It was my long ride this morning. In fact my longest in this incarnation of my cycling career. 80 km. Thirty years ago I would have made sure I ate a good breakfast and would have taken a banana or two and some other snacks perhaps. This morning was devoid of breakfast and there were no snacks en route. I just took plenty of fat, all stored internally and it will be a long time before that runs out!
After my low carb lunch my ketones were ~6mm/litre. My fat cells are throwing ketones around like the missus spends my money, my muscle cells by comparison are as tight as Mr Scrooge. (Forgive me Gayle I know you are very sensible with our money and I’m the one that throws it around).
The reason that fat cells waste energy when ketones are present whilst muscle cells, including heart muscle, are very efficient are complex. Dr Bikman explains this as clearly as is humanly possible …
He has a book coming out in a few months entitled Why We Get Sick. Spoiler – it’s because of insulin resistance but it will be very interesting to read what he has to say about that and I expect it will be remarkably lucid.
In my recent reading I came across a paper in the medical literature than mentioned ketosis and followed that in brackets with ketoacidosis as though the two were synonymous. How dumb is that I thought and moved on. Now I can’t find it again and dumb is not a useful search term – way too many results.
On a carb restricted diet the body produces a group of chemicals called ketones, hence the keto in keto diet. Ketones are excellent fuel for the brain and heart in the absence of normal amounts of glucose. Our ancestors went through lean times it was ketones that got them through. Nutritional ketosis is a normal response to fasting and carbohydrate restriction.
Ketoacidosis on the other hand is a medical emergency. It occurs mostly in people with type 1 diabetes mellitus. Ketones are present at more than ten times the quantity found in dietary ketosis along with very high blood sugar. The combination causes a pH change in the blood which will bring liver and kidney function into a downward spiral. This is sometimes the way that diabetics first present and remains a risk if patients fail to manage their insulin properly or hit the booze. Death is the likely outcome in the absence of prompt treatment.
Type 1 diabetes occurs because the islet cells in the pancreas that make insulin are snuffed out by the body’s own antibodies. If there are still some functional islet cells ketoacidosis is less likely.
What stops the enthusiastic keto dieter from slipping into ketoacidosis? Two things. On a low carb diet blood sugar is not through the roof. Secondly functional islet cells mean that insulin is available when needed. Insulin doesn’t only regulate glucose it can also turn down the production of ketones. Ketosis is a normal functional response so it is hardly surprising that it is well regulated.
My low carb diet is rolling along quite nicely. A reduction of five inches off my circumference is evidence enough that I am maintaining an effective level of ketosis but it is easy to check. Ketones can be measured in blood, breath or urine. There is a good article on the available technologies at Diet Doctor. Given that I have no interest in checking every day for the rest of my life I opted for the low tech urine sticks. The brand available at the local pharmacy is Keto-Diastix which measures glucose and ketones and gives a numerical result. I am pleased to say that glucose has been absent from my urine, as it should be, whilst ketones have ranged from 1.5 to 4.0 mm/litre.
I have departed the ranks of the obese and I am now proudly overweight!