It really is a sad fact that some experts add more to the confusion surrounding health and nutrition then they do to clear things up.
One such area is that of ketosis vs ketoacidosis.
While you may be unfamiliar with these terms, you will most certainly know about low carb and very low carb diets, and it is likely you’ve heard health professionals warning against the dangerous side-efffects of low-carbing.
Well, ketosis and ketoacidosis are often quoted as two of those dangerous side-effects. This advice, however, is partly misinformed, partly overcautious.
I read about Jimmy’s (Livin’ La Vida Low-Carb) experience recently when he went to give blood. He struck up a conversation with the type 2 diabetic nurse, and talk turned to eating a low carb diet. Her immediate response was that ketosis is a dangerous condition to be avoided.
This is a pretty common opinion echoed by many health professionals. Here is what WebMD say on the subject of ketosis;
Unhealthy metabolic state (ketosis). Low-carb diets can cause your body to go into a dangerous metabolic state called ketosis since your body burns fat instead of glucose for energy. During ketosis, the body forms substances known as ketones, which can cause organs to fail and result in gout, kidney stones, or kidney failure. Ketones can also dull a person’s appetite, cause nausea and bad breath. Ketosis can be prevented by eating at least 100 grams of carbohydrates a day.
It is hardly surprising that the general public are confused, when health professionals and mainstream websites like WebMD make statements like this. And that’s only two examples.
If this is all starting to sound a bit worrying, let me clarify things for you by firstly defining the difference between ketosis and ketoacidosis.
Ketosis vs Ketoacidosis
What is ketosis?
If you eat a low carb diet (defined as eating less than 50g of carbs a day), you will likely be in ketosis.
Ketosis is actually the normal response to restricting carbohydrate intake, intermittent fasting or starvation. It simply means your body is using fat for energy, rather than carbs.
When fat is metabolized ketones are produced, and it doesn’t matter whether that fat comes from the fat in your bacon, or from the fat you were carrying around your mid-section.
Most cells (including brain cells) are able to use these ketones for at least part of their energy. But, one type of ketone molecule (acetone) cannot be used, and is excreted as waste, mostly in the urine and breath.
If enough acetone is found in urine, it can be detected using a dipstick (e.g. Ketostix), and this is defined as “ketosis.”
This is a normal process and not something to worry about, it simply means the level of ketones in your body are slightly higher — between 3 mM and 5 mM, as apposed to 0.5 mM with a higher carb intake.
What is ketoacidosis?
The problem comes about when the normal process breaks down, notably via untreated type 1 diabetes (insulin is a major regulator of ketone production).
This is when you may get an over-production, or ketoacidosis, which is a dangerous condition.
Ketoacidosis occurs when ketone levels rise to between 15 mM and 25 mM.
It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances, as a result of a shortage of insulin.
In ketoacidosis, the body cannot use sugar as it’s source of fuel because there is no insulin (or not enough insulin) to get the sugar into the cells, so it switches to using fat instead.
But, because the whole process is not working correctly, ketones (from the break down of fat) build up to an abnormally high level, and ketoacidosis is the result.
Type 2 diabetes who control their condition with insulin injections, normally do produce enough insulin of their own to prevent ketoacidosis.
Far from being dangerous for type 2 diabetics, one study actually recommended a low carb ketogenic diet;
This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.
So as you can see, ketosis and ketoacidosis are two quite different conditions.
But, would you really want to be encouraging your body into a state of ketosis by eating a low carb diet?
Why Ketosis is Not Abnormal
While some professionals make ketosis sound frightening and something to be completely avoided, it is actually a vital process that is advantageous to the body.
Your brain can only function with glucose and ketones, however the body does not store more than about 24 hours worth of glucose.
This means that if we were ever forced to fast for more than 24 hours we would die from hypoglycemia.
This doesn’t happen, though, because the liver has the ability to take fat and certain amino acids, and convert them into ketones to supply the brain with what it needs.
Hence, our body’s ability to produce ketones is required for basic survival.
Check out this article for some really interesting expert opinions on ketosis.
In fact, in certain parts of the world people spend seasonal or extended periods of time in ketosis, without serious damage to their health or longevity.
Arctic explorer Vilhjalmur Stefansson, documented that the Inuit would often go 6 to 9 months in the year eating nothing but meat and fish.
And, he found that when he and his fellow explorers followed the same diet they were perfectly healthy.
When they were questioned on this by the medical authorities, Stefansson undertook a fascinating study, which demonstrated they could eat a 100% meat diet with no ill consequences.
After one year following a this diet, it was concluded;
The subjects were mentally alert, physically active, and showed no specific physical changes in any system of the body… the clinical observations and laboratory studies gave no evidence that any ill effects had occurred from the prolonged use of the exclusive meat diet.
While some have suggested that groups like the Inuit may have a genetic predisposition which allows them to eat this type of diet and remain healthy, this is not supported by the evidence.
In a comprehensive review of the anthropological and nutritional evidence collected on hunter-gatherer societies, it was found that;
Most (73%) of the worldwide hunter-gatherer societies derived >50% (≥56–65% of energy) of their subsistence from animal foods, whereas only 14% of these societies derived >50% (≥56–65% of energy) of their subsistence from gathered plant foods.
This suggests that the ability to thrive on ketogenic diets (high fat, adequate protein, low carb) is widespread, and not limited to any particular genetic predisposition.
So, is nutritional ketosis for everyone?
While I’ve already pointed out that we all go into a state of ketosis at times, and that this is completely normal, there are diets which actively promote remaining in this state on a consistent basis.
But, is that a wise aim?
There is certainly no doubt the body can tolerate ketosis, and that it undeniably leads to weight loss.
One review concluded rather reservedly;
In general, studies have shown greater weight loss at 3—6 months with KLC (ketogenic low carb) diets compared with LF (low fat) diets, however this difference is no longer apparent at 12 months. The majority of studies have found that KLC diets are associated with favourable changes in triglyceride and HDL levels, but higher LDL levels than LF diets.
However, another study concluded;
Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.
This study in children, concluded;
The ketogenic diet revealed more pronounced improvements in weight loss and metabolic parameters than the hypocaloric diet and may be a feasible and safe alternative for children’s weight loss.
Regardless of what the research states, getting into ketosis, and actually staying there, isn’t an easy task.
Many feel sluggish, cranky, and generally down when they start following a ketogenic diet, although this does stabilize after a short while.
For others, it is not a condition they enjoy being in for extended periods of time.
Dipping into occasional short-term ketosis is unlikely to be a serious health risk, and may actually provide some health benefits.
But for extended periods of time, I’d say it’s pretty advanced stuff, and not for the majority of users, at least not without good support from a health professional who actually knows what they are on about.
I also have a major battle with any diet that suggests the avoidance of fruits and vegetables.
Obviously this is a must, if you are trying to keep your carb intake to a minimum to get into ketosis, but I think some individuals would end up missing out on vital nutrients, unless they were extremely careful about their diet.
So, for those reasons, I suggest a less complex approach is more acceptable for the majority of people, which focuses on nourishing your body with high quality foods, and eating sensibly most of the time.
Have you tried a ketogenic diet? What are your thoughts on this?