Ketosis: Explanation, 10 Symptoms, 6 effects and 6 Dangers
You have probably heard that glucose is essential for your body because it is used as a primary source of energy.
However, this is not entirely true and the idea that carbohydrates are essential for energy is incorrect.
Ketosis is a popular weight loss method.
When ketosis occurs, the body starts burning fat and the body produces ketones as an alternative fuel for glucose.
The understanding of ketosis is of great importance for a ketogenic diet to succeed.
Following a ketogenic diet is only sensible if you are prepared to seriously limit daily carbohydrate intake. Of course, there are exceptions that I will tell later.
In this article, you will learn everything you need to know about ketosis.
You learn, among other things:
- What you can and can not eat during ketosis
- The fastest way to get into ketosis
- The most unpleasant side effects of the keto diet
- How long your body needs time to adjust to ketosis
- 6 possible dangers if you perform the diet in the wrong way
- The redemptive answer to the question of whether ketosis can help with weight loss
- And much, much more ..
What is ketosis?
Ketosis (or ketogenesis) is a metabolic process in which the body breaks down fatty acids in ketones or ketone bodies.
In other words, when the body produces ketones, we are in ketosis.
Synthesis of ketones by means of ketosis takes place during severe carbohydrate limitation or periods of fasting.
At the moment that our body no longer has access to sufficient carbohydrates, an alternative energy source is used: body fat.
This physiological response is known as ‘nutritional ketosis’, the primary goal of a ketogenic diet.
Most people will come in ketosis with up to 50 grams of carbohydrates per day, while some have to limit their carbohydrate intake to less than 30 grams per day.
The best way to benefit from the benefits of ketosis is to follow a strict keto diet for at least several months. This is the only way for your body cells to adapt to this way of life.
How does ketosis work?
When we eat large amounts of carbohydrates, our body stores them as glycogen.
Glycogen is a form of stored glucose that is found in our liver and muscles. In the presence of sufficient glucose, the body burns this carbohydrate as the primary energy source.
However, when we significantly limit carbohydrates, our glycogen stores become exhausted after a few days. As a result, our body needs a new energy source: body fat.
To burn fat for energy, our body first has to convert the fatty acids in our body into compounds known as ketones.
These molecules are produced by the liver in times of drastic carbohydrate limitation and they are also known as ketone bodies.
The term ‘ketosis’ refers to the condition or the process by which the body burns fat for fuel.
During ketosis the body makes three types of ketones:
- Beta-hydroxybutyric acid
What happens to your body in ketosis?
Several things happen when your body switches from sugar burning to fat burning.
As our body adjusts and begins to enter into ketosis, enzymes begin to break down the fat molecules. This process takes place in the liver.
Our liver starts to convert fatty acids into ketones as fuel. The restriction of carbohydrates has an effect on blood sugar levels (and insulin).
Remember, however, that it may take some time for the body to get used to these changes …
After years of following a diet with industrially processed food, our body does not know better than to burn glucose for energy. The primary energy source has been glucose for a long time, we can not simply turn over a biological switch and burn fat immediately.
Moreover, most of the population will never get into ketosis because they are constantly exposed to processed carbohydrates. When the intake of (processed) carbohydrates is drastically reduced, either due to a lack of food or by following a low-carbohydrate diet, our body can be brought into ketosis.
Although this sounds like a radical change for the body, it is a natural metabolic state. Indeed, it is most likely that humanity has spent time during a famine (ice age) or for longer periods of fasting in a ketogenic state
Because we used to do something in the past, it does not necessarily make it good or healthy of course. But getting into ketosis actually yields certain health benefits that I will discuss later in this article.
How long it takes before you are in ketosis
Your body needs some time to adjust to the ketogenic state. We call this the induction phase.
During this adjustment period, the carbohydrate intake is significantly reduced and the glycogen stores become depleted. Most people get into ketosis after 5 days.
It is important to realize that being in ketosis does not mean that your body has fully adapted to ketosis.
