Ketosis

Ketones can be a sign of ketoacidosis, which is very, very bad.

They can also be a sign of ketosis, which is very, very, good for weight loss, and not at all harmful.

Consultants that confuse ketosis and ketoacidosis are very, very, bad, and IMHO are not fit to practice medicine.

borofergie said:

Ketones can be a sign of ketoacidosis, which is very, very bad.

They can also be a sign of ketosis, which is very, very, good for weight loss, and not at all harmful.

Click to expand...

My Endo has always insisted both are harmful.

noblehead said:

My Endo has always insisted both are harmful.

Click to expand...

:shock:

noblehead said:

My Endo has always insisted both are harmful.

Click to expand...

Has your Endo much experience of ketosis in his patients?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/

However, during very low carbohydrate intake, the regulated and controlled production of ketone bodies causes a harmless physiological state known as dietary ketosis. In ketosis, the blood pH remains buffered within normal limits [5]. Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively [9]. Ketones also have a direct inhibitory effect on lipolysis in adipose tissue [10].

Interestingly, the effects of ketone body metabolism suggest that mild ketosis may offer therapeutic potential in a variety of different common and rare disease states [11]. The large categories of disease for which ketones may have therapeutic effects are: 1) diseases of substrate insufficiency or insulin resistance; 2) diseases resulting from free radical damage; and 3) disease resulting from hypoxia [11].

Click to expand...

I'll hold him Swim, you hit him.

borofergie said:

I'll hold him Swim, you hit him.

Click to expand...

..And then make him eat pork scratchings dipped in Cornish clotted cream.

Paul1976 said:

borofergie said:

I'll hold him Swim, you hit him.

Click to expand...

..And then make him eat pork scratchings dipped in Cornish clotted cream.

Click to expand...

:lol:

That sounds like an excellent last meal for me tonight, before I go "Whole 30" tomorrow.

Ketosis can be dangerous in cases where insulin is deficient.
This is always possible if you need to take insulin. Presumably if you take insulin, whether T1, T1.5 or T2 then you must be at least relatively deficient. In those cases seeing dark purple on a urine strip or levels above 0.6mmol/l in the blood is not a good thing.
Nigel's endo is not the only one concerned about the possible dangers. When I first went on a pump (so no long lasting insulin) I was told to test every morning for ketones and to react to small amounts with a small extra dose of insulin to prevent them rising. Any higher and the extra insulin doses rise commensurately.

If you produce enough insulin of your own , it would normally (though not in all cases)act as a brake and stop ketones rising to these levels which will cause the blood to become acidic. Not enough insulin and those 'starvation' ketones can quickly become larger.

Only recently a parent posted of a child with low glucose levels but who was vomiting. They couldn't give insulin without glucose as the levels would fall too low but the child couldn't retain oral glucose. The only solution was a trip to hospital by air ambulance and intravenous insulin and glucose.

I should think that in a hospital setting, a doctor has a lot of experience of high levels of ketosis, which in the worst case scenario ends up in a coma in ICU. Perhaps it's understandable that h/shes very wary.

phoenix said:

I should think that in a hospital setting, a doctor has a lot of experience of high levels of ketosis, which in the worst case scenario ends up in a coma in ICU. Perhaps it's understandable that h/shes very wary.

Click to expand...

It's not understandable. It shows a fundamental misunderstanding of human physiology. Confusing dietary ketosis with ketoacidosis is like saying "you shouldn't take a bath" because "some people get drowned in a tsunami".

Dietary ketosis produces plasma ketone levels of 0.5 - 5 mmol/l
Ketoacidosis kicks in between 15-25 mmol/l

It is very, very difficult to get to 5mmol/l on dietary ketosis. The highest I've ever heard of is 9mmol/l from a migrane sufferer who ate a diet of protein and coconut oil.

No-one goes into ketoacidosis because they are too deeply into ketosis, they go into ketoacidosis because they don't take enough insulin. As an insulin producing T2, it would be kind of difficult for Swim to get there, even if he didn't take his insulin.

Dietary ketosis produces plasma ketone levels of 0.5 - 5 mmol/l
Ketoacidosis kicks in between 15-25 mmol/

Click to expand...

Where did you read that? Levels of 15-25mml/l are very high.
Heres typical advice from Abbott
0.6–1.5mmol/l
Test your blood glucose after 1 hour. Continue regular insulin regimen.
Consider increasing insulin after 1 hour. If blood glucose and ketones are falling retest hourly until ketones are below 1.1mmol/l.
1.5–3mmol/l
Take additional short- or rapid-acting insulin. If you do not have this type of insulin
use your usual premix insulin. Take the amount shown below or take 1/5 of YOUR total daily dose. If this is above 10 units only take 10 units. Drink 1 cup of sugar free clear liquid every 15 minutes (500ml per hour)
Retest ketones and blood sugar in 1 hour
If blood ketones not falling contact professional advice.
Above 3mmol/l
SEEK SPECIALIST ADVICE IMMEDIATELY
and/or continued vomiting Take additional short- or rapid-acting insulin. If you do not have this type of insulin
and unable to tolerate fluids use your usual premix insulin. Take amount shown below or 1/5 of YOUR total daily dose. If this is above 10 units only take 10units.

A blood ketone result of 3.5 mmol/L yielded 100 percent specificity and sensitivity for the diagnosis of DKA.
http://www.ncbi.nlm.nih.gov/pubmed/17975686

Whilst it is true that most people will have blood glucose levels above 14mmol/l , there are cases at lower levels. You will find cases on this forum of people who have had DKA below that level and case studies on the net.
Most involve some other factor such as sickness or pregnancy(when essentially 2 brains require glucose) alcohol or starvation .
As I implied in the earlier post most diabetologists will be dealing with people who don't produce enough insulin to limit ketone production.

