Ketosis Is Often Misunderstood And Confused With Ketoacidosis

…A good number of less-informed doctors and medical professionals confuse ketoacidosis, a diabetic complication, with the dietary ketosis that is associated with ketogenic diets and fasting states in the body…which leads them to advise you that ketosis is dangerous.

Ketosis Vs Ketoacidosis

The truth is, ketosis and ketoacidosis are completely different, and nutritional ketosis is totally safe.

Now, clearly, if you’ve had previous health problems involving your liver, kidneys, gallbladder, or pancreas, then you should seek advice from your doctor before making any changes to your diet, to insure your safety.

Differentiating Nutritional Ketosis & Ketoacidosis

First, let’s cover some semantics. Your body can produce, from fat and some amino acids, three ketone bodies (“ketone” refers to the chemical structure where oxygen is double-bonded to carbon sandwiched between at least two other carbons), which are: acetone, acetoacetone, and beta-hydroxybutyrate (B-OHB).

And why does your body produce ketones?

…Basically, it’s a key evolutionary advantage. Your brain can only function with glucose and ketones. And, since you can only store about 24 hours worth of glucose, you would die of hypoglycemia if you were ever forced to fast for longer than 24 hours.

Quite fortunately, however, your liver can turn fat and certain amino acids (the building blocks of proteins) into ketones to feed our brains (among other uses). So the ability of our bodies to produce ketones is required for even basic survival.

Next, what is diabetic ketoacidosis? …A diabetic person will effectively go into a state of starvation when they don’t receive enough insulin (typically a Type I diabetic, but sometimes in insulin-dependent Type II diabetics). They may have all the glucose imaginable in their bloodstream, but without insulin, none of it can actually get into their cells. Therefore, they would essentially go into starvation. As a result, the body does what it would do in anyone’s body: it would begin to produce ketones out of fat and amino acids.

…The problem, however, is that the diabetic person can’t produce insulin, so no feedback loops exists to control and regulate the biochemical situation, and their body would continue producing more ketones without end.

Essentially, the difference between the two conditions comes down to volume and flow rate:

The following table provides a visual comparison of the levels of ketones being produced in the various situations, showing the large difference between benign nutritional ketosis and ketoacidosis:

Body ConditionQuantity of Ketones Being Produced
After a meal (Post Prandium):0.1 mmol/L
Overnight Fast:0.3 mmol/L
Ketogenic Diet (Nutritional ketosis):1-8 mmol/L
>20 Days Fasting:10 mmol/L
Uncontrolled Diabetes (Ketoacidosis):>20 mmol/L

Once ketone levels (specifically, beta-hydroxybutyrate) reach the 15 to 25 mM range, the resulting pH imbalance of the body would lead to dramatic metabolic derangement and the person would become critically ill.

But, it isn’t actually possible in a person who can produce insulin, even if in small amounts to reach this level of pH imbalance, because the existing feedback loop would prevent the ketone levels from reaching a high enough level that changes the pH (which leads to the cascade of health problems).

Do I Need To Worry About Ketoacidosis On A Ketogenic Diet?

Nutritional ketosis, which is associated with a properly executed ketogenic diet, does not pose any danger to you. It is simply the metabolic process of burning body fat for fuel.

Unless you are diabetic and lacking insulin, or an extreme alcoholic, a ketogenic diet is completely safe. Ketone body levels for adults with a properly functioning pancreas rarely reach above 8-10 mmol/L. As mentioned previously, these critically high levels of ketones aren’t actually possible in a person who can produce insulin, even if in small amounts…because the existing feedback loop would prevent the ketone levels from reaching a high enough level that changes the pH (which leads to the cascade of health problems).

Through significant restriction of carbohydrate intake (usually less than 50 grams per day, even more strict in some individuals), one become “keto-adapted”, or in a state of nutritional ketosis, in which their body switches from reliance on glycogen for energy to fat.

…The brain shifts from being primarily dependent upon glucose to being primarily dependent upon beta-hydroxybutyrate. And this has no correlation or connection with what happens in a diabetic person during ketoacidosis.

It does, however, illustrate how quick-to-react and poorly informed the general medical community is. As Dr. Attia of the Eating Academy puts it:
[quote_center]Ketoacidosis and nutritional ketosis have as much in common as a house fire and a fireplace.[/quote_center]

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