In last week’s blog article, we addressed some common myths about ketogenic diets. There’s no shortage of these to discuss, so today let’s look at three more, including concern regarding the potential for ketoacidosis.
1. Keto is expensive.
To the contrary, some people find that their food budget decreases after going keto. As stated above, keto doesn’t have to be high-tech to be effective. People can get their desired results without buying anything they weren’t buying before. Despite the valiant marketing efforts behind them, neither exogenous ketones nor MCT oil are required (although these may be helpful in specific situations). Individuals who adopt a ketogenic diet were likely buying some combination of meats, vegetables, eggs, berries, dairy products, and nuts and seeds on their usual higher-carb diet. Those are keto-compliant, and when someone cuts carbs, several things come off the shopping list. Money no longer needs to be spent on bread, pasta, bagels, rice, beans, cereal, and other foods high in starch or sugar.
2. You have to eat a lot of meat.
Here again social media can be misleading. Steaks topped with steaks with a side of bun-less burger patties might be a common sight on some keto accounts, but this way of eating doesn’t have to be meat-heavy. Keto dieters can get quality proteins and nutrients from poultry, seafood, and eggs if they prefer. It’s even possible to do keto as a vegetarian and get protein from eggs and dairy products. (A fully plant-based keto diet is also possible, although use of protein powders such as pea or rice or synthetic meat products made from these may be needed, since vegan protein sources—such as beans—are typically high in carbohydrates.)
3. Ketosis is dangerous.
One of the biggest misconceptions standing in the way of ketogenic diets being more widely recommended by healthcare professionals is confusion between nutritional ketosis and diabetic ketoacidosis (DKA). These are not the same things. There are three major differences between ketoacidosis and nutritional ketosis:
- In nutritional ketosis, the blood ketone level stays within a safe range. In the metabolic state induced by a keto diet, blood ketone levels generally stay below 4.0-5.0 mmol/L. (And most people rarely see levels this high unless they’re fasting.) There is no formally agreed upon range of serum ketone concentration (β-hydroxybutyrate) that defines nutritional ketosis, but in their book, The Art and Science of Low Carbohydrate Living, well-known keto researchers Stephen Phinney, MD, PhD, and Jeff Volek, PhD, posit that a typical range is 0.5 to 5.0 mmol/L. This is a world apart from DKA, in which blood ketones may exceed 20 mmol/L—more than ten times the level seen in dietary ketosis.
- In nutritional ketosis, the blood does not become acidic. Because the blood ketone level does not become excessive, blood pH stays within a safe range and there is no acidosis. Drs. Phinney and Volek wrote, “There is a persistent myth that nutritional ketosis results in clinically significant acidosis, despite overwhelming evidence to the contrary. Yes, the modest rise in serum ketones will shift serum chemistries a bit toward the acid end, but blood pH and serum bicarbonate values almost always remain well within the normal range. […] Put another way, the buffering capacity of otherwise healthy humans is able to compensate across the full range of nutritional ketosis without any significant metabolic disturbance.”
- In nutritional ketosis, blood glucose is normal. In DKA it isn’t just ketones that are dramatically elevated, but also typically blood glucose—as high as 250-600 mg/dL. Some researchers have even defined DKA as the presence of three things: metabolic acidosis, high blood glucose, and ketones in the blood and urine. In the nutritional ketosis that results from a keto diet, at least two of these don’t apply—acidosis and high blood glucose. Ketones will be present in the blood and urine, but at levels far lower than those seen in DKA. There have been reports of euglycemic ketoacidosis—ketoacidosis in the presence of normal blood glucose, and/or in people who don’t have diabetes. It’s critical to know, however, that this doesn’t occur spontaneously with no cause, and keto diets, by themselves, don’t bring this on. One of the most common causes of euglycemic ketoacidosis is use of sodium glucose co-transporter-2 inhibitors (SGLT-2i), used for both type 2 and type 1 diabetes. Most of the rare instances of ketoacidosis among people following low-carb or keto diets have occurred in people using these drugs for diabetes—acidosis was not brought on by the diet itself.
When concerns are addressed and fears allayed, people may feel more confident in giving keto a try. It’s certainly not the only way to lose weight or improve health, but it has an impressive track record for both.
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