First, we are all different and this transition is not the same for everyone. Getting into ketosis means considerable metabolic changes, and the body needs time to get used to it. For some people, the adjustment period can be quick and painless, while for others it can take a little longer.
The hardest part of starting a ketogenic diet will always be the first week because of the first flu-like symptoms.
During this adjustment period, many people feel uncomfortable or even sick until they can efficiently burn fat. The common side effects are also described as the ‘keto flu’.
Until the body becomes efficient in the use of fat for energy, these symptoms of fatigue remain. For the majority of people, these side effects last 2 to 3 days to a week.
How long it takes before you get into ketosis depends on the extent to which you follow the diet (strictly).
Some people want to try a ketogenic diet, but eat the same carbohydrates when they start to get a lack of energy.
If you suffer from a draw in sugar, then it is important to offer resistance.
If you can not resist the temptation and still get something sweet, this will only slow down the ketosis process.
To fully utilize the benefits of ketosis, it is important that your body adjusts well to ketosis. However, this can take longer than a month.
Therefore, do not try a ketogenic diet if you are not prepared to drastically reduce the daily amount of carbohydrates. It does not make any sense.
How you know if you are in ketosis
A common way is to test for ketosis. Some people like to know whether they are in ketosis or not.
If you want to keep track of this, you can have a urine analysis done to find out. This is done with the help of ketose sticks and ketosis strips.
After taking a urine sample, keep the ketosis strip in the urine until it changes color. The color in which it changes represents the number of ketones in the urine.
Ketosis strips are not a 100% watertight method to measure the concentration of ketones, but generally work reasonably well.
Looking for other methods?
Ketosis symptoms and side effects
It can sometimes be difficult to know whether you are capable of ketosis or not.
However, there are some signs and symptoms of ketosis that often occur during the adjustment period. These symptoms usually appear in the first five days. Unfortunately, these symptoms are not all that good.
Bad breath is a common side effect in people who get into ketosis. This creates a fruity odor caused by an increased concentration of ketones. The specific culprit is acetone, a type of ketone that leaves the body through the urine and breath (source).
Although this breath smell is less ideal for those around you, it is a positive sign that your body is adjusting to ketosis.
You can brush your teeth several times a day or use sugar-free chewing gum to solve this problem. If you use chewing gum, look at the packaging for carbohydrates. These can increase your blood sugar levels and lower the number of ketones.
Other common ketosis symptoms are:
- Sudden weight loss (mainly due to loss of fluid)
- Digestive problems and upset stomach
- A headache (a headache is a common side effect of low carbohydrate intake in the first few days)
- Irritability (dietary changes affect hormones and can make people irritable)
- Complaints of fatigue and lethargy as the body adjusts to fat burning
- Lack of focus
- Reduced sports performance (less power, explosiveness)
- Nausea (nausea is experienced especially during the first few days)
- Sleepiness (this feeling is due to a lack of energy because your body is less able to burn glucose)
- A desire for sugar and carbohydrates (refined carbohydrates and added sugars can be very addictive, giving up can cause withdrawal symptoms)
- Better satiety (reduced appetite and less appetite)
Known side effects that occur in the ketogenic diet are:
- Constipation (constipation)
- Abdominal pain and cramps
- A headache
- Brain fog
- Bad breath
As you can see, there are overlapping side effects with the symptoms of ketosis. They can be explained by the fact that the body has to adjust itself when using fats as a new energy source.
All the above symptoms and side effects related to ketosis are generally only short-lived and disappear within the first two weeks (except for the improved satiety).
What can I eat during ketosis?
The ratio is usually 65% fat, 35% protein and 5% (complex) carbohydrates.
A keto diet contains the following groups of foods:
Dairy: limit the milk and prefer fat-rich dairy products such as butter, cheese and sour cream.
- Meat: all types of meat are allowed.
Fish: in principle all fish is good, but to get a lot of omega-3 fatty acids you can eat the best fatty fish. Think of salmon, trout, anchovies, sardines and herring, etc.
