Can A Ketogenic Diet Cause Ketoacidosis?

The low-carbohydrate, high-fat ketogenic diet has recently been popularized in the press due to multiple health benefits such as weight loss and increased energy. In this diet, people  intentionally push themselves into a state of Ketosis and usually do not develop metabolic complications or illness unless put under certain circumstances such as stress and prolonged fasting. Despite the similarity in name, Ketosis and Ketoacidosis are two different things. Let's explore each one of them in detail.

What is a Keto Diet?

A ketogenic diet is a low-carb, high-fat diet. It is a protein-based diet that powers the body to consume fats instead of starches to produce energy. When your body is devoid of sufficient carbs to burn for energy, it starts burning fat, which results in ketone formation and is used to draw power for all the activities; this process is known as Ketosis.

Metabolic Pathways:

The body, in general, follows two metabolic pathways, namely, glycolysis and Ketosis. In the absence of sufficient carbohydrates, the body resorts to Ketosis in which it starts burning the fats stored in the body to gain energy.

Glycolysis:

• The body breaks down carbs into glucose, which can then enter your bloodstream. If glucose in your bloodstream and energy is relatively high, then your body will convert glucose into glycogen. 
• Glycogen is stored in your muscles and liver for later use.
• When carbs are scarce and glucose levels in the blood are low, your body will start converting glycogen back to glucose for energy. 

Ketosis:

• However, what happens if your body's glycogen stores start dropping down? Once you've depleted your glycogen stores, your body has to turn to ketone bodies for energy. 
• Our bodies are always producing small amounts of ketones. However, in a state of Ketosis, your body will boost the production of ketones from fat. This fat either comes from your food or already stored body fat. 
• Contrary to glucose, ketones that aren't used as a fuel source are not stored and are waste products. The kidneys filter them out of the blood, which is then excreted out from the body.

What can you eat while on Ketosis? 

Whole foods, such as eggs, lean meat, oily fish, low-carb veggies, and low-carb naturally grown sustainable products, like low-carb flours (almond, chickpea, etc.). When on a ketogenic dietary regimen, you cannot eat any processed or refined foods items. A keto diet is quite impressive compared to other diets with regards to demonstrated weight reduction benefits. It has also appeared to decrease cancerous tumours’ danger, treat cognitive impairments like Dementia, Depression, Alzheimer's disease, and control diabetes and insulin levels. 

Ketosis versus Ketoacidosis: What's the difference?

Ketosis:

Nutritional Ketosis occurs when the body starts burning fat instead of glucose—inducing Ketosis aims for a ketogenic diet or "keto" diet. Ketosis may cause bad breath. Ketones are broken down for use as a fuel source, and acetone is one of the by-products excreted from the body in the urine and breath, which may smell fruity, but not in the right way. Having a diet low in carbohydrates is a risk factor for Ketosis. This may be purposeful, for instance, as a weight-loss strategy. People on restrictive diets for people with an eating disorder may be at a higher risk for Ketosis.

Ketoacidosis:

Ketoacidosis occurs when the body produces dangerously high levels of ketones, and it is often a complication of type 1 diabetes. Ketoacidosis refers to diabetic Ketoacidosis and is a complication of type 1 diabetes. It's a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change internal organs' normal functioning like your liver and kidneys. It would help if you got prompt treatment. Ketoacidosis symptoms include extreme thirst, frequent urination, dehydration, nausea, vomiting, stomach pain, tiredness, breath that smells fruity, shortness of breath, and feelings of confusion. The symptoms of diabetic ketoacidosis include:

• high blood glucose levels
• rising levels of ketones in the urine
• thirst and frequent urination
• exhaustion
• dry or flushed skin

How can Ketoacidosis be prevented?

Risk factors for Ketoacidosis:

• This Ketosis can develop into overt Ketoacidosis in certain conditions, causing a decrease in pH and serum bicarbonate level, leading to severe illness and hospitalization. 
• While Ketoacidosis is most frequently associated with diabetes mellitus type I and alcoholism, starvation, particularly in individuals following low-carbohydrate and low-calorie diets, should not be overlooked as a possible reason.
• Malnutrition and inadequate dietary intake are ways to enter a state of starvation that may result in Ketoacidosis. 
• Gastric banding has also been associated with a risk of starvation ketoacidosis. Besides Ketoacidosis, the ketogenic diet may lead to electrolyte abnormalities, hypoglycaemia, acute pancreatitis, and dyslipidemia.

People with diabetes can reduce their risk of Ketoacidosis by:

• checking blood glucose levels routinely and notifying a doctor if they are not under the control
• testing the pee for ketones if blood glucose levels are over 240 mg/dl 
• keeping away from workout sessions if ketones are available in the pee and blood glucose levels are high 
• taking insulin as per the medical treatment plan 
• adhering to a fortifying and adjusted eating regimen 
• abstaining from skipping suppers

Ketosis generally isn't dangerous. It's usually related to a planned, low-carbohydrate diet or a transient condition related to diet. The first step after recovery from diabetic Ketoacidosis is to review your recommended diet and insulin management program with your doctor. Make sure you understand what you have to do to keep diabetes under control. Talk to your doctor if you're unclear about anything.

How can Ketoacidosis be treated? 

• Diabetic Ketoacidosis is a health-related crisis that can advance rapidly, yet it is likewise profoundly treatable. 
• Specialists, for the most part, treat individuals with diabetic Ketoacidosis in a clinic or trauma center. Treatment includes insulin treatment typically along with liquid and electrolyte substitution. 
• The vast majority of diabetic Ketoacidosis should remain at the emergency clinic for observation. As blood ketone levels get back to business as usual, the specialist may prescribe extra testing to decide if an individual has other danger factors for Ketoacidosis.

Bottom-Line

Although the ketogenic diet with or without periods of fasting might yield short-term weight loss, it has potentially dangerous side effects, including Ketoacidosis. It is recommended that people, especially those with comorbidities such as diabetes mellitus type II, consult their physicians before initiating this diet. Clinicians must keep a broad differential when evaluating acute metabolic acidosis.