Adverse Reactions To Ketogenic Diets: Caution Advised
As the ketogenic diet gains popularity, it’s important to have a balanced discussion regarding the merits of this diet. Let me emphasize right out of the gate that this is not a diet without merits (excuse the double negative); in fact, it has significant therapeutic potential for some clinical pathologies. However, it is also a diet with inherent risk, as evidenced by the extensive list of adverse reactions reported in the scientific literature—and this has not yet been a thorough enough part of the public discussion on ketogenic diets. The AIP Lecture Series is a 6-week video-based, self-directed online course that will teach you the scientific foundation for the diet and lifestyle tenets of the Autoimmune Protocol. This is the first of a series of articles discussing various facets of a ketogenic diet with an inclination toward balancing the discussion of the pros and cons of this high-fat, low-carb, low/moderate-protein diet. My interest in this topic stems from concerns I have over its general applicability and safety, simultaneous with its growing popularity. I feel a moral and social obligation to share what I understand of these diets, from my perspective as a medical researcher. The dangers of a ketogenic diet was, in fact, the topic of my keynote presentation at Paleo F(x) this year (links to video will be provided once available). This series of articles will share the extensive research that I did in preparation for this presentation, including all of the topics covered during my talk as well as several topics that I didn’t have time to discuss (also see the free PDF Literature Review at the bottom of this post). For every anecdotal story of someone who has regained their health with a ketogenic diet, there’s a counterpoint story of someone who derai Continue reading >>
Ketones In Urine: All You Need To Know
Authored by Robert Iafelice , Dr. Brianna Stubbs and Nate Martins For a biohacker practicing intermittent fasting, urine ketones are a useful metric to track a state of ketosis . It's a quick and cost-effective way to indicate elevated ketone levels, which provide numerous health benefits. But for someone with uncontrolled type 1 diabetes or type 2 diabetes? Extremely high ketone levels in urine may be a sign of ketoacidosis a serious complication of diabetes which, if left untreated, can lead to coma and death. More on this outlier below. Normally, elevated ketones in urine are a good thing. In this piece, well cover what ketones in urine mean, how they get there and ways to test for ketones. But lets start with a refresher: The two predominant ketone bodies in human metabolism acetoacetate (ACAC) and beta-hydroxybutyric acid (BHB) are made in the liver from fatty acids. When glucose is not available, theyre transported by blood to other body tissues to be used as an energy source. Acetone, the third and least abundant ketone, is spontaneously formed from the breakdown of acetoacetate. Its found mostly in breath, and its contribution as an energy source is insignificant. There are always some ketones present in the blood, but levels naturally increase in response to fasting, prolonged or strenuous exercise, and a low-carbohydrate ketogenic diet . 1 This is called ketosis . Like glucose, ketones are important metabolic fuels reabsorbed through the kidneys as the blood is filtered. When blood passes through the kidneys, small molecules like glucose and ketones end up in the urine, and so must be taken back up. Reabsorption of ketones prevents energy wastage and is especially important during extended fasts. The body doesnt want to flush good energy down the drain, so ke Continue reading >>
What Is “nutritional Ketosis”?
