Talk:Ketosis

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Ketosis v Ketoacidosis?

My understanding is that these are parts of the same spectrum; severe ketosis is called ketoacidosis. This article implies that they're different things. Anyone have a source? Friday 21:24, 22 July 2005 (UTC)

Yes, Harrison's Principles of Internal Medicine, see the section on the body's defense against hypoglycemia.--Silverback 06:32, July 23, 2005 (UTC)

Sort of. Ketoacidosis is when you have so many ketone bodies that your blood becomes acidic. So it's sort of like having severe ketosis, but it turns into a slightly different condition I guess. Not exacly the same spectrum. Ashleyisachild 22:51, 25 September 2005 (UTC)

Ketoacidosis is metabolic acidosis of the blood due to elevated levels of ketones. Ketosis is a physiological condition while ketoacidosis is more of a pathological condition. i.e. Ketosis is normal, ketoacidosis is an illness. --Av01d 07:37, 22 June 2006 (UTC)

I get the sense that that this article has settled down into a reasonable NPOV state. I'm wondering if there have been any studies of the effects of ketosis on blood parasites, viruses and other bad stuff in the body. I'm kind of thinking of the effect that sub-critical poisons sometime have in 'curing' vs diseases, killing parasites (worms) and knocking back cancers etc. The theory being that if vs parasites and diseases have 'evolved and optimised' to work in the human body (and in the human body's 'normal' environment), then putting the 'body' (and particularly the blood) into an 'different' state occasionally may be a natural control mechanism (much like fever is). Any thoughts? Tban 00:34, 12 October 2006 (UTC)

"People who are unable to secrete basal insulin, such as type 1 diabetics and long-term type II diabetics, are liable to enter an unsafe level of ketosis, eventually resulting in a coma that requires emergency medical treatment." - WRONG

This doesn't seem to be a NPOV issue, but one of a widespread but incorrect belief that ketosis is in effect an alternative spelling of ketoacidosis. Ketosis can actually be enjoyed by people with diabetes of types 1 and 2. All that is necessary to avoid ketoacidosis from any dietary change, including a high-fat, high-protein, low-net carbohydrate ketogenic diet, is the usual daily monitoring of blood glucose, and reduction of insulin, Metformin, or other diabetic medicine when needed. This article would be much improved if a medical expert could confirm what I'm saying here so the article could be edited to remove the misleading fear/uncertainty/doubt created by the confusion or conflation of ketosis with ketoacidosis. David Spector (talk) 01:53, 4 February 2017 (UTC)

I have tried to edit this to clarify the difference between ketosis and ketoacidosis. I have also updated the ketoacidosis page to be consistent. I think this is an improvement and am familiar with the physiology from my medical studies and research interests but would appreciate other editors reviewing the content. Pattkait (talk) 13:13, 9 October 2019 (UTC)

Ketosis - Ketoacidosis - Undernutrition/Starvation

The entry differentiates between Ketosis and Ketoacidosis by saying that Ketoacidosis is more severe and only relevant in Diabetes, where the lack of insulin prevents utilisation of glucose. Under the Ketoacidosis entry, there is a very soft reference to starvation as a cause of Ketoacidosis, but that entry still only strongly links Diabetes or Alcohol consumption with the condition.

Can a person experience Ketoacidosis where they don't ingest enough glucose or carbohydrates in a period of time (and still have normal insulin function) - or would the symptoms of extreme thirst, fruity breath and saliva, fatigue, lack of endurance, etc, just be extreme Ketosis? How does one tell the difference between extreme Ketosis and mild Ketoacidosis? Is it safe to stay in a state of extreme Ketosis (as opposed to just "mild ketosis" or "mild ketoacidosis")?

_____________________________

Starvation is correct. Animals often undergo periods of starvation when they must rely on their body fat to survive. Scientifically, this is the correct term.

Ketosis by definition is elevated levels, but not adversely elevated. Ketoacidosis is the term for when the levels are harmful, as in the case of diabetics who do not get insulin User: John R Moffett.

I believe the comments here, while well-meaning, are misleading. Ketosis is neither normal nor abnormal: it is simply a less-common form of metabolism. Ketoacidosis is always abnormal and life-threatening. One does not imply the other, and neither is a form of the other. Errors of this kind should be removed from WP by editors with medical credentials, IMO. David Spector (talk) 02:13, 4 February 2017 (UTC)

Unclear for me

I was unclear in the article about Ketosis, I would like to understand a little more about the transition between "normal" metabolism, Ketosis and Ketoacidosis. Is it 3 separate states or represents a spectrum of increasing reliance on lipolysis and gluconeogenesis?

For example people on moderate weight loss diets (I guess weigh watchers) with will lose weight, clearly metabolism of adipose tissue fat is occuring, is this moderate "ketosis" even if the person is eating enough intake of carbohydrates to statisfy the needs of the central nervous system. How is this different to someone on a ketogenic diet? --61.213.69.51

Not an expert here but my understanding, as you imply, is that all of this is a matter of degrees. Ketogenesis and glucogenesis only occur to the degree that the body needs them just as sugar->fat conversion only occurs to the extent that the body needs it to prevent toxicity from the sugar. These processes are directed by the relative production of insulin and glucagon.

Ketoacidosis, in essence, is ketosis and glucogenesis with high sugar content in the blood. Under normal circumstances the body is not supposed to allow that to occur (i.e. high blood sugar should trigger insulin production and halt glucagon production) but conditions such as diabetes can cause this to happen.--Mcorazao 21:32, 22 November 2006 (UTC)

OK So Let me check my understanding. Ketoacidosis is abnormal condition of the metabolism (ketone bodies and elevated blood sugars), not the end point of a spectrum of increasing reliance on glucogenesis?

