K is for Ketones

Ketones are good for you. No, they're bad.

With one exception, I don't think that there's any diabetes disagreement that is more serious than this one about ketones. The exception is whether a low-carbohydrate diet is something that you should follow, particularly if you want to lose weight.

Is a low-carb diet good or bad for you? Actually, some of the reason that we differ on the answer to that diet question is because we can't agree on ketones.

We do know what ketones are. Ketones are acids released into the blood when your body breaks down its stores of fat and burns it for energy. Two things can cause your body to do that. One is when you don't have enough glucose to use for energy. The other is when your insulin level is too low. In either case your body then make ketones, which are waste products that might cause the acid level in your blood to become too high.

Since ketones are a waste produce, you pass them in the urine. That means you can detect them with a urine test, which has been the traditional, but sometimes messy way check them. Now, however, you can do that with a blood test that measures a specific ketone called beta-hydroxybuyric acid.

In fact, two meters will measure either your ketones or your blood glucose. Abbott Diabetes Care offers the Precision Xtra. Polymer Technology Systems has the CardioChek, which can also measure lipid levels.

It's handy to have a meter that measures both, because when are your blood glucose level is higher than 240 mg/dl (13.3 mmol/L), you need to test for ketones too. But it's not only when your blood glucose is high that you might have ketones in your blood. You may have ketones if you are pregnant and have diabetes. That's the third major type of diabetes, which we call gestational diabetes. And if you have any type of diabetes and are sick, under stress, or have any symptoms of high ketones, the usual recommendation is to test for them.

So, what are the symptoms? Unfortunately, they aren't so specific as to be easy for you to diagnose. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says that they are "nausea, vomiting, and stomach pain."

A high ketone level may not be easy to diagnose, but at least the experts pretty much agree about what it is. The disagreement is with the relationship between ketones, sometimes called ketone bodies, and diabetic ketoacidosis, sometimes called ketoacidosis.

Worse, the experts tell me that when you have diabetic ketoacidosis you may also have these same symptoms. But the NIDDK also lists "fruity breath odor and rapid breathing" among the symptoms of diabetic ketoacidosis. It goes on to say that untreated diabetic ketoacidosis can lead to coma and even death.

So it's no wonder that controversy rages about ketones. This stuff is something that all of us need to take seriously.

Then, why would anyone even suggest that ketones might be good for you? The guru of low carb, Dr. Robert C. Atkins, certainly thinks that they are a good sign.