IN A NUTSHELL: Nutritional ketosis is a state of health in which your body is efficiently burning fat as its primary fuel source instead of glucose. When undergoing a ketogenic diet you are essentially converting yourself from a “sugar burner” to a “fat burner”. This is accomplished by reducing your consumption of carbohydrates, increasing your intake of fat, and consuming only an adequate amount of protein to meet your body’s needs. The term nutritional ketosis is claimed to have been coined by Dr. Stephen Phinney & Jeff Volek, two of the leading experts and researchers in the field of low carbohydrate dieting (Check out this informative video to hear a talk from Dr. Phinney). Ketosis is achieved by following a “ketogenic diet” which is high in fat, very low in carbohydrates, and adequate in protein (Please Note: It is “adequate” in protein, NOT “high” in protein. More on this later). By consuming more lipids you are enhancing your body’s fat burning function by up-regulating the enzymes and other “metabolic machinery” needed to burn fat more efficiently, therefore making it easier for your body to tap into stored adipose tissue as an energy source (i.e. you turn yourself into a fat-burning machine!). But don’t we NEED carbohydrates? While it’s true that our red blood cells and a small percentage of brain cells and kidney cells are exclusively glucose dependent, the body can actually GENERATE carbohydrates in a process called gluconeogenesis in which certain non-carbohydrate substrates like proteins (amino acids) and certain constituents of fatty acids (glycerol) can be converted into glucose. The quantities of glucose produced by the body are sufficient to meet the needs of these particular cells and also help to balance the body’s bl Continue reading >>
> Hyperglycemia And Diabetic Ketoacidosis
When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>
The Truth About Ketosis & Low-carb Diets, Backed By Science
A lot of people are confused by the term “ketosis.” You may read that it is a “dangerous state” for the body, and it does sound abnormal to be “in ketosis.” But ketosis merely means that our bodies are using fat for energy. Ketones (also called ketone bodies) are molecules generated during fat metabolism, whether from the fat in the almonds you just ate or fat you were carrying around your middle. When our bodies are breaking down fat for energy, most of it gets converted to energy, but ketones are also produced as part of the process. When people eat less carbohydrates, their bodies turn to fat for energy, so it makes sense that more ketones are generated. Some of those ketones (acetoacetate and ß-hydroxybutyrate) are used for energy; the heart muscle and kidneys, for example, prefer ketones to glucose. Most cells, including the brain cells, are able to use ketones for at least part of their energy. Is ketosis a bad thing? There is an assumption that if a body is burning a lot of fat for energy, it must not be getting “enough” glucose. However, there is no indication, from studying people on reduced carbohydrate diets, that this is the case (though there is usually a short period of adjustment, less than a week, in most cases). It takes about 72 hours to burn up all of the reserve glycogen (sugar loads). Although it’s true that our bodies can’t break fat down directly into glucose (though, interestingly, they easily use glucose to make fat), our bodies can convert some of the protein we eat into glucose. Indeed, this works well for people who don’t tolerate a lot of sugar, because this conversion happens slowly so it doesn’t spike blood glucose. What is the danger of ketosis? It is important that if you are following a ketogenic nutritional pro Continue reading >>
Metabolic Effects Of The Very-low-carbohydrate Diets: Misunderstood "villains" Of Human Metabolism
Go to: The Ketone Bodies are an Important Fuel The hormonal changes associated with a low carbohydrate diet include a reduction in the circulating levels of insulin along with increased levels of glucagon. This activates phosphoenolpyruvate carboxykinase, fructose 1,6-biphosphatase, and glucose 6-phosphatase and also inhibits pyruvate kinase, 6-phosphofructo-1-kinase, and glucokinase. These changes indeed favor gluconeogenesis. However, the body limits glucose utilization to reduce the need for gluconeogenesis. In the liver in the well-fed state, acetyl CoA formed during the β-oxidation of fatty acids is oxidized to CO2 and H2O in the citric acid cycle. However, when the rate of mobilization of fatty acids from adipose tissue is accelerated, as, for example, during very low carbohydrate intake, the liver converts acetyl CoA into ketone bodies: Acetoacetate and 3-hydroxybutyrate. The liver cannot utilize ketone bodies because it lacks the mitochondrial enzyme succinyl CoA:3-ketoacid CoA transferase required for activation of acetoacetate to acetoacetyl CoA . Therefore, ketone bodies flow from the liver to extra-hepatic tissues (e.g., brain) for use as a fuel; this spares glucose metabolism via a mechanism similar to the sparing of glucose by oxidation of fatty acids as an alternative fuel. Indeed, the use of ketone bodies replaces most of the glucose required by the brain. Not all amino acid carbon will yield glucose; on average, 1.6 g of amino acids is required to synthesize 1 g of glucose . Thus, to keep the brain supplied with glucose at rate of 110 to 120 g/day, the breakdown of 160 to 200 g of protein (close to 1 kg of muscle tissue) would be required. This is clearly undesirable, and the body limits glucose utilization to reduce the need for gluconeogenesis Continue reading >>
