What are ketones?

You've probably heard of the ketogenic diet, or the keto way of eating before. The aim of this way of eating is to adapt the body to use fat instead of sugar as its primary source of energy. The body uses fat as an energy source by first converting fat into ketones. So what are ketones?

The role of ketones

Our ancestors certainly did not eat 5 meals a day, usually not even three. They ate when food was available and when they caught or gathered it. This means that long periods without food may have passed between individual meals. In order for them to survive, the organism had to adapt in such a way that it could use fat as a source of energy. 

What about sugar for energy?

Today's society is different from our ancestors. There is plenty of food in all forms, but they all have something in common. Food is rich in carbohydrates, sugars... Eating such food several times a day causes the body to lose its ability to use fat for energy, so it does not produce ketones.

The advantage of ketones

The mitochondria, which are body's own "little factories of energy", metabolize energy from glucose or ketones and make sure the body gets the needed energy. Here's the difference - ketones generate much more energy per molecule unit than glucose. Simply put, this means that when the body starts to transfer fat into ketones, we get a much better and sustainable source of energy. It is necessary to point out another advantage of ketones - the blood sugar does not rise and insulin levels stay low, when the body starts using the fat. This is a very welcome benefit of ketosis, in addition to many other benefits.

Using fat for energy means that the source or the fuel that the body needs is constantly available - in the form of fat on the body itself or in the form of fat as a source in the diet. As a result, this means that a person who is adapted to the use of fat for energy (this is also called keto adaptation) rarely feels the real hunger, since there are no insulin fluctuations and sugar drops. Ketones take care of this.

How does the body get into ketosis and what is ketosis?

The body can use either sugar or fat as an energy source. Sugar is converted into glucose by our body, while fat is converted into ketones by the liver.

Types of ketones

Unlike the simple conversion of sugar into glucose, fat metabolism produces ketones. 

Types of ketones:

• Acetate (acetone)
• Acetoacetate (AcAc)
• Beta Hydroxybutyrate (BHB)

Strictly chemically, BHB is not a “ketone", due to its molecular structure. But it is an important part and plays an important role in ketosis. AcAc and acetone are ketones in structure. Acetone is excreted by the body through urine or exhaled air.

Measurement of ketones

When the body produces ketones, it uses most of them for energy and excretes the rest. Because of this, ketones can be measured in blood, urine or exhaled air. 

BHB is measured in blood, acetone is measured in exhaled air, and AcAc is measured in urine.

The most accurate method of measuring ketones is measurement in blood or exhaled air, while determination of ketones in urine is not the most reliable.

Measuring ketones in the blood:

Measuring ketones in the blood is a reliable method of determining the amount of ketones. As already mentioned, BHB is measured in the blood. The downside of this method of measurement is that the measurement requires "needle" and, of course, the financial aspect. The strips are quite expensive.

How we interpret the results:

Low ketone level: less than 0.5 mmol/l

Ketosis: 0.6 – 1.5 mmol/l

Optimal (deep) ketosis: 1.6-3.0 mmol/l

Very high ketone value: more than 3.0 mmol/l

Measurement of ketones in exhaled air:

Ketones (or acetone) can be measured in exhaled air with the help of a special device. There are more of them on the market, many of them are still under development. The best seller is Ketonix. The advantages of this method of measurement are its simplicity (no need for strips or blood), reliability (comparable results to blood tests) and unlimited applicability. Buying an appliance is quite a financial commitment, but we have to weigh up the benefits against our purpose or goal.

Measurement of ketones in urine:

The presence of acetoacetate (AcAc) can be measured in the urine. This method is the least reliable of all. It is carried out with the help of special strips, where the presence of AcAc can be read with the help of a colored scale. The result only tells us that ketones are present in the urine, but nothing about whether the body actually uses them or just excretes them because it doesn't know how to use them yet (this is especially important during keto adaptation). Another reason that the measurement of ketones in urine is unreliable is that the final result is also highly dependent on the level of hydration or dehydration of the organism. Dehydration will cause the strip to turn dark purple, which otherwise symbolizes a high value of ketones, but in fact this is not true. And, of course, the counter-high level of hydration causes the strip to not be colored or to be colored brightly, despite the fact that the measurement in the blood would show a perfectly decent concentration of ketones. 

In the stage of keto adaptation - at the beginning of the keto diet - our body does not yet know how to use ketones for energy, despite the fact that they are produced in the body. As a result, the body excretes ketones. We excreet them with urine. When our organism becomes keto-adapted, the body starts using ketones for energy, and that's why there are suddenly fewer or no ketones in the urine. But there are enough of them in our blood. These are the reasons why measurement of ketones in urine is unreliable and even misleading at certain times.

Ketosis - ketoacidosis

You've probably heard of ketoacidosis? Many people confuse these two terms. And what is ketoacidosis? It is an extreme condition that can usually affect diabetics. When the production of insulin is unable for certain reasons, sugar cannot enter the cells. The organism's response to such a situation is to drastically increase the production of ketones (ketones reach 20 mmol/l or more). Such a condition - elevated blood sugar and at the same time greatly elevated ketones - causes the pH of the body to drop to a critical level, which can be fatal in extreme cases. 

The condition of ketoacidosis usually occurs in diabetics where the disease has not yet been detected and is not controlled. In a healthy individual, ketoacidosis cannot occur despite a ketogenic diet or even very long fasting. In other words, if you are not a diabetic, such a situation is practically impossible.

Summary

Ketones are a wonderful source of fuel for our body. They are produced during the breakdown of fatty acids and provide the body with a much longer and more stable energy state. Unlike sugar (glucose), ketones do not affect inflammatory conditions and blood sugar drops.

The modern diet, which is rich in carbohydrates and sugars, has caused our body to use glucose as its energy source. However, when following the guidelines of the keto diet, the body adapts to fats and uses ketones as a source of energy. Ketones pass through cell walls more easily and are used by the brain more easily than glucose. Therefore, they can be extremely therapeutic in the treatment of epilepsy, migraines and many other diseases.

Sources:

https://www.webmd.com/diabetes/type-1-diabetes-guide/what-is-ketosis#1
https://www.psychologytoday.com/blog/evolutionary-psychiatry/201104/your-brain-ketones
https://drjockers.com/what-are-ketones/
https://www.dietdoctor.com/?s=ketones
https://sl.wikipedia.org/wiki/Mitohondrij

17.11.2017, Katja, LCHF Style