Ketosis

[Grateful]

This is one of the most common terms used in this forum and other places where diet is discussed, yet I am still very confused.

"Ketosis is a metabolic state in which some of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis in which blood glucose provides energy. Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose. It is almost always generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body." (From Wikipedia: https://en.wikipedia.org/wiki/Ketosis.)

Apparently it is something that we all use for energy-production some of the time, for instance while fasting during a night's sleep. It is characterized by getting the energy from fat, which is why those with excess fat will see it "melt away."

But there is also the "ketogenic diet." As I understand it, this involves lowering carbs so much that the body enters into permanent "ketosis" because there is never enough ingested carb to get enough energy from glucose. Once you are in that state, you will stay there unless you increase carb intake. Once you are "out" of that ketonic state, it could then take a while, maybe a few days (?) to re-enter it.

If a "keto diet" is one of permanent ketosis, then I think it is likely that relatively few of us are doing this, even on a very-low-carb diet. I can see that we would be using ketosis a fair amount of the time, but that we would also be non-ketonic some or most of the time. If on the other hand a "keto" diet is characterized by "sometimes" being in ketosis, then it must apply to all of us at one time or another, even those who are not dieting (???).

Finally, there is the unfortunate similarity with the name of the dangerous condition called "Diabetic Keto-Acidosis." Most people on places like this forum understand the difference between "ketosis" and DKA but apparently that knowledge is not universal!

Finally: As many have pointed out, if a low-carb diet "works for you," then it doesn't really matter whether it is "keto" or not!

 

[bulkbiker]

If a "keto diet" is one of permanent ketosis, then I think it is likely that relatively few of us are doing this, even on a very-low-carb diet.

why do you think that? If you eat very few carbs then you are highly likely to be in a state of nutritional ketosis. If you are on an extended fast then you are likely to be in a state of nutritional ketosis.

 

[Grateful]

why do you think that? If you eat very few carbs then you are highly likely to be in a state of nutritional ketosis. If you are on an extended fast then you are likely to be in a state of nutritional ketosis.

Because we are eating some carbs (some of us more than others, even on a VLC diet) so surely there is some "glycolysis" taking place? Or is it possible for that process to happen simultaneously in time with ketosis?

 

[bulkbiker]

Because we are eating some carbs (some of us more than others, even on a VLC diet) so surely there is some "glycolysis" taking place? Or is it possible for that process to happen simultaneously in time with ketosis?

Maybe.. but I think it's more a case of if you don't eat many carbs.. and lets face it for me most of my daily intake comes from cream in coffee, then you don't go out of nutritional ketosis. I tend to go between 10 and 25g of carbs per day and although I test rarely when I do I'm in ketosis. I don't think it's as hard as you think and once your body gets used to running this way it seems fine with it.

 

[Kristin251]

I eat a vlc ketogenic diet, as you know but I do dip out of ketosis as alcohol will take you out. That being said I am always in a state of fat burning ( to the best of my knowledge) as I don’t eat carbs per se. I guess I don’t care what it’s called as like you said, if it’s working, great. I’m not giving up my happy hour for a ‘name’ Haha. I just like to keep my glycogen stores as empty as possible or my bg goes up, as well as my insulin needs

Had an incident with veggies again yesterday so my aversion to them is back. Now I’ll be even lower carb for awhile!

 

[Grateful]

Maybe.. but I think it's more a case of if you don't eat many carbs.. and lets face it for me most of my daily intake comes from cream in coffee, then you don't go out of nutritional ketosis. I tend to go between 10 and 25g of carbs per day and although I test rarely when I do I'm in ketosis. I don't think it's as hard as you think and once your body gets used to running this way it seems fine with it.

I think it's playing with words, to some extent, but words are rather important. If "ketosis" means that you are in a permanent state of "getting all your energy from fat" then I don't doubt that you, among others, are in that state.

Where it gets a bit sloppy is when diets are called "keto" and "ketosis" is mentioned, as if there were a kind of switch between a (fairly) low-carb and a keto diet. The more I read, including what you have just posted, the more I think for most people it may be more like a gradual spectrum rather than a brutal on-off switch.

It does sound, though, as if people at your end of the spectrum can sort of "lurch out" of permanent ketosis by eating too many carbs and that it can take a little while to get back in there. Do you think that is the case?

