Q. Isn’t Ketosis Dangerous? (Ketosis vs. Ketoacidosis)

A. Ketosis is a normal metabolic state that the body switches to when carbohydrate intake is low. Remember, humans are a “dual fuel” system. The ability to burn stored fat and thus enter ketosis allowed us to survive when carbohydrate food was scarce. In cold climates, carbohydrates were not  available much of the year. Meat and animal fat were the primary food sources during Winter months and still are for some populations like the Eskimos.

The fallacy that ketosis is dangerous comes from the confusion between diet-caused ketosis and ketoacidosis, a life-threatening state that occurs primarily in type I diabetes. These two metabolic states are very different and should not be confused.

Ketoacidosis is a severe and potentially life-threatening state most often seen in type I diabetes. In diabetic ketoacidosis, severe insulin deficiency causes ketone bodies to rise precipitously, often exceeding 25 mM in blood. This level of ketosis does not occur in individuals with normal pancreatic function, even during starvation. Non-diabetic ketoacidosis can also occur as a result of alcohol or drug-induced states, exuberant lactation and extreme high thyroid function.      

In ketoacidosis, the blood buffering systems are stressed until they fail to function. The combination of extremely high ketone levels and loss of blood buffering results in severe acidosis. In addition, severe water loss caused by high blood sugars and extremely high ketone levels creates a perfect storm of life-threatening potential.

The ketone levels seen in ketoacidosis exceed 15 mmol.  This is quite high. Non-diabetic people cannot achieve these levels because of a protective feedback loop in the body.

Ketosis Ketoacidosis
● Caused by diet ● Caused by insulin deficiency
● Blood ketone levels: 2-7 mM ● Blood ketone levels:  >15 mM
● NO acidosis ● Acidosis from stress to blood buffering system
● Low blood sugar ● High blood sugar
● Insulin feedback: prevents higher ketone levels ● NO insulin feedback: ketone levels uncontrolled
● Mild sodium and potassium loss ● Extreme sodium and potassium loss



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