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A lot of people are confused by the term “ketosis.” You may read that it is a “dangerous state” for the body, and it does sound abnormal to be “in ketosis.” But ketosis merely means that our bodies are using fat for energy.

Ketones (also called ketone bodies) are molecules generated during fat metabolism, whether from the fat in the almonds you just ate or fat you were carrying around your middle. When our bodies are breaking down fat for energy, most of it gets converted to energy, but ketones are also produced as part of the process.

When people eat less carbohydrates, their bodies turn to fat for energy, so it makes sense that more ketones are generated. Some of those ketones (acetoacetate and ß-hydroxybutyrate) are used for energy; the heart muscle and kidneys, for example, prefer ketones to glucose. Most cells, including the brain cells, are able to use ketones for at least part of their energy.

Is ketosis a bad thing?

There is an assumption that if a body is burning a lot of fat for energy, it must not be getting “enough” glucose. However, there is no indication, from studying people on reduced carbohydrate diets, that this is the case (though there is usually a short period of adjustment, less than a week, in most cases). It takes about 72 hours to burn up all of the reserve glycogen (sugar loads).

Although it’s true that our bodies can’t break fat down directly into glucose (though, interestingly, they easily use glucose to make fat), our bodies can convert some of the protein we eat into glucose. Indeed, this works well for people who don’t tolerate a lot of sugar, because this conversion happens slowly so it doesn’t spike blood glucose.

What is the danger of ketosis?

It is important that if you are following a ketogenic nutritional protocol that you have your urine monitored by a health care practitioner that understands chemistry. Left unchecked the body can switch into a muscle burning state and use muscle for energy if ketone levels become too strong.

A dangerous condition called ketoacidosis can develop in those with type 1 diabetes, and it is sometimes confused with normal ketosis. The body usually avoids this state by producing insulin, but people with type 1 diabetes are unable to produce insulin. Even most people with type 2 diabetes who inject insulin usually produce enough insulin of their own to prevent ketoacidosis. This fact renders using ketosis as a fat burning tool relatively safe.

Ketosis and Diabetes

Ketoacidosis is a condition whereby the levels of ketones in the body are at an abnormally high level, poisoning the body. It is a dangerous and serious condition that can develop very quickly, sometimes within the space of 24 hours. Most commonly occurs in a type 1 diabetic patient. Type 1 diabetics lack the hormone insulin.

There are several different potential triggers for ketoacidosis. It is most commonly caused by illnesses that lead to the production of higher levels of hormones that work against insulin, or with problems with insulin therapy, either through missing scheduled treatments or not being given enough insulin.

Less common triggers of ketoacidosis include:

  • Drug abuse
  • Emotional trauma
  • Physical trauma
  • Stress and stressful events (i.e. surgeries, deaths, accidents)

Ketoacidosis can also occur in people with type 2 diabetes, although it is much less common. Individuals who do not care for themselves with a healthy lifestyle may fall into this category.

A Deeper Look at the Process of Ketosis

In normal circumstances, the body gets its energy from glucose. Typically, glucose comes from carbohydrates (sugar and starchy foods such as bread and pasta) which the body is able to break down. Glucose can either be used to fuel the body or stored in the liver and muscles as a chemical called glycogen.

If there is not enough glucose present, the body will resort to an alternative strategy in order to fuel itself. Excess fat will begin to be broken down in order to provide a source of glucose. The by-product of this process are ketones. Ketosis is the name of this metabolic process whereby the body converts fat into products that can be used to burn for energy, in turn making ketones.

Ketones are acids that build-up in the blood and can appear in urine. In small amounts, they serve to indicate that the body is breaking down fat, but high levels of ketones can poison the body, leading to a process called ketoacidosis. We have previously visited the process of ketoacidosis.

Due to the fact that ketosis breaks down fat stored within the body, some diets instigate the process with an aim to losing weight.

Ketosis diets are also referred to as ketogenic diets, ketotic diets, or sometimes low-carbohydrate diets. The diet itself can be regarded as a high-fat diet, with around 60-75% of calories being acquired from fats. In contrast, around 20%-30% and 5% of calories are gained from proteins and carbohydrates respectively. The protein and fat load varies from individual to individual with what it takes to begin to produce notable ketones and the state of ketosis.

