• Ketogenic diet- high fat, low carbs
• Dicholoacetate- blocks enzyme that phosphorylates PDH, thus inactivating it. Therefore, DCA keeps PDH active

• Cofactor for E₁ of PDH (which decarboxylates pyruvate)
• Can lead to Berberi or Wernicke-Korsakoff syndrome (in alcoholics)
• Neurological and cardiovascular disorder often seen in malnurished individuals
• *Unable to oxidize pyruvate
• Organs, like brain, that heavily depend on aerobic oxidation of glucose are affected
• *Elevated levels of pyruvate, alanine, and lactate often seen in blood

Wernicke's encephalopathy

• Triad of opthalmoplegia:
• Weakness or paralysis or eye
• Ataxia- unbalanved
• Sudden confusion
• *Nystagmus- rapid involuntary eye movements

Korsakoff psychosis

• Persistent deficits in learning and memory
• Amnesia: Anterograde (rapidly forget new info) and Retrograde (forget old info)
• Confabulation- unable to recall what really happened, while making up plausible stories, without being aware of doing so
• Wernicke-Korsakoff syndrome when occurs in conjection with Wernicke's encephalopathy
• Hemorrhages are classic signs

Medical emergencies

• *IV thiamine must be given BEFORE IV glucose 
• Also seen in extended vommitting, thiamine deficiency, and systemic diseases like HIV, cancer, uremia with hemodialysis

Turned off when energy is high and turned on when energy is low- you don't need more energy if you have a lot

Allosteric

• Activation: low energy molecules
• Long chain FA, NADH, acetyl-COA, ATP
• Inhibition: high energy molecules
• AMP, CoA, NAD+

Phosphorylation

• Protein kinase- inactivates E₁
• Inhibited by high levels of ATP
• Phosphoprotein phasphatase- active E₁
• Stimulated by Ca²⁺