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Ketosis vs Ketoacidosis – What is the Difference and Why it’s Important


  • Ketosis vs Ketoacidosis – What is the Difference and Why it’s Important

    Both ketosis and ketoacidosis involve the synthesis of ketone bodies or ketones inside the body. Although ketosis is considered usually safe, ketoacidosis may be a life-threatening situation.

    Nutritional ketosis is a naturally occurring state in which your body starts breaking down fat in place of carbohydrates (glucose) to obtain energy. Achieving ketosis is the main aim of the keto diet that is a very low-carb, high-fat diet, which can assist people in losing weight.

    Meanwhile, ketoacidosis occurs to be an abnormal condition in which dangerously increased levels of ketone bodies are produced within the body. It is usually a complication of type 1 diabetes.

    Below we will thoroughly discuss these two metabolic states, including their symptoms and the main differences between them.

    What is Ketosis?

    Ketosis is basically a metabolic state that occurs by following a high-fat, low-carb diet, commonly called the ketogenic diet. The body’s preferred energy source is carbs (glucose), so the body burns glucose first when it is available.

    But during ketosis, your body shifts its energy source to breaking down fat as opposed to carbs. The body uses it as a survival adjustment for handling times of fasting or famine, extreme workout, or anything, which starves the bodily system of sugar or carbs.

    Keto dieters mimic this adjustment process by intentionally restricting their carbohydrate intake, thereby depleting their glucose (glycogen) stores. Once depleted, the body turns to its excess fat stores to generate ketone bodies. At this stage, ketones behave as your energy or fuel rather than glucose.

    In order to attain ketosis, you have to limit your daily intake of carbohydrates to 20 to 50 grams. During ketosis, ketones are produced from fatty acids by the body’s liver. These ketone bodies are then utilized by your body to provide energy to all of the vital organs, which include the brain as well.

    Whether you have entered the ketosis can be checked by testing your level of ketones. Moreover, you will encounter some symptoms, which indicate ketosis.

    In healthy people, the normal ketone range is from 0.5-3.0 mmol/L. Some individuals attain ketosis within some days of limiting carbohydrates, and for some, it may take weeks.

    Many people don’t know that ketosis was originally devised for treating epilepsy during the 1920s. Numerous studies reveal that it has a plethora of health advantages that we shall discuss subsequently.

    Ketosis vs. Ketoacidosis – What is the difference?

    You have just learned above that nutritional ketosis happens to be a natural and safe process that is sparked by a low-carb eating pattern such as the ketogenic diet. On the contrary, ketoacidosis may sound similar but is an entirely different condition.

    What is Ketoacidosis?

    As previously mentioned, ketoacidosis is a life-threatening condition that is often a complication of type 1 diabetes, a condition in which individuals are unable to synthesize insulin. For this reason, it is referred to as DKA or diabetic ketoacidosis. It may rarely occur among individuals having type 2 diabetes with no or little insulin production.

    What is the cause of ketoacidosis? It occurs when excess ketones are produced within the body that accumulates inside the blood.

    The individual doesn’t have sufficient insulin, so the cells are unable to use glucose to derive energy. And with the non-availability of glucose, the body turns to its fat deposits for producing ketones.

    The combination of high blood sugar and ketones level makes the body excessively acidic that can alter the normal working of body organs such as your kidney and liver.

    The body’s ketone concentration can be three to five times higher than what is required for entering ketosis. It is a critical situation that requires prompt treatment.

    Diabetic ketoacidosis can occur really fast. It can even develop within less than twenty-four hours.

    A lot of things can result in ketoacidosis, including improper diet, illness, or not properly taking a sufficient insulin dose.

    Ketone levels can go above 3mmol/L during ketoacidosis. However, someone who already has diabetes should keep a regular check on their ketones. A level of 1.6-2.9 mmol/L implies that they’re at the risk of developing DKA. They must discuss it with their doctor immediately.

    Ketoacidosis statistics

    Diabetic ketoacidosis is the major cause of mortality among diabetic people below the age of 24. The overall mortality rate due to ketoacidosis is two to five percent.

