DIABETIC KETOACIDOSIS VS. DIETARY KETOSIS
Diabetic patients know that the detection in their urine of the ketone bodies is a danger signal that their diabetes is poorly controlled.
Indeed, in
severely uncontrolled diabetes, if the ketone bodies are produced in
massive supranormal quantities, they are associated with ketoacidosis. In this life-threatening complication of diabetes mellitus, the acids 3-hydroxybutyric acid and acetoacetic acid are produced rapidly, causing high concentrations of protons, which overwhelm the body’s acidbase buffering system. However, during very low carbohydrate intake, the
regulated and
controlled production of ketone bodies causes a
harmless physiological state known as dietary ketosis. In ketosis, the blood pH remains buffered within normal limits.
Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively. Ketones also have a direct inhibitory effect on lipolysis in adipose tissue.
Interestingly, the effects of ketone body metabolism suggest that mild ketosis may offer therapeutic potential in a variety of different common and rare disease states. (...)
Although some studies suggest that preexercise muscle glycogen stores determine capacity for prolonged exercise, there is no clear
requirement for dietary carbohydrates for human adults. Current carbohydrate recommendations are based on 1) preventing ketosis, and 2) providing glucose beyond minimal needs. However, it is clear that ketosis is not harmful except in the high levels seen in type 1 diabetes.
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