Is ketosis dangerous?

“My GP told me that ketosis is dangerous”. It’s not uncommon to hear this from someone who asked his doctor information about a ketogenic diet, and the cause of this mistaken answer is a confusion between ketosis (technically called nutritional ketosis, or NK) and ketoacidosis (diabetic keto acidosis DKA).

And while it’s not only safe ofr human beings to be in a state of nutritional ketosis, it’s very true that diabetic ketoacidosis is a pathological state that can be very dangerous if not deadly.

Both names come from ketone bodies, a number of molecules produced by our body: acetone, acetoacetone, and beta-hydroxybutyrate (don’t worry, you don’t need to know their names to be healthy).

Ketones are constantly produced in our liver as a backup in case of lack of glucose in our bloodstream. Glucose is the preferred fuel of our cells, but it’s storage is limited to a day or less of energy and without ketones we would die of hypoglycemia just after a day without eating sugars. Of course we couldn’t have evolved all those millennia without a backup energy systems, enter ketones.

Ketones are produced by the liver from fat and amino acids, either ingested fat or the one in your adipose cells. They can then be used as a source of energy both by our brain and our muscles. Practically everyone enter in a state of ketosis at night, after fasting for a few hours.

Diabetic ketoacidosis is a completely different beast, though. Our bodies can enter into a pathological state of DKA only when there is no insulin available, not even traces, a condition that can happen to type-1 diabetes patients and also to type-2 diabetes patients in some specific conditions, like in case of an infection for example but also in case of insufficient insulin administered.

What happen is that the glucose in their bloodstrean cannot be transported into their cells, a function of insulin, and exactly like someone on a ketogenic diet, their liver start to produce ketones.

But not having enough insulin, what happen is that the adipose tissue continues to release fatty acids into the bloodstream, and the liver continues to produce ketones until the blood pH is extremely low (acidic), causing a serious metabolic stress.

But with a functioning pancreas, the amount of insulin produced is always enough to limit the process of producing ketones, and it doesn’t matter if you fast for a day or for a year (yes, it has been done!), you’ll never produce enough ketones to enter ketoacidosis.

Short answer: no, ketosis and ketoacidosis are two different things, enjoy your bacon!

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