Is ketosis dangerous?

So is Ketosis dangerous? I’ve received this question a lot from those just starting out.

The short answer, for most people, is not at all.

Suffice it to say that practically every one of us has been in some degree of ketosis—many pregnant women experience mild ketosis and human newborn infants are born in a state of ketosis and stay in ketosis as long as he/she is exclusively breast-fed.

If you have heard this from a healthcare professional it would certainly be in their best interest (as well as yours) to know the critical difference between ketosis and diabetic ketoacidosis, often referred to as DKA. Simply put, nutritional ketosis, is a natural and benign metabolic state with evolutionary origins and implications. Meaning that, as a form of survival, our bodies have been able to adapt to periods of ‘feast vs famine” by utilizing ketone bodies, which are produced by the liver from both fats and proteins (amino acids), as an energy source. As our bodies are unable to store more than 1-2 days worth of glucose, our body has developed a back-up ‘hybrid’ energy system, providing us with an alternative source to fuel our cells, including, very importantly, our brain cells.

It is essential for anyone considering a ketogenic diet to understand that our brain can function with ketones—in addition to glucose. It is mind-boggling that, in this ‘information age’ there still are a large number of health care providers that are unaware of this basic physiological fact.

If we hadn’t had this ‘back-up’ form of energy known as ketone bodies, humans would never have evolved as a species.

Nutritional ketosis (commonly referred to being within a range of ~0.5 to 3.0 mOsm/L), which describes our body’s ability to produce ketones for energy, is fundamental for our survival. In addition to pregnant woman and newborn infants, anyone who has fasted for several hours, such as between dinner and breakfast the following morning, is in a state of mild ketosis. Don’t get excited just yet though—this doesn’t mean you’re successfully using fat and ketones for fuel!

Bottom Line

Bottom line, nutritional ketosis, associated with a properly formulated ketogenic diet, is not dangerous because it is regulated by insulin within our body. On the other hand, a person who is in diabetic ketoacidosis is not producing any insulin, so there is no ‘feedback-type’ regulation taking place. Their body continues to produce more and more ketones and their ketone levels continue to rise from a lack of insulin. The resulting markedly elevated levels of ketones (up to 25 mOsm/liter) create a severe metabolic and pH imbalance. At this dangerously high level of ketosis, the individual is critically ill.

👑 Mary

Mary Paley

Fearless Dietitian; 30+ years as a professional dietitian; Master’s Degree in Nutrition and Dietetics at the MGH Institute of Health Professions; Lead research dietitian for several major pharmaceutical companies; Currently focused on health and wellness and the benefits of ketogenic diets for both obesity and diabetes management. MS, RDN, CDE, LD/N

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