- Eggs: eggs contain mostly fats and proteins, and are full of essential vitamins and minerals.
- Nuts and seeds: most nuts and seeds are suitable for ketosis, but eat cashews and pistachios in moderation because they contain a fair amount of carbohydrates.
- Vegetables: green vegetables you can eat as much as you want.
- Herbs and spices: feel free to use herbs and spices during cooking.
- Fruit: select only fruits that contain few carbohydrates, such as berries, avocados and olives.
Which foods should I avoid or limit during ketosis?
In particular, foods with high carbohydrate content and industrially processed fats (trans fats) must be avoided.
- Vegetable oils
- Breakfast cereals
- Starchy vegetables
- Pastries and cookies
What can you drink during ketosis?
You might not think so, but many drinks are allowed in the keto diet.
You can drink all the drinks provided they contain little carbohydrate.
Then think of:
As you can see, red wine is also allowed in moderation.
Beers and sweetened alcoholic drinks (cocktails) should not be drunk. Red wine and spirits, however, contain few carbohydrates and are suitable for a ketogenic diet.
That said, you still have to be careful with alcohol. Although a small to moderate amount of alcohol can be healthy, excessive alcohol consumption is very harmful to your health.
It goes without saying that people with alcohol addiction or dependency problems should completely avoid all alcohol.
Benefits of ketosis
Being in ketosis has several health benefits. In this article, I will focus on the main benefits.
Alzheimer’s disease is one of the most terrible diseases and the most common cause of dementia.
The idea has been around for some time, but recent research suggests that Alzheimer’s disease can be a form of diabetes. Some researchers have even given it the provisional name of ‘type 3 diabetes’ (source, source).
They refer to Alzheimer’s disease as insulin resistance of the brain. The idea is that the condition is similar to type 2 diabetes, where our body becomes resistant to insulin. The only difference is that Alzheimer’s happens in the brain (source).
Insulin resistance means that our body no longer reacts well to insulin, so our brains become ‘starved’ by energy (glucose).
This causes glucose to build up in the brain (hyperglycemia) and causes oxidative stress and damage. Brain cells starve and die because they can not use enough energy.
Can ketones be an alternative fuel for the damaged brain? That is being investigated now. By ketosis, the body can produce ketones that form a source of energy that the brain can use.
This should not be interpreted as an extremely low carbohydrate or ketogenic diet can cure Alzheimer’s disease, but ketones may play a role in the treatment of the disease.
# 2: It lowers blood sugar levels
The blood sugar level must be very low for the induction phase of ketogenesis. At the moment the body produces ketone bodies, the blood sugar level will be very low.
A reduced blood sugar level also means that the amount of insulin (which the body releases) decreases.
As the diagram above shows, a high-fat diet leads to less insulin release in diabetics.
What are the benefits of regulating blood sugar and insulin sensitivity?
First, there is a difference between short-term insulin release (of course) and too high a fasting insulin level.
Higher blood glucose and hyperinsulinemia (constantly increased insulin levels) are associated with many chronic diseases:
Research shows that hyperinsulinemia increases the risk of cancer, independent of diabetes. In other words, higher fasting blood glucose and insulin levels are harmful to everyone – whether you have diabetes or not (source).
Higher insulin levels have an anti-inflammatory effect and there is a link between hyperinsulinemia and cardiovascular diseases (source).
There are different ways to lower your blood sugar.
Research shows that ketosis helps to reduce fasting blood sugar levels and improve insulin sensitivity.
In addition to diet, exercise, adequate sleep and stress reduction also play a role.
# 3: Ketones regulate mitochondrial metabolism
In every cell of our body, mitochondrion plays a vital role because it produces 90% of the energy that each cell needs (source).
The mitochondria break down carbohydrates and fatty acids and convert them into a usable form of energy (adenosine triphosphate, or ATP).
The mitochondria are essential for our overall health and play a crucial protective role in our cells.
For example, they regulate apoptosis (programmed cell death). This process is essential to keep the number of cells in our body in balance, especially for damaged cells.
