Ketogenic diets have been used in the treatment of seizure disorders, neurodegenerative disorders, and more recently have become mainstream as a method for weight loss, although its weight loss implications have been described as early as the s [ 2 ].
It can be modified by the addition of intermittent or prolonged fasting which will also restrict caloric intake. In certain conditions, this ketosis can develop into overt ketoacidosis, causing a decrease in pH and serum bicarbonate level, leading to serious illness and hospitalization.
Malnutrition and poor dietary intake are ways to enter a state of starvation that may result in ketoacidosis [ 4 ].
Gastric banding has also been associated with a risk of starvation ketoacidosis [ 5 ]. Besides ketoacidosis, the ketogenic diet may lead to electrolyte abnormalities, hypoglycemia, acute pancreatitis, and dyslipidemia [ 6 ].
A year-old male with a history of well-controlled diabetes mellitus type II presented to the emergency department after having a witnessed syncopal episode at home. He was a follower of a vegetarian version of the popular ketogenic diet who engaged in intermittent fasting.
While following this strict diet for roughly the past year and increasing his exercise, he reported losing 20 pounds and decreasing his hemoglobin A1C HbA1C from He decided to challenge himself by going on a multiple day fast by foregoing food and only drinking water. He intended to transition into ketosis at a quicker rate, thereby possibly helping him further manage his diabetes. After 5 days of fasting, the patient broke his fast by eating soup and taking a chlorophyll supplement, which he usually took, which caused him to vomit and become dizzy.
He later syncopized in front of his wife, hitting his head on the shower door and briefly lost consciousness. He presented to the emergency department with persistent nausea and vomiting. His only prescription medication was metformin mg twice a day, and he denied alcohol or recreational drugs. He did not take any alkalizing supplements. On evaluation, he was hemodynamically stable with baseline normal mental function.
Physical examination was unrevealing. He reported resolution of symptoms and tolerated an oral diet. He was discharged home with instructions to follow up with his primary care physician for further management.
Fat metabolism primarily in liver hepatocytes produces 2 ketone bodies, i. As acid anions, beta-hydroxybutyrate and acetoacetate can result in a decreased blood pH acidemia , if present in higher levels. A third ketone, acetoacid is produced by the spontaneous decarboxylation of acetoacetate, acetone, and is neutral and cannot alter blood pH [ 7 ]. One of the reasons for the increased popularity in the ketogenic diet is its effectiveness in weight loss.
There was also decreased emotional eating, increased body image satisfaction, and improved physical importance [ 9 ]. Another study that focused on individuals with diabetes mellitus type II found that participants who followed a very-low-calorie ketogenic diet compared to those following a hypocaloric diet had a significant reduction in weight loss and waist circumference and had better glycemic control [ 10 ].
It is hypothesized that using energy from protein in a ketogenic diet is more energy-intensive which results in the loss of more calories [ 11 ]. Other proposed methods for weight loss in the ketogenic diet include a reduction in appetite due to a higher satiety effect of proteins, a possible direct appetite suppression from ketone bodies, and increased lipolysis [ 11 ].
However, if the caloric intake is too low or a periodic fasting is performed, there is a chance to enter ketosis faster and possibly develop clinically significant ketoacidosis with symptoms such as fatigue, nausea, and vomiting.
This is likely what happened to our patient. Other cases of ketoacidosis developing from low carbohydrate and high protein diets, such as the South Beach Diet and the Atkins Diet, have been reported [ 12 , 13 ].
Although there is data regarding the short-term success of low-caloric, low-carbohydrate diet, there is only limited data regarding the long-term success of the ketogenic diet — this might be due to the difficulty in maintaining a strict low-carbohydrate rule for longer periods of time. The high protein and fat diet is also unlikely to be cardioprotective, since it might cause an increase in LDL cholesterol and serum triglycerides [ 11 ].
Starvation ketoacidosis is an uncommon cause of acute metabolic acidosis. In our patient, our initial differentials were possible diabetic ketoacidosis due to the fasting followed by vomiting versus lactic acidosis secondary to metformin use versus acidosis due to herbal supplements that sometimes contain unregulated additives.
Through clinical and laboratory evaluation, we were able to diagnose his fasting while on a ketogenic diet as the cause of acidosis. In this patient with diabetes mellitus type II, diabetic ketoacidosis should be considered as the cause of his metabolic acidosis. This serious….
While specialists do not recommend a specific diet for diabetes, research has shown that people who follow a ketogenic diet can improve the management…. Urine tests play a role in diagnosing diabetes and its complications. Both individuals and doctors can use them to monitor health and check for…. Ketone testing is an essential part of managing diabetes. High ketone levels can be dangerous, and may lead to ketoacidosis. Find out when, how, and…. Ketosis is a metabolic process in which the body burns stored fat for energy, instead of glucose.
Some people try to induce ketosis with a low carb…. Differences between ketosis and ketoacidosis. Medically reviewed by Debra Sullivan, Ph. Ketosis vs. Share on Pinterest A doctor may recommend blood or urine tests to determine if someone is experiencing ketosis or ketoacidosis. Symptoms of ketoacidosis. Symptoms of ketosis. Share on Pinterest Symptoms of ketosis may include fatigue, feeling cold, and general weakness.
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Medically reviewed by Deborah Weatherspoon, Ph. Does the ketogenic diet work for type 2 diabetes? Malkoff explains that the ketogenic diet works by rewiring metabolism so that it can burn fat more efficiently over time, and it uses specific levels of macronutrients fats, carbs, and proteins to keep the body in a constant state of ketosis.
The plan has become popular among people with type 2 diabetes because of its potential to lower blood sugar while leading to weight loss. For people who are able to stick with it, the ketogenic diet can reduce appetite and lower triglycerides — a form of fat that can affect heart-disease risk — while contributing to weight loss and sharper brain function.
Particularly, people with kidney damage, women who are breast-feeding or pregnant, and some individuals on certain kinds of medication should avoid ketosis. It's important to discuss your diet goals with your doctor before trying to achieve this state. Also important to note is there are no long-term studies on ketosis and the ketogenic diet, so it's unclear what health effects the approach may have on the body if sustained. Some dietitians warn the ketogenic diet may lead to nutritional deficiencies in the long run.
People with type 1 diabetes should not try to achieve ketosis through the ketogenic diet or otherwise. Because people with type 1 diabetes don't have insulin, they cannot metabolize ketones, which are gradually flushed through urine in people without the disease.
For people with type 1 diabetes, ketosis can result in an accumulation of ketone acids in their bloodstream known as diabetic ketoacidosis DKA , says Dr. Whereas ketosis is natural and harmless, diabetic ketoacidosis can be life-threatening if left untreated. Too much acid in the blood can poison the body, causing loss of consciousness and death. Ketoacidosis is most common in people who have type 1 diabetes, but it can sometimes develop in type 2 diabetes due to low insulin levels.
Ketoacidosis is rare in people without diabetes, but it might occur in cases of starvation.
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