POSSIBLE DANGERS
There is a small but real possibility, if you are regularly experiencing post- exercise ketosis, that your liver just cannot make enough glucose for your needs. (Remember that ketone bodies are produced as a consequence of the gluconeogenic process. See: Footnote.) When I was inducing post-exercise ketosis in the subjects for my research (healthy young students), a few of them would start to feel faint, sweaty and very unsteady on their feet about 6 hours after the exercise (they were allowed no food intake during those 6 hours). Their ketone bodies levels in the blood would then be sky high; but what was making them feel faint and dizzy were the low levels of glucose in the blood. Their livers were just not coping with the demand for glucose (despite just sitting around doing nothing - except watching videos - for those 6 hours after exercise). The treatment was simple: we just gave them a plateful of cake and muffins with lots of jam to eat. Within minutes the symptoms were gone, and when we tested the blood, ketone bodies could no longer be found, and their blood sugars would be normal.
A more serious situation could arise if the low blood sugar develops while you are out running. Apart from the dangers of falling into the traffic, there is the further danger that people would not automatically think of giving you cake to eat while you are lying in the road in a semi-conscious, or confused state!
DO NOT DRINK ALCOHOL IF YOU ARE KETOTIC!
Alcohol is a powerful inhibitor of gluconeogenesis. In fact, it forces part of the gluconeogenic metabolic process into reverse. This means that if all the glucose in the blood is being derived from gluconeogenesis then the consumption of alcohol will inevitably cause the blood glucose level to fall. Worse still, the alcohol also stops ketone body production, thus leaving the brain entirely without fuel.
A person who is ketotic is 100% reliant on gluconeogenesis to maintain adequate levels of glucose in the blood. If, under these circumstances alcohol is taken, the person will become disorientated and might lose consciousness, not just from the alcohol, but from low blood sugar. Needless to say, this could be very dangerous, and even fatal.
Alcohol does not have these effects if the glycogen stores in the liver are normal. Under these circumstances the blood glucose level in the blood is maintained by the breakdown of liver glycogen, a process that is not influenced by alcohol. If a person becomes confused under these circumstances it is due simply to the pharmacological effects of the alcohol!
DIABETES MELLITUS
In diabetes mellitus the liver is furiously engaged in gluconeogenesis whether you are eating carbohydrates or not. The liver, in diabetes, is systematically turning your body into glucose. Everything mentioned above applies: as well as churning out vast quantities of glucose, the liver also produces large amounts of ketone bodies. So these people also smell strongly of acetoacetic acid.
But in diabetes mellitus the ketosis does not go away on eating a generous slice of cake! In fact it just steadily gets worse whatever you do.
The other give away is that in diabetes mellitus you lose weight very rapidly without having to restrict your diet or needing to exercise. You also pass large amounts of urine, and are constantly thirsty. If you have none of these symptoms then you do not have diabetes mellitus.
THE COMBUSTION OF FAT
When fats (more correctly: "fatty acids"), which consist of long carbon chains (usually 16 or 18 carbon atoms long), are metabolized they are first broken into 2-carbon pieces, releasing considerable quantities of energy in the process. These 2-carbon molecules are in the form of acetic acid (the acid in vinegar).
To burn this acetic acid to carbon dioxide and water, it is first attached to oxaloacetic acid. The combined molecule (acetic acid-oxaloacetic acid) then undergoes a series of chemical changes which result in the acetic acid turning into carbon dioxide and water, leaving, once again, a molecule of oxaloacetic acid which combines with the next acetic acid to be released from the breakup of the fatty acid. A large amount of energy is released during this process, which can be used for muscle contraction and all of the other activities in the cell and, ultimately, in the body.
IMPORTANCE OF OXALOACETIC ACID
Oxaloacetic acid is reformed every time one acetic acid molecule is burnt. But it can also be formed (or topped up), via a few metabolic steps, from glucose, pyruvic acid, lactic acid, and several amino acids (the components of proteins).
Whichever way oxaloacetic acid arises, it is absolutely essential for the final combustion of acetic acid. In fact, this is its primary function in most tissues - allowing the final complete breakdown of fats into carbon dioxide and water.
Footnote:
GLUCONEOGENESIS
AND THE FORMATION OF KETONE BODIES
However, in the liver, oxaloacetic acid can also be used to form glucose during gluconeogenesis. In fact, pyruvic acid, lactic acid and some amino acids have first to be converted into oxaloacetic acid before their atoms can be rearranged to form glucose. Thus, when the liver is engaged in vigorous gluconeogenesis all of its oxaloacetic acid is turned into glucose, leaving none to combine with acetic acid.
The liver cannot turn acetic acid production off, since the breakdown of fats to acetic acid provides the energy for gluconeogenesis. The liver is left with no option but to convert this acetic acid, which it cannot use, into acetoacetic acid (2 acetic acid molecules joined end-to-end). This is then exported via the blood to the rest of the body, including the heart, muscles and brain, which seem to love this semi-digested form of fat!
Acetoacetic acid is a "ketone body". The other ketone bodies are formed from it. It is only ever formed in quantity by the liver when oxaloacetic acid is diverted from its normal use, to form glucose instead. Gluconeogenesis and ketone body formation therefore always go hand in hand.
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