What is Ketosis?

Ketosis means that the body is adapted to use fat as the major fuel source. It simply describes the state of your metabolism as fat burning. Although many “authorities” treat ketosis as the metabolic equivalent of starvation, it does not represent an abnormal state. Achieving ketosis requires a diet which is very low in carbohydrates and high in fat (healthy fats) with careful, moderate protein intake. Keep in mind, the liver will turn some of the protein that you eat into sugar.


What are Ketones?

Fat is stored in the body as large fatty acid chains linked to glycerol (a holding molecule) in fat cells. In this configuration fat cannot be burned for energy. It must be broken down into individual fatty acid chains, and transported through the blood stream. These in turn must be broken down to further shorten the molecules. Ketones represent the smaller portions of the fatty acid molecules. They are burned by many cells including brain, heart and skeletal muscle for energy. Certain ketone molecules can be measured in the blood, urine and breath, which makes them a convenient way to keep track of fat burning in the body. When there is a significant amount of ketones in your body you are breaking down fat, from the diet and/or your own fat stores, and you are in ketosis. A diet which promotes this fat burning is called ketogenic.

Why You Should Care About Ketones

Since these nifty ketone molecules are part of the alternative fuel source, they allow people, including diabetics (type 1 and 2), to function without the need to ingest large amounts of carbohydrates. Think of them as “clean energy”. This means that you no longer need large amounts of insulin to mop up the extra sugar! A type 2 diabetic may actually be able to return to a nearly normal metabolic state, without the need for drugs or Insulin. If you are not presently a diabetic the benefits come from avoiding the large amounts of sugar, present in the typical western diet which will cause elevated insulin levels. Because of its role as the chief promoter of fat storage, author and film producer, Tom Naughton has nicknamed insulin the “make me fat hormone.” If you are even a little bit overweight, ask yourself, can you benefit from lower levels of insulin coursing through your system? If you think you won’t immediately benefit, there is much evidence that elevated blood sugar and insulin levels over time cause type 2 diabetes and blood vessel damage.

What About Ketones in Type 1 Diabetes?

The presence of ketones in your body does not mean that you have Diabetic Ketoacidosis. The medical abbreviation for this condition is DKA. It is a complex set of metabolic disturbances that will appear when the carbohydrate adapted person is unable to meet their metabolic needs due to lack of insulin. DKA is a medical emergency. The metabolic state of ketosis differs from DKA, because it is not the result of a metabolic emergency. It is possible to gradually change to a fat burning state (ketosis), without the dangerous metabolic disturbances of DKA. Most doctors and patients are alarmed by the appearance of ketones in a type 1 diabetic, because they have only experienced the presence of ketones in the context of serious imbalance in glucose metabolism. In medical training the dogma is: ketones equal a deranged metabolism. I am living proof that this is just plain wrong!

What Does Ketosis Do For Type 1 Diabetes?

The state of ketosis does not cure Type 1 Diabetes. If you have type 1 diabetes you will still have to take insulin, but ketosis has two major advantages. Most importantly, it gives you a profound tolerance of hypoglycemia. Your brain and many body tissues can adapt to run on ketones so you will not be incapacitated by the hypoglycemia that can still occur. A blood sugar in the 30 – 40mg/dl range would likely render the conventional type 1 diabetic unconscious. The ketone adapted type 1 diabetic will still have symptoms, but will be conscious and capable of self-treatment. Hypoglycemia is a serious, life-threatening condition. I do not advocate it as a treatment goal, rather I offer a management strategy which allows a person to better tolerate and treat it. The other major advantage of ketosis is a lower insulin requirement to achieve blood sugar control. Ketosis necessarily means very few carbohydrates in the diet. Avoidance of dietary carbohydrates reduces spikes in the blood sugar, and the obligate compensatory insulin dose(s). The additional insulin subjects you to hypoglycemia and another round of carbohydrate ingestion to treat that, and the vicious cycle repeats. Remember, there is no dietary requirement to eat the foods (carbohydrates) that make diabetes management more difficult than it already is.