Uncontrolled cell growth can lead to cancer, and recent research has shown that mitochondrial disturbance plays a central role in various chronic diseases (source).
Now it appears that ketones may help protect against mitochondrial dysfunction.
As soon as ketogenesis starts and the body begins to produce ketones, some important changes take place.
First, mitochondria prefer fat for energy because it can be more easily converted to ATP.
- Ketones stimulate and improve mitochondrial respiration and function
- Ketones exert an antioxidant effect in the mitochondria and help inhibit oxidative stress (which can lead to mitochondrial dysfunction and other diseases)
Calorie reduction is known to prolong life. In times of calorie restriction, our mitochondria begin to burn fat instead of glucose. Therefore, these benefits can also apply to the limitation of carbohydrates to get into ketosis.
# 4: Probably helps to suppress the appetite
Processed foods with fast carbohydrates (also referred to as refined carbohydrates) cause high peaks in blood sugar levels. We become saturated for just a moment and feel hungry again within a few hours.
For some people, it is a daily fight to resist the temptations of unhealthy food.
People who have experience with ketosis, however, claim that they are barely hungry, which makes weight loss easier.
Can the presence of ketones in the body suppress the appetite? Or is it mainly due to the satiating effect of proteins?
What we at least know is that:
The hunger hormone ghrelin rises during weight loss and fuels the desire for food. In a recent study, this increased concentration was suppressed in people with ketosis despite a shortage of calories.
In the same study, the satiety hormones leptin and amylin increased, despite the participants losing weight in the study. When the subjects were allowed to eat carbohydrates, the satiety hormones dropped and the hunger hormones rapidly increased.
A high presence of ketones in the body can give a signal to suppress the production of hunger hormones. A meta-analysis of available studies suggests that ketones can help to directly suppress appetite. To achieve this effect, a minimal level of ketosis is required.
Personally, I think that the satiety benefits of low-carbohydrate diets also result from higher protein intake. In fact, the eating of proteins increases the feeling of fullness and satiety, even more than fats (source).
# 5: Reduced triglycerides and elevated HDL cholesterol
The ratio triglycerides to HDL cholesterol is one of the most reliable predictors of cardiovascular risk.
Probably you have ever heard of the ‘good cholesterol’ (HDL) and the ‘bad cholesterol’ (LDL). But these markers are not yet clear predictors of cardiovascular diseases.
In recent years, the triglycerides / HDL-cholesterol ratio has become a much more reliable marker (source).
A 2015 study showed that the triglyceride to HDL ratio is the most important independent marker for cardiovascular death (source).
How can ketosis exactly influence this ratio?
A low HDL level and a high concentration of triglycerides often go together with a large amount of insulin in the blood (source).
In other words, when we control our blood sugar level, insulin usually drops and the triglycerides / HDL-cholesterol ratio improves.
Research generally shows that a ketogenic diet has a beneficial effect on cardiovascular risk:
In a study with obese participants, a ketogenic diet of fewer than 20 grams of carbohydrates per day reduced total cholesterol, LDL cholesterol, triglycerides and blood sugar levels.
In contrast, there was a significant increase in HDL cholesterol. This study lasted 56 weeks and all measured health markers appeared to be consistent during the seven different tests done every 8 weeks (source).
A six-week study of men with a healthy weight showed that a ketogenic diet, in which about 8% of the energy requirement was derived from carbohydrates, significantly increased HDL cholesterol levels without influencing LDL or total cholesterol (source).
A lower concentration of triglycerides in the blood and a higher HDL value seems to reduce the risk of heart disease. When the body is in ketosis, the triglycerides / HDL ratio usually improves.
# 6: Ketosis improves mental health
A fair amount of research suggests that this can lead to improvements in mental health and the decrease in depressive symptoms.
A randomized, controlled study concluded that a low carbohydrate diet produced a statistically significant improvement in mood among participants. In comparison with a low-fat intervention group, participants with a low-carbohydrate diet also experienced fewer mood swings and irritability (source).
