Ketosis vs Ketoacidosis – What’s the difference?
Although ketosis and ketoacidosis sound very similar, they are two significantly different conditions.
Ketosis (or nutritional ketosis)
Ketosis is a diet-induced condition to support weight loss. By consuming low-carb/high-fat foods, usually combined with fasting, the body starts producing ketones as it breaks down fats for energy. Higher-than-normal levels of ketones in the bloodstream trigger ketosis, which is touted to have several health benefits. Supervised diet-induced ketosis is often referred to as nutritional ketosis, which is a balanced state of ketosis essential for maintaining general well-being and health.
Starvation may occur due to various reasons such as swallowing disability, prolonged fasting, or eating disorders like anorexia nervosa. Prolonged eating restrictions/constraints for medical, economic, or self-imposed dietary reasons lead to starvation ketoacidosis (SKA). The SKA manifests itself in extreme weakness, the thinning of the body and bones, and severe loss of strength due to muscle breakdown. Screening for starvation ketoacidosis can be carried out by checking glucose and ketone levels in the blood and urine.
If the ketone levels surge to dangerously high levels, it is referred to as ketoacidosis, which is a life-threatening condition. An unsupervised keto diet, in rare cases, can lead to ketoacidosis in the non-diabetic population.
Diabetic ketoacidosis, on the other hand, is usually not a metabolic process. It is a diabetes-related complication in which ketone and glucose concentrations in the blood get dangerously high due to a lack of insulin. It usually takes two to three days for the body to transition from ketosis to ketoacidosis. Soon after, the typical effects of DKA may begin.
How to differentiate between nutritional ketosis and diabetic ketoacidosis?
Differentiating between nutritional ketosis and diabetic ketoacidosis is simple. In diabetic ketoacidosis, both ketone and glucose levels in the blood are elevated. Excess amounts in the blood often result in elevated levels of glucose and ketones in the urine as well. Diabetic ketoacidosis also causes acidic pH of the blood. In contrast, nutritional ketosis does not result in elevated blood glucose levels. Since nutritional ketosis is achieved by restricting carbohydrate intake, blood glucose levels are expected to be low. In nutritional ketosis, you may find ketones in urine but should not find glucose in urine.
Why do ketone levels in the keto diet need monitoring?
A keto diet is considered safe as long as too many ketones do not accumulate in your blood. Keto-flu, the body's response to a sudden drop in blood glucose levels, is a typical consequence of a keto diet. It occurs in the early stages of a ketogenic lifestyle and manifests as muscle cramps, fatigue, mood swings, sleeplessness, and constipation. Some remedies can help alleviate these acute symptoms.
It is essential to keep track of your nutritional needs. Nutritional imbalance sometimes occurs, causing problems such as extreme weakness and fatigue, inability to concentrate, mood swings, anemia, and chills, which require prompt attention to avoid any risks or complications, such as those due to ketoacidosis. Any nutrition plan should, therefore, be adopted after consultation with a nutritionist or a healthcare professional.
Ketone buildup in the bloodstream due to nutritional ketosis or fasting can be particularly risky for those with diabetes or other medical conditions involving the kidneys, liver, and gallbladder. Therefore, regular monitoring of blood and/or urine ketone levels is strongly recommended for these at-risk groups.
At-home urine ketone test
A urinalysis test is performed to measure the levels of ketones in the urine. The test can be administered both in clinical and home settings using ketone test strips (dipsticks) which people refer to by different names such as keto strips, keto test strips, and ketosis strips. Multiparameter urine test strips such as Urinox-10 are typically lined with multiple reagent test pads that check for other chemicals besides ketones in the urine. When dipped in the urine, the ketone reagent pad changes color from buff-pink to dark purple. The color of the reagent pad is then compared with the accompanying color key to interpret ketone levels in the urine. The intensity of the reagent pad color increase with the urine ketone concentration. The results of a ketone test are read 30- 40 seconds after dipping it in the urine stream to get accurate results.
Normal and Abnormal Ranges of Ketones in Urine
A ketone-in urine dipstick test yields a negative result if significant quantities of ketones are not detected. A positive result is indicated by five different levels depending on the concentration, from trace to large levels of ketones, as shown below:
- Trace level: 5 mg/L
- Small: 15-20 mg/dL
- Moderate: between 30 and 40 mg/dL
- Large: 80 to 160 mg/dL
A positive result for ketone in urine can mean different things to people with various health goals. For example, trace to moderate levels are targets for people on a keto diet. However, even trace levels of ketone in urine can be alarming for diabetic patients.
You should consult your healthcare provider if your ketone in urine test shows abnormal values, particularly if you have diabetes or other health conditions.
Drinking more water, avoiding sugary foods and drinks, and desisting from exertion can be handy if expert medical intervention is not readily accessible.
Why are ketones in urine tests important?
The urinary ketone test is one of the most valuable, simplest, and cost-effective ways to detect, manage and monitor diabetes, and to forestall diabetic, alcoholic, or starvation ketoacidosis. The test is also relevant in situations such as nutritional ketosis, fasting, overexertion, or to measure ketones in urine during pregnancy. Any possible accumulation of ketones in the body can be avoided by proactively tracking our metabolic states.
Monitoring of ketone levels is warranted for individuals on a keto diet. It helps them regulate their dietary requirements based on their body's metabolic condition. A urine ketone test allows you to determine if the body is in a healthy (safe) state of ketosis, where a steady production of ketones signifies that your body is using the stored and consumed fat as an energy source.