Intermittent Fasting Beats Traditional Diets and Even Chronic Calorie Restriction for Weight Loss and Other Health Benefits. Ketones; Normal: There are no ketones in your blood or urine. Abnormal: Ketones are present in your blood or urine. Getting to Know Ketones - Diabetes Self- Management. People with diabetes, particularly those with Type 1 diabetes, have been at least vaguely aware of the word ketones for a long time. With the recent resurgence of popular interest in low- carbohydrate diets, however, just about everyone seems to be talking about ketones these days. But does anyone really know what ketones are? Are they a danger to your health (as in diabetic ketoacidosis), or a sign that you have lowered your carbohydrate intake enough to cause weight loss (as some people who follow low- carbohydrate diets believe)? What are ketones? Ketones are end- products of fat metabolism in the body. That is, they are formed when fat is burned for energy by the muscles. Chemically, they are acids known as ketone bodies, and there are three types: beta- hydroxybutyric acid, aceto- acetic acid, and acetone. But you don’t have to be a chemist to understand what role they play in the body. To get to know ketones, it’s helpful to understand how your body burns fuel. A simple analogy is that of an automobile. For a car engine to run, the engine must burn fuel (gasoline), and when the fuel is burned, exhaust (carbon monoxide) is created. The carbon monoxide is the end- product of gasoline combustion. Your body also has an engine that must burn fuel to operate. The engine is muscle, and the fuel is fat, carbohydrate (glucose), and, in certain conditions, protein. When fat is burned, the “exhaust” is ketones, and when glucose is burned, the “exhaust” is lactic acid. Fat is more desirable as a fuel than glucose because there are more calories in a gram of fat (9 calories per gram) than there are in a gram of glucose (4 calories per gram), so you get more energy per gram of fat burned. In a sense, you could call fat a high- test fuel. But there is one catch to burning fat: To burn it efficiently, with little “exhaust,” you have to burn glucose at the same time. If you don’t have glucose available for fuel (because you are on a low- carbohydrate diet, for example), you will form ketones when your muscles burn fat. For most people, the ketones that form as a normal product of fat burning and weight loss are nothing to be concerned about because they are simply burned for energy by the body, and any excess are passed out of the body in the urine. In fact, while the brain normally uses glucose for energy, during exercise — and particularly during long- distance events like marathons, when glucose reserves may drop very low — the brain can use ketones for energy. Your liver makes extra ketones when glucose reserves are low so that your brain has enough energy. For people with Type 1 diabetes, however, having measurable amounts of ketones in the urine or blood is cause for concern. Ketones in a person with Type 1 diabetes may be a sign that his diabetes is out of control, he is ill or has an infection, or he is under extreme stress. Because above- normal levels of ketones in the blood can lead to diabetic ketoacidosis, a life- threatening condition, people with Type 1 diabetes who have measurable ketones in their blood or urine should speak with their diabetes educator or doctor promptly. Low- carbohydrate diets. Low- carbohydrate diets are sometimes called “ketotic” diets because they cause the body to burn mostly fat for energy (since the intake of carbohydrate is so low), which in turn causes the formation of ketones. Some people who follow low- carbohydrate diets periodically test their urine for ketones to see if fat- burning is indeed taking place. However, people who are losing weight on any diet might have a trace of ketones in their urine since a person who is losing weight is almost certainly burning and losing fat. With all the talk of ketones, some people have the mistaken impression that ketones are a sort of magic bullet that melt fat from the body, no matter how much a person eats. That’s simply not the case. Ketones are only by- products of the metabolism of fat and are markers that show that you are burning fat. They have no active role in burning fat or weight loss. In fact, ketone levels in people who are on low- carbohydrate diets are just barely above baseline, indicating they have no role in producing weight loss. The reason people lose weight on low- carbohydrate diets is not because of ketones; it’s because they have cut out a large food group from what they eat, and as a result, they end up eating fewer calories. Another unproven belief about both ketones and low- carbohydrate diets is that they suppress appetite, and that’s why people lose weight. Some scientists believe that the excess fat a person eats while on a low- carbohydrate diet has a satiating effect, causing people to eat less. Other experts believe that an elevated level of ketones causes a decrease in appetite, while still others believe that a high protein intake suppresses appetite. There are some studies in rats to suggest that elevated levels of protein during low- carbohydrate diets can cause a decrease in appetite, but so far, research on the effect of ketones and fat on appetite is inconclusive. The jury is still out on the long- term safety and effectiveness of diets that are low in carbohydrates for the general population, although some nephrologists link a growing incidence of kidney stones to high- protein diets. According to Joslin Diabetes Center, as much as 4. Type 1 diabets and 2. Type 2 diabetes have some form of kidney disease. You may find it easier to control your blood glucose if you severely restrict your carbohydrate intake, but keep in mind that even in people without kidney disease, no one knows the effects of a high- protein diet on the kidneys over the long term. If you’re considering a low- carbohydrate, high- protein diet for weight loss or blood glucose control, check with your doctor or diabetes educator first. Exercise and ketones. During exercise, both fat and glucose are burned for fuel by the muscles. If your glucose stores are low, fat will be your body’s primary fuel. If you exercise and burn lots of fat without glucose, you will make ketones.