From Dr Stephen Phinney and Dr Jeff Volek:

This 10-fold range of serum ketones, from 0.5 to 5mmol/l is your body's normal physiolocial response to varying degrees of dietary carbohydrate and protein restriction. This response range is called 'nutriotional ketosis' and is associated with metabolic adaptions allowing your body to maintain a stable set of inter-organ fuel homeostasis. This process is dependent of an adequate, albeit minimal, ability of the pancreas to produce insulin in resonse to dietary proteins and serum ketones, thus maintaining serum B-OHB in the range where it replaces much of your body't (and you brain's) need for glucose without distroting the whole-body acid-base balance.

Click to expand...

Nutritional ketosis is by definition a begnign metabolic state that gives human metabolism the flexibility to deal with famine or major shifts in available dietary fuels. By contrast "diabetic ketoacidosis" is an unstable and dangerous condition that occurs when there in inadequate pancreatic insulin respnse to regulate serum B-OHB. This occurs only in T1 diabetics or in late stage T2 diabetes with advanced pancreatic burnout. In this setting of deficient insulin, when exigenous insulin is withheld, serum B-OHB levels reach the 15-25 mmol/l range, 5 to 10 times higher than the levels characteristic of nutrionional ketosis".

Click to expand...

I've got my own blood ketones as high as 5mmol/l through carbohydrate restriction and exercise.

http://women.webmd.com/guide/high-prote ... rate-diets

What Are the Risks Linked to High Protein, Low-Carb Diets?
High protein, low-carb diets can cause a number of health problems, including:

Kidney failure. Consuming too much protein puts a strain on the kidneys, which can make a person susceptible to kidney disease.
High cholesterol . It is well known that high-protein diets (consisting of red meat, whole dairy products, and other high fat foods) are linked to high cholesterol. Studies have linked high cholesterol levels to an increased risk of developing heart disease, stroke, and cancer.
Osteoporosis and kidney stones. High-protein diets have also been shown to cause people to excrete a large amount of calcium in their urine. Over a prolonged period of time, this can increase a person's risk of osteoporosis and kidney stones. A diet that increases protein at the expense of a very restrictive intake of plant carbohydrates may be bad for bones, but not necessarily a high-protein intake alone.
Cancer. One of the reasons high-protein diets increase the risks of certain health problems is because of the avoidance of carbohydrate-containing foods and the vitamins, minerals, fiber, and antioxidants they contain. It is therefore important to obtain your protein from a diet rich in whole grains, fruits, and vegetables. Not only are your needs for protein being met, but you are also helping to reduce your risk of developing cancer.
Unhealthy metabolic state (ketosis). Low-carb diets can cause your body to go into a dangerous metabolic state called ketosis since your body burns fat instead of glucose for energy. During ketosis, the body forms substances known as ketones, which can cause organs to fail and result in gout, kidney stones, or kidney failure. Ketones can also dull a person's appetite, cause nausea and bad breath. Ketosis can be prevented by eating at least 100 grams of carbohydrates a day.


I wonder if the above explanation of the risks associated with ketogenic diets is why diabetes consultants are concerned when their patients are in ketosis or following a ketogenic diet?

noblehead said:

http://women.webmd.com/guide/high-protein-low-carbohydrate-diets

What Are the Risks Linked to High Protein, Low-Carb Diets?
High protein, low-carb diets can cause a number of health problems, including:

I wonder if the above explanation of the risks associated with ketogenic diets is why diabetes consultants are concerned when their patients are in ketosis or following a ketogenic diet?

Click to expand...

With respect Nigel, we're talking about "ketogenic diets", which are by definition carbohydrate and protein restricted, so no-one who is eating a ketogenic diet is consuming large amounts of protein.

If you eat more than 18% of your calories from protein (or more than 1g per pound of lean body mass), then the excess gluconeogenesis will knock you out of ketosis.

Any diabetes consultant who thinks that ketosis causes kidney problems through too much protein, lacks even a basic understanding of what ketosis is. If my endocronolgist* told me that "ketones would damage my kidneys and liver" I'd run her out of the building.

(*I am a T2 diabetic, I have more chance of getting a private audience with the Pope than I have of getting an appointment with an endocronolgist).

noblehead said:

I wonder if the above explanation of the risks associated with ketogenic diets is why diabetes consultants are concerned when their patients are in ketosis or following a ketogenic diet?

Click to expand...

Oh Nigel! Come on; you're not serious about that post are you? We've spoken about this so many times and almost all of that post is wrong. They can't tell the difference between ketosis and ketoacidosis which is my yard stick for telling whether the person/article/doctor in question knows what they are talking about.

Then all that protein / kidney failure is nonsense; it's like saying if you breath too much your lungs will be damaged. Again, we've spoken about this so much already.

It's well known that high protein diets are linked to high cholesterol? Er, no it's not. For instance the main driver of raised triglycerides is our good friend the carbohydrate...

High vitamin content of carbohydrate? Carbohydrates have no vitamins; that's why all those breakfast cereals and all those breads have added vitamins because they are nutritional deserts.

Best

Dillinger

As I've always said Stephen, if anyone is in any doubt then they are better discussing their concerns with their own consultant for clarification, neither you nor I or anyone else on the forum are medically qualified to give a definitive answer.