Ketosis as a "condition" however is not a back or white just a label placed on metabolic in which the body is highly dependant on metabolism of lipids? Thus anybody currently "losing weight" or more specifically reducing body fat %, will be in some kind of ketogenic state? Body fat % reduction implies lipid/adopose tissue metabolism, which can only be achived by ketogenesis? Is there no other metabolic pathway?

Partially correct. Ketoacidosis is not an end point but an abnormality as you say.

Ketosis occurs when the body does not have any glucose stores left. So it has to switch to some other process to get energy. One process is gluconeogenesis in which the body creates glucose from fat/protein. The other is ketosis which is literally referes to the creation of ketone bodies from fat/protein. Almost all cells in the body can use ketones in place of glucose (and ketones are easier to generate). There is, of course, the great debate on whether using ketones for energy is healthy or not.

But not all weight loss involves ketosis. You can, for example, lose weight on an all sugar diet as long as you keep your calorie intake very low (and you don't mind turning into a vegetable because of malnutrition). In such a case you will definitely not be in ketosis.

Hope that helps.

--Mcorazao 16:46, 1 December 2006 (UTC)

I should amend my statements by stating that I have read that some doctors actually do still say that ketacidosis is actually extreme ketosis. So that part of my statement is I guess still controversial (I am not a doctor so certainly take anything I have to say on the subject as just interpretations by a layman).

--Mcorazao 21:13, 1 December 2006 (UTC)

Ketosis should not be regarded as yielding ketoacidosis under any conditions. Ketosis is a normal alternative type of metabolism that gets established under certain dietary conditions (high fat and protein, and sufficiently low net carbohydrates). Ketoacidosis is a life-threatening condition seen mostly in those with diabetes (types 1 or 2) when the blood glucose falls to a very low value. Unfortunately, both ketosis and ketoacidosis produce ketone bodies in the blood and urine, which generates no end of confusion in the article and on this talk page. Ketosis itself, properly induced, is harmless and indeed was the standard metabolism type in certain ancient humans. David Spector (talk) 02:32, 4 February 2017 (UTC)

The Ending

There were a couple of edits done to the ending debating the safety of ketosis and low carb diets. The previous one put a statement at the end about the results of one study. Although certainly adding peer reviewed references is good it seems that the way this was put in tended to make the article look like it was really about low carb diets. I eliminated this paragraph, added a clause in the previous paragraph mentioning the controversy briefly, and cited that reference and another article. Note that there are MANY studies on the efficacy and safety of low carb diets and ketosis (see low carb diets) with quite varied results and there are many opinions out there from a variety of medical experts. --Mcorazao 22:03, 22 November 2006 (UTC)

Agree. No researchers have yet spent the kind of money that pharmaceutical companies routinely spend to prove the safety and effectiveness of medicines, so the current research results for ketosis and ketogenic diets is unreliable and inconsistent. Until good research is available on which to base medical recommendations, the current unhealthy state of the world population regarding obesity, heart and circulatory diseases, and diabetes is likely to continue unabated, with the notable exception of those willing to experiment on themselves based only on anecdotal evidence. David Spector (talk) 02:41, 4 February 2017 (UTC)

Oh wow. How long has the main definition of ketosis been wrong???

"Ketosis (IPA pronunciation: [ki'tosɪs]) is a stage in metabolism occurring when the liver converts fat into fatty acids and ketone bodies which can be used by the body for energy. It was identified by Dr. Stephen Moody in 1969"

I saw this cited on answers.com - how long has this misinformation been up there? Any Intro to Biochemistry textbook easily has the correct definitions, why did no one correct information that's contradicted by every single medical school there is?

1. There is no such thing as a metabolic "stage." I think the intended referral was metabolic state.

2. Ketosis is DEFINITELY not when the liver converts fat into fatty acids and ketones, that's actually called lipolysis.

3. Ketosis is simply an increase or excess of ketone bodies in the blood.

4. I searched google and every medical journal I have access to, and there is no Dr. Stephen Moody who discovered ketosis. In fact, it's questionable if there even is a Dr. Stephen Moody that exists.

I am going to make the aforementioned corrections, as well as notice of the previous definition being incorrect.

Shenan01 13:44, 13 July 2007 (UTC)

Agree with most, except that ketosis can be detected by the existence of certain kinds of ketone bodies in both blood and urine. Urine measurements using Ketostix(tm) are not reliable; there are other ways to measure whether ketosis is present (such as an electronic device that I believe takes a blood sample). David Spector (talk) 02:47, 4 February 2017 (UTC)

This article is compromised by for-profit marketing propaganda.

