Fuel metabolism in starvation.
Level 5 - mechanism / opinion, no new human data
Narrative review and autobiographical perspective with mechanism-based reasoning
PubMed 16848698 · doi:10.1146/annurev.nutr.26.061505.111258
What was done
This is an autobiographical and scientific review detailing the historical evolution and physiological understanding of human fuel metabolism during prolonged starvation. The author recounts clinical observations from 1953 to subsequent research characterizing insulin, free fatty acids, glycerol, glucose, lactate, pyruvate, and D-beta-hydroxybutyrate using indirect calorimetry in near-steady starvation states.
What was found
The abstract provides a conceptual and historical overview rather than quantitative experimental data. It highlights that D-beta-hydroxybutyric acid is utilized by the brain to enable survival during prolonged starvation, and notes its proposed therapeutic potential for delivering cellular energy during ischemic and metabolic challenges, such as stroke, myocardial insufficiency, neonatal stress, genetic mitochondrial disorders, and physical fatigue.
Why it matters
The review synthesizes seminal historical insights into how ketone body metabolism sustains human brain function during prolonged nutrient deprivation, framing ketone utilization as a fundamental adaptive mechanism with broad therapeutic implications for metabolic and ischemic disorders.
Limits
The abstract is a narrative, autobiographical review containing no specific sample sizes, trial data, effect estimates, or quantitative metrics. Proposed therapeutic applications represent mechanistic hypotheses rather than clinical trial results within this text.
Cited by
- supports During ketosis, the brain metabolizes both glucose and ketones rather than completely stopping glucose utilization, while blood glucose is maintained near normal and insulin drops.