Ketogenic diets (KD) and other low carbohydrate diets have become popular for weight loss and fitness. A word of caution – these should be prescribed with physician guidance something not always seen in this unregulated ‘fitness’ industry.  Also, with the availability of several do-it-yourself guides on social media many are tempted to try these methods without any professional guidance from a qualified dietitian or nutritionist. We describe one case where there was a serious health problem following use of the KD with prolonged fasting.

This is a report is from the American Journal of Case Reports 2019.

A 60-year-old male with uncontrolled diabetes mellitus type II (DM2) started the KD with good results the HbA1C dropping from 11.5 % to 7 % and around 5 Kg weight loss. He then became adventurous and embarked on 5 day prolonged water only fast. On breaking his fast with vegetable soup he started vomiting and landed in the emergency ward in acidosis but with a urine ketone level of only 2+. The acidosis was due to the prolonged fasting and the symptoms more due to acidosis than ketosis. He reverted to normal after appropriate intravenous infusions.  This amply illustrates the perils of self-administered dieting. The fasting tipped the balance and pushed his body swiftly into acidosis. Only on the KD this would not have happened as the ketones are not known to rise above a blood level of 4 mmol/L or 6 mmol/L as the ketones produced are being utilized by the brain and muscles. Ketoacidosis on the other hand is seen in diabetes occurs when the blood ketones rise above 10 mmol/L or 12 mmol/L.

None of this would have happened is he was being monitored and advised by a trained professional.

The moral of the story: warn your patients not to try any tweaking or enhancing of KD by themselves. 

Reference:

Blanco, J.C., Khatri, A., Kifayat, A., Cho, R. and Aronow, W.S., 2019. Starvation Ketoacidosis due to the Ketogenic Diet and Prolonged Fasting-A Possibly Dangerous Diet Trend. The American journal of case reports, 20, pp.1728-1731.