I don't know who has filled this article with information that is contrary to modern medicine, and greater reality, but it seems like diet fad propaganda when I see citations like "proteinpower.com", which is inexcusably ri-goddamn-diculous. If you actually go to the website, it's a husband-wife team trying to defraud people by selling "get thin quick" bullshit (they've already published several books). For all their books, oddly, I can't find more than one article they've ever written in a refereed medical journal, and that one has nothing to do with ketosis. --70.131.247.129 (talk) 23:49, 11 April 2008 (UTC)

If you've seen his blog, Dr. Eades actually appears to know what he's talking about. I haven't read any of his wife's material. I don't think it's appropriate for the wikipedia, but I can tell you that Dr. Eades is legit. Challenging modern medicine is how we improve it, and so I don't see anything wrong with that. 74.78.98.109 (talk) 20:43, 13 April 2008 (UTC)

Why did you restore the 'life-threatening condition' hogwash? I reverted your edit. I don't much care for Atkins, but I wouldn't call it a fad diet: certainly, it has gone through periods of fat dietism, but it's been around for a long time. Not sure about South Beach. Also, 'ref name=ridiculous'? Come on. Try to be professional here. 74.78.98.109 (talk) 05:13, 15 April 2008 (UTC)

The first reference under "Controversy" is also authored by a for-profit physician who runs a low-fat starch-based diet center. No citation to the research literature, just conclusory scare statements. 97.91.254.54 (talk) 07:37, 23 January 2017 (UTC)

References in controversy section do not support statements

In the controversy section there are links to three articles, of which only one mentions ketosis. They are the following: Weighing In on Low-Carb Diets - Shape Up America! Reveals The Truth About Dieters - High-Protein Diets

I also have to wonder if the sources are accurate or academic. The AHA article, the only one to mention ketosis, says: "In the diets that are also high in protein, substances called ketones are formed and released into the bloodstream, a condition called ketosis. It makes dieting easier because it lowers appetite and may cause nausea."

I cannot begin to describe how terrible this sounds. I've never heard of ketosis lowering appetite through any means other than providing energy. Nausea wouldn't surprise me (though I've never heard of it associated with ketosis) but it makes the article look terribly biased. On top of that, the diet being high in protein doesn't determine whether ketosis happens. 67.246.176.132 (talk) 08:58, 29 March 2010 (UTC)

Maybe the controversies section should be deleted, if it is not supported by the references. Ketosis can be dangerous by causing ketoacidosis in extreme cases, and it might have other long term effects, but if we have no references, it has no place here. —Preceding unsigned comment added by 89.160.88.119 (talk) 21:13, 7 June 2010 (UTC)

The concept here is to provide accurate information. With respect to Ketosis, the initial changeover from carbohydrate based diets to ketogenic diets are generally met with sugar/carb withdrawal, a process many people consider worse than quitting smoking. The symptoms of carb withdrawal vary person to person but can be accurately stated to include nausea and lethargy. The best solution I can think of to the lack of clarity in this section is to include a reference to a carb withdrawal article. Then we could state most people will experience carb withdrawal in the first 3 months of changeover and then the symptoms will abate. This would move the issue to another article where both sides of the argument could be presented objectively without filling up this article with unrelated junk. — Preceding unsigned comment added by 150.101.216.145 (talk) 03:08, 24 October 2011 (UTC)

Also, Shape Up America! Reveals The Truth About Dieters is not saying there is a danger to ketosis itself but in failing to correctly maintain ketosis. When someone on a carb based diet eats fat it can cause a large number of problems. This is because of the high insulin levels caused by the carbs in the diet. Remove the carbs, this removes the insulin, and then the fat is not a problem. Same with cholesterol. HDL and LDL cholesterol are referred to as good and bad respectively. This is reasonably accurate in a carb based diet but in a ketogenic diet the LDL is not being broken down by insulin, so it clumps and does not stick to the arterial walls. — Preceding unsigned comment added by 150.101.216.145 (talk) 03:13, 24 October 2011 (UTC)

-Comments From a Medical Physician (M.D.)-
The 'controversy' section contains a very improper statement; "Some clinicians regard ketosis as a dangerous and potentially life-threatening state that stresses the liver." It should at least say something like, "[...] while on the other hand, many physicians regard it as a safe biochemical process that occurs during the the fat-burning state." Apart from actual incision and physical liposuction procedures, a human being cannot burn fat without entering a state of mild ketosis. It is biochemistry folks; one cannot burn fat without producing ketones.
I do not dispute the fact that severe ketosis (<80mg/dL) is harmful, whether due to acidity, liver stress, or rapid dystrophic catabolism of adipose tissue. Severe ketosis is termed 'ketoacidosis' and it is impossible for a normal functioning person to enter this level, due to basal secretion of insulin which shuts off passive fat burning (where ketones ultimately arise from after liver transformation). Type I diabetics (and long-time Type II's) cannot produce any insulin on their own. If they stop taking prescribed insulin, they will eventually become very sick and enter a state of ketoacidosis. This is due to absolutely zero insulin being present in their bodies, causing the passive process of fat burning to occur. They eventually reach such a high level of ketones in the blood, that they become comatose. This does not happen in a normal person. A morbidly obese man, for example, could become stranded on a remote island and survive for a few months with zero food intake, so long as he had water (and perhaps a multivitamin). How could this man survive without food? He has tremendous fat stored as a very obese man and can survive on this fat (and in this case muscle tissue breakdown as well).
As a medical physician who spends a lot of time counseling patients on diet, weight loss, and exercise, I can assure you that mild (~10mg/dL) to moderate (~40mg/dL) ketone levels of ketosis are very safe. The proof is in our evolutionary development. We are evolved to be fat storing during times of abundance of food sources and fat burners during times of scarce food sources. Imagine a bear for a moment, that couldn't store or burn fat... it simply couldn't survive hibernation in a cave. A bear stores fat in the fall as it prepares for winter, and burns that fat as it sleeps, entering a state of mild ketosis in the process. It is with these rationales that I will alter the statement, so as to avoid confusion for anyone reading this article for the purpose of learning.
-Medical Moose, M.D.- MedicalMoose (talk) 07:16, 10 February 2012 (UTC)