Adhering to the ketogenic diet can lead to short-term weight loss. A study conducted in 2008 and published in the American Journal of Clinical Nutrition found that obese men following a ketogenic diet for 4 weeks lost an average of 12 lbs during this time. The participants were able to consume fewer calories without feeling hungry while following the diet. To elicit a state of burning fat as fuel is a very energy dense plan. Burning one gram of fat is 9 calories and burning one gram of sugar or protein is 4 calories/gram.

According to the Mayo Clinic, the ketogenic diet could have a healthful effect on serious health conditions such as cardiovascular disease, diabetes and metabolic syndrome. It may also improve levels of HDL cholesterol better than other moderate-carbohydrate diets. These health benefits could be due to the loss of excess weight and eating of healthier foods, rather than a reduction in carbohydrates. Among otherwise healthy people, ketosis can be prevented by following a healthy, balanced diet and exercising regularly. In addition, there are a number of measures that people with diabetes can take to help prevent ketoacidosis

  • Monitor blood sugar levels carefully and frequently – at least three to four times a day
  • Discuss insulin dosage with a specialist and follow a diabetes treatment plan
  • Keep an eye on ketone levels with a test kit, particularly when ill or under stress.

The Risks of High-Protein, Low-Carb Diets

High-protein, low-carbohydrate diets (Atkins Diet), have been widely promoted as effective weight loss plans. These programs generally recommend that dieters get 30% to 50% of their total calories from protein. If you are considering a ketotic plan, discuss it with a health care practitioner to avoid any unnecessary health complications.

Some experts have raised concern about high-protein, low-carb diets:

  • High Cholesterol – Some protein sources (like fatty cuts of meat, whole dairy products, and other high-fat foods) can raise cholesterol, increasing your chance of heart disease. Caution should be used when drastically increasing your intake of fats.
  • Kidney Problems – If you have any kidney problems, eating too much protein puts added strain on your kidneys. This could worsen kidney function.
  • Osteoporosis and Kidney Stones – When you’re on a high-protein diet, you may urinate more calcium than normal. There are conflicting reports, but some experts think this could make osteoporosis and kidney stones more likely.
  • Unhealthy Metabolic State (Ketosis) – During ketosis, the body forms substances known as ketones, which can dull appetite and cause nausea and bad breath. Ketosis can be prevented by eating at least 100 grams of carbohydrates a day.

All of the above reasons are counts for reasons to partner with your health care practitioner when you are thinking about such a diet.

Is a low-carb diet right for you?

If you’re considering a high-protein diet, check with your doctor or a nutritionist to see if it’s okay for you. They can help you come up with a plan that will make sure you’re getting enough fruits and vegetables, and that you’re getting lean protein foods. Remember, weight loss that lasts is usually based on changes you can live with for a long time, not a temporary diet.

Not all metabolic engines run effectively on the low carbohydrate plan. Most metabolisms, however, do. We are completely over fed in our American diet. Being in optimal ketosis for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet.

If this doesn’t result in noticeable weight loss, you can be certain that too many carbs are NOT part of your weight issue and not the obstacle to your weight loss. There are, in fact, other causes of obesity and being overweight. The next three tips in this series might help you.

Is ketosis similar to starvation?

The primary goal of our metabolic system is to provide fuels in the amounts needed at the times needed to keep us alive and functioning. As long as we’ve got plenty of food, the metabolic systems busies itself with allocating it to the right places and storing what’s left over.

In a society such as ours, there is usually too much food so the metabolic system has to deal with it in amounts and configurations that it wasn’t really designed to handle, leading to all kinds of problems. The largest problem, no pun intended, is obesity.

Everything that happens during starvation happens during carbohydrate restriction as well. There have been a few papers published recently showing the same thing: the metabolism of carb restriction = the metabolism of starvation. I would maintain, however, based on my study of the Paleolithic diet, that starvation and carb restriction are simply the polar ends of a continuum, and that carb restriction was the norm for most of our existence as upright walking beings on this planet, making the metabolism of what biochemistry textbook authors call starvation the ‘normal’ metabolism.

