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Ketosis vs. Ketoacidosis

by Fred Hahn on October 25, 2011

You can purchase one of these at the Metabolism Society store!

You can purchase one of these ketosis tees at the Metabolism Society store!

It’s a sad fact that some experts who certainly should know better confuse ketosis with ketoacidosis, misleading people into thinking that they are one and the same. Worse, they suggest that a low carb diet can cause the bad one – which is ketoacidosis.

Dr. Oz is one such expert.

The good Dr. Oz wrote in an Time magazine article on September 12th 2011:

Artisanal bakers wept (no carbs means no baguettes), and the uberfaithful (Note: here he is referring to low carbers) began to suffer the bad breath of ketoacidosis, which occurs when glycogen stores are too low.

DOH! No it doesn’t – unless you are a type 1 diabetic that is. In other words, you can’t enter into the evil netherworld of ketoacidosis unless you are one of those rare people who produces little if any insulin because insulin regulates acidosis as you will learn soon.

Now, was this just an innocent typo made by Dr. Oz’s editor? Maybe. But thus far, no retraction has been made – none that I am aware of at least. As I see it, Dr. Oz doesn’t understand the difference or doesn’t want to. But fear not – I’m here to help!

I feel that it’s very important for people (especially doctors) to know the difference between the two so as not to fear diet-induced ketosis caused by a low carb diet or by intermittent fasting. Ketosis is a perfectly normal and healthy state to be in.

Since I have a cursory understanding of the two being a layman, I decided to ask an expert, Dr. Richard Feinman, to spell it out for us.

Here you go:

Ketosis vs. Ketoacidosis

So what is the distinct difference between the two? Both are a condition of high levels of ketone bodies in the blood but one is life threatening and one is not. So why would this be?

1. Ketone bodies in the blood is called ketosis. Ketone bodies in the urine, which is the common way we measure them, is called ketonuria.
2. Ketone bodies are acids.
3. Blood contains several acids, phosphoric acid, carbonic, and these are neutralized (buffered) by the sum of acids and bases.
4. If acid levels exceed a certain point, that is called acidosis.
5. Because ketone bodies are also acids, they could contribute to an acidosis at very high levels. This is referred to as ketoacidosis and like any acidosis is dangerous.
6. Any ketosis might be considered “high” because modern man is rarely in a state of prolonged fasting.
7. Ketosis is the normal response to starvation or dietary carbohydrate restriction.
8. The ketosis from starvation or carbohydrate restriction is regulated by hormones and other metabolic effects to prevent over-production, that is, prevents ketoacidosis.
9. If the regulation breaks down for some reason, notably untreated type 1 diabetes (insulin is a major regulator of ketone body production), then you can have over-production or ketoacidosis.
10. Ketone bodies are normal because not having food all the time was normal. That is why we call ketone bodies “food of our ancestors.”

Minor note.
1. The ketone bodies are acetoacetate, beta-hydroxybutyrate. These are the physiologic ketone bodies. Acetone can be produced non-enzymatically and is also considered a ketone body.
2. The term “ketone” is commonly used in discussing the more precise term “ketone bodies.” Organic chemists, curmudgeonly professors and others think it is a good idea to be precise because ketone is a particular type of compound (acetone is one) of which there are an infinite number and, oddly, one of the ketone bodies (beta-hydroxybutyrate) is not actually a ketone. The other acetoacetate is chemically both a ketone and an acid.

Here is a good paper on low carb diets/ketosis.

There you have it. So, next time someone tells you that ketosis is evil (like Dr. McDougall) and that life-threatening ketoacidosis can happen if your carb intake goes too low, print this out and hand it to them.

I've been involved in exercise ever since I became a member of The Charles Atlas Club when I was 10 years old. In 1998, I founded and established Serious Strength on the Upper West Side of NYC. My clients include kids, seniors (and everyone in between), top CEOs, celebrities, bestselling authors, journalists and TV personalities.
my book. my Gym.

in Uncategorized · 12 comments


mking October 26, 2011 at 8:01 AM

I think Dr. Oz is just not reading the right books. Way to go Fred, keep them on their toes.:)

Fred Hahn October 26, 2011 at 9:10 AM

I’ll do my best! thanks mking! (Is this Melissa King?)

mike October 26, 2011 at 6:28 PM

going to have surgery no lifting for 2 months how do i minimize muscle loss

Fred Hahn October 26, 2011 at 7:30 PM

you have to give me more info than this. What kind of surgery?

palo December 12, 2011 at 1:56 PM

“So, next time someone tells you that ketosis is evil (like Dr. McDougall) and that life-threatening ketoacidosis can happen if your carb intake goes too low, print this out and hand it to them.”

Sorry Fred, but I will walk away because based on prior experience, I know I’m dealing with a fool or an unscrupulous liar.

Life is too short to waste on these people.

Low Carb Master June 20, 2012 at 12:37 AM

Hey Fred. I’m very interested in that paper about ketosis that you linked in this post. It seems like the link is no longer valid though. I keep getting a “No input file specified.” message. Just thought I’d let you know………..Plus I’m dying to read it! :)

Fred Hahn June 20, 2012 at 12:55 PM

Hmmm…it does appear gone. I din’t remember where I found it. Crap.

Frank June 22, 2012 at 11:34 PM
Fred Hahn June 25, 2012 at 10:19 AM

No but that’s a good one!

diet March 8, 2013 at 9:04 AM

Good day! I know this is somewhat off topic but I was wondering if you knew where I could get a captcha plugin for my
comment form? I’m using the same blog platform as yours and I’m having problems finding one?

Thanks a lot!

Al March 12, 2014 at 8:41 PM

“Grain Brain” by David Perlmutter MD goes into more detail about ketosis although he approaches it primarily from the perspective of brain health.

Debbie Potts August 6, 2016 at 3:16 PM

hi there
I am writing an article on ketosis vs. ketoacidosis and I would love to include this information you shared in my blog… could I included your link to my blog?

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