape drug…biochem is so cool! P.P.S. You should definitely post the details of that inner mitochondrial membrane transport. I’m curious how much energy expenditure we’re talkin there.. Keep doin your thing! Your Fan, Trey No, I don’t think people are messing up if they don’t get into full-blown ketosis. For short term low-carb dieting, the body turns to glycogen. Gluconeogenesis kicks in fairly quickly, though, and uses dietary protein – assuming there is plenty – before turning to muscle tissue for glucose substrate. And you have the Cori cycle kicking in and all sorts of things to spare muscle, so I wouldn’t worry about it. And you can continue to drink while low-carbing. 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 >>

Ketoacidosis

Ketoacidosis

GENERAL ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions). ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. a relative or absolute insulin deficiency is present in all cases. CAUSES The three major types of ketosis are: (i) Starvation ketosis (ii) Alcoholic ketoacidosis (iii) Diabetic ketoacidosis STARVATION KETOSIS when hepatic glycogen stores are exhausted (eg after 12-24 hours of total fasting), the liver produces ketones to provide an energy substrate for peripheral tissues. ketoacidosis can appear after an overnight fast but it typically requires 3 to 14 days of starvation to reach maximal severity. typical keto-anion levels are only 1 to 2 mmol/l and this will usually not alter the anion gap. the acidosis even with quite prolonged fasting is only ever of mild to moderate severity with keto-anion levels up to a maximum of 3 to 5 mmol/l and plasma pH down to 7.3. ketone bodies also stimulate some insulin release from the islets. patients are usually not diabetic. ALCOHOLIC KETOSIS Presentation a chronic alcoholic who has a binge, then stops drinking and has little or no oral food intake for a few days (ethanol and fasting) volume depletion is common and this can result in increased levels of counter regulatory hormones (eg glucagon) levels of free fatty acids (FFA) can be high (eg up to 3.5mM) providing plenty of substrate for the altered hepatic lipid metabolism to produce plenty of ketoanions GI symptoms are common (eg nausea, vomiting, abdominal pain, haematemesis, melaena) acidaemia may be severe (eg pH down to 7.0) plasma glucose may be depressed or normal or Continue reading >>

Fasting Ketosis And Alcoholic Ketoacidosis

Fasting Ketosis And Alcoholic Ketoacidosis

INTRODUCTION Ketoacidosis is the term used for metabolic acidoses associated with an accumulation of ketone bodies. The most common cause of ketoacidosis is diabetic ketoacidosis. Two other causes are fasting ketosis and alcoholic ketoacidosis. Fasting ketosis and alcoholic ketoacidosis will be reviewed here. Issues related to diabetic ketoacidosis are discussed in detail elsewhere. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment".) PHYSIOLOGY OF KETONE BODIES There are three major ketone bodies, with the interrelationships shown in the figure (figure 1): Acetoacetic acid is the only true ketoacid. The more dominant acid in patients with ketoacidosis is beta-hydroxybutyric acid, which results from the reduction of acetoacetic acid by NADH. Beta-hydroxybutyric acid is a hydroxyacid, not a true ketoacid. Continue reading >>

Ketone Body Metabolism In The Ketosis Of Starvation And Alloxan Diabetes

Ketone Body Metabolism In The Ketosis Of Starvation And Alloxan Diabetes

Ketone Body Metabolism in the Ketosis of Starvation and Alloxan Diabetes From the Departments of Internal Medicine and Biochemistry, The University of Texas (Southwestern) Medical School at Dallas, Dallas, Texas 75235 Concentrations of acetoacetate and -hydroxybutyrate and their specific radioactivities were shown to be assayable directly in plasma of the rat without the need for prior deproteinization. By utilizing this technique ketone body turnover was estimated in the isotopic steady state and after the single injection of radioactive acetoacetate or -hydroxybutyrate. While difficulties exist in both types of experiments, the turnover rate of total ketones in the rat was shown to be in the range of 8.1 to 13.2 moles per min per 100 g of body weight during starvation ketosis with the true rate probably being closer to the lower figure. The turnover rate in acute diabetic ketosis approximated 15 moles per min per 100 g of body weight. The liver was shown to play a central role in interconverting acetoacetate and -hydroxybutyrate in the intact rat. In functionally hepatectomized animals the capacity to bring radioactive acetoacetate or -hydroxybutyrate into equilibrium was virtually abolished while in diabetic animals this capability was enhanced. 1970, by the American Society of Biological Chemists, Inc. September 10, 1970 The Journal of Biological Chemistry 245, 4382-4390. 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 >>

