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NickP

What Consumer Reports said about the Atkins Diet

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modcarb
Thanks. The site does list and sell the current book, but is not run by the Atkins Foundation or the authors of the book. I don't know if the site is true to the book with regards to the recipes and two week diet. Just because they sell the book, don't believe everything you see. Again, I would not recommend any "Atkins" labeled food products.

 

With regards to protein, if you go to pages 42-44 of the The New Atkins for a New You Book, you will see the protein recommendations that are laid out by the Atkins diet. On page 44, they specifically state:

 

 

 

Looking at the tables at pg 42-43, for my height and weight, it shows an optimium protein level of 15-30%. Sorry, but that is NOT a high protein diet.

 

Nick,

Good grief!!

I posted that link for anyone who wanted to check out the new Atkins diet without purchasing the book. I wasn't expecting a lecture about it.

 

I definitely won't make that mistake again.

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samorgan

C'mon Deus, we've been through all that before: EXCESSIVE KETONES CANNOT BE PRODUCED VIA DIETARY KETOSIS. Remember? That's a red herring.

 

Actually I always assumed the importance of 'Low Carb Living ' was the idea that you were supposed to avoid excess blood sugar and reduce your insulin requirements. Incidentally, while ketosis is a benign state, an excess of ketones will be just as deadly for you as an excess of glucose. It's just that in people with diabetes, it's a lot harder to regulate your glucose than it is your ketones!

 

 

 

Indeed we do, which is why I continue to advocate people finding diets that work for them personally. For some people, this means high-carb. For some people, it means low-carb. Neither of those choices (or the sheer range that sits in between) is necessarily 'better' than all the others.

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samorgan

Please don't get upset. To some of us that was a very interesting and important issue - is the Atkins diet (past or present) inherently high-protein? I'm grateful to Nick for putting this to rest once and for all. Not a lecture, he did his job and brought the needed information.

 

 

Nick,

Good grief!!

I posted that link for anyone who wanted to check out the new Atkins diet without purchasing the book. I wasn't expecting a lecture about it.

 

I definitely won't make that mistake again.

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DeusXM
EXCESSIVE KETONES CANNOT BE PRODUCED VIA DIETARY KETOSIS. Remember? That's a red herring.

 

Really? I'd just argue it's unlikely. It's certainly possible. In fact, looking at a study of a ketogenic diet (which of course is just one study and I'm sure we'll all be able to find flaws in it somewhere)....

 

Clinical Aspects of the Ketogenic Diet - Hartman - 2007 - Epilepsia - Wiley Online Library

 

Side effects of ketogenic diet include:

 

Acidosis

Rapid ketosis/acidosis

Vitamin, trace element deficiency

 

Among others.

 

Another important quote is "Most patients have a mild acidosis at baseline." Which suggests to me that the majority of people on ketogenic diets (where the ratio of fat is four times greater than that of protein or carbs, according to this study) are at potential risk of developing ketoacedosis. Given that insulin plays an important role in warding off certain forms of ketoacedosis, arguably a ketogenic diet could pose a risk to some individuals with diabetes who have less control over their insulin levels.

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samorgan

Well, you've got a number of your own "assumptions" in there. I only see the possibility of transition to ketoacidosis in your words, not in anything you quoted. I'm not sure what "mild acidosis" is supposed to mean but I've seen very detailed studies which show that they highest level of ketones possible by dietary means is well below the threshold which poses any danger of ketoacidosis. Barring other, unrelated issues being the cause, you simply "can't get there from here."

 

So, subjective opinions of what is "too high" aside, there appears to be no pathway at all from diet-induced ketosis to ketoacidosis. None. Just to begin to study this, you have to get past hundreds of studies and articles which confuse (intentionally or otherwise) the two definitions: ketosis and ketoacidosis. While they share some things like elevated ketones and low insulin, the latter only occurs in the context of high blood glucose and another poorly understood extreme starvation state which has been observed in places like India. It does not and cannot occur in a condition of ample nutrition on a ketogenic diet which inherently does not allow high blood glucose.

 

BTW, the original ketogenic diet used to treat childhood epilepsy (quite successfully I might add) is radically different from that used by many to treat T2 diabetes. For one thing, it is severely calorie-restricted. I can't remember seeing anyone using a ketogenic diet to address diabetes who did that.

