9

votes

Why isnt Ketoacidosis a problem for LC and VLC Paleo-eaters?

Answered on August 19, 2014
Created October 28, 2011 at 3:31 PM

I'm sitting in a lecture about nutrition and metabolism for people with diabetes. The instructor keeps insisting that if you are metabolizing ketones for any length of time, it will result in ketoacidosis, and eventually kill you.

I've not heard anything about LC and VLC paleo eaters having problems with ketoacidosis, but I'm not sure how we avoid it while primarily metabolizing ketone bodies. I understand that people with diabetes have more issues to work with, and are metabolically deranged, but how do people with normal metabolisms avoid acidosis issues?

Can anyone please shed some light on this for me? I googled around and haven't found explanation.

Cc69a51b427eaad36251cce9dcca4d3a

(1074)

on September 07, 2013
at 01:28 AM

the reason is insulin from beta cells directly inhibits release of glucagon from the outer pancreas' alpha cells. glucagon is the antithesis of insulin, and by definition is released upon clearing of insulin (fasting) to stimulate gluconeogensis, and later on when intermediates are depleted, stimulates ketone body formation. in diabetics with abnormally low insulin production, ketone formation is excessively high, much higher than in VLC'ers. this leads to pathology

7fc82eebafd44badc73c520f44660150

(3275)

on May 29, 2013
at 07:37 PM

great answer!..

80890193d74240cab6dda920665bfb6c

(1528)

on May 12, 2012
at 05:34 AM

Wow Kathy if that's the doctor's understanding of metabolism, you need to find a better doctor!

9d43f6873107e17ca4d1a5055aa7a2ad

on May 12, 2012
at 01:28 AM

Have you read any of the reserachers refereed to you in the last thread? If ketones are so harmful, everyone would be harmed because infants rely on them http://www.shoreline-man.name/homo_litoreus_nl/bronnen/Cunnane_Fattest_CBP_2003.pdf

3aea514b680d01bfd7573d74517946a7

(11996)

on May 12, 2012
at 12:55 AM

I'm not dismissing the direness of ketoacidosis, btw. That is indeed a very serious condition. But ketosis does not inevitably, or even usually, lead to it. A good place to start is with Phinney and Volek, and their research into ketogenic eating, a WOE enjoyed by many people (like me) for years with not only no ill effects, but improved health. See also Dr. Bernstein's Diabetes Solution -- he's a T1 who avoided an early death using a LC diet that almost certainly has him in ketosis fairly often. Finally, we all go into ketosis when we sleep, unless we sleep-eat, yet somehow we all wake up. :)

3aea514b680d01bfd7573d74517946a7

(11996)

on May 12, 2012
at 12:51 AM

Ketones are not harmful to the kidneys and liver even in small doses, or I'd be very sick instead of healthier than I've been in my life. Also, see the Inuits. Saying that ketosis is the "step before too many ketones enter the bloodstream" is like saying that walking is the step before falling, or being born is the step before dying. It's meaningless.

D7cc4049bef85d1979efbd853dc07c8e

(4029)

on May 12, 2012
at 12:11 AM

Just because he is credentialed doesn't make him right. There are copious amounts of research by equally credentialed researchers on the POSITIVE effects of ketones and ketosis to physical and mental health.

Cc69a51b427eaad36251cce9dcca4d3a

(1074)

on November 07, 2011
at 03:34 AM

the reason is insulin release from beta cells DIRECTLY inhibits glucagon release from the outer pancreas' alpha cells. in diabetes, the LACK of insulin means a ridiculous amount of glucagon in circulation (it automatically is released if insulin is absent), which leads to a physiologically abnormal amount of ketone formation.

100fd85230060e754fc13394eee6d6f1

(18696)

on October 28, 2011
at 08:56 PM

Right. Ketoacidosis consists of both higher levels of ketones (by something like a factor of 10) than what would occur in LC/VLC, and simultaneous high levels of blood glucose, which only happens when insulin can't be produced to respond to the glucose.

77877f762c40637911396daa19b53094

(78467)

on October 28, 2011
at 07:36 PM

Yes, eventually, your body gets better adapted at using ketones and you spill less into the urine/saliva.

8949bf87b0e0aefcad10f29975e4fa2b

(8989)

on October 28, 2011
at 05:47 PM

but it wouldn't make sense evolutionarily to waste precious food. I think ketosis comes in handy for people who want to sleep instead of get up every couple of hours to eat.