Starvation Ketoacidosis: Treatment Pitfalls

Starvation Ketoacidosis: Treatment Pitfalls

Dear Editor, Yeow et al.1 describe a case of non-diabetic euglycaemic acidosis resulting from post op dysphagia and poor intake of approximately six weeks duration. We have seen a similar case of ‘starvation ketoacidosis’ in a patient undergoing percutaneous endoscopic gastrostomy feeding tube replacement. We think that intravenous (IV) glucose should be the initial treatment, with the addition of insulin only if required. The correspondence from Frise and Mackillop2 states this strategy is effective for treating ketoacidosis in pregnancy; however, there are also some other pitfalls in treatment of starvation ketoacidosis which must be considered, and some overlap with alcoholic ketoacidosis. Unlike patients with diabetic ketoacidosis, patients with starvation ketosis release insulin when carbohydrate is administered. They are also producing high levels of glucose elevating hormones such as glucagon and have depleted glycogen stores. These hormones cause the lipolysis which helps generate ketones for fuel. The addition of exogenous insulin in this state risks hypoglycaemia. Once provided with adequate carbohydrate the insulin levels will rise and counter-regulatory hormone levels will fall, resolving the ketosis. Alcoholics are another group prone to ketosis (alcoholic ketoacidosis (AKA)) and are particularly prone to hypoglycaemia; administration of insulin to those patients would have to be with caution and literature3 on AKA reports resolution without insulin administration, although there is little evidence outside of case reports. Starved patients and alcoholics are also both at risk of thiamine deficiency. Depletion of body thiamine stores can occur within four weeks. It is important to consider this, as administration of IV glucose in thiamine deficiency can Continue reading >>

What Is Starvation Ketosis?

What Is Starvation Ketosis?

Starvation ketosis is a metabolic state in humans and many animals in which the body breaks down fat and produces acids known as ketones, then uses these as a primary energy source. The “starvation” part of the name owes to the fact that, in most cases, people only use ketones for energy when they aren’t getting adequate glucose from food. The body typically converts carbohydrates to glucose as a main source of energy, but once the liver has used all of its stored glucose it begins to metabolize fatty acids, forming ketone bodies. Malnutrition and fasting are two of the most common causes, but it can also be the result of conditions like diabetes, alcoholism, and a low carbohydrate diet. People sometimes intentionally trigger this state as a means of burning fat to lose weight, but whether this practice is safe or even advisable is widely disputed in the medical community. Ketones are capable of supplying energy to the body, but an abnormally high level can cause a number of problems, including organ damage, coma, and even death. Understanding Ketones The liver typically makes ketones in response to some sort of energy crisis in the body. People generally get the majority of their energy by synthesizing glucose, which is a sugar molecule found in carbohydrates like bread and grain products. When people aren’t getting enough glucose, the liver begins creating ketones that the body uses in combination with any fat stores it has on hand. Ketones in many ways prevent the body from robbing muscles of their core proteins. Starvation ketosis happens when these become the body’s primary source of energy. The condition can usually be identified by looking for excesses. The body gets rid of unneeded supplies by spilling them out through exhalations, urine, and sweat. Wh Continue reading >>

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Copyright © 2014 Nupur Sinha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as “accelerated starvation.” Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA). We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of AGMA. Intravenous fluids, dextrose, thiamine, and folic acid were administered with resolution of acidosis, early extubation, and subsequent normal delivery of a healthy baby at full term. Rapid reversal of acidosis and favorable outcome are achieved with early administration of dextrose containing fluids. 1. Introduction A relative insulin deficient state has been well described in pregnancy. This is due to placentally derived hormones including glucagon, cortisol, and human placental lactogen which are increased in periods of stress [1]. The insulin resistance increases with gestational age Continue reading >>

What Is Ketosis, And Is It Healthy?

What Is Ketosis, And Is It Healthy?

Ketosis is a natural metabolic state. It involves the body producing ketone bodies out of fat, and using them for energy instead of carbs. You can get into ketosis by following a very low-carb, high-fat ketogenic diet (1). In addition to fast weight loss, ketosis may have several health benefits, such as reduced seizures in epileptic children (2). Ketosis is quite complex, but this article explains what it is and how it can benefit you. Ketosis is a metabolic state in which fat provides most of the fuel for the body. It occurs when there is limited access to glucose (blood sugar), which is the preferred fuel source for many cells in the body. Ketosis is most often associated with ketogenic and very low-carb diets. It also happens during pregnancy, infancy, fasting and starvation (3, 4, 5, 6). To go into ketosis, people generally need to eat fewer than 50 grams of carbs per day and sometimes as little as 20 grams per day. This requires removing certain food items from your diet, such as grains, candy and sugary soft drinks. You also have to cut back on legumes, potatoes and fruit. When eating a very low-carb diet, levels of the hormone insulin go down and fatty acids are released from body fat stores in large amounts. Many of these fatty acids are transferred to the liver, where they are oxidized and turned into ketones (or ketone bodies). These molecules can provide energy for the body. Unlike fatty acids, ketones can cross the blood-brain barrier and provide energy for the brain in the absence of glucose. Ketosis is a metabolic state where ketones become the main sources of energy for the body and brain. This happens when carb intake and insulin levels are very low. It's a common misunderstanding that the brain doesn't function without dietary carbs. It's true that glu Continue reading >>

Warning! Starvation Ketosis Is Serious

Warning! Starvation Ketosis Is Serious

Beware of Starvation Ketosis Starvation ketosis is a serious condition that happens when your pregnant body is starved for nutrition, especially carbohydrates. With starvation ketosis, your tissues begin to breakdown and the byproducts of this ketabolism are called ketones, which actually aggravate nausea. To prevent starvation ketosis, try the following: Salty fluids, such as broths in chicken soup Oral electrolyte solutions (Pedialyte, available over the counter) Sports drinks Continue reading >>