 

 

 

Really? I'd just argue it's unlikely. It's certainly possible. In fact, looking at a study of a ketogenic diet (which of course is just one study and I'm sure we'll all be able to find flaws in it somewhere)....

 

Clinical Aspects of the Ketogenic Diet - Hartman - 2007 - Epilepsia - Wiley Online Library

 

Side effects of ketogenic diet include:

 

Acidosis

Rapid ketosis/acidosis

Vitamin, trace element deficiency

 

Among others.

 

Another important quote is "Most patients have a mild acidosis at baseline." Which suggests to me that the majority of people on ketogenic diets (where the ratio of fat is four times greater than that of protein or carbs, according to this study) are at potential risk of developing ketoacedosis. Given that insulin plays an important role in warding off certain forms of ketoacedosis, arguably a ketogenic diet could pose a risk to some individuals with diabetes who have less control over their insulin levels.

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modcarb
Please don't get upset. To some of us that was a very interesting and important issue - is the Atkins diet (past or present) inherently high-protein? I'm grateful to Nick for putting this to rest once and for all. Not a lecture, he did his job and brought the needed information.

 

I simply posted a link and was flamed for doing so.

IMHO the Atkins diet is not a high protein or high fat diet as the diet plan I posted shows. It is definitely a low carb diet in the induction phase. The next three phases add more vegetables and low glycemic fruit as well as whole grains as tolerated.

IMHO it is a good plan.

Now please don't flame me for posting MHO.

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NickP
Really? I'd just argue it's unlikely. It's certainly possible. In fact, looking at a study of a ketogenic diet (which of course is just one study and I'm sure we'll all be able to find flaws in it somewhere)....

 

Clinical Aspects of the Ketogenic Diet - Hartman - 2007 - Epilepsia - Wiley Online Library

 

Side effects of ketogenic diet include:

 

Acidosis

Rapid ketosis/acidosis

Vitamin, trace element deficiency

 

Among others.

 

Another important quote is "Most patients have a mild acidosis at baseline." Which suggests to me that the majority of people on ketogenic diets (where the ratio of fat is four times greater than that of protein or carbs, according to this study) are at potential risk of developing ketoacedosis. Given that insulin plays an important role in warding off certain forms of ketoacedosis, arguably a ketogenic diet could pose a risk to some individuals with diabetes who have less control over their insulin levels.

 

Interesting....I followed the link, and here is the summary from the study

 

The ketogenic diet remains a valuable therapeutic option for patients with intractable epilepsy. Clinical aspects of the diet's success may provide insights into epileptogenesis and anticonvulsant action. The diet's efficacy has been established primarily through large case series. The diet has been used successfully in patients with many different epilepsy syndromes in countries around the world. Potential adverse effects can be avoided with careful attention during the diet's initiation and maintenance phases. In the last decade, variations to the classical ketogenic diet have been utilized. Ketogenic diets now are being used for diseases other than epilepsy. This critical analysis of the diet should provide the impetus for further clinical and basic research into the diet's application and mechanisms of action.

 

I saw the list of side effects, and I believe if you compared this list to a safe and common drug like Metformin, you would see many similiarities.

 

Nice article....it did state that most side effects (again...this was a study on children) could be easily managed.

 

It's interesting to see an Study actually take a look at how Nutrition can be a "valuable therapeutic option".

 

Thanks for posting Deus!

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NickP
I simply posted a link and was flamed for doing so.

IMHO the Atkins diet is not a high protein or high fat diet as the diet plan I posted shows. It is definitely a low carb diet in the induction phase. The next three phases add more vegetables and low glycemic fruit as well as whole grains as tolerated.

IMHO it is a good plan.

Now please don't flame me for posting MHO.

 

Hey modcarb....I certainly was not attempting to flame anyone. If you took offense, I apologize.

 

I have a deep respect for the work that Dr Atkins performed. I appreciated you posting the link and giving me an opportunity to discuss some common misconceptions about the commercial "Atkins" products and the true "Atkins Diet"

 

On the other hand, I am always happy to continue to the debate or dialogue.....I am always trying to learn more (and have much more to learn)!

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modcarb
Hey modcarb....I certainly was not attempting to flame anyone. If you took offense, I apologize.

