Ketosis - in, out, (shake it all about)?

[LittleGreyCat]

I've been looking via Google and in the fora for information on ketosis.
As usual I'm looking for a simple explanation and not finding one.

As far as I can tell, you move into ketosis as soon as you run out of glucose to metabolise.
That is, glucose firstly from liver stores, carbohydrates, then more slowly processed proteins.
Most people may go into ketosis over night at some point.
Presumably this may be one thing that triggers a liver dump.
Anyway, if you are burning fat you are in ketosis to at least a degree which means that if you are consistently losing weight then you must be spending time in ketosis.
I assume with a diet or eating plan where the calories are less than those burned during a 24 hour period (leaving aside digesting your own muscles) you must burn glucose, then switch to burning ketones, then switch back again.
Urgh! If you are exercising at an aerobic level you are burning a mixture of glucose and fat. So are you in ketosis when burning fat or are you only in ketosis when all the glucose has run out?

To stay out of ketosis more or less all day, I read that you need to eat around 130g of carbs (although this must obviously vary with the amount of protein you eat).

On this site I read in various places that to be 'in ketosis' you need to eat less than 50g (preferably 30g) of carbohydrate.

Which brings me to the question of how you define 'being in ketosis'?

Are you in ketosis only when you are exclusively burning dietary and body fat for more than say 80% of a 24 hour period?
Or are you in ketosis as soon as the last bit of glucose leaves your system?
Or what??
Oh, and the last bit of glucose can't have left your system or your BG meter would read 0 and you would presumably be dead!

Oh, and is there anything in the standard blood test for your diabetic review which can indicate the level of ketones (if any) in your blood?
I can't see an entry for 'ketones' in my printed results.

Cheers

LGC

 

[robert72]

My Freestyle Optium Neo BG meter also reads ketones (different strips).

I'm on a low carb diet 30g/day so use it to keep a check on my glucose and ketone levels.

If you were tested for ketones at the doctors, it would only give you a snapshot of what they were at that point in time, like your blood glucose level (as opposed to an HbA1c)

 

[tomvonc]

Urrggghhhhh, why anyone would CHOOSE to have ketones in them? (I've had DKA twice)

Tom

 

[robert72]

Urrggghhhhh, why anyone would CHOOSE to have ketones in them? (I've had DKA twice)

Tom

It's not like DKA (had that at diagnosis) as blood ph is in the normal range

 

[tomvonc]

It's not like DKA (had that at diagnosis) as blood ph is in the normal range

Still, just the hearing the word 'Ketones' makes me shiver :-/

Tom

 

[robert72]

My ketones are usually less than half that and I wouldn't want to go too much higher - even with normal BGs.

 

[Brunneria]

Another wee factoid to add to your confusion - ketones can be measured by testing blood, urine, or smelling the breath. However, some people can be in ketosis but not show ketones in their urine - because their body chooses to excrete the ketones through the lungs, not the kidneys. That little info-gem came from the book Low carb dieting 101 by Jenny Rhul.

@tomvonc
I can honestly say that my experience of ketosis (via low carbing) is the healthiest I have felt during the whole of my adult life, and I'm now 47 yrs old.

For me, ketosis means

• No aches and pains in muscles and joints
• Clear, sharp thinking (no brain fog - ever!)
• Deep, restful sleep
• Constant energy levels
• No fatigue
• Improved, sustained concentration
• No food (esp carb) cravings

It is a TOTALLY different experience from diabetic ketoacidosis (which I have never experienced, thank goodness!)

 

[Mrs Vimes]

I constantly have ketones with low carbing. The nurse calls it starvation ketones even though I lost the weight and actually maintained it for the past 4 months. I don't have any symptoms of DKA and my blood sugars are running between 5-8, sometimes 9 (rarely).
Healthiest I've ever been. HbA1c has been 6.5% past 6months.
I never tested for ketones before but what given a meter when I went on the pump. Boy did I get a shock- thought I'd have a go. 1.7. But my blood sugar was 8. So panic over.


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[Yorksman]

As far as I can tell, you move into ketosis as soon as you run out of glucose to metabolise.
That is, glucose firstly from liver stores, carbohydrates, then more slowly processed proteins.
Most people may go into ketosis over night at some point.
Presumably this may be one thing that triggers a liver dump.

