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
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