• I have modified the statement to be accurate. Koop talks about it being dangerous to remove all carbs from the diet, however, this isn't necessary to get to a state of Ketosis anyway, just limiting the amount and types of carbs you eat. He did not mention ketosis in that article at all, and not qualifying the statement seems a clear NPOV issue, as well as good old fashioned "factual accuracy". Dennis Brown (talk) 16:46, 20 February 2012 (UTC)

I have removed the "Controversy" heading and instead included the relevant information under a new "Safety" heading. I think this is a more appropriate layout and reduces the potential for poorly sourced material and opinions. Pattkait (talk) 13:16, 9 October 2019 (UTC)

Ketoacidosis

The article states "Ketoacidosis may also result from prolonged fasting or when following a ketogenic diet." An article in Epilepsia is cited. The cited article does not support the proposition. In fact, a search discloses that the word "ketoacidosis" does not even appear in the cited article. Instead, the article is about the use of ketogenic diets in cases of epilepsy. The article states that many epileptic patients following a ketogenic diet have "mild acidosis," but this is not at all the same thing.

Maybe the author of this sentence in the article only intended the citation to provide an explanation of "keotgenic diet," but as it stands it suggests the article supports the sentence's assertions about ketoacidosis when it does not. I might also note that this sentence is contrary to one in the Ketoacidosis article that says ketoacidosis does not result from fasting.

I am new to editing Wikipedia, but as soon as I set up an account and learn how to edit I propose to delete the sentence. Anyone with a citation supporting the proposition is of course welcome to reinstate it. 38.117.178.5 (talk) 23:14, 4 May 2011 (UTC)

Please see my comments above in the first "ketoacidosis" section. David Spector (talk) 01:57, 4 February 2017 (UTC)

Foster Article as Evidence of Controversiality?

I don't understand why the Foster article is referenced as authority for this assertion. Foster et al. found statistically significant results in favor of low carb high fat diets over high carb low fat diets for both 3 and 6 months, and then no statistically significant result for 12 months. I have no idea how that would possibly make the diet controversial. Joshua Auriemma (talk) 19:48, 9 January 2013 (UTC)

Ketosis Occurs even when Glycogen Stores Exist

"Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted."

This statement may literally be true, but is incomplete and misleading. It suggests that ketogenesis oocurs only when liver glycogen stores are depleted, which is not true. The liver oxidizes medium-chain triglycerides to produce ketone bodies even in the presence of carbohydrates. Thus dietary medium-chain triglycerides can produce some level of ketosis without depleted glycogen stores. And healthy gut bacteria ferment resistant starch and fiber into short-chain fatty acids, which are ketogenic. Rcauvin (talk) 20:45, 22 August 2013 (UTC)

References

Inuit Genetics

The page currently reads:

Whether a no-carbohydrate diet would be safe for non-Inuit is also disputed: Nick Lane [46] speculates that the Inuit may have a genetic predisposition allowing them to eat a ketogenic diet and remain healthy. According to this view, such an evolutionary adaptation would have been caused by environmental stresses.[47] This speculation is unsupported, however, in light of the many arctic explorers, including John Rae, Fridtjof Nansen, and Frederick Schwatka, who adapted to Inuit diets with no adverse effects.[48]

I don't think this is speculation anymore. The New York Times recently published an article highlighting the evidence of unique Inuit genes for metabolizing fats.

A study published last week in the journal Science reported that the ancestors of the Inuit evolved unique genetic adaptations for metabolizing omega-3s and other fatty acids. Those gene variants had drastic effects on Inuit bodies, reducing their heights and weights... Even more intriguing was the fact that one of these gene variants was present in almost every Inuit in the study. It is much less common in other populations: About a quarter of Chinese people have it, compared with just 2 percent of Europeans... Natural selection is the only known way this gene variant could have become so common in the Inuit.

A completely separate gene from the genes mentioned in the NYTimes article is the autosomal recessive CPT1a mutation, which is highly prevalent in the Inuit (otherwise extremely rare in other populations) and the deficiency of that particular liver enzyme makes it so that fats aren't easily metabolized in the liver, like Westerners do. The deficiency makes it so that fats are preferentially shunted to other areas of the body for energy and for thermogenesis. The gene makes it difficult for the Inuit to produce ketones making it difficult for them to fast, which explains why they are well known to snack constantly. The mutation not only seems to explain how the Inuit evolved to withstand cold temperatures, but it also seems to explains why they weren't observed by scientists to be in ketosis, as mentioned in the Wiki article.

I also found this news article from Alaska Dispatch News:

Now, there is evidence that the historic diet based on foods like muktuk and seal and walrus meat has been imprinted on the genes of Inupiat, Yupik and other northern peoples, with health effects that are potentially dangerous for babies and young children but potentially helpful for adults. At issue is a gene that produces a key enzyme used in the liver: carnitine palmitoyltransferase 1A, or CPT1A for short.

The enzyme is needed in the process that burns fat for energy within the liver. It allows the body to switch between burning glucose -- the simple sugar broken down from carbohydrates -- and burning body fat. The CPT1A gene in some far-north indigenous people dramatically slows the burning of stored fat, preventing the body from getting the energy it needs to function.

That Arctic variant version of CPT1A is found in Inuit, Inupiat and Yupik populations of Alaska, Canada and Greenland and among some Natives in British Columbia, mostly on Vancouver Island, and the Tsimshian of Southeast Alaska who are related to them. It is not found among Interior Alaska or Canadian Native groups like the Athabascan and Cree, nor is it found among Natives in the Lower 48 states.