    Individuals under 30 years old comprise 36% of ketoacidosis cases. 27% of individuals having DKA lie between the age group of 30-50, 23% between the age group of 51-70, plus 14% are above 70 years old.

    Symptoms of Ketoacidosis

    Ketoacidosis is linked with several adverse effects, and as discussed earlier, its symptoms may develop in just twenty-four hours. Here are some symptoms it may involve:
    • Frequent urination
    • Raised levels of blood glucose (raised levels of blood sugar)
    • Dry mouth or excessive thirst
    • Dehydration
    • Flushed or dry skin
    • Hyperglycemia
    • Abdominal pain or nausea
    • Vomiting
    • Gasping or difficulty breathing
    • Bad breath or fruity odor
    • Feeling confused
    • Feeling too tired

    In extreme cases, an individual will experience decreased blood pressure. And without prompt treatment, diabetic ketoacidosis can result in coma or even death.

    Symptoms associated with ketoacidosis can be the initial sign that you’re suffering from diabetes. In a scientific study concerning the hospital entries for diabetic ketoacidosis, 27% of individuals who were admitted with this condition were newly diagnosed for diabetes.

    Symptoms of Ketosis

    Ketosis is a beneficial state for your body. However, before you encounter its full advantages, your body usually experiences some negative symptoms.

    The initial phase of this metabolic state is known as the keto-adaptation or fat-adaptation stage. During this phase, you are producing ketones, however, your body is not completely adapted to synthesizing them or utilizing them as energy.

    Your body becomes fat-adapted when it starts producing ketones more regularly. Now the body has fully switched to breaking down fats as its main energy source, to an extent it has metabolic flexibility, which is you may eat carbohydrates and get out of ketosis, but the body will turn back into ketosis once it has processed the carbohydrates. This can take one month or even more.

    Many individuals encounter flu-like symptoms in this adaptation stage, which include:
    • Brain fog
    • Confusion or dizziness
    • Keto breath or bad breath
    • Irritability
    • Nausea
    • Constipation or diarrhea
    • Muscle soreness or cramps
    • Lack of focus or concentration
    • Trouble staying or falling asleep
    • Heart palpitations
    • Sugar cravings

    All these symptoms happen to be temporary in nature and get subsided in one or two weeks. Remember that these symptoms are an indication of your body getting adapted to the new pattern of eating.

    Risk Factors of Ketoacidosis

    Poor management of diabetes is a major cause of DKA in both types of diabetes (type 1 and type 2). Not receiving enough insulin or using incorrect insulin doses can result in ketoacidosis in those with diabetes.

    If you are already a patient of diabetes or vulnerable to develop it, you should always ensure to follow the insulin therapy and blood sugar control guidelines your doctor has provided you.

    Some other likely triggers for diabetic ketoacidosis include:
    • Starvation together with alcoholism
    • A hyperactive thyroid
    • Misusing alcohol
    • Infections or illness like pneumonia and urinary tract infections
    • Acute major disorders like pancreatitis, myocardial infarction, or sepsis
    • Medications, which may inhibit the proper utilization of insulin
    • Heart attack
    • Stress
    • Drug abuse, especially cocaine
    • Severe dehydration

    How do you feel when you are in ketosis?

    Several people describe having different feelings when they are in ketosis. Some visible side effects observed in ketosis include:
    • Reduced cravings
    • More consistent energy
    • Mental clarity
    • Weight loss
    • More endurance

    You may also test your level of ketones to confirm you are in ketosis and have a healthy ketone level in your body.

    How to measure ketone levels?

    The ideal way of determining whether you are in ketosis plus if you have a healthy level of ketones inside the body is through testing your level of ketones.

    When you are in ketosis, the ketones synthesized by the body that are not used will overflow in different parts of your body that is within your blood, urine, and breath.

    The concentration of blood ketones ranges from 0-very high, plus their regular measurement may provide you a clear knowledge of where you’re in ketosis. It is measured in mmol/L or millimoles per liter.

    The level between 0.6-3.0 mmol/L is generally considered an optimal range of ketones for an individual following a ketogenic diet. As discussed above, during DKA, the level of ketones is 3 to 5 times greater to the healthy range of nutritional ketosis, which is often above 3.0 mmol/L.

