Ketosis vs ketoacidosis: What is the difference?

Dr. Stephen Phinney and the Virta Team

Ketosis: Endogenous ketones are known to be safe at physiologic levels. It has long been known that ketones are an effective alternate metabolic fuel and recent studies have shown them to be potent epigenetic and hormonal signaling molecules as well (Newman, 2014; Rojas-Morales, 2016; Nagao, 2016). In nutritional ketosis, serum ketones range from 0.5 to 5 mM. This is the body’s normal state of lipolysis that occurs when carbohydrates are avoided (Manninen, 2004; Veech, 2004).

Ketoacidosis: In stark contrast to this normal physiology of ketosis, pathologic ketoacidosis manifests with serum ketone levels of 15-25 mM (i.e., three- to ten-fold higher than in nutritional ketosis). Lipolysis is exquisitely regulated, so it is exceedingly rare for a patient with normal pancreatic beta cell function to enter ketoacidosis.

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