The Difference Between Ketosis And Ketoacidosis
When you hear these two terms it’s easy to see how they can be confused. The confusion also stems from the fact that the two are both metabolic processes involving the breakdown of fats in the body (plus they look and sound like similar words). The truth is ketosis and ketoacidosis are two completely different things. Ketosis and the Ketogenic Diet Ketosis is a normal metabolic process in which the body has a high fat-burning rate. It is a healthy and natural state your body enters when your body is running on fat rather than glucose1. The state of ketosis occurs when ketone levels are raised in the blood due to the conversion of fats into fatty acids and ketones. This happens when the body runs out of carbohydrates – usually because a person hasn’t eaten in a while, for example during fasts, or they eat a very low-carbohydrate diet – leaving little sugar to convert into glycogen. Without glycogen, the body breaks down fat cells for energy. A low-carb, high fat diet, also known as a ketogenic diet, is necessary to enter and stay in ketosis long-term. When you eat a low-carbohydrate diet, your body enters the metabolic state of ketosis within 2 days but it can vary from person to person. There are many benefits2 to being in longer-term ketosis including: lowered triglycerides levels no spikes in blood glucose levels greater mental clarity lowered blood pressure and cholesterol reduced food and sugar cravings weight loss Ketoacidosis – The Body in a State of Toxicity Ketoacidosis is a metabolic state of toxicity. It occurs when the body fails to regulate ketone production resulting in severe accumulation of keto acids which cause the pH of the blood to decrease substantially making the blood more acidic. The most common causes for ketoacidosis are Type 1 Diabete Continue reading >>
Low Carb Ketogenic Diet & Diabetes: Is It Safe?
You might be surprised to know that the ketogenic diet has been around for over 80 years. It was originally used to treat people with epilepsy. The ketogenic diet is very high in fat, extremely low in carbohydrate with a moderate amount of protein. The severe restriction of carbohydrate resulted in improvements in the seriousness and frequency of seizures. The diet is also associated with weight loss, improvement in risk factors for diabetes and enhanced brain health. How the Ketogenic Diet Works Carbohydrate is the body’s primary source of energy. When following a very low carbohydrate diet, the body is forced to burn stored fat for energy. But fat isn’t clean fuel: it leaves an acidic waste in your blood stream called ketones. Your body can get rid of some, but not all, of the ketones by excreting them in the urine. This process is known as nutritional ketosis. It is not the same as diabetic ketoacidosis, which can be fatal. In diabetic ketoacidosis, ketones build up to much higher levels than those found with nutritional ketosis. The blood glucose levels are also extremely high in diabetic ketoacidosis due to insufficient insulin. Research shows when the body is in a state of nutritional ketosis there is a decrease in hunger and longer satiety after eating, resulting in weight loss. Are Low Carb Ketogenic Diets Safe? Before the discovery of insulin therapy in the early 1920s a ketogenic type diet was used for people with diabetes. However, after the discovery of insulin therapy and oral hypoglycemic medications, recommendations for carbohydrate intake gradually increased. Today the question about how much carbohydrate is a source of controversy. Some diabetes experts say limit carbohydrate for better diabetes control and others say higher carbohydrate—noting co Continue reading >>
The Ketogenic Diet And Type 1 Diabetes: What I Eat
I recently began writing about the ketogenic diet and type 1 diabetes in an attempt to optimize my blood sugar in relationship to athletic performance. This podcast episode can provide some additional perspective about how I arrived at the ketogenic diet for type 1 diabetes. It started with a low-fat plant-based diet and I have recently changed my approach (dramatically) to a Ketogenic diet (low-carb, high-fat). The results have been remarkable and I feel like this dietary approach is a worthwhile consideration for anyone who is in a position to optimize their diabetes management–or who just wants better energy with no “crashes” throughout the day. In case my standpoint isn’t obvious, let me clarify, there is no should or shouldn’t implied in my writing about this or any other diet. Some people eat pizza. Some people drink diet soda. Some never consume either–or do but always feel guilty. Still others know the drawbacks and act in moderation and feel great about it. My goal is to inform those who are interested in trying something new or just knowing what else is out there–not to persuade those who are happy with an already satisfactory approach. I wrote an eBook compiling my experiments with the ketogenic diet and type 1 diabetes which you can check out here: In my last blog I focused on the comparative results between the two diets, and this blog will hopefully answer the one major question I got–‘what do you eat on a daily basis?’ Not all low-carb diets are Ketogenic, but the Ketogenic diet is low-carb. In the coming weeks I will be sharing more about how my transition to this diet came together as well as mistakes I made along the way. I will also probably put up a post along the lines of “What is a Ketogenic diet?” although that is lower pri Continue reading >>
Is Ketosis Dangerous?
