Food Freedom Friday Edition 244 - Ketosis vs. Ketoacidosis

Ketosis and ketoacidosis may sound the same, but in reality, they are two different things.

Confused between the two? Don’t be. The first thing you need to know is this:

Nutritional ketosis is a natural state in the body and can be beneficial for many people. Meanwhile, ketoacidosis is an abnormal, life-threatening condition. It often happens as a complication of type 1 diabetes.

What is Ketosis?

Ketosis results from following a carbohydrate restricted diet commonly known as the keto diet.

Ketosis occurs because when you reduce your carbohydrate intake, your glycogen stores get depleted as well. Once depleted, your body begins to access its own fat as an alternate source of fuel. This fat then stimulates the liver to generate ketones. At this point, ketones act as your fuel instead of glucose.

You need to reduce your carbs to 20-50 grams daily to induce ketosis. You will know that you hage entered this state by checking your ketone levels along with experiencing certain symptoms that indicate ketosis.

It is normal to have ketones ranging from 0.5 to 3.0 mM in healthy individuals. Some people enter nutritional ketosis within a few days of restricting carbohydrate intake whilst for others, it can take weeks. 

For those who don’t know, ketosis has been used traditionally in the 1920s as a treatment for epilepsy. Research shows that ketone bodies have anticonvulsant effects.

Today, many people use the keto diet for its benefits on weight loss, blood glucose management, and physical perforWhat is Ketoacidosis?

Ketoacidosis is different. As mentioned earlier, it is an abnormal condition that often happens as a complication in type 1 diabetes. That is why it is also called diabetic ketoacidosis (DKA). It’s rare in type 2 diabetes.

It occurs when the body produces too many ketones that build up in the blood.

A person, especially a type 1 diabetic, does not have sufficient insulin meaning cells cannot use glucose for energy. Since glucose is not available, the body taps into its fat stores. Ketones are produced.

During ketoacidosis, ketone concentrations go over 3 mM. This is particularly important for someone who is already diagnosed with diabetes and ketones should be regularly monitored. A reading of 1.6 to 2.9 mM implies an elevated risk for DKA and a health care provider immediately should be contacted immediately.

Ketosis vs. Ketoacidosis

It is important to clearly understand the difference between ketosis and ketoacidosis as this will provide important and realistic expectations.

Symptoms

Ketosis is a beneficial state for the body. Often, before you experience the full benefits of ketosis, your body may go through some adaptation and you may experience negative symptoms. These symptoms can last for a few days to a month. Keep in mind that this is your body adjusting to this new way of eating.

Some of the common symptoms to expect include:

·       Fatigue

·       Weakness

·       Headache

·       Intense sugar or carb cravings

·       Bad breath (“keto breath”)

·       Digestive issues

·       Insomnia

People with type 1 diabetes can develop DKA as a complication. Patients with ketoacidosis usually present with the following symptoms:

·       Nausea

·       Vomiting

·       Abdominal pain

·       Rapid and shallow breathing

·       Thirst and dehydration

·       Dry mouth

·       Confusion

·       Tiredness

In severe cases, a person will have low blood pressure. Without immediate treatment, DKA can lead to coma or death.

Risk Factors

What can trigger ketosis?

Ketosis can only take place as a result of reducing your carbohydrate intake, exercising to exhaustion or fasting. Each of these circumstances force your body to use up its stored glycogen. After that, it breaks down fat to produce ketones.

What can lead to ketoacidosis?

As mentioned earlier, type 1 diabetes is the most common cause of ketoacidosis. In 30 to 50 percent of cases, infection triggers DKA. These include urinary tract infection (UTI) and pneumonia. Another trigger is when a patient is incompliant with their insulin therapy.

Whilst diabetes diagnoses pose significantly higher risk for DKA, other risk factors include drug misuse or extremely low calorie or carb intake.

Ketone levels

What level of ketones indicates ketosis?

Normal ketosis levels should range between 0.5 to 3.0 mM. it is important to note ketones are very sensitive to the foods you eat on a very individual level. Eating something that contains a moderate amount of carbs can easily throw you out of ketosis and decrease your ketone levels.

If you have diabetes and follow a ketogenic diet with the guidance of a health professional, you will not be at risk for ketoacidosis as long as you maintain normal blood glucose levels. Ketoacidosis is diagnosed with abnormal ketone concentrations. The range is usually above 3 mM – higher than typical ketosis levels.

Ketone levels are best measured using a blood ketone meter. This measures the amount of beta-hydroxybutyrate in the blood. (Note: Beta-hydroxybutyrate is the major ketone body produced in ketosis.) Using ketone urine strips is also helpful, although it not as accurate. Breath meters are becoming more popular but are still not as accurate as measuring concentrations in the blood.

Prevention

The good news is, DKA is preventable. The onus is on the individual and you need to be attentive to your health regularly.

Here are some things you can do:

·       Monitor your ketone levels at home, especially when you have high blood glucose readings.

·       Check your blood glucose levels. If they are above-normal, let your health care provider know about it.

·       Know the warning signs of ketoacidosis. Contact your doctor immediately. Do the same when you feel ill.

·       Follow your prescribed insulin regimen.

·       Protect yourself from infection or intense physical stress.

If you are away from home, make sure that you wear a medical identification bracelet. This will ensure that you get prompt medical help from strangers in case something happens.

Treatment

Diabetic ketoacidosis may be life-threatening, but it is treatable. The first step is being able to properly identify it. Treatment usually includes the following.

·       Administering insulin

·       Replacing electrolytes

The patient will be closely monitored until their ketone concentrations return to normal.

Can Ketosis Lead to Ketoacidosis?

Common question that arise are whether ketosis can lead to ketoacidosis and if a low carbohydrate diet outs one at a greater risk for finding themselves experiencing ketoacidosis.

These are important questions….Although ketosis and ketoacidosis are not the same, abnormal ketosis levels can trigger DKA.

….and the answer is yes, ketosis that allows ketones to reach a high level in the blood can lead to ketoacidosis. The blood becomes overly acidic and organs begin to function inadequately.

With what you know now, you might be wondering if those at risk for diabetes or already have type 2 diabetes can safely enter nutritional ketosis.

The answer to that is also yes. In fact, following a low-carb, high-fat diet keeps diabetes under control. As long as you do it under the supervision of a health professional, and monitor your health and symptoms regularly.

To Summarize

Nutritional ketosis is beneficial while DKA is an abnormal condition. If you are a diabetic and follow a keto diet without properly monitoring your ketones and health, or following your doctor’s orders, your ketones could rise to abnormal levels. This triggers ketoacidosis, a life-threatening condition that needs to be treated immediately.

However, the ketogenic diet is safe and good for healthy people looking to lose body fat and optimize their physical health as well as those at risk for certain diseases. It may also help manage certain conditions. At the end of the day, it is best to discuss any nutrition or lifestyle changes with a qualified professional to determine what is best for your personal needs, concerns and goals.