Ketones: friend or foe?

This totally befuddled me when I heard this on a recent episode of one of my favorite programs, Dr. G: Medical Examiner. She examined the cause of death of a woman who turned out to be diabetic and without her medication. The final cause of death: diabetic ketoacidosis, a condition that results when someone's blood sugar is so high that the ketones produced eventually become toxic. The way to check is by looking for the presence and amount of ketones. My problem occurred with the following statement:

...a high level of a toxic substance called ketones...which turn the blood acidic. - narrator on Dr. G: Medical Examiner program

That would be all well and good, but it's only partly true. Ketones are also produced when a person is on a very low-carbohydrate diet. There is a difference between benign dietary ketosis and ketoacidosis. The difference is blood sugar. Someone is ketosis due to restricting carbohydrates will have normal blood sugar. Someone in ketoacidosis has blood sugar that is sky high and has certainly been eating carbohydrates to achieve that. It is impossible to get ketoacidosis while restricting carbs. They are complete opposite conditions.

From Wikipedia.org:
Ketoacidosis is a type of metabolic acidosis which is caused by high concentrations of keto acids, formed by the deamination of amino acids. This is most common in untreated type 1 diabetes mellitus...Ketoacidosis should not be confused with ketosis, which is one of the body's normal processes for the metabolism of body fat. In ketoacidosis, the accumulation of keto acids is so severe that the pH of the blood is thrown off.

Ketosis is different:
Ketosis is a stage in metabolism occurring when the liver has been depleted of stored glycogen...Energy from fat is mobilized to the liver and used to synthesize glucose (a process called gluconeogenesis)... Ketone bodies are also produced...and are burned throughout the body...Deliberately induced ketosis through a low-carbohydrate diet has been used to treat medical conditions (such as) epilepsy (and) obesity.

As you can see, in the presence of enough calories from protein and fat, this is not dangerous and is simply an alternate pathway for the body to meet its energy needs when there is not enough glucose from carbohydrates. Our bodies are not stupid and can deal with the restriction of carbohydrates indefinitely. Restricting protein and/or fat is another matter, as those are necessary to not just health, but life itself.

I understand the program talked about a specifically diabetic woman who clearly died of ketoacidosis, but to say that ketones are toxic without further explanation can give people the wrong idea - ketones are toxic, the body produces ketones on the Atkins diet, therefore, the Atkins diet is toxic. It doesn't take a huge leap of logic to make that connection, even if the connection is totally wrong!

Even Dr. Atkins seemed to sense this was a losing battle of words, and began using the word "lipolysis" instead of "ketosis." Lipolysis is simply defined as (t)he breakdown of fat stored in fat cells... Ketones are produced, leading to the process of ketosis in the case where insufficient carbohydrates are present in the diet.

Technorati tagged: atkins, diet, atkins diet, low carb, weight loss, health, health and wellness, ketoacidosis, ketosis, diabetes, fat

Picture of Dr. G courtesy Discovery Health.