In a rat study, the rats that followed a ketogenic diet showed fewer symptoms of depression than those on a control diet. This group of rats also showed the same improvements in positive emotions as the rats treated with antidepressants (source).
Several randomized controlled trials with more than 280 participants show that ketogenic diets may be beneficial for epilepsy patients.
In short, the researchers believe that ketosis offers advantages in the short to medium term in the management of epileptic seizures (source).
Is ketosis good for weight loss? Hell yes!
People who start with keto will experience significant weight loss in the first week.
Why this rapid weight loss?
This is simply because the body stores about 3 grams of water with every gram of glycogen. By reducing carbohydrates in the diet, the glycogen stores decrease and we also lose a lot of moisture.
But ketosis not only causes weight loss in the short term, but you will also benefit from it in the longer term.
Several studies show that a strict low-carbohydrate diet works better for weight loss than a low-fat diet (source, source). An important advantage is that it reduces appetite, so you take fewer calories.
“Tommy, how many kilos can I lose?”
This question is difficult to answer, because everyone is different. Moreover, it depends on several factors. Hormones, body weight, diet, fat percentage, lifestyle, sleep quality and a whole range of other factors play a role.
People who are extremely overweight can lose dozens of pounds, while others lose less weight. If you follow a low carbohydrate or ketosis diet, you should lose weight in the foreseeable future.
Possible dangers of ketosis
The state of ketosis remains controversial. Some people believe that ketosis is the best way to lose weight, while others find the diet dangerous.
What is the truth?
Ketosis is certainly not suitable for everyone. A ketogenic diet can have some very beneficial health benefits, but can also have unpleasant (and sometimes dangerous) side effects if it is ‘done’ in the wrong way.
So let’s look at the most common mistakes that are made when trying to reach the state of ketosis.
A good fluid balance is always important, but especially if you decide to start a keto diet.
When we drastically limit our intake of carbohydrates in food, a lot of things happen in our body. Blood sugar levels and insulin levels decrease (source).
Remember that many people who have become a standard Western diet (with many refined sugars) have become insensitive to insulin (also known as insulin resistance).
Why does this matter?
Because a high insulin level causes the kidneys to store more sodium, which causes the kidneys to retain more fluid (source).
Because a keto diet strictly limits carbohydrate intake, the insulin level falls within the first few days. When the insulin level drops, our kidneys release substantial amounts of fluid. If someone does not drink enough water during this period, this may cause dehydration.
Many people who start ketosis for the first time complain of headaches in the first week. In addition to a disturbed electrolyte balance, this is one of the reasons why. Not drinking enough water is a common mistake that can easily be avoided.
Danger # 2: Inadequate magnesium
Unfortunately, that water contains high concentrations of sodium and electrolytes. Magnesium is one of them.
The disturbance of the electrolyte balance can cause various symptoms that people often call the ‘keto flu’.
Although all minerals are important, magnesium plays an essential role in our bodies. In fact, it plays a role in more than 300 biochemical processes (source).
So it is not surprising that the loss of this essential mineral can cause problems. A prolonged low magnesium level can cause various physical complaints. Think of muscle spasms, irritability, low libido, hypersensitivity, etc.
To get sufficient magnesium you will have to search for magnesium-rich foods that are also allowed in a ketosis diet.
Think of foods such as:
It may also be worth investing in a good quality magnesium supplement. The magnesium supplements that I use yourself can be ordered here.
Danger # 3: don’t get enough sleep
Getting enough sleep is crucial for everyone.
If you do not get enough sleep, it will endanger your health. Good sleep quality is just as important as our diet.
For example, some people choose to enter ketosis to achieve a constant blood sugar level. That is a healthy goal, but a lack of sleep has an adverse effect on blood sugar levels and insulin sensitivity (source, source).
If you use a ketogenic diet to improve these values, but then negatively influence them by lack of sleep, it is as if you are taking a step forward and then two steps back.
Danger # 4: Eating insufficient fat
As you know, our body can use both carbohydrates and fats to meet its energy needs.
