Ketones - Are they Bad?

Once again, I am hoping to spark some discussion surrounding Ketones, and Ketogenic Diets in particular. I know DKA is bad. What do you know about ketones, and what are your thoughts and opinions on the body using Ketones for fuel as opposed to Carb? I share my opinion on my latest blog post at Three 2 Treat
Cheers and happy debating!

Producing ketones on a low carb ketogenic diet means you are buring fat for energy. As long as your bgs are in a good range, you are fine. If your bgs are very high 500+ and you don’t have enough natural insulin or injected insulin to lower it then you could go into DKA which is something totally different.

Yes, I think they are bad for all people. Particularly bad for Type 1s. Starvation ketones less dangerous, obviously, but I would try to avoid diets that encourage you to produce them, such as Atkins.

I would agree with this except that your BG does not need to be super high to make ketones dangerous. Even a BG of 200 or 250 can be dangerous with high ketone levels, if it’s caused by having so little insulin that your cells are unable to access glucose as fuel. They have done studies that show that the ketone level actually rises faster than the BG level (for people who make no natural insulin) if insulin delivery on a pump is cut off, for example. So you may find yourself with lots of ketones even though your BG looks relatively okay (which is how people can miss developing DKA if they don’t regularly test for ketones).

Personally, I would not go on a ketogenic diet because I already get ketones easily if I have pump problems or get stressed or sick. I would be too scared that already having ketones to begin with would tip the balance towards DKA if I were to ever have an insulin-delivery problem.

Ketones in smaller quantities are perfectly normal. Everyone has them at some point during the day, whether D or non-D, high carber or low carber. You make them whenever you burn fat. The most pronounced time is after fasting. Once the body has stored excess carbs as fat (via insulin, injected or self-produced), that fat can then be accessed whenever it’s needed for fuel. Ketones result.

The only difference for low carbers is that they’ll be eating fewer carbs > using less insulin > using more fat for fuel and will generate modestly higher ketones, but nowhere near the levels required to alter blood pH. The ketones themselves are not a major fuel source, though the brain and some other tissues can use them in exigent circumstances.

Even low carb brains run mostly/partly on glucose under normal circumstances (as opposed to running off of just ketones), but it need not come from carbohydrate intake. Protein (and to a much lesser extent fat) can be converted to glucose so that the brain, red blood cells, and other tissues that need glucose for full function can get it. As long as enough is generated for critical functions, all is well. It’s only when insulin levels fall to critically low levels (like in untreated D) that metabolism shifts too far and starts generating too many ketones > acidosis > very bad things.

The body is a beautiful machine. It was designed to not waste a drop of energy. It can survive on what’s available, whether it’s carbs or protein, veggies or meat. Anything extra, it’s saved for later (which, maybe, is why losing weight can be so difficult). What you fill your fuel tank with is a personal choice…I don’t think there’s a one-size-fits-all answer.

I suppose, theoretically, a low-carber may be a tad closer to the threshold of DKA bc of lower starting insulin / higher ketones, but I think this would be minimal because DKA can happen so fast anyway once insulin is withdrawn for whatever reason.