Paleo Diet and Paleolithic Diet Questions & Answers

Question

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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.

flag	asked Oct 28 2011 at 15:31 TomInTexas 1,435●1●3●15

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It has been my experience that many professional nutritionists look upon ketosis and ketogenesis as inherently pathological, and to various degrees, pathogenic. – Dorado Galore Oct 28 2011 at 16:07

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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 – DH Nov 7 2011 at 3:36

Olivia · Accepted Answer · 2011-10-28 16:00:10Z UTC

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.

Lucas Tafur · Answer 2 · 2011-10-28 16:10:55Z UTC

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.

The Loon · Answer 3 · 2011-10-28 15:41:11Z UTC

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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?

answered Oct 28 2011 at 15:41

The Loon
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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 ;). – Beth-WeightMaven Oct 28 2011 at 16:09

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. – Travis Culp♦ Oct 28 2011 at 16:13

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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. – The Loon Oct 28 2011 at 17:47

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Yes, eventually, your body gets better adapted at using ketones and you spill less into the urine/saliva. – Cody Oct 28 2011 at 19:36

Kasra · Answer 4 · 2011-10-28 15:57:20Z UTC

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

answered Oct 28 2011 at 15:57

Kasra
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kathy · Answer 5 · 2012-05-11 22:56:06Z UTC

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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

answered May 11 2012 at 22:56

kathy

community wiki

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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. – Anondson May 12 2012 at 0:11

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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. – Rose May 12 2012 at 0:51

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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. :) – Rose May 12 2012 at 0:55

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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 shoreline-man.name/homo_litoreus_nl/bronnen/… – Bread-Eating Beelzebub May 12 2012 at 1:28

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Wow Kathy if that's the doctor's understanding of metabolism, you need to find a better doctor! – Wowza May 12 2012 at 5:34

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

5 Answers