Talk:Ketosis/Archive 1

Some Errors and Edits
This article is missing fasting (complete water fasting) as the most powerful path to ketosis. And missing all the health benefits proven during fasting by Dr. Joel Fuhrman http://en.wikipedia.org/wiki/Joel_Fuhrman and Herbert Shelton (see http://en.wikipedia.org/wiki/Herbert_shelton). — Preceding unsigned comment added by Jgauthier96 (talk • contribs) 21:21, 19 July 2013 (UTC)

I've corrected some mistakes in the text of the body and sort of reformatted the paragraphs to make it more readable.

"Energy from fat is mobilized to the liver and used to synthesize glucose..." The liver cannot convert fatty acids to glucose, only lactic acids, amino acids and glycerol are involved in gluconeogenesis.
 * Glycerol itself is a product of fat (trigyceride) breakdown, yes? So "fat," as originally stated (i.e., not "fatty acids" that you misquote), is a starting resource for gluconeogenesis.209.48.229.98 (talk) 16:44, 19 January 2009 (UTC)

"...fasting mode such as occurs during sleep..." AFAIK, the body has enough glycogen stored to cover sleep. During this period other cells such as muscle, switch to using fatty acids while cells that are obligate users of glucose continue to use glucose during this acute stage. Only when glycogen has been used up does the body start to engage in gluconeogenesis (a very inefficient process) and ketogenesis.

"Ketosis, which is one of the body's processes for the metabolism of body fat..." Lipolysis is the process where fat is metabolized. Ketosis is exclusive for periods of prolonged starvation.

"Glucose accumulates to the point that the kidney must use water to spill it into the urine, losing that water and causing dehydration in the process." This doesn't happen, glucose is ALWAYS excreted in the glomerulus of the kidney. However, the tubules are capable of reabsorbing the excreted glucose. But when hyperglycemia is present, the reabsorbing mechanism is unable to reabsorb all the glucose, hence there is residual glucose in the urine (glycosuria). The increase in osmolarity of the fluid in the tubules of the kidney exerts an osmotic pressure on water causing water to leak out of the extracellular tissue into the tubules generating more and more urine (called osmotic diuresis).

"...in a vicious cycle." There is no vicious cycle, acidosis does not lead to diuresis nor does it increase the level of glucose in the blood.

"Alcoholic ketoacidosis presents with similar symptoms but different origin. Excessive consumption of alcohol causes dehydration and inhibits gluconeogenesis. Thus the body is unable to synthesize enough glucose to meet its needs, thus the energy crisis begins." This is not quite right because there is more to it than just dehydration and inhibition of gluconeogenesis. The body must have a low insulin, high glucagon content before ketosis even takes place. Hence in normal people who have drank alcohol, there is more than enough glucose in the blood stream such that there is absolutely no need for gluconeogenesis or ketosis. So i've removed this part by using <! --   -- > brackets for future edits.

--Av01d 07:37, 22 June 2006 (UTC)

is a low carb diet then bad for you? If not, should this be just a temporary diet?


 * You're probably thinking of ketoacidosis, which can occur in patients with diabetes mellitus. Ketosis occurs in normal cells as a part of metabolism. Ketoacidosis occurs when too many acidic ketone bodies are produces, which (IIRC) is not prominent in low carbohydrate diets such as the Atkin's diet. --Diberri | Talk 06:10, Apr 21, 2004 (UTC)

20 grams?
I presume the number "20" is only correct for some "average Joe," right? Can you provide the assumptions in the article in order to be more precise? Awolf002 21:11, 16 Aug 2004 (UTC)

This article sounds is written in a biased tone
This discussion of ketosis sounds almost like it was made by the USDA... All these comments are written from the point-of-view that a high-carb diet is optimal for humans:


 * "an abnormal amount of ketone bodies build up in one's bloodstream"
 * "no more carbohydrates available from the bloodstream's glucose (either from not having eaten enough carbohydrates ...)"
 * "ketosis is an abnormal state of having too many ketone bodies"
 * "these conditions may be caused not by the ketosis itself, but by lack of carbohydrates"

I'd like to make some moderate changes to these things to put them on a more factual basis, and also to provide counter-arguments to the claim that "other symptoms might be associated with prolonged ketosis (heart palpitations, kidney stones, osteoporosis, calcium depletion, electrolyte imbalances, gout, dehydration, dizziness, constipation, light-headedness, fatigue, depleted mineral stores)". I thought I'd post here first as I'm new to Wikipedia and don't want to tread on any toes... ashley_moran 21:17, 11 October 2005 (UTC)


 * Someone quite ignorant of the condition, had recently made massive changes. I have switched back to the version that had persisted.  Let me know if it repeats any of the flaws that attracted your attention.--Silverback 21:36, 11 October 2005 (UTC)