People who are very lean and efficient at burning fat, people who are losing weight, and people who do lots of endurance exercise (like training for a marathon) use up their stores of glucose rather quickly, and when they do, they frequently develop ketones in the blood. The type of ketone they develop is acetone, and it’s not unusual for their breath to smell fruity or like alcohol as the acetone leaves the body through their breath. For people with diabetes, exercise typically lowers blood glucose. But sometimes exercise can raise blood glucose. This can happen when you are low on insulin. As you exercise, your liver converts stored glycogen into glucose to use for energy and pumps it into your bloodstream. If there’s little insulin available, your muscles can’t use the glucose and your blood glucose level will rise. If you have even a trace of ketones when you begin your exercise and your blood glucose rises as you exercise, the amount of ketones in your blood may rise as well, particularly if you have Type 1 diabetes. Although diabetic ketoacidosis as a result of exercise is very rare, it is possible, so precautions need to be taken. The American Diabetes Association guidelines for exercise, blood glucose, and ketones are as follows: Avoid exercise if blood glucose levels are greater than 2. Use caution if blood glucose levels are greater than 3. If your blood glucose level is higher than 2. I recommend starting your workout then stopping after 1. If it’s dropping, it’s OK to continue exercising. If it’s rising, you should stop exercising and follow your doctor’s recommendations for treating high blood glucose. Diabetic ketoacidosis. As stated earlier, for most people, ketones are nothing to worry about. But when you have diabetes, particularly Type 1 diabetes, they may signal that your diabetes is out of control. Your body may make ketones when you are sick, have an infection, are injured, or are experiencing high levels of stress. They can appear in your urine (ketonuria) and in your blood (ketonemia). The problem with high levels of ketones is that they are relatively strong acids, and because of their acidity, their presence in the blood can reduce the ability of oxygen to bind to hemoglobin, the molecule that transports oxygen to cells that need it. That means muscles and other organs might not function as well as they should. In addition, high levels of ketones for people with Type 1 diabetes can lead to dehydration and diabetic ketoacidosis (sometimes called DKA). Diabetic ketoacidosis is rarely seen in people with Type 2 diabetes because their pancreases usually still produce some insulin, which means that the body is able to burn some glucose. Testing for ketones. People with Type 1 diabetes have most likely been asked by a doctor or diabetes educator to test their urine for ketones at one time or another. The Nova Max Plus and Abbott Precision Xtra meters make it possible to check blood levels of ketones at home. Two other home analyzers, the Cardio. Chek and the Cardio. Chek/PA (which also measure blood cholesterol levels), can also measure blood ketone levels. It’s a good idea to review ketone testing guidelines with your doctor or diabetes educator, but here are some general guidelines for who should test and when: People with Type 1 diabetes whose blood glucose level is over 2. Pregnant women with diabetes are usually advised to check their urine for ketones every morning before eating and additionally if their blood glucose level is above 2. Most adults with Type 2 diabetes don’t need to worry about ketones, but check with your doctor or diabetes educator for specific instructions. Most of the time, children with Type 2 diabetes don’t need to check for ketones, but ask your doctor, especially if your child experiences unexplained weight loss or his blood glucose level consistently remains over 2.
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