It is now confirmed in the indigenous people of northern Siberia as well. A Cambridge University-led study, published in October in the American Journal of Human Genetics, found that 68 percent of test subjects carried the gene. An earlier study by the many of the same researchers, published in May in the journal PLOS ONE, identified the CPT1A gene as one of several carried by indigenous Siberians that appeared to have been shaped by Arctic conditions.

The findings are the first to provide concrete evidence backing up the idea that CPT1A Arctic variant is a product of the Arctic environment and Arctic diet, said David Koeller, a pediatrician and geneticist at Oregon Health and Science University and an expert in CPT1A Arctic variant...

...Anecdotal evidence is that some adults have long coped with the effects of this gene, if unknowingly, Hirschfeld said. They may talk about how they make sure to carry along snacks if they are engaged in strenuous activity like hunting, he said. After a few hours of exertion and no eating, as these adults describe it, they get sluggish, sleepy and “real jittery,” classic signs of hypoglycemia, Hirschfeld said. “They’d have a candy bar, and they’d snap out of it.”

Adults, with their larger bodies, can store more sugar in their blood and livers, and even those with the Arctic variant of the gene are able to fast for longer periods than children, unless they are exercising strenuously, Hirschfeld said...

...A more recent study by 10 researchers, including Boyer and others at the Institute of Arctic Biology, cited the Arctic variant of CPT1A as a reason for the “healthy obesity” found among Alaska Yup’ik people. The Arctic variant appeared to be protective regardless of test subjects’ body weight, said the study, published in 2012 in the Journal of Lipid Research.

The mutation's major symptom is also discussed in the Carnitine-acylcarnitine translocase deficiency wiki article, which says:

This disorder may also cause extremely low levels of ketones (products of fat breakdown that are used for energy) and low blood sugar (hypoglycemia). Together, these two signs are called hypoketotic hypoglycemia

So, it appears that the Inuit have unique genetic adaptions to their environment, that prevents them from generating many ketones. JamesPem (talk) 04:23, 3 December 2015 (UTC)

Actually, everything I wrote, above, is all now summarized in this recent 2015 review paper..JamesPem (talk) 20:22, 4 December 2015 (UTC)

Unless anyone has any objections, I will add the information I've cited, above, and delete the paragraph that start with Nick Lane's speculation—which, as far as I can tell, is incorrect since he only speculated on heat production from Arctic diets, not safety, per se. The subsequent response to Lane's speculation is also incorrect and now irrelevant given that A) we now have evidence of unique Inuit genetics for fat metabolism and B) the examples that are cited to purportedly refute his speculation are all based on white explorers who would not have CPT1a mutations and unique fat burning genes to begin with. It's a logical fallacy to use the dietary response of white explorers to somehow disprove that the Inuit were genetically unique. Not to mention that the McClellan/Du Bois source used there is improper as the source admits that the white explorers could not eat the level of protein consumed by the Inuit.

I will also delete the first half of the next paragraph as Schwatka's experience has nothing to do with the Inuit's own genetics and unique metabolisms. Nor is there relevance to the dietary habits of many other non-ketogenic cultures that happen to eat a fair amount of calories from meat.

The paragraph on exercise and the "Schwatka Imperative" can move down as it is not related to unique Inuit genetics and is a separate controversy altogether.

Unless there are any objections, I will make those changes. JamesPem (talk) 18:03, 16 December 2015 (UTC)

References

External links to Ketoacidosis

Several of the external links point to sites related to Ketoacidosis, which is very different to Ketosis, and may be confusing for anyone reading this article. Indeed this article starts with "Not to be confused with Ketoacidosis". — Preceding unsigned comment added by 80.174.78.122 (talk) 09:15, 20 July 2016 (UTC)

Please see my comments above in the first "ketoacidosis" section. David Spector (talk) 01:58, 4 February 2017 (UTC)

Ketoacidosis as a cause for Ketosis?

The first subsection in the Cause section is titled Ketoacidosis. In what way is Ketoacidosis a cause for ketosis? I suggest that subsection be removed from the Cause section. It is confusing. — Preceding unsigned comment added by 80.174.78.122 (talk) 09:51, 20 July 2016 (UTC)

I Agree. The Cause > Ketoacidosis section is confused and confusing and ought to be removed by someone with medical credentials. Please also see my comments above in the first "ketoacidosis" section. David Spector (talk) 02:06, 4 February 2017 (UTC)

I edited this out as i agree it is confusing and misleading. Pattkait (talk) 03:29, 30 September 2019 (UTC)

The "Inuit People" section is too long

The section on the "Inuit People" is interesting, but it is too long and detailed compared to the length of this article and most of its content doesn't really further the understanding of ketosis. Because of it's length it is a distraction to the overall content of the article. I encourage someone with good editing skills to see if they can convey the essential content of this section in a paragraph. 71.12.2.174 (talk) 15:02, 12 November 2016 (UTC)

I agree. It is very tangential to the subject of the page since most of the discussion focuses on the idea that the Inuit diet is not actually ketogenic. The discussion of inuit genetics is also not relevant to this discussion and uses a lot of primary sources. I am trying to decide if it should just be deleted or moved to another page (Inuit diet, etc). Pattkait (talk) 17:56, 2 October 2019 (UTC)

