Keto Diet: Why Does It Cause Smelly Urine?

The ketogenic, or keto, diet is a popular, effective way to lose weight and improve health. However, it can also lead to some adverse side effects, including bad breath, body odour, and smelly urine. The cause of this is acetone, a ketone produced by the body when it is in a state of ketosis, which occurs when the body burns fat instead of glucose. While this is a normal part of fat metabolism, it can result in an unusual, fruity smell to the breath and urine, as well as other symptoms such as fatigue and nausea.

Ketosis and ketoacidosis

Ketosis

Ketosis is a natural metabolic state where the body burns fat for energy due to a low intake of carbohydrates. Ketosis may be a normal, safe body response to low-carb diets, fasting, or not eating for a certain period of time. When the body is in a state of ketosis, it uses fat instead of glucose as fuel. The liver breaks down this fat into chemicals called ketones, which are released into the bloodstream and used as an energy source. The ketogenic diet aims to induce nutritional ketosis by having people eat foods that are high in fat but very low in carbohydrates.

Symptoms of ketosis can include fatigue, nausea, dizziness, headaches, insomnia, and general weakness. Nutritional ketosis is not a medical condition and does not require a diagnosis. Most people with ketosis do not need medical treatment because it is one of the body's natural states.

Ketoacidosis

Ketoacidosis, or diabetic ketoacidosis (DKA) in people with diabetes, is a serious, potentially life-threatening condition where the body produces dangerously high levels of ketones, making the blood acidic. It is a complication of diabetes (usually Type 1) that occurs when a person does not have enough insulin. The body responds by breaking down fat into ketones too rapidly, resulting in high levels of ketones in the blood.

Ketoacidosis is a dangerous condition that can lead to a diabetic coma and even death. Symptoms of ketoacidosis include fatigue, confusion, abdominal pain, vomiting, extreme thirst, fruity-smelling breath, and frequent urination. Diabetic ketoacidosis is a medical emergency that can progress quickly but is highly treatable. Treatment typically involves insulin therapy together with fluid and electrolyte replacement.

Ketones in urine

Ketones in the urine can be a result of the body producing ketones due to a very low-carb diet. This can cause an unappealing odor, which is often described as "fruity", and sometimes like nail polish remover, due to the presence of acetone. The higher the concentration of ketones in the blood, the more pungent the smell is likely to be.

The body will produce ketones when it does not have enough sugar or glucose for fuel. This might happen overnight or when a person is fasting. Having a small number of ketones in the bloodstream is normal, especially for people who exercise a lot or engage in other activities that encourage the body to burn fat.

Ketone levels can be measured using a specialized meter that calculates the amount of beta-hydroxybutyrate (BHB) in the blood. This is one of the primary ketones present in the bloodstream. Nutritional ketosis is defined as blood ketones equal to or above 0.5 millimolar (mM).

The presence of ketones in the urine can also be detected using ketone strips, which are available in drugstores or online. These strips will change color in the presence of ketones, with darker colors indicating higher concentrations.

In addition to a low-carb diet, other factors that can contribute to ketone production include:

• Pregnancy: Hormonal changes during pregnancy, especially increased levels of the hormone human chorionic gonadotropin (hCG), can cause urine to smell different or stronger.
• Diabetes: People with diabetes may have high levels of ketones in their bloodstream, which can be excreted in the urine and give it a sweet or fruity smell.
• High protein intake: Eating a lot of protein instead of carbohydrates can lead to increased ketone production as the body uses protein and stored fat for energy.
• Dehydration: When the body is dehydrated, the urine becomes more concentrated, darker, and stronger-smelling. This can enhance the odor of any ketones present in the urine.

It is important to note that while ketones in the urine can be a normal part of a low-carb diet, a high level of ketones in the urine or blood can be a sign of a dangerous condition called ketoacidosis, especially in people with diabetes. This requires immediate medical attention.

Dehydration

To combat dehydration, it is important to increase your fluid intake. The recommended amount is 11.5 cups of fluids a day for women and 15.5 cups for men. Staying hydrated will not only improve the odour of your urine but also help with other symptoms of dehydration, such as tiredness and dizziness, which can be more intense when starting a keto diet.

In addition to increasing your water intake, it is also important to be mindful of your protein intake. The keto diet is not a high-protein diet, but some people may eat more protein than necessary. Excess protein is broken down into ammonia, which, when combined with acetone, can make your breath and urine smell worse.

If you are experiencing dehydration, it is important to address it not only to improve the smell of your urine but also to maintain overall health. Dehydration can have serious consequences, so it is crucial to prioritize fluid intake, especially when on the keto diet.

High protein intake

A high-protein keto diet is one version of the standard keto diet, which is a high-fat, low-carb eating regimen. The high-protein keto diet is designed to meet the needs of bodybuilders and older people who want to prevent muscle breakdown. It involves increasing protein intake to about 30% of calories, with 65% coming from fat and just 5% from carbs.

This version of the keto diet is meant for those who require protein to maintain muscle mass. It is also suitable for those who exhibit signs of protein deficiency, such as hair thinning and loss of muscle. However, it may not be the best option for those following the keto diet for therapeutic reasons, as the higher protein intake can lower ketone levels in the blood.

The keto diet, in general, can cause a host of side effects, including bad breath, dizziness, constipation, and low energy levels, often referred to as "keto flu." It is also important to note that the keto diet can be dehydrating, and proper hydration is crucial to prevent dizziness and fatigue.

Additionally, the keto diet can lead to weight cycling, which may put a strain on the heart. It is also essential to consult a doctor or dietitian before starting the keto diet, especially for those with certain medical conditions or who are pregnant.

Diabetes

People with diabetes may have high levels of ketones in their bloodstream, which can be excreted in the urine, giving it a sweet or fruity scent. This is a result of the body breaking down fat for energy when there is not enough insulin or sugar (glucose) available. The condition is called diabetic ketoacidosis (DKA) and is a serious and potentially life-threatening complication. DKA can cause a person's breath to have a fruity odour as well. Other signs and symptoms of DKA include excessive thirst, nausea, vomiting, abdominal pain, constant tiredness, and difficulty paying attention.

Managing Diabetes and Urine Smell

Managing blood sugar levels is crucial for people with diabetes to prevent complications such as DKA. This can be achieved through a combination of lifestyle changes, medication, and insulin therapy. Eating a healthy, balanced diet, maintaining a healthy weight, and engaging in regular physical activity are important components of diabetes management. Additionally, monitoring blood sugar levels and seeking medical care when needed are essential to prevent DKA and other diabetes-related complications.

When to See a Doctor

If you notice that your urine smells sweet or fruity and you have other symptoms of diabetes, such as increased thirst, blurred vision, or frequent urination, it is important to consult a healthcare professional. They can perform tests to determine the underlying cause and provide appropriate treatment. Sweet-smelling urine can be an early indication of diabetes or a sign of DKA in people with existing diabetes. Therefore, it should not be ignored and requires medical attention.

Frequently asked questions