Why Benign Dietary Ketosis Is NOT Dangerous
By Sonya Tilley, CarbSmart Contributor
Here we go
Every human endeavor, it seems, has got to have its very own set of buzzwords. Why? I think it's because we like to think that we are in a secret club, like the ones we had in elementary school. Only certain kids knew the secret password or the secret handshake, and we felt really smug around those who did not share the secret. Well, low carbohydrate dieting has its buzzwords, some self-explanatory, and some downright scary. In the scary group, the scariest for a diabetic are ketones and its friend ketosis.
Unless you are diabetic, you cannot understand the fear that is stricken into the heart of a diabetic at the sound of the word "ketones." High blood sugar is bad and can become deadly in the long run. Everyone knows this. But, high blood sugar is, to a diabetic, a passing thing. It's something you can correct as long as it doesn't get too high. Ketones, however, are a whole 'nother matter.
When you become diabetic, you go through an education period, especially if you have to take insulin. I started my diabetic career with gestational diabetes when I was carrying my fourth, and final, baby. This condition appears, as the name implies, during pregnancy and is temporary. When the baby is born, the diabetes usually goes away. But it is a signal that the you will probably be diabetic in the future.
The specialist I was sent to put me in the hospital for three days to educate me about the care of my diabetic condition. I had to check my blood sugar four times a day and my results were compared to the lab's results through samples drawn from my blood. By the end of the three days, my readings were a reasonable distance from the lab's readings.
I was insulin dependent immediately. A nurse taught me how to give myself an insulin injection. It is amazing how like giving an injection on human flesh is giving one to an orange. Even the orange's rind mimicked my cellulite, a fact with which I was not unduly amused at the time. By the end of the three days, I was able to draw my insulin into the syringe without air bubbles, and inject it into my flesh with alacrity. Well, maybe not "with alacrity," but I could do it.
Then they told me about ketones. What they told me was that I didn't want them. As the doctor explained to me the three possible readings on the ketone stick, I translated them in my mind thus:
- Small = You're in a little trouble, here. Take a couple units of fast-acting insulin, drink a glass of water every hour and check it again in 3 hours. If blood glucose is still high and you are still throwing ketones, better call the doc.
- Medium = Why the hell are you checking this again? You should be in the doctor's office by now.
- Large = Are you NUTS!? You're gonna die! Get to the nearest emergency room, STAT!
The bottom line was: if you are throwing ketones (ketones are appearing in your urine) beyond trace or small, there's nothing you can do about it yourself. You need help. Go to the doctor or an emergency room. This condition can kill you pretty fast. Okay. I get it. High sugar is bad; high ketones are very, very bad.
And, now comes the low carbohydrate diet. A doctor is telling me I WANT to throw ketones. WHAT? You can't be serious! He was serious. It took a great deal of study on my part to get it straight in my mind why this was okay.
The best place to start in explaining the difference is to get an understanding of what a ketone is. Your body breaks down carbohydrates to use as fuel. This fuel is called glucose. Your body can also break down fat or muscle to use as fuel. This fuel is called ketones. It's almost too easy, isn't it?
Now, for the tricky part.
If your blood glucose is normal and you are throwing ketones, this is okay. It means that your body has no available glucose to use as fuel and must dip into its store of ketones to use as fuel. This condition is called either ketosis or benign dietary ketosis (BDK). The symptoms, if you could even call them that, are lack of hunger, acetone breath and an overall sense of well-being. The ketone stick could read anything from trace to large.
However, if your blood glucose is high (over 240) and you are throwing ketones, this can be bad. In the absence of insulin, your body cannot use the glucose in your blood for fuel. It will begin to break down the fat or muscle in your body for fuel. This produces ketones. These ketones will spill over into your kidneys and trigger urine production, which will dehydrate you very fast. The combination of high blood glucose, throwing ketones, and dehydration is called diabetic ketoacidosis (DKA). Far from having a sense of well-being, you will almost certainly know something is very wrong. In addition to the loss of hunger and acetone breath which characterize BDK, you will experience some or all of these symptoms: extreme thirst, stomach pain, nausea, vomiting, dry mouth, dry and flushed skin, fatigue, fever, drowsiness, frequent urination, and labored breathing. If DKA persists untreated, it can result in coma or death. Over 1,700 insulin dependent diabetics, mostly children, die every year of DKA.* This condition is not to be trifled with!
So, where does that leave us? In short, if your blood glucose is controlled and you are throwing ketones as a result of low carbohydrate dieting, you have no problem and the amount of ketones is irrelevant. If your blood glucose is not controlled and you are throwing ketones, you need the advice of a physician.
*Signs, symptoms and statistics concerning DKA taken from an article by Michael Castleman called High Blood Glucose With Ketones
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