Dangers of a Keto diet

Nutritional ketosis is safe and beneficial for people of all ages but it’s also somewhat related to ketoacidosis, a dangerous condition that is deadly if untreated. But should you worry about it? 

One of the biggest misconceptions about the keto diet is that it’s almost the same as ketoacidosis. It’s easy to see where this myth stems from: both nutritional ketosis and ketoacidosis are defined by the presence of ketone bodies in the blood. 

Well, let’s get this straight: 

It is virtually impossible to develop ketoacidosis if you have a healthy pancreas, are not an alcoholic, and are not in a state of severe starvation. 

That being said, there are still a few details you should know, just to stay properly informed. What’s the difference between these two states? Who’s at risk of ketoacidosis and how do you prevent it?
 

Stay tuned, we’re diving in! 

Both nutritional ketosis (the goal of the keto diet) and ketoacidosis are defined primarily by the presence of ketone bodies in the blood, but their level plays a great role here. For instance, take a look at the reference ranges for blood ketones: 

No ketosis: up to 0.5 mmol/l 

These are most people’s baseline ketone levels. 

Light to moderate ketosis: between 0.6 and 1.5 mmol/l 

Most people reach these ketone levels after an overnight fast or after skipping breakfast. Constantly staying in this zone results in effective loss of body weight (via burning fat), but doesn’t bring you the full set of astounding benefits of keto. 

High (optimal) ketosis: between 1.6 and 3.0 mmol/l 

This is the range you should aim for, as it provides the best results and gives you all the known keto benefits. Going higher is pointless (no extra benefits but a whole lot of additional work, self-control, and stress), but still not dangerous for most people. 

Very high ketosis: greater than 3.0 mmol/l 

Again, being in this range is pointless. Sometimes it may be an indicator that you’re not getting enough food, so consider reevaluating your diet.

KETOACIDOSIS: about 15.0 mmol/l and higher 

Basically, ketoacidosis is a state of uncontrolled, relentless, extremely high ketosis (30 times greater than the normal range, 10 times greater than optimal ketosis). Besides significantly elevated ketone levels, this state is also characterized by a severe lack of insulin and is often paired with extremely high blood glucose. This level of ketone bodies is extremely dangerous for anyone’s health and life. 

Most people have a hard time controlling themselves to reach optimal ketosis, now imagine how hard it would be to get into ketoacidosis. That isn’t something you do accidentally, at least not if your pancreas works properly. Why is that important? 

Ketone bodies are produced from fatty acids, but it’s insulin and glucagon that control this process. Both are produced in the pancreas. 

The main function of insulin is to get the glucose you get from carbs into the cells of your body, where it can be used for energy. Insulin also blocks fatty acids from being transformed into ketones, so that the body stays in the ”carb-fueled” state. To summarize, it decreases blood glucose and decreases ketone levels. The production and release of insulin are stimulated by increased blood glucose levels, like after eating carbs. 

Glucagon is the counterpart of insulin - it stimulates the release of fatty acids and increases production of ketones. The production and release of glucagon are stimulated by low insulin levels, just to keep everything in balance. Like when you’re in keto. 

So, insulin decreases ketones, glucagon boosts ketones, and both are controlled linked to blood glucose levels. This is how the interaction looks like in a healthy person: 

High blood glucose -> high insulin, low glucagon = body fueled by carbs; low ketone level 

Low blood glucose -> low insulin, high glucagon = body fueled by fats; high ketone levels 

However, healthy people cannot develop ketoacidosis on the keto diet because they will still have a good level of insulin - not enough to block nutritional ketosis, but just enough to prevent the excessive formation of ketones and development of ketoacidosis. 

So who’s at risk then? You’ve guessed it: people with impaired insulin production and/or severe hypoglycemia (low blood glucose). 

Namely diabetics, alcoholics, and people in a state of severe starvation.

Long story short, people with diabetes don’t have enough insulin to pump the glucose from the blood into the cells to be used as fuel. The body enters into ”survival mode” and starts producing ketones for energy: but there is no insulin to control their amount. 

So, diabetics have: 

- Low insulin (due to impaired production) 

- High glucagon (due to low insulin) 

Combined, these result in ABUSRD ketone levels, and that’s where the real problems begin. 

Ketones are acidic by nature (we’ll not go into deep chemistry here, don’t worry), so having too much of them drives the body into systemic acidosis. The latter is extremely dangerous and can easily result in death if untreated.

Chronic alcohol intake is known to severely deplete the body’s carb stores over time. Additionally, acute alcohol intake is known to cause hypoglycemia (low blood sugar). A healthy person would compensate this low blood sugar using some previously stored carbs like glycogen, but an alcoholic doesn’t have much of those (due to the chronic depletion) - so the state persists.

This leads to a dramatic decrease in insulin, a boost in glucagon, and results in a huge amount of ketones released into the blood. For a person who’s not adapted to keto, this is too much to use up effectively, so the ketones circulate freely and cause systemic acidosis.

Months of severe starvation eventually result in an exhaustion of nutrient stores and drastically impair insulin production. If the state persists, the same mechanism as during diabetes takes place: low insulin, high glucagon, a storm of ketones. 

Although the keto diet can be considered a specific form of carb-starvation, it still includes a certain amount of carbs per day - and a whole lot of other nutrients to provide the energy, vitamins, and minerals needed to promote health. That’s why SKA does not happen on keto.

So, just to summarize everything mentioned above. People with healthy pancreas don’t develop ketoacidosis for two main reasons: 

- They have a healthy rate of insulin production, which keeps the ketone levels in the safe range (thus excluding the risk of DKA) 

- Even on the keto diet, they still consume the daily amount of carbs needed to ensure healthy insulin production (thus excluding the risk of SKA) 

Basically, the only way for a healthy person to develop ketoacidosis on the keto diet is by becoming an avid alcoholic. 

So, just don’t drink too much - and you’re in the safe keto zone. Easy as that! :)