It really is a sad fact that some experts add more to the confusion surrounding health and nutrition then they do to clear things up. One such area is that of ketosis vs ketoacidosis. While you may be unfamiliar with these terms, you will most certainly know about low carb and very low carb diets, and it is likely you’ve heard health professionals warning against the dangerous side-efffects of low-carbing. Well, ketosis and ketoacidosis are often quoted as two of those dangerous side-effects. This advice, however, is partly misinformed, partly overcautious. I read about Jimmy’s (Livin’ La Vida Low-Carb) experience recently when he went to give blood. He struck up a conversation with the type 2 diabetic nurse, and talk turned to eating a low carb diet. Her immediate response was that ketosis is a dangerous condition to be avoided. This is a pretty common opinion echoed by many health professionals. Here is what WebMD say on the subject of ketosis; 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. It is hardly surprising that the general public are confused, when health professionals and mainstream websites like WebMD make statements like this. And that’s only two examples. If this is all starting to sound a bit worrying, let me clarify things for you by firstly defining the difference between ketosis and ketoacidosis. Ketosis vs Ketoacidosis Continue reading >>
What’s The Difference Between Ketosis And Diabetic Ketoacidosis?
Ketosis and ketoacidosis sound similar and are sometimes confused, but don’t mistake these conditions for one another. These involve two different sets of circumstances with considerably different outlooks. Both are triggered by an increase of ketones in the body, which are acids released into the bloodstream when the body burns fat for energy instead of carbohydrates. But it’s how the body responds to this increase that sets ketosis and ketoacidosis apart from each other. RELATED: How to Tell the Difference Between Good and Bad Carbs What Is Ketosis and How Does the Process Work? “Ketosis is a natural state that occurs when you start to metabolize fat instead of sugar,” says Michael Greenfield, MD, endocrinologist and chief medical officer at El Camino Hospital in Palo Alto, California. “It occurs often when people fast and use up the stores of sugar in their body." To understand ketosis, it helps to understand how the body burns energy. Carbohydrates and fat are both energy sources, and the body typically burns carbs (sugar or glucose) first, and then fat. If there aren’t enough carbohydrates in your system, it begins to break down fat for energy, which puts your body into a state of ketosis. While in this state, the body becomes a fat-burning machine. For this reason, ketosis is the goal of many diets, particularly those that restrict carbohydrate intake and rely on fat for energy, such as the ketogenic diet. Understanding the Relationship Between the Ketogenic Diet and Ketosis “The ketogenic diet is a high-fat (60 to 80 percent of your total daily calories), moderate-protein (10 to 15 percent of your total daily calories), and low-carbohydrate diet (less than 10 percent of your total daily calories) that forces your body into ketosis, where it burns fa Continue reading >>
Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?