Mechanism Section

Hey all,

I believe the mechanism section could go into more detail of how Ketosis comes about, and exactly what Ketosis is. I plan on writing up a draft of this section in the next couple days. I'm going to go more in-depth into Ketogenesis and B-oxidation on this page. I see these as essential in understanding what Ketosis as a metabolic state is. As a side note, I do believe this article should talk more about Starvation too! I saw someone else mention that onto the talk page. I've got a list of sources I'll be using here:

The Neuropharmacology of the Ketogenic Diet Ketoacids? Good medicine? [2,4-13C2]-β-Hydroxybutyrate Metabolism in Human Brain Ketone Bodies as a Fuel for the Brain during Starvation Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes Physiological roles of ketone bodies as substrates and signals in mammalian tissues. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism Effect of ketone bodies on lipolysis in adipose tissue in vitro Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood "Villains" of Human Metabolism

Feel free to let me know if you have sources that apply, or do not agree with any sources listed. — Preceding unsigned comment added by Matt34am (talk • contribs) 04:19, 28 March 2017 (UTC)

ketones and ketone "bodies"

Why is it necessary to refer to ketones as ketone bodies? I have never heard anyone refer to sugar bodies. 94.196.123.128 (talk) 10:13, 27 August 2017 (UTC)

Ketone bodies is a term used for a specific subset of ketones. Deli nk (talk) 11:59, 9 September 2017 (UTC)

Hepatic encephalopathy isn't just hepatomegaly

So why is "hepatic encephalopathy" explained as "enlarged liver" in the Eskimo section? If Eskimos all have HE they should be dead. If they all have livers down to their knees but are otherwise healthy, it's not HE. Please explain. I'm going to plug the source into Sci-Hub now to see if HE is mentioned. Thank you for your coöperation. Ellenor2000 (talk) 02:14, 7 December 2018 (UTC)

This is an important clarification. I think this entire section is pretty tangential but I'll try to make it more concise Pattkait (talk) 19:06, 2 October 2019 (UTC)

Undertaking Major Edits to this Page

I am interested in reawakening the discussion around this topic and work on major edits that improve the readability and accuracy of this page. I noticed the discussion has been dormant for several years and many of the issues discussed have not been revised or resolved. I have made some edits to the lead and will continue to refine this and other sections. I also deleted “ketoacidosis” as a subtitle of “Causes” as this is inaccurate and has been discussed on the talk page previously. I will also work to make the discussion of the Inuit more concise and place it in a more appropriate context. Edits, revisions, comments welcome and happy to collaborate with anyone interested. Pattkait (talk) 12:54, 2 October 2019 (UTC)

Other proposed changes- Adding "Adverse Effects" heading to discuss any negative health effects, continuing to identify outdated, Adding new heading "Cultural Relevance"? (not sure what to call it) to add Inuit population as a subheading, broken or primary citations and replace with reviews (will continue to post sources here), expand section on medical uses, edit "Controversy" section to eliminate pop culture citations. Pattkait (talk) 19:06, 2 October 2019 (UTC)

After further review of the article, references and talk page discussion I would like to propose the following changes which I am currently working through.

-"Causes"- added "Physiologic" and "Pathologic" subheaders to attempt to clarify the chronic misunderstanding surrounding this concept (completed)

-"Diagnosis"- may change to "Measurement" as it is not exactly a medical condition to be "diagnosed." Will also add more info on ketone blood testing

-"Controversy"- propose deleting this section as the references are inappropriate and the paragraph is mostly speculative

-Addition of "Safety" heading- for discussion of research on long-term safety, adverse events and controversy surrounding chronic ketosis

-Addition of "Signs and Symptoms" heading

-Restructuring of "Inuit Population" section to focus on aspects relevant to ketosis and link to other wiki pages on Inuit diet and nutrition

-Edit lead to reflect above changes

-Delete primary references

Again, comments or suggestions welcome. Pattkait (talk) 15:53, 3 October 2019 (UTC)

Review of revised article - October 18, 2019

For this review, I have compared a version of the article (from September 28, 2019) before you started making edits to the current version (October 18, 2019).

First of all, very nice work on this article! Overall, it is well-organized and would be easy to understand for a variety of readers, both those looking for a basic understanding of the topic and advanced readers with prior knowledge of ketosis. I see that you have re-written major sections and have followed guidelines for improving technical articles as outlined by Wikipedia, in addition to specific changes to sub-sections you included in your plan posted above. I believe these changes will be very beneficial to future readers who come across the Ketosis article. All points for improvement I have included below are relatively minor.

Lead: The lead section provides a good overview of the topic and is consistent with information included in the body of the article. You have effectively restructured the lead section, starting with a significantly improved introduction sentence which now plainly and concisely defines the topic. I appreciate that the rest of the lead section is organized from least to most specific, such that it does not confuse readers by jumping into details too quickly. I commend you for implementing this organization in subsequent sections as well.

The first sentence of the third paragraph (“Ketosis is generally characterized by serum concentrations…”) seems a bit out of place, given that the rest of the paragraph deals with diet/treatment. Perhaps it might work well immediately after the definition of ketosis in the first paragraph.

Content and organization: The headings and sub-headings are appropriate and easy to navigate. You have made many positive changes to the order and organization of sub-sections such that the article now resembles other well-written articles on a medical topics and no single section has too much weight anymore. The addition of the “definition” section is a very useful clarification and excellent way to start off the article. Throughout, the tone is neutral and there is no evident bias in the article. You did a nice job re-writing the measurement and medical uses sections. Both are clear, well-organized, and have new proper references. I like that the medical uses section is concise yet informative. You have set it up in such a way that would allow for future edits as more research becomes available (or if someone simply wants to expand on this sub-section) to cleanly fit into the existing organization.The safety, inuit, and veterinary sections are informative and well-written, without becoming a major focus of the topic. This is a great revision and makes the entire article much more cohesive and appropriate as an encyclopedia entry.

