Helping you to understand Ketones

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Ketones metabolism is a normal physiological process in the body. They help give the body much needed energy and are made through normal fat metabolism. Some patients I meet have no clue about ketones whereas others have a solid understanding.

Some people are more familiar with the keto or ketone diet. This is how ketones have entered the mainstream and what most people mean when discussing them.

These diets are very low carbohydrate. The idea being by allowing your stores of carbohydrate to deplete, your body turns to fat metabolism to fuel the body. If this causes a negative energy balance, it will result in weight loss. I won’t go into this here as I have blogged about it in detail previously which you can find here.

However, in certain instances, an accumulation of ketones can signal trouble. In type 1 diabetes, excessive ketone accumulation can signal a lack of insulin in the body and become life threatening.

In a hospital setting, we find excessive ketone formation may also indicate a state of starvation where our patients have not eaten for some time.

Both are bad situations often resulting in medical support.

Ketone metabolism

Usually if you have a good amount of carbohydrate in your diet your body will use glucose for a lot of its energy needs. Especially when powering the brain, central nervous system and red blood cells.

Fat metabolism also provides energy. It has 2 pathways it uses to produce energy. One is via fatty acid breakdown. The second is via ketone metabolism. There are 2 types of ketones – acetoacetate and betahydroxybutyrate.

The Liver

The liver decides how much and what type of energy is distributed around the body. Usually this is a combination of glucose (from carbohydrates) and fat. However, if we restrict our carbohydrate intake, your liver quickly uses up its stores of glucose. It therefore needs fat to start picking up the slack and producing more energy. Unfortunately, fatty acids cannot fuel the brain, central nervous or red blood cells but ketones can. So the body starts to increase its production of ketones to compensate for the lack of glucose.

Acetyl – CoA

Most energy providing molecules are too big to get into cells. So they need to be deconstructed and then rebuilt once inside the cell. Think like a sofa not fitting through your front door so you need to break it into smaller segments to get it in the house but then rebuild once inside.

Fat, ketones and glucose are all deconstructed into a substance called Acetyl CoA to get into cells. As a result of this rather ingenious step, the body can detect when Acetyl – CoA is insufficient to meet the bodies energy requirement. It can then trace it back to the substance that isn’t pulling its weight. In this instance it is glucose, Therefore, the body increase its production of ketones to take up the slack for glucose and produce more Acetyl-CoA.

Once Acetyl -CoA is inside the cell, glucose, fatty acids and ketones can be reconstructed and metabolised for energy. In order to yield energy, each molecule is broken down into smaller and smaller molecules until they reach a point where they can actually provide energy. So they are all interconnected.

The Keto Community

Many people follow a keto diet and swear by it. They use it to help control blood glucose levels (particularly in type 2 diabetes) and lose weight. As mentioned above I have discussed the pros and cons of this diet previously and if you’re interested in this, follow the link above.

I think it is a diet that can work for some people. In type 1 diabetes patients, I get uneasy. This is because excessive ketone production in type 1 diabetes can be dangerous. If these patients are already running high ketones due to their diet, it only takes an illness or something to go wrong with their insulin before they are in trouble.

All diets have good and bad points. Ultimately we are looking at the diets overall adequacy. Whereas many diets on the market only focus on weight loss irrespective of the medical evidence suggesting certain ways of eating reduce cancer, diabetes, CVD, bowel problems etc. So there’s more to diets and healthy eating than just what your weight is doing. Even though that is an important component.


I hope this video has given you a better understanding of how ketones are formed and I would suggest reading the pros and cons of the keto diet if you are interested.

Need more help

If you need more support we offer a range of 1:1 consultancy services and online programmes focused on helping you improve your glucose control and health for the long term. These include our type 2 diabetes recovery programme, type 1 glucose stability programme and winning weight loss programme. Go to the pages using the links above or in the headers or get in touch if you have questions.

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