 

[Guzzler]

I think there is a need for more understanding about just how differently carbs are used as a fuel as opposed to fat/ketones. Humans have evolved to run on fat as fuel not to depend soley on carbs.

 

[bulkbiker]

It does sound, though, as if people at your end of the spectrum can sort of "lurch out" of permanent ketosis by eating too many carbs and that it can take a little while to get back in there. Do you think that is the case?

Yes probably.. which leads to a lot of keto eaters advising not to eat many carbs at all ... it takes a while to get into ketosis so if you do "cheat" days or weekends as some try then you are bouncing in and out of ketosis. Not great for weigh loss or blood sugar control. So for example if you ate ultra low carb monday to friday and had a "cheat" weekend then you wouldn't probably be back into ketosis until wednesday or thursday the following week so if you did another"cheat" weekend then you'll carry on a rather pointless cycle of being in ketosis for maybe 2 days out of 7.

 

[Grateful]

I think there is a need for more understanding about just how differently carbs are used as a fuel as opposed to fat/ketones. Humans have evolved to run on fat as fuel not to depend soley on carbs.

Precisely.

One of the things I see bandied around is that "the brain cannot function without carbs" and yet people in "ketosis" seem to live perfectly healthy lives. It is a large and energy-hungry organ. I don't doubt that it craves carbs at times, but way back in the mists of time carbs were less easy to come by and yet we survived as a species.

 

[bulkbiker]

I think it's playing with words, to some extent, but words are rather important. If "ketosis" means that you are in a permanent state of "getting all your energy from fat" then I don't doubt that you, among others, are in that state.

Agree that words are important that's why I say I follow an ultra low carb way of eating.
"Low Carb" if defined as fewer than 100g of carbs will probably not get you into ketosis although it may well lead to some weight loss and less volatile blood sugar numbers.

 

[Grateful]

So for example if you ate ultra low carb monday to friday and had a "cheat" weekend then you wouldn't probably be back into ketosis until wednesday or thursday the following week so if you did another"cheat" weekend then you'll carry on a rather pointless cycle of being in ketosis for maybe 2 days out of 7.

That's an excellent explanation, thanks. On balance I think the word "keto" is overused and I like your "ultra-low-carb" moniker. I get concerned when I find people who aren't diabetic, or even trying to diet, somehow think "keto food" has some kind of benefit in isolation. It's not by eating some keto foods that you will necessarily achieve any of the benefits of ketosis, because if your carb load is otherwise at the non-diabetic "normal" or "moderate" then you won't be in ketosis for any useful amount of time.

Mind you, my daughter (who is an excellent cook) has generously adopted "keto" cooking whenever I visit, so I suppose the existence of a "catch phrase" is probably rather helpful when describing one's lifestyle to non-diabetics. (I never mentioned the word "keto" to her but she figured it out.)

 

[Guzzler]

Precisely.

One of the things I see bandied around is that "the brain cannot function without carbs" and yet people in "ketosis" seem to live perfectly healthy lives. It is a large and energy-hungry organ. I don't doubt that it craves carbs at times, but way back in the mists of time carbs were less easy to come by and yet we survived as a species.

Indeed. Some anti low carbers spout that myth all the time. The human brain is quite happy to use glucose from other sources. One fact I've heard repeated is that the human body, under normal circumstances, has between one and two teaspoons of 'sugar' in total bloods. So little? Aye, because we really do not need any more than that. This myth that we need XX (I forget the number that the morons use) amount just to sustain the brain alone is total codswallop.

 

[Kristin251]

If I have a CHEAT meal, not even just with carbs but excess protein, my bg will run higher for up to three days, until I empty my glycogen stores. I think @bulkbiker saw this when he did a home GCT. Exceess protein can take you out/ keep you out of ketosis as well as carbs.
So to me, eating a ketogenic diet means 80% fat, 25% protein and 5% carbs. Or 20or less. My brain is fueled well and when it’s not it’s not diet dependent lol

 

[Grateful]

My brain is fueled well and when it’s not it’s not diet dependent lol

I hear you. Today is my zero-coffee experiment.

