Ketosis is the survival state your body enters when deprived of glucose for energy. The body relies on stored fat instead, and acids called ketones build up from the fats in the liver. You can force your body into this state by lowering your carbohydrate intake. This is called the ketogenic (low-carb, high-fat) diet. The purpose is to burn fat by using fat for energy instead of carbs. Furthermore, ketosis commonly appears in diabetics if they are not taking or producing enough insulin.
Carbohydrates create glucose, which is normally the body’s main source of energy. Foods that contain carbs are sugary and starchy in nature. Bread, pasta, fruit, potatoes, quinoa, and soda are all high in carbs. Your body breaks glucose down into sugar, which is either stored in your muscles or used for fuel.
How Do You Know if You’re in Ketosis?
When the body is running low on carbs to use for energy, it will begin to break down stored fats into fuel from triglycerides. This process produces a by-product: ketones. Ketones can be detected in the blood, and they leave the body through urine. There are ketone urine testing strips if you want to see if your body is burning fat as opposed to carbs. However, being dehydrated can result in testing for a higher level of ketones than are actually in your blood. The alternative is also true; drinking too much water can cause the test to show lower levels of ketones. There are more accurate blood tests, but they are more expensive and require you to prick your finger. People who are in ketosis have also reported a change in their breath. “Fruity” and “metallic” scents have been reported. When the ketone levels in the blood are abnormally high, the body can develop a condition called ketoacidosis.
Ketoacidosis
Ketoacidosis essentially poisons the body. This is not a desirable state to be in, and it is dangerous. Ketoacidosis can develop extremely quickly, sometimes even within 24 hours. When an illness causes the body to work against its natural insulin, ketoacidosis can occur. It can also be brought on by stress, physical or emotional trauma, and drug abuse. People with type 1 diabetes are at high risk for developing ketoacidosis because of their lack of insulin.
Symptoms:
- nausea and vomiting
- shortness of breath
- excessive thirst or dry mouth
- abdominal pain
- flushed skin
- “fruity-smelling” breath
- frequent urination
Ketosis vs. Ketoacidosis: Understanding the Difference
These two terms are easy to confuse, but they are not the same. During nutritional ketosis, the body produces a moderate amount of ketones, and its acid-base balance stays under control. Ketoacidosis, on the other hand, is an uncontrolled buildup of ketones that turns the blood acidic. One is a metabolic state many healthy people choose, while the other is a medical emergency.
What to Expect When Starting a Ketogenic Diet
According to Cleveland Clinic, most people need to keep their carbohydrates under 50 grams per day to enter and stay in ketosis, and it may take a week or longer to get there. During this adjustment period, some people experience what is commonly called the “keto flu,” which can include an upset stomach, headache, and fatigue. These symptoms are usually temporary, but staying hydrated and giving your body time to adapt can make the transition easier.
Carbohydrate restriction is not the only way to reach ketosis. Researchers note that it can also be triggered by modified fasting, intermittent fasting, and even medium-chain triglyceride (MCT) oil.
Who Should Talk to a Doctor First about Ketosis
Because ketosis changes how your body uses energy, it is not right for everyone. Anyone with diabetes, particularly type 1, should speak with a healthcare provider before making major dietary changes, since insulin levels play such a large role in whether ketones stay in a safe range. The same goes for people who take medications for blood sugar or blood pressure, are pregnant or breastfeeding, or have a history of liver, kidney, or pancreatic conditions.
When to Seek Emergency Care
If you have diabetes and notice symptoms such as nausea, vomiting, abdominal pain, shortness of breath, or fruity-smelling breath, do not wait to see whether they pass. The CDC provides guidance on diabetic ketoacidosis, and prompt medical treatment is essential because the condition can become life-threatening. At-home test kits can help you monitor ketone levels, but they should never replace professional medical care.
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Updated on 10/22/26 by Keana Lujan.
