Ketogenic Diets and Ketosis (Part 2)

To refresh your memory from my last post, ketosis is the metabolic state in which some to all of the energy a body needs is derived from ketone bodies in the blood, as opposed to glycolysis where blood glucose is used to provide energy.  People often confuse diabetic ketoacidosis (DKA), which is a dangerous medical condition, with ketosis, which is a desirable state where your body is using your fat stores as fuel.  Ketoacidosis is a condition that can occur in Type I Diabetes and requires a triad of findings:  1.  high blood ketones (10-20 mmol/L or higher), 2. high blood glucose or sugars (often in the 300-500s) and 3. high blood acidity, or low blood pH.  Ketoacidosis requires hospitalization and medical treatment by a doctor, and can even be life threatening.  When you eat a low carb, moderate protein, high fat diet (a ketogenic diet), then your insulin and glycogen levels drop enough that your liver starts making ketone bodies from the breakdown of fat.  This is ketosis, and is characterized by blood ketone bodies (typically 0.5-3 mmol/L), low blood glucose, and a normal blood acidity.  So really the only thing in common between ketosis and ketoacidosis is blood ketones, and the levels of ketones in DKA is much higher than in ketosis.

How can you get into ketosis?  The best way to get into ketosis is to eat a ketogenic diet, as described in my earlier post.  When you are first starting to eat like this, the most painful and most important thing, is to keep your carbs as low as possible.  I ate between 20-40 grams of net carbohydrates a day when I was starting.  This allows your insulin levels to fall and your glycogen stores to get depleted.  The first couple weeks are critical, can be difficult, and the best way to go about it is to jump right in.  During this time I kept track of every single thing I ate so I knew exactly how many grams of carbohydrate I was consuming, and I also avoided all alcohol.  One common pitfall during this time is to eat too much protein, while you are cutting back on carbs.  If you consume too much protein then your insulin levels will rise,  and it can keep you out of ketosis.  It is best to focus on high quality saturated fats as the majority of your diet which will make you feel full, and help get you into ketosis.   Fasting is another thing you can do to help get into ketosis.  During fasting insulin levels and blood sugars drop very low and it forces your body to start burning fat for fuel.  This pressures your body to start manufacturing the different machinery (enzymes, transport proteins, etc…) that allow it to utilize your fat stores.  So, once you train your body to get into ketosis, if you fast you do not need to be as strict on the carbohydrate restriction to stay in ketosis since you have longer periods of low insulin.  A final thing that helps you get into ketosis is fasted exercise.  This is low intensity cardio that can help your body switch over to ketosis by also pressuring it to use fat for fuel.

Another common question i get is “How do I know if I am in ketosis?”.  There are several ways to have a good idea, but really only one way to know for sure.  The way to know for sure is to get a ketone meter of some type that will test you for ketones.  The most common and least expensive is the urine strips.  These test for acetoacetate (one of three ketone bodies) in the urine.  There are a couple of problems with these strips however.  One is that the ketone body they measure is not the one the body is using the most for energy, that one is Beta-hydrxybutyrate or βHB.  The strips are not as sensitive either, and so you must have a large amount of ketones in your urine before they show up positive.  This is probably because they are meant for diabetics who are worried about DKA.  The second ketone measurement tool is the blood ketone meter.  This measures βHB and is very sensitive.  It does require that you buy a meter and strips, which can be kind of expensive ($30 for the meter and about $0.50 per strip is what I pay), but gives you fast and accurate results.  This is the method I used when I was starting my ketogenic journey.  The third way to measure ketones is a breath test, which is a new technology.  The breath test measures acetate which we exhale when in ketosis.  This requires a big financial investment in the beginning, but then there is nothing else to buy like strips.  It is very sensitive, but acetone is also not the most important ketone body for energy utilization. It is important to check ketone levels more frequently when you’re first starting to get into ketosis, and after a while you can tell by how you feel that you are in ketosis.  you shouldn’t be surprised if it takes a couple of weeks to get into ketosis, after all you have spent most of your life in the glycolytic pathway.  The changes that need to happen do not occur overnight, but over time.  Stick with it, it is so very worth it!

The thing that surprised me the most about ketosis is what a fragile state it is.  A big carbo bingeing night was enough to keep me out of ketosis for days.  When I first started, I was also surprised that the more time you spend in ketosis, the easier it is for your body to get back into ketosis when you fall out of it.  The big carbo filled nights that would keep me out of ketosis for days at the beginning would now only keep me out of ketosis for a day.

Here is the recipe for the best Brussel Sprouts you’ll ever eat!!

Yummy Keto Brussel Sprouts

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