Medium avatar

(39831)

on October 28, 2011
at 04:13 PM

Beth: Hadn't thought of it like that, but that's totally true. Over the course of an extended period it would definitely add up.

332d9f75d1077abafff6887681f6b130

(1081)

on October 28, 2011
at 04:09 PM

Great answer, thanks Olivia

7dc950fc76a046048e683d2a27dced37

on October 28, 2011
at 04:09 PM

Hey, back when I was LCing, any ketones I peed out were calories I didn't have to burn. Negligible perhaps, but over time I liked to think it added up ;).

7dc950fc76a046048e683d2a27dced37

on October 28, 2011
at 04:08 PM

Hey, back when I was LCing, any ketones I peed out were calories I don't have to burn. Negligible perhaps, but over time I liked to think it added up ;).

Medium avatar

(8239)

on October 28, 2011
at 04:07 PM

It has been my experience that many professional nutritionists look upon ketosis and ketogenesis as inherently pathological, and to various degrees, pathogenic.

  • 332d9f75d1077abafff6887681f6b130

    asked by

    (1081)
  • Views
    4.3K
  • Last Activity
    1280D AGO
Frontpage book

Get FREE instant access to our Paleo For Beginners Guide & 15 FREE Recipes!

6 Answers

best answer

16
7d0c3ea9bf8be00b93e6433d8f125ac3

(7540)

on October 28, 2011
at 04:00 PM

There are a lot of metabolic derangements going on in diabetic ketoacidosis. Very very simplified: in a healthy person, ketone production will be kept in check by insulin. Even on a low carb diet, a healthy person doesn't produce zero insulin. But in a state of absolute insulin deficiency like uncontrolled Type 1 diabetes (DKA isn't as common in untreated type 2, though it can happen), the pancreas can't produce any insulin in response to increasing ketone body production, so they accumulate to dangerous levels.

The body does have a bicarbonate buffering system that helps maintain blood pH, but it eventually becomes overwhelmed by this pathological production of ketone bodies, hence the metabolic acidosis.

332d9f75d1077abafff6887681f6b130

(1081)

on October 28, 2011
at 04:09 PM

Great answer, thanks Olivia

100fd85230060e754fc13394eee6d6f1

(18696)

on October 28, 2011
at 08:56 PM

Right. Ketoacidosis consists of both higher levels of ketones (by something like a factor of 10) than what would occur in LC/VLC, and simultaneous high levels of blood glucose, which only happens when insulin can't be produced to respond to the glucose.

Cc69a51b427eaad36251cce9dcca4d3a

(1074)

on November 07, 2011
at 03:34 AM

the reason is insulin release from beta cells DIRECTLY inhibits glucagon release from the outer pancreas' alpha cells. in diabetes, the LACK of insulin means a ridiculous amount of glucagon in circulation (it automatically is released if insulin is absent), which leads to a physiologically abnormal amount of ketone formation.

7fc82eebafd44badc73c520f44660150

(3275)

on May 29, 2013
at 07:37 PM

great answer!..

9
68f2734a5078a7106f560a7079df45fd

on October 28, 2011
at 04:10 PM

Check the table in the end in the following link:

http://www.ketotic.org/p/ketosis-basics.html

In a nutshell, as Olivia has mentioned, ketogenesis is controlled by:

  • FFA.
  • Ketones (negative feedback).
  • Insulin.

Uncontrolled diabetics have no insulin or a non-functional isoform. This causes

  • Lack of supression of lipolysis by HSL. FFA levels increase dramatically.
  • Lack of supression of gluconeogenesis. Blood glucose levels increase dramatically.
  • Excessive FFA cause an increased supply of hepatic acetyl-CoA. Excessive KB are produced. Because there is no insulin, ketogenesis is uncontrolled.

6
8949bf87b0e0aefcad10f29975e4fa2b

(8989)

on October 28, 2011
at 03:41 PM

The nutritionist is incorrect. Ketoacidosis is caused when there is an extreme build-up of ketones. This is not the same as ketosis. Ketosis just occurs when components are being broken down into ketones and then burned in cells, instead of burning glucose. Usually, these ketones don't build up, they are used up, which is another reason why ketosticks aren't a good indicator of whether someone is fat-burning. Why go to the bother of making ketones and then just peeing them out?

8949bf87b0e0aefcad10f29975e4fa2b

(8989)

on October 28, 2011
at 05:47 PM

but it wouldn't make sense evolutionarily to waste precious food. I think ketosis comes in handy for people who want to sleep instead of get up every couple of hours to eat.

