Ketoacidosis versus Ketosis

The difference between the two conditions is a matter of volume and flow rate:

• Benign dietary ketosis is a biochemically regulated and controlled process which results in a mild release of fatty acids and ketone bodies.
• Ketoacidosis is a condition in which massive, way above normal quantities of ketones are produced in an unregulated, wildly out of control biochemical situation.

Here's a more detailed explanation:

Fact 1:  Every human body maintains the blood and cellular fluids within a very narrow range between being too acidic (low pH) and too basic (high pH).  If the blood pH gets out of the normal range, either too low or too high, big problems happen.

Fact 2:  The human pancreas is an organ which secretes insulin, a hormone that helps the body manage blood sugar and fat storage.  Without insulin, the body cannot utilize glucose for fuel in the cells, AND cannot store fat in the fat cells.

This is why one of the symptoms of Type 1 diabetes is unexplained weight loss.  Type 1 diabetics have pancreatic damage which results in a complete lack of insulin production, and as a consequence, their fat cells have no insulin message telling them to "hold on to those fatty acids". 

Without that message from insulin, vast quantities of fatty acids flow out of the fat cells and are broken down in the liver into acetoacetic acid and D-3-hydroxybutyric acid (ketones).

This is ketosis, but an unrestrained, abnormally excessive ketosis.

The danger of keto-acidosis is in the amounts of the ketone bodies being released. Because ketone bodies are slightly acidic in nature, and so many are released at once, they build up in the bloodstream.

The sheer volume quickly overwhelms the delicate acid-base buffering system of the blood, and the blood pH drops to become more acidic than normal. 

It is this low pH, acidic condition known as acidosis which is dangerous, not the ketones themselves.

Acidosis symptoms include fruity breath, nausea, hyperventilation, (deep, rapid breathing) dehydration and low blood pressure, as the body tries to rid itself of the abnormal amounts of ketones through the lungs and urine.

If left untreated, ketogenic acidosis can result in a coma and death. Treatment includes the administration of insulin to slow the ketosis and fluid replacement.

Diabetics can develop diabetic ketoacidosis if they don't inject enough insulin to compensate for activity and food levels.

Ketogenic acidosis can also happen during:

• extended periods of starvation
• prolonged severe exercise
• alcoholic binges (this condition is called alcoholic ketoacidosis)
• This paper published in Diabetic Medicine discusses several cases in which the drug Ecstasy combined with the excessive movements of rave dancing caused ketoacidosis.

Benign Dietary Ketosis is Controlled

The ketosis that happens on a ketogenic diet is not dangerous because it is regulated by insulin levels within the body.

It's simply the metabolic process of burning your own body fat for fuel, and unless you are diabetic and lacking insulin, or you are a raging alcoholic, it is perfectly safe.

Here's another explanation from a medical professional with extensive knowledge about ketosis.

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