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Ask the Doctors: Ketosis and Ketoacidosis Only Sound the Same | Various

Dear Doctors: I mentioned to a friend that I was starting a low carb diet that puts your body into ketosis. She said no, because ketosis is one of the dangerous complications that can occur in people with diabetes. Is it correct? If so, how can low carb diets be safe?

Dear reader: Your friend made a fairly common mistake. She confused ketosis, which is a change in the way the body uses energy when carbohydrates aren’t available, with ketoacidosis, which is a serious complication of type 1 diabetes.

The names are similar as both involve chemicals called ketones. It is an alternative fuel source that the liver makes from stored fat. This happens when glucose, which is derived from carbohydrates and is the body’s main source of energy, becomes scarce. However, ketosis and ketoacidosis are not the same thing. Unlike ketosis, which is generally harmless, ketoacidosis is a serious and potentially life-threatening condition. Also known as diabetic ketoacidosis, it occurs in people with type 1 diabetes when their insulin levels get too low. This results in a buildup of ketones in the blood, which makes the blood dangerously acidic. The condition is usually triggered by hormonal imbalances resulting from certain types of diseases or by a problem with insulin therapy.

Diabetic ketoacidosis is a medical emergency. Without immediate care, it can lead to death. Although it is most commonly seen in people with type 1 diabetes, under certain conditions it is also possible for it to occur in someone with type 2 diabetes.

For those who are healthy, non-diabetic, and non-pregnant, ketosis can be a safe and effective way to aid weight loss. It is a metabolic state that is achieved by strictly limiting the amount of carbohydrates in the diet. Without carbs to turn into glucose for fuel, the body instead switches to burning stored fat for energy. It takes three to four days of consuming 50 grams or less of carbs to push the body into ketosis.

People who follow low-carb weight loss plans that keep the body in ketosis report reduced appetite and possibly cravings for sweets. This type of diet also leads to rapid weight loss, especially in the beginning, as excess water leaves the body. Without carbohydrates in the diet, blood sugar control tends to improve, as do blood lipid levels. Another potential benefit is that the initial fat loss tends to come from the abdominal cavity. However, there are also challenges. Among these is keeping the body in ketosis while consuming enough fresh fruits, vegetables, and greens for a healthy diet. Fifty grams of carbs a day quickly disappears. There is also evidence that, over the long term, this type of restrictive diet can have a detrimental effect on the health and diversity of the all-important gut microbiome.

If you are still interested in following this type of diet, we suggest that you seek advice from your health care provider or a registered dietitian.