The atkins diet says for two weeks super low but 20-30 and then increase after the two weeks. Obviously this woman over did a good thing. We need to be accountable and discusing it with your doctor is number one.

This woman was following the no-carbs version of Atkins according to her husband... but realistically, it was a combination of ketogenic and the first old-school version of Atkins...

What sucks is that the Endo treating her gave her a very specific guideline to follow, advised her of a list (in writing) of foods to avoid, but also provided her Calorieking.com's Nutritional data book for when she travels, and advised her also to use MFP for tracking, and Calorieking.com online for free nutritional data. She was on a very similar restriction like me but, an 1800cal restriction, have a healthy carb before all workouts, and eat back some (but not all) of the exercise calories. Her carb restriction was 140g per day. Per review of her food diary, she barely took in anything at all.

(To emphasize this:) Her average daily caloric intake was 900 (rounded) calories. Its a damn miracle this woman is alive. The Endo was quite angry that this patient (or any patient) would willingly consume below the 1200 calorie mark - bad enough she didnt follow her advice on 1800!

I wont even begin to say what the Nephrologist said... it wasnt good....

(To emphasize this:) Sad part is the woman hadnt lost any weight either.... cortisol levels through the roof, kidneys on a revolt and also quitting... ughhhhhhhhhhhhhhhhhhhhhh

I know the Endocrinologist... I not only work in Healthcare and she sees some of my patients, but she is also MY Endocrinologist. Both her and I must have emailed back and forth several times over this case...

I was compelled to share some of the information to serve the purpose of not only a PSA, but more like a reality check.... crappola can happen... and I will tell you right now: that crappola can happen to any of us if we dont make smart choices about this....

Hi,
To what extent did this happen because she was diabetic? That is, whilst I understand any kind of extreme is probably bad for anyone, in a person without diabetes am I right in thinking it would not have come to this type of emergency situation even at negligible carb intake?
Thanks.

She is a prediabetic (Type 2)... as I posted earlier, she presented to the ER from having a syncopal episode... a full workup was performed while the husband was updating the clinical team.

You are not right in thinking - it took coming from the pt's husband, that she was hardly hitting 10g of carbohydrates.. there were too many days where it was just extreme doses of proteins and moderate fat....

This can happen to anyone ...even without the prediabetic status (abnormally high A1c).... which is why I posted this incident here as a reminder to everyone in our group that this can happen. Negligible amounts is dangerous in the long term picture. This patient willingly did this to herself and against the Endocrinologist's advice.... and as a result of her extremely poor choices, she was hospitalized.

Side note: Ketogenic Diets original main function in its earliest days, was a medical treatment for refractory epilepsy under strong medical advisement and supervision. It continues to this day, to still be used in the medical community for those patients. Anyone outside of that equation definitely needs to consider the advice of a treating healthcare practitioner...


Lets start it this way... and yes, LowcarbNY is absolutely right - I know my patient's history well, hence the reason why I built this thread as a reminder to everyone in our group that those who are looking to be in a state of ketosis, to do so very carefully, and preferably under the advisement of treating providers - a responsibility that I hold very seriously.




The syncope she experienced was the first indicator for the need to have blood work - why? Syncopal episodes do not just apply to low blood pressure. In my patient's case it did not relate to blood pressure at all.

In this patient's case - had her husband not reacted fast enough to get his wife to the ER to get medical attention, she may very well have entered into a Diabetic Coma. Lucky for her, she didnt as ketoacidosis CAN lead to a diabetic coma in rare situations for Type 2 and prediabetics.


The husband gave detailed information about her intake. Referred the clinic team to her food diary. She averaged 900 calories per day. Most days she had no vegetable intake, just animal proteins, butter, oils, etc. The days that she did consume vegetables, they were extremely marginal. He commented on how his wife was excessively working out at the gym but did not have any positive weight loss changes, the fact that she didnt eat back any calories from her workouts - thus her 900 caloric intake was significantly reduced.

Her body no longer produced enough insulin - in fact the readings for insulin production were marginal at best.
On average, her ketostix registered a black color in the morning and again in the afternoon. please take note of this: there are no black colored readings on a bottle of ketostix. Her readings were black by visual, when the urine was measured.

Several components read extremely high, including protein and ketones. She required an immediate evaluation by a Nephrologist to determine kidney function, if any existed due to the preliminary tests performed. Her saving grace is that her pancreas did not shut down - thus hope for her kidney function.

