Nutritional Ketosis vs Starvation States vs Diabetic Ketoacidosis
These are distinct metabolic processes and are characterised by the following;
| Calorie restriction in the absence of TCR = starvation ketosis | Diabetic Ketoacidosis (DKA) | Nutritional Ketosis (induced via TCR) | |
|---|---|---|---|
| Metabolic state | This is an insulin-mediated glucose dependent state where insulin spikes suppress lipolysis/access to stored fats. This results in dependence on limited glycogen stores for energy | This is a glucose-dependant state of ‘internal starvation’ where there are high circulating glucose levels with inadequate insulin levels to allow for intracellular access to glucose | This is a normal physiological state. Reduced insulin requirements enable a metabolic shift from glucose dependence, towards lipid oxidation with the utilisation of free fatty acids and ketones as an alternative fuel source. |
| Nutritional status | Nutritionally deplete. Marked by hunger. Can be life threatening. | Nutritionally deplete. Life threatening emergency | Nutritionally replete. Absence of hunger. Safe. Thriving state. |
| Insulin | Significant fluctuations from low to normal levels secondary to carbohydrate intake | Extremely low levels resulting in much higher ketone production | Insulin requirements (and therefore release) are low, however there is adequate insulin available to suppress ketoacidosis |
| Ketones | 1–7 mmol | 5–10 times higher vs nutritional ketosis | 0.5 to 3 mmol/L |
| pH | Normal | Metabolic acidosis | Normal |
| BSL | Low to normal | High | Lower level of normal |
| Outcome | See “weight regulation tab” re Minnesota starvation study. Other effects include osteoporosis and sarcopenia. | Short term: extreme thirst, polyuria, tiredness, dizziness, nausea and vomiting, confusion, coma, death. Long term: diabetic complications such as kidney/eye/nerve damage, brain damage and cardiovascular disease. |
Significant benefits in metabolic health such as remission of diabetes, improved cholesterol profile; improved blood pressure control; improved cardiovascular risk; improved fertility; improved mood and sense of well-being; reduced risk of neurodegenerative diseases and cancer. |
