Ketosis, Explained in-depth
Article from a low carb website explaining ketosis, comment plz
Ketosis: Mystery or Misconception?
by Tanya Zilberter, PhD
Did you know that two ketone bodies, acetoacetate and D-3-hydroxybutyrate, are the only freely soluble fats (lipids) the body can use? This very important fact explains a significant part of the ketosis mystery.
Ketosis: Mystery or Misconception?
Did you know that the two ketone bodies, acetoacetate and D-3-hydroxybutyrate, are the only freely soluble fats (lipids) the body can use? This very important fact explains a significant part of the ketosis mystery.
Ketosis is achieved by reducing carbohydrates to such a low level that the body is forced to use incompletely metabolised fats (ketone bodies) as fuel.
Ketone bodies function as:
* Brain fuel. The major role of ketone bodies is to supply an alternative (to glucose) fuel for the brain in situations where there are little or no carbohydrates available with food.
* Building blocks for brain tissue. Ketone bodies are precursors for the essential substance (acetyl-CoA) required in the synthesis of lipid (myelin) in the neural cells.
The mechanisms for both major functions are described in the tiniest details. It is well known how they act on the cellular and intracellular (mitochondrial) levels and how they can correct certain pathological states of the brain cells.
The concentration of ketone bodies in the blood at any time represents a balance between the rate of their production by the liver and the rate of their use by tissues.
What concentration is normal?
* Norm (normoketonaemia) is a concentration of total ketone bodies in blood below 0.2 mmol/l.
* Ketosis (hyperketonaemia) is concentrations above this level but below the ketoacidosis.
* Ketoacidosis are concentrations above 7 mmol/l.
Past Technical Mistake Leads to Modern Misconception
Historically, ketosis was associated with the pathology of diabetes, resulting in the view that ketone bodies were toxic waste products. It happened simply because the only available test at that time detected 3-hydroxybutyrate (which, in fact, is not a ketone body at all but here it doesn't matter) in diabetic urine. Acetone on the other hand is a ketone and is present in blood and urine when the plasma concentration of acetoacetate is elevated. The body gets rid of it through the lungs; this is where the sweet smell on the breath during ketosis comes from.
In 1967, the streamline health sciences developed a so-called enzymatic method of analysis of acetoacetate and 3-hydroxybutyrate, which led to the dramatic finding that the human brain, while in the condition of prolonged starvation, was able to use ketone bodies.
This finding triggered a reversal of the negative opinion of ketosis as a pathological and dangerous condition -- well, almost.
Many, if not most, dieticians and nutritionists continue to warn dieters against the dangerous consequences of ketosis. However, the facts are:
Babies are naturally adapted to ketosis, thanks to their high-fat diet of mother's milk. In adults, the liver is the only organ other than the brain that can use ketones for fuel and produce them out of circulating free fatty acids (FFA.)
FFA are not created equal. Some enter the liver to be converted into ketones easier than others. The "easiest" FFA originate from dairy ? giving us one more reason to regard this food group. It may well be that so-called French and Mediterranean paradoxes can be explained, in part, by profound use of cheeses and yogurts.
Interestingly, there are two other less significant sources for ketone productions: amino acids (leucine and isoleucine) and acetate produced in the process of food fermentation in the intestines. One of the most well-documented successful low-carb diets, the GO-diet, prescribes the dairy products probiotics that promote intestinal fermentation as essential foods.
The fats we seek to get rid ourselves of
However, the fats we seek to get rid ourselves of -- those in our fat depots -- are not the "easy" ones to be converted and used. The success of their conversion, or "burning," depends heavily on the hormones adrenaline and noradrenaline. These hormones' opponent and enemy, insulin, inhibits the "burning" activity. This is why, after a high-carbohydrate meal, when insulin secretion and its concentration in the blood are high, the release of fatty acids from fat depots (adipose tissue) is suppressed. And this is why insulin has a bad reputation -- unfairly so, because in the absence of high-carbohydrate meals, the problem doesn't exist.
To the contrary, during exercise or stress, when adrenaline and noradrenaline levels are elevated, the "burning" of fatty acids is increased.
KetoStix controversy
Another interesting fact that can unpleasantly surprise those who religiously aim to increase ketone bodies' concentration and who hold their breath while checking the KetoStix: increased ketone bodies concentration suppresses the fat burning! It happens because ketones increase the secretion of insulin and directly inhibit lipolysis in the adipose tissue.
There are various states of ketosis:
Physiological Ketosis
As we've mentioned, suckling babies (high-fat diet of the milk) are in a natural state of ketosis. Another natural ketosis occurs after exercise, caused by the depletion of stored carbohydrate reserves (glycogen) in the liver. Yet another natural state, which less desirable, is fasting that is prolonged beyond 24 hours. All these situations have in common a low carbohydrate-availability status.
The first event, after withdrawal of food (or carbohydrates), is a lowering of plasma insulin accompanied by stimulation of fat burning. However, for the first 8-10 hours, there is no increase in blood-ketone bodies.
Once food is introduced back into the system (unless it consists of low-carb foods,) when insulin concentration rapidly increases and FFA concentration decreases, there's a parallel decrease in ketone bodies. If the meal consists mainly of fats with little carbohydrates, the liver senses a continuing decrease in plasma insulin and the concentration of ketones remains high. This is why the truly low-carbohydrate diets sometimes are called regulated fasting.
Pathological Ketosis
The best example of pathological ketosis is insulin-dependent or Type I diabetes. The changes in this condition are similar to those during fasting, but they are dangerously pronounced. Insulin is pathologically very low and therefore there is no means to restrain adrenaline, noradrenaline and glucagon from excessive fat burning that can actually cause the deterioration of tissue.
Metabolic Acidosis
The ketone bodies acetoacetate and hydroxybutyrate are both strong acids, which makes them metabolically disadvantageous since they decrease in the blood pH. The symptoms of severe acidosis include depression, weakness, anorexia and vomiting, and may eventually lead to coma.
To the contrary, even prolonged fasting, where the blood ketone bodies may reach 8-10 mmol/l, does not cause a serious disturbance of the acid-base balance because there are natural biochemical-protective mechanisms, including acetone conversion into glucose in the liver.
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