KETONES, KETOSIS AND FAT...OH MY!

Here was a great question sent to me in regards to ketosis;
 
I’ve had a great deal of difficulty finding a straight answer regarding ketosis. Not ketone production; but specifically what the levels really mean – what to look out for – and do you really need to be in ketosis? Let alone, all the time?

More important to me though, is not being able to find studies / info that talk to Low Carb and young children. LC is so 'taboo' in American society; people seem to be fearful to say its ok for kids too. It should be though, am I right? (All those years of brain washing by industry have left me doubtful - could I be hurting my children by having them avoid excessive carbs? - Stevia is great - but is Splenda ok for them?) The other day I walked into my son's Beaver Scout meeting to see the "dreaded" Canadian Food Guide on the wall (don't even get me started). Turns out teachers don’t appreciate it when a 6 year old advises the information is incorrect. *laughing to myself*. I want to be sure that my kids have the right information on how-to-eat so that they will always be able to make informed decisions. I want to know if ketosis is a state that is ok for children. Can levels ever be too high? Does it need to be monitored? I very sincerely appreciate any insight.

Your loyal reader/follower ~
 
Physicians who are first learning about low carbs will often confuse benign dietary ketosis with the life threatening diabetic ketoacidosis. Benign dietary ketosis is just that, benign, and it has nothing to do with diabetic ketoacidosis. In fact, the only similarity between the two is that both have the 4 letters 'keto' shared among the terms, but that's where the similarity ends. Oh, and a 'sis' and a 'di' and a couple t's etc....
 
Benign dietary ketosis occurs when one is using free fatty acids for the creation of the universal energy source ATP. Not that I want to get too biochemical on anyone, but notice I am refraining from using the word 'burn', i.e. as in 'burning' fat for fuel. There is absolutely no burning of anything going on here. What is occurring is that the free fatty acid is being broken down by enzymes which cleave off 2 carbon fragments at a time from the fatty acid. These two carbon fragments are referred to as acetylCoA, which then enter a pathway referred to as the Kreb's cycle, where ATP is produced. Of course there is creation of other biomolecules e.g. FADH, NADH, but I want to limit our discussion to where the term ketosis applies. The term used in biochemistry to describe the whittling away of fatty acids to create ATP is referred to as beta oxidation.
 
It is when our bodies use the beta oxidation pathway to create ATP that ketones are created. Ketosis simply means we are creating ketones because we are using free fatty acids for the creation of energy. Here are a few interesting points; in order for the 2 carbon fragments to enter the Kreb's cycle, some carbs need to be consumed. This is because the acetylCoA molecules neeed to combine with another molecule called oxaloacetate in order to get into the Kreb's cycle. Since our bodies can only make oxaloacetate from sugar (glucose and/or fructose), some carbs need to be consumed in order to keep the cycle going. This is why I often will repeat to my patients to not do no carbs and try to get at least 20 to 30 grams of carbohydrates a day. Another interesting point is that our bodies can use ketones for fuel e.g. heart, kidney (renal cortex), respiratory muscles and brain. (Berg, Biochemistry,7th. edition, pp 654-655.)
 
Now I know the question wasn't really asking me about how ketones are produced,  I just wanted to provide a brief run down on how and why ketones appear in our blood; and I also want to point out that I am not talking about diabetic ketoacidosis, I will discuss that condition further below; here I am focusing on benign dietary ketosis only.
 
So what do the levels mean?
 
The level of ketosis can be measured by performing blood work or by checking the urine. There are strips on the market which check for ketones in the urine and a lot of people who start low carbs purchase these strips. The problem with these strips is that some people, even if they are in the beta-oxidative pathway and losing weight, may test negative. This is because some people's physiologies are better at utilizing ketones than others, resulting in a negative result on the ketostix and causing confusion. I generally tell my patients to not get these strips because if they are losing weight they have to be utilizing fat for the creation of ATP, so it's a waste of time and money to get them.
 
So basically I don't even have my patients check their ketone levels at all, so I'm not concerned about how high (or low) the levels are. Those of us eating more fat and less carbs will tip the biochemical scales in favor of ketone creation and again, I'm not concerned about the level in benign dietary ketosis. We can generally remain in ketosis for our whole lives and I remember reading somewhere  Eskimos (Inuit?) eating their native diet stay in ketosis their entire lives. As far as if we really need to be in ketosis my answer is that you will be, so long you are eating more fat and less carbs, it's a biochemical certainty. Remember that when we are eating lower carbs and more fat we are also secreting less insulin and influencing enzymes (HMG-CoA, acetyl CoA carboxylase, Hormone sensitive lipase) to utilize fat for energy production, lower production of cholesterol and will keep the body in a beta oxidative mode, hence perpetuating the ketotic state.
 
