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Ketones: Dangerous For Diabetics, Crucial For Keto Dieters
This article has been written by experts and fact-checked by experts, including licensed nutritionists, dietitians or medical professionals. The information in the article is based on scientific studies and research.
It is designed to be honest, unbiased and objective, and opinions from both sides of an argument are presented wherever there is disagreement.
The scientific references in this article (marked by 1, 2, 3, etc.) are clickable links to peer-reviewed research material on the subject being discussed.
When you get the results from blood tests ordered by your healthcare provider, you may see your levels of red blood cells, white blood cells and platelets. You might see listings that detail your glucose or cholesterol levels.
You probably won’t see results for “ketones.” But everyone has them, and they’re important.
High levels of ketones can be dangerous, particularly if you have diabetes. But they can also be crucial for your body’s functioning when you’re on certain types of diets.
If the word ketones sounds familiar, there’s a good reason. You’ve probably heard it in conjunction with discussions of the keto diet or the metabolic state known as ketosis, which is crucial for weight loss when you’re on keto or another low-carb diet.
Let’s take a closer look at the good – and the bad – implications of high ketone levels in the body.
What Are Ketones?
Ketones (short for ketone bodies) are chemical compounds produced by the liver by converting fatty acids. They’re generally referred to as a group, but the body actually makes three different ketones: acetoacetate (AcAc), acetone, and beta-hydroxybutyric acid (BB).
The body is always producing small amounts of ketones because there are times they’re needed as an alternate energy source.
Normally, the body is powered by glucose (blood sugar) it creates by converting dietary carbohydrates. During sleep or prolonged exercise, though, there may not be enough glucose to be used as a power source; that’s when ketones are valuable. They’re even more valuable during low-carb diets like keto, and we’ll discuss that shortly.
In normal circumstances, the body’s production of ketones is simply part of its daily metabolic function. Insulin and other hormones work to make sure that ketone levels don’t get too high.
For those people, ketones are certainly nothing to be concerned about – and there’s no need for them to think about their ketone levels.
For diabetics, though, it can be a very big deal when ketones build up.
Diabetes and Ketones
People with relatively-rare type 1 diabetes have to worry about their ketone levels.
Type 1 diabetes (one form of diabetes mellitus) usually appears during childhood, which is why it used to be called juvenile diabetes. It’s a life-long autoimmune disease that causes the body to attack cells in the pancreas. That leaves the organ either unable to produce insulin or only able to make small amounts of the hormone.
An insulin deficiency causes several major problems.
First, it prevents blood sugar from getting into the cells that need it as an energy source, causing glucose to build up in the bloodstream instead. Daily insulin injections are required to lower blood sugar levels and ensure normal body function.
Second, it creates a high risk for several serious complications. One is hypoglycemia, or low blood sugar; that’s a dangerous condition that diabetics must immediately treat by eating or drinking high-sugar foods or beverages. The other potential issue brings us back to ketones. It’s called diabetic ketoacidosis, or DKA.
DKA develops when there’s not enough insulin in the body, preventing the body from obtaining the glucose it needs to function. That’s an obvious problem, but it’s not the only one.
Ketoacidosis and Ketones
During diabetic ketoacidosis, the shortage of insulin means the liver’s ketone production can’t be controlled. That means the body’s levels of ketones escalate rapidly. When the concentration of ketones in the blood is too high, the condition is considered a medical emergency and can be life-threatening.
Diabetic ketoacidosis usually occurs when diabetics don’t take their insulin shots, but it can also be caused by illness. The American Diabetes Association says the initial symptoms of DKA include dry mouth, unusual thirst, fruity-smelling breath, fatigue, and urination.
If left untreated, DKA causes a loss of electrolytes. That can lead to red skin, stomach pain, nausea and vomiting, breathing difficulties and mental confusion. Worst case: diabetes ketoacidosis can lead to diabetic coma or death.
Treating Diabetic Ketoacidosis
When DKA is suspected, the first step should immediately be ketone testing, done with either a urine test or blood test. Ketone urine test kits are available at drugstores, and a blood test is normally done at a doctor’s office or hospital. Some meters that check glucose levels are also able to measure ketones.
