Ketosis, ketoacidosis and very-low-calorie diets: putting the record straight

Very-low-calorie diets (VLCDs) are used to treat obesity, often in a non-clinical setting, and the typical formulation of a minimum of 50 g carbohydrates daily can induce a mild dietary ketosis. This clinically benign state is sometimes confused with the non-metabolically adapted state of ketoacidosis, and this misunderstanding may lead to the rejection of VLCDs as a suitable obesity treatment. This paper summarises and discusses the difference between physiological ketosis and pathological ketoacidosis, the benefits of ketosis-inducing weight-loss regimen such as VLCDs and why ketoacidosis should never be the diagnosis in a non-type 1 diabetic on a carbohydrate-restricted diet.