 * For my part, I actually found that it is written from a point of view that is heavily biased towards ketosis diets; this is especially evident in the "Controversy" section, which is something around 80% off topic, essentially being little more than a listing pro-ketosis talking points instead. A separate section for proponents point of view could help probably, instead of trying to water down the controversy section with an argument full of weasel wording. Melissia (talk) 09:26, 30 June 2012 (UTC)

Ketosis harmful?
Is ketosis harmful to one's health? Maybe the headaches are just temporary until one is accustomed to this metabolic state. Are there any animals living in ketosis? What about carnivores? --DenisDiderot 02:37, 18 January 2006 (UTC)


 * For what it's worth, your question is one of the major medical debates of the last decade or so. The majority opinion is that it is harmful but that opinion is widely disputed. The headaches you are talking about are temporary (unless there is something else going on with you independent of changing diets). Mammalian carnivores indeed do mostly live in a state of ketosis (perhaps other animal kingdoms too. I don't know). The basic mainstream argument has been that we are an omnivorous species that cannot survive in ketosis. There is clinical evidence to support that viewpoint but most of it has been based on extremely short term studies (i.e. when one switches abruptly from a high-carb to a low-carb diet their metabolism, kidney function, etc. often act pretty strange but that has mostly only been shown to be a short-term effect [which one would expect with any abrupt change in diet]).


 * I think this article should address this question more than it does. However, I don't think it should imply an opinion as it seems to now. --Mcorazao 17:13, 16 November 2006 (UTC)

__________________

Ketosis, or elevated ketone body concentrations in the blood, is absolutely not harmful unless the levels are very high, as in the case of diabetic ketoacidosis. Normally everyone produces ketone bodies to some extent when fatty acids undergo "beta-oxidation". Ketone bodies are simply a way of redistributing the products of fatty acid breakdown from the liver to other tissues of the body. It is not only healthy, it is essential, especially when food availability is very low (e.g., periods of starvation which almost all animals undergo at times, especially in the winter). So you first need to be clear that ketosis (elevated levels of ketones in blood) is not necessarily ketoacidosis (extremely elevated levels). Ketoacidosis is always bad, ketosis is not.

Description of Ketosis by Hans Krebs et al. in 1968: "The sequence of events leading to 'physiological ketosis' may be visualized as follows. As a consequence of hormonal interrelationships a low blood sugar concentration (starvation) causes an increase in adipose-tissue lipolysis and a rise in the concentration of free fatty acids in the plasma. This in turn results in an increased rate of ketogenesis in the liver, which is followed by a rise in blood ketonebody concentrations and an increased rate of peripheral utilization. Only in the more severe stages of diabetes does there appear to be a real overproduction of ketone bodies beyond physiological needs. The high blood concentrations reached in these situations result in large losses of ketone bodies and alkali via urine."

Bates, M.w., Krebs, H.A. and Williamson, D.H., Turnover Rates of Ketone Bodies in Normal, Starved and Alloxan-Diabetic Rats, Biomhem. J. (1968) 110, 655, p 661.

User:John R Moffett.

Starvation?
I realize there has been some effort to neutralize this article but, at the risk of being biased myself, I still believe this article demonstrates too much bias. Among other things, the use of the term "starvation" I don't believe is justified here, at least not without a lot more clarification. This term implies that the body is missing something very important which certainly not all in the medical community (and related communities) agree with. Even removing this word the implication is still there in some of what is being said.

I realize that the "mainstream" thinking says that ketosis is "unnatural" and certainly no article should try to acknowledge every crackpot opinion out there. Nevertheless I think there areenough credible contrarian opinions out there to say that the mainstream opinion should not be treated as THE authority on the subject.

I would suggest approaching this by first simply discussing how the body switches between the two modes of operation without implying that one or the other is more "normal." Then go into a discussion of the opinions regarding which mode is "normal" emphasizing which is the mainstream opinion.

A couple of other things: The article implies that high insulin is bad but doesn't explain. Granted this isn't an article about insulin but without explaining that it's confusing. The article also seems to imply glucagon is strictly a bad thing. Again this is not an article about glucagon but the way the article is written it implies something misleading since increased glucagon levels have been shown to promote health (indeed some argue that the extreme low CALORIE diets are beneficial largely because they boost glucagon). --Mcorazao 22:21, 5 November 2006 (UTC)

