Avoid Ketoacidosis on Keto Diet
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How to Avoid Ketoacidosis on Keto Diet?

Due to increasing obesity and other associated disorders, people prefer to lose weight by following certain sorts of diets. One of the significant diets that most people follow is the keto diet. The Keto diet has shown excellent results related to weight loss. But, it requires specific modification and variety in diet planning if you are following a keto diet to prevent diabetic ketoacidosis. So, how to avoid ketoacidosis on keto diet?

You can avoid ketoacidosis on a keto diet if you adopt the following measures:

  • Follow the diabetes treatment plan given by your healthcare provider
  • Take the recommended dose of insulin daily
  • Check the blood glucose levels regularly
  • Check the presence of ketones in urine if blood glucose is high
  • Follow a balanced diet having low-glycemic index foods.

People often confuse ketosis and ketoacidosis, but both terms are different. Ketosis is the body’s metabolic state in which enough energy is not provided through carbs. Circulating sugar is not used by the body for energy.

On the other hand, ketoacidosis is a complication of diabetes (diabetes type 1) that causes the body to produce excess blood acids. DKA can be life-threatening and can lead to diabetic coma. It can also be triggered by illness, infections like urinary tract infection, pregnancy, or not following a proper diabetes plan.

Symptoms Associated with Ketoacidosis:

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Ketoacidosis can be prevented if you know the symptoms that could save a life. If you have diabetes and you observe the following symptoms, then you seek medical attention as soon as possible:

  • Fatigue
  • Confusion
  • Abdominal pain
  • Vomiting
  • Extreme thirst
  • Polyuria
  • Polydipsia

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Diagnosis of Ketoacidosis:

Urine Ketone LevelsBlood Ketone Levels
<0.5 mmol/L = low/normal<0.6 mmol/L = normal
>10 mmol/L = diabetic ketoacidosis0.6-1.5 mmol/L = beginning ketosis
 >3 mmol/L = diabetic ketoacidosis
Urine ketone levels<0.5 mmol/L>0.5mmol/L0.5-3 mmol/L3-5 mmol/L>5mmol/L>10mmol/L
What do my ketone levels mean?Normal to lowBeginning ketosisNutritional ketosisStarvation ketosisHigh risk for ketoacidosis (If blood sugar is greater than 250 mg/dL, call your doctor)DKA (seek medical attention immediately)
Blood ketone levels<0.5 mmol/L0.5 mmol/L0.5-1.5 mmol/L1.5-3.0 mmol/L3 mmol/L 
What do my ketone levels mean?Normal to lowBeginning ketosisModerate levelHigh level, may be at risk for DKADKA (Seek medical attention immediately) 

Foods to Consume and Avoid Avoid Ketoacidosis on Keto Diet :

Keto-Friendly FoodsAvoid These Foods To Enter Sustainable Ketosis
Meats- fish, beef, lamb, poultry, eggsGrain and grain-based foods-wheat, corn, rice, pasta, granola, cereal
Low-carb veggies- spinach, kale, broccoliSugar and sugar-sweetened products-table sugar, soda, sports drinks, honey, agave, maple syrup
High-fat dairy- hard cheeses, high fat cream, butterMost fruits-apples, bananas, oranges
Nuts and seeds-macadamias, walnuts, sunflower seedsTubers and tuber-based food products-potatoes, potato chips, French fries, yams
Avocado and berries- raspberries, blackberries 
Sweeteners- Stevia, erythritol 
Other healthy fats- coconut oil, avocado oil, olive oil, animal fats 

Replacing High Carb Foods with Keto-Friendly Substitutes:

You might think that most of the food items are on a restricted list then what should we eat now? It is not so. There are still many keto-friendly foods, beverages, and ingredients that you can consume to mimic the flavor and textures to optimize your health.

Here we’ll discuss some simple food swaps which you can implement in your breakfast, lunch, dinner, and even dessert option. 

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Replace All-Purpose and Other-Grain Based Flour with Almond and Coconut Flour:

All-purpose flour is used in almost all food items, including bakery goods such as loaves of bread, pasta, cereals. You can still enjoy these products on the keto diet by swapping the all-purpose flour with almond or coconut flour. You can make the low-carb version of your favorite food items like bread, pizza crust, pancakes, and waffles to enjoy them.

Replace Pasta with Keto Veggies or Homemade Low-Carb Noodles:

Pasta is a flour-based food item, so creating a keto-approved version using low-carb flour is not recommended. The easiest keto hack for this is the julienne or pasta noodle size zucchini, eggplant, or cabbage.

Avoid Ketoacidosis on Keto Diet

Replace Sugar, Honey, and Artificial Sweeteners with Stevia Extract and Erythritol:

You can create a sweet taste in your keto-friendly foods without worrying about excess calories by using stevia, monk fruit, or Erythritol. They provide a balanced sweetness making a perfect keto-friendly sugar substitute.

