After blogging against a widely reported released this week about a 40-year-old obese patient suffering from ketoacidosis allegedly from being on the Atkins diet, I heard back from the lead researcher with his comments on my criticism of his study. Lessnau posted his comments at my blog today and claims that he stands by his study's conclusion that his patient got sick after "meticulously adhering to the Atkins' diet." Did the patient read Dr. Atkins New Diet Revolution and follow it exactly as prescribed? Or did she merely cut back on her carbs and only eat steak, bacon and eggs all day as the media would have us believe represents the Atkins diet? Urging me to shell out big bucks to read his ridiculous case study report in its entirety at The Lancet , Dr. Lessnau said his patient was forced to be admitted into intensive care because of the Atkins diet. But who's to say it was the Atkins diet that caused your patient to end up in ICU, Dr. Lessnau? If you don't know what caused this disease, then how can you so easily attribute it to the Atkins diet? It seems rather convenient for you to point the finger at your patient's alleged eating habits (which are still highly suspect whether or not she actually ate a "low-carb" diet) rather than looking at other areas of her lifestyle that could have contributed. Rather than relying on a singular example in your patient of what ALL Atkins dieters are like, how about asking those of us who have been doing this for a while to see what our health is like eating this way? Of course it is, but so is describing the Atkins diet as unhealthy and dangerous. Since I am not a medical doctor, I am obviously not legally allowed to give out medical advice nor do I even pretend to know what caused your patient's ketoacidosis. But what I do know is this is not such a common problem with the Atkins diet that it should be avoided as you claim along with all the obnoxious, sensationalist headlines from your buddies in the media over the past couple of days. If this problem is so prevalent, then find me 100 more cases just like your case study who by following the Atkins diet were hospitalized for "severe metabolic acidosis." And at the time I was studying dietetics with plans to become dietician. I lost weight with "my" plan, and continued it through young motherhood, teen motherhood and now as a grandmother, continue to follow this diet plan, but a bit more stringently now. Now if I don't want to take more insulin, I absolutely must follow Atkins, South Beach, whatever other low carb diet forms there be, very strictly. It would be interesting for someone to examine what this ONE patient actually ate and whether THAT had anything to do with the ketoacidosis than the fact that she was on the Atkins diet. Where have these cases of ketoacidosis been for the past three decades since Dr. Atkins first released his diet? Surely there would be hundreds of thousands of cases like this one by now if this was such a widespread problem with the Atkins diet, right? 3-20-06 UPDATE : I received a response for Dr. Lessnau regarding "any alternative explanation" for his patient's ketoacidosis from a three-decades long physician today: For starters, I applaud Dr. Lessnau for bringing this interesting case up for discussion. That said, however, Dr. Lessnau seems a bit too eager to blame carbohydrate restriction for his patient's metabolic acidosis. In the Lancet case report, Chen and Lessnau (see ref 1 below) suggest that a carbohydrate-restricted diet can induce ketoacidosis in a non-diabetic patient, but the data presented do not support this conclusion. As an academic physician with 30 years of experience in adult weight management, I have not seen a similar case in over 3000 patients followed closely during a very low calorie ketogenic diet. A life-threatening complication of Atkins diet. Capacity of moderate exercise in obese subjects after adaptation to a hypocaloric, ketogenic diet. 3-21-06 UPDATE : Another nutrition expert weighs in on Dr. Lessnau's conclusions about his patient with ketoacidosis: Dr. Lessnau: I don't believe you are the real Dr. Lessnau. However, if there is ONE diet that has been shown to offer absolutely superior glycemic control, dear doctor, it is a low-carb diet. So, this "dangerous condition" that you discovered has nothing to do with the Atkins diet, or any other low-carb diet for that matter. Nevertheless, a case report, published in The Lancet, described a 40-year-old female patient who was vomiting as often as six times daily and had difficulty breathing after strictly following the Atkins diet for a month. The ketones are, in fact, not sufficient to have caused the acidosis and while high for most people on the Atkins diet, they are in the ball-park of people who are in starvation for 10 days (who can live for at least another 20-60 days) and less than half of the ketoacidosis seen in untreated type 1 diabetes. The Atkins diet still has so much baggage in medical circles that they didn't realize you can't attribute things to diet just on what people tell you. In any case, she apparently hadn't retained much food at all for three days and was probably in starvation rather than on any diet. Also, even if the problems were due to the diet, millions of Americans are on some kind of carbohydrate restricted diet and nutritionists have been trying unsuccessfully to find a problem for thirty years. Do you know any drug, or even any weight loss diet, that has this kind of record?'" In a commentary also published in The Lancet, Drs. Lyn Steffen and Jennifer Nettleton of the University of Minnesota's School of Public Health blasted low-carbohydrate/high-protein diets like there's no tomorrow. They stated, "These [low-carb/high-protein] diets also increase the protein load to the kidneys and alter the acid balance of the body, which result in loss of minerals from bone stores, thus compromising bone integrity." Many experimental and clinical studies indicate that low-protein diet negatively affects bone health. I'm not advocate for the Atkins diet. I feel a diet containing moderate amounts of low-glycemic carbohydrates is generally the healthiest way to achieve and maintain ideal body weight. However, I realize one diet approach doesn't fit all. Thus, I advocate for applying science to ALL diets, including the Atkins diet.
