This is a concept familiar to many of us in the keto world. Who hasn’t bought ketone test strips (also known as “Ketostix”) at your local drugstore to see if we’re in ketosis yet?
At Keto we want to make ketones – lots of them! Which helps nourish the body while enjoying its many health benefits.
Once you cut off carbohydrates and produce ketones, some of them will be excreted through the kidneys in the urine, which is technically known as ketonuria.
But is this a bad thing? “Ketonuria” looks a bit ominous.
For most healthy people who follow a ketogenic diet to enter nutritional ketosis, ketosis and the resulting urinary ketones are not a cause for concern.
Registered Nurse David Spiro, RN He notes, “If your glucose level is close to normal and you’re well hydrated, ketosis isn’t a problem. Many low-carb diets intentionally create ketosis, which can be an indicator of fat burning and weight loss.”
Ketouria becomes a problem primarily for people who do not produce enough insulin naturally, such as people with type 1 diabetes. For these individuals, ketoacidosis can be a symptom of a very serious condition called ketoacidosis.
In order to distinguish ketosis that results from healthy ketone metabolism from a more serious medical condition, some sources define the term more stringently.
For example, the Oxford Dictionary says ketosis is “the excretion of abnormally large amounts of ketone bodies in the urine, which is a feature of diabetes, starvation, or other medical conditions.” (1)
For our purposes this second definition is more useful. Read on as we discuss the causes and symptoms of ketosis, situations that require additional medical attention, and who is most at risk.
Symptoms of ketonuria
For generally healthy people who do not have diabetes, the body has a mechanism to prevent ketone levels from rising too high. For these people, ketones in the urine are simply one of the signs of ketosis.
Other signs include increased thirst, decreased appetite, weight loss, and bad breath. In this context, these represent little or no risks, and they are often mitigated with electrolytes and over time.
For people with type 1 diabetes and other more serious medical conditions, ketones can build up to very high levels. Besides high blood sugar, high ketone levels can lead to a condition called ketoacidosis, which is a life-threatening condition.
Routinely testing urine for ketosis can be an important step in detecting ketoacidosis early and getting appropriate treatment.
- extreme thirst
- frequent urination
- Vomiting and nausea
- Shortness of breath or shortness of breath
- Fruity smell in the breath
- dilated pupils
It is important to clarify this point: If you don’t have diabetes, keto won’t give you ketoacidosis. Likewise, ketosis is only a sign of a problem for people with certain types of diabetes, pregnancy, or other high-risk medical conditions.
Causes of ketonuria
When the body produces ketones, some of them end up in the urine. So to identify the causes of ketosis, we don’t need to look for the causes of ketosis, or ketone production.
Our bodies are wonderfully adapted to produce ketones to keep us going when there isn’t enough food, or when the body thinks there isn’t enough. So in cases of starvation, fasting and prolonged exercise, you may enter a state of ketosis.
Ketonuria may occur during severe stress or illness. It is estimated that about 15% of hospital patients without diabetes have ketones in their urine. (1)
Of course, sometimes we intentionally create ketones by following a ketogenic diet.
In all of these cases, ketosis is common and generally not a cause for concern.
For people whose bodies do not produce enough insulin naturally, ketosis is a warning sign of the presence or development of ketoacidosis.
In these cases, according to the UK’s National Institute for Health and Care Excellence, “the presence of ketones indicates that insulin concentrations are too low to not only control blood glucose concentrations but also to prevent the breakdown of fats (lipolysis).” (1)
Excessive alcohol intake can also lead to ketonuria and ketoacidosis. Alcoholism often accompanies a poor diet and nutrient deficiencies, so the body breaks down fats to maintain itself, producing ketones in the process.
ketonuria in diabetes
By far, the most common medical condition that leads to ketosis is uncontrolled diabetes. Insulin is necessary to shut down climbing ketone levels before they get too high. Without enough insulin, ketoacidosis and ketoacidosis can develop.
For these individuals, ketonuria is a danger sign – one that requires close monitoring and medical attention.
A routine urine test is common for diabetics, to detect the presence of ketonuria. Diabetics are often advised to check their urinary ketones when their blood sugar is greater than 240 mg/dL. (1)
The American Diabetes Association recommends calling your doctor if a urine test shows high levels of ketones, with or without high blood sugar. (1)
Testing ketosis at home is simple and inexpensive, and may make the difference in getting the right medical treatment before ketone levels rise too high.
ketonuria in pregnancy
Ketouria can be very common during the different stages of pregnancy, labour, delivery, the postpartum period and even during lactation. It affects at least one in five women. (1)
Some typical – and usually temporary – causes of ketosis in a healthy pregnancy include vomiting, exercising or simply fasting all night. In each of these cases, the body notices a lack of energy, so it breaks down body fat for energy.
Ketones are naturally produced as a byproduct of this metabolism. In most of these cases, ketone production stops when the body can again access food.
Ketosis and ketosis become more concerning in the later months of pregnancy.
In some rare cases, vomiting during the third trimester of pregnancy leads to “starvation ketosis.” (1In this case, ketone levels can rise dramatically, leading to metabolic acidosis, a condition that is very dangerous for the baby.
In the second half of pregnancy, hormones secreted by the placenta can break down fats, which leads to the production of ketones. (1This is a natural process, but at the beginning of the third trimester, the risks of insulin resistance and gestational diabetes also increase significantly.
These factors, if not properly controlled, can pose a very dangerous condition to the fetus.
Research has shown that high ketone levels can have a negative effect on a child’s nervous system. (1).
Some studies suggest that ketonuria is associated with worse outcomes for the fetus, including decreased amniotic fluid volume and abnormal fetal heart rate. (1This is observed even with small levels of urinary ketones.
In one study, an IQ test was completed on babies born to mothers with high levels of ketones in the blood. They found that the higher the mother’s ketone levels during pregnancy, the lower the baby’s IQ score. (1)
Studies have also found that babies exposed to high levels of ketosis in the womb are also at greater risk for brain anatomical changes, developmental abnormalities, and impaired psychomotor development.
In each of these cases, ketonuria exists because the body produces ketones. Ketonuria is an important sign that additional monitoring and medical intervention is necessary.
For people who are not diabetic or pregnant, ketones in urine are simply part of a healthy metabolic system. For most people, ketosis recovers once you have breakfast, eat some carbohydrates, or stop exercising.
The medical treatment offered for ketoacidosis varies somewhat, depending on the clinical need of the patient.
In case of diabetic ketoacidosis according to Dr. William C. Shell Jr., MDTreatment with insulin and intravenous fluids can restore normal blood sugar levels and end ketoacidosis and ketosis.
Electrolyte substitutes, such as sodium, potassium, and chloride, may also be added, due to the higher potential for dehydration and mineral loss.
In one case study, a 32-week-old pregnant woman tested positive for ketoneuria as well as blood ketones. After she was diagnosed with starvation ketoacidosis, treatment with “intravenous fluids, dextrose, thiamine, and folic acid” was started. She continued to give birth to a healthy full-term baby. (1)
Know the risks of developing ketoacidosis
It’s important to keep a close eye on any medical conditions that put you at risk of developing ketoacidosis or ketoacidosis. For some people, ketonuria is a sign of a more serious problem and the need for medical intervention.
However, if you are on a ketogenic diet and you don’t If you have any of the high-risk conditions discussed here, urinary ketones are normal and a sign that your body is in ketosis. Well done!