A metabolic state wherein the body utilizes ketone bodies—specifically beta-hydroxybutyrate (BHB), acetoacetate, and acetone—as a primary energy substrate for cellular respiration, particularly for the brain and skeletal muscle. This alternative fuel source is produced by the liver during periods of carbohydrate restriction or fasting, offering a highly efficient and clean-burning energy substrate. Shifting to this fuel source is a core component of therapeutic metabolic strategies.
Origin
The concept originates from the study of fasting and ketogenic diets, with the term “ketone body” first used in the 19th century to describe the compounds found in the urine of diabetic patients. Modern clinical and wellness applications focus on the non-pathological, physiological state of nutritional ketosis, recognizing ketones as a superior brain fuel and signaling molecule. This shift represents a re-evaluation of metabolic flexibility.
Mechanism
When hepatic glycogen stores are depleted, the liver initiates fatty acid oxidation, leading to the production of acetyl-CoA. This acetyl-CoA is then diverted into ketogenesis, forming the three ketone bodies. These molecules are released into the bloodstream, transported to extra-hepatic tissues, and reconverted back into acetyl-CoA within the mitochondria, where they enter the Krebs cycle to produce ATP. BHB, in particular, also acts as a signaling molecule, modulating gene expression related to oxidative stress and longevity.
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