Ketosis in people who are overweight is "benign," he said when he spoke at the "Great Nutrition Debate" that then U.S. Secretary of Agriculture Dan Glickman convened in Washington seven years ago. When dieters who put out too much insulin cut way back on carbohydrates, Dr. Atkins says, this benign dietary ketosis leads to a normal pH. "There is no acidosis."
But, he says that diabetic ketoacidosis is "diametrically opposed" to this, caused by an increased intake of carbohydrates in the absence of or deficiency of insulin. Thus ketones are a good thing because having them means losing weight on the Atkins low-carb diet.
Not surprisingly the advocates of diets that are moderate or high in carbohydrate have a radically different take on this question.
"The longer you stay in ketosis, you turn yourselves into fat magnets, and you accumulate body fat more readily," Dr. Barry Sears of the Zone diet told the same debate. "The longer you stay in ketosis, you begin to oxidize lipoproteins, so these are long-term consequences which begin to explain why high protein diets fail."
Dr. John McDougall, the author of The McDougall Plan, picked up on the comparison that Dr. Atkins made of his diet to fasting. That's because, Dr. McDougall says, that "nature has designed us so that if we don't have food and we are starving to death, it doesn't hurt so much to die, so we develop ketosis, which suppresses the hunger drive."
Dr. McDougall says that we also get ketosis when we are severely ill and that the reason for that is that we are supposed to be recuperating then, not gathering and preparing food. "That's why I call them the ‘make yourself sick diets.'"
I think the jury is still out on whether ketones are good or bad. But the verdict is in on ketoacidosis, and it's clear that you don't want to go there.
The two conditions are certainly linked. They even have more in common. The NIDDK's list of symptoms of ketoacidosis include fruity breath. But I don't see fruity breath on its list of symptoms of high levels of ketones.
Yet, Dr. Atkins himself talks about the breath of his followers. "Whether the sweet smell of ketones is considered bad breath or just sweet breath," he said, "is a matter of opinion."
The debate's moderator, Carolyn O'Neil, however, seemed to like the smell. That breath, she said as she closed the debate, "smells like money." That's really what these diets are all about.