    The level of ketones in your body can be tested in three ways, which include:

    Blood Testing

    In this type of ketone test, a blood glucose meter can be used to test the level of BHB ketone. As there exist very few factors, which can alter results from this method, it is a very accurate way of measuring the body’s ketone levels.

    Urine Testing

    This method involves the use of urine strips. Package instructions may vary a little, but usually, after approximately 45 to 60 seconds, the color can be seen, which indicates the level of ketones present in urine.

    This method has the lowest cost among all the testing options but is the most unreliable as well. The body adapts to using ketone bodies when you have been in this metabolic state for some time, so the urine strips may indicate lower ketosis levels than you are actually having.

    Moreover, other variables such as levels of hydration, and electrolyte can alter the readings. Therefore it is better to opt for this way of measuring ketones if you are completely new to this metabolic state.

    Breath Testing

    It is used best as an addition to a urine or blood test for confirming the level of ketones. A Ketonix meter tests the concentration of ketones in the breath. The benefit of this type of testing is you can buy the meter once and use it as often you want – no strips needed.

    Treatment of Ketoacidosis

    DKA can be a life-threatening condition; however, it is highly curable. The initial step is properly identifying it. Its treatment frequently involves the administration of insulin together with electrolyte and fluid replacement.

    Most individuals with DKA will be required to stay in a hospital for close monitoring until their level of ketones goes back to normal. The doctor can suggest further testing to find out if the individual has other ketoacidosis related risk factors.

    Prevention of Ketoacidosis

    Diabetic ketoacidosis can be preventable, and this is good news. The heart of the matter is that you have to keep a close watch on your health.

    Some of the things that you may do include:
    • Monitor your level of ketones at home, particularly when you tend to have high readings of blood glucose.
    • Check your levels of blood glucose and notify your doctor in case of not being under control.
    • Know the early warning signals of ketoacidosis and contact the doctor immediately.
    • Follow your specified insulin regimen by the doctor.
    • Protect yourself against infection and avoid exercise when ketone bodies exist in your urine, and your levels of blood glucose are high.
    • Avoid skipping meals and eat a balanced and healthy diet.

    If you’re away from your home, you should ensure wearing a medical recognition bracelet, which will assure that you receive prompt medical assistance if something happens.

    Since ketosis is a relatively safe state compared to ketoacidosis and is known for having several health benefits, let us discuss some of them.

    Health Benefits of Ketosis

    It has been seen that one of the well-researched dietary patterns within the nutrition sciences is ketosis. Its impacts on brain health and physical performance are particularly impressive. And several people around the world use the ketogenic diet for getting rid of excess fat while sustaining muscle mass.

    Below we will discuss only a few of the known benefits that are offered by ketosis on the keto diet:
    • Weight Loss

    Possibly the most extensively discussed benefit of ketosis at the moment occurs to be weight loss. Since you are using fat for deriving energy, ketosis may help you breakdown fat stores much quickly.

    You can also lose more weight while in this state due to its impacts on insulin, blood sugar, energy, cravings, and appetite.
    • Fewer Cravings

    While you are in ketosis, another way through which it helps in weight loss is fewer cravings.

    Scientific evidence analyzing the effects of low-carb diets and low-fat diets on cravings has found that low-carb meal plans considerably decrease food cravings, whereas low-fat meal plans enhance them.

    With ketosis, you may stop depending upon your self-control and rather depend upon naturally decreased cravings and balanced hormones.

    Moreover, ketosis is also found to cause suppression of your appetite, which makes you full with small portions.
    • Improves Brain Health

    Ketone bodies can pass the blood-brain barrier plus provide clean energy to the brain without the fall that happens with high carb meals.

    While glucose is considered the preferred energy source of the human body, a major portion of the brain can use ketones as energy fuel for cognitive function on a ketogenic diet as well. Also, the body can deliver internally produced glucose to your brain during ketosis (through gluconeogenesis).

