I understand that insulin prevents ketosis and glucagon prompts it. Aside from these antagonistic, pancreatic hormones, ketosis and keto-adaptation seems to emerge and establish itself through other metabolites and hormones that apparently provide fuel and epigenetic signaling... what are these?

I'm trying to understand physiologic indicators of a fully keto-adapted person, i.e. one that thrives on no-to-low carbohydrates (I'm not asking for dietary advice here, merely the evolving effects and adaptations of such sustained keto-adapted diets regardless their macronutrient composition and frequency).

My limited understanding is that the initial and early sequence of ketosis and keto-adaption is:

  1. Free fatty acids are mobilized from adipose tissue by glucagon in lieu of blood glucose and the prevalence of insulin (could be as a result of fasting, caloric restriction, intense exercise, whatever),

  2. Metabolizing ketone bodies first appear by the liver (converting mobilized free fatty acids into acetoacetate) and then, after a period, the liver converts the acetoacetate ketones as a precursor into beta-hyrdoxybutyrate.

  3. The body can be observed initially shedding excess acetoacetate ketones through urine in early stages of ketosis (and acetone through respiration after adaptation occurs).

  4. At some point beta-hydroxybutyrate production becomes sufficient enough to be the primary fuel for the brain, presumably causing a cascading series of epigenetic changes throughout the body, e.g. increased human growth hormone production, autophagy, etc.

  5. At some concurrent point mobilized free-fatty acids replace acetoacetate as fuel for skeletal muscles, which presumably is now conserved to the primary role of beta-hydroxybutyrate precursor.

Is this accurate, are there other evolving aspects of metabolite, endocrine or any physiologic changes that are key and/or playing pivotal roles... and what about someone that spends years this way... what's the baseline conditions of sustained and fully evolved keto-adaptation?


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