Replace cereals, oatmeal with low-carb nuts, seeds, and sugar-free sweeteners

Instead of consuming high sugar-based cereals, oatmeal, and high-carb snacks, you can make your cereal or granola bars through the right amount of nuts, seeds, and keto sweeteners.  

Replace Rice with Cauliflower Rice:

You might be thinking that this swap option is not for me. But, you’ll be amazed to know that even if you are not a cauliflower fan, you can still consume it by cooking it in the form of a delicious dish.

Avoid Ketoacidosis on Keto Diet

Replace Chips with Baked Cheese Crisps or Rinds:

You can swap the chips and other munching snacks with cheese crisps and rinds. Potato chips, either in the form of packaged or fried, are full of carbs. So, you can swap it with these products.

Replace Yogurt with Full-Fat Greek Yogurt or Coconut Milk Yogurt:

Yogurt is packed with carbs, sugars, or milk sugar. But it does not mean that you cannot eat yogurt on a keto diet. You can consume low-sweetened full-fat Greek yogurt or low-carb yogurt. Other than this, you can also add low-carb nuts and seeds, keto granola, and a few fresh berries too.

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Replace Sugary Ice Cream and Gelato with Coconut Milk and Keto Sweetener:

Here is the solution if you are a massive fan of gelato but are not consuming it due to high-fat keto ingredients. You can make your heavy cream or coconut milk as a base and add natural keto-sweeteners or flavorings instead of sugar.

Replace High-PUFA Oils with Avocado or Coconut Oil:

Instead of high PUFA oils and spreads, you can use extra virgin olive oil, refined coconut oil, and avocado oil for keto frying and cooking. These oils are more heat-stable than other cooking oils high in PUFAs, such as canola oil, vegetable oil, and peanut oil.

Replace Salad Dressings with MCT Oil-Based Dressing and Avocado Oil:

For optimal health and nutrition, use MCT oil and avocado oil products as high PUFA content is more vulnerable to damage when exposed to high heat, air, or light. It all can occur in the production of dressings, mayos, and other condiments.

Replace Sugar Condiments and Sauces with Sugar-Free Products and Keto Alternates:

Make sure to read the label on the sugar condiments and sauces before purchasing them. Typical sauces and dressings packed with sugar include jam and jellies, BBQ sauce, honey mustard, maple syrup, ketchup, and tomato sauce.

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Keto-Friendly Drink Swaps:

You can replace your high-carb and sweet drinks and beverages with keto-friendly drink options. Instead of water, black coffee, or unsweetened tea, try these simple alternatives. You can replace regular soda with zero-carb soda like zero-sugar virgils. Sweetened coffee and tea drinks can be replaced with heavy cream and natural keto-sweeteners. Sweetened margaritas and traditional beer can be replaced with unsweetened dry wine and low-carb beer.

Be cautious with these products:

Here we will discuss some common ingredients in low-carb products which you should look out for.

1. Artificial Sweeteners:

If you are selecting artificial sweeteners, then carefully look at the pack and manufacturing labels. In some cases, artificial sweeteners can disrupt ketosis, and there are some hidden sugars in them. Look out for artificial sweeteners like Equal, Splenda, acesulfame, aspartame, saccharin, and sucralose. You should consume such sweeteners in their purest form without any additives. 

2. Maltodextrin and Dextrose:

 These two ingredients should be considered as they are not keto-friendly options. These two ingredients break down rapidly into glucose and are absorbed in the mainstream. They can increase blood sugar and insulin levels and eventually lower the ketone levels. 

3. Artificial Flavors, Colorings, and Preservatives:

It is recommended to consume these products in lower quantities as their health effects are still not well-known. It is best to avoid them whenever possible as many fall into questionable ingredients.

4. IMO:

Isomaltooligosaccharide, also known as IMO, is a new ingredient claimed as a dietary fiber. But researches have shown that they readily absorb the sugar in the mainstream and small intestine. Thus, it is considered technically as a net carb and not as a dietary fiber.

Formulating The Optimal Keto Lifestyle For You:

Keep these three fundamental principles in your mind when selecting foods, drinks, and products for your keto diet. 

  • Will the product fit in my daily carb limit? For this, you can use ‘’How to determine if a certain food is keto-friendly.’’
  • Will the product help to melt the fat and protein needs? You can bring out an estimate to determine your intake goals.
  • Will the product improve your health and well-being? 

How to Determine if Food is Keto-Friendly and Healthy: 

You can lose weight and improve your health by following an essential keto diet, but you might still not be sure about some food products. In such conditions, you can apply three keto-friendly food principles.