Bearing in mind that carb restriction and starvation are opposite ends of the same stick and that what applies to one applies to the other. In starvation mode, all the mechanisms work the same for a carb-restricted diet. During starvation, the primary goal of the metabolic system is to provide enough glucose to the brain and other tissues (the red blood cells, certain kidney cells, and others) that absolutely require glucose to function.

You’re a Paleolithic man or woman, you’re starving, you’ve got to find food, you need a brain, red blood cells, etc. to do it. You’ve got to be alert, quick on your feet, and not focused on how hungry you are.

If you’re not eating or if you’re on a low-carbohydrate diet, where does this glucose come from?

If you’re starving, glucose comes mainly from one place, and that is from the body’s protein reservoir: muscle. A little can come from stored fat, but not from the fatty acids themselves. Although glucose can be converted to fat, the reaction can’t go the other way.

A starving person can get a little glucose from the fat that is released from the fat cells, but not nearly enough. The lion’s share has to come from muscle that breaks down into amino acids, several of which can be converted by the liver into glucose. (There are a few other minor sources of glucose conversion: the Cori cycle, for example.)

But the breakdown of muscle creates another problem, namely, that (in Paleolithic times and before) survival was dependent upon our being able to hunt down other animals and/or forage for plant foods. It makes it tough to do this if a lot of muscle is being converted into glucose and your muscle mass is dwindling. The metabolic system is then presented with two problems: 1) getting glucose for the glucose-dependent tissues; and 2) maintaining as much muscle mass as possible to allow hunting and foraging to continue.

Early on, the metabolic system doesn’t know that the starvation is going to go on for a day or for a week or two weeks. At first, it plunders the muscle to get its sugar. Normal blood sugar represents only about a teaspoon of sugar dissolved in the entire blood volume. Keeping the blood sugar normal for a day doesn’t require a whole lot of muscular sacrifice.

If we figure that an average person requires about 150-200 grams (the metabolic sweet spot) of sugar per day to meet all the needs of the glucose-dependent tissues, we’re looking at maybe a third of a pound of muscle per day, which isn’t all that big a deal over the first day. But we wouldn’t want it to continue at that rate. If we could reduce that amount and allow our muscle mass to last as long as possible, it would be a big help. The metabolic system could solve its problem by a coming up with a way to reduce the glucose-dependent tissues’ need for glucose so that the protein could be spared as long as possible.

Ketones act as a stand in for glucose.

The liver requires energy to convert the protein to glucose. The energy comes from fat. As the liver breaks down the fat to release its energy to power gluconeogenesis, the conversion of protein to sugar, it produces ketones as a byproduct. And what a byproduct they are. Ketones are basically water soluble (meaning they dissolve in blood) fats that are a source of energy for many tissues including the muscles, brain and heart. In fact, ketones act as a stand in for sugar in the brain.

Although ketones can’t totally replace all the sugar required by the brain, they can replace a pretty good chunk of it. By reducing the body’s need for sugar, less protein is required, allowing the muscle mass (the protein reservoir) to last a lot longer before it is depleted. And ketones are the preferred fuel for the heart. Fat is the perfect fuel. Part of it provides energy to the liver so that the liver can convert protein to glucose. The unusable part of the fat then converts to ketones, which reduce the need for glucose and spare the muscle in the process.

Instead of starving, following a low-carb diet gets even better. The protein you eat is converted to glucose instead of the protein in your muscles. If you keep the carbs low enough, the liver still has to make some sugar, then you will be in fat-burning mode while maintaining your muscle mass. How low is low enough? When the ketosis process is humming along nicely and the brain and other tissues have converted to ketones for fuel, the requirement for glucose drops to about 120-130 gm per day. If you keep your carbs below that at 30-60 grams per day, you’re liver will have to produce at least 60-70 grams of glucose to make up the deficit. You will generate ketones that entire time.

Looking at the totality of chemistry you can see you being on a low-carb diet you can feast and starve all at the same time. Maximizing biochemistry makes it a perfect tool for weight loss.