Monitoring Editor: Charles Boone Various forms of stress induce pathways that converge on the phosphorylation of the alpha (alpha) subunit of eukaryotic translation initiation factor eIF2 at serine 51 (S51), a modification that results in a global inhibition of protein synthesis. In many cases eIF2alpha phosphorylation is a biological response that facilitates cells to cope with stressful environments. Glucose deficiency, an important form of stress, is associated with an induction of apoptosis. Herein, we demonstrate that eIF2alpha phosphorylation is a key step in maintaining a balance between the life and death of a glucose deficient cell. That is, eIF2alpha phosphorylation acts as a molecular switch that shifts cells from a proapoptotic to a cytoprotective state in response to prolonged glucose deficiency. This adaptation process is associated with the timely expression of proteins and activation of pathways with significant contributions to cell survival and adaptation including the X-linked inhibitor of apoptosis protein (XIAP). We also show that among the eIF2alpha kinases GCN2 plays a proapoptotic role whereas PERK and PKR play a cytoprotective one in response to glucose deficiency. Our data demonstrate that eIF2alpha phosphorylation is a significant determinant of survival and adaptation of glucose deficient cells with possible important implications in biological processes that interfere with glucose metabolism.