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The result is a rate of ketone production higher than the rate of ketone disposal, and a decrease in blood pH. [12] In extreme cases the resulting acetone can be detected in the patient's breath as a faint, sweet odor. There are some health benefits to ketone bodies and ketogenesis as well.
Ketone bodies are water-soluble molecules or compounds that contain the ketone groups produced from fatty acids by the liver (ketogenesis). [1] [2] Ketone bodies are readily transported into tissues outside the liver, where they are converted into acetyl-CoA (acetyl-Coenzyme A) – which then enters the citric acid cycle (Krebs cycle) and is oxidized for energy.
Oxaloacetic acid (also known as oxalacetic acid or OAA) is a crystalline organic compound with the chemical formula HO 2 CC(O)CH 2 CO 2 H. Oxaloacetic acid, in the form of its conjugate base oxaloacetate, is a metabolic intermediate in many processes that occur in animals.
The ketones are released by the liver into the blood. All cells with mitochondria can take up ketones from the blood and reconvert them into acetyl-CoA, which can then be used as fuel in their citric acid cycles, as no other tissue can divert its oxaloacetate into the gluconeogenic pathway in the way that this can occur in the liver.
This malate is then oxidized to oxaloacetate by cytosolic malate dehydrogenase, generating a reduced NADH in the cytosol. Oxaloacetate is one of the keto acids preferred by transaminases, and so will be recycled to aspartate, maintaining the flow of nitrogen into the urea cycle. We can summarize this by combining the reactions:
The ketone bodies are released by the liver into the blood. All cells with mitochondria can take ketone bodies up from the blood and reconvert them into acetyl-CoA, which can then be used as fuel in their citric acid cycles, as no other tissue can divert its oxaloacetate into the gluconeogenic pathway in the way that the liver does.
Two low-energy waste products, H 2 O and CO 2, are created during this cycle. [9] [10] The citric acid cycle is an 8-step process involving 18 different enzymes and co-enzymes. During the cycle, acetyl-CoA (2 carbons) + oxaloacetate (4 carbons) yields citrate (6 carbons), which is rearranged to a more reactive form called isocitrate (6 carbons).
However, drinking exogenous ketones will not trigger fat burning like a ketogenic diet. Most supplements rely on β-hydroxybutyrate as the source of exogenous ketone bodies. It is the most common exogenous ketone body because of its efficient energy conversion and ease of synthesis. [1] In the body, β-HB can be converted to acetoacetic acid.