Nutritional ketosis is a controlled metabolic state induced by a very low-carbohydrate, high-fat dietary pattern, resulting in the liver producing a significant quantity of ketone bodies as an alternative fuel source. This physiological adaptation occurs when hepatic glycogen stores are depleted, shifting the body’s primary energy substrate from glucose to fat-derived ketones, specifically beta-hydroxybutyrate (BHB) and acetoacetate. It is a distinct, regulated state different from pathological ketoacidosis.
Origin
The term combines “nutritional,” indicating the state is achieved through dietary means, with “ketosis,” referring to the accumulation of ketone bodies in the body. The concept gained clinical prominence with the therapeutic use of the ketogenic diet, which historically treated epilepsy and more recently has been explored for metabolic health and weight management. This metabolic flexibility represents an evolutionarily conserved survival mechanism.
Mechanism
The primary mechanism is the severe restriction of carbohydrate intake, which lowers circulating insulin levels and elevates glucagon. This hormonal shift signals the adipose tissue to release fatty acids, which travel to the liver. In the liver, the lack of insulin-mediated glucose oxidation channels fatty acids into beta-oxidation, producing acetyl-CoA. This acetyl-CoA is then diverted into the process of ketogenesis rather than the Krebs cycle, resulting in the efficient synthesis and release of ketone bodies to fuel extrahepatic tissues, including the brain.
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