The whole idea of ketosis is to have our body switch to fat-burning. Therefore, if we reduce the carbohydrates, we must increase our fat intake.
Some people who start ketosis reduce their carbohydrates, but do not replace this lost energy with fat. One reason for this could be that people still feel a bit uncomfortable when they eat fats.
However, you do not have to worry about fats in natural foods, such as avocados, fish, olives, oils, etc.
While proteins can deliver energy through the process of gluconeogenesis, it is an inefficient energy source compared to ketones (fat) and glucose (carbohydrates (source).
Completely trying to live on proteins and vegetables will quickly cause fatigue and lack of energy and eventually make it an unsustainable diet.
I hear ketosis users sometimes say they do not eat too much protein because they come from ketosis differently.
This is nonsense in my opinion. Proteins play an important role in our body and the effect on blood glucose levels is exaggerated.
This claim is based on the process of gluconeogenesis, in which glucogenic amino acids can be converted to glucose (source).
Put simply, this means that our body can change proteins in glucose. This biological process is a protective mechanism that can help us survive in times of hunger or food scarcity.
For example, if we need energy, our body can convert amino acids (or muscle tissue) into glucose.
But it is not that eating more protein leads to more gluconeogenesis and therefore more glucose. Higher protein intake may influence the speed of gluconeogenesis, but not as much as you would expect.
Of the macronutrients, protein, like fat, has less influence on blood sugar than carbohydrates (source).
In healthy people, the process of gluconeogenesis only starts when it is needed, rather than being regulated by the availability of amino acids in the body.
Moreover, it is important to distinguish between healthy people and people with diabetes. The amount of protein we eat has a greater effect on blood glucose in diabetics, but not in non-diabetics (source).
Danger # 6: eat too many carbohydrates
Someone who eats fewer carbohydrates increases his fat intake and occasionally still eats a cookie will hardly achieve ketosis.
Moreover, the induction phase (initial period) of ketosis can have some unpleasant side effects, so the repeated restart (and stopping) of the diet is unwise and possibly even dangerous.
A ketogenic diet requires dedication. Starting and stopping over and over again is not conducive to your body.
Is ketosis dangerous?
No, ketosis is in principle not dangerous for healthy people (if it is applied correctly, see the possible hazards I have described in this article).
Sitting in ketosis for too long would not be as healthy because of the increase in oxalic acid content in the body. Oxalic acid can reduce the absorption of iron and calcium. But people with healthy kidney function need not be afraid of a little more oxalic acid.
Ketosis is a natural metabolic state of the body that can be achieved when the intake of carbohydrates for a certain period is very low.
If you are in ketosis you have a higher than normal level of ketones in your blood or urine. Ketones are chemicals that your body produces when the stored fat burns. In general, the main problem is the side effects that can occur in the short term while the body adapts to this new condition.
Personally, I find the ketogenic diet too extreme to follow, but I do not see the dangers of eating a lot of fish, avocado, oils, etc.
A ketogenic diet in practice means more butter, olive oil, cream, coconut oil, avocados, fish and meat. This is a shock to most people because for decades we have been mistakenly told that eating fat is bad for our health.
But the real problems with fats come from:
- Industrially produced trans fats
- Vegetable oils (rapeseed oil, soy, corn)
You can compare it with the low-carbohydrate diet because you remove the processed carbohydrates in particular. This leaves more room for protein and fat and results in better control of the appetite.
A normal low-carbohydrate diet is less extreme than the keto diet and in my view much easier to sustain. You leave processed carbohydrates away from your diet, and still get around 30-40% of your calories from carbohydrates from natural sources.
Ketosis is sometimes confused with ketoacidosis. Despite the similarity in name, ketosis and ketoacidosis are two different things.
Ketosis is the presence of ketones in your body. It is not harmful.
Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It is a life-threatening condition that results from a dangerously high level of ketones and blood sugar.
Did you know that research shows that 1 in 3 just gains from a diet instead of losing weight? (source)
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