Diabetic ketoacidosis occurs when ketone levels become too high and poison the body. This condition is more common in people with type 1 diabetes because their bodies don’t make insulin. In the event that their ketone level rises, their bodies are unable to produce insulin to slow down this production. If left untreated, this condition can lead to a diabetic coma or death.
There are many misconceptions about ketosis. The most common is mixing it up with ketoacidosis – a rare and dangerous medical condition that mostly happen to people with type 1 diabetes if they don’t take insulin. Even some health care professionals tend to mix up these two situations somewhat, perhaps due to the similar names and a lack of knowledge about the distinct differences.
Moreover, in the above study of Sumithran et al. (2013), ketosis maintains post-prandial secretion of CCK as previously demonstrated by other researchers (Chearskul et al., 2008). Note that the orexigenic effect of BHB is blocked by transection of the common hepatic branch of the vagus nerve (Langhans et al., 1985). The hepatic branch contains fibers from the proximal small intestine, stomach and pancreas, and is sensitive to CCK (Horn and Friedman, 2004); ghrelin signals to brain are also transmitted via vagus nerve (Habara et al., 2014). Thus, the effects of ketosis on these two appetite-related hormones could be one of the many factors related to the effects of such nutritional regimen on food control.
Moreover, recent studies show that the Inuit have evolved a number of rare genetic adaptations that make them especially well suited to eat large amounts of omega-3 fat. And earlier studies showed that the Inuit have a very high frequency—68% to 81% in certain arctic coastal populations—of an extremely rare autosomal recessive mutation of the CPT1A gene—a key regulator of mitochondrial long-chain fatty-acid oxidation—which results in a rare metabolic disorder known as carnitine palmitoyltransferase 1A (CPT1A) deficiency and promotes hypoketotic hypoglycemia—low levels of ketones and low blood sugar. The condition presents symptoms of a fatty acid and ketogenesis disorder. However, it appears highly beneficial to the Inuit as it shunts free fatty acids away from liver cells to brown fat, for thermogenesis. Thus the mutation may help the Inuit stay warm by preferentially burning fatty acids for heat in brown fat cells. In addition to promoting low ketone levels, this disorder also typically results in hepatic encephalopathy (enlarged liver) and high infant mortality. Inuit have been observed to have enlarged livers with an increased capacity for gluconeogenesis, and have greater capacity for excreting urea to remove ammonia, a toxic byproduct of protein breakdown. Ethnographic texts have documented the Inuit's customary habit of snacking frequently  and this may well be a direct consequence of their high prevalence of the CPT1A mutation as fasting, even for several hours, can be deleterious for individuals with that allele, particularly during strenuous exercise. The high frequency of the CPT1A mutation in the Inuit therefore suggests that it is an important adaptation to their low carbohydrate diet and their extreme environment.
You could certainly use butter, but I’m not sure how that would be more appealing to him if he thinks fat is the enemy. It’s tough to get heart patients to go against the “conventional wisdom” we’ve been fed for so many decades. They have a right to be fearful, but I would suggest offering him research that shows fat isn’t the enemy at all. For what it’s worth, after 6 months of heavy keto (my testing period, though I’ve been keto longer than that) with lots of fats, including butter, bacon, and avocados, my cholesterol and triglycerides dropped! And I’m not the only person to have those same results. Best of luck!
Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?
As ketones levels rise in the body, the cells of heart, brain and muscles begin to use them for fuel. And once the body is using ketones as a main fuel source, there are some profound and positive health effects. Ketogenic diets are very effective for correcting cellular metabolic dysfunction. The high blood sugar of diabetes gets reversed, the seizures of epilepsy can be calmed, Alzheimers and Parkinsons symptoms are alleviated, extra weight can be lost, joint pain is diminished and so on. In other words, the ketogenic diet is not a “fad.” It is a potent regulator of metabolic derangement, and when formulated and implemented correctly, it can be extremely effective at reversing all kinds of health problems. (See this paper.)
A review of multiple studies in the journal Nutrients found that ketogenic diets are connected to significant reductions in total cholesterol, increases in “good” HDL cholesterol levels, dips in triglycerides levels and decreases in “bad” LDL cholesterol; there are questions as to whether diets high in saturated fat negate these benefits. The same paper reports that a ketogenic may slightly reduce blood pressure, but science is still very scant on this point.
You’ll need to focus on titrating your insulin. Given the low amount of carbs in the Keto diet, I suggest you take detailed notes on how your blood sugar reacts to protein and fats. That way you can determine how much insulin to take with food. As for your basal, if you consistently go high/low without any bolus on board it might be a good idea to revisit your basal rates
Most obese people become so adept at releasing insulin that their blood is never really free of it and they're never able to use up their fat stores. By primarily burning fat instead of carbohydrates, lipolysis breaks the cycle of excess insulin and resultant stored fat. So by following a fat containing, controlled carbohydrate regimen, you bypass the process of converting large amounts of carbohydrate into glucose. When your carbohydrate intake drops low enough to induce fat burning, abnormal insulin levels return to normal - perhaps for the first time in years or decades.
The first cellular fuel is glucose, which is commonly known as blood sugar. Glucose is a product of the starches and sugars (carbohydrates) and protein in our diet. This fuel system is necessary, but it has a limitation. The human body can only store about 1000-1600 calories of glucose in the form of glycogen in our muscles and liver. The amounts stored depend on how much muscle mass is available. Men will be able to store more because they have a greater muscle mass. Since most people use up about 2000 calories a day just being and doing normal stuff, you can see that if the human body depended on only sugar to fuel itself, and food weren’t available for more than a day, the body would run out of energy. Not good for continuing life.
Because people with type 2 diabetes are at an increased risk for cardiovascular disease, there’s a specific concern that the saturated fat in the diet may drive up LDL, or “bad,” cholesterol levels, and further increase the odds of heart problems. If you have type 2 diabetes, talk to your doctor before attempting a ketogenic diet. They may recommend a different weight-loss diet for you, like a reduced-calorie diet. Those with epilepsy should also consult their doctor before using this as part of their treatment plan.