7dc950fc76a046048e683d2a27dced37

on October 28, 2011
at 04:09 PM

Hey, back when I was LCing, any ketones I peed out were calories I didn't have to burn. Negligible perhaps, but over time I liked to think it added up ;).

Medium avatar

(39831)

on October 28, 2011
at 04:13 PM

Beth: Hadn't thought of it like that, but that's totally true. Over the course of an extended period it would definitely add up.

77877f762c40637911396daa19b53094

(78467)

on October 28, 2011
at 07:36 PM

Yes, eventually, your body gets better adapted at using ketones and you spill less into the urine/saliva.

7dc950fc76a046048e683d2a27dced37

on October 28, 2011
at 04:08 PM

Hey, back when I was LCing, any ketones I peed out were calories I don't have to burn. Negligible perhaps, but over time I liked to think it added up ;).

4
5ef574d7893bc816ec52e04139e9bc09

(6097)

on October 28, 2011
at 03:57 PM

"Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis...Fasting leads to ketosis but not ketoacidosis." - wiki

0
Ae731bd418e33a448b2d51c904556d6e

on May 29, 2013
at 07:11 PM

Hello,

I have recently started the Paleo diet, and am a Type 1 Diabetic. IN attempting to adjust to this diet, I have been experiencing moderate ketones in my urine. I believe this is happening as my body just releases glucagon because it thinks that it is starving. I would really like some feedback/advice, as I would like to stay on the Paleo plan, but cannot do it at the expense of going into full blown ketoacidosis. I have never had a problem with ketones before I started this plan, and my blood sugars are higher than ever! I would appreciate someone shedding some light on this, or refer me to sources that can help.

-2
43fc93341e50688992ebd7de8535da18

on May 11, 2012
at 10:56 PM

i discussed this issue with my daughter's endocrinologist and posted here, but my post was closed b/c it was considered to be duplicate to this post.

for the record, my daughter is a Type 1 Diabetic (T1DM). This is NOT Type 2. It is b/c the body stops making insulin.

my daughter's doctor (professor of endocrinology and chair of childhood diabetes dept.) said that ketosis is just the step before too many ketones enter the bloodstream, causing ketoacidosis. ketones are acids that are, EVEN IN SMALL DOSES, harmful to the kidneys and liver.

my daughter's doctor said that chronic ketosis could be damaging to one's liver and kidneys.

my post was closed, but here is a link:http://paleohacks.com/questions/118163/ketosis-ketoacidosis-just-a-difference-of-degree-so-why-promote-ketosis-clos#axzz1ubRXdzx8

3aea514b680d01bfd7573d74517946a7

(11996)

on May 12, 2012
at 12:55 AM

I'm not dismissing the direness of ketoacidosis, btw. That is indeed a very serious condition. But ketosis does not inevitably, or even usually, lead to it. A good place to start is with Phinney and Volek, and their research into ketogenic eating, a WOE enjoyed by many people (like me) for years with not only no ill effects, but improved health. See also Dr. Bernstein's Diabetes Solution -- he's a T1 who avoided an early death using a LC diet that almost certainly has him in ketosis fairly often. Finally, we all go into ketosis when we sleep, unless we sleep-eat, yet somehow we all wake up. :)

80890193d74240cab6dda920665bfb6c

(1528)

on May 12, 2012
at 05:34 AM

Wow Kathy if that's the doctor's understanding of metabolism, you need to find a better doctor!

3aea514b680d01bfd7573d74517946a7

(11996)

on May 12, 2012
at 12:51 AM

Ketones are not harmful to the kidneys and liver even in small doses, or I'd be very sick instead of healthier than I've been in my life. Also, see the Inuits. Saying that ketosis is the "step before too many ketones enter the bloodstream" is like saying that walking is the step before falling, or being born is the step before dying. It's meaningless.

D7cc4049bef85d1979efbd853dc07c8e

(4029)

on May 12, 2012
at 12:11 AM

Just because he is credentialed doesn't make him right. There are copious amounts of research by equally credentialed researchers on the POSITIVE effects of ketones and ketosis to physical and mental health.

9d43f6873107e17ca4d1a5055aa7a2ad

on May 12, 2012
at 01:28 AM

Have you read any of the reserachers refereed to you in the last thread? If ketones are so harmful, everyone would be harmed because infants rely on them http://www.shoreline-man.name/homo_litoreus_nl/bronnen/Cunnane_Fattest_CBP_2003.pdf

Answer Question


Get FREE instant access to our
Paleo For Beginners Guide & 15 FREE Recipes!