The human brain itself is over 50% fat, and you have no control over where fat is taken from your body when it's being catabolized, i.e. via ketosis. If this ever becomes your primary source of energy, you are -- by definition -- starving to death. This is not the same as burning fat via aerobic exercise, during which normal metabolism is never replaced with (only supplemented by) the breakdown of fat. Chronic ketosis is a life-threatening condition that requires immediate medical attention, or else you will die, because your body is digesting your brain, among other parts. Not to mention filling your precious bodily fluids with increased levels of acetone (which is toxic at those increased levels). If you don't understand the term, then don't fucking edit the article. --70.131.247.129 (talk) 00:02, 12 April 2008 (UTC)
 * Please don't use that sort of language on talk pages, and try to work constructively with editors rather than insulting them. Without trying to defend the fad diet or POV issues here, it is not true that ketosis implies "digesting your brain" or that this is a path to certain death. Under medical supervision (and I strongly emphasise that), ketosis can be maintained for years. See the ketogenic diet. Those attempting such a radical alteration of their body metabolisms without such supervision are, I agree, putting their health at risk. The use of hyperbole doesn't help your argument, which would be stronger if you can cite a medical review paper, for example. Colin°Talk 09:07, 12 April 2008 (UTC)

I've never read anything more absurd and biased on wikipedia than "It is a life-threatening condition, which requires immediate medical attention." This entire article is almost comical in its misinformation and odd interpretation of empirical science. Mightysween (talk) 23:54, 13 April 2008 (UTC)

Please look to investigating the blogs of Dr Peter Attia and Dr Mary Vernon, both who have been in ketosis for a number of years and have optimum health. And at consuming over 4000 calories (yes not a typo) per day, Peter is far from starving. In fact there are many people who have been in dietary ketosis for many years now and don't seem to be digesting their brains, but trying to teach people that we don't in fact need carbohydrates (more than 20-30grams per day) to live optimally. Please also read Gary Taubs, Robert Lustig and of course Dr Atkins who will all explain why Ketosis is different from Ketoacidosis. (You only need minimum insulin in your body to utilise the ketones as energy instead of glycogen - if you have no insulin ie type 1 diabetic ketones will continue to rise until they reach a dangerous level - ie ketoacidosis. Healthy people including  type II diabetics wlll only benefit from having their fat converted to ketones which all the organs of the body ae more than happy to use indefinately.)

Starvation ?
"switches to a chronic fasting mode during long periods of starvation." and "During the initial stages of starvation". I think this could be reworded. Starvation being extreme malnutrition, any individual who is in a state of starvation will by definition be catabolysising fat and muscle mass to supply energy and nutrient needs to vital organs of the body. It would be true that a starving individual will be in the state of ketosis.

However what I see (correct me if I am wrong) is that it is perfectly possible to be in a state of ketosis and not be classified as in a state of starvation eg. those who are on Akins or other ketogenic diets. Thus the term "Starvation" is just not specific enough nor inclusive enough. Ketosis is simply a metabolic state the body enters when it has depleted glucose/glygogen resources generally caused someone doesnt consume enough carbohydrates to supply energy needs from sugar metabolism. Starvation is in comparison a state in which someone on a long period cannot consume enough "food" to supply total energy needs. I assume Inuit (Eskimo's) eating a traditional diet could during many periods of the year be in a state of ketosis but not classified as starving due to consumption of meat, fish other energy rich foods

Thus I think "switches to a chronic fasting mode during long periods of starvation" should be edited to something like "switches to metabolising fats or lipids after a period of time should an individual fail to consume enough carbohydrates to statisfy energy needs". The text "During initial stages of starvation" should also be reworded to "During initial stages of glycogen depletion"


 * I've taken the liberty of trying to neutralize the whole description to get away from the debates about starvation and "normal diets." I'll argue this is the right thing to do since, today, there is significant controversy in this regard. I did, though, state specifically the "majority opinion" in this debate in a statement separate from the main description.
 * Please comment on these edits and/or modify if you have better ideas.
 * P.S. With respect to wording like "During initial stages of glycogen depletion" I avoided even this wording because it still implies (although not so emphatically) that the healthy state of the body is to have substantial glycogen stores present. Although, again, this is the "majority opinion" it is still controversial enough that I believe it should be treated as a controversy.
 * --Mcorazao 23:24, 1 December 2006 (UTC)

test strips
These "special" test strips are just regular pH test strips, right? Like the kind used to test aquarium water? That's what it appears to be. Can anyone clarify? I might try an experiment or something. Yeah, I have no life.

65.12.119.107 05:58, 4 August 2007 (UTC)The test strips are not testing pH. They are testing for the presence of a specific ketone (I can't recall which one).

Dangers hinted at, but not mentioned?
In recent years this viewpoint, both the body's preference for glucose and the dangers associated with ketosis, has been challenged by some doctors.

This sentence implies that the mainstream view is that ketosis is at least potentially harmful, yet the article does not mention a single danger (or alleged danger) associated with ketosis.

