Lactation Ketoacidosis Risk

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In this lecture, Dr. Bikman explores how ketogenesis—our body's ability to produce ketones from fat—operates differently in men and women. While the foundational metabolic machinery is the same, hormonal influences, fat distribution, and physiological demands like pregnancy and lactation create meaningful divergences in how each sex mobilizes fat and enters ketosis.

Women typically exhibit higher levels of free fatty acids and ketones during fasting compared to men. Estrogen drives this effect by enhancing both fat storage in subcutaneous areas and the enzymes responsible for fat breakdown. This dual effect—storing fat in a metabolically healthy way and releasing it efficiently when needed—makes women more metabolically flexible, especially during periods of energy demand like fasting or exercise.

Men, by contrast, tend to have higher lean mass and rely more heavily on glucose oxidation. Their metabolic machinery still supports fat burning and ketogenesis but often ramps up more slowly. Interestingly, while women tend to reach ketosis faster, men may show more consistent weight loss over time on ketogenic diets—partly due to greater muscle mass and a more sustained shift toward fat burning once adapted.

A fascinating part of the lecture touches on lactation-induced ketoacidosis, a rare but documented condition in breastfeeding women following strict low-carb diets. This underscores how a woman’s enhanced capacity for fat mobilization and ketone production, while advantageous, can potentially overshoot during intense metabolic demands—highlighting the importance of mindful dietary strategies that are tailored to sex-specific physiology.

Show Notes/References:

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IMPORTANT NOTE: The information presented is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Dr. Bikman is not a clinician—and, he is not your doctor. Always seek the advice of your own qualified health providers with questions you may have regarding medical conditions.

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