Starvation Ketosis And Priority Of Brain Fuels

Starvation Ketosis And Priority Of Brain Fuels

Posted on March 15, 2018 | Leave a comment Priority is a funny concept the fields of nutrition , metabolism, etc. For the brain, it is said to be glucose. Itll use ketones when glucose is low and ketones are really high, like during starvation, but otherwise its just glucose. Why is this? One of my mentors had some great insights It seems that the loss of some energy as ketones in the urine is the price we pay to provide the brain with a suitable fuel. But there are a number of unanswered questions about brain fuel use. Why does the brain not use free fatty acids? The usual answer given is that they are not transported across the blood-brain barrier fast enough to be used as a major fuel and this is probably true. However, why did the brain not develop a suitable transport system, or localized store of glycogen for that matter. For the rest of this article and more, head over to Patreon ! Five bucks a month for full access and there are many other options. Its ad-free and you can cancel if it sucks Also, Im open to suggestions, so please dont hesitate to leave a comment or contact me directly at [email protected] . Affiliatelinks:stilllookingforapairofhotblueblockers? Carbonshade and TrueDark areoffering15%offwiththecouponcodeLAGAKOSand Spectra479 isoffering15%off HERE . IfyouhavenoideawhatImtalkingabout,read this then this . 20%offsomedelishstocksandbrothsfrom KettleandFire HERE . Ifyouwantthebenefitsofshroomsbutdontlikeeatingthem, RealMushrooms makesgreatextracts.10%offwithcouponcode LAGAKOS .IrecommendLionsManeforthebrainand Reishiforeverythingelse . Continue reading >>

Ketosis: Symptoms, Signs & More

Ketosis: Symptoms, Signs & More

Every cell in your body needs energy to survive. Most of the time, you create energy from the sugar (glucose) in your bloodstream. Insulin helps regulate glucose levels in the blood and stimulate the absorption of glucose by the cells in your body. If you don’t have enough glucose or insufficient insulin to get the job done, your body will break down fat instead for energy. This supply of fat is an alternative energy source that keeps you from starvation. When you break down fat, you produce a compound called a ketone body. This process is called ketosis. Insulin is required by your cells in order to use the glucose in your blood, but ketones do not require insulin. The ketones that don’t get used for energy pass through your kidneys and out through your urine. Ketosis is most likely to occur in people who have diabetes, a condition in which the body produces little or no insulin. Ketosis and Ketoacidosis: What You Need To Know Ketosis simply means that your body is producing ketone bodies. You’re burning fat instead of glucose. Ketosis isn’t necessarily harmful to your health. If you don’t have diabetes and you maintain a healthy diet, it’s unlikely to be a problem. While ketosis itself isn’t particularly dangerous, it’s definitely something to keep an eye on, especially if you have diabetes. Ketosis can be a precursor to ketoacidosis, also known as diabetic ketoacidosis. Ketoacidosis is a condition in which you have both high glucose and high ketone levels. Having ketoacidosis results in your blood becoming too acidic. It’s more common for those with type 1 diabetes rather than type 2. Once symptoms of ketoacidosis begin, they can escalate very quickly. Symptoms include: breath that smells fruity or like nail polish or nail polish remover rapid breat Continue reading >>

Diabetic, Alcoholic And Starvation Ketoacidosis

Diabetic, Alcoholic And Starvation Ketoacidosis

Copious amounts of ketones which are generated in insulin-deficient or insulin-unresponsive patients will give rise to a high anion gap metabolic acidosis. Ketones are anions, and they form the high anion gap. Management of DKA and HONK is discussed elsewhere. Meet the ketones Chemically speaking, a ketone is anything with a carbonyl group between a bunch of other carbon atoms. The above are your three typical ketoacidosis-associated ketone bodies. The biochemistry nerds among us will hasten to add that the beta-hydroxybutyrate is in fact not a ketone but a carboxylic acid, but - because it is associated with ketoacidosis, we will continue to refer to it as a ketone for the remainder of this chapter, in the spirit of convention. In the same spirit, we can suspend our objections to acetone being included in a discussion of ketoacidosis, which (though a true ketone) is in fact not acidic or basic, as it does not ionise at physiological pH (its pKa is 20 or so). So really, the only serious ketone acid is acetoacetate, which has a pKa of 3.77. However, beta-hydroxybutyrate is the prevalent ketone in ketoacidosis; the normal ratio of beta-hydroxybutyrate and acetoacetate is 3:1, and it can rise to 10:1 in diabetic ketoacidosis. Acetone is the least abundant. The metabolic origin of ketones The generation of ketones is a normal response to fasting, which follows the depletion of hepatic glycogen stores. Let us discuss normal physiology for a change. You, a healthy adult without serious alcohol problems, are fasting from midnight for a routine elective hernia repair. You will go to be after dinner with a few nice lumps of undigested food in your intestine, as well as about 75g of hepatic glycogen. As you sleep, you gradually digest the food and dip into the glycogen store. At Continue reading >>

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