You're correct, low carb is a taboo when it comes to children and even more of a taboo when it comes to  pregnant moms. Children should absolutely be eating low carbs and it is safe for them to be in ketosis. I have had the privilege to work with thousands of pregnant moms who I have, and I might add, very safely placed them on low carbs, and yes they were eating more fat and cholesterol and protein and they all did fantastic! Especially moms with a histroryof gestational diabetes, pregnancy induced hypertension, preeclampsia etc; do exceptionally well and most do not need to take any medicine at all once started on low carbs. An interesting side note is that the biggest chapter in my groundbreaking, whistle-blowing, soon-to-be-number-one-globally book Genocide:How Your Doctor's Dietary Ignorance Will Kill You! is my chapter on pregnancy; go figure....
 
But getting back to children, they absolutely should be in a ketotic state i.e. eating low carbs and more cholesterol, fat and protein. And no, don't even get me started on the ridiculous My Plate campaign (we had to convert to descriptive circles here in America, I guess the pyramid was too complicated), so I am soooo with you on the 'Canadian' food guide.
 
I personally have never tried Stevia, but I can comment on both splenda and equal as sweeteners. I can also comment on Stevia come to think of it, it's safe so no worries. Splenda's ingrediants are actually dextrose, maltodextrin and sucralose. I learned from Judy Barnes Baker ( an expert who has written low carb cookbooks, and yes, you too Dana Carpender, another low carb cookbook expert, I think she has like 13 now, showoff :-) over the summer that when splenda is used for baking purposes that there could be an appreciable increase in the carb amount. This is due to the dextrose, maltodextrin ingrediants, not the sucralose, so we need to be cautious when using splenda to bake with. As a side note, there exists a few products that are liquid sucralose only, which one can use for cooking and provides zero carbs in the finished product.

Since sucralose is chlorinated sucrose, there have been some concerns as to its safety. I have come across no studies showing any danger with the use of sucralose. Yes, I have come across anecdotal reports written by non-scientists voicing concerns over sucralose, but from a biochemical perspective I have seen no ill effects. I want to emphasize that the vast majority of my patients do low carbs, use splenda to cook with and their blood work as far as liver, kidneys, etc. have all been normal, so I personally have no issues with it.

Equal's first 2 ingredients are the same as splenda, but the sweetener in equal is the dreaded aspartame. Let me assure you that for most people aspartame is a safe sweetener. the only people who have to worry about aspartame (which is really just 2 amino acids linked together) are people who lack the enzyme necessary to break down aspartame; they are referred to as phenylketonurics or PKUs for short.

LOL! No, teachers do not appreciate being corrected by anyone, let alone a 6 year old. It reminds me when my daughter was in, I believe third grade and the following question was on her nutrition quiz; 'What is the healthiest snack?'

A. apple
B. candy bar
C. potato chips
D. cookie.

So what does my daughter do, she writes in E. none of the above; and yes, she failed that test.

So yes, ketosis is ok for children of any age;  and, no, don't bother checking or monitoring the levels.

Now the above conversation pertained to benign dietary ketosis. Diabetic ketoacidosis is a life threatening medical condition seen in Type 1 diabetics and is the reason most physicians counsel their patients, especially the ones on a low carb diet, to avoid ketosis on any level. These doctors are confusing the two different types of ketosis and because of this, these docs will often give contradictory advice. We discussed above a little bit about how we get into dietary ketosis, by utilizing fatty acids for the production of energy. Once we are in the beta-oxidative pathway we will create ketones, period. So here's the conundrum; when a doctor suggests to a patient they need to lose weight, but also tells them to not go into ketosis. This is a contradictory state of affairs because the only way to lose weight (excepting liposuction) is for the body to get into ketosis; that is, to lose fat stores, hence to lose weight, occurs by utilizing the fat for the creation of ATP and requires the body to be in ketosis; there is no other way! These docs might as well be telling their patients to jump in a pool naked, but don't get wet!

An interesting side note and a very important one for Type 1 diabetics, is when a Type 1 diabetic follows a low carb diet, their sugars become easily manageable and they don't see the highs and lows as the Type 1's eating too many carbs. A great book for any diabetic is Dr. Bernstein's Diabetes Solution by Richard K. Bernstein M.D. a must have if you or a loved one suffers from diabetes. My comment to my patients about Dr. Bernstein's book is that for Type 1's it's a solution, for type 2's, it's a cure.

Hope this helps!

dr jim :-)

Genocide: How Your Doctor's Dietary Ignorance Will Kill You!
Soon to be available on Kindle!

The answers to these questions are for informational purposes only and are not intended to prevent, diagnose, treat or cure any illness. They are, however, meant to hopefully eradicate the profound persistent nutritional ignorance of most medical professionals;

Dr. Jim