Urine test strips simply indicate zero, trace, moderate or high amounts of ketones, but blood ketone tests will be more accurate. Test results between 1.5 and 3.0 mmol/L indicate moderately high ketone levels; the Joslin Clinic says that predicts a risk of developing DKA. When the reading is over 3.0, the results mean a very high ketone level which is even more serious.
Moderate to large amounts of ketones are a call for action. A doctor should be consulted immediately to find out whether increased insulin doses are the proper treatment, or if the test results require a trip to the emergency room.
Diabetics who use an insulin pump may be more at risk for DKA because the pumps are used for short-acting insulin therapy. Those patients should be sure to keep a supply of urine ketone tests on hand.
Type 2 diabetics can also develop diabetic ketoacidosis, but that’s much less common. Risk factors other than missed insulin doses include serious infection and high blood sugar levels for a prolonged period of time.
DKA is a serious condition that makes ketones sound like villains. When you’re trying to lose weight, though, they can be important allies.
Ketones and the Ketogenic Diet
You already know that there are times the body uses ketones as an alternative energy source, such as when you get a long night’s sleep. If you fast for more than 8-12 hours, ketones’ ability to act as a substitute for glucose is also important.
That’s essentially the science behind the ketogenic diet, usually referred to by the shorthand “keto.”
How Keto Dieting Works
By design, keto is a low-carbohydrate eating plan. It’s designed to starve the body of the carbs it normally turns into glucose, forcing the body to produce higher amounts of ketones over a longer period of time.
What does “low-carb” mean for keto dieters? It depends on how strictly they follow carbohydrate restrictions.
The most rigorous keto plan limits them to 20 grams of net carbs per day, which basically means eliminating all bread, pasta and rice, sugar and products with added sugar like soda and fruit juice, bakery and processed foods, starchy vegetables and most fruits.
More relaxed keto diets set the limit as high as 50 carbs per day, which is still less than one-quarter of the carbohydrates most normal adults consume on a daily basis.
Once the body isn’t getting enough carbs to make glucose, it enters a metabolic state called ketosis. It usually takes 2-3 days for the body to completely enter ketosis and be able to use ketones as a full-time energy source, because it first calls on glucose that’s been stored in the form of a substance called glycogen.
During that 2-3 day period (which can last as long as a week for some people), keto dieters often suffer from relatively mild symptoms similar to those caused by a case of the flu. That’s why the collective group of symptoms, like headache, fatigue, irritability and brain fog is known as the keto flu.
After that, it’s clear sailing – as long as the dieter doesn’t consume enough carbs for their body to start producing glucose again. A single slip-up or cheat day could be enough to kick them out of ketosis. Once that happens, ketone production largely stops. So does weight loss, and the dieter will have to start keto all over again.
Ah, weight loss. Why do people lose weight on keto? Once again, the answer involves ketones.
How the Body Produces Ketones
We’ve briefly mentioned that the liver makes ketones by burning fatty acids. What we didn’t mention is where those fatty acids come from. The last piece of the puzzle explains why the keto diet usually leads to rapid weight loss.
The fatty acids the body uses to produce ketones come directly from stored body fat. And if you’ve ever had to lose weight, you know that stored body fat is the primary culprit that makes your scale go tilt. Most diets and exercise plans are designed to help you burn that fat, and one of the most efficient ways to do it is to force the body to use stored fat to produce ketones.
So the longer you stay on the ketogenic diet, the longer your body depends on ketones for fuel and the more body fat you lose. That’s the key to weight loss on the ketogenic diet. (Important note: many experts say it’s not safe to stay on keto for more than 30 days in a row.)
In fact, many keto dieters add something called MCT oil to their coffee, salad dressings or other foods, to encourage even more weight loss.
MCTs (medium-chain triglycerides) are a special kind of fatty acid found in coconuts and palm kernels. They provide a number of health benefits, but more importantly, MCTs are smaller than most fatty acids and can be turned into ketones more quickly.
In short, they support and promote ketosis, making the production of ketones – and weight loss – even more efficient.
Ketones: The Bottom Line
To diabetics, ketones are compounds to be feared. To keto dieters, ketones are the secret to losing weight.
To everyone else, they’re just one of the many behind-the-scenes wonders of a healthy, well-functioning body.