You may want to clarify nutritional ketosis. The term is defined once and then used again in the lead section, but then only mentioned once in the main article (causes section). If it is important enough to include in the lead section, it seems like it may warrant more discussion in the main article. Is nutritional ketosis a separate category of ketosis in addition to physiologic ketosis and ketoacidosis? Is it the mechanism behind keto diet? It’s not entirely clear how it fits in.

In the causes section, it might be helpful to include a very basic introduction sentence or two. At present, you start with talking about increased ketone production but that makes me wonder, can you get ketosis from other mechanisms (e.g. decreased breakdown)? If not, it may be useful to spell that out plainly right from the start (something like, elevated ketone levels in the body are caused by states of increased ketone production). Providing a bit more structure to this section may also help the last sentence in the section about ketogenic fats and exogenous ketones not seem out of place.

In the biochemistry section, I wonder if an image (and informative caption) of relevant biochemical cycles might be useful to quickly summarize the information. Not sure how difficult it would be to find an appropriate image online without copyright restrictions!

Super minor point - I think when you’re referring to the Inuit population, it should be singular rather than plural (therefore “…population is often cited” rather than “…are often cited” in the first sentence of the Inuit populations paragraph).

References: Your citations appear to be mostly secondary sources from peer-reviewed journal articles and books which is an excellent update from the previous version. You have pared down the list to good quality sources that readers can access for further reading, instead of the confusing hodgepodge of old citations.

Another nit-picky style thing, your citation formatting is slightly inconsistent. Not something that affects quality of the article in the slightest, and it can be left as is. For instance, some include the full date for journal articles rather than just including the year. When editing on wikipedia myself, I’ve found this to be a slightly annoying part of the automatic citation generator from a PMID or DOI. This will often come up as an error message in red, and you can edit the specific field from the edit menu once you've inserted the citation.

Thank you for your excellent work in improving this article! Mlshulk (talk) 20:47, 18 October 2019 (UTC)

I disagree with the elimination of the controversies section. There are real documented controversies around ketosis, and Pattkait has whitewashed those controversies away with the recent deletions—without any discussion about the specific issues around any particular points or passages. For instance, the Inuit controversy was well referenced and highlighted the very controversy that promoters of ketosis speculate over the Inuit's metabolisms to justify chronic ketosis as a lifestyle.

For example, the text in this article previously read:

However, in multiple studies the traditional Inuit diet has not been shown to be a ketogenic diet. Not only have researchers been unable to detect any evidence of ketosis resulting from the traditional Inuit diet, but also the ratios of fatty-acid to glucose were observed at well below the generally accepted level of ketogenesis.

The edits by Pattkait turned that controversial subject into a speculative "Culture and society" section that speculates that all the scientific measurements were incorrect and that the Inuit might have been in ketosis. It now reads:

However, it is unclear if their diet causes a prolonged state of ketosis as ketone levels in this population are lower than expected when tested. This may be due to limitations in urine ketone testing, adaptation to a long-term ketogenic diet, higher than expected dietary carbohydrate, or genetic factors.

The newly cited O'Hearn paper is highly speculative, but offers no new conclusive findings about the Inuit. All it does is question previous findings—deepening the controversy.

I am surprised that the controversy section was discarded so easily. And I'm even more surprised that it was replaced with a speculative section suggesting the Inuit might have been in ketosis after all. The new passage essentially adds fuel to the original controversy.

To remedy this situation, I would recommend that the "Culture and society" section be deleted—since the Inuit have not been shown to be a "Culture or Society" in ketosis and the controversy still exists. JamesPem (talk) 22:23, 28 November 2019 (UTC)

@JamesPem I apologize if my edits were overly aggressive or undertaken without discussion. The discussion on this page has been dormant for quite a while despite my posts on the Talk page and ongoing edits. I tried to condense the discussion of the Inuit population and reduce the amount of primary literature cited as it was a long and unwieldy section that dwarfed the rest of the article. Some of the content was moved the the Inuit or Inuit cuisine articles where it was more relevant. I added the Hearn citation as a secondary source as the rest of the articles are primary literature, however am open to further discussion about its appropriateness. I thought I preserved the ideas around the ongoing uncertainty about Inuit ketosis and acknowledged that it is unclear if they were actually chronically in ketosis. I tried to convey this in the quote above, but I realize it might not be as clear as I hoped. It didn't seem that "Controversies" was the most appropriate title for this section but would not be staunchly opposed to restoring this section title or otherwise altering the section title. I addressed the other potentially controversial content in the "Safety" section. I definitely welcome continuing discussion and suggestions! Pattkait (talk) 14:35, 29 November 2019 (UTC)

I have removed the speculative sentence that was not cited. I also changed the heading to "Inuit populations" which is more accurate that the previous heading title. I think it is appropriate to acknowledge the uncertainty surrounding Inuit ketosis in this article, however a more lengthy discussion may be more appropriate in the "Inuit" or "Inuit cuisine" articles. I prioritized maintaining a neutral tone in this article and was not attempting to remove any discussion about ongoing uncertainties. Thanks for starting the discussion! Pattkait (talk) 14:54, 29 November 2019 (UTC)

@Pattkait Thank you for the reply and I appreciate your willingness to discuss this. But, even if the tone is attempting to be neutral, the text is still speculative and promotes a specific side of the controversy. You wrote:

However, it is unclear if their diet causes a prolonged state of ketosis as ketone levels in this population are lower than expected for people adhering to a long-term ketogenic diet.

