This is a recent hypothesis paper regarding SGLT2 positive and unexplained outcome improvements in Macrovascular disease complications of diabetes and metabolic syndrome by extension.
Previous studies showed that Microvascular outcomes such as neuropathy, nephropathy and retinopathy improve with A1C control. But not Macrovascular.
Metabolic flexibility, the ability to variably use glucose or fatty acids according to glucose scarcity or abundance, is enhanced by BHB, beta hydroxybutyrate a super efficient fuel that also is an energy signaler or switcher analagous to a fuel injector for the mitochondria.
BHB is produced by exercise induced ketosis, fasting induced ketosis, Ursolic acid triglyceride metabolism derived BHB and coconut/MCT oil liver produced BHB.
Question: does BHB production predominate from somatic cells or liver cells?
Can a Shift in Fuel Energetics Explain the Beneficial Cardiorenal Outcomes in the EMPA-REG OUTCOME Study? A Unifying Hypothesis | Diabetes Care
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