Ketosis- Dangerous Metabolic State or Naturally Occurring Bodily Process?

This question has been so well addressed by many before me, with one of my favourite explanations coming from Peter Attia. However, throughout my time of working with individuals who have been following a low carbohydrate diet, still the most cited question to me is “isn’t being in ketosis for any period of time dangerous to my body?”  More often or not I get asked this question by people who have gone to see their GP or other health professional. When they have informed them of the dietary approach they are following, they have been sternly told to come off it as “ketosis is very bad for your body”.

Had you asked me this question just after I graduated from my under grad degree, I would most certainly have followed suit with other health professionals and said of course it is dangerous and to avoid at all cost. However, I can now say with great conviction and very simply that in fact ketosis is a completely normal physiological mechanism for the body. In fact, it was the biochemist Hans Krebs who first referred to ketosis in order to differentiate it from the pathological state known as diabetic ketoacidosis. Through time however, this differentiation has been lost and indeed it is this state of diabetic ketoacidosis that many health professionals are confusing with ketosis.  

Diabetic ketoacidosis occurs when a diabetic (namely type 1 or insulin controlled type 2 diabetes) does not have the correct amount of insulin in their body to cope with the circulating levels of glucose. Although they will have a high circulating level of glucose in the blood stream, without the insulin it cannot be taken into the cells. This effectively to the body will look like that it is not getting enough energy and so put it into “starvation” mode. The body will then begin to burn fat and protein to produce ketone bodies which can be used for energy. However, as there is still no insulin present, it means that there is no way for the body to switch off this process meaning that it will continue to produce ketone bodies as well as having a dangerously high level of glucose circulating in the blood. In the state of ketosis, ketone body concentration would generally never exceed 7/8mmol/L (many individuals rarely if ever, even get to this level) and there is no subsequent drop in blood pH level. In diabetic ketoacidosis however, the ketone body level can exceed 20mmol/L with a concomitant reduction of blood pH to that of an acidic level. If these levels are reached then it is indeed very dangerous to the body and can induce what is known as a diabetic coma.

This state of diabetic ketoacidosis can never be reached in a person who can effectively produce and utilise insulin. I remember one clear case of this exact confusion being caused. A client of mine had gone to his doctors for a random health check-up. After getting blood tests back that showed a higher blood ketone level than should be “normal”, he was rushed off to be tested for diabetes. The results came back showing that in fact he did not have diabetes (blood levels and HbA1c were all normal), but the doctor could not understand why this was the case and instead warned him to stop the diet as he was sure to go into a coma anytime soon. You can imagine my reaction to this story and after a 45 minute explanation on the difference and assurance that unless he actually had diabetes, he would never go into a coma. What this does do is simply illustrate how quickly to react and unfortunately misinformed certain health professionals are on this topic. It also highlights though how more people need to share the benefits that certain people can achieve by being in this metabolic state. Granted I would like to state here that ketosis will not be a dietary approach that is right for everyone, far from it. But for those who it would be beneficial for, they need to know that they are getting the correct advice and guidance on the principles of ketosis and that in fact it is a naturally occurring bodily process.