 

I have a deep respect for the work that Dr Atkins performed. I appreciated you posting the link and giving me an opportunity to discuss some common misconceptions about the commercial "Atkins" products and the true "Atkins Diet"

 

On the other hand, I am always happy to continue to the debate or dialogue.....I am always trying to learn more (and have much more to learn)!

 

Thanks Nick.

I have been looking into the new Atkins diet which is why I had the site bookmarked. I don't like the products they push because of the sugar alcohols they contain. They also don't taste that great!

I need to get the book and read it especially the part you mentioned about finding out your true weight.

I also am not an expert on diets as a full bookcase shelf of different ways to treat diabetes indicates. I read a lot and usually find a gem in each book.

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NickP
Thanks Nick.

I have been looking into the new Atkins diet which is why I had the site bookmarked. I don't like the products they push because of the sugar alcohols they contain. They also don't taste that great! I need to get the book and read it especially the part you mentioned about finding out your true weight.

I also am not an expert on diets as a full bookcase shelf of different ways to treat diabetes indicates. I read a lot and usually find a gem in each book.

 

Hey Modcarb.....I agree with you 100% -- The "Atkins" labeled commercial products are cr@p, the sugar alcohols are usually molitol (bad stuff), and the net carbs that they list on the product do not match what my BG tells me. And....yes....they also taste bad.

 

Let me make this up to you -- If you PM your home address (or any mailing address....your call), I will send you a copy of the new Atkins Book. I would love to have the opportunity to talk with you further about it.

 

I love my Low Carb Diet! It has changed my life and my health, and I would like to share this experience with anyone who can stand to listed to me!

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DeusXM
While they share some things like elevated ketones and low insulin, the latter only occurs in the context of high blood glucose and another poorly understood extreme starvation state which has been observed in places like India. It does not and cannot occur in a condition of ample nutrition on a ketogenic diet which inherently does not allow high blood glucose.

 

 

According to, of all things, Wikipedia...

 

Ketoacidosis occurs when the body is producing large quantities of ketone bodies via the metabolism of fatty acids (ketosis) and the body is producing insufficient insulin to slow this production. The excess ketone bodies can significantly acidify the blood. The presence of a high concentration of glucose in the blood (hyperglycemia) caused by the lack of insulin can lead to further acidity. In healthy individuals this normally does not occur because the pancreas produces insulin in response to rising ketone/blood glucose concentration.

 

If you read this through, it's quite clear that for individuals with impaired insulin production (which includes all T1s and some T2s) to suffer from ketoacidosis related to a ketogenic diet. You argue a ketogenic diet cannot result in high blood glucose level. For T1s at least, it can and does. I've done ketogenic diets before and I have to pay very careful attention to the amount of insulin I take because it means I'm already have greater concentrations of ketones. I imagine this would also be the case for T2s where the issue is limited insulin production, as opposed to insulin resistance. Let's also not forget the Chinese Restaurant Effect, which will also cause a rise in BGs in T1s and some T2s.

 

Once again, as I've iterated to you before, arguing that something is not 100% safe is not the same as saying it is dangerous. It is a falsehood to suggest that a ketogenic diet is entirely safe and that someone with diabetes can essentially switch off worrying about their body just because they're eating a hf/lc diet. Once again...while ketosis is a benign state, an excess of ketones will be just as deadly for you as an excess of glucose. It's just that in people with diabetes, it's a lot harder to regulate your glucose than it is your ketones!

 

You argue you can't get from "there to there". Pay for my flight to San Diego and I'll be happy to demonstrate to you how an individual with diabetes on a ketogenic diet can end up going from ketosis to ketoacidosis. Yes, this won't happen to people whose bodies automatically control their insulin and glucose levels. But this happens to be a forum where none of us have that ability and so you have to consider that factor in your advice.

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NickP
According to, of all things, Wikipedia...

 

If you read this through, it's quite clear that for individuals with impaired insulin production (which includes all T1s and some T2s) to suffer from ketoacidosis related to a ketogenic diet. You argue a ketogenic diet cannot result in high blood glucose level. For T1s at least, it can and does. I've done ketogenic diets before and I have to pay very careful attention to the amount of insulin I take because it means I'm already have greater concentrations of ketones. I imagine this would also be the case for T2s where the issue is limited insulin production, as opposed to insulin resistance. Let's also not forget the Chinese Restaurant Effect, which will also cause a rise in BGs in T1s and some T2s.

