Triglycerides and Ketones


Eleanor Kellon, VMD
 
Edited

I'm getting messages confused about what to do about TG and ketones, and why.  I'll try to explain here.

The two steps in metabolizing triglycerides where something can go wrong is getting them into the mitochondria and then getting them into the Krebs cycle to be burned. Most fats from triglycerides need a carrier to get into the mitochondria. That is L-carnitine. If you are already using ALCar instead, that's fine. The other issue is that the fat gets broken down to acetyl-CoA which needs to attach to oxaloacetate to enter the cycle. Oxaloacetate needs to be produced from pyruvate. The primary source of pyruvate is glucose but under conditions of energy shortage more glucose bypasses pyruvate and ends up as lactate.  Many amino acids can also be metabolized to pyruvate and then oxaloacetate so that is why we are trying protein. Whey or pea. Pea is going to be more palatable. Many horses object to dry powders puffing up in their face when they are eating so add to a wet meal or mix the protein powder with water then top dress or mix in.

Also get as much beet pulp as you can into the horse. This ferments to acetate which easily enters energy generation pathways and will stem the message to release triglycerides.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

The other thing I failed to re-emphasize here is that ketones mean triglycerides are not being efficiently utilized. They are NOT a  good thing despite what the keto diet proponents would tell you https://wp.me/p2WBdh-1jE .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

Thanks Dr Kellon this is so helpful.  Vinnies pattial labs came back and TG is now 568. I will make a full update when I get the rest of the labs.

I am holding steady as V is eating well.  I am slowly increasing BP too.
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

Nancy,

Don't panic on that number. We'll work through ways to get it down and as long as Vinnie is happy and sound there is no reason to worry about it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 


Frances C
 

Ah, this is so confusing to my old brain! I don't even want to entertain the idea of Ivokana for my mare but perhaps Alcar or L-carniine (both available at bulksupplements.com -which would be better?) would be of some benefit. Supposedly she is diabetic and pretty thin but otherwise looking good. My primary focus is on DSLD and arthitis and for this she is on pasture about 18 hours a day to get her to move around. I threw up my hands and said "go be a horse" when labs came back Dec. 2020 with glucose of 155 (range 68-120) and insulin of 85 (range 0-42). The labs of May 2022 confirm with glucose 245 (range 75-115) and insulin 39.7 (range 4.5-20). Her ATCH both times was good at 21 and 22.
If she is truly diabetic does that mean she is starving? If so would this alternative method via triglycerides and ketones be of any use to her?
Her appetite is not very good even for pasture grass. She'll eat some fine alfalfa and 2-3 lbs of bucket feed (teff pellets, Stabul 1, Zero, flax, H.A., and human dose of astaxation and shilajit.
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382


Eleanor Kellon, VMD
 

Your mare appears to be truly diabetic with low insulin.  The good news is she is at low risk for laminitis in this condition from what we have seen in previous cases but the weight loss is the most common sign. My first approach with her would be to get her to eat as much beet pulp as possible. The acetate from beet pulp fermentation is a substitute for glucose that doesn't need insulin.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Frances C
 

Ah, many thanks again for your wisdom. Will start to find ways to increase beet pulp.
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382