More interestingly, ketones are histone deacetylase inhibitors (HDACi)… this leads to more histone acetylation.  Benefits of fasting sans fasting?  Modulating of acetylation is a MAJOR regulator of circadian rhythmicity.
Butyrate is another HDACi, so have some fibrous plant foods with your red wine and dark chocolate.  Anti-aging (mostly worm studies, but still). Ketone production is regulated in part by FOXA2, which activates HMG-CoA synthase, an enzyme inhibited by insulin.  FOXA2 works better when it’s acetylated, which is enhanced by ketones (ketones enhance ketone production in this regard).
The higher level of free fatty acids seen in ketogenic diets are obviously important for their pleiotropic effects on metabolism (eg, see Hyperlipid), but ketones are pretty cool, too.
This entry was posted in Advanced nutrition, chocolate, circadian, Dietary fat, fat, insulin, Ketosis, microbiome, wine and tagged carbs, circadian rhythm, ketones. Yes – a lot of butyrate is oxidized in intestinal cells, but some also ends up in acetoacetate. Thomas Seyfried readjusted his ideas on the need for caloric restriction when it came to ketogenic diets and cancer.
SIRT1 is an HDAC, ketones & butyrate are HDAC inhibitors, and CLOCK is a histone acetyltransferase. I am sure you have a paper or two that have looked at this, but “hitting the bloodstream at once” would refer to primarily the CHO?
Extended wakefulness of modern society affect the redox state of Locus ceruleus cells in the brain.
Bad sleep cause massive oxidation and a loss of reduction = low NAD+ levels in the mitochondria.
We also should remember that mitochondria are subject to evolutionary selection pressures due to altered circadian signaling within the brain and body clocks. Bill saw this today and it makes the points about the need for small amounts of inflammation to stimulate SIRT action. SubscribeNever miss a beatSign up to be notified when a new article is published (and check your spam folder).
In recent wars, as many as 30% of all casualties had burns with or without associated injuries. In treating burns, it is essential that the Australian Defence Force Medical Officer follows the logical sequence of triage, timely diagnosis, accurate assessment of surgical priorities, appropriate early treatment and evacuation. Casualties with burns up to 10% of total body surface area (BSA) are classified as having minor injury, for which hospital care can be delayed and minimal treatment is required in the first instance. Casualties with burns between 10%-60% BSA are classified as having major injury requiring early hospital care and intensive treatment.
Casualties with burns over 60% BSA are classified as having severe injury with unlikely salvage and should, except in ideal circumstances, be treated expectantly, without expenditure of significant medical resources.
These criteria are modified by factors such as co-existing inhalation injury (common when burns are sustained in armoured vehicles or other confined spaces) or significant associated mechanical trauma. Comprehensive triage should include taking a history outlining the time of burning, details of the associated event, nature of the burning agent, details of whether the burn occurred in an enclosed space and the nature of first aid treatment given.
The depth of a burn is often overestimated in areas where the skin is thick (ie, scalp, palm, sole, buttock and back), and understimated where the skin is thin (dorsum of the hands and feet, the anterior surface of the wrist, and around the eyes). Respiratory burns are common in war and can be expected in patients burned in confined spaces (eg, armoured vehicles and bunkers) and in patients who have burns to the head and neck, especially intraoral areas. Treating other life-threatening injuries always takes precedence over treatment of burns, except for chemical burns. If there is any evidence of respiratory obstruction (ie, stridor or difficulty breathing), or if there is evidence of burn injury to the mucous membranes of the mouth or pharynx, the casualty should be intubated before evacuation. Casualties suffering from major burn wounds should be evacuated without delay to a treatment centre where immediate fluid replacement can be provided. The burn patient should be managed, in the first instance, in a Level 2 or 3 medical facility.