Not quite. When your blood glucose drops to something in the 3s, your liver uses its glycogen stores to top you up. It is when your liver glycogen stores are depleted that ketogenesis occurs.

There are several similar sounding functions, gluconeogenesis, glycogenolysis and so on and each has a number of intermediate stages. It all depends on what the glucose is needed for and what stores of various chemicals you have available. It's quite a complex set of pathways, don't ask

 

[LittleGreyCat]

Even when on very low carbs there must be something keeping your BG topped up - at or around the 4.0 level - and even when your brain is burning mostly ketones there must be some glucose interaction to prevent a severe hypo.

Just now wondering if this comes from protein (including body protein) or if some glucose is release during ketosis and fat burning.

Nice diagram

Next question is where the glucogenic amino acids come from.

 

[Spiker]

As far as I know

- ketosis is not on or off like a switch, it is turned up and down like a dial.
- some ketone metabolism is happening all the time. Heart muscle cells run preferentially (or is it only?) on ketones
- the "dial" is not glucose availability, but blood insulin level. (however obviously blood glucose influences blood insulin, at least in anyone with beta cell function)
- yes the body attempts homeostasis of a minimal level of blood glucose to support the brain, even the ketone-adapted brain
- in the absence of dietary or stored glucose, it does this by degrading protein in gluconeogenesis, and scavenging glycerol from lipolysis. This causes loss of body fat and structural protein [if dietary fat and protein are insufficient]. This is the only thing properly called "starvation" ketones.
-just to emphasis that, ketone metabolism and fat metabolism are normal and are going on all the time. What we are doing by trying to go "into ketosis" is to dial the process up higher than normal.
- a carb rich diet inhibits ketosis and lipolysis but it is metabolically abnormal to be in such a state all the time (cue "metabolic syndrome")

This is my understanding, I could be wrong. There are definitely people on here who know the biochemistry much better than me.

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[phoenix]

Even when on very low carbs there must be something keeping your BG topped up - at or around the 4.0 level - and even when your brain is burning mostly ketones there must be some glucose interaction to prevent a severe hypo.

Just now wondering if this comes from protein (including body protein) or if some glucose is release during ketosis and fat burning.

Nice diagram

Next question is where the glucogenic amino acids come from.

Have a look at figure 1 in this classic paper. http://www.med.upenn.edu/timm/documents/ReviewArticleTIMM2008-9Lazar-1.pdf It is about fuel metabolism in starvation but as the author says '
'Absent carbohydrate is similar to total starvation. However, protein intake plays very large role. One can consider 1 gram of protein to produce about a half gram of glucose'

 

[Mrs Vimes]

Tested for ketones before bed - 4.1. My cgm and finger stick tests showed my blood sugars never went over 7 throughout the night.
I'd ran out of cream and hadn't been adding it to coffee yesterday. I had to eat my sugar free jelly by itself. But we soldier on.


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[Brunneria]

I'd ran out of cream and hadn't been adding it to coffee yesterday. I had to eat my sugar free jelly by itself. But we soldier on.
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Yes, but steady on! It's a slippery slope.

 

[Spiker]

Tested for ketones before bed - 4.1. My cgm and finger stick tests showed my blood sugars never went over 7 throughout the night.

When you guys quote ketones are you using mmol/L? So 4.0 = medium?

 

[modesty007]

When doing LCHF and some other low carbing, we talk about nutritional ketosis to separate this from DKA, Peter Attia writes about this here http://eatingacademy.com/sports-and-nutrition/ketones-carbohydrates-can-co-exist and here http://eatingacademy.com/nutrition/is-ketosis-dangerous

 

[Mrs Vimes]

Hi Spiker, mmol/ L. Above 1.5mmol/L with blood sugars of 16.7 mmol/L or above at risk of DKA.
Bright red on my chart. But as sugars are normal no DKA.


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[mojo_101]

Hi Spiker, mmol/ L. Above 1.5mmol/L with blood sugars of 16.7 mmol/L or above at risk of DKA.
Bright red on my chart. But as sugars are normal no DKA.


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Hi Mrs Vimes, do you have the chart you mentioned, is it a downloadable sheet?
I am trying to learn how to maintain ketosis and want to do that safely. Any information welcome. Thanks.