To determine if the food is keto-friendly and healthy, consider the following:

  • Net carb content
  • Protein and fat content
  • Health effects

The question that if the food is keto-friendly or not can be resolved if the specific food:

  • It helps you to stay within your carb limit.
  • It allows you to meet your fat and protein needs.
  • It allows you to meet your macros with that food.
  • Improves your health and well-being

Relation of High Protein Foods and Ketosis:

Protein consumption is also associated with the production of ketones. It creates much less impact than carbs. The amino acids found in the protein can sometimes increase insulin levels. It can provide substrates to the liver and decrease ketone production, thus potentially kicking out the body from a state of ketosis.

But still, one high-protein meal will not affect your ketone levels in the body. We recommend you stay within the following range based on your activity level.

  • If your activity level falls in the sedentary group, 0.6g and 0.8g protein per pound of lean body mass are recommended.
  • If your activity level drops in the active state, 0.8g and 1.0g protein per pound of lean body mass are recommended.
  • If your activity level falls in the lift weight category, 1.0g and 1.2g protein per pound of lean body mass are recommended.

Blood Ketone Level Chart:

Ketosis LevelBlood Ketone RangeWhat Does This Mean?
Sugar-burning mode<0.2 mmol/LYour body has enough sugar, so ketone production is inconsistent.
Transitional phase0.2-0.5 mmol/LYour body is likely starting to produce ketones consistently.
Light ketosis0.5-0.8 mmol/LConsistent ketone production Experiencing the benefits of ketosis Ideal for everyday dieting
Medium ketosis0.9-1.4 mmol/L 
Deep ketosis1.5-3.0 mmol/LMight help promote weight loss Might confer more neurological benefits
Therapeutic ketosis3.0-5.0 mmol/LOnly recommended under close medical supervision for the treatment of certain medical conditions
Extended fast ketosis3.0-5.0 mmol/LMay only be reached during extended fasts or extreme caloric restriction Achieving this range consistently is unnecessary and indicative of a poorly-formulated keto diet
Sign of ketoacidosis>10 mmol/LUsually only occurs as a result of uncontrolled diabetes or alcoholism

How to Determine if a Food is Keto-Friendly?

Keto diet involves an important part of personalizing it according to one’s lifestyle, goals, and preferences. When we succeed in adjusting the diet according to our lives, it becomes easier to achieve and maintain the results. 

We must choose the food items which are accessible and enjoyable. It then becomes easy to meet the fat and protein needs while keeping the net carbs lower. You can easily figure out whether a specific food or product is usable for the keto diet or not.

You can follow a standard keto diet for a few weeks. It can give you a baseline of the carbs you will need to sustain ketosis.

Gather the relevant information related to the food product like fat, protein, fiber, and net carb content.

Figure out facts that you will need to cut or add to the new food of your diet. Point out the adjustments you will make to stay below the carb limit, keeping you in the ketosis state.

After all these steps, if your food is high enough in net carbs and is not within your carb limit, it is not keto-friendly, and you should avoid it. If your food fits the other nutritional needs in the keto diet, then it is keto-friendly for you.

Foods having 10 grams of net carbs or more are difficult to fit into the keto diet. It is the reason that any food with more than 6 grams of net carbs per serving typically comes on the ‘’do not eat’’ or ‘’eat in moderation’’ list for a keto diet list.

Optimal health and sustaining ketosis do not rely only on carb intake. Net carb is not only the factor we should consider when picking keto foods. We should consume the right amounts of protein and fats from high-quality foods. One teaspoon of sugar has 4 grams of net carbs. So, two or three teaspoons of sugar are considered keto-friendly.

Also Read: What Is a Lazy Keto Diet? How to Do and Implications

Frequently Asked Questions (FAQs):

Can you achieve ketoacidosis state on a keto diet?

High fat may induce ketoacidosis. Besides this, lactation can also aggravate the condition and trigger you into ketoacidosis.

How can we prevent ketoacidosis?

 We can prevent ketoacidosis by following these measures:
– Managing diabetes and following a healthy eating and physical activity plan.
– Monitor the blood sugar level regularly.
– Adjusting the insulin dose as needed.
– Checking the ketone levels.

What promotes ketoacidosis?

Ketoacidosis and ketosis are triggered by the increase of ketones in the body. Ketones are acids released into the bloodstream when the body burns fat for energy instead of carbohydrates.

Can ketones be high on a keto diet? 

Healthy people can develop high ketone levels on a ketogenic diet. The Keto diet promotes weight loss and encourages the body to make more ketones to burn fat.

Which is the fastest way to get rid of ketones?

If ketones are detected in your blood or urine, you should drink plenty of water to flush out the ketones from your body. Other than this, take insulin to bring the blood glucose level to normal range and check the ketone levels every three to four hours.

What is the most common cause of ketoacidosis?

 The common causes of diabetic ketoacidosis include missing insulin, illness, infection, or a clog in an insulin pump.

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