In this article we will cover what a Ketogenic diet is and if you can manage your diabetes while on this diet. Ketogenic diet for diabetics is a highly controversial topic, but we will break down everything here for you! As a Certified Diabetes Educator (CDE), I have to tell you from the start I will have a biased view here. Sorry, but I feel that I need to be completely honest right up front! I will however, present all the evidence that is available currently on the subject. As a CDE, I have been taught to follow the American Diabetes Association Dietary Guidelines for Americans which is low in carbohydrates, high in fiber, with fresh vegetables, fruits and whole grains. The Ketogenic Diet this article will be discussing is much lower in carbohydrates, in order to promote the state of nutritional ketosis, or the fat burning state for weight loss. What is a Ketogenic Diet? The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up? Your body uses the carbohydrates you eat for energy, so if we restrict how many carbohydrates we eat, the body has to get its fuel source from fat. A byproduct of this fat burning state are ketones which are produced; this is called nutritional ketosis. You can determine if you are in this fat burning state by purchasing urine ketone testing strips from your local pharmacy. The Ketogenic Diet with Diabetes Some precautions must be made clear; this diet is not appropriate for people with any Continue reading >>
Ketoacidosis (dka) Vs Ketosis What’s The Difference?
Although ketosis and ketoacidosis may sound the same, they are two distinct things. We are going to be talking about the difference between ketoacidosis and ketosis and what makes the two diverse from one another. In order to provide a good explanation of what these conditions are and how they affect the body, we must talk about their main common denominator, the ketones. These are organic compounds that the body will provide when it starts to burn stored fat instead of burning glucose or sugar when it requires energy. What is Ketoacidosis? DKA applies to diabetic ketoacidosis and is a complication of type 1 diabetes. Ketoacidosis is a very dangerous condition that makes it difficult for your body to be able to produce a good level of insulin. Your levels of ketones can rise to very dangerous levels, which will also increase your blood sugar. The ketones create a very acidic environment inside your body, and the function of certain organs will be affected severely. It becomes a life-threatening situation when presented with high levels of ketones and excess blood sugar. Anyone not given proper treatment for DKA could end up in a coma and even die. The kidneys and liver are affected more than most other organs, and this can create a very serious health issue. Once a person develops what is known as diabetic ketoacidosis, they will show severe symptoms within as little as 24 hours. When a person has type one diabetes, they are in great danger of developing diabetic ketoacidosis. What is ketosis The best way to explain ketosis is to consider it a very mild form of ketoacidosis, and the truth is that this is not going to be harmful most of the time. In your lifestyle, if you’re on a ketogenic diet nutrition plan or any long-term low-carb diet, you might be experiencing ke Continue reading >>
Low-carb Diets & Ketoacidosis
Drastically switching up your diet always carries the risk of side effects -- which is why it's important to talk to a doctor first -- but low-carb diets shouldn't cause ketoacidosis. This life-threatening condition, which develops when the blood becomes acidic, is generally only a risk for people with undiagnosed or poorly controlled type-1 diabetes. Low-carb diets actually put you in ketosis, a very mild form of ketoacidosis that does not carry the same life-threatening risk. Video of the Day Low-Carb Diets and Your Metabolism Reducing your carb intake can whittle your waist, and more restrictive low-carb diets speed up weight loss by affecting how your body generates energy. Normally, your body turns to carbs as the primary source of energy for your cells, and several tissues -- like your liver and muscles -- store carbs in the form of glycogen for almost-immediate energy. However, on a low-carb diet you're not getting enough carbs to replenish those glycogen stores, so your body turns to fat. It burns fatty acids -- the fat molecules that help make up your fat tissue -- to create ketone bodies, an alternate source of fuel. Because you're creating more ketone bodies for energy, you're burning more fat -- and losing weight. Low-Carb Diets Cause Dietary Ketosis Diets low enough in carbs to switch your primary fuel source over to ketone bodies are called ketogenic diets, and those that restrict your carb intake to 20 to 25 grams daily are typically low-carb enough to put you into ketosis. In addition to burning fat, ketogenic diets help you lose weight by controlling your appetite. One study, published in the American Journal of Clinical Nutrition in 2008, found that men following a ketogenic diet ate less and reported feeling less hungry than dieters following a modera Continue reading >>
Understanding And Treating Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>