Purpose of Review
The goal of this paper is to review current literature on nutritional ketosis within the context of weight management and metabolic syndrome, namely, insulin resistance, lipid profile, cardiovascular disease risk, and development of non-alcoholic fatty liver disease. We provide background on the mechanism of ketogenesis and describe nutritional ketosis.
Nutritional ketosis has been found to improve metabolic and inflammatory markers, including lipids, HbA1c, high-sensitivity CRP, fasting insulin and glucose levels, and aid in weight management. We discuss these findings and elaborate on potential mechanisms of ketones for promoting weight loss, decreasing hunger, and increasing satiety.
Humans have evolved with the capacity for metabolic flexibility and the ability to use ketones for fuel. During states of low dietary carbohydrate intake, insulin levels remain low and ketogenesis takes place. These conditions promote breakdown of excess fat stores, sparing of lean muscle, and improvement in insulin sensitivity.
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This is in stark contrast to, and should not be confused with, the pathophysiologic state of type 1 diabetic ketoacidosis (DKA). Despite similar sounding names, they are two distinct metabolic processes. The production of endogenous insulin is protective against the occurrence of DKA; the range of ketones present in DKA is 5-10 fold greater than the levels achieved during nutritional ketosis. Additionally, while in nutritional ketosis, the body is able to maintain normal blood glucose levels and maintain a normal pH, as opposed to extremely elevated blood sugars and acidic pH associated with DKA.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
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The authors would like to thank Robin Noel for her technical assistance in the creation of the graphics for the figure.
Conflict of Interest
Victoria M. Gershuni, Stephanie L. Yan, and Valentina Medici declare they have no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Gastroenterology, Critical Care, and Lifestyle Medicine
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Gershuni, V.M., Yan, S.L. & Medici, V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep 7, 97–106 (2018). https://doi.org/10.1007/s13668-018-0235-0
- Nutritional ketosis
- Metabolic syndrome
- Ketogenic diet
- Insulin resistance
- Weight loss
- Low-carbohydrate diet
- Ketone bodies
- Glucose metabolism