As it turned out, her kidneys, for lack of a better way to describe it - pooped out. It could no longer function to remove the copious amounts of acid, aka ketones. The liver also was compromised - it simply did not perform well because it was too busy filtering her blood as fast it could. Her blood was supersaturated with ketones. Where the liver (like the kidneys) is considered a filter, cant work effectively if there's so much contaminant in the blood that it has to get rid of, and has to work even harder to produce more oxygen rich plasma.

Remember the part where we learned she was over exercising? She clearly was not taking in nearly enough water at all. Our body uses/needs water (among other things) to help flush contaminants away via our urine output. The liver dumps into it, the kidneys dump into it, travelling down the ureters, into the bladder and out the urethra. If you dont have enough hydration (again, another common issue for some low carbers), the body cant get rid of the contaminants the body is trying to get rid of.....


This patient did not just do a two week course of Atkins - she took it to an extreme level of two months and pair it up with large sessions of exercise, lack of adequate proper hydration, poor dietary intake, severe caloric reduction. Her body is carrying almost 300lbs (if memory serves me right she weighed 297lbs, as reported by her husband from the last physical she had with her PCP)

When asked whether or not the wife understood that this was not the avenue instructed of her by the Endocrinologist, the husband admitted to the clinical team "she was desperate to get a jumpstart on losing weight, read all about how people lost alot of weight really fast, and she thought she could do better".

Her care-plan almost three months ago was an 1800 calorie/day restriction. Her total daily carbohydrate restriction was no more than 140g per day, the bulk of the carbs were to be consumed in the morning provided she balanced it with at least 50g of protein. She was required to do a food elimination of everything having to do with breads, flour, rice, pasta, corn and all white potatoes. She was advised to only consume no more than two servings of fruit - preferably from the berry family as outlined in the glycemic index - a medically sound resource from the University of Sydney. This was due to her extremely high insulin readings from the last fasting blood work performed. She was also told to only consume real whole foods which meant a total clean up of her daily dietary intake. The husband could not respond because he was in shock... he claimed to have not known about any of those restrictions citing that his wife never shared the information with him, and thought what his wife was doing was exactly what she was told to do.

She was put on IV fluids and Insulin therapy immediately. A serious interventional educational session was held with both the patient and her husband on the serious nature of the current situation. The patient was actually embarassed that things ended up the way they did. The first 24 hours was to get her stabilized. She was tested again in the morning - her ketones had improved but were still very high. She received nutritional advice from an RD working the floor for patients who are under medical/food related restrictions and showed her how she could still have a complete meal while balancing everything out, again - under the Endo's previous medical advice and guidelines. By the end of day two, she was able to eat an actual dinner as they gradually decreased the insulin treatment. Her newer test results were improving - but not enough to discharge her.

Have you ever seen surgical specialists get rip-roaring angry? I see it every day when physicians come face to face with a patient who was clear-as-day defiantly going against medical advice. Their situations could have been handled correctly had the patient made the right choice to listen to the advice that was given to her. This woman was so desperate that it nearly cost her own life. She is the rare case that can happen and full blown, at that.

LowcarbNY - everything you said is a carbon-copy of what happened to her: hydration compromised, extremely poor nutrition, paired with excessive exertion via exercising and not replenishing anything fluid-based or food-based, and on top of that, it not only flared her current medical conditions, but developed new ones that sent her to the hospital.


Morbid Obesity
High Blood Pressure
Dysmetabolic Syndrome X (this family includes hyperinsulinemia)
Hirsutism
Hypersecretion of Ovarian Androgens
Severe Ketoacidosis (new)
Unspecified Renal Failure (new)


Again, this patient represents the rare cases that happen.

This should be considered a reminder that it ****can**** be any of us. Diabetics, PreDiabetics, no diabetics... its not often with the type 2 variety - but this was an example best shared with here in our group - its a reminder to not be afraid of foods... be more mindful of what you are eating and by all means - if a treating clinician is giving you sound advice (one that is realistic, which for the subject matter, it was very realistic for her pt), swaying away from said advice will potentially subject you to compounding the problems, if not increasing others to manifest.


Not trying to sound like a "Direct TV" commercial but it needs to be said: Dont be like this patient and ignore your healthcare physicians' recommendations"...

Thank you,


CramerNH
Moderator
Low Carber Daily Forum