In Part 1 we discussed how the basics of what Ketosis is on a very fundamental level. Today we will talk more in depth about how ketosis works, and the process of how the body makes ketones.
Ketosis is a state in which your liver breaks down body fat for fuel, the byproduct of which is ketones. This is an energy source for your body similar to carbohydrates (such as breads and pastas) which ultimately break down into simpler forms of sugars. There are 3 types of ketone bodies: acetone, acetoacetate, and beta-hydroxybuterate (BHB) . When we first go into ketosis, we start “spilling” the ketone acetoacetate, which is found in the urine. If you’ve heard people checking to see if they’re in ketosis by peeing on test strips (Ketostix), this is the form of ketone that is being tested. First, a portion gets spontaneously converted into the ketone acetone (the form of ketone found in the breath) and is then turned into beta-hydroxybuterate (the form of ketone found in the blood and the type your body uses most as a fuel source).
A big part of becoming fat adapted is your body becoming better at making an enzyme called beta-hydroxybutyrate dehydrogenase. This is a pivitol adaptation that your body makes to better use ketones and fat for energy. This can take a few weeks, so give it time. Think about it. If you’ve been a sugar burner your whole life, your body has not had to make much of this enzyme before. So it’s going to take time. Much like if you have a broken leg that has been in a cast for months. You can’t just take the cast off and immediately run a marathon. It’s going to take time for the bones and muscles to strengthen back up.
Believe it or not, most of the cells in your body can use ketones directly for energy as well or even better than they can with glucose . Yes, there are some parts of the body that require glucose like red blood cells and parts of your brain. However, your body already comes prepared to meet these demands without taking a single bite of carbohydrates. Your liver is fully able to derive glucose from protein via a process called gluconeogenesis. Breaking that word down backwards:
Genesis= Create. Neo=new. Gluco=sugar. So using spare protein from diet and general body processes, the liver can convert some of this excess protein to sugar. This is exactly how hunter gatherer tribes were able to survive in harsh winters when vegetables, fruits, and other plant matter was scarce. Or how tribes like the Inuit in Antarctica were able to thrive without a hint of dietary carbohydrates . It should also be noted that some tissues like the brain can utilize BHB even better than glucose once adapted (we’ll talk about that more in future articles)
Ok, so we’ve talked about how your body can use fat for fuel, and why you don’t need to eat carbs to live. Let’s get the next question… WHY would I want go keto? You can also lose weight by just eating less and moving more right? I mean, that’s what has been touted as dietary advice for the last 30 years, nevermind the fact that people are getting fatter and sicker in the process. So what benefits does a ketogenic lifestyle have over that of a sugar burner? Great question. Here is a list of documented health benefits from being in a state of nutritinal ketosis:
- Natural hunger and appetite suppression
- Much easier weight loss
- Better sleep
- Increased Mental Clarity
- Blood sugar stabilization
- Decreased insulin resistance
- Better mood and decreased depression/anxiety
- Lower blood pressure
- Increased HDL (aka the “good”) cholesterol
- Reduced triglycerides and small LDL (the “bad) cholesterol
- Improved fertility and sex drive
- Reduction in systemic inflammation
- Reduction in acne
- And more….
I will be providing a page for scientific resources in the near future, so if you want to really nerd out on this stuff, feel free.
That’s it for part 2. Next in part 3 we’ll be tackling some frequently asked questions and debunking some myths you may have heard surrounding the ketogenic diet.
 Berg, Jeremy M., John L. Tymoczko, Lubert Stryer, and Lubert Stryer. Biochemistry. 6th ed. New York: W.H. Freeman, 2006. Print. Pages 630-634
 Volek, Jeff, and Stephen D. Phinney. The art and science of low carbohydrate performance: a revolutionary program to extend your physical and mental performance envelope. Lexington, KY: Beyond Obesity, 2012. Print. Pages 29-41
 Volek, Jeff, Stephen D. Phinney, Eric Kossoff, Jacqueline A. Eberstein, and Jimmy Moore. The art and science of low carbohydrate living: an expert guide to making the life-saving benefits of carbohydrate restriction sustainable and enjoyable. Lexington, KY: Beyond Obesity, 2011. Print. Pages 14-15
Consider me very intrigued. I’ve done Paleo in the past with good success. It allowed me to essentially eat without reservation as my body seemed to process everything efficiently. Blood analysis was solid and I usually enjoyed the food.
The problem is that my physical activity isn’t as consistent as it was do to complicating factors/priorities. Also, I never felt like Paleo was helping me to lose as much as it was helping me to maintain and build lean mass. I have sufficient mass for my lifestyle. I just want to lean up.
Here’s the number one complication, though. I’m a Type 1 Diabetic. I understand that I must always be flexible to account for lows. But, by definition Ketosis and Ketoacidosis are similar processes, though brought about be different circumstances. In fact, almost opposite in that the former occurs in relative absence from sugar while the latter occurs in the presence of abundant sugar but relative lack of insulin. So:
Why is Ketosis ‘safe’ while Ketoacidosis is deadly?
Am I correct to assume that in ideal ketosis, blood sugars should remain ideal 80-120?
I hope I’m not overloading you.
Baron, GREAT questions!
First off, I’m not surprised with your previous success with paleo. Paleo/primal diets and nutritional ketosis are like friendly cousins. I can’t remark about why you weren’t leaning out while on paleo, as I don’t know what kind of carbs and starches you were consuming, what type of workouts you were doing, and also how much sleep you were getting and how much stress you were under. Unfortunately, for folks with chronic stress (be it mental, physical, or both), many people have great difficulty losing body fat. I will be covering stress and its hormonological effects in the future.
With being a Type 1 Diabetic, you are correct to use caution. The simplest way I can explain the difference between nutritional ketosis (safe) and ketoacidosis (deadly) is the amount of ketones. It goes back to the saying “The Dose Makes the Poison”. Most keto experts claim that benefits from ketosis come from B-OHB (beta-hydroxybutyrate) levels of 0.5 mM to 3.0 mM in the blood. Most diabetic ketoacidosis levels that lead to a pH imbalance are anywhere between 15-25 mM. Its much like the difference between a sprinkle and a downpour. Ketoacidosis has blood ketone levels 5-8 times higher than the upper levels of nutritional ketosis.
Type 1 diabetics can utilize Blood glucose monitors that also test blood ketones, like the Precison Xtra, and keep a very close eye on this themselves. Also, many Type 1 Diabetics report that as their blood sugar becomes controlled though a low carb or keto diet, their number of insulin injections go down significantly. All this being said, it’s important to consult with your physician.
As far as blood sugars go, the normal stays the same, but usually on the lower end of the spectrum.
A lot of these topics will be talking about in Part 3, so be sure to check that out. But I was more than happy to go ahead and jump in.
Hope this helps, and take care.
Great. Thanks for the feedback. I look forward to reading part 3.