Ketosis (metabolism)

As ketosis , partly Ketolyse is referred to in the medical a metabolic state in which a rise in the concentration of acidic ketone bodies ( acetoacetate , 3-hydroxybutyrate , acetone ) in the blood and extracellular space is observed over the standard values. The ketone bodies can replace glucose as the organism's primary energy source. Ketosis can occur in inadequately treated diabetes mellitus and ketoacidosis can lead to a life-threatening coma .

physiology

The cause of ketosis from infancy is either a prolonged state of hunger , for example when fasting , or a long-lasting low intake of carbohydrates of less than 50 grams per day in adults, with intended restriction (mostly in combination with a significantly increased fat percentage) as a ketogenic diet designated. Under the influence of glucagon, to cover the energy requirement, there is an increased breakdown of fatty acids into ketone bodies in the liver as an alternative to providing glucose from the breakdown of carbohydrates.

If the carbohydrate intake is reduced, newborns can enter ketosis for a short period of six hours.

The ketone bodies are used by all tissues, but especially by the muscles and the brain, as a source of energy. Ketone bodies can easily cross the blood-brain barrier . Any remaining carbohydrate requirement, for example for the synthesis of secretions such as saliva, can be covered by gluconeogenesis from amino acids and the glycerine in fats.

The increased concentration of ketone bodies in the blood also leads to increased excretion of ketones in the urine ( ketonuria ) and in the exhaled air. The bad breath or body odor can in this case have a characteristic fruity ketone odor.

Switching from a high-carbohydrate to a low-carbohydrate diet and fasting are often accompanied by short-term side effects. Symptoms here are reduced performance, headaches , tiredness, general weakness, nausea and even vomiting , which however completely subside after a few days.

Differentiation from ketoacidosis

The plasma concentration of ketone bodies in a ketotic metabolic state is about 2 to 5 mmol / L. Numerous other blood values, for example blood salts and blood gases, are not changed. A diabetic ketoacidosis , however, includes a lethal effect on acid-base balance, blood gases and blood salts, and the ends untreated fatal. In diabetic ketoacidosis, the concentration of ketone bodies in the organism is often 25 mmol / L and more.

Ketosis in diseases

This section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

Connection to hypothyroidism is not proven

A ketogenic diet is a recognized treatment for certain forms of childhood epilepsy .

The so-called ketotic types of glycogen storage diseases ( Crohn Cori , Crohn Hers , glycogen storage disease type IX and glycogen storage disease type 0 ) sets the ketosis, not always together with hypoglycemia , after a few hours without eating one. In these metabolic disorders , ketosis is an undesirable metabolic condition that can lead to numerous complications. Nutritional therapy aims to avoid ketosis. For glycogen storage disease III, however, a ketogenic diet could be helpful.

There are concerns that people with hypothyroidism or Hashimoto's thyroiditis during ketosis may experience a significant shift in hormone levels that may require readjustment of medication; such an influence has been reported in otherwise thyroid healthy subjects.

Some researchers recommend a ketogenic diet as the first component of diabetes mellitus therapy.

There is some evidence that the ketogenic diet offers a cancer survival benefit.

Veterinary medicine

In dairy farming, ketosis is also known as acetonemia . It can occasionally occur in high- yielding cows , especially in the first three weeks after calving . It can be both a primary disease and a secondary disease as a result of another disease, e.g. B. the birth palsy occur. A German study from 2011 found that the fats the animals use to produce the milk fat is decisive for the development of ketosis : ketosis-prone animals are more likely to mobilize body fat , while robust animals are more likely to mobilize phosphatidylcholine (lecithin) from the blood use as a supplier of fatty acids. Feeding in the transit phase influences the origin of the fatty acids. Animals with a high percentage of fat tend to mobilize body fat instead of phosphatidylcholine. Healthy animals can therefore be recognized by a high content of glycerophosphocholine and a low content of phosphocholine in their milk.

A lack of feed and certain feed ( silage containing butyric acid ) can promote ketosis.

See also : fat-protein quotient

Web links

• Ketosis in cows ( memento from February 9, 2008 in the Internet Archive ). Ludwig Maximilians University Munich , Clinic for Ruminants, lecture notes, November 3, 2003.

Individual evidence

1. ↑ Eric C Westman: Is dietary carbohydrate essential for human nutrition? In: American Journal of Clinical Nutrition . tape 75 , no. 5 , May 2005, pp. 951-953 , PMID 11976176 ( ajcn.org ). Is dietary carbohydrate essential for human nutrition? ( Memento of the original from February 22, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice.  
2. ↑ Martin Ward Platt, Sanjeev Deshpande: Metabolic adaptation at birth . In: Seminars in Fetal and Neonatal Medicine . tape 10 , no. 4 , p. 341-350 , doi : 10.1016 / j.siny.2005.04.001 ( elsevier.com [accessed November 24, 2017]).
3. ↑ Nicholas J Krilanovich: Benefits of ketogenic diets . In: American Journal of Clinical Nutrition . tape 85 , no. 1 , January 2007, p. 238-239 , PMID 17209202 ( ajcn.org ).
4. Jump up ↑ EG Neal, H. Chaffe, RH Schwartz, MS Lawson, N. Edwards, G. Fitzsimmons, A. Whitney, JH Cross: The ketogenic diet for the treatment of childhood epilepsy: a randomized controlled trial . In: The Lancet Neurology . tape 7 , no. 6 , June 2008, p. 500-506 , PMID 18456557 ( elsevier.com ).
5. ↑ Margaret A. Chen, David A. Weinstein: Glycogen storage diseases: Diagnosis, treatment and outcome . In: Translational Science of Rare Diseases . tape 1 , no. 1 , August 26, 2016, p. 45-72 , doi : 10.3233 / trd-160006 ( medra.org [accessed May 2, 2017]).
6. ↑ S. Mayor Andan, U. Meyer, H. Hartmann, AM That: glycogen storage disease type III: modified Atkins diet Improves myopathy. In: Orphanet J Rare Dis . tape 9 , 2014, p. 196 , doi : 10.1186 / s13023-014-0196-3 , PMID 25431232 , PMC 4302571 (free full text) - ( nih.gov ).
7. ↑ E. Kose, O. Guzel, K. Demir, N. Arslan: Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. In: J Pediatr Endocrinol Metab . tape 30 , no. 4 , 2017, p. 411-416 , doi : 10.1515 / jpem-2016-0281 , PMID 28076316 ( nih.gov ).
8. ↑ RD Feinman, WK Pogozelski, A. Astrup, RK Bernstein, EJ Fine, EC Westman et al: Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. In: Nutrition . tape 31 , no. 1 , 2015, p. 1–13 , doi : 10.1016 / j.nut.2014.06.011 , PMID 25287761 ( nih.gov ).
9. ↑ Rainer J. Klement Nanine Brehm Reinhart A. Sweeney: Ketogenic diets in medical oncology: a systematic review with Focus on clinical outcomes . In: Medical Oncology . tape 37 , no. 2 , January 11, 2020, ISSN  1559-131X , p. 14 , doi : 10.1007 / s12032-020-1337-2 .
10. ↑ MS Klein, N. Buttchereit, SP Miemczyk, AK Immervoll, C. Louis, S. Wiedemann, W. Junge, G. Thaller, PJ Oefner, W. Gronwald: NMR metabolomic analysis of dairy cows reveals milk glycerophosphocholine to phosphocholine ratio as prognostic biomarker for risk of ketosis. In: Journal of Proteome Research . 11, 2012, pp. 1373-1381. PMID 22098372

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