Ketogenesis and Ketone Utilization in Various Health Conditions

Part 1: Ketogenesis

Ketones will only be created in the body if blood sugar and insulin concentration in the blood is low. If the body is in the process of ketogenesis (making ketones for fuel) and sugars/carbs are introduced, insulin will be released and ketogenesis will stop. Sugar and carbs are always the primary fuel.

When glucose is not available, stored fat in adipose tissue is mobilized. This would occur during fasting.  Fat is stored as a triglyceride, it its broken down by the enzyme “hormone sensitive lipase’ into 1 glycerol molecule and 3 fatty acid molecules. The fatty acids are then transported into the cell’s mitochondria with the aid of acetyl-L-carnitine where the process of turning fatty acid molecules into energy molecules (ATP) occurs.

In the mitochondria, the process of beta-oxidation breaks the fatty acids down into smaller carbon chains (used for energy) and Acetyl CoA. In the process the Acetyl CoA accumulates, which triggers the process of ketogenesis.

Within a few steps acetyl CoA is converted to acetoacetate which can then be converted into beta hydroxybutarate and acetone. These later 3 molecules are collectively known as ‘ketone bodies’. Without delay the ketones are used as a cellular fuel source in all tissues except for the liver. Primarily, the brain, heart and muscle tissue will use ketones efficiently when they are available.

The main concept here is that stored fat breaks down into energy while simultaneously evoking the production of ketones, which, in turn, are used for energy.

Part 2: Ketone utilization

With a very low carb diet, prolonged fasting, and/or when taking supplemental/exogenous ketones, the concentration of ketones in the blood remains elevated and being in a ‘state of ketosis’ is based on the blood concentration, which can be measured.

By staying in ketosis for extended periods of time, a wide array of health benefits quickly emerges.

The ketogenic state helps stabilize blood sugar, thereby decreasing the many adverse effects linked to this and also decrease or eliminating the need for pharmacologic medications. More importantly, suppressing insulin will, over time, improved ‘insulin sensitivity’ and lead to long-term improvements in blood sugar control. Reversal of type 2 diabetes is possible with dietary and lifestyle changes and ketosis plays a central role in this.

The ketogenic diet first showed promise in cases of epilepsy and has been used clinically for over 80 years. By shifting neuron metabolism from glucose-dependent, to ketone-dependent, seizure frequency and severity has decreased. Long-term benefit and safety has been documented in epileptic cases.

Alzheimer’s and Parkinson’s disease:
For similar reasons as described above, neurons that are fueled by ketones have improved physiologic function. Animal study findings suggest a lasting neuro-protective role from a ketogenic diet and evidence is mounting that most diseases that are characterized by neuron death would be improved with a ketogenic diet, though the exact mechanisms are currently unknown. The link between Alzheimer’s and insulin dysregulation is strong, to the point where many researchers are starting to classify the disease as ‘Type-3 diabetes’.

Traumatic brain injury, Stroke and Concussion:
These conditions are characterized by neuron excitotoxicity, mitochondrial dysfunction and increased oxidant concentrations. Each of these are improved when in a state of ketosis.

Clinically, the neuroprotective nature of the ketotic state is being researched for most brain-related conditions and the results thus far are positive. My clinical experience with patients with post-concussion syndrome is that their symptoms improve when scheduled fasting and supplemental ketones are introduced.

It has been established that cancer cells are far more dependent on glucose availability than normal healthy human cells. It has been thought that this need for glucose was driven by the increased metabolic rate that is characteristic of these cells. Recently it has been discovered that the need for glucose is specifically required to balance the oxidative stress that is derived from the heightened metabolic rate.

The line of research currently being explored is testing the idea that a ketogenic approach leaves cancer cells especially vulnerable to oxidative damage because glucose availability remains low over an extended period. Essentially, starving the body of available glucose will specifically damage cancer cells, which, in theory, should leave them more susceptible to chemotherapy or radiation and improved outcomes would be expected. From a naturopathic perspective, oxidative therapies (such as ozone therapy or certain IV therapies) can further tip the balance in favour of healthy, non-cancerous cells and improve outcomes whether chemotherapy/radiation is used or not.

To conclude, the ketogenic diet is not a “fad diet”. We are only now coming to understand the full potential of this approach. Ketosis is an extremely powerful regulator of cellular metabolism and when formulated and implemented correctly, it can be extremely effective at reversing a wide variety of serious, chronic health problems.

To learn if this approach is safe and useful for you, please book in to see Dr. Sal Meli ND.

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