 

Once again, as I've iterated to you before, arguing that something is not 100% safe is not the same as saying it is dangerous. It is a falsehood to suggest that a ketogenic diet is entirely safe and that someone with diabetes can essentially switch off worrying about their body just because they're eating a hf/lc diet. Once again...while ketosis is a benign state, an excess of ketones will be just as deadly for you as an excess of glucose. It's just that in people with diabetes, it's a lot harder to regulate your glucose than it is your ketones!

 

You argue you can't get from "there to there". Pay for my flight to San Diego and I'll be happy to demonstrate to you how an individual with diabetes on a ketogenic diet can end up going from ketosis to ketoacidosis. Yes, this won't happen to people whose bodies automatically control their insulin and glucose levels. But this happens to be a forum where none of us have that ability and so you have to consider that factor in your advice.

 

Interesting. There is no doubt that a Type 1 using a Ketogenic diet can get himself into trouble, no different than if he could with any other diet.

 

Deus, we all have our own unique issues and trust me, I am NOT advising what is best for you. You obviously have looked at this closely and made an informed decision.

 

However, the ketogenic diet can be beneficial to both Type 1's and Type 2's (I don't think most Type 2's have the risk you described above).

 

In fact, there is more and more research being done on the ketogenic diet. This study shows that two months on ketogenic diet can actually reverse diabetic nephropathy.

 

Diabetic nephropathy, as indicated by albumin/creatinine ratios as well as expression of stress-induced genes, was completely reversed by 2 months maintenance on a ketogenic diet. However, histological evidence of nephropathy was only partly reversed. These studies demonstrate that diabetic nephropathy can be reversed by a relatively simple dietary intervention

 

This study was done on mice, and needs some more additional research. The abstract for this study is here:

 

PLoS ONE: Reversal of Diabetic Nephropathy by a Ketogenic Diet

 

Here is another study that compared a Ketogenic Diet to a Low GI Diet. This is posted at Diabetes Health: Extremely Low-Carb “Ketogenic Diet” Leads to Dramatic Reductions in Type 2 BG Levels, Medications - Diabetes Health

 

Two diets - one severely restricting carbohydrate intake but with no limit on calories, and the other emphasizing low-glycemic carbohydrates and low calories - allowed high percentages of obese type 2 patients in a university study to reduce or even eliminate their diabetes medications (95.2 percent of the patients on the extreme low-carb diet and 62.1 percent of the patients on the low-glycemic diet).

 

Researchers at Duke University Medical Center assigned 84 patients to one of two diets over a 24-week period. The first, called a "ketogenic diet," restricted carbohydrate intake to 20 or fewer grams per day, a radical amount compared to the ADA's recommended daily minimum of 130 grams and even to low-carb advocate Dr. Richard K. Bernstein's 30-grams-per-day recommendation.

 

In a ketogenic diet, the body is forced to use fat to provide energy, a process that produces a metabolic product called ketones.

 

The other diet stressed the consumption of low-glycemic foods, which are absorbed slowly by the body and do not cause spikes in blood sugar levels. The diet also severely restricted daily caloric intake to 500 calories. That drastically low number came about because the study was designed to test intense approaches to treating obese people with diabetes whose previous forms of diet and management had not worked.

 

Although both diets produced substantial improvements in patients, the ketogenic diet was clearly more effective. While Duke researchers did not always spell out the actual measurements produced by each diet, they said that the ketogenic group enjoyed lowered A1cs, greater weight loss, and a larger increase in "good" cholesterol compared to the low-glycemic group.

 

The medical center quoted Dr. Eric C. Westman, who led the study, as saying, "It's simple. If you cut out the carbohydrates, your blood sugar goes down and you lose weight, which lowers your blood sugar even further. It's a one-two punch." In fact, reports Reuters, the Duke researchers concluded that "lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes."

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samorgan

Nothing I said applies to you. You are a T1. It is different. Everything I said stands. You can't get there from here. It has been well established, your quasi-relevant paragraph from Wikipedia notwithstanding.

 

If you still don't believe it, find me one example of a TYPE TWO diabetic who ended up in DKA exclusively from maintaining a ketogenic diet without any other unrelated cause. I don't think you will find one. Possibly and extreme late-term T2 with zero insulin-producing ability might be an exception to this. That's not relevant to me or most of the people on the T2 forum, but even so I have never heard of such a case. Also, that would be revealed because such a person would be unable to control their condition with any diet by itself. They are more like a T1 in that regard.

 

They are two VERY different states, an issue which many have attempted to cloud.

 

DKA (or KA) comes about when the amount of available insulin is hugely out of line with the glucose in the blood in need of processing. For a T2 on a ketogenic diet with any significant insulin producing remaining, this condition cannot come about because there is very, very little glucose entering the bloodstream. Any T2 successfully using a ketogenic diet to control their condition has only normal or low-end normal BG and very little need for insulin, so the conditions for DKA simply cannot come about.

 

According to, of all things, Wikipedia...

 

 

 

If you read this through, it's quite clear that for individuals with impaired insulin production (which includes all T1s and some T2s) to suffer from ketoacidosis related to a ketogenic diet. You argue a ketogenic diet cannot result in high blood glucose level. For T1s at least, it can and does. I've done ketogenic diets before and I have to pay very careful attention to the amount of insulin I take because it means I'm already have greater concentrations of ketones. I imagine this would also be the case for T2s where the issue is limited insulin production, as opposed to insulin resistance. Let's also not forget the Chinese Restaurant Effect, which will also cause a rise in BGs in T1s and some T2s.

 

Once again, as I've iterated to you before, arguing that something is not 100% safe is not the same as saying it is dangerous. It is a falsehood to suggest that a ketogenic diet is entirely safe and that someone with diabetes can essentially switch off worrying about their body just because they're eating a hf/lc diet. Once again...while ketosis is a benign state, an excess of ketones will be just as deadly for you as an excess of glucose. It's just that in people with diabetes, it's a lot harder to regulate your glucose than it is your ketones!

 

You argue you can't get from "there to there". Pay for my flight to San Diego and I'll be happy to demonstrate to you how an individual with diabetes on a ketogenic diet can end up going from ketosis to ketoacidosis. Yes, this won't happen to people whose bodies automatically control their insulin and glucose levels. But this happens to be a forum where none of us have that ability and so you have to consider that factor in your advice.

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DeusXM
Any T2 successfully using a ketogenic diet to control their condition has only normal or low-end normal BG and very little need for insulin, so the conditions for DKA simply cannot come about.

 

Which does of course leave us with all the T2s on insulin and many T2s on medication. There are likely plenty of T2s out there who cannot control their diabetes through diet alone and they possibly at a (admittedly small) risk of developing DKA through a ketogenic diet.

 

Nothing I said applies to you. You are a T1. It is different. Everything I said stands. You can't get there from here.

 

No offence mate but when you write on a diabetes forum that dietary ketones can't ever lead to a problem, it's a heck of a backtrack to suddenly say..."oh, but I didn't mean all the T1s who post on the board." I guess the lesson from this is that when we're posting advice in a part of the forum that's just generic diabetes, if we're passing type-specific advice it's probably a good idea to flag that up first.

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gphx

Here's a study comparing low carb (less than 20 grams per day in this case which I can only imagine qualifies as ketogenic) diets and low fat diets in general. As I read it, low carb wins hands down in every meaningful statistic:

 

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samorgan

I'm still waiting for any example which goes against anything I ACTUALLY said...

 

 

Which does of course leave us with all the T2s on insulin and many T2s on medication. There are likely plenty of T2s out there who cannot control their diabetes through diet alone and they possibly at a (admittedly small) risk of developing DKA through a ketogenic diet.

 

 

 

No offence mate but when you write on a diabetes forum that dietary ketones can't ever lead to a problem, it's a heck of a backtrack to suddenly say..."oh, but I didn't mean all the T1s who post on the board." I guess the lesson from this is that when we're posting advice in a part of the forum that's just generic diabetes, if we're passing type-specific advice it's probably a good idea to flag that up first.

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HelenM
the two definitions: ketosis and ketoacidosis. While they share some things like elevated ketones and low insulin, the latter only occurs in the context of high blood glucose and another poorly understood extreme starvation state which has been observed in places like India.

It's untrue that DKA only happens at high glucose levels, in a percentage of cases, 10% according to one recent paper, it occurs at levels ≤250 mg/dl . Hyperglycemic Crises in Adult Patients With Diabetes

Euglycemic DKA is more frequent in children, young people and pregnant women(both t1 and t2); in the latter it's dangerous for both mother and foetus. It's is most associated with vomiting. I've know of person on a forum who didn't believe she could have DKA because she'd read that it only happened at high levels.

Someone with very low glycogen stores to draw upon (as occurs after sustained exercise or in a person on a LC diet) may start to develop ketones very rapidly. Even though I'm in none of the 'at risk' categories. I 've had ++ ketones after vomitting just once, my BG level was in the 4s. .. the cure sipping sweetened fluids ie carbs in an easily digested form.

An older paper (1973) specifically mentions 5 cases of euglycemic DKA ,where there was no vomitting but where the patients had made an 'inappropriate reduction in carbohydrate intake' ( though as an older paper the definition of 'normal' was higher than today,)

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Daytona

I just finished the Atkins book (from 1972, not the new one). I figured since this thread inspired me to read it, I would share what I learned about the diet.

 

1. You start out low carb eating any meat you would like, creams, cheese, etc and small salads (1c loosely packed lettuce).

2. He doesn't specifically address %'s of fat and protein, just that your carbs need to stay below whatever amount works for you.

3. Every week you add back 5g of carbs (from veggies to bread to fruits to alcohol, whichever you would like) until you stop being in ketosis. Then dial it back a notch so that you stay in ketosis.

4. Once you hit your target weight, stay on the same diet and keep an eye out for feeling tired/hungry or weight gain. Reevaluate your amount of carbs if this occurs.

 

So while it is initially a ketogenic diet, the end goals seems to be as many carbs as you personally can handle so that the diet is sustainable.

 

As a side note, I can see why he got peoples' backs up. I personally did not like his writing style, and he came off like he was selling something. :) However comparing the actual information in the book to say Good Calories Bad Calories, the key points are quite similar when it comes to how to lose weight (considering one was written 35 years before the other).

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NickP
I just finished the Atkins book (from 1972, not the new one). I figured since this thread inspired me to read it, I would share what I learned about the diet.

 

That's excellent! Thanks for sharing!

 

I still hear folks refer to the Atkins Diet as a "fad diet"....it really hasn't changed much in nearly 40 years! Dr Atkins was really ahead of his time and his peers!

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samorgan

The original contention (mine) was that a ketogenic diet does not represent (or increase) risk of DKA and that "you can't get there from here". That is not to say that no one on this diet could ever get DKA. As someone already pointed out, a T1 can get DKA no matter what diet they are on - all they have to do is lose their insulin. Rather, the assertion is that this idea that because slow, carefully monitored dietary ketosis introduces ketones and DKA expresses highly elevated ketones (as a SYMPTOM, not a cause), that the former could somehow lead to or increase the risk of the latter - is nothing but myth or simplistic a priori reasoning which doesn't hold.

 

And it's not true.

 

DKA comes about when the amount of available insulin is grossly insufficient for the incoming (and present) glucose in the blood. T1 diabetics who don't get insulin either because they are undiagnosed or some other reason are the vast majority - nearly all - of cases. It comes about when available insulin is way too low relative to need. The body reacts by rapidly metabolizing fats producing ketones in the blood. Unfortunately, cells cannot switch immediately to using them if they have been relying solely on glucose up to that time. It is rare for anyone practicing LC/HF to get into ketosis in less than three days. In a DKA crisis you don't have three days to adjust!

 

So, it seems intuitive that if ketosis introduces "some" ketones (WAY below the danger level as previously pointed out) and DKA causes LOTS of ketones they could be related or it could increase your risk. No. DKA is a metabolic crisis situation. It is the breakdown of one of the body's loopback mechanisms which escalates rapidly and can lead to death in a short period of time. Ketosis, on the other hand is a completely normal state for the human body. Most humans enter it at least once in a while (mostly at night) and some have lived in this state nearly constantly their whole lives. Entire peoples have lived this way for millenia.

 

But couldn't ketosis put you a step closer to DKA if you are in any danger of it? What about the ketones and low insulin they have in common? No, actually, it will only put you several steps FARTHER from it than any other diet you care to compare it to.

 

1) On a ketogenic diet your incoming glucose is extremely low - lower than any alternative you can think of except perhaps extreme starvation.

2) If you have any insulin-producing capability you are most likely not using it fully and so have some spare to deal with any glucose which might get introduced and/or insulin shortage which may come about. This and previous item clearly mean that the large gap between insulin supply and insulin demand (which is the CAUSE of DKA) is LESS likely/possible, not more.

3) Your cells are already "switched" to using ketones and can use them just as well as glucose. In a DKA crisis, this probably won't save you, but it certainly won't increase risk or harm.

 

So, even those at risk for DKA would be at relatively LESS risk not more if practicing a LC/HF ketosis-inducing diet at minimum based on the above three factors. If you are at risk for DKA, you would be well-advised to consider a ketogenic diet to REDUCE that risk.

 

 

It's untrue that DKA only happens at high glucose levels, in a percentage of cases, 10% according to one recent paper, it occurs at levels ≤250 mg/dl . Hyperglycemic Crises in Adult Patients With Diabetes

Euglycemic DKA is more frequent in children, young people and pregnant women(both t1 and t2); in the latter it's dangerous for both mother and foetus. It's is most associated with vomiting. I've know of person on a forum who didn't believe she could have DKA because she'd read that it only happened at high levels.

Someone with very low glycogen stores to draw upon (as occurs after sustained exercise or in a person on a LC diet) may start to develop ketones very rapidly. Even though I'm in none of the 'at risk' categories. I 've had ++ ketones after vomitting just once, my BG level was in the 4s. .. the cure sipping sweetened fluids ie carbs in an easily digested form.

An older paper (1973) specifically mentions 5 cases of euglycemic DKA ,where there was no vomitting but where the patients had made an 'inappropriate reduction in carbohydrate intake' ( though as an older paper the definition of 'normal' was higher than today,)

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samorgan

This "Euglycemic DKA" you refer to is what I referred to in an earlier post as:

 

"and another poorly understood extreme starvation state which has been observed in places like India"

 

I had read about it mainly in India but apparently it's not limited to there. However, it is also irrelevant to this discussion because:

 

1) Exclusive to T1s

2) What they mean by "normal" is anything 300 or less. This they call "euglycemic ketoacidosis" if it is as low as 180 or less (some say 200), they call it "true euglycemic ketoacidosis" - and that one is extremely rare. A diabetic utilizing a ketogenic diet for control would never be anywhere near either of those numbers - nor would they be mal-nourished or starving.

3) As I mentioned originally, it only happens in the context of STARVATION - that's the only reason glucose is low.

 

Since its prime cause is starvation, it is recommended to check the patient for depression (anorexia, etc.):

 

From: NIH

 

True euglycemic diabetic ketoacidosis [blood glucose <200 mg/dl (11.1 mmol/l)] is relatively uncommon and in type 1 diabetes can be caused by starvation of any cause in conjunction with an intercurrent illness. We report a case of euglycemic diabetic ketoacidosis precipitated by starvation resulting from severe depression in a patient with type 1 diabetes. He was acidotic with ketonuria, but his blood glucose was only 105 mg/dl (5.8 mmol/l). He was rehydrated, the acidosis was corrected, and his depression was later treated. This case involves the complex interplay among type 1 diabetes, depression, ketoacidosis, and starvation physiology resulting in glucose concentrations in keeping with euglycemic diabetic ketoacidosis. The case also highlights that even in the absence of hyperglycemia, acid/base status should be assessed in an ill patient with diabetes, and in cases of euglycemic diabetic ketoacidosis, the diagnosis of depression should be considered as a cause for suppressed appetite and anorexia.

 

It's untrue that DKA only happens at high glucose levels, in a percentage of cases, 10% according to one recent paper, it occurs at levels ≤250 mg/dl . Hyperglycemic Crises in Adult Patients With Diabetes

Euglycemic DKA is more frequent in children, young people and pregnant women(both t1 and t2); in the latter it's dangerous for both mother and foetus. It's is most associated with vomiting. I've know of person on a forum who didn't believe she could have DKA because she'd read that it only happened at high levels.

Someone with very low glycogen stores to draw upon (as occurs after sustained exercise or in a person on a LC diet) may start to develop ketones very rapidly. Even though I'm in none of the 'at risk' categories. I 've had ++ ketones after vomitting just once, my BG level was in the 4s. .. the cure sipping sweetened fluids ie carbs in an easily digested form.

An older paper (1973) specifically mentions 5 cases of euglycemic DKA ,where there was no vomitting but where the patients had made an 'inappropriate reduction in carbohydrate intake' ( though as an older paper the definition of 'normal' was higher than today,)

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