This is speculative. It would be as if I edited an article about penguins and wrote:

However, it is unclear if their wings are capable of flight as the air pressure produced by their wing movements is lower than expected for birds of flight.

Notice the implication? No one has ever observed a penguin achieving flight and they are limited by physics. Similarly, no one has ever observed an Inuit in ketosis and they are limited by their high protein diet and their CPT1A deficiencies. The fact some people see uncertainty, while the overwhelming published literature does not, is the controversy. Thus, to suggest that the Inuit might have been in ketosis is taking a side in that previously documented controversy.

Secondly, O'Hearn is a heavily biased source. Her Twitter handle is "@KetoCarnivore" and her bio page says she is a computer scientist who "has eaten almost nothing but meat since 2009." Nearly all of her tweets are biased towards justifying a carnivorous lifestyle. This is a heavily biased, and likely unqualified, author. The Journal of Evolution and Health also appears to have rather low standards. I believe that particular source should be removed from this article.

Thirdly, there was clarifying text removed from the previous controversy section that clearly documented that the traditional Inuit diet could not be considered ketogenic. The text previously read.

However, in multiple studies the traditional Inuit diet has not been shown to be a ketogenic diet. Not only have multiple researchers been unable to detect any evidence of ketosis resulting from the traditional Inuit diet, but the ratios of fatty-acid to glucose were observed to be well below the generally accepted level of ketogenesis.

If we're going to speculate on Inuit diets in this article, then I don't understand why clarifying observations were removed. (To use the example, above, it would be like removing observations and explanations why penguins can't fly). All the published scientific observational evidence shows that the Inuit ate a high protein diet and to my knowledge no scientist or arctic explorer has ever claimed that the Inuit ate the levels of fat necessary to achieve ketosis. (Even Stefansson's recipe for Inuit pemmican calculates to less than 60% fat).

Therefore, I believe the entire Inuit section is speculative, which was exactly what the original controversy was about in the first place. I understand you think it is appropriate to acknowledge some uncertainty, in this article, but there is significantly more evidence observing and explaining the lack of ketogenesis than there is of uncertainty. In terms of the quality of the sources, there is no contest.

If we're not going to present all the evidence that clarifies the uncertainty, to set the record straight, then I think it's probably best to remove the entire speculative section—particularly since the only published uncertainty comes from a heavily biased and low quality source. And if we don't want the controversy to dwarf this article then it's probably not the place to be presenting such speculations. JamesPem (talk) 05:42, 4 December 2019 (UTC)

@JamesPem thanks for the input. I agree about the questionable usage of the Hearn citation and it has been removed and the article edited accordingly. I also agree about the speculative nature of this entire section and honestly am not sure if this section belongs in the article at all. I have not been able to find any reliable tertiary sources for this section and would propose eliminating it, adding any critical material to the "Inuit" or "Inuit cuisine" articles. Thoughts? Pattkait (talk) 03:11, 7 December 2019 (UTC)

@Pattkait Yes, I agree it's best to simply eliminate the Inuit section from this article. As I understand it, the "Inuit" article is intentionally vague and the "Inuit Cuisine" article already has plenty of detail on this subject. I don't get the sense there's anything to add there, from here. JamesPem (talk) 04:34, 9 December 2019 (UTC)

@JamesPem sounds great. I was uncomfortable with all the references used in this section and I agree that it does not add anything meaningful to the article so I am happy to eliminate it. Pattkait (talk) 13:40, 10 December 2019 (UTC)

References

References

Coatracking

I am concerned that this article, which is nominally about "ketosis", a "metabolic state" is a bit of coat-rack for ketogenic diets (about which we have other article: Ketogenic diet and Low-carbohydrate diet). This is evident from some slippages in language such as saying "Ketosis induced by a ketogenic diet is a long-accepted treatment for refractory epilepsy". In fact the epilepsy "treatment" is the ketogenic diet, the cited article is about ketogenic diets, and ketosis is a consequent mechanism of action. I think the entire "Medical uses" section should be replaced with a section on "The role of ketosis in medical interventions" and then sources limited to ones which discuss ketosis, so we prevent drift into discussing the diets that give rise to it. Alexbrn (talk) 14:30, 5 May 2020 (UTC)

What is krtosis?

I don’t know why there are some foods that make me feel sad or happy I need to know what foods that I can eat now? 73.69.78.249 (talk) 22:28, 10 December 2021 (UTC)

Type 2 Diabetes

This section could provide more information on how ketogenic diets are linked to improving the markers of Type 2 Diabetes. Toribarr123 (talk) 16:12, 29 April 2022 (UTC)

Breath measurement

Article mentions ketones in breath can be measured but gives no example. A device by Ketonix is blown into and a reading is given as a number of LED blinks in red, yellow or green. Should it be noted and its accuracy be stated, if data is available? FL Carpetbagger (talk) 13:36, 15 November 2022 (UTC)

Out of date distinctions

The current distinctions of ketosis are "nutritional ketosis," "starvation ketosis," and "ketoacidosis." Nutritional ketosis is the modern medical term for the fed state of ketosis, which distinguishes it from starvation/fasted ketosis, which produces more ketones in the serum. "Nutritional ketosis" was originally coined by Dr. Jeff Volek and Dr. Stephen Phinney Starnche (talk) 22:24, 29 January 2023 (UTC)