Peter Attia

You're going to create all of the various metabolites.

And the reason your transaminases are elevating is those enzymes are leaking out of hepatocytes because the hepatocytes are injured due to the inflammation that results from that metabolic pathway.

Is that at all analogous to what's happening with a comparable dose of 1,3-butanediol?

Do you generate the same amount of aldehyde?

And why can't that patient make enough insulin in response to the beta-hydroxybutyrate to bring the acidosis under control?

Oh, you're saying the liver doesn't respond to the insulin signal to make less BHB in that situation?

It does?

So why does it in the rest of us?

Like when you and I used to do our ridiculous 10-day fast, do you still do those, by the way?

Yeah, yeah, yeah.

When we used to do these 10 and 14-day water-only fasts, our ketones would actually plateau.

And even when George Cahill did the seminal studies of 40-day water-only fasts, their ketones plateaued at 7 to 10 days.

And a big part of that was that insulin is now keeping them in check.

The reason the ketones aren't going to produce a level of acidosis is that, and that's why, of course,

Kids primarily with type 1 diabetes can develop ketoacidosis.

They don't have the beta cell capacity to offset that rise in ketones.

This case of the alcoholic is very interesting to me.

I actually was never aware of this.

I used to buy it at Sigma Chemicals.

The stuff was dirt cheap.