Safe Ketone levels beyond 6 mmol/L?

(Herb Martin) #1

Anyone have any knowledge or references for really high ketone levels (beyond 6 mmol/L)?

In Dr. Boz’s book “Anyway You Can” she shows a chart (page 133 in Kindle) a chart with something lile the following:

  • 9.5-10.0 Ketoacidosis (red zone above about 6.8)
  • 6.8 Starvation Ketosis
  • 5.3-6.0 Yellow (just below Starvation Ketosis)
  • 4.0 Fasting Ketosis

I’m pushing this region today at 6.2 (on 8th water fast day), and though not particularly concerned it’s best to stay ahead of such things and prepared for issues. (GKI is 0.71)

(Going on an Internet search but ideas and references are greatly appreciated…)

Thank you.

(You've tried everything else; why not try bacon?) #2

As long as your pancreas is making insulin, the risk of ketoacidosis is virtually 0. There is a workshop by Dr. Phinney on LCDU’s YouTube channel, in which he asks the audience what their highest measured ketone level was. One guy says something like 12.4, and Dr. Phinney hardly bats an eyelash.

The concern is really for Type I diabetics, because when their ketones get up to about 10, the doctors do have to worry about ketoacidosis. The adidotic level is actually higher than that, but they start worrying at 10, so as to have time to take action. Ketoacidosis is not fun, and it can be fatal. That said, a Type I who faithfully takes his or her insulin usually has little to worry about, either. Nevertheless, the doctors are right to worry, since losing a patient can ruin your whole day.

(You've tried everything else; why not try bacon?) #3

Here is Phinney’s and Volek’s famous chart:
blob

Note that it basically says the same thing as Dr. Boz.

(Herb Martin) #4

Thank you so much Paul, that is precisely the type of thoughtful information and useful references I was seeking.

As you say, the common understanding of ketoacidosis is a life threatening emergency even though no ketogenic dieter runs that risk.

I am old enough to remember Type 1 Diabetics dying often enough it was a common knowledge issue, and I have known a few decades ago who had got into trouble but survived. With today’s better medicines, better monitoring, and education it’s apparently quite uncommon for even Type 1’s to get so screwed up.

That chart in your 2nd post looks to be precisely the chart from Dr. Boz except that she apparently rotated, flipped, and reformatted it for vertical orientation.

KetoneLevelChartDrBozp133
KetoneLevelChartDrBozp133.jpg760×641 30.2 KB

There is one remaining confusion that doesn’t quite make sense to me:

If making insulin is critical, and we are in extreme ketosis with glucagon active this would mean insulin is suppressed.

What details am I missing to explain the difference?

(Going to watch and read your references.)

Your help has been much appreciated. Thank you.

(You've tried everything else; why not try bacon?) #5

As noted, we need a certain minimal level of insulin in our blood at all times, in order to be able to use our food to live.

The effects of glucagon and insulin are relative, and appear to depend more on the ratio between them than on the absolute amounts. Apparently, when the two hormones are at nearly the same level (i.e., insulin/glucagon ratio < approx. 2.0) the twin processes of gluconeogenesis and ketogenesis are stimulated in the liver. From what I have been reading and watching, I believe there may be some uncertainty whether the stimulus is low insulin or high glucagon. What is clear, however, is that the ultimate trigger is low dietary carbohydrate intake.

This makes evolutionary sense, since there are certain cells in the body—such as the red blood cells for sure, and possibly certain brain cells or parts of brain cells—that cannot survive without glucose, so when we don’t eat long strings of glucose molecules (i.e., carbohydrate), the necessary glucose has to be made by the body. Likewise, when there is no need to scavenge glucose from the blood stream, the muscles can quite happily metabolize fatty acids instead (after a period of adaptation, of course, when we switch from a high-carb diet), and other organs (such as most, if not all, of the brain) can feed quite happily on β-hydroxybutyrate, the main ketone body. The three ketone bodies also act as signaling hormones, regulating the expression of certain genes. The upshot of all this is that when the insulin/glucagon ratio is low, the body can produce the glucose we need without our having to worry about stimulating insulin, since the concomitant glucagon secretion holds the effects of insulin in check.

So if I got it right, this is basically a long-winded way of saying what you said, depending, I suppose, on what precisely you meant by “suppressed.” I’m not entirely clear whether insulin secretion gets inhibited or not, because Prof. Bikman makes it sound as though it does, but there’s a matching glucagon secretion that blocks (most of) the effects of the secreted insulin. Either way, you and I do agree on the ultimate practical effect.

ETA: Please look this over and tell me if it sounds coherent.

(Herb Martin) #6

Definitely coherent, and I agree about what I think Bikman said (should have used the word “inhibited” rather than “suppressed”) – as I recall the Alpha (Glucagon producing) and Beta (Insulin producing) cells of the pancreas are adjacent and signal to mediate which is the more active (activate/inhibited coordination).

More later when I’ve had time to process through more of the links. Thx again.

(Karim Wassef) #7

My ketones hit a high of 8 and my glucose usually dips into the high 30s, low 40s when that happens. No I’ll effects - no symptoms of hypoglycemia - just an amazing amount of energy.

#8

I’ve been at 6.9 ketones and I wasn’t starving, I was fasting.
My blood glucose was stable and I was very healthy, no problems.
So “6.8 starvation ketosis” is inaccurate I believe, it is for some us, simply fat adapted and burning fat during a water fast (in my own experience).

(Karim Wassef) #9

The term starvation is really off here.

It’s deep fasting ketone levels. Starvation is when there is some calorie intake to not be in deep ketosis or if there is insufficient body fat to generate ketones and the body cannibalizes protein (tissue) for gluconeogenesis.

Both involve not eating - but organ cannibalization for energy is starvation, while endogenous fat oxidation for energy is fasting ketosis.