So, what *are* the dangers/alleged dangers? Any unpleasant bad symptoms associated with it? Are there any doctors out there saying that ketosis can lead to ketoacidosis in non-diabetic individuals?

Some preliminary Googling shows only a bunch of pages defending ketosis, with a handful maligning it due to lowered blood PH (which--according to Wikipedia--is actually ketoacidosis and not ketosis, although the difference seems to be merely one of severity.) If it turns outthat there isn't any reliable data that ketosis is harmful, then the sentence needs to be rewritten. --Lode Runner 01:36, 12 August 2007 (UTC)

Some resources on Ketosis
'''STUDIES ON  KETOSIS* VI. QUANTITATIVE STUDIES  ON  fl  OXIDATION''' http://www.jbc.org/cgi/reprint/109/2/597.pdf

Experience With the Ketogenic Diet in Infants http://pediatrics.aappublications.org/cgi/content/full/108/1/129

Metabolic substrates and Hormones During Starvation Ketosis in Children http://www.ajcn.org/cgi/reprint/21/11/1268.pdf

--85.210.145.17 20:02, 13 August 2007 (UTC)


 * in the article there is no mention of ketosis in infants...could anyone provide? My knowledge of the matter is definitely not enough. --77.185.108.220 (talk) 06:21, 21 January 2008 (UTC)

gluconeogenesis role?
"If the diet is changed from a highly glycemic diet to a diet that does not provide sufficient carbohydrate to replenish glycogen stores, the body goes through a set of stages to enter ketosis. During the initial stages of this process the adult brain does not burn ketones, however the brain makes immediate use of this important substrate for lipid synthesis in the brain. After about 48 hours of this process, the brain starts burning ketones in order to more directly utilize the energy from the fat stores that are being depended upon, and to reserve the glucose only for its absolute needs, thus avoiding the depletion of the body's protein store in the muscles"

Can someone provide a cite for this? My understanding is that, in a restricted carbohydrate, but unrestricted caloric, setting, the liver will readily engage in gluconeogenesis. This process, while not providing levels of glucose comparable to that from dietary carbohydrate intake, provides sufficient blood glucose to correct hypoglycemia and for brain functioning. Thus, it does not follow that the brain sacrifices substrate ketones for energy (or even "starts burning ketones" any more readily) in a restricted carbohydrate setting. Rather, this seems to be the case in a starvation setting. Discussion on this is welcome. 209.48.229.98 (talk) 16:59, 19 January 2009 (UTC)

"Ketoacidosis, by contrast..."
According to the article's intro, "ketosis...is a state of the organism characterised by elevated levels of ketone bodies in the blood". Now, the corresponding image is labeled "ketone bodies" and shows chemical structures for acetone, acetoacetate, and beta-hydroxybutrate.*

The last sentence of the intro previously stated, "Ketoacidosis, by contrast, is the accumulation of excessive keto acids in the blood stream (specifically acetoacetate and beta-hydroxy butyrate)." I have deleted this sentence, as it conflicts with the image and the rest of the article.


 * (Note that the image actually shows the acidic forms, acetoacetic acid and beta-hydroxybutric acid, but I believe that in this context it is acceptable to use the names of the acidic and basic forms synonymously.)

Une Limonade (talk) 16:50, 29 August 2009 (UTC)

Metabolic pathways section
This section currently has a "confusing" tag on it, which I definitely agree with. I think it may be misleading or mistaken in places as well. I'm going to try to clean it up.

I plan to do this in two stages. First I'll remove parts not specifically relevant to ketosis, so I can get a better handle on what's remaining. Then I'll try to rewrite what remains into something that can be more easily understood. Warren Dew (talk) 18:41, 18 March 2010 (UTC)

Did it in one step, with an additional minor cleanup. Didn't find good references, though I found the following academic source that probably isn't formal enough:

http://www.rpi.edu/dept/bcbp/molbiochem/MBWeb/mb2/part1/fatcatab.htm

If anyone can find secondary sources that can be used as references, that would be good. Warren Dew (talk) 19:33, 18 March 2010 (UTC)

Missing captions
The diagram needs captions (links). Newcomers will not be familiar with the names of the three ketone bodies. David Spector (talk) 00:16, 24 July 2010 (UTC)

plain English?
Is there any chance this article would be revised into plain, ordinary English so that EVERYONE could understand it and not just a handful of experts and/or scientists?

I thought the whole point of Wikipedia was to make information available to the layman, not people who already know about the subject, and this is written as if it comes right out of a college textbook (or worse). — Preceding unsigned comment added by 108.91.173.41 (talk) 05:30, 4 December 2011 (UTC)