(To avoid derailing this "ketosis" thread, the zero-coffee stuff starts around here: http://www.diabetes.co.uk/forum/threads/blood-pressure-mountain-molehill.129450/page-2#post-1622895).

 

[ringi]

Open in one of my other tabs http://blog.virtahealth.com/paleo-vs-keto-whats-the-difference/ Virtahealth is using VLC diets to get people with Type2 of all meds other then metformin, this includes people who were on 400 units of insilin a day! However most of us can get good result just by "eating fewer carbs".

Some people can switch qickly into and out of ketogenic, these tend to be people who don't have issues with inslin resistance.... It can often take someone's body a few weeks to get used to running on ketones, and they may need to increase their salt intake. There is a "carb zone" a little above the level that someone switches into ketogenic where some people's bodies don't like being, they feel a lot better if they reduce their carbs a little or increase them a little.

Being in full ketosis long term, "turns of" the glycogen storgage process, and as this process depends on insulin, its easy to see way ketosis can give very good BG control even when "low carb" does not work for someone.

@Grateful The leading book on the subject is "The Art and Science of Low Carbohydrate Living", it is aimed at people who know a little about how the body works, you will have no problems understanding it.

At the present time I can get very good BG control from "low carb" without having to consider VLC, given we both like to eat lots of meat and my wife still quesions very high fat "low carb" fits my life better then VLC.

 

[Grateful]

One thing I have been a bit dim about is I didn't really understand that in ketosis, the body is manufacturing glucose even though it is not ingesting significant quantities of carbohydrates. That is quite a trick! I guess I had thought of ketones, and ketosis, as some weird alternative energy-from-fat system that did not involve glucose.

It also makes sense because otherwise, those of us who are in ketosis would have plummetting blood glucose levels and would die of a massive hypo!

I think I now have the answer to my wife's longstanding question, "On this very-low-carb diet, won't your sugar levels go too low?" (She specifically asked about my HbA1c, which is now significantly lower than hers, and she is not diabetic.) I did manage to reassure her that without drugs or insulin injections, it is very unlikely for BG to be too low (except for a non-diabetic hypo, perhaps exercise-induced), but I didn't really have the science to back up that statement.

I hope I am getting this right....

 

[Guzzler]

If you are eating plant material then you are ingesting/making glucose. That is why some die hard keto fans eat only an animal based diet.

 

[LittleGreyCat]

Precisely.

One of the things I see bandied around is that "the brain cannot function without carbs" and yet people in "ketosis" seem to live perfectly healthy lives. It is a large and energy-hungry organ. I don't doubt that it craves carbs at times, but way back in the mists of time carbs were less easy to come by and yet we survived as a species.

Overlapping with the keto testing thread.

Parts of the brain and your blood cells need glucose because they can't handle ketones.
You always have glucose in your blood, but this isn't the same as needing carbs. Your body can use gluconeogenesis to make glucose.

Again repeating(ish) myself (but you may miss the other discussion) as far as I can see once you get below 100 grams of carbohydrate a day then you must be burning a lot of ketones. Working on a rough 4 kcalories per gram of carbohydrate, and a need for 1,600 kcals a day, 100 grams of carbohydrate would supply 400 kcalories or 25% of your energy needs. 50 grams of carbohydrate would supply only 12.5% of your energy needs. At that level you are getting 87.5% of your energy needs from protein and fat. Fat burning metabolic pathways must be humming. Larger and more active people will be getting even less of their energy needs from carbohydrates.

 

[Kristin251]

https://drjockers.com/6-ways-ketogenic-diet-improves-brain-function/

https://www.psychologytoday.com/blog/evolutionary-psychiatry/201104/your-brain-ketones

 

[Brunneria]

@Grateful

Check out http://www.tuitnutrition.com/ for some excellent myth busting on ketosis. Also useful info on gluconeogenesis and a few other topics.

I always feel like tearing my hair out when ppl declare they are ‘kicked out of ketosis’ or ‘a diet must be below 20g carbs to be ketogenic’ or a whole host of other stuff. Basically, if your calorie intake from carbs (and some protein) is too low to fuel your body, then you are running on a sliding scale of ketones - whether they come from dietary fat or bodily fat. It will vary through the day, and depending on what you eat, but the on/off switch is a nonsensical concept. So many myths...

I hope you enjoy Tuit. I think she is great.