    Ketosis has been used in helping control seizures among the pediatric population with epilepsy as well. Plus, it is beneficial for individuals having degenerative brain disorders like Alzheimer’s disease and Parkinson’s disease.
    • Maintains the Balance of Blood Sugar

    Ketosis helps in stabilizing blood sugar, along with preventing insulin resistance. Research has found that limiting your daily intake of carbs can improve triglyceride levels, insulin sensitivity, and obesity.

    In one scientific investigation, the level of insulin in the keto group reduced threefold more compared to the low-fat group.

    Maintaining stable levels of insulin and blood sugar will not just prevent type 2 diabetes and metabolic syndrome, it may lead to fewer cravings as well.
    • Greater Athletic Performance

    When you are performing the exercise for long periods, the body utilizes both what you have recently consumed and also the stored glycogen for powering you through.

    However, when these glycogen stores get depleted and you need further energy, the body has to turn to fat or protein for more fuel. This isn’t a very efficacious process unless your body has become adjusted to staying in the ketosis state.

    When you are in ketosis, the body instantly converts stored fat or dietary fat into useful ketones or fatty acids for instant fuel.
    • Disease Prevention and Longevity

    Ketosis is found to lower inflammation that is an underlying problem of several chronic diseases, which include many autoimmune disorders.

    Levels of insulin and blood glucose are directly associated with brain health. Therefore, it isn’t surprising that many investigators are considering ketosis as an option for treating degenerative brain disorders like dementia and Alzheimer’s disease.

    Ketosis can be useful in balancing blood sugar, along with making the body cells more responsive to insulin. For this reason, many investigators are considering this metabolic state as an alternate treatment for patients with type 2 diabetes.

    Cancer cells use glucose from carbohydrates to thrive. So, there exist few theories that attaining the ketosis state can help in starving cancer cells plus can be an acceptable complementary treatment for people with cancer.

    Although most research on cancer and keto is performed in animals, one study conducted in 2007 revealed that the low-carb meal plan was useful in the management of brain cancer.

    Outlook of Individuals with Ketosis

    The ketosis is absolutely safe. As discussed above, low-carb diets, in fact, help individuals to get rid of unwanted fat, perform much better at gym and work, and avoid chronic disorders and metabolic disease.

    Many people may wonder what will be the long-term impacts of ketosis.
    • Does a high-fat diet kill you?
    • Does ketosis starve your body of essential nutrients?

    Fortunately, none of these are true.

    Ketosis doesn’t lead to Heart Disease

    We have been told for long that fat, particularly saturated fat along with dietary cholesterol, results in hardening of arteries which leads to heart disease. But as per the latest research, it is not true.

    4 meta-analyses performed in the past decade (observing over 500,000 subjects) have revealed that there is no association between heart disease and saturated fat.

    Ketosis doesn’t cause starvation of Micronutrients

    If keto is followed incorrectly, it may end up causing a deficiency of certain minerals and vitamins. But when keto is performed correctly by eating real whole food items, then it should not cause an issue.

    The logic is: healthy fats, meat, and vegetables belong to the food group, which is highly nutrient-dense. Grains and sugar-rich fruits are insignificant in comparison.

    For how long Ketosis is considered Safe for the Body?

    High-fat, low carb way of eating is far from being harmful in the near term. But what about over the long run like in years or even decades?

    There is not much scientific evidence up till now that shows the impacts of the keto diet over a long period of time. However, there is no evidence that recommends long-term ketosis is not healthy for your body, either.

    Staying in the state of ketosis for over a year demonstrates improvements in:

    If the body did not like ketones, it is highly unlikely you would observe so many benefits of ketosis.


    While ketoacidosis and ketosis both cause a rise in the level of ketones inside the body, they are completely different metabolic states.

    Nutritional ketosis is usually safe and is the focus of the keto meal plan, whereas ketoacidosis occurs to be a potential complication of diabetes (usually type 1 diabetes) and can be a life-threatening situation.

    Diabetic people should avoid low-carb nutrition and follow the treatment recommended by their doctor for preventing ketoacidosis.

    Ketosis has been seen to help people in losing weight and can offer many other health benefits as well. But it is always good to discuss with your doctor before attempting a new eating pattern.
    Last edited by Jamie Adams; 07-04-2020, 10:37 AM.

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