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What is ketosis and should I worry about it on a low carb diet?

Published on August 24, 2012,

Anyone who is on or thinking about going onto a low carb diet will become familiar with the concept of ketosis – a biochemical process associated with the fat burning state. However, it is an area where there is much confusion and this can result in anxiety. In the blog ketopia there is an excellent new article with numerous references explaining the difference between ketosis and the dangerous condition of ketoacidosis which is often mistakenly confused with ketosis. It’s a technical article but should be very reassuring for anyone on a low carb diet…

Perhaps nothing is more damaging to the new low-carber than the intentional spread of fear, uncertainty and doubt regarding the state of ketosis compared to the dangerous state of ketoacidosis. The former is a natural and healthy state of existence, the latter is a condition that threatens the life of type 1 diabetics and type 2 diabetics whose disease has progressed to the point where their pancreatic beta cells can no longer produce insu

chemical structures of various ketone bodies -...

chemical structures of various ketone bodies – acetone, acetoacetic acid, and beta-hydroxybutyric acid (Photo credit: Wikipedia)

lin (ketoacidosis is also a risk for alcoholics). So if you’re not an alcoholic, a type 1 diabetic or a late-stage type 2 diabetic, fear of ketosis is misdirected.  You should regard with suspicion anyone who confuses the two and warns you against a low-carb diet because they cannot tell the difference.

The confusion between ketosis and ketoacidosis is a sign of a grave misunderstanding of basic biology (if not a complete lack of critical faculty).  So too is the assumption that ketosis is the “early stage” of ketoacidosis or that “ketosis leads to ketoacidosis” in a person whose pancreas is still able to produce insulin.

If you don’t trust me (and why should you), you should consider listening to some people who know a lot more about this than either you or I ever will:

Nutritional ketosis is by definition a benign metabolic state…  by contrast, ‘diabetic ketoacidosis’ is an unstable and dangerous condition that occurs when there is inadequate pancreatic insulin response to regulate serum B-OHB. This occurs only in type-1 diabetics or in late stage type-2 diabetics with advanced pancreatic burnout. (Dr. Phinney & Dr. Volek, The Art and Science of Low Carbohydrate Living, p.4)

Later in the book (p.80), Phinney and Volek explain further:

[Type-1 diabetics] need insulin injections not just to control blood glucose levels, but also to regulate the release of fats from fat cells.  When fat cells release fatty acids too rapidly, ketone production becomes imbalanced, and this leads to diabetic ketoacidosis. Thus, ketoacidosis is is characteristic of type-1 diabetes, or of late stage type-2 diabetes that has progressed to the point that the pancreas can no longer produce the minimal amount of insulin required to limit fatty acid release from the body’s fat cells. (Dr. Phinney & Dr. Volek, The Art and Science of Low Carbohydrate Living, p.80)

The last point warrants repeating, because it is an important one.  Insulin regulates not just blood glucose, but also the production of ketone bodies.  When a person has an illness that inhibits their ability to produce insulin, they are at risk of ketoacidosis.  This excludes the vast majority of people…even most type-2 diabetics. Remember, type-2 diabetes is characterized by insulin resistance, not an inability to produce insulin). Because type-2 diabetics tend to overproduce insulin (because their cells need higher and higher doses of insulin to achieve the same effect), they typically are not at risk of ketoacidosis, regardless of diet.  It is only when a type-2 diabetic experiences pancreatic beta cell death (and the resultant inability to produce insulin), that they are at risk of experiencing ketoacidosis.

What then are ketones and ketosis?….

More at: Ketosis: Fear, Uncertainty and Doubt

How Much Protein Do I Need on a low carb diet?

Published on August 9, 2012,

Blog Kickin’ Carb Clutter has a fascinating post questioning how much protein people on a low carb diet should be eating and conclude it might not be as much as you think.

The current rage beginning within the low-carb community is blood ketone meters that measure the amount of ketones in your blood, rather than your urine. The sticks are somewhat expensive, but for those who have purchased and used them, they have received a very eye-opening revelation about their low-carb diet plan.

What people are discovering is not new. Both Stargazey and I have been saying this ever since we investigated and tried a no-carb diet several years ago. Stargazey has a Ph.D. in Biochemistry and her blog is LowCarb4U if you’re interested. The series starts with a post on protein intake and blood glucose levels and runs for about half a dozen more posts, or so. Make sure you read all of the comments for each post as well.

Today, there are low-carb experts who say the same thing, so low carbers are beginning to sit up and take notice – especially since Ketone Blood Meters are making the problem more real. Regardless of what you want to believe, you most certainly can be eating more protein than your metabolism can handle adequately. According to Dr. Atkins, “A total of 58 percent of dietary protein is converted by the body into sugar.” When you’re young, this doesn’t seem to be as large a problem as it is for those over 50, but that depends on your degree of Insulin Resistance and how many healthy Beta Cells you have.

Is a Low-Carb Diet a High-Protein Diet?

Nutritional ketosis is a new term that describes the situation that occurs when you enter the state of ketosis due to carbohydrate restriction. Dr. Atkins used to call it dietary ketosis. It is defined as a blood ketone level of .5 to 3.0 mg/dl. You may, or may not, have ketones in your urine. Those ketones are irrelevant. What’s important is that your body makes the switch from predominantly burning glucose for fuel to burning fatty acids and ketones.

But…many low-carb dieters have never made the switch.

On a typical, low-calorie diet, protein intake is kept low. That results in as much as 50 percent of your weight loss actually coming from muscle tissue rather than body fat. So eating adequate amounts of protein is essential, but how much is that? Is a low-carb diet supposed to be a high-protein diet?

Protein supplies your body with the amino acids it needs to create hormones and repair or build muscle, organs and other body tissues. To do that, you need to eat about .6 grams of protein for every pound of lean body mass you have. That’s just for repair and basic body functions. It doesn’t take into account any extra for gluconeogenesis or the extra you need if you have an active lifestyle or lift weights.

For those with about 100 pounds of lean body mass, you need a minimum of 60 grams of protein per day. If you have 120 pounds of lean body mass, that comes to 72 grams. If you have a sedentary lifestyle by choice or due to health restrictions, you need a little less.

Either way, that doesn’t make a high-protein diet. That’s quite low when you consider that an ounce of meat or an egg contains about 6 to 7 grams of protein. Lean meats have higher protein counts than fatty meats. Depending on your meat, cheese and egg choices, that comes to about 10 to 12 eggs or ounces of meat and cheese per day. That’s far less than most people realize, especially when you take into account that you can easily consume 12 to 16 ounces in a single steak! And quite a few Atkins followers go out of their way to consume the 4 ounces of cheese they’re allowed per day…

The concluding comments are:

We think we are doing the right thing by turning to meats and other no-carb choices, but maybe we’re hurting ourselves more than we realize. Instead of grabbing those left-over baked chicken legs for a snack because they’re easy and convenient, maybe we should be reaching for the left-over salad instead.

Full article at: How Much Protein Do I Need?

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