Pain is seldom a major problem in the patient with full thickness burns, but extensive partial thickness burns are often extremely painful and require an adequate dose of parenteral pethidine or morphine based upon the patient's weight. Antibiotic therapy must start at a Level 1 or 2 facility and should be continued until definitive treatment is reached at a specialist burns unit. Water, electrolytes and plasma are lost from the burnt surface and into the surrounding tissues. To understand the fluid shifts that occur after a burn, it is necessary to go back to the basic mechanism of transfer of fluid from the vascular compartment to the interstitial space.
The balance of forces which regulates fluid transfer across the capillary wall is expressed in Starling's law of tissue equilibrium.
The first inflammatory response is the release of mediators such as histamine, serotonin, thromboxane, prostaglandins and kinins. Loss of fluid from the circulation invokes a response throughout the whole body, integrated by the autonomic system and including release of catecholamines. Even before hypovolaemia has caused a generalised response (including vasoconstriction), a massive burn wound has an immediate and ill-understood effect on the circulation. Since loss of fluid starts immediately after the burn injury, fluid replacement should start as rapidly as possible.
The patient's vital signs should be monitored to assess the response to fluid resuscitation.
The volume of fluid replacement therapy for days 2-4 depends on the response to treatment, but is roughly half of that required on the first day.
Respiratory burns are difficult to predict, although they are more common in confined spaces and when smoke has been inhaled. Carbon monoxide poisoning is a potent cause of respiratory depression in respiratory burns and, if present or suspected, high concentrations of oxygen should be given early (hyperbaric therapy with oxygen is not usually required).
If pulmonary insufficiency develops and the use of humidified oxygen alone cannot maintain normal blood oxygenation, sophisticated respiratory support, including nasotracheal intubation and assisted respiration, may be necessary. Circumferential full thickness burns of the limbs may result in impaired circulation to distal parts because of constriction caused by oedema beneath the inelastic eschar produced by the burn. Swelling and coldness of distal, unburned parts are not absolute indications for escharotomy, but cyanosis, impaired capillary filling and progressive signs of neurological damage are. If there is evidence of vascular impairment, escharotomy is carried out in the mid-lateral line of the involved extremity and, if distal blood supply is not improved, a second escharotomy incision is made in the midmedial line in the longitudinal axis of the limb. The procedure can be carried out without anaesthesia, as it is performed through insensitive, full thickness burned tissue.


Escharotomy is of particular importance in relation to the forearm and hand, as necrosis of small muscles of the hand can occur rapidly. Patients with circumferential truncal burns may require escharotomies in the anterior axillary line to relieve restriction of chest wall movement and permit more satisfactory ventilation. No treatment of burn injuries should be undertaken until the patient regains haemodynamic stability. Without escharotomy, the hand muscles of this severely burned patient would have been at risk of ischaemic necrosis.
Every effort should be made to evacuate the casualty to a specialised burns unit capable of undertaking comprehensive and definitive care (Level 5) within 72 hours. In practice, particularly during military operations, it may not be possible to achieve this ideal. The depth and severity of chemical burns are related to both the concentration of the agent and the duration of the contact with the tissues. Phosphorus is used in antipersonnel weapons, smoke screens, incendiary bombs and tracer bullets. At a Level 2 or 3 medical facility the burnt area is treated by rinsing with water or a suspension of Antiphos solution (5% sodium carbonate, 1% hydroxy ethyl cellulose, 3% copper sulphate, 1% sodium lauryl sulphate).
All ADF Medical Officers who may be deployed into areas of military conflict should have successfully completed the course on Early Management of Severe Burns run by the Australian and New Zealand Burns Association. About a third of all patients with significant electrical injury of the extremities will require amputation of nonviable parts or extensive debridement and plastic surgical repair using local pedicled flaps or distant free-tissue transfer. Bill, what is the relationship between butyrate (the short-chained fatty acid) and beta-Hydroxybutyric acid (the ketone)? That contributes to mitochondrial biogenesis, decreased Akt and mTor signaling as well as other implications that could contribute to prolonged life-span.
I love the common assumption by so many “Fat burns in the flame of carbohydrate” It becomes very evident as people try to lose weight by running a lot. The timely triage, diagnosis, and management of these burns is central to the survival and long term physical welfare of these patients.
The ignition of these fuels has been largely responsible for the thermal burns seen in military casualties. Burns of the hands, feet, face and perineum, as well as circumferential full thickness burns (which threaten peripheral circulation), are considered an absolute priority in treatment.
Thorough examination should include the assessment of associated injuries, particularly those of the abdomen and chest.
Area and depth are the two most important factors in determining probable morbidity and mortality, initial treatment, metabolic consequences, character of healing and ultimate functional and cosmetic result.
The depth of the burn can only be determined with certainty by histological examination, but the clinical criteria in Box 2 permit an initial and reasonably accurate assessment. The mucosa of the mouth should be inspected carefully for oedema, erythema, blisters and carbonaceous material. Chemical agents should be washed immediately from the skin surface by copious water lavage. Burning clothing should be extinguished but not removed from the casualty unless it is constricting the tissues. The development of upper respiratory tract oedema may render subsequent intubation difficult or impossible. Initial consideration of the burn patient includes removal of clothing and a complete physical examination. Anxiety and restlessness may require mild sedation using intravenous midazolam or oral temazepam.
The use of a broad spectrum antibiotic, such as cephalothin sodium, which covers skin commensal organisms, is the antibiotic of choice. The changes in fluid dynamics seen in burns result from the inflammatory response to the thermal injury.
These cause capillaries to dilate and their walls to become more permeable to large molecules, such as albumin, with a consequent loss of fluid from the circulation.
Large volumes of fluid will be needed, the exact amount depending on the extent of the burn and the patient's body weight.
Half of the volume should be delivered in the first 8 hours after the burn and the second half in the next 16 hours. Blood is generally not required in the early post-burn period unless there are associated injuries.
All patients with significant burns (ie, >40% BSA) should have regular chest x-rays and early blood gas and carbon monoxide level estimations to check for the onset of pulmonary insufficiency. If there is an indication for their use, they must be given very early in the course of respiratory failure. In such cases an escharotomy is needed to prevent secondary ischaemic necrosis of these tissues.
The escharotomy incision should be extended throughout the entire length of full thickness burns to ensure adequate release of vascular compression. These patients will frequently be restless, agitated and hypoxic before escharotomy and show prompt clinical improvement as well as improved ventilatory exchange and blood oxygenation after escharotomy. The first image shows the patient's hands two hours after burning; escharotomy was performed as soon as possible.
The depth of chemical burns is often underestimated, as chemicals continue to penetrate tissues even after the burn victim is removed from the scene of injury.
First aid measures in both cases involve immediate, constant irrigation with water for up to 10 minutes. If so, the procedure is performed with constant saline irrigation of the operative field, and the operating theatre is darkened to facilitate the location of phosphorus particles in the wound.
The patient should be monitored for electrocardiographic changes, including ventricular arrhythmias, as well as biochemical changes, such as a shift in the calcium-phosphorus ratio and abnormalities of liver enzymes. Limited areas of cutaneous necrosis may only be evident at points of entry, exit or arcing, but there may be extensive subcutaneous deep tissue involvement.
Something tells me that the absence of calories in itself must have some sort of distinct action (whether relevant or not to the purposes of ketosis in cancer).
My thought behind an intermittent faster who eats once a day is that the meal is so large they end up digesting and assimilating those nutrients (macro) for the equivalent hours (or potentially very close) to that of someone who would eat 2-3 meals in that same time period…thoughts??


I wonder if you have a diet rich in fats, say 60% cal from fat the body becomes more able to burn fat? Respiratory tract injury should always be suspected, especially in burns involving the head and neck. Watches, rings, belts, boots and any other item likely to constrict tissue should be removed or loosened. Nasotracheal intubation, secured by a transfixing nasal septal suture, should be performed in preference to oro-tracheal intubation. This should be given either intravenously or orally in divided doses of 250mg every 6 hours. Once a secure intravenous pathway has been established, resuscitation fluid requirements can be estimated. Inflammation is a reaction in damaged but viable tissue and consists of both a cellular and a fluid response.
The cellular part of the inflammatory reaction starts with the adherence of neutrophils to the endothelium of the capillary and migration through the capillary wall. 2 It is only after some hours that loss of fluid from the plasma causes hypovolaemia, an increase in the concentration of red cells (haematocrit) in the blood and accumulation of oedema. Because the fluid loss involves plasma with all its electrolytes, the fluid used for replacement must contain about the same quantities of electrolytes as plasma. Injuries included respiratory burns with moderate oedema, but he did not require intubation. Progressive pulmonary failure appears to result from the inhalation of toxic products in smoke and may occur without any skin burn at all. Similarly, escharotomy in a circumferential full thickness burn of the chest prevents respiratory restriction. An incision along the lower margin of the ribcage may be necessary in patients with deep burns extending onto the upper abdominal wall. The cream should be applied in a layer 3mm thick to the whole burn with a sterile gloved hand and then the limb or part wrapped in a sterile Melolin dressing.
Particular attention should be given to the eyes, as they are most vulnerable (acid and caustic soda burns of the eyes are common). Where practical, the burnt area is initially immersed in or liberally doused with cold water before being covered. Tetanus prophylaxis should conform to accepted military practice and is essential in the management of burns, as in any other wound management.
These are quickly followed by monocytes, which are important in controlling bacterial invasion, as well as contributing to the release of mediators and cytokines.
Loss of fluid from the circulation is maximal in the first eight hours after the injury and the capillary membrane tends to stabilise after 48 hours.
Much debate is centred on whether the fluid should be a pure electrolyte solution or should contain colloid, 3,4 but, for practical purposes, particularly early on, the debate is academic. In a patient of average weight, this translates to a urinary output of about 50mL per hour.
Twelve hours later, the coat of cream should be renewed on those areas where it has been removed by bedclothes. Following irrigation and neutralisation of the acid or alkali, the treatment is the same as for any other burn.
When united with oxygen, it forms phosphorus pentoxide, which emits a green or bluish light. The presence of brawny, deep induration in a limb involved in electrical injury, with signs of vascular impairment, indicates the need for fasciotomy. Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R’s through dietary manipulation. Is there such a thing as a metabolism that is more “prone” to burn carbs or fat?
Casualties with chemical burns, including those from phosphorus, require immediate wound care to prevent continuing damage to tissue by the active chemical.
The patient's weight in kilograms should be ascertained by questioning or by estimation and the extent and depth of the burn must be recorded. Whenever possible, Melolin dressings or sterile polyurethane foam should be used to cover the burn, but, if these are not available, makeshift wrappings such as sheets can be used.
For practical reasons of availability, shelf life and cost, electrolyte solutions are preferred and the balanced composition of Hartmann's solution (ie, lactated Ringer's solution) makes it the best. Daily wound toilet should be carried out by gently cleansing the cream from the wound to the point of bleeding or pain, without employing anaesthesia. Phosphorus burns tissues with which it comes into contact, and phosphorus pentoxide is hygroscopic, thereby dehydrating tissues. Since glucose is a readily available form of energy; could it be a certain preference for this energy production system? If urinary output is unexpectedly low, exclude mechanical problems, such as blockage or displacement of a catheter, before changing the fluid regimen.
Ingrained dirt or charring should be quickly washed off with a surgical solution such as Chlorhexidine. When combined with water, phosphorus pentoxide produces phosphoric and phosphorous acid, which cause chemical burns. First aid treatment involves copious cold-water lavage and removal of phosphorus particles, after which the involved area is covered with saline-soaked dressings and kept moist until the patient reaches a definitive treatment centre. Blood gas determinations, serum electrolyte levels and haematocrit estimations are essential in the management of severe burns. During the period of active wound exudation, bulky absorbent dressings should be placed beneath the burned parts to absorb the serous exudate.
Normal circadian signaling of daily light oxidation during wakefulness upregulates SirT3 and antioxidants in these critical neurons.




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