A study material in respect of LCHF

It is believed that low-carbohydrate diets work best in reducing weight when producing ketosis.1 We report on a 51-year-old white woman who does not have diabetes but had ketoacidosis while consuming a “no-carbohydrate” diet. There was no family history of diabetes, and she was not currently taking any medications. While adhering to a regimen of carbohydrate restriction, she reached a stable weight of 59.1 kg, a decrease from 72.7 kg. After several months of stable weight, she was admitted to the hospital four times with vomiting but without abdominal pain. On each occasion, she reported no alcohol use. Her body-mass index (the weight in kilograms divided by the square of the height in meters) was 26.7 before the weight loss and 21.7 afterward. Laboratory evaluation showed anion-gap acidosis, ketonuria, and elevated plasma glucose concentrations on three of the four occasions (Table 1TABLE 1

Laboratory Values during Four Episodes of Ketoacidosis.

). She had normal concentrations of plasma lactate and glycosylated hemoglobin. Screening for drugs, including ethyl alcohol and ethylene glycol, was negative. Abdominal ultrasonography showed hepatic steatosis.

On each occasion, the patient recovered after administration of intravenous fluids and insulin, was prescribed insulin injections on discharge, and gradually reduced the use of insulin and then discontinued it while remaining euglycemic for six months or more between episodes. Testing for antibodies against glutamic acid decarboxylase and antinuclear antibodies was negative. Values on lipid studies were as follows: serum triglycerides, 102 mg per deciliter; high-density lipoprotein (HDL) cholesterol, 50 mg per deciliter; and calculated low-density lipoprotein (LDL) cholesterol, 189 mg per deciliter.

The patient strictly adhered to a low-carbohydrate diet for four years, with an estimated carbohydrate intake that was often less than 20 g per day. When she was put on a diet containing normal amounts of carbohydrates, her fasting plasma glucose concentration and the results of oral glucose-tolerance tests were normal. With a normal carbohydrate intake, she had no more episodes of ketoacidosis.

Citrate generated by glycolysis inhibits carnitine palmitoyltransferase complex I, limiting the beta-oxidation of fatty acids and thereby reducing ketogenesis. Lactate, which increases during starvation, can induce hepatic ketogenesis.2 Low-carbohydrate, fat-rich meals can enhance alpha-cell secretion of glucagon and lower insulin concentrations.3,4 Plasma fatty acid concentrations can be twice as high during low-carbohydrate diets as compared with the usual carbohydrate intake in the postabsorptive period.5 Increased concentrations of free fatty acids in the absence of carbohydrate-induced inhibition of beta-oxidation of fatty acids and in the presence of an abnormally high ratio of glucagon to insulin and elevated concentrations of lactate may have caused ketoacidosis in our patient, who was trying to avoid all dietary carbohydrates. Low-carbohydrate, high-fat diets are generally associated with higher concentrations of LDL and HDL cholesterol and lower serum concentrations of triglycerides than is the conventional intake of carbohydrates and fat.1

Benign dietary ketosis resulting from restricting carbohydrates could, theoretically, cause ketoacidosis in persons with a predisposition to the condition. Carbohydrate-restricted, high-fat diets may have adverse metabolic sequelae when followed for protracted periods.

8 Replies

  • I'm struggling to understand the point of this post. Are you implying that a low carbohydrate diet is dangerous?

    Anybody with a normal metabolism has no need whatsoever for exogenous carbohydrate - glucose needed for red blood cells will be made from protein via gluconeogenesis.

    I would suggest this patient was metabolically damaged, the finger pointing to 'abnormally high glucagon' necessitating insulin therapy.

    I would point you to the record for fasting whereby a scotsman fasted for 382 day and ate nothing whatsoever in a clinically controlled environment. His blood glucose remained stable at the lower end of normal whilst losing 125 kg (275 lb) of body weight.

  • Anup Arun kumar and Samarth may share your opinion

  • Such "stories" have no relevance as few things don't add up and the most GLARING HOLE in this attempted "THRILLER AGAINST LCHF" is:

    Ketoacidosis also means SKY high blood sugars. But, NON Diabetic cannot have SKY High blood sugars. So, the thriller sounds more like AS SEEN ON TV AD:

    "Everything was perfect but KETOACIDOSIS struck on LCHF diet. WOW"

    In the past, anti LCHF experts have quoted studies against LCHF from a doctor convicted for serial medical fraud. Many LW sellers were posting on LCHF threads to attract them into a switch from LCHF to LW with LURE of CURE.

    Not surprising that this thriller story comes from a LW follower, apparently. So, I can understand all the attempts against LCHF and can find gaping holes in such thriller/sensational "stories" against LCHF that has continued from Jan 2013 out here and always comes from guys who aren't even following LCHF. :)

  • It is impossible to hit Ketoacidosis with insulin present in body. So things don't add up when one says that NON Diabetic hit KETOACIDOSIS because KETOACIDOSIS also needs HIGH BLOOD sugar and high blood sugar in NON DIABETIC simply not possible.

    So, don't mind, but all this sounds like a cooked up story by some anti LCHF camp with half the facts not revealed, or distorted, to make a convincing case against LCHF. FAILS to convince me at least. May convince someone who doesn't know LCHF if this goes unchallenged.

    Indian diabetics on LCHF diet do not follow Ketogenic diet. What we folow and preach is noted here:


    For this "one" case of apparently concocted story, there will be 100 cases of real world diabetics on ketogenic diet for decades. Check it out and you will find many "DIABETICS" living on KETOGENIC Diet for decades.

    IF you are trying to SCARE people away from LCHF, which many in the past have tried here over three years but have FAILED to get any traction, it won't help. In fact, a Indian lady doctor is now handling her 10 year old daughter's Type 1 -- who are most prone to hit DKA -- through LCHF .

    So, those who know what they are doing, they handle it well year after year. Others can keep criticizing LCHF.

    A NON Diabetic with no medical history and on no drugs cannot hit Sky High Sugar and hence cannot hit Ketoacidosis. However, Type 2 diabetics have started hitting KETOACIDOSIS -- unheard of so far -- by using the "modern" anti-diabetic drug called Invokana that releases sugar thru URINE.

    {Edited by admin to remove link}

  • Good reasoning, but ...


  • Still doesn't explain how a NON DIABETIC can HIT Ketoacidosis. For hitting Ketoacidosis one needs to have sky high sugar readings also. How does a non diabetic get to achieve that?

    Last line says:

    "Benign dietary ketosis resulting from restricting carbohydrates could, theoretically, cause ketoacidosis in persons with a predisposition to the condition."

    So, what was that "predisposition"?

  • ketogenic diet tofollowed is very difficultOnly One Dr Berinstein may follow or some of very few may be followed both ar foreigners In Indian soil and condition it is too difficult

    for vegetarians it is most not possible for 99 % Every foodcontain carb It is difficult to vegetarians who restrict carb below 100 gms some of them may posted they consume below 70 gms It may be very tough if it is possible please share daily brakfast lunch dinner totally below 70 gms It is too much difficult Offcourse one or two days maybe but entire years it is not possible .

    further every person may follow any diet plan but criticising other diet plan and should not be done

    Here both lchf and LW and ADA f ollowers are also members of this group

    Any membes used LW may share the nutritional content in long Wheat

    before previousdiscussion I am asking this but no members may share this if theymaybe forgotten /

    Now LW